Good Neighbor Podcast: Bergen
Bringing together local businesses and neighbors of Bergen County
Good Neighbor Podcast: Bergen
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
(201) 731-3134
reception@drabramson.com
drabramson.com
This is the Good Neighbor Podcast, the place where local businesses and neighbors come together. Here's your host, Doug Drohan.
Speaker 2:Hey everybody, welcome to another episode of the Good Neighbor Podcast. I am thrilled to be joined once again with David Abramson. David has a great article in this month's issue of Neighbors Magazine Neighbors of Closter, demerson-hallworth Today and in this month he's speaking about breast reconstruction options after cancer treatment. So, dr Abramson, welcome to the show again. Great, I'm happy to join you. Yeah, so you talk. I mean, you know, as we lead into October, it's Breast Cancer Awareness Month and obviously it's a growing, you know, issue with women in America and very personal experiences that they go through when they suffer with a mastectomy or lymphectomies. And I think one of the things that speaks kind of jumps out at this article is how there's a lot of different reconstruction options that can help with your physical appearance and basically help people feel better about themselves again and bring that confidence back. So what are the different, you know? What do you kind of touch on Like? What are the basic types of options available?
Speaker 3:Well, I think it really matters. You know what kind of breast cancer treatment they're having, matters you know what kind of breast cancer treatment they're having, and sometimes the patient may decide what type of treatment they're having based on what kind of reconstructive options there are. So I think we really need to divide it up into what you can do if someone's having a mastectomy, because that's the traditional area where people envision breast reconstruction, the traditional area where people envision breast reconstruction. So if someone's having breast reconstruction there's really we divide it into two buckets. One is what we call implant based reconstruction, where we use a breast implant, and another one is what we call autologous reconstruction, where we use the person's own tissue. So if we talk about using an implant, mostly that is a two-stage. We'll call it a two-stage reconstruction where at the time of the mastectomy we'll put in what's called the tissue expander and then a few months later, after, if they need any other treatment is done, we'll put in a permanent implant.
Speaker 3:Things like nipple reconstruction and things like that can be done as well. It is possible in some patients to do a single stage where you go direct to implant. There are some limitations but you know, depending on the person and their needs are. They can have a one-stage direct implant reconstruction at the time of mastectomy. There's what we call autologous reconstruction, where we use the patient tissue and most commonly that is tissue from the abdomen. And obviously many of these issues that come into determining what the best form of reconstruction relates to the type of cancer, where it is if they're going to need radiation therapy or chemotherapy afterwards and the person's body, because you can't take tissue from an abdomen if a person weighs 100 pounds because they're not going to have anything on their abdomen.
Speaker 3:So, when we take tissue from the abdomen, traditionally it was what was called a tram flap, but now what we do is what's called a deep flap, which the tissue is actually completely separated and then the blood vessels that supply that tissue from the abdomen are plugged into the chest. It can be done at the same time as a mastectomy or it can be done later. The chest it's done. It can be done at the same time as a mastectomy or it can be done later. There are also other flaps that can be done, whether it be from the buttocks, inner thigh, things like that, but those are much less common and most people don't have enough tissue in those spots and you frequently would have to use more than one flap to do a reconstruction yeah.
Speaker 2:So what does that? Basically, yeah, go ahead. What does that do to the, to the appearance of your stomach? So if you're taking, well, I mean people would kind of people.
Speaker 3:Yeah, so when people have a deep flap, you know, I'd say the closest thing is it's like a tummy tuck, but with a scar that's a little bit higher. There is a little some of the muscle. Even though we try to preserve as much as possible, some of the muscle either loses its innervation or has to be removed as part of the deep flap. So there can be some weakness on the abdominal wall, but it's usually not that significant and as long as the blood vessels stay open, which is, you know, like a 99 percent of the time Once that tissue is up there and the breast has been shaped, it's there forever. The only changes are if the person gains or loses weight, because it is the tissue from their abdomen and it will behave as if your abdomen did when you gained or lost weight. So that's just something people need to be aware of. It's where the tissue comes from, not where it's living.
Speaker 2:Got it, got it, okay, interesting. So now there's there's lump ectomies and there's mastectomies. So what's the difference in terms of the types of reconstruction that you do?
Speaker 3:So when someone has a lump ectomy there it's a portion of the breast that's being removed and it really will depend on the person's anatomy and if they're a good candidate for a lumpectomy.
