Ep # 138 The Art and Science of Post-Mastectomy Options

Breast cancer affects one in eight women in their lifetime, and the journey doesn't end with treatment. In this deeply informative conversation, Dr. David Abramson brings 25 years of specialized experience to explain the full spectrum of breast reconstruction options available to cancer survivors.

Dr. Abramson breaks down the two primary approaches to reconstruction after mastectomy: implant-based and autologous tissue methods. He expertly explains how implant reconstruction typically involves a tissue expander followed by permanent implant placement, while revealing when patients might qualify for a single-stage direct-to-implant procedure. The conversation explores DIEP flap reconstruction, where tissue from the abdomen is transplanted to create a natural breast, with fascinating insights about how this tissue continues to behave as abdominal tissue even in its new location.

For those undergoing lumpectomies, Dr. Abramson details creative approaches to maintaining breast symmetry, including tissue repositioning, breast reduction, and carefully planned procedures that account for expected changes from radiation treatment. He also touches on innovative techniques like fat grafting and less common procedures using tissue from various donor sites.

What makes this discussion particularly valuable is Dr. Abramson's practical guidance on the decision-making process. He emphasizes that reconstruction options should be considered early in treatment planning, as they might influence cancer treatment decisions. He reassures listeners that reconstruction is covered by insurance at any point after cancer treatment, whether immediately or years later.

Ready to explore your reconstruction options? Contact Dr. Abramson's office at 201-731-3134 for a consultation with a surgeon who combines extensive experience with innovative approaches to help restore confidence after cancer.

David L. Abramson, MD
363 Grand Ave Englewood, NJ 07631
[phone]
[e-mail]
drabramson.com

Episode Transcript

Speaker 1 (00:00):
This is the Good Neighbor Podcast, the place
where local businesses andneighbors come together.
Here's your host, Doug Drohan.

Speaker 2 (00:11):
Hey everybody, welcome to another episode of
the Good Neighbor Podcast.
I am thrilled to be joined onceagain with David Abramson.
David has a great article inthis month's issue of Neighbors
Magazine Neighbors of Closter,demerson-hallworth Today and in
this month he's speaking aboutbreast reconstruction options

(00:32):
after cancer treatment.
So, dr Abramson, welcome to theshow again.
Great, I'm happy to join you.
Yeah, so you talk.
I mean, you know, as we leadinto October, it's Breast Cancer
Awareness Month and obviouslyit's a growing, you know, issue
with women in America and verypersonal experiences that they
go through when they suffer witha mastectomy or lymphectomies.

(00:56):
And I think one of the thingsthat speaks kind of jumps out at
this article is how there's alot of different reconstruction
options that can help with yourphysical appearance and
basically help people feelbetter about themselves again
and bring that confidence back.
So what are the different, youknow?
What do you kind of touch onLike?
What are the basic types ofoptions available?

Speaker 3 (01:18):
Well, I think it really matters.
You know what kind of breastcancer treatment they're having,
matters you know what kind ofbreast cancer treatment they're
having, and sometimes thepatient may decide what type of
treatment they're having basedon what kind of reconstructive
options there are.
So I think we really need todivide it up into what you can
do if someone's having amastectomy, because that's the

(01:40):
traditional area where peopleenvision breast reconstruction,
the traditional area wherepeople envision breast
reconstruction.
So if someone's having breastreconstruction there's really we
divide it into two buckets.
One is what we call implantbased reconstruction, where we
use a breast implant, andanother one is what we call
autologous reconstruction, wherewe use the person's own tissue.

(02:02):
So if we talk about using animplant, mostly that is a
two-stage.
We'll call it a two-stagereconstruction where at the time
of the mastectomy we'll put inwhat's called the tissue
expander and then a few monthslater, after, if they need any
other treatment is done, we'llput in a permanent implant.

