Breast Reconstruction Doctors: NYC Dr. Vickery on Top Concerns

Listen to Dr. Carlin Vickery, one of the top breast reconstruction doctors NYC has to offer, speaks frankly about what breast cancer patients should be thinking about when considering surgery.

Video Transcription:

You're listening to Dr. Carlin Vickery from 5th Avenue Millennium Surgery.

Let's discuss the top concerns of any patient that comes in to discuss breast reconstruction with me. Generally, these patients are already overwhelmed by all of the decisions that they are making about the treatment, their cancer, and first I have to say for most of them the fact that now they have to work through a series of decision makings regarding what type of reconstruction they're going to have comes as a big surprise. But it really is important that every patient who's about to undergo a mastectomy spend the time and do the due diligence to understand what is available to them, what are the pros and cons of each procedure and which one is going to suit them best and patients fall into several categories.

There are patients who are really candidates for several breast reconstructions, both because of the type of cancer they have, whether or not they've had radiation prior to it, their age group and their body habitus. There are other patients who because they've already have radiation or because they're very thin or because they're very obese in which some of the reconstructive types that we have available would not suit them and would pose certain risks to them and that unfortunately is a lengthy conversation and frequently these patients are already somewhat exhausted from even dealing with their diagnosis.

As an overview in a simple way there are basically two types of breast reconstruction. There are implant breast reconstructions and they can be done as what we call, immediate reconstructions, which mean at the time of the mastectomy or they can be done in a delayed fashion. There are reconstructions where we are able to immediately go straight to the stage of putting a breast implant in but the vast majority of patients will go through a two stage procedure where they have a tissue expander which is like an implant and I'm not going to get into the details, which would be expanded and then at a later stage they will then have an exchange to an implant. So those are called implant reconstructions and in that instance the patient is really having their breast volume replaced by an artificial device like a breast implant.

One thing that comes as a surprise to patients again because implants are so ubiquitous in our society that they are under the wrong assumption that this is a simple procedure. But utilizing implants in breast reconstruction is entirely different than what happens for cosmetic augmentation because the breast has been removed and because you do not have the natural breast to cover that implant so it is a much more challenging procedure and it is critical that patients really understand that and that they find a surgeon who is skilled in doing it and who is going to follow them through the course of their reconstruction.

So one of the considerations is, and realizations honestly for patients is that they are going to have a very close relationship for a long time with their plastic surgeon. The second overview type of reconstruction utilizes a patient's own tissue and in medical lingo we call that autologous reconstruction and there are several different types but as an overview essentially we're utilizing that patient's fat and skin by large to reconstruct the breast and to replace the tissue that's been removed.

Now the advantage of that type of reconstruction is that it's the patients own tissue and once the reconstruction is complete then it's their own biology and if they gain weight, it gains weight and if they lose weight it loses weight and it's there forever and they don't have to face the ongoing change of implants as they age ten to fifteen years down the road. The disadvantage of that type of autologous reconstruction is they tend to be more lengthy procedures and the initial postoperative recovery is more arduous and it also, not every patient is a great candidate for that type of surgery.

The consideration if a patient wants to go with utilizing their own tissue is what type of reconstruction, where are they going to harvest essentially the tissue from and this has developed and changed over a thirty year period such that the most skilled plastic surgeons are able to do procedures where we literally take only skin and fat based on some very fine blood vessels and we transplant them to the chest wall much like a kidney is transplanted between two people, we are now going to transplant one part of their body to another part of their body. It is extremely elegant and satisfying surgery but it is only performed in the most skilled hands and the surgeons who perform the surgery have to be trained in that surgery, in microsurgery, in order to successfully perform those operations.

So patients in the trauma of having a cancer diagnosis need to take a breath, need to do their research, need to ask questions because they generally are going to be referred by their breast surgeon and particularly, if they're out in more of a community based settings, they may or may not be offered some of these procedures, these more technically elegant procedures because they are lengthy and time consuming and technically more demanding and as a result they may or may not be somebody who performs them.

So I think the biggest concern is that a patient do her research on her reconstructive surgery, educate herself at that point prior to making a decision even though that's going to awful lot more work at that moment when she's already feeling overwhelmed by her cancer diagnosis and decision making.

Before we move from this topic, are all types of reconstruction fully covered by their insurance?

By federal law, all reconstructive surgery must be covered and actually the Women of America are some of the few medical groups who went all the way through congress and got that mandated. The kicker in our present reconstructive and insurance environment is that there is wide variability on the way that insurance companies reimburse these procedures and unfortunately, and it's not widely discussed, but the more technically complex procedures can take anywhere from ten to twelve hours for two breasts and if you have a system which is not going to compensate the medical institution or surgeon adequately for that type of surgery then it becomes economically impossible to offer those types of procedures.

It is not something which is discussed a great deal but it is definitely unintended consequences of the present insurance environment so yes it is covered but patients sometimes have to be very proactive in order to find surgeons who are willing to be able to perform some of these more complex procedures and unfortunately I'm not certain in the ongoing environment, there's a great deal of uncertainty as to how that is going to play out.

Categories: New York Plastic Surgery Blog