Speaker 3:Sometimes you can just reposition breast tissue to fill the area where the lumpectomy came from and give the breast a good shape. Sometimes people are large-breasted, their breasts are what we call tautic or saggy, and they can take the opportunity of a lumpectomy to actually do either a breast reduction or a breast lift so that they can achieve symmetry. Because obviously if you take out a portion of the breast and then usually those people need radiation, that side would wind up being smaller. So what we do at the time of a lumpectomy is actually we can do a bilateral breast reduction and we take the side that's not having the lumpectomy and make it a little bit smaller, because the side that is having the lumpectomy, once the radiation happens, that will shrink over time. So we try and judge them a little different in size so that after the treatment is completely done they're as symmetric as possible Got it Got it.
Speaker 2:So I mean, those are, I guess you know, for the lay person like myself, those are some procedures that I've heard of, but there are some others that you speak about in the article that I never heard of and 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 talked about the, you know the flap, I guess reconstruction, but you know what are the other ones, other types of options available.
Speaker 3:Well, I mean, you can create a breast with fat grafting as well, where and we use fat grafting as an augmentation to either an implant-based reconstruction or a flap augmentation to either an implant-based reconstruction or a flap but you can actually create an entire rest by doing a series of fat grafting procedures where we do liposuction and then put some of the fat in and start to build a breast over time. That is another option. Sometimes we'll do that if a reconstruction has not been successful or there's been radiation to try and make the tissue a little easier to work with, and some of these are. There's other flaps that are more traditional latissimus flap, which is from the back, but that also frequently needs an implant with it because most people don't have enough fat on their back. And then there's what I mentioned before. There's, you know, flaps from the thighs and buttocks, which are some of the ones I think you were 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:So what I mean? What is like? What do people take into account when they're making this decision? Obviously, it's not a one size fits all solution and, as you mentioned, everyone's body's different. The treatment they're going through could be different, like what are their next steps If someone who's listening to this is going through breast cancer and maybe they've had their mastectomy or lumpectomy, what are the next steps? And maybe they've had their mastectomy or lumpectomy? What are the next steps?
Speaker 3:So I would say most reconstruction is performed at the same time as the breast cancer treatment.
Speaker 3:So the first thing would happen is your breast surgeon frequently will talk to you about what you might have done in terms of the cancer treatment and briefly discuss with you some of the options and then refer you to a plastic surgeon to talk about at that time If you've already had treatment and didn't have that for whatever reason more commonly, with a lumpectomy and you develop, you know, some asymmetry or deformity or something like that related to your breast, you just need to make an appointment with a plastic surgeon.
Speaker 3:Because you know breast reconstruction at any point any 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 talk to someone and find out what the options are that fit you and your body type, because, listen, everyone's different and you need to sit down and identify the problem first and then lay out what the solutions are, or potential solutions, and there could be two or three different options that may rank from best to not as good, but it also depends on what the person's willing to go through, whether they want one stage, whether they're willing to have multiple stages, whether they want an implant. So there's a lot to discuss and you know, usually a discussion like that will take 30 to 45 minutes once you've taken a look at the patient.
Speaker 2:Right, Okay, so if someone were to reach out to you, let's, you know, backtrack to early days of our first podcast. How do they reach you? And then, why? Why should they call you? You know, to put you on the spot.
Speaker 3:Sure, well, first, the best way to reach me is our office phone number, which is 201-731-3134. Call and make an appointment. They should reach out to me because I've been performing breast reconstruction for 25 years. I perform all different types of breast reconstruction. I've actually published some articles that created novel ways to correct certain problems lumpectomy defects, doing various types of breast reduction that give you better, long-lasting results. So, because of my experience, my innovation, that's why someone should call me and talk to me about the options available for breast reconstruction. That's great.
Speaker 2:And you're located in Burden County and your office is in Englewood.
Speaker 3:Yes, I have an office on Grand Avenue in Englewood and also another office in Englewood Hospital where I'm actually on the board of the trustees for the hospital as well.
Speaker 2: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 I don't know what the figures are, but I think everyone I know knows someone who's either had breast cancer or knows someone in their family who's had breast cancer. So it's definitely an issue that you know that's people are going through and having to restore confidence is huge and I don't know like what's the average? Is there an average age of of of women in bergen county in terms of um, you know, being diagnosed with breast cancer?
Speaker 3:I would say the probably the average age is in the 50s, but you have to remember that between one and eight and one and nine women in their lifetime will get diagnosed with breast cancer. Wow.
Speaker 2:Wow, so it's a, it's a large number. Yeah, yeah, exactly Well, thank you again for being on the show and you know, I just want to let everyone know to tune in the next few months We'll have another episode from Dr Abramson and thanks very much. We're just going to have Chuck take us out, thank you.
Speaker 1:Thank you for listening to the Good Neighbor Podcast. To nominate your favorite local businesses to be featured on the show, go to gnpbergen. com. That's gnpbergen. com, or call 201-298-8325.