Question 1

Implant Based Reconstruction

Accepted Answer

Implant-based breast reconstruction using a tissue expander followed by a permanent silicone implant is one of the most commonly performed approaches today. It typically involves a shorter initial operation and, for many patients, an easier early recovery compared with flap reconstruction.That said, the overall process usually takes longer because it occurs in stages. After mastectomy, a tissue expander is placed to gradually stretch the remaining skin. The expander is then slowly filled during weekly or biweekly office visits over roughly 3–6 months, followed by a second procedure to remove the expander and place the permanent implant. The implant recreates the breast mound, and additional finishing steps—such as nipple reconstruction and nipple-areola tattooing—may be performed to help the breast look as natural as possible.

Question 2

Surgical Risks

Accepted Answer

Risks include bleeding, infection, hematoma, seroma, changes in skin sensation, scarring, damage to underlying structures, injury to nerves, asymmetry, loss of nipple (nipple sparing mastectomy), loss of flaps, unsatisfactory results requiring additional surgery.Dr. Capuano consistently achieves excellent results with breast reconstruction.  He is a Board Certified Plastic Surgeon, and is a member of the American Society of Plastic Surgeons, a member of the American College of Surgeons, the immediate past president of the New Jersey Society of Plastic Surgeons and the Vice Chair for the Department of Plastic Surgery at The Valley Hospital, he would be happy to discuss your options if you require breast reconstruction.

Question 3

I had reconstruction and have been experiencing some pain in my armpits, do you know what this is from and how it can be resolved?

Accepted Answer

Hi there—thank you for your question. There can be a number of reasons for armpit (axillary) discomfort after breast reconstruction, including scar tissue, tightness from healing, changes in sensation, or irritation related to the surrounding tissues. Because the cause can vary, the best next step is to schedule an exam with the plastic surgeon who performed your reconstruction so they can evaluate you in person.During that visit, it’s reasonable to ask whether treatments such as fat grafting (fat transfer) could help soften the area and improve comfort, or whether a scar tissue release (if appropriate) might relieve tightness. Your surgeon can help determine what’s driving the pain and which option—if any—is safest and most likely to help.

Question 4

How do I make an appointment for a consultation?

Accepted Answer

Contact the office of the Northern Center for Plastic Surgery @ (201)820-5280 to schedule an appointment. Dr. Capuano or Dr. Marchese will be happy to discuss your reconstructive options with you.

Question 5

How long will I be out of work post mastectomy?

Accepted Answer

Hi there—great question, and one we hear often. In general, most patients plan to take about 10 days to two weeks off work for the initial recovery after mastectomy and breast reconstruction, though the exact timeline depends on your specific procedure, your job demands, and how you’re healing.It’s also helpful to know that breast reconstruction is considered part of breast cancer treatment, and many patients have workplace protections that support medically necessary time off. If you’d like, our team can talk through your procedure and job requirements and help you plan a realistic return-to-work timeline. Please feel free to call us with any additional questions.

Question 6

How much pain will I be in post mastectomy?

Accepted Answer

Everyone’s pain experience after mastectomy can be a little different. While the initial surgery can be uncomfortable, we use several strategies to help keep you as comfortable as possible. One option is Exparel, a long-acting local anesthetic that can be injected during surgery and may provide pain relief for up to three days. When combined with appropriate oral pain medication, it can make the early recovery period significantly more manageable.

Question 7

What does DIEP flap mean?

Accepted Answer

DIEP is a medical acronym used in breast reconstruction. It stands for Deep Inferior Epigastric Perforator flap. This advanced technique uses a patient’s own tissue—typically skin and fat from the lower abdomen—to rebuild the breast after a mastectomy.

Question 8

How is a DIEP flap performed?

Accepted Answer

A DIEP flap (Deep Inferior Epigastric Perforator) is an advanced option for breast reconstruction that is offered when the patient is a suitable candidate for that specific surgery. Having a DIEP flap performed requires using sources of skin, fat and blood vessels from the lower abdomen. It does not use abdominal muscles-only the perforating blood vessels that run through the muscle are carefully preserved. This is a microsurgery technique that requires specialized training. The tissue is completely detached from the abdomen with its blood supply and transferred to the chest and reconnected using microsurgical techniques. Blood vessels are reconnected to vessels in the chest to restore blood flow.

Question 9

What is Oncoplastic Reconstruction?

Accepted Answer

This refers to a group of surgical techniques—based on breast lift (mastopexy) and breast reduction (reduction mammoplasty) principles—used to reshape the remaining breast tissue after a partial breast resection (lumpectomy). These techniques are especially helpful when a larger portion of tissue must be removed, such as with relatively large tumors in smaller breasts, tumors located in the lower or inner breast, or in women with very large breasts who may benefit from a wider resection combined with a breast reduction at the same time.

Question 10

Length of Surgery

Accepted Answer

The procedure takes between 3.5 to 5 hours depending on the patient’s anatomy and the type of breast reconstruction, it is performed in the hospital under general anesthesia.  An overnight stay will depend on individual medical condition and extent of surgery.

Question 11

Expected Recovery

Accepted Answer

Most patients are able to return to work within about 2 weeks.  You may begin light exercise at 2 weeks, while 6 weeks is required, before returning to strenuous activity or lifting.  Bruising may be present for up to 3 weeks.  Patients are instructed to protect themselves from direct sun exposure for 1 year, and to wear sunscreen.   Silicone therapy is additionally used to improve appearance of scars.   Small drains are left in place following surgery and are removed postoperatively within 1-2 weeks.

Question 12

Common Side Effects

Accepted Answer

Bruising, swelling, temporary numbness or weakness, a sensation of tightness in the chest area, burning and itching.

Question 13

Autologous Flap Reconstruction

Accepted Answer

Flap reconstruction uses your own tissue—skin, fat, and sometimes muscle—to rebuild the breast. This approach may be recommended when there isn’t enough healthy tissue to support an implant-only reconstruction, such as after a mastectomy that removes significant skin or after radiation therapy. Depending on the technique, flap tissue can be used to create the entire breast mound or to provide healthy coverage over an implant.DIEP flap (Deep Inferior Epigastric Perforator flap)A DIEP flap uses skin and fat (but preserves the abdominal muscles) from the lower abdomen, along with the tiny blood vessels that supply that tissue. The tissue is transferred to the chest, Dr. Capuano in tandem with a team of Plastic Surgeons—use microsurgical techniques—connect the flap’s blood vessels to blood vessels in the chest to restore circulation and reconstruct the breast.TRAM flap (Transverse Rectus Abdominis Myocutaneous flap)A TRAM flap also uses tissue from the lower abdomen. In a traditional TRAM flap, the tissue remains attached to its original blood supply and is carefully tunneled under the skin to the chest, where it is shaped to recreate the breast mound. Because this technique uses some abdominal muscle, recovery and long-term abdominal strength considerations are part of the planning discussion.Latissimus dorsi flapThe latissimus dorsi flap uses tissue from the upper back. The flap stays connected to its original blood supply and is tunneled through the underarm (axilla) to the chest. It is commonly combined with an implant, providing additional healthy tissue coverage to help recreate the breast mound—especially in patients who have had radiation or have limited chest tissue.

Question 14

I was recently diagnosed with breast cancer and was told I have to have a mastectomy, will I be deformed? What reconstruction procedure should I ask for so I can avoid being deformed?

