One of the most devastating experiences a woman can face is the diagnoses of breast cancer. If you or someone close to you has been told you have breast cancer, it is important to learn about all the options available before making any decisions. Only in the most extreme cases will you be told to make an overnight decision. You have enough time to do some due diligence on your own behalf.
Today, there are breast-conserving and non-breast-conserving procedures. Breast conserving surgeries remove the cancer, but not the breast itself. “Lumpectomy” or “partial mastectomies” are regional procedures where the suspicious mass and varying degrees of tissue around it are removed. A sentinel node biopsy is where one or more lymph nodes in the arm pit are remove and tested for cancer spread; this can determine if you may be a candidate for radiation or chemotherapy. Both of these cases can offer the benefit of immediate reconstruction.
Total, modified, and radical mastectomies are surgeries that do not conserve the breast. However, simple mastectomies shell out the breast tissue leaving she entire breast skin and either the areola or nipple and areola. These options are determined by the location of the questionable mass as well as your surgeon’s personal philosophy. Reconstructive choices may include breast implants, tissue expanders or flap procedures. Your breast surgeon and oncologist will counsel you as to the timing, advantages and disadvantages of certain reconstructive techniques.
The important thing to recognize is that mastectomies and reconstruction do not need to be done in a hospital. They are equally, if not more, successful when accomplished in a private surgery center with a breast surgeon and plastic surgeon as a team for optimal results and a more personalized overall experience.
What part(s) of body treated by this method: breast
Time for procedure: depends upon type of reconstruction required, usually 2-4 hours
Number of sessions required: one
Recovery: one night recovery with nurse
Downtime: one week
Complications/Risks: similar to in-hospital
How long results last: forever
Cost of in-house breast reconstruction ($/$$/$$$): $$
One on one with Dr. Andrew Kornstein:
Roughly seven years ago a well known pop star, Anastacia began her search for a plastic surgeon in New York City. She was interested in a breast lift and lipoplasty. After getting several opinions, she called our office and said she had chosen our practice for her procedure. During her routine preoperative examination she was given a prescription for a pre-op mammogram. Though routine now, mine was one of few offices requiring this precaution. She protested at first, but later acquiesced. Within 24 hours, Anastacia switched from being an aesthetic patient to a patient battling breast cancer. Another woman in her late 30s consulted me for breast augmentation revision for bilateral capsular contracture (hardening of the implants.) She was also sent for a pre-op mammogram which unfortunately turned out to be positive for cancer. These two patients were pioneers in sparking a new trend of delivering breast cancer surgery and reconstruction in the private and comfortable office of an accredited plastic surgery center.
In both cases I called upon one of New York’s most eminent breast cancer surgeons who happened to be a professor of mine during my surgical training. The patients were not only given the comfort of knowing their reconstruction would be done by the plastic surgeon trusted to do their cosmetic work, but they would also be in the hands of one of New York’s finest cancer surgeons. It is important to note that this combined approach enables each surgeon to do what they do best. The cancer surgeon approaches their role without consideration for the future task of the reconstructive breast surgeon. Their primary job is dealing with the cancer, leaving reconstruction to the aesthetic breast surgeon. This is something the patient is made aware of during consults with each surgeon pre-operatively.
In addition to the warm and welcoming environment of the Museum Mile facility and staff there are additional advantages. This particular cancer doctor is one of the pioneers in nipple and areola sparing breast surgery. The advantage of this conservation is a more natural result through maintenance of the entire breast skin envelope as well as the natural nipple/areola complex. In addition, hospital infection rates even in best institutions are around 2%. This sounds low unless you are in that 2%. We have never had one.
This ideal situation is not available to all patients because certain more advanced breast cancer procedures are not safely accomplished in an office setting. Likewise, women who have had radiation therapy cannot have reconstruction after tissues are radiated, but reconstruction can be accomplished through fat grafting. Certain insurance companies while willing to pay for procedures in hospitals are at this point unwilling to fund the same procedure in an office setting. This is being actively fought through the society of New York Office Based Surgical Facilities (NYOBS.)
Having done breast surgery for 20 years, I certainly understand the psychological import of women and their breasts. It is deeply connected to their identity and femininity. But strictly speaking from a surgical standpoint, it is associated with repairing layers of skin and not nearly as complex as other aesthetic surgeries done on a daily basis. Years ago, the thought of doing breast reductions in an office setting were met with similar opposition, yet today they are performed more often in private surgery centers than in hospitals. The reason I mention this is to underscore the complete safety of having breast reconstruction in an office setting. The safety, comfort, convenience and results are echoed by every one of the patients we treat. It allows us to be the silver lining in an otherwise dark cloud and brings me great personal satisfaction.
Dr. Kornstein is featured in this ABC news story about in-house mastectomies: