This document summarizes an article about breast reconstruction surgery options after mastectomy. It discusses the three main types of reconstruction - implants, pedicled or free flaps using a patient's own tissue, and latissimus flaps. It provides details on specific procedures like DIEP flaps, TRAM flaps, and SIEA flaps. It also discusses the process of tissue expansion and permanent implant placement for implant-based reconstruction. Risks, expectations, and nipple reconstruction are briefly covered. The document aims to celebrate empowerment and healing options for women's health.

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Editor’s Note: Today’s story is the first in a
monthlong series on cosmetic surgery procedures.
Beauty most certainly comes from within, but in honor
of Breast Cancer Awareness Month, we wanted to take
the opportunity to celebrate self-empowerment — from
the inside out.
Growing up, women’s health issues surrounded Dr.
Michael Rose.
“Mymother’sbestfriendhadbreastcanceranddied
of it subsequently,” says Rose, a member of The Insti-
tute for Advanced Reconstruction at The Plastic Sur-
gery Center in Shrewsbury, and chief of the division of
plastic surgery at Jersey Shore University Medical
Center for Meridian Health. “And my mother is a huge
(Susan G.) Komen supporter — that’s her life, sort of
charity goal, and to raise as much money for cancer re-
search, and sort of avenge her best friend’s demise. I
was brought up in a household where this whole aspect
of women’s health was talked about all the time.
So when it became a part of my career, it was natural
that I would gravitate toward doing as much of this as
possible.”
Breast reconstruction surgeries
heal the mind and body
GINA COLUMBUS @GINACOLUMBUSAPP
See BREAST, Page D2

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indulge
Rose has been performing breast re-
construction surgeries, among others,
for the last15 years. And the procedures
for it are more innovative than ever, he
adds.
Breast reconstruction surgery is des-
ignated for women who have lost one or
both of their breasts due to a mastecto-
my, injury or an inherited physiological
problem, Rose says.
Also, if a woman tests positive for a
gene that may lead to breast cancer, she
may opt for a mastectomy — similar to a
move made by actor Angelina Jolie in
2013, when she underwent a double mas-
tectomy.
“Mostcommonly,it’sfrombreastcan-
cer or the threat of breast cancer with
(the) gene,” says Rose as to why women
choose breast reconstruction.
With the surgery’s advancements in
recent years, the procedure also serves
as a feminine rebirth and does wonders
for a woman’s body image.
“In many cases, after we’re all done,
we can reconstruct them a breast that
they can feel even better about them-
selves than they did before,” Rose says.
“The breast doesn’t have the same sensi-
tivity as before — but the form is still
there, and the way they look in clothing
and even out of clothing. They can forget
about the scarring a little bit, and just
look at the shape, and the position of the
breast and the size of the breast — they
can look fabulous. I can honestly say, 50
percent of the time, me and the patient
agree that they look better after recon-
struction than they did before recon-
struction.”
Explore the cutting-edge breast re-
construction procedures available to-
day.
An overview
Thanks to the Women’s Health and
Cancer Rights Act — passed in 1998 —
women are protected by their choice,
and right, to have breast reconstruction.
The law mandates that insurance pro-
vides coverage for breast reconstruc-
tion following a mastectomy surgery, ac-
cording to The Institute for Advanced
Reconstruction.
Under the law, mastectomy benefits
must cover, according to the American
Cancer Society:
» Reconstruction of the breast that
was removed by mastectomy
» Surgery and reconstruction of the
other breast to make the breasts look
symmetrical or balanced after mastec-
tomy
» Any external breast prosthesis
breast forms that fit into your bra need-
ed before or during the reconstruction
» Any physical complications at all
stages of mastectomy, including lym-
phedema (fluid build-up in the arm and
chest on the side of the surgery)
Breast reconstruction surgery can be
delayed until a patient is ready, but is
more effective immedi-
ately following a mastec-
tomy.
“The breast surgeon
will do the removal of the
breast, and then I will be
there,” Rose says. “Then
whatever method of re-
construction (we choose),
we will get the ball roll-
ing, we will get started. Then, they’ll
wake up with part of the reconstruction
done or the whole thing, for the most
part, done.”
Rose understands why some women
might not want to rush for reconstruc-
tion.
“I could understand — why a woman’s
firstconcern,anditshouldbe,is‘justget
this cancer off of me, I just want it off’ ...
‘why should I worry about my figure and
my femininity,’ ” Rose says. “I get that —
butitismuchhardertobuildabreastlat-
erthanitisatthetimeofthemastectomy
surgery.Italsoisneverquiteasgood,be-
cause the tissue has undergone a lot of
shrinkage, and maybe radiation treat-
ments. There is a very significant psy-
chological advantage — to waking up
from an operation as traumatic as hav-
ing your breasts removed, and still hav-
ing either a breast already reconstruct-
ed or halfway into the process. You feel
like you’re not just skin and ribs. It’s a
huge, psychological advantage.”
There are three basic types of recon-
structionprocedures:implants,pedicled
(attached) or free flaps, or latissimus
flaps, Rose says. The latter two groups
are part of a process where the breast is
reconstructed using the patient’s own
tissue.
“It really does depend on the patient,”
says Dr. Denise Johnson Miller, director
of breast surgery at Jersey Shore Uni-
versity Medical Center for Meridian
Health. “Patients are going for the flaps
because they give a better cosmetic ap-
pearance. But more elderly women, they
prefer the tissue expander (implants).”
All methods can be used alone or in
combination with other procedures, Mil-
ler adds.
Patients may go for an implant-based
reconstructionrightafteramastectomy,
then later reconstruct with their own tis-
sue.
“This allows people to think about
whattheywant,”Millersays.“It’salotof
decisions to make.”
One of the latest advances in breast
reconstruction is a microsurgical proce-
dure,calledtheDeepInferiorEpigastric
Perforator (DIEP) flap.
“They take the tissue from the abdo-
men, and reconnect it to blood vessels up
in the chest area,” says Rose. “They fig-
ured out a way where they don’t have to
take any muscle. It used to be you’d have
to sacrifice your abdominal muscle to
get the tissue out.”
What other advances in breast recon-
struction could we one day see?
“I think as they perfect tissue engi-
neering techniques, at some point,
they’re going to probably take some part
of the mold of your breast,” Rose says.
“They’re going to take a vile of blood
from the arm, and they’re going to use
some technique with stem cells to grow
you another breast and it’s going to get
transplanted in there somehow.”
Reconstructing with tissue
In flap procedures, breast recon-
structionsurgerypatientsareabletouse
their own tissue from another part of
their body — often the abdomen — along
with its blood supply, to form a breast.
“Those are where we use other parts
of your body, a little excess tissue, very
common, from the abdomen — to natu-
rally reconstruct the breast with it,”
Rose says, adding such microsurgical
procedures can take anywhere from
nine to 14 hours. “What women love
aboutthatis,there’snottoomanywomen
out there who wouldn’t want to get rid of
a few extra pounds around the middle.
And that goes along with the whole con-
cept of feeling better about themselves
aftersurgerythantheydidbefore.Their
tummies are nice and flat, and their
breasts are full and perky, and what’s
better than that?”
The pedicled transverse rectus ab-
dominis myocutaneous TRAM flap is
one of the most common methods of
breast reconstruction, The Institute for
Advanced Reconstruction at The Plastic
Surgery Center states online. Pedicle re-
fers to the part of a skin graft that re-
mains attached to the original donor site,
soittransfersthetissuesofthelowerab-
domen and rectus muscle to where the
new breast will be constructed. It helps
to provide blood flow to the skin and fat
that composes most of the flap, the Cen-
ter adds.
There are also free flap reconstruc-
tions,whicharedescribedasamicrosur-
gery that uses miniaturized instruments
and a microscope. Here, the flap of skin,
fat, muscle and blood vessels are cut
from its original location and attached to
the chest’s blood vessels, according to
the Center.
Free TRAM flaps connect veins and
arteriestothenewbreasttissue.Howev-
er, they can result in the weakening of
the abdominal muscles.
