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JeffAschermanMD
(Physician
- Surgery - Plastic
(Verified)
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| Communities: Breast Cancer | Thank You's: 2 |
| Member Since: Jan. 2012 | Questions: 0 |
| Answers: 13 |
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Professional Statement
Dr. Ascherman is a Professor of Clinical Surgery at New York - Presbyterian Hospital/Columbia University Medical Center.
Professional Info
Credential:
MD
Primary specialty:
Surgery - Plastic
Medical school:
Columbia University College of Physicians and Surgeons
Residency:
NewYork-Presbyterian Hospital/Columbia University Medical Center
Fellowship:
Hospital Necker-Enfants Malades & Hospital Saint Vincent de Paul - Paris, France
Professional memberships:
American Society of Plastic Surgeons, American Cleft Palate - Craniofacial Association, American Medical Association, Plastic Surgery Research Council, American Society for Peripheral Nerve, Medical Society of the State of New York New York, Regional Society of Plastic and Reconstructive Surgery New York County Medical Society, Jerome P. Webster Society
Areas of expertise:
Cosmetic/plastic surgery
Craniofacial surgery
Breast reconstruction
Pediatric plastic surgery
Craniofacial surgery
Breast reconstruction
Pediatric plastic surgery
Research interests:
Breast reconstruction
Cranial reossification
Wound healing
Cranial reossification
Wound healing
Awards and publications:
Included in New York Magazine’s “Best Doctors” issue, 2009, 2011
Teacher of the Year Award, Division of Plastic Surgery, New York Presbyterian Hospital, 2009
Included in Castle Connolly's How to Find the Best Doctors: New York Metro Area, 1997-2011
“Gold Doc” Award from the Arnold P. Gold Foundation “for demonstrating compassion, empathy and respect in the practice of medicine,” 2005
Teacher Recognition Award, Columbia University College of Physicians & Surgeons, 2000
Best Research Paper Award at the 1994 Plastic Surgery Senior Residents Conference
For publications see: http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=jaa7&DepAffil=Surgery
Teacher of the Year Award, Division of Plastic Surgery, New York Presbyterian Hospital, 2009
Included in Castle Connolly's How to Find the Best Doctors: New York Metro Area, 1997-2011
“Gold Doc” Award from the Arnold P. Gold Foundation “for demonstrating compassion, empathy and respect in the practice of medicine,” 2005
Teacher Recognition Award, Columbia University College of Physicians & Surgeons, 2000
Best Research Paper Award at the 1994 Plastic Surgery Senior Residents Conference
For publications see: http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=jaa7&DepAffil=Surgery
Hospital affiliation:
NewYork-Presbyterian Hospital/Columbia University Medical Center
Practice address:
161 Fort Washington Avenue Herbert Irving Pavilion Room 5-509
New York, NY
10032
Practice phone number:
212-305-9612
JeffAschermanMD Activities
This is actually a controversial area among plastic surgeons, but at the current time the official guidelines are to obtain an MRI 3 years postoperatively and then every 2 years after that. However, if there is a suspected problem with an implant, the MRI may certainly be obtained at the time of the concern. Furthermore, the official guidelines may change in the future, but your plastic surgeon should be able to keep you updated on this.
This is actually a controversial area among plastic surgeons, but at the current time the official guidelines are to obtain an MRI 3 years postoperatively and then every 2 years after that. However, if there is a suspected problem with an implant, the MRI may certainly be obtained at the time of the concern. Furthermore, the official guidelines may change in the future, but your plastic surgeon should be able to keep you updated on this.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Implants, Silicone Implants, Breast Implant Monitoring, Breast Magnetic Resonance Imaging (MRI), MRI (Magnetic Resonance Imaging), Breast Reconstruction
2
Answers |
3 months ago
I would say that this is very normal to have these difficulties, but would also say that with time most of my patients are very happy with their reconstructions, and these emotional difficulties usually go away with time. I also have a number of patients who have finished the reconstruction process and have volunteered to speak with new patients, and this can often be very helpful for new patients. Additionally, having a very understanding spouse or significant other, as well as family and/or friends, is usually very helpful.
I would say that this is very normal to have these difficulties, but would also say that with time most of my patients are very happy with their reconstructions, and these emotional difficulties usually go away with time. I also have a number of patients who have finished the reconstruction process and have volunteered to speak with new patients, and this can often be very helpful for new patients. Additionally, having a very understanding spouse or significant other, as well as family and/or friends, is usually very helpful.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Support, Communication, Emotional Support, Breast Cancer, Breast Reconstruction, Patient Communication, Mastectomy
5
Answers |
3 months ago
There are different types of necrosis. Necrosis of the remaining breast skin is probably more likely to occur at the time of mastectomy than with delayed reconstructions, but even with immediate reconstructions this is usually not a problem. With regard to a flap used for breast reconstruction, I do not think there is a big difference in flap necrosis rates with immediate versus delayed reconstructions.
There are different types of necrosis. Necrosis of the remaining breast skin is probably more likely to occur at the time of mastectomy than with delayed reconstructions, but even with immediate reconstructions this is usually not a problem. With regard to a flap used for breast reconstruction, I do not think there is a big difference in flap necrosis rates with immediate versus delayed reconstructions.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Reconstruction, Side Effects, Breast Reconstruction Side Effects, Necrosis
1
Answer |
3 months ago
I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants.
I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Implants, Breast Implant Rejection, Silicone Implants, Breast Reconstruction, Side Effects, Breast Reconstruction Side Effects
1
Answer |
3 months ago
There are usually a number of options. Perhaps minor adjustments can be made to the implant reconstruction in the surgeon's office or as an outpatient procedure in an operating room. If more significant revisions are needed, this may require replacing the implant with a new implant, or replacing it with a flap. An experienced plastic surgeon can give you more details on what would be appropriate for you after he or she examines you.
There are usually a number of options. Perhaps minor adjustments can be made to the implant reconstruction in the surgeon's office or as an outpatient procedure in an operating room. If more significant revisions are needed, this may require replacing the implant with a new implant, or replacing it with a flap. An experienced plastic surgeon can give you more details on what would be appropriate for you after he or she examines you.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Implants, Breast Reconstruction Options, Breast Reconstruction, Cosmetic
1
Answer |
3 months ago
The scars vary widely, and are determined by the incision used for your mastectomy, and the type of reconstruction you are having. Some incisions are very well hidden, such as in the inferior fold of the breast, while others need to be placed on the more visible areas of the breast, depending on where the cancer is and the comfort level of your breast surgeon with different approaches. Furthermore, implant reconstructions usually involve some type of a single line closure, whereas flap reconstructions sometimes involve more circular or elliptical shape inicisions, depending on the amount of skin removed by the breast surgeon. Your breast and plastic surgeons can probably tell you preoperatively what type of scar you will have, as they will know the specifics of your surgery.
The scars vary widely, and are determined by the incision used for your mastectomy, and the type of reconstruction you are having. Some incisions are very well hidden, such as in the inferior fold of the breast, while others need to be placed on the more visible areas of the breast, depending on where the cancer is and the comfort level of your breast surgeon with different approaches. Furthermore, implant reconstructions usually involve some type of a single line closure, whereas flap reconstructions sometimes involve more circular or elliptical shape inicisions, depending on the amount of skin removed by the breast surgeon. Your breast and plastic surgeons can probably tell you preoperatively what type of scar you will have, as they will know the specifics of your surgery.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Scars, Breast Reconstruction, Breast Reconstruction Scars
1
Answer |
3 months ago
I am seeing increasing numbers of women these past few years who are undergoing prophylactic mastectomies who are BRCA positive. However, even if a woman is BRCA negative, there may still be a very valid reason for prophylactic mastectomies, such as a very strong family history of breast cancer. In such a case, it is important to discuss the decision with your breast surgeon and other members of your health care team, as there are certainly many factors to be considered in the decision that can best be answered by those who know the specifics of your situation.
I am seeing increasing numbers of women these past few years who are undergoing prophylactic mastectomies who are BRCA positive. However, even if a woman is BRCA negative, there may still be a very valid reason for prophylactic mastectomies, such as a very strong family history of breast cancer. In such a case, it is important to discuss the decision with your breast surgeon and other members of your health care team, as there are certainly many factors to be considered in the decision that can best be answered by those who know the specifics of your situation.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Prophylactic Mastectomy, Brca-2, Brca-1, BRCA Mutations
1
Answer |
3 months ago
With current technologies, I think there is a limit to how much reconstruction can be done with fat injections or fat grafting alone. Thus, at the current time, I think the fat injections are more useful for secondary breast reconstruction procedures, such as for smoothing out the transition from a reconstructed breast to a woman's remaining chest wall.
With current technologies, I think there is a limit to how much reconstruction can be done with fat injections or fat grafting alone. Thus, at the current time, I think the fat injections are more useful for secondary breast reconstruction procedures, such as for smoothing out the transition from a reconstructed breast to a woman's remaining chest wall.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Fat Grafting, Breast Reconstruction, Fat Injections, Lipofilling
1
Answer |
3 months ago
Everyone is different, but I have had patients who have had reconstructions with implants and others with TRAM flaps who have become pregnant, and had no issues with their reconstructions during their pregnancies. Thus, there may be no affect on the reconstructed breast. However, your natural breast may become larger during the pregnancy, so you may develops some asymmetries with the pregnancy that may or may not go away after the pregnancy. Additionally, if your reconstructed breast is made from your own tissue, it may enlarge during the pregnancy as you gain weight elsewhere.
Everyone is different, but I have had patients who have had reconstructions with implants and others with TRAM flaps who have become pregnant, and had no issues with their reconstructions during their pregnancies. Thus, there may be no affect on the reconstructed breast. However, your natural breast may become larger during the pregnancy, so you may develops some asymmetries with the pregnancy that may or may not go away after the pregnancy. Additionally, if your reconstructed breast is made from your own tissue, it may enlarge during the pregnancy as you gain weight elsewhere.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Reconstruction, Breast Reconstruction And Pregnancy, Pregnancy
1
Answer |
3 months ago
Some implants remain perfectly fine for many years. Others may develop firm capsules, known as capsular contractures, or may develop leaks. Other problems can also occur long-term, but are less common. It is important, however, that you have regular follow-up exams with a plastic surgeon who can monitor you to see if any of these issues are developing.
3 years after my mastectomy I had a lump develop in the muscle over my implant, about 1/2 an inch above the scar line. On ultrasound it appeared like a mass. Breast MRI confirmed that it is likely scar tissue. It is tender and painful. Nobody ever warned me about this being a possibility. The constant worry and surveillance is something I am learning to live with.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified))
2
Answers |
3 months ago
The 2 main breast implant manufacturers in the U.S. are Allergan and Mentor, and both have very long records of excellent safety.
The 2 main breast implant manufacturers in the U.S. are Allergan and Mentor, and both have very long records of excellent safety.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Implants, PIP Breast Implants, Breast Implant, Breast Reconstruction
1
Answer |
3 months ago
Reducing reconstructed breasts is usually not a problem. Just be sure that whoever is doing the reduction is familiar with the details of your original free flap procedure so that the reduction procedure does not jeopardize the blood supply to the portions of your breasts that will remain and are not being reduced.
Reducing reconstructed breasts is usually not a problem. Just be sure that whoever is doing the reduction is familiar with the details of your original free flap procedure so that the reduction procedure does not jeopardize the blood supply to the portions of your breasts that will remain and are not being reduced.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Reduction, Flap Reconstruction, Breast Reconstruction
2
Answers |
3 months ago
Depending on the specifics of your situation, you may still be a good candidate for another type of flap, or for a tissue expander. If you feel more comfortable getting a second opinion, then I'm sure your original plastic surgeon will understand. Because of the complexity of your case, if you do see another plastic surgeon it would be best if it is someone with significant experience in breast reconstruction, either here in the NYC metro area, or closer to your home if you prefer and can locate someone with the appropriate experience.
Depending on the specifics of your situation, you may still be a good candidate for another type of flap, or for a tissue expander. If you feel more comfortable getting a second opinion, then I'm sure your original plastic surgeon will understand. Because of the complexity of your case, if you do see another plastic surgeon it would be best if it is someone with significant experience in breast reconstruction, either here in the NYC metro area, or closer to your home if you prefer and can locate someone with the appropriate experience.
New answer by JeffAschermanMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Surgery, Breast Reconstruction, DIEP Flap, DIEP Flap Breast Reconstruction
1
Answer |
3 months ago
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