Question 1

Implant Based Reconstruction

Accepted Answer

Breast reconstruction using a tissue expander to stretch the remaining skin following a mastectomy, and subsequent placement of a permanent silicone implant is the most common type of surgery performed today.   It requires the shortest operating time, and allows the quickest recovery.  However, implant based reconstruction is a more lengthy process than flap reconstruction, because it entails weekly or biweekly office visits during a 3 to 6 month period to inflate the expanders, and a second surgery to remove the expanders and place permanent implants.  The implants will re-create a breast mound, and a nipple reconstruction then can be performed, as well as nipple-areolar tattooing, to make the breast appear more natural.

Question 2

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 will be happy to discuss your reconstructive options with you.

Question 3

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 the question.  I am happy that you are taking these important steps for yourself when considering your breast reconstruction needs.  We are here for any questions you may have regarding this process.  You can reach out to our patient care coordinator and ask her to vet your benefits for coverage. Our Patient Care Coordinator and Billing Supervisor will discuss your benefits and get back to you within two business days.  Feel free to call and ask how your insurance coverage can benefit you at this time.  Keep in mind this very important caveat Federal Law requires insurance companies cover breast reconstruction for patients following mastectomy for cancer.  This important rule can often be used to the advantage of patients to keep the out of pocket costs low whether you choose to go to a surgeon who is in or out of your carriers network.

Question 4

How long will I be out of work post mastectomy?

Accepted Answer

Hi there! This is one of the most common questions that we answer. Typically we see patients taking between 10 days and two weeks off from work for their initial phase of mastectomy and reconstruction.  Keep in mind that Federal law requires employers to give adequate time off to undergo breast reconstruction as part of your cancer surgery.  Feel free to call us with any additional questions and for more details.

Question 5

How much pain will I be in post mastectomy?

Accepted Answer

Everyone's pain post mastectomy is a little different.  Although the initial procedure including the mastectomy is uncomfortable, this is improved with Exparil, a long acting pain inhibitor that is injected locally and lasts three days, with the addition of oral pain medications it can make the experience considerably better.

Question 6

What does DIEP flap mean?

Accepted Answer

DIEP is an acronym that is used in the medical field regarding breast reconstruction and it stands for (Deep Inferior Epigastric Perforator) Flap. This is an advanced breast reconstruction technique that uses a patient's own tissue to rebuild their breast after a mastectomy.

Question 7

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 doesn 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 8

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

Accepted Answer

The benefit of DIEP (Deep Inferior Epigastric Perforator) Flap is that it uses your own tissue, so it can look and feel natural, it offers a permanent reconstruction vesus implants that may need replacement, there is no risk of implant rupture or capsular contracture. unlike older TRAM flap procedures, it preserves the abdominal muscle strength. Some see the DIEP as a dual benefit to losing excess abdomen fullness (though it does not replace a tummy tuck). The things that are important to consider are that it is a complex surgery: usually taking over 6 hours and the recovery time is between 4-6 weeks before returing to normal activity, it isn't suitable for thin patients. the scarring includes a hip to hip incision in addition to the breast area incisions. The largest risk is a falied flap which would require taking more tissue from a site that has not been touched like the inner thigh.

Question 9

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

Accepted Answer

Yes, in collaboration with a trained microsurgeon both Dr. Capuano and Dr. Marchese perform DIEP flaps. Because of the level of complexity, DIEP flaps need two plastic surgeons in the case. Both Dr. Capuano and Dr. Marchese are skillful in their work and collaboration with microsurgery trained surgeons to perform this type of breast reconstruction.

Question 10

Autologous Flap Reconstruction

Accepted Answer

Flap reconstruction uses donor muscle, fat and skin from a woman’s abdomen (TRAM flap) or back (Latissimus Dorsi flap) when insufficient tissue remains after a mastectomy or radiation for an implant based reconstruction.  The techniques reposition your own muscle, fat and skin to re-create a breast mound, or coverage for an implant.A DIEP (deep inferior epigastric perforator) flap uses donor tissue from the abdomen to reconstruct the breast. The DIEP flap uses skin and fat along with the attached blood vessels from your lower abdomen and transfers it to the chest where Dr. Capuano, aided by a microscope will attach the donor tissue blood vessels to the chest blood vessels to reconstruct the breast.A TRAM flap uses donor tissue from the abdomen to reconstruct the breasts.  The flap remains attached to it’s original blood supply, which is tunneled through the upper abdomen and lower chest to the mastectomy sight, where it can be used to re-create the breast mound.The Latissimus dorsi flap uses donor tissue from the back to reconstruct the breasts, in conjunction with an implant based reconstruction.  The flap remains attached to it’s original blood supply, which is tunneled through the axilla to the mastectomy sight, where it can be used to cover a breast implant to re-create the breast mound.

