My patients are not only given the comfort of knowing their reconstruction is being done by the plastic surgeon trusted to do their cosmetic work, but they know I partner with one of New York’s finest cancer surgeons. This combined approach enables each surgeon to do what they do best in a private, relaxed environment. It allows us to be the silver lining in an otherwise dark cloud and brings me great personal satisfaction.
What patients should know about in-house Breast Reconstruction / Mastectomies…
- You have time to make the right decision.
- Mastectomies and reconstruction do not need to be done in a hospital.
- Today, there are innovative breast-conserving procedures.
- Total, modified radical and radical mastectomies are not recommended as often as in years past.
- A small percentage of women are not candidates for in house mastectomies.
You have time to make the right decision. 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.
Mastectomies and reconstruction do not need to be done in a hospital. 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. The cancer doctor I partner with 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.
Today, there are innovative breast-conserving procedures. Today, there are 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 radical and radical mastectomies are not recommended as often as in years past. Thankfully, treatment protocols have changed to reflect the latest research which supports the idea that less aggressive surgery does not influence survival or recurrence rates. Total, modified radical 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.
A small percentage of women are not candidates for in-house mastectomies. 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. Some 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.)
“Physically I look even better than before my mastectomy. Emotionally the worry toll is gone.”
At 48, Judy heard the words every woman dreads. “You have breast cancer.” Thirteen years prior, Judy had a breast augmentation with Dr. Kornstein. She decided to ask his opinion on lumpectomy vs. mastectomy since he performed breast reconstruction.
The breast surgeon Dr. Kornstein recommended was away at a seminar, so she decided to visit with him first. Judy’s diagnoses of Stage 2 cancer would most likely signal a lumpectomy accompanied by chemo and radiation. Dr. Kornstein explained that a mastectomy would most likely avoid both depending upon whether the cancer had traveled outside the breast. “I made up my mind then and there. I was never comfortable with the idea of radiation and I wondered deep down if a lumpectomy was an extreme enough measure.” Yet, the idea of a mastectomy sent chills down her spine. “My grandma had breast cancer in her 30’s and a radical mastectomy. The butchering and scars…I couldn’t imagine that being me.” “He pulled out a book and showed me the before and after pictures of women who had single stage breast reconstruction using a technique called “skin and nipple sparing.” It was remarkable. They looked so natural, normal and intact.” Dr. Kornstein said, “Don’t worry, I will make you beautiful.” “I was thinking more like never wanting anyone to ever see me naked again--including me. Being beautiful post cancer never crossed my mind.” But there was another more compelling piece of advice Judy would hear and it resonated. “He told me not to risk my life by playing around with a lumpectomy.” Surgery was scheduled for April of 2012.
The surgery was done at Dr. Kornstein’s in-house surgical suite which is AAAA certified--the same standard required in hospital operating rooms. The breast cancer surgeon removed her tissue and Dr. Kornstein did the reconstruction using silicone implants. One night was spent in his recovery room. “The drains are what bothered me the most, but I had no pain. There was a soreness similar to when your milk comes in, but that was all. The scars are minimal and hidden. I was back at work in 2 weeks.” Judy credits her ease of recovery both physically and emotionally not only to Dr. Kornstein, but his staff. “They are phenomenal. The care was so reassuring. I never had to chase anyone down--their response was immediate. I could call the doctor on his cell phone and get right through.”
Today, Judy puts a low cut dress on and feels she looks better than before her mastectomy. Her husband, who mentally prepared for the worst is thrilled. “He told me before the surgery, he didn’t care about my breasts, he just wanted me with him. Well, all I can say is the physical desire is just as intense, if not more because I have no reason to hide and he loves how I look.”
Above all, Judy is happy she took Dr. Kornstein’s advice. Emotionally the worry toll is gone. “A friend of mine was diagnosed very shortly after me. She decided to do a lumpectomy. She is still looking over her shoulder wondering if it will come back. The unknown can kill you.”
Two months after surgery Judy and her husband went down to their Florida home. She was walking down the beach in a bathing suit when one of her mother’s friends spotted her. “She came up to me and gave me a hug. My mother told her one of her daughters was having a mastectomy, so she asked me how my sister who had breast cancer was doing. I told her it was not my sister. She simply couldn’t believe it was ME.”