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JoshLevineMD
(Physician
- Surgery - Plastic
(Verified)
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| Communities: Breast Cancer | Thank You's: 3 |
| Member Since: Jun. 2011 | Questions: 0 |
| Answers: 15 |
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Professional Statement
Dr. Joshua L. Levine is a board-certified microsurgical plastic surgeon that specializes in perforator flap breast reconstruction. He is currently the Director of Surgical Services at the New York Eye and Ear Infirmary, where he operates, but also performs perforator flap breast reconstruction at hospitals throughout the New York City tri-state area.
Dr. Levine is a proud member of the ASPS, ASRM, and New York Metropolitan Breast Cancer Group. He is also on the advisory board of the FORCE organization, and actively supports organizations like Young Survivors Coalition and the Komen Foundation.
Dr. Levine is frequently invited to speak, and operate all over the world. He continues to publish current techniques in peer-review journals, and is the author of many text book chapters.
Originally from Atlanta, Georgia, Dr. Levine attended Tulane University for his undergraduate education, and obtained his medical degree from the Medical College of Georgia. He completed two residency programs at The Albert Einstein College of Medicine/Montefiore Medical Center in New York. The first one in general surgery, and the second in plastic surgery with Dr. Berish Strauch, a founding father of microsurgery.
Following his plastic surgery residency, Dr. Levine elected to pursue further training in cosmetic surgery and breast reconstruction. For cosmetic surgery, he completed a fellowship with the world-renowned Dr. Donald Wood-Smith at The New York Eye and Ear Infirmary. He then moved to New Orleans, and completed a fellowship in microsurgical breast reconstruction with Dr. Robert Allen, who originated and developed perforator flaps for breast reconstruction and is the leading authority on this technique.
Dr. Levine has a private practice in Manhattan.
Dr. Levine is a proud member of the ASPS, ASRM, and New York Metropolitan Breast Cancer Group. He is also on the advisory board of the FORCE organization, and actively supports organizations like Young Survivors Coalition and the Komen Foundation.
Dr. Levine is frequently invited to speak, and operate all over the world. He continues to publish current techniques in peer-review journals, and is the author of many text book chapters.
Originally from Atlanta, Georgia, Dr. Levine attended Tulane University for his undergraduate education, and obtained his medical degree from the Medical College of Georgia. He completed two residency programs at The Albert Einstein College of Medicine/Montefiore Medical Center in New York. The first one in general surgery, and the second in plastic surgery with Dr. Berish Strauch, a founding father of microsurgery.
Following his plastic surgery residency, Dr. Levine elected to pursue further training in cosmetic surgery and breast reconstruction. For cosmetic surgery, he completed a fellowship with the world-renowned Dr. Donald Wood-Smith at The New York Eye and Ear Infirmary. He then moved to New Orleans, and completed a fellowship in microsurgical breast reconstruction with Dr. Robert Allen, who originated and developed perforator flaps for breast reconstruction and is the leading authority on this technique.
Dr. Levine has a private practice in Manhattan.
Professional Info
Credential:
MD
Primary specialty:
Surgery - Plastic
Areas of expertise:
Breast reconstruction using the body's own tissue (autologous) specializing in DIEP/SIEA, Stacked DIEP, I/SGAP, TUG, PAP, ICAP/TDAP flaps
Hospital affiliation:
New York Eye & Ear Infirmary, NY Downtown, Montefiore Medial Center, Hackensack University Medical Center, Stamford Hospital, Greenwich Hospital, Lawrence Hospital
Practice address:
1776 Broadway, Suite 1200
New York, NY
10019
Practice phone number:
212-245-8140
Webpage:
www.diepflap.com
JoshLevineMD Activities
Implants will never develop sensation.
Autologous tissue reconstructions usually do. The degree to which sensation returns and the amount of time it takes is very variable. If sensation is a priority, some plastic surgeons can offer to connect a sensory nerve to your autologous flap. This may help the tissue to develop sensation quicker, but it requires sacrifice of sensation to the remaining breast skin, so the effectiveness of this extra step is still controversial.
The skin over the reconstruction is more likely to develop sensation with autologous tissue reconstruction because nerves can grow thought the transferred tissue to the overlying skin. Implants will never develop sensation.
Autologous tissue reconstructions usually do. The degree to which sensation returns and the amount of time it takes is very variable. If sensation is a priority, some plastic surgeons can offer to connect a sensory nerve to your autologous flap. This may help the tissue to develop sensation quicker, but it requires sacrifice of sensation to the remaining breast skin, so the effectiveness of this extra step is still controversial.
The skin over the reconstruction is more likely to develop sensation with autologous tissue reconstruction because nerves can grow thought the transferred tissue to the overlying skin.
Autologous tissue reconstructions usually do. The degree to which sensation returns and the amount of time it takes is very variable. If sensation is a priority, some plastic surgeons can offer to connect a sensory nerve to your autologous flap. This may help the tissue to develop sensation quicker, but it requires sacrifice of sensation to the remaining breast skin, so the effectiveness of this extra step is still controversial.
The skin over the reconstruction is more likely to develop sensation with autologous tissue reconstruction because nerves can grow thought the transferred tissue to the overlying skin. Implants will never develop sensation.
Autologous tissue reconstructions usually do. The degree to which sensation returns and the amount of time it takes is very variable. If sensation is a priority, some plastic surgeons can offer to connect a sensory nerve to your autologous flap. This may help the tissue to develop sensation quicker, but it requires sacrifice of sensation to the remaining breast skin, so the effectiveness of this extra step is still controversial.
The skin over the reconstruction is more likely to develop sensation with autologous tissue reconstruction because nerves can grow thought the transferred tissue to the overlying skin.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified))
1
Answer |
2 days ago
There is plenty of good evidence that Implant reconstruction in a patient who has been or will be radiated results in a high complication rate. Therefore, using your body’s own tissue (autologous) is preferable in anyone who is a candidate.
There is plenty of good evidence that Implant reconstruction in a patient who has been or will be radiated results in a high complication rate. Therefore, using your body’s own tissue (autologous) is preferable in anyone who is a candidate.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified))
1
Answer |
2 days ago
SIEA stands for superficial inferior epigastric artery free flap. This is a breast reconstruction procedure in which living tissue is taken from the lower abdomen attached to the SIEA blood vessels, and transferred to the chest. This operation, like almost any other, can cause a seroma, or fluid collection at the surgical site. Because much of the dissection of the tiny vessels is in the groin area, where there are many lymph nodes, the risk of seroma is actually higher with this procedure. Therefore drains are very important to manage fluid output post-operatively. Drains can be brought out laterally in the corners of the wound, or inferiorly in the pubic area. Both locations are common and acceptable.
SIEA stands for superficial inferior epigastric artery free flap. This is a breast reconstruction procedure in which living tissue is taken from the lower abdomen attached to the SIEA blood vessels, and transferred to the chest. This operation, like almost any other, can cause a seroma, or fluid collection at the surgical site. Because much of the dissection of the tiny vessels is in the groin area, where there are many lymph nodes, the risk of seroma is actually higher with this procedure. Therefore drains are very important to manage fluid output post-operatively. Drains can be brought out laterally in the corners of the wound, or inferiorly in the pubic area. Both locations are common and acceptable.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified))
1
Answer |
2 days ago
Expansion is a technique used in breast reconstruction when implant reconstruction is performed. Implants for breast reconstruction go underneath the chest muscle (pectoralis major). There is not enough space under this muscle such that the implant can be entirely covered at the time of mastectomy. Therefore an expander is placed under the muscle first. The expander is gradually filled with saline until the desired volume is achieved. This allows the muscle to stretch over time to accommodate the implant later on.
The idea is that the final implant must have thick tissue covering it, and skin alone is not enough. In order to avoid expansion, some plastic surgeons are now offering “direct to implant” procedures. To compensate for the lack of muscle coverage, a piece of cadaveric (from a cadaver) dermal tissue is used to support the implant below the muscle.
Expansion is a technique used in breast reconstruction when implant reconstruction is performed. Implants for breast reconstruction go underneath the chest muscle (pectoralis major). There is not enough space under this muscle such that the implant can be entirely covered at the time of mastectomy. Therefore an expander is placed under the muscle first. The expander is gradually filled with saline until the desired volume is achieved. This allows the muscle to stretch over time to accommodate the implant later on.
The idea is that the final implant must have thick tissue covering it, and skin alone is not enough. In order to avoid expansion, some plastic surgeons are now offering “direct to implant” procedures. To compensate for the lack of muscle coverage, a piece of cadaveric (from a cadaver) dermal tissue is used to support the implant below the muscle.