Question 11

Oncoplastic Reconstruction

Accepted Answer

Is a group of surgical techniques, based on mastopexy and reduction mammoplasty principles, used to remodel the remaining breast tissue following a partial breast resection.  The techniques are most useful for patients with large tumors and small breasts, tumors located near the inferior or medial portions of the breast, or in women who have very large breasts, who would benefit from a wide resection and a breast reduction procedure simultaneously.

Question 12

Length of Surgery

Accepted Answer

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

Question 13

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 14

Common Side Effects

Accepted Answer

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

Question 15

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, and he would be happy to discuss your options if you require reconstruction.

Question 16

How safe is a nipple sparing mastectomy?

Accepted Answer

Thank you for the question. A nipple sparing mastectomy can be effective in the right person. It is very important to consult with a board-certified plastic surgeon who is well versed with this technique to find out whether or not you are a good candidate for this procedure over and above my information within this post.  This is for several reasons.First and foremost, not every woman's body type and breasts are compatible with this procedure. For the aesthetics of it, one must consider the breast shape and nipple arrangement on the pre-operative breast. If your breast does not fit that criteria, the aesthetic outcome may not out-weigh the associated risk, read on regarding what that risk could be. More important, you must have your breast surgeon and plastic surgeon communicate whether or not this is a viable reconstructive option for you as the nipple itself carries a risk for ductal carcinoma and it is a risk that is not acceptable in all patients given their initial breast cancer diagnosis.  In addition, the location and size of the tumor and relationship to the nipple itself are all important criteria in discovering whether this is right for you.  I hope this helps as this is a weighted decision between you the patient and your surgical team of physicians.  All my best.

Question 17

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

Thank you for the question and I am sorry you are going thru this.  To start, the Federal government requires that insurance companies cover breast reconstruction following breast cancer surgery this includes rebuilding the breast with either an implant or your own tissue and any other procedures associated with this including symmetry procedures for the opposite breast. The right procedure for your concerns depends on several factors.  The first pertains to your cancer and what needs to be done to cure it.  Some tumors require more aggressive removal of tissues then others, which will change which reconstructive procedure is optimal.  Second, you may or may not require chemotherapy or radiation.  Radiation and chemotherapy may also effect which type of reconstruction that can be performed. The last factors have to do with the proportions of your body including the width of your chest, the size of your breasts and the amount that they droop.  And finally, the last factor has to do with your own reconstructive goals, how large or small you want to be and whether or not you are willing to have both breasts addressed if needed. We are here for you...We will help guide you through the process and its many nuances.  It is important you consult with Dr. Capuano prior to your mastectomy procedure so he can help you choose the best option for the aesthetic portion of your reconstructive goals. This is not something that should be considered after your mastectomy as the best options are offered at the time of your mastectomy procedure.  Reconstruction of breasts following mastectomy has greatly improved in the last decade. We can often provide you with natural looking symmetrical breasts, where most of the incisions are well hidden. Some of the ways we rebuild your breasts after mastectomy include use of expanders which are placed at the time of mastectomy and exchanged for final implants.  Another method includes use of your own tissue to rebuild the breast called autologous reconstruction. Patients who have large pendulous breasts or require radiation therapy are often candidates for autologous reconstruction.

Question 18

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

Accepted Answer

The current model for 2019 shows that 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 12% of the population. More advanced protocols, breast centers, breast screening and genetic testing are helping combat the morbitity 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 19

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 physchatrist 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 20

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 this question.  There may be a variety of reasons for the pain in your armpit post breast reconstruction.  I would definitely consult with the plastic surgeon who has reconstructed you.  I would ask him or her about the possiblity for fat transfer to the area, that can certainly aid in the relief near the armpit area or possibly ask for the release of scar tissue in the effected area.

Breast Reconstruction following Mastectomy

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