Accepted Answer

I’m so sorry you’re going through this, and I’m glad you reached out. To start with some reassurance: federal law requires most health insurance plans to cover breast reconstruction after breast cancer surgery. This typically includes rebuilding the breast with an implant or your own tissue, as well as related procedures—such as nipple reconstruction (when appropriate) and symmetry procedures on the opposite breast.The best reconstructive option depends on several factors. First is your cancer diagnosis and the type of surgery needed to treat it—some tumors require a wider removal of tissue than others, which can influence what reconstruction will look best. Next is whether chemotherapy and/or radiation will be part of your treatment plan, since these therapies can affect timing and the safest reconstruction approach. We also consider your anatomy (chest width, breast size, and degree of droop) and, just as importantly, your personal goals—how you want your breasts to look and feel, and whether addressing one or both breasts makes the most sense for symmetry.We’re here for you, and we’ll help guide you through each step and the many nuances along the way.We recommend meeting with Dr. Capuano as soon as you are diagnosed with breast cancer—before your mastectomy is scheduled whenever possible. An early consultation allows your breast surgeon and plastic surgeon to coordinate your care and helps ensure your reconstructive options (including incision placement, timing, and symmetry planning) are considered from the start. Many of the best options—especially for incision placement, breast shape, and symmetry—are planned at the time of mastectomy rather than after.Breast reconstruction has advanced significantly over the past decade, and in many cases we can achieve natural-looking, symmetrical results with well-concealed incisions. Common approaches include implant-based reconstruction using a tissue expander placed at the time of mastectomy and later exchanged for a permanent implant, as well as autologous (your own tissue) reconstruction. Patients who need radiation therapy or who have larger, more pendulous breasts may be especially good candidates for autologous reconstruction, depending on their overall treatment plan and anatomy.

Question 15

How safe is a nipple sparing mastectomy?

Accepted Answer

Thank you for the question. A nipple-sparing mastectomy can be an excellent option for the right patient, but it’s important to be evaluated by a board-certified plastic surgeon who is experienced with this technique. A personalized consultation is essential, because candidacy depends on both aesthetic factors and—more importantly—oncologic safety.From an aesthetic standpoint, not every breast shape or nipple position is ideally suited for a nipple-sparing approach. Your surgeon will consider your breast size, degree of droop, skin quality, and where the nipple sits on the breast. If your anatomy isn’t a good match, the cosmetic outcome may be less predictable, and the trade-offs may not be worth it.Most importantly, your breast surgeon and plastic surgeon must review whether nipple-sparing mastectomy is appropriate based on your cancer diagnosis. The nipple-areola complex contains breast ducts, and preserving it is not considered safe for every patient. Factors such as the size and location of the tumor, its distance from the nipple, and your overall pathology all play a role in determining whether this is a reasonable option. Ultimately, this is a carefully weighed decision made together by you and your surgical team.

Question 16

How many women are diagnosed with breast cancer in the United States?

Accepted Answer

About 1 in 8 women in the United States are diagnosed with invasive breast cancer over their lifetime according to BreastCancer.org, which is equivalent to roughly 13% of the population. More advanced protocols, breast centers, breast screening and genetic testing are helping combat the morbidity and mortality related to a breast cancer diagnosis.  It is important to know your family history, do breast self exams monthly and make sure you are getting checked by your physician at your annual well visits, if you feel something do not ignore it.  Age Specific Risk:By age 40: 1 in 69By age 50: 1 in 43By age 60: 1 in 29By age 70: 1 in 26Lifetime (to age 90): 1 in 8

Question 17

I have just been diagnosed with Breast Cancer, I am nervous to go thru the process because I have clinical depression and am worried I won't be able to deal with the reconstruction, what can I expect?

Accepted Answer

Thank you for the question.  I am sorry to hear your news. Receiving a diagnosis for Breast Cancer is a very intimidating time in ones life.  It can pose uncertainty and incredible stress but the good news is that you found out and now you are going to act on your own behalf and take good care of yourself. Fortunately, we live in a time where relevant information is at our fingertips and we don't have to sit idly by and rely on word of mouth to find out how we can help ourselves.  You know this because of your being diagnosed with clinical depression, you have clearly been an advocate for yourself in doing the right thing and finding the appropriate treatment.  I can tell you there is so much you can find in terms of support and guidance regarding your Breast Cancer diagnosis. Make sure go to a hospital that has a dedicated Breast Center and let them know your struggles with depression and your concern with the reconstruction phase of your treatment.  I can assure you that you are not alone and this is a common concern and it is ok to be concerned about it.  Your breast surgeon will understand your path and everyone along the way will encourage you to take the right steps toward recovery, you can find solace with support groups and continue ongoing treatment with your psychiatrist during the recovery phase.  I would recommend and I am certain your breast surgeon will, that you see a Board Certified Plastic Surgeon sooner then later so that you can see understand the recovery post surgery, the before and after pictures of other women with a similar diagnosis and start to understand and process the reconstruction phase and reach a decision that is right for you.Once you meet with your Plastic Surgeon and have a better understanding what the specific steps are with reconstructing your breasts you may feel a lot less intimidated because sometimes the scariest part is not knowing what to expect.  I wish you well, you will do great!