The idea is that the final implant must have thick tissue covering it, and skin alone is not enough. In order to avoid expansion, some plastic surgeons are now offering “direct to implant” procedures. To compensate for the lack of muscle coverage, a piece of cadaveric (from a cadaver) dermal tissue is used to support the implant below the muscle.
Expansion is a technique used in breast reconstruction when implant reconstruction is performed. Implants for breast reconstruction go underneath the chest muscle (pectoralis major). There is not enough space under this muscle such that the implant can be entirely covered at the time of mastectomy. Therefore an expander is placed under the muscle first. The expander is gradually filled with saline until the desired volume is achieved. This allows the muscle to stretch over time to accommodate the implant later on.
The idea is that the final implant must have thick tissue covering it, and skin alone is not enough. In order to avoid expansion, some plastic surgeons are now offering “direct to implant” procedures. To compensate for the lack of muscle coverage, a piece of cadaveric (from a cadaver) dermal tissue is used to support the implant below the muscle.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified))
1
Answer |
2 days ago
There are several ways to borrow living tissue from the patient’s own body to replace the breast after mastectomy. Tissue is most commonly taken from the abdomen (TRAM, DIEP, SIEA) because there is commonly enough tissue there to make one or two breasts.
Tissue can also be used from the buttocks, hips thighs and trunk. When tissue is taken from the trunk or side next to the breast we call it a lateral thoracic flap. The TDAP is one example.
TDAP stands for Thoracodorsal Artery Perforator Flap. This is a local flap, meaning that it comes from near the area of the defect (breast). The skin and fat is harvested in one elliptical piece that is still connected to a tiny blood vessel that supplies it. This tissue is then moved over into the defect to either create a new breast or to correct a lumpectomy defect.
TDAPs (and other lateral thoracic flaps) are used when there is enough volume of extra tissue at the donor area (the lateral thorax) to correct the defect caused by breast cancer surgery. Usually there is not enough extra tissue there to make a whole breast, so these procedures are most commonly used for partial breast reconstruction.
The advantages of the lateral thoracic flaps are:
1. Short hospital stay (24 hours)
2. Low failure rate
3. Favorable scar within the bra line
4. Gets rid of unwanted extra tissue under the arm There are several ways to borrow living tissue from the patient’s own body to replace the breast after mastectomy. Tissue is most commonly taken from the abdomen (TRAM, DIEP, SIEA) because there is commonly enough tissue there to make one or two breasts.
Tissue can also be used from the buttocks, hips thighs and trunk. When tissue is taken from the trunk or side next to the breast we call it a lateral thoracic flap. The TDAP is one example.
TDAP stands for Thoracodorsal Artery Perforator Flap. This is a local flap, meaning that it comes from near the area of the defect (breast). The skin and fat is harvested in one elliptical piece that is still connected to a tiny blood vessel that supplies it. This tissue is then moved over into the defect to either create a new breast or to correct a lumpectomy defect.
TDAPs (and other lateral thoracic flaps) are used when there is enough volume of extra tissue at the donor area (the lateral thorax) to correct the defect caused by breast cancer surgery. Usually there is not enough extra tissue there to make a whole breast, so these procedures are most commonly used for partial breast reconstruction.
The advantages of the lateral thoracic flaps are:
1. Short hospital stay (24 hours)
2. Low failure rate
3. Favorable scar within the bra line
4. Gets rid of unwanted extra tissue under the arm
Tissue can also be used from the buttocks, hips thighs and trunk. When tissue is taken from the trunk or side next to the breast we call it a lateral thoracic flap. The TDAP is one example.
TDAP stands for Thoracodorsal Artery Perforator Flap. This is a local flap, meaning that it comes from near the area of the defect (breast). The skin and fat is harvested in one elliptical piece that is still connected to a tiny blood vessel that supplies it. This tissue is then moved over into the defect to either create a new breast or to correct a lumpectomy defect.
TDAPs (and other lateral thoracic flaps) are used when there is enough volume of extra tissue at the donor area (the lateral thorax) to correct the defect caused by breast cancer surgery. Usually there is not enough extra tissue there to make a whole breast, so these procedures are most commonly used for partial breast reconstruction.
