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Breast Reconstruction NYC


Breast cancer and its treatment exact a significant physical and emotional toll on affected women. Reconstructive breast surgery is a procedure to rebuild the breast(s) and give women who have faced this scourge a better outlook. The goal of this treatment is to contribute to the healing process as patients try to regain their health, sense of self, and agency.

Achieving an efficient outcome requires a comprehensive approach to care, taking each woman and her unique needs into account. As the former Director of Breast Reconstruction at the Yale School of Medicine, Dr. Tomer Avraham is extensively trained and experienced with breast reconstruction procedures and is regarded as a leader in this field. Dr. Avraham combines state-of-the-art technology, sophisticated techniques, and an ability to truly connect with his patients to help women from New York and surrounding areas rebuild their breasts and restore their sense of wholeness.

Am I a Candidate for Breast Reconstruction?

Breast reconstruction surgery may be a good decision for you if:

Dr. Avraham understands that deciding on breast reconstruction is a big step. You deserve to feel fully informed and supported throughout the process. His office will walk you through every option, answer your questions openly, and help you explore what feels right for you.

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Why Choose Dr. Tomer Avraham for Breast Reconstruction?

Dr. Avraham is a board-certified plastic surgeon and the former Director of Breast Reconstruction at the Yale School of Medicine. He is uniquely skilled in numerous reconstructive techniques, including implant-based breast reconstruction and advanced microsurgical approaches necessary for DIEP flap, PAP flap, and other autologous breast reconstruction options. Due to his reputation for producing beautiful and natural-looking results, Dr. Avraham is often sought after by patients dissatisfied with the outcome of a previous breast reconstruction performed by another surgeon. He takes a multidisciplinary approach to reconstructive care, working closely with oncologists and cancer care teams to deliver the best possible patient outcome. Dr. Avraham understands that breast reconstruction—and cancer treatment in general—involves a complex set of choices and decisions, and he will take the time to talk through the various treatment options with you in order to tailor a plan that fits your needs and goals.

Dr. Avraham’s Cutting-Edge Techniques

Breast reconstruction is constantly evolving, with newer options to achieve beautiful and natural-looking results:

  • Minimally invasive approaches – Dr. Avraham prioritizes techniques that minimize scarring and recovery time.
  • Advanced tissue transfer – for qualified women, this approach allows the surgeon to rebuild a natural breast mound using tissue from the patient’s own body – and often with improved nipple sensation.
  • Direct-to-muscle implant placement – this technique creates a more natural look and feel by placing the implant beneath the chest muscle.
  • Air-expandable implants – these are newer implants that offer patients more control over the breast shape during expansion.

“When I received my diagnosis in December, I somehow knew everything would be okay. To be carefree and restored mentally and physically is a gift! Thank you for exceeding all expectations. I am beyond thrilled with the outcome and grateful to have had such a skilled and wonderful surgeon, and team of healthcare experts at my side. Thank you .”

RT

Mastectomy

Mastectomy Types

Dr. Tomer Avraham is committed to educating his patients and giving them all the information they need to make better decisions during their breast cancer treatment.

  • Skin Sparing Mastectomy – breast cancer treatment and reconstruction were revolutionized in the 1970s and 1980s with the determination that breast skin is not part of the breast tissue. This means that the skin of the breast can be preserved in the vast majority of mastectomies. This is often referred to as a “skin sparing mastectomy.” In this type of mastectomy, the nipple as well as a small amount of skin is removed, leaving the rest of the skin to take part in the reconstruction.
  • Nipple Sparing Mastectomy – in the 2000s, the next advancement in mastectomy techniques was the advent of the “nipple sparing mastectomy.” In this type of mastectomy, an incision underneath the breast or its side is used to “shell” out the breast, leaving behind all of the skin of the breast, as well as the nipple. For obvious reasons, there are many cases where this can result in the most natural-looking result.

Deciding on the type of mastectomy a woman will undergo is a decision that requires input from the breast oncologic team, the reconstructive surgeon, and of course, you. Dr. Avraham will help facilitate this discussion and ensure you have a plan that sets you up for success.

