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Breast Reconstruction by Dr. Wolfeld in New York City

Plastic surgeon Dr. Michael Wolfeld performs breast reconstruction surgery and consultations for women who have had a mastectomy, are planning to undergo mastectomy for breast cancer, or who plan on having a prophylactic mastectomy because they have a strong genetic risk for developing breast cancer. Breast reconstruction is also an appropriate procedure for patients that have had breast conservation treatment with lumpectomy and radiation, but have a contour deformity or asymmetry as a result of the treatment.  Reconstruction of a breast following mastectomy can produce a very aesthetically pleasing result, but more importantly, for most women it helps them feel "whole again." The procedure may be performed at the same time as the mastectomy (immediate) or sometime later (delayed). Additionally, health insurance companies are required to cover this procedure and any surgery on the opposite breast which may be needed to obtain symmetry.

There are two basic techniques for breast reconstruction. One utilizes a saline or silicone filled implant to recreate a breast mound. The other uses a patient's own tissue, also known as a "flap" for the reconstruction. Your best option will depend upon your body type, breast size, age, overall general health and your personal goals. Not all women are good candidates for every method and Dr. Wolfeld will make recommendations that are tailored to you based on your individual anatomy, medical history and whether you received radiation to your chest. The goal is to make your breast reconstruction safe and an aesthetically pleasing life-long result.

Although some women will not require tissue expansion prior to implant insertion, more commonly this reconstruction process generally requires two stages. First, an inflatable device known as a tissue expander is positioned in the area of the missing breast tissue. The expander is gradually inflated with saline during weekly office appointments until a match is achieved with the opposite side.  The expander is then replaced by a permanent breast implant.

Flap reconstruction involves transferring muscle, fat, and skin from another body area, such as the abdomen, in order to reproduce the missing breast mound. The TRAM (transverse rectus abdominis myocutaneous) flap using tissue from the lower abdomen is the most commonly used flap.  Dr. Wolfeld does perform other types of flaps for breast reconstruction and he can discuss these with you during your consultation.  The recovery period for the flap surgery will generally take longer than with the implant procedure because there will be healing in the donor as well as the reconstructed site. However, unlike implants, a flap surgery is a one-stage procedure and does not carry the risks associated with the use of implants.  The recovery period will vary by individual but will take longer (up to six weeks) for the flap procedure.

Patients who had unilateral (one-sided) breast reconstruction are offered surgery on the opposite, unaffected breast to achieve symmetry and equalization. Surgical procedures on the opposite breast may include a breast reduction, breast lift, or breast augmentation with an implant, or a combination of these procedures. This step is optional but often enhances the final form and symmetry.  Reconstruction of the nipple-areola area can be started once the breast mound reconstruction is complete.  It is usually performed several months after the first stage.  The preferred method of nipple reconstruction is to use the skin already on the breast mound. This is done as a minor procedure under local anesthetic.  The reconstructed nipple is without color. The final step of the breast reconstruction process is to tattoo a color around the reconstructed nipple that matches your other nipple and this is done a month or two after the nipple reconstruction. This completes the breast reconstructive process. The benefit is the final result, which is a natural long lasting breast reconstruction that reestablishes symmetry and form without the need for wearing external breast prosthesis.

If you are interested in discussing your options for breast reconstruction with Dr. Wolfeld, you may schedule a private consultation by calling 212-281-1000.

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