The advantages of the lateral thoracic flaps are:
1. Short hospital stay (24 hours)
2. Low failure rate
3. Favorable scar within the bra line
4. Gets rid of unwanted extra tissue under the arm There are several ways to borrow living tissue from the patient’s own body to replace the breast after mastectomy. Tissue is most commonly taken from the abdomen (TRAM, DIEP, SIEA) because there is commonly enough tissue there to make one or two breasts.
Tissue can also be used from the buttocks, hips thighs and trunk. When tissue is taken from the trunk or side next to the breast we call it a lateral thoracic flap. The TDAP is one example.
TDAP stands for Thoracodorsal Artery Perforator Flap. This is a local flap, meaning that it comes from near the area of the defect (breast). The skin and fat is harvested in one elliptical piece that is still connected to a tiny blood vessel that supplies it. This tissue is then moved over into the defect to either create a new breast or to correct a lumpectomy defect.
TDAPs (and other lateral thoracic flaps) are used when there is enough volume of extra tissue at the donor area (the lateral thorax) to correct the defect caused by breast cancer surgery. Usually there is not enough extra tissue there to make a whole breast, so these procedures are most commonly used for partial breast reconstruction.
The advantages of the lateral thoracic flaps are:
1. Short hospital stay (24 hours)
2. Low failure rate
3. Favorable scar within the bra line
4. Gets rid of unwanted extra tissue under the arm
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified))
1
Answer |
2 days ago
Lumpectomy is the surgical removal of the breast cancer tumor with enough surrounding tissue such that the margins are free of cancer. This is different from a mastectomy, which removes the entire breast. Mastectomy results in the absence of breast, so reconstructive options are designed to replace the entire breast. Lumpectomy may or may not require any reconstruction.
If the tumor is small enough within the breast, removing it may not cause a noticeable defect, and reconstruction is not needed. That is the best-case scenario, and a good argument for lumpectomy, which is also called "breast conservation therapy".
If the tumor is in a place where its removal can be combined with a reduction or lift, this is another option. Of course, this would probably require a similar procedure on the other side for symmetry. These options are in a category knows as "onco-plastic” procedures.
There are also a number of autologous options (using the body's own tissue) for lumpectomy defects that can be done at the time of the lumpectomy or later on. These options include local flap procedures, which borrow tissue from the side (next to the breast), and free flap procedures, which borrow tissue from further away, like the abdomen.
There are good reasons to wait to do the reconstruction for a lumpectomy defect at a later time:
1. You won’t know the extent of the defect at the time of the lumpectomy, especially since radiation will almost certainly be done after surgery. Radiation causes changes to the remaining breast.
2. You will not know for sure that the margins of the lumpectomy are clear (free of cancer) until several days after the lumpectomy
Fat grafting (using your own liposuctioned body fat) can also be done to fill in depressed areas in the breast. The main problem with this technique is that the results are unreliable. There is also concern about whether or not this influences the recurrence rate for developing cancer in the future. Lumpectomy is the surgical removal of the breast cancer tumor with enough surrounding tissue such that the margins are free of cancer. This is different from a mastectomy, which removes the entire breast. Mastectomy results in the absence of breast, so reconstructive options are designed to replace the entire breast. Lumpectomy may or may not require any reconstruction.
If the tumor is small enough within the breast, removing it may not cause a noticeable defect, and reconstruction is not needed. That is the best-case scenario, and a good argument for lumpectomy, which is also called "breast conservation therapy".
If the tumor is in a place where its removal can be combined with a reduction or lift, this is another option. Of course, this would probably require a similar procedure on the other side for symmetry. These options are in a category knows as "onco-plastic” procedures.
There are also a number of autologous options (using the body's own tissue) for lumpectomy defects that can be done at the time of the lumpectomy or later on. These options include local flap procedures, which borrow tissue from the side (next to the breast), and free flap procedures, which borrow tissue from further away, like the abdomen.
There are good reasons to wait to do the reconstruction for a lumpectomy defect at a later time:
1. You won’t know the extent of the defect at the time of the lumpectomy, especially since radiation will almost certainly be done after surgery. Radiation causes changes to the remaining breast.
2. You will not know for sure that the margins of the lumpectomy are clear (free of cancer) until several days after the lumpectomy
Fat grafting (using your own liposuctioned body fat) can also be done to fill in depressed areas in the breast. The main problem with this technique is that the results are unreliable. There is also concern about whether or not this influences the recurrence rate for developing cancer in the future.