DIEP flaps are the newest advance,
touted earlier by Rose.
“A DIEP flap does not disrupt or use
any of the abdominal muscle, it only uses
the skin and the fat,” says Rose, explain-
ing it does not weaken the abdominal
muscles.
Superficial Inferior Epigastric Ar-
tery (SIEA) flaps are a variation of DIEP
flaps, Rose says, but use more superfi-
cialarteriesandasmallersectionofskin
and fat to reconstruct a breast.
Latissimus dorsi myocutaneous
flaps,alsoknownaslatissimusflaps,use
tissue from a patient’s back — just below
the shoulder and behind the armpit —
and are rotated around to the chest to re-
construct a breast. However, Rose says
in most cases, an implant is also used in
this procedure.
“It’s a hybrid, a little bit of both,” Rose
says.
If for some reason a patient’s abdomi-
nal tissue can not be used for the recon-
struction, they can go for what is called a
non-abdominal free flap. Instead, sur-
geons will pull tissue from the hips, glu-
teal area, and posterior thigh.
“Those are some other donor areas,
they’re not commonly done, but we do do
them,” Rose says.
“They’re great when you don’t have
abdominal tissue available.”
Implant-based reconstruction
If a patient vies for implants as a
breast reconstruction method, it seems
to be the quickest process. On top of a
mastectomy,animplantproceduretakes
roughly one and a half hours.
“If we’re using implants to recon-
struct the breast, that’s the simplest
way,” says Rose, who has been a board
member of the Cancer Support Commu-
nity of The Wellness Community of the
Jersey Shore since 2008.
However, there are multiple phases
of this reconstruction process.
Implant-based reconstruction, which
is a one- to two-month process, is divided
into two steps: tissue expansion and
placement of a permanent implant, ac-
cording to the Center. The two types of
implants, which can come in various
shapes and sizes, are saline-filled, sili-
cone gel-filled, or both, Miller says.
“Therearealotofoptionsforpeople,”
Miller says.
In tissue expansion, a pocket of skin is
formed under the chest wall muscle.
This is done in order to fit a tissue expan-
der,whichisasiliconeballoonfilledwith
saline.Theexpanderistheninserted,ac-
cording to the Center.
Gradually, additional saline is added
weekly or bi-weekly during outpatient
visits, until the desired volume is
reached in order to stretch the muscle
andskintothedesiredsize.Patientsthen
undergo an outpatient surgery to re-
move the tissue expander and insert the
permanent implant, the Center states.
Regardless of which reconstruction
method a patient goes with, there are
risks to keep in mind, Rose explains.
“With any procedure, there’s always
the risk of infection, bleeding, scarring.
Eventhoughwe’retryingtoteaseoutthe
muscle, they could have some muscle
damage, weakness of the abdominal
wall,” Rose says. “With the microsurgi-
cal (procedure), there is the possibility
that the body won’t restore the blood
flow to that ... artery. But that only hap-
pens a couple percent of the time.”
It’s helpful, Miller says, for people to
know their expectations prior to sur-
gery.
“It’s a good idea that if they know
someone who’s had breast reconstruc-
tion,” says Miller, “talk to patients who
have had those experiences.”
Nipple/areola reconstruction
A nipple/areola reconstruction fol-
lows that of the breast for a patient, Rose
explains. There are also various proce-
dures for this.
Said to be a separate, minor surgery
done as an outpatient, the procedure is
often done after the reconstructed
breast has had roughly three to four
months to heal, he says.
“Oncethereconstructionisdone,usu-
ally we wait a few months,” Rose says.
“We see how the breasts are going to be,
and how they’re sitting on the chest wall.
We can figure out where the nipple and
areola are going to go, and we can con-
struct from there.”
Tattooingisadifferentprocess,andis
usually done between three and six
months of breast reconstruction. It can
alsobedoneeitherinconjunctionwithor
instead of having the nipple/areola re-
construction, the Center states. The tat-
tooed nipples and/or areolas are de-
signed to match the skin’s pigment and
have a 3-D appearance.
Breast
Continued from Page D1
Dr. Michael
Rose