As the Sunshine State, the climate in Miami, FL., allows residents to enjoy the warmth of the sun year-round, which translates into summer attire and long days at the beach. For this reason, breast reconstruction surgery following a mastectomy is especially important for the women who reside here in South Florida. Dr. Sam Gershenbaum is a Miami plastic and reconstructive surgeon who performs reconstruction procedures using innovative techniques, and devices that allow him to create a breast that closely resembles the natural breast.
For the majority of women, the breasts play an important part in their sense of femininity. Therefore, breast restoration following a lumpectomy, mastectomy or breast trauma is a critical aspect of the rehabilitation process.
Breast reconstruction is a surgical procedure used to rebuild the breast following breast removal due to cancer (mastectomy), some other type of breast disease, a lumpectomy or breast trauma.
Breast reconstruction and cosmetic breast surgery are very different procedures. A reconstruction focuses on the creation of an entirely new breast closely resembling the patient’s natural anatomy; whereas, cosmetic breast surgery focuses on improving the already existing breast(s).
Understandably, after a mastectomy or some other breast-related trauma, a return to normalcy is desired. Reconstruction surgery with Dr. G in Miami can assist women in accomplishing this.
A successful breast reconstruction requires the union of advanced reconstructive techniques in conjunction with knowledge and cosmetic discernment of the natural form of the breast. For Dr. Gershenbaum, creating his patient a new breast via reconstruction is one of the most rewarding surgeries he performs. The new medical devices and techniques available today combined with Dr. G’s expertise allows him to create his patients beautiful, natural-looking results.
Since every woman is unique, Dr. Gershenbaum creates each of his patients an individualized treatment plan specifically designed to meet her needs.
When a breast cancer diagnosis is verified, the patient’s surgical oncologist will discuss her options during her consultation. Once the patient is aware which procedure her surgical oncologist will perform, she should consider contacting Dr. G Cosmetic Surgery in Miami to discuss her breast reconstruction options.
The patient’s surgical oncologist may recommend that she have one of the breast conservation surgeries: This type of surgery is designed to remove a portion of the breast tissue, as opposed to the entire breast.
Although breast conservation procedures do not require removal of the entire breast, sometimes Dr. Gershenbaum will aid in the reconstruction of the breast.
– during this surgery, the oncologist removes the portion of the breast that has cancer as well as some of the non-cancerous tissue surrounding it.
– during this surgery, the oncologist removes the malignant tumor and some of the non-cancerous tissue that surrounds it.
– Breast-cancer patients who are candidates for breast-conserving surgery may also have a lymph node dissection during their surgery or after. A lymph node dissection involves removing a piece of the lymph node that is located under the arm for biopsy. If the surgical oncologist is performing a lymph node dissection, a separate incision is required.
– during this procedure, the surgical oncologist removes the entire cancerous breast, the lining that rests above the chest muscles as well as most of the patient’s lymph nodes that are located under her arm. In addition, patients may need Dr. G to remove a portion of their chest wall muscle.
– during this procedure, the oncologist removes the entire breast. During the same surgery (or after), the oncologist may remove some of the lymph nodes that are located under the patient’s arm. These lymph nodes are collected so that they can be biopsied. A separate incision is required to obtain these samples.
The surgical oncologist will remove all of the cancerous breast tissue and Dr. Gershenbaum will begin reconstructing the patient’s breasts so they appear as natural-looking as possible. By having an experienced surgical oncologist and reconstructive surgeon, the chances of a successful outcome, without compromise are greatly improved.
While Dr. G can reconstruct the patient a new nipple and areola, the preservation of this area during a mastectomy (if feasible) is beneficial to the patient’s final aesthetic results. Once complete, some of the nipple-sparing reconstructions closely resemble the results achieved with cosmetic breast implant procedures.
The surgical oncologist determines whether nipple preservation during the mastectomy is possible. The decision is based on several factors, including the:
Whether a patient needs a nipple-sparing, prophylactic, skin-sparing or more extensive mastectomy procedure, during the patient’s initial consultation with Dr. Gershenbaum at Dr. G Cosmetic Surgery in Miami, with each of his patient’s Dr. G takes the time to discuss all of the reconstructive options available. He will also answer any of the patient’s questions at this time.
Women who are still contemplating whether or not to undergo a mastectomy should consider scheduling an appointment with Dr. Gershenbaum to inquire about having a mastectomy and breast reconstruction surgery during the same procedure. When possible, this method is ideal in that the patient wakes up with her breast mound already in place; thus, being spared the experience of waking up without any breast, whatsoever.
If an individual is a good candidate for a combination procedure, Dr. G will need to work with the patient’s surgical oncologist so as to schedule a breast reconstruction directly following her mastectomy.
Some women in Miami do prefer to have their breast reconstruction at a later date, especially in the event that only one breast needs to be removed. Many times, women who only have one breast removed choose to have Dr. G perform a breast lift, a breast reduction or a breast augmentation on the remaining breast at the same time he performs her reconstruction. By performing these procedures at the same time, Dr. Gershenbaum can create a breast that closely resembles her remaining breast.
Even when a woman is not a good candidate for a combination procedure, Dr. Gershenbaum will want to speak with her surgical oncologist so he can schedule her breast reconstruction surgery as soon as possible following her mastectomy.