If the tumor is small enough within the breast, removing it may not cause a noticeable defect, and reconstruction is not needed. That is the best-case scenario, and a good argument for lumpectomy, which is also called "breast conservation therapy".
If the tumor is in a place where its removal can be combined with a reduction or lift, this is another option. Of course, this would probably require a similar procedure on the other side for symmetry. These options are in a category knows as "onco-plastic” procedures.
There are also a number of autologous options (using the body's own tissue) for lumpectomy defects that can be done at the time of the lumpectomy or later on. These options include local flap procedures, which borrow tissue from the side (next to the breast), and free flap procedures, which borrow tissue from further away, like the abdomen.
There are good reasons to wait to do the reconstruction for a lumpectomy defect at a later time:
1. You won’t know the extent of the defect at the time of the lumpectomy, especially since radiation will almost certainly be done after surgery. Radiation causes changes to the remaining breast.
2. You will not know for sure that the margins of the lumpectomy are clear (free of cancer) until several days after the lumpectomy
Fat grafting (using your own liposuctioned body fat) can also be done to fill in depressed areas in the breast. The main problem with this technique is that the results are unreliable. There is also concern about whether or not this influences the recurrence rate for developing cancer in the future. Lumpectomy is the surgical removal of the breast cancer tumor with enough surrounding tissue such that the margins are free of cancer. This is different from a mastectomy, which removes the entire breast. Mastectomy results in the absence of breast, so reconstructive options are designed to replace the entire breast. Lumpectomy may or may not require any reconstruction.
If the tumor is small enough within the breast, removing it may not cause a noticeable defect, and reconstruction is not needed. That is the best-case scenario, and a good argument for lumpectomy, which is also called "breast conservation therapy".
If the tumor is in a place where its removal can be combined with a reduction or lift, this is another option. Of course, this would probably require a similar procedure on the other side for symmetry. These options are in a category knows as "onco-plastic” procedures.
There are also a number of autologous options (using the body's own tissue) for lumpectomy defects that can be done at the time of the lumpectomy or later on. These options include local flap procedures, which borrow tissue from the side (next to the breast), and free flap procedures, which borrow tissue from further away, like the abdomen.
There are good reasons to wait to do the reconstruction for a lumpectomy defect at a later time:
1. You won’t know the extent of the defect at the time of the lumpectomy, especially since radiation will almost certainly be done after surgery. Radiation causes changes to the remaining breast.
2. You will not know for sure that the margins of the lumpectomy are clear (free of cancer) until several days after the lumpectomy
Fat grafting (using your own liposuctioned body fat) can also be done to fill in depressed areas in the breast. The main problem with this technique is that the results are unreliable. There is also concern about whether or not this influences the recurrence rate for developing cancer in the future.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified))
1
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2 days ago
JoshLevineMD (Physician - Surgery - Plastic (Verified)) began following the conversation.
2
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10 months ago
JoshLevineMD (Physician - Surgery - Plastic (Verified)) began following the conversation.
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10 months ago
JoshLevineMD (Physician - Surgery - Plastic (Verified)) began following the conversation.
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10 months ago
The best time for breast reconstruction is at the time of the mastectomy. This is called “immediate” breast reconstruction (as opposed to “delayed”). In addition to the advantages mentioned above, it is the best opportunity for the plastic surgeon to achieve an optimal result. There is more skin available in the chest, and the skin envelope provides an excellent shape for the reconstruction of a natural-looking breast. The only caveat is the need for radiation therapy. If we know for sure that a patient will need radiation after mastectomy, I recommend waiting until after radiation to have reconstruction. Radiation is known to cause problems in a reconstructed breast.
The best time for breast reconstruction is at the time of the mastectomy. This is called “immediate” breast reconstruction (as opposed to “delayed”). In addition to the advantages mentioned above, it is the best opportunity for the plastic surgeon to achieve an optimal result. There is more skin available in the chest, and the skin envelope provides an excellent shape for the reconstruction of a natural-looking breast. The only caveat is the need for radiation therapy. If we know for sure that a patient will need radiation after mastectomy, I recommend waiting until after radiation to have reconstruction. Radiation is known to cause problems in a reconstructed breast.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Reconstruction, Mastectomy, Post Mastectomy
3
Answers |
10 months ago
If the patient already has a DIEP or TRAM reconstruction on one side, this means that her lower abdominal skin and fat are no longer available for breast reconstruction should she require another mastectomy. Other autologous (her own body tissue) options include the buttocks (GAP flaps), the love handles (lumbar area) and the thighs (TUG and PAP flaps). Other options include implants.
