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Breast reconstruction to restore the female breast following a mastectomy, can be performed at the same time as the mastectomy procedure or months or even years later. There are many options available in post-mastectomy reconstruction. Planning your surgeryDr. Burt Greenberg will discuss the option which is best for you, based on your anatomy, state of health, and after consultation with your oncologic surgeon. The skin expansion technique combines skin expansion and the subsequent insertion of a saline or silicone gel implant in the submuscular pocket. Following mastectomy, a tissue expander is inserted beneath the skin and muscle unit. Over several weeks to months, Dr. Burt Greenberg will inject a saline solution to gradually fill the expander, using a percutaneous approach. After the skin over the breast area has been stretched, the expander will be removed and a second procedure to place the permanent implant will be performed. Most breast reconstructions involve a series of procedures over time. The initial reconstruction is the most complex, but follow-up surgery may be done to modify the new breast, reconstruct the nipple and areola, or adjust the existing breast to match the reconstructed breast. If sufficient abdominal wall tissue is present "TRAM" Flap Surgery may be recommended. Flap surgery is more complex than a tissue expansion or implant surgery. The TRAM procedure is performed in the hospital. Scars are left at the donor site and recovery is longer than implant surgery. TRAM flaps are generally more natural to the touch. Possible complications involved with any implant surgery are avoided. In some cases, you may have the added benefit of a tummy-tuck with improved abdominal contour. SurgeryDepending on the procedure used, the reconstructive surgery initially requires hospitalization for between one to five days. It may take up to six weeks to recover from a combined mastectomy and flap reconstruction. If implants are used, the recovery time is less. Reconstruction can't restore sensation to the breast, but it can restore balance and eliminate the need for special undergarments. Most scars fade substantially over time. Dr. Burt Greenberg will provide instructions on returning to normal activities and exercise. The newly constructed breast may feel firmer than the existing breast. It will not exactly match the opposite breast, but reconstruction will dramatically improve the appearance and quality of life after surgery. Secondary procedures are performed either at the ambulatory hospital unit or at the Great Neck Cosmetic Surgery and Laser Facility. Dr. Burt Greenberg has performed hundreds of breast reconstructions and has been consulted as a local, expert plastic surgeon in the production of the video, "Breast Cancer on Long Island: The Facts, The Fears, and The Future." He has lectured extensively to women's organizations and support groups throughout Long Island on new techniques following mastectomy and on the management of congenital breast abnormalities. |
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 Patient 1 Post-Operative TRAM flap (2 months) |
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| Patient
2 6 months following TRAM flap & nipple reconstruction |
Patient
2 Side View |
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| Patient
3 After tissue expansion and implant placement |
Patient
3 6 months after nipple reconstruction and left mastopexy |
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Breast
implant
benath pectralus major muscle |
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| Latissimus dorsi flap reconstruction |
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Latissimus
muscle brought into front position; usually requires a sub-muscular additive
prosthesis |
Tram
(transverse lectus abdominal myocutaneous flap) is transposed using blodd
supply from rectus muscle. Microscopic transfer can also be done in selected
patients. |
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 Tram flap healed. A soft, supple breast which does not require an implant results. A gradual softening and settleing of the new breast creates near symmetry. Occasionally intralateral procedures are required. |
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BURT GREENBERG,
MD. FACS
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