(02:25):
Things like nipplereconstruction and things like
that can be done as well.
It is possible in some patientsto do a single stage where you
go direct to implant.
There are some limitations butyou know, depending on the
person and their needs are.
They can have a one-stagedirect implant reconstruction at
the time of mastectomy.
There's what we call autologousreconstruction, where we use

(02:54):
the patient tissue and mostcommonly that is tissue from the
abdomen.
And obviously many of theseissues that come into
determining what the best formof reconstruction relates to the
type of cancer, where it is ifthey're going to need radiation
therapy or chemotherapyafterwards and the person's body
, because you can't take tissuefrom an abdomen if a person

(03:18):
weighs 100 pounds becausethey're not going to have
anything on their abdomen.
So, when we take tissue from theabdomen, traditionally it was
what was called a tram flap, butnow what we do is what's called
a deep flap, which the tissueis actually completely separated
and then the blood vessels thatsupply that tissue from the

(03:38):
abdomen are plugged into thechest.
It can be done at the same timeas a mastectomy or it can be
done later.
The chest it's done.
It can be done at the same timeas a mastectomy or it can be
done later.
There are also other flaps thatcan be done, whether it be from
the buttocks, inner thigh,things like that, but those are
much less common and most peopledon't have enough tissue in
those spots and you frequentlywould have to use more than one

(03:59):
flap to do a reconstruction yeah.

Speaker 2 (04:02):
So what does that?
Basically, yeah, go ahead.
What does that do to the, tothe appearance of your stomach?
So if you're taking, well, Imean people would kind of people
.

Speaker 3 (04:13):
Yeah, so when people have a deep flap, you know, I'd
say the closest thing is it'slike a tummy tuck, but with a
scar that's a little bit higher.
There is a little some of themuscle.
Even though we try to preserveas much as possible, some of the
muscle either loses itsinnervation or has to be removed

(04:34):
as part of the deep flap.
So there can be some weaknesson the abdominal wall, but it's
usually not that significant andas long as the blood vessels
stay open, which is, you know,like a 99 percent of the time
Once that tissue is up there andthe breast has been shaped,
it's there forever.
The only changes are if theperson gains or loses weight,

(04:57):
because it is the tissue fromtheir abdomen and it will behave
as if your abdomen did when yougained or lost weight.
So that's just something peopleneed to be aware of.
It's where the tissue comesfrom, not where it's living.

Speaker 2 (05:12):
Got it, got it, okay, interesting.
So now there's there's lumpectomies and there's
mastectomies.
So what's the difference interms of the types of
reconstruction that you do?

Speaker 3 (05:24):
So when someone has a lump ectomy there it's a
portion of the breast that'sbeing removed and it really will
depend on the person's anatomyand if they're a good candidate
for a lumpectomy.
Sometimes you can justreposition breast tissue to fill
the area where the lumpectomycame from and give the breast a

(05:46):
good shape.
Sometimes people arelarge-breasted, their breasts
are what we call tautic or saggy, and they can take the
opportunity of a lumpectomy toactually do either a breast
reduction or a breast lift sothat they can achieve symmetry.
Because obviously if you takeout a portion of the breast and
then usually those people needradiation, that side would wind

(06:08):
up being smaller.
So what we do at the time of alumpectomy is actually we can do
a bilateral breast reductionand we take the side that's not
having the lumpectomy and makeit a little bit smaller, because
the side that is having thelumpectomy, once the radiation
happens, that will shrink overtime.
So we try and judge them alittle different in size so that

(06:31):
after the treatment iscompletely done they're as
symmetric as possible Got it Gotit.

Speaker 2 (06:37):
So I mean, those are, I guess you know, for the lay
person like myself, those aresome procedures that I've heard
of, but there are some othersthat you speak about in the
article that I never heard ofand some of them I can't
pronounce uh that well, but, um,you know what, if you want to
speak to a couple more of those,you know you have, um, we

(06:58):
talked about the, you know theflap, I guess reconstruction,
but you know what are the otherones, other types of options
available.

Speaker 3 (07:09):
Well, I mean, you can create a breast with fat
grafting as well, where and weuse fat grafting as an
augmentation to either animplant-based reconstruction or
a flap augmentation to either animplant-based reconstruction or
a flap but you can actuallycreate an entire rest by doing a
series of fat graftingprocedures where we do
liposuction and then put some ofthe fat in and start to build a

(07:33):
breast over time.
That is another option.
Sometimes we'll do that if areconstruction has not been
successful or there's beenradiation to try and make the
tissue a little easier to workwith, and some of these are.
There's other flaps that aremore traditional latissimus flap
, which is from the back, butthat also frequently needs an

(07:54):
implant with it because mostpeople don't have enough fat on
their back.
And then there's what Imentioned before.
There's, you know, flaps fromthe thighs and buttocks, which
are some of the ones I think youwere thinking of, but those are
much less common.
I mean those.
If you add them all together,they're far less than one
percent of the of the options.