If the patient already has a DIEP or TRAM reconstruction on one side, this means that her lower abdominal skin and fat are no longer available for breast reconstruction should she require another mastectomy. Other autologous (her own body tissue) options include the buttocks (GAP flaps), the love handles (lumbar area) and the thighs (TUG and PAP flaps). Other options include implants.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Cancer, Breast Surgery, Breast Reconstruction, DIEP Flap, Plastic Surgery, TRAM Flap
1
Answer |
10 months ago
Getting a good result from breast reconstruction depends on many factors including your general health, your body, what type of reconstruction you have, how well the surgery goes, how well you heal and whether or not you have any complications. Unfortunately patients have very little control over many of these things. So the best advice is to do plenty of research, get second and third opinions, talk to patients who have been through it, and chose your surgical team well. Be comfortable with your choice, and understand the possible outcomes and complications. Have realistic expectations. One thing you can do is to keep your incisions out of the sun for better scaring.
Getting a good result from breast reconstruction depends on many factors including your general health, your body, what type of reconstruction you have, how well the surgery goes, how well you heal and whether or not you have any complications. Unfortunately patients have very little control over many of these things. So the best advice is to do plenty of research, get second and third opinions, talk to patients who have been through it, and chose your surgical team well. Be comfortable with your choice, and understand the possible outcomes and complications. Have realistic expectations. One thing you can do is to keep your incisions out of the sun for better scaring.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Surgery, Healing, Breast Reconstruction, Surgery
2
Answers |
10 months ago
Increased risk of infection after breast reconstruction is associated with obesity, high blood pressure and smoking. These issues should be controlled as much as possible. Of course keeping the wounds clean is imperative.
Increased risk of infection after breast reconstruction is associated with obesity, high blood pressure and smoking. These issues should be controlled as much as possible. Of course keeping the wounds clean is imperative.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Infection, Breast Reconstruction, Surgery, Plastic Surgery
1
Answer |
10 months ago
Depending on the size of the tumor, and it's size relative to the breast, lumpectomy and radiation may be an option. The other is mastectomy. Nipple preservation is not recommended if the tumor is too close to the nipple.
Depending on the size of the tumor, and it's size relative to the breast, lumpectomy and radiation may be an option. The other is mastectomy. Nipple preservation is not recommended if the tumor is too close to the nipple.
Depending on the size of the tumor, and it's size relative to the breast, lumpectomy and radiation may be an option. The other is mastectomy. Nipple preservation is not recommended if the tumor is too close to the nipple.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Stage I (Stage 1) Breast Cancer, Breast Surgery, Lumpectomy, Surgery, Nipple Retraction, Mastectomy
1
Answer |
10 months ago
I usually recommend that patients take one month off from work to fully recuperate. Depending on what they do, how quickly they heal, and how motivated they are to get back, this can be variable. The only absolute restrictions are no heavy lifting or rigorous activity for 4 weeks. After that, there are no restrictions. After DIEP patients are walking on the first day after surgery, and discharged on the 4th. By that time they can do whatever they need to take care of themselves, like shower, walk stairs and drive a car.
I usually recommend that patients take one month off from work to fully recuperate. Depending on what they do, how quickly they heal, and how motivated they are to get back, this can be variable. The only absolute restrictions are no heavy lifting or rigorous activity for 4 weeks. After that, there are no restrictions. After DIEP patients are walking on the first day after surgery, and discharged on the 4th. By that time they can do whatever they need to take care of themselves, like shower, walk stairs and drive a car.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Surgery Recovery, Recovery, Breast Reconstruction, DIEP Flap, Surgery, Plastic Surgery, DIEP Flap Breast Reconstruction
2
Answers |
10 months ago
Reconstruction in your case is what we called “delayed”. This means that you undergo reconstruction after (not during) mastectomy. If you were small breasted and would be comfortable with that same size again, we can usually get enough of your own tissue (autologous tissue) to make new breasts from your abdomen. In this operation, called the DIEP, skin and fat from the abdomen is transplanted to the chest to make new breasts. The advantage of the DIEP over the more common TRAM is that the underlying muscle is not destroyed with the DIEP. If you want autologous tissue and there is not enough to donate from your abdomen, we can usually get enough of your own tissue to make new breasts from another site, like the buttocks or thighs.