Types of Breast Reconstruction Surgery

Dr. Avraham specializes in both implant and flap reconstruction to allow each woman to choose the best option for their needs. The precise techniques and timelines involved with breast reconstruction surgery will vary depending on the unique needs of the patient, but the overarching goal is to help women whose lives and bodies have been impacted by cancer feel healthy, empowered, and restored.

While every reconstructive option has specific benefits and possible drawbacks (which Dr. Avraham will discuss with you during the consultation and treatment planning stages), studies show that immediate reconstruction following a mastectomy or lumpectomy generally produces superior results to delayed reconstruction. However, for a variety of reasons, this may not be an option for all women, and Dr. Avraham will coordinate with you and your cancer care team to choose an optimal time for surgery.

Breast Implant Reconstruction

Implant-based reconstructions involve the placement of a breast implant to help restore the form of the breast. The implants used during each procedure are meticulously chosen to provide the most natural look and feel possible.

While recovery after implant reconstruction is often more rapid when compared with tissue-based breast reconstruction options (described below), some women may be disconcerted by the idea of having a foreign body, such as a breast implant inserted into the breast tissue. It is also important to note that implants are not “lifetime devices” and will eventually need to be replaced—meaning another surgery at a later date.

There’s also an ongoing conversation around breast implant illness (BII) that has left some patients wary of breast implants altogether. Dr. Avraham will take the time to thoroughly address your questions and concerns during your consultation. Implant-based breast reconstruction may be single-stage, i.e. direct-to-implant, or two-stage, i.e. utilizing a tissue expander (see below).

Direct-to-Implant

Direct-to-implant reconstructions can be an excellent option for patients who retain enough healthy breast skin after their mastectomy to support breast implants. It is a “one-step” procedure, meaning that the breasts are reconstructed with a single operation, usually with the implants being placed at the time of mastectomy. This option often produces the shortest “down time” and allows the breast to be reconstructed with a single operation.

Tissue Expansion

Tissue expansion is a tried and true aspect of reconstructive surgery that takes advantage of the fact that skin can be gradually stretched over time. Therefore, a tissue expander is a temporary implant that is used as part of a “two-stage” breast restoration. It is a device inserted under the remaining breast skin that will be gradually filled with saline (sterile saltwater) or air over the course of several office visits in order to create a new breast pocket.

Once the skin has stretched sufficiently, the expander may be removed and replaced with a breast implant. Tissue expansion is an implant reconstructive approach that is necessary in cases where the skin that remains following a mastectomy is insufficient to form an appropriate breast shape.

Autologous Breast Reconstruction

Autologous breast reconstruction techniques involve taking tissue “flaps” from elsewhere on the body and transferring them to the breasts.

A flap is tissue transferred from one part of the body to another, along with its blood supply. When tissue needs to be moved beyond a certain distance, its blood supply may be disconnected at its origin (donor site) and then reconnected at its destination (recipient site). This is referred to as a “free flap,” and can be considered a transplant of skin and fat to reconstitute the breast. This approach utilizes microsurgery, an advanced technique whereby arteries and veins (and sometimes nerves) are reconnected utilizing a microscope for magnification. These techniques require specialized training and an experienced plastic surgeon like Dr. Avraham.

While autologous operations tend to be more involved than implant reconstructions, many patients feel that they produce results that look and feel more natural, utilizing the patient’s own skin and fat. Further, a flap reconstruction will age naturally with the patient—unlike implants, which will need to be replaced over time.

DIEP Flap

DIEP flap reconstruction involves taking skin and fat from the lower abdomen, along with the blood supply, and using those tissues to rebuild the breasts. The DIEP flap is a popular choice for autologous reconstructions since the removal of excess skin and tissue from the lower abdomen to reconstruct the breast can actually provide patients with additional benefits, in some ways similar to a tummy tuck surgery. Women who are good candidates for this surgery have some excess skin and fat in their lower belly, a finding that is present in many women after childbirth.

PAP Flap and Other Thigh Flaps (VPAP, TUG, DUG)

The thighs can be an alternative tissue donor site for women who do not have enough abdominal tissue for a DIEP flap, as many women tend to keep excess tissue in their lower body. Tissue may be taken from the buttock, the back of the thigh, or the inner thigh, a decision Dr. Avraham can help guide you through.

