This year will continue to bring new advances and exciting developments in this field. Review our website to find out the latest and most innovative techniques in the field of breast reconstruction including the use of acellular dermal matrix and microsurgical techniques and post-operative management. Bergen Plastic Surgery remains a source for the women of Bergen County New Jersey to find out about the latest and most cutting edge advances in the field of breast reconstruction.

For those joining us for the first time from either Facebook, Twitter, or LinkedIn, welcome to our blog! We will be updating regularly on the latest in Plastic Surgical and Reconstructive procedures. Make sure to check out our site www.bergenplasticsurgery.com for more information, videos, and photos. And of course, feel free to give us a call if you need more information!

Once it is determined during consultation that you are in fact a candidate for an autologous tissue flap to be harvested from your abdomen, the rest is up to your internal anatomy. Dr Small always first dissects out the Superficial Inferior Epigastric Arteries to evaluate their suitability for a flap to be based on them. Although the literature states that around 10-15% of patiens are candidates for the SIEA procedure, in fact, much fewer that that are safe candidates. We have found the flap to be much less reliable than a DIEP and better suited when the breast to be reconstriucted is very small. Dr. Small then explores the perforating vessels of the Deep Inferior Epigastric Artery. Those vessels are much beter suited for reconstruction ona regular basis. Rarely, usually when there has been prior gynecologic surgery, a free muscle sparing TRAM is performed if their is concern about the ability of the vessels to support the flap.

It is basically a factor of blood supply. The operation that is performed (DIEP vs SIEA vs Free TRAM) is the operation with the best blood supply to prevent fat necrosis with the least toll on the abdomen.

Dr. Small’s goal during the day of microsurgical breast reconstruction by either DIEP or other means, is to successfully transfer the flap to the breast area and to shape the new breast. This is a lengthy and complex procedure that is vastly shortened in duration by the use of a second microsurgical team. This vastly shortens OR time and helps to hasten recovery.

Like any type of procedure, recovery after a DIEP Flap varies from patient to patient. We have had patients back to work in 3 weeks and some who have taken up to three months to resume pre-operative activities. We tell all preoperative patients that typical recovery after DIEP Flap surgery is around 6 weeks. That is six weeks until you are able to get back to your normal routine. Most people are standing completely upright after 10-14 days (as any tummy tuck patients). By the sixth week, they are driving completely on their own and may resume all normal preoerative activities. But again, it may be longer in some patients.

Patients who are the most motivated to do well, simply do better. A healthy and forward thinking attitude most certainly helps in the recovery. A strong social network is also invaluable.

The key to this answer is that DIEP or Implant based reconstruction is in fact “a process”. No patient wakes up with a complete breast consisting of a skin envelope, tissue or an implant to make it protrude, and a nipple-areolar complex. It requires several stages before the reconstructive process is complete. Only the first stage (either the DIEP or insertion of the tissue expander) is a procedure that requires hospitilization. The other stages are all ambulatory procedures that have minimal recovery. Some in fact, (nipple reconstruction or tatoo placement) can be done in the office.

A rough estimate of the total reconstructive process in an woman who is undergoing IMMEDIATE DIEP or implant based reconstruction without the knowledge of the final pathology available at the the time of initial consultation is 3-9 months. Obviously, the need for chemotherapy, possible need of radiotherapy, and allowing for time for vacation, breaks and possible complications, all play a role in total time until completion. The reconstructive process is obviously much quicker when there is no need for chemotherapy (ie delayed reconstruction or when done for prophylactic reasons BRCA etc).

What a success! Our annual Breast Cancer Awareness tribute to our New Jersey Breast cancer patients was a huge success! Over 100 people from all over New Jersey were in attendance to salute our beautiful breast cancer survivors! Patients who had undergone implant reconstruction, DIEP Flap reconstruction and Microvascular TRAM Flap reconstruction were all in attendance as well as their friends and family. Everyone enjoyed mingling and hearing one another’s stories of survival and paying tribute to their heroism. Dr. Small was blessed with a gift from one of his patients: a beautiful portrait from reknowned artist and former patient Phoenix Smith. All in all, it was a wonderful evening of cocktails and good friends sharing their triumph over breast cancer and their resumption of a normal life.

If you or anyone you know has either undergone a mastectomy or is planning on undergoing a mastectomy, whether in New Jersey or not, please feel free to refer them to our office to learm more about DIEP Flap surgery as well as Free TRAM Flap and implant based reconstructive techniques.

Stay tuned for the latest updates on some of the least invasive and safest techniques in microvascular reconstuction. We all know that microvascular reconstruction offers the least invasive and most natural appearing results…but did you know that most plastic surgeons do not offer the option of microvascular techniques to ther patients due to lack of expertise in the procedure? Please call the office to find out information on DIEP flaps and other microvascular techniques offered by Dr Small.