A variety of breast reconstruction methods are available in Miami. These methods range from using the patient’s own tissue, using a breast implant or using a combination of the two. Dr. G works closely with the patient’s surgical oncologist to provide her with the reconstruction method that will meet her specific needs.
A combined mastectomy and breast reconstruction may be an option for women who do not need radiation therapy. Additionally, women who undergo a ‘skin-sparing’ or ‘nipple-sparing’ procedure may be a good candidate for a combination procedure.
Once the surgical oncologist completes the removal of the cancerous breast tissue, Dr. Gershenbaum will be able to place the patient’s implant immediately. Many times, an acellular dermal matrix (mesh) is placed to assist in positioning the breast implant properly. Patients who require nipple reconstruction will typically undergo that procedure with Dr. G approximately three months after their combination procedure.
The majority of women who undergo a single or double mastectomy are good candidates for a reconstruction procedure.
Dr. Gershenbaum encourages his patients to discuss their feelings and thoughts with him. As a board certified plastic and reconstructive surgeon, he has a wealth of knowledge and is always happy to answer his patients’ questions.
Dr. Gershenbaum will evaluate the quality of the patient’s skin as well as her overall emotional and physical health. He may decide to take photographs to place in the patient’s record. Dr. G will determine which procedure(s) he believes will benefit the patient the most. Once he determines the procedures that will accomplish what the patient desires, he will discuss the risks and limitations of the procedure(s) he recommends as well as provide the patient with information related to her recovery.
Women who smoke need to discontinue smoking and avoid second-hand smoke for at least four weeks prior to their reconstruction. In addition, certain medications must be avoided for at least two weeks before surgery. These medications include certain anti-inflammatory medications and aspirin. Dr. Gershenbaum provides his patients with a list of the medications, vitamins, and herbal supplements they should avoid.
If the reconstruction procedure begins at the same time as the mastectomy, it is usually performed as an inpatient surgery. The patient receives general anesthesia. Patients should expect to remain in the hospital for one or two nights.
A tissue expander is a device that is made from elastic silicone rubber. During the mastectomy, this balloon-like device is placed after the surgeon removes skin and tissue to allow for placement of the tissue expander beneath the remaining muscle and skin of the patient’s chest.
The tissue expanders are inserted either empty or with a minute amount of saline in them. As time passes, sterile saline fluid is added to the expanders: This is accomplished by inserting a small needle into the filling port of the expander and adding sterile saline fluid. As the expanders are gradually filled, the tissues over the expanders begin stretching. The expander creates a breast-shaped pocket where Dr. Gershenbaum can place the patient’s breast implant.
Expansions are performed at Dr. G Cosmetic Surgery Center in Miami. The expansion process generally begins within a few weeks of the patient’s mastectomy and continues for a week or two until the tissue expansion is complete. Each patient is unique, therefore, Dr. Gershenbaum monitors each patient’s progress until the tissue expansion is adequate for providing the patient with the breast size she desires.
Reconstruction surgery may be able to be completed in combination with a mastectomy or at some point after the patient has her mastectomy and completes her cancer treatments.
During this procedure, Dr. Gershenbaum reconstructs the patient’s breast using abdominal tissue. A tummy tuck (abdominoplasty) and TRAM procedure are similar, however, the tissue discarded during an abdominoplasty is used for reconstructing the breast. With this type of reconstruction, an implant is not necessary and unwanted abdominal fat, and skin are removed. In addition, muscle from the patient’s abdomen may be used.
This procedure is comparable to the TRAM reconstruction procedure, except only fat and skin are taken from the patient’s abdomen (no muscle).
Dr. G uses tissue from the patient’s back to create her a new breast. The breast size that the patient desires determines whether or not an implant is utilized during a Latissimus Muscle Flap reconstruction.
Fat grafting can be used as a tool to assist Dr. Gershenbaum as he creates the shape of the reconstructed breast. Fat grafting can provide a more natural, soft shape to the breast and can be used after implant or flap reconstruction.
The SIEP Flap is also similar to the TRAM reconstruction and just as the DIEP Flap only uses fat and skin from the abdomen (not muscle), so does the SIEP Flap.
Directly after surgery, patients receive a surgical bra. This bra helps reduce inflammation and provides support for the newly reconstructed breast(s). Dr. Gershenbaum will place a drainage tube to ensure that excess fluid and blood does not accumulate within the tissues. Dr. G provides his patients with medications for nausea and pain.
Each patient receives specific instructions concerning eating, bathing, restrictions and medications. Prior to leaving the hospital, patients will most likely receive information related to their first post-operative visit at Dr. G Cosmetic Surgery in Miami.
For about two weeks after reconstruction, patients will need to limit their activity. Following this two-week period, patients are usually permitted to return to work. After about six weeks, patients can become more active and typically begin exercising again.
Dr. Sam Gershenbaum’s dedication to his patients, caring demeanor, experience and skills make him one of the premier plastic and reconstructive surgeons in South Florida. If you are considering a mastectomy or have already had a mastectomy and you would like to learn more about a breast reconstruction with Dr. Gershenbaum, contact Dr. G Cosmetic Surgery Center in Miami at (305)933-1838 or click here to fill out our online contact form