Latissimus Dorsi Flap

The latissimus dorsi flap technique uses skin, fat, and muscle tissues from the upper back to recreate the breast mound. It is a type of “pedicled” flap, meaning that the tissues remain connected to their original blood supply throughout the reconstruction—unlike the “free” DIEP and thigh flaps. Since there is typically less tissue to work with, latissimus dorsi flap reconstruction is often paired with a breast implant to improve the overall size and projection of the restored breast. The latissimus dorsi flap approach may be an ideal option for patients who have had radiation therapy and are undergoing delayed breast reconstruction. This type of reconstruction may also be an excellent option for women whose previous reconstructions have failed.

Oncoplastic Reconstruction

Oncoplastic reconstruction is a term that refers to reconstruction following a lumpectomy—a partial mastectomy where only a portion of the tissue from one or both breasts is removed. Most women who undergo a lumpectomy will not require a reconstructive procedure. However, in women with a tumor that is large or located in an unfavorable position within the breast, these techniques can be quite helpful. Depending on the nature of the lumpectomy and the patient’s preferences; a variety of techniques can be employed—all with the end goal of restoring a more symmetrical and aesthetically pleasing breast appearance using the remaining natural breast tissue. Options include designing the reconstruction as a breast reduction, breast lift (mastopexy), or a rearrangement of local tissues.

Nipple and Breast Sensation

An unfortunate consequence of mastectomy is loss of sensation in the breast and nipple. Most nerves that provide sensation to the nipple and breast run through the breast tissue and are therefore removed during a mastectomy. This results in loss of sensation that can negatively impact quality of life, both on a day-to-day basis and in intimacy. Recently developed techniques show great promise in restoring breast sensation over time, and these have become important adjuncts to breast reconstruction. Dr. Avraham will discuss these options with you at your consultation.

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Breast Reconstruction and Radiation

Radiation therapy is a powerful tool for fighting breast cancer, but one that can all the same affect your reconstruction options. Radiation may weaken tissues and make it more challenging to achieve a natural look with implants. However, this doesn’t necessarily mean reconstruction is impossible! Our office at Avraham Plastic Surgery NYC is equipped to discuss various techniques that might work well for you (e.g. using flap surgery or tissue expanders). The timing of reconstruction is also important. In some cases, we may perform reconstruction at the same time as a mastectomy, while in others, it may be best to wait until after radiation is complete. Dr. Avraham will carefully examine your situation and discuss all the factors to determine the best approach for breast reconstruction after radiation treatment.

Will Insurance Cover My Reconstruction?

The Women’s Health and Cancer Rights Act of 1998 (WHCRA) mandates that commercial insurance cover all stages of mastectomy reconstruction and necessary revisions. If only one breast is removed and reconstructed, insurance must also cover any procedures performed on a native breast to improve symmetry. Dr. Avraham is passionate about breast reconstruction, and our office will work with you and your insurer to make sure that breast reconstruction does not cause our patients undue financial hardship.

Breast Reconstruction from Out of Town?

Thought about coming to New York for your breast reconstruction? The office of Dr. Tomer Avraham is more than ready to accommodate you:

  • Virtual Consultations – we can arrange a virtual consultation to discuss your goals and answer any questions you have before you travel.
  • Personalized Care – you’ll receive personalized attention throughout your journey, from the initial consultation to the post-surgical follow-up.
  • Support System – our team will help you navigate logistics and connect you with resources to make your experience in New York as comfortable as possible.

If you’re based out of New York and would like to take advantage of Dr. Avraham’s years’ long expertise, don’t hesitate to reach out.

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Reconstruction in a Modern Facility

Your breast reconstruction will be performed at a state-of-the-art surgical facility in New York City. This ensures access to the latest technology and equipment for a safe and successful procedure. Here’s what you can expect:

  • Modern amenities – a calm and comfortable environment to prepare for and recover from surgery.
  • Experienced staff – you’ll be cared for by a team of experienced nurses and anesthesiologists who prioritize your well-being.
  • Safety focus – a surgical facility that adheres to the highest safety standards to safeguard your health and comfort throughout your procedure.

Breast Reconstruction FAQs