Speaker 2 (08:16):
So what I mean?
What is like?
What do people take intoaccount when they're making this
decision?
Obviously, it's not a one sizefits all solution and, as you
mentioned, everyone's body'sdifferent.
The treatment they're goingthrough could be different, like
what are their next steps Ifsomeone who's listening to this
is going through breast cancerand maybe they've had their

(08:39):
mastectomy or lumpectomy, whatare the next steps?
And maybe they've had theirmastectomy or lumpectomy?
What are the next steps?

Speaker 3 (08:43):
So I would say most reconstruction is performed at
the same time as the breastcancer treatment.
So the first thing would happenis your breast surgeon
frequently will talk to youabout what you might have done
in terms of the cancer treatmentand briefly discuss with you
some of the options and thenrefer you to a plastic surgeon

(09:05):
to talk about at that time Ifyou've already had treatment and
didn't have that for whateverreason more commonly, with a
lumpectomy and you develop, youknow, some asymmetry or
deformity or something like thatrelated to your breast, you
just need to make an appointmentwith a plastic surgeon.
Because you know breastreconstruction at any point any

(09:28):
time, the side with the cancer,the other side, are all required
to be covered by insurance,both by federal and state law.
So what you do is you go talkto someone and find out what the
options are that fit you andyour body type, because, listen,
everyone's different and youneed to sit down and identify

(09:49):
the problem first and then layout what the solutions are, or
potential solutions, and therecould be two or three different
options that may rank from bestto not as good, but it also
depends on what the person'swilling to go through, whether
they want one stage, whetherthey're willing to have multiple
stages, whether they want animplant.

(10:10):
So there's a lot to discuss andyou know, usually a discussion
like that will take 30 to 45minutes once you've taken a look
at the patient.

Speaker 2 (10:20):
Right, Okay, so if someone were to reach out to you
, let's, you know, backtrack toearly days of our first podcast.
How do they reach you?
And then, why?
Why should they call you?
You know, to put you on thespot.

Speaker 3 (10:36):
Sure, well, first, the best way to reach me is our
office phone number, which is201-731-3134.
Call and make an appointment.
They should reach out to mebecause I've been performing
breast reconstruction for 25years.
I perform all different typesof breast reconstruction.
I've actually published somearticles that created novel ways

(11:01):
to correct certain problemslumpectomy defects, doing
various types of breastreduction that give you better,
long-lasting results.
So, because of my experience,my innovation, that's why
someone should call me and talkto me about the options
available for breastreconstruction.
That's great.

Speaker 2 (11:19):
And you're located in Burden County and your office
is in Englewood.

Speaker 3 (11:28):
Yes, I have an office on Grand Avenue in Englewood
and also another office inEnglewood Hospital where I'm
actually on the board of thetrustees for the hospital as
well.

Speaker 2 (11:34):
Very good, All right, Dr Abramson, this was really
really helpful and, as I said,we're leading into Breast Cancer
Awareness Month into October.
You know, in Bergen County Idon't know what the figures are,
but I think everyone I knowknows someone who's either had
breast cancer or knows someonein their family who's had breast
cancer.

(11:54):
So it's definitely an issuethat you know that's people are
going through and having torestore confidence is huge and I
don't know like what's theaverage?
Is there an average age of ofof women in bergen county in
terms of um, you know, beingdiagnosed with breast cancer?

Speaker 3 (12:12):
I would say the probably the average age is in
the 50s, but you have toremember that between one and
eight and one and nine women intheir lifetime will get
diagnosed with breast cancer.
Wow.

Speaker 2 (12:22):
Wow, so it's a, it's a large number.
Yeah, yeah, exactly Well, thankyou again for being on the show
and you know, I just want tolet everyone know to tune in the
next few months We'll haveanother episode from Dr Abramson
and thanks very much.
We're just going to have Chucktake us out, thank you.

Speaker 1 (12:41):
Thank you for listening to the Good Neighbor
Podcast.
To nominate your favorite localbusinesses to be featured on
the show, go to gnpbergen.
com.
That's gnpbergen.
com, or call 201-298-8325.