Question 18

I was referred by a friend who you have reconstructed, she is so happy with what you have done for her, my breast reconstruction needs sound quite extensive, I'm concerned if I am able to afford reconstruction with you. Who can I discuss this with?

Accepted Answer

Hello, and thank you so much for your question. I’m glad you’re taking these important steps as you explore your breast reconstruction options, and please know we’re here to support you through the process and answer any questions along the way. You’re welcome to contact our Patient Care Coordinator to help schedule a consultation—our office prioritizes appointments for patients who have recently received this diagnosis.We accept most commercial insurance plans, and we are opted out of Medicare and Medicaid. One very important note: federal law requires insurance companies to cover breast reconstruction after mastectomy for breast cancer, including related reconstructive procedures. In many cases, this coverage can significantly reduce—and sometimes eliminate—out-of-pocket costs, even if you choose a surgeon who is in-network or out-of-network, depending on your specific benefits.Because every plan is different, we’ll help you understand what your coverage looks like and what documentation may be needed so you can make decisions with clarity and confidence.

Question 19

What are the pros and cons of a DIEP flap following mastectomy?

Accepted Answer

One of the biggest benefits of a DIEP (Deep Inferior Epigastric Perforator) flap is that it uses your own tissue, which can create a breast that looks and feels very natural. Because it’s an autologous (your-tissue) reconstruction, it’s also considered a long-lasting option—unlike implants, which may require replacement over time. It avoids implant-related concerns such as rupture and capsular contracture. And compared with older TRAM flap techniques, a DIEP flap is designed to preserve the abdominal muscles, helping maintain core strength.Many patients also appreciate that tissue is taken from the lower abdomen, which can reduce abdominal fullness—although it’s important to note that a DIEP flap is not the same as a tummy tuck. There are also important considerations: this is a complex microsurgical procedure that often takes 6+ hours, and recovery is typically 4–6 weeks before returning to normal activity. It may not be the best option for very thin patients who don’t have enough donor tissue. Scarring generally includes a hip-to-hip incision on the lower abdomen as well as incisions on the breast.The most significant risk is flap failure, which occurs when the transferred tissue does not establish or maintain adequate blood flow. If that happens, additional surgery may be required, and reconstruction may involve tissue from another donor site (such as the inner thigh) or a different reconstructive approach, depending on the situation.

Question 20

Do Dr. Capuano and Dr. Marchese perform DIEP flaps?

Accepted Answer

Yes. In collaboration with a microsurgery-trained surgeon, Dr. Capuano and Dr. Marchese perform DIEP flap breast reconstruction. Because this procedure is highly complex and requires meticulous microsurgical technique, it is typically performed with two plastic surgeons involved in the case. Dr. Capuano and Dr. Marchese work closely with experienced microsurgery specialists to provide this advanced reconstructive option.

Question 21

Is a DIEP flap a mommy makeover?

Accepted Answer

A DIEP flap is not—and should not be viewed as—a “mommy makeover” or a cosmetic shortcut. It is an advanced, medically focused breast reconstruction procedure designed to restore the breast after mastectomy. While it uses tissue from the lower abdomen, it should never be chosen primarily for abdominal contouring.Because a DIEP flap is a complex, metabolically demanding microsurgical operation with a longer surgery time and recovery, the decision to pursue it should be based on your reconstructive needs, overall health, and what is safest and most appropriate for your cancer care plan.

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