Another option is implant reconstruction. This would certainly require expansion in a delayed reconstruction, because there is not enough skin in your chest to allow the implant to hang naturally (ptosis). Expanders are placed under your chest skin and muscle and expanded over time. When there is enough skin and muscle to hold the implant and allow it to hang, the expander is replaced with a permanent implant. If you had radiation, the complication rate with implants is high.
Reconstruction in your case is what we called “delayed”. This means that you undergo reconstruction after (not during) mastectomy. If you were small breasted and would be comfortable with that same size again, we can usually get enough of your own tissue (autologous tissue) to make new breasts from your abdomen. In this operation, called the DIEP, skin and fat from the abdomen is transplanted to the chest to make new breasts. The advantage of the DIEP over the more common TRAM is that the underlying muscle is not destroyed with the DIEP. If you want autologous tissue and there is not enough to donate from your abdomen, we can usually get enough of your own tissue to make new breasts from another site, like the buttocks or thighs.
Another option is implant reconstruction. This would certainly require expansion in a delayed reconstruction, because there is not enough skin in your chest to allow the implant to hang naturally (ptosis). Expanders are placed under your chest skin and muscle and expanded over time. When there is enough skin and muscle to hold the implant and allow it to hang, the expander is replaced with a permanent implant. If you had radiation, the complication rate with implants is high.
Another option is implant reconstruction. This would certainly require expansion in a delayed reconstruction, because there is not enough skin in your chest to allow the implant to hang naturally (ptosis). Expanders are placed under your chest skin and muscle and expanded over time. When there is enough skin and muscle to hold the implant and allow it to hang, the expander is replaced with a permanent implant. If you had radiation, the complication rate with implants is high.
Reconstruction in your case is what we called “delayed”. This means that you undergo reconstruction after (not during) mastectomy. If you were small breasted and would be comfortable with that same size again, we can usually get enough of your own tissue (autologous tissue) to make new breasts from your abdomen. In this operation, called the DIEP, skin and fat from the abdomen is transplanted to the chest to make new breasts. The advantage of the DIEP over the more common TRAM is that the underlying muscle is not destroyed with the DIEP. If you want autologous tissue and there is not enough to donate from your abdomen, we can usually get enough of your own tissue to make new breasts from another site, like the buttocks or thighs.
Another option is implant reconstruction. This would certainly require expansion in a delayed reconstruction, because there is not enough skin in your chest to allow the implant to hang naturally (ptosis). Expanders are placed under your chest skin and muscle and expanded over time. When there is enough skin and muscle to hold the implant and allow it to hang, the expander is replaced with a permanent implant. If you had radiation, the complication rate with implants is high.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Cancer, Breast Reconstruction, DIEP Flap, Surgery, Plastic Surgery, DIEP Flap Breast Reconstruction, Mastectomy
1
Answer |
10 months ago
Yes, thin women are often good candidates for DIEP breast reconstruction. Thin women typically have breasts that are proportional to their body size. If a thin woman is having a mastectomy, she should consider what size breast reconstruction she wants. If her preference is to have reconstructed breasts approximately the same size as her current breasts, we can usually get enough from the abdomen (the DIEP) to replace the mastectomies. If there is not enough, or she wishes to be bigger, there are several other autologous (her own body tissue) options. These include using tissue from the lower back (love handles), the buttocks or thighs.
Yes, thin women are often good candidates for DIEP breast reconstruction. Thin women typically have breasts that are proportional to their body size. If a thin woman is having a mastectomy, she should consider what size breast reconstruction she wants. If her preference is to have reconstructed breasts approximately the same size as her current breasts, we can usually get enough from the abdomen (the DIEP) to replace the mastectomies. If there is not enough, or she wishes to be bigger, there are several other autologous (her own body tissue) options. These include using tissue from the lower back (love handles), the buttocks or thighs.
New answer by JoshLevineMD (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Cancer, Breast Reconstruction, DIEP Flap, Surgery, Plastic Surgery, DIEP Flap Breast Reconstruction
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10 months ago
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