Not all DIEP flaps are created equal. The dissection of a DIEP flap requires the selection of the appropriate perforator blood vessels to supply and drain the tissue of blood. Any perforator or combination of perforators may not supply enough blood to drain the flap adequately to prevent fat necrosis (tissue death). So how is the “right” perforator selected? Blood flow to many flaps and to the DIEP flap is axial. That means that there is a dominant direction from which the piece of tissue gets its blood supply. Additionally, size matters. Flow is proportional to the 4^th power of the radius. In layman’s terms, a vessel with one half the diameter has 1/16^th the flow. The venous return is particularly sensitive to size because it is a low pressure system. So we need a large perforator in the right location. Some perforators directly join with the large superficial veins. These perforators are particularly good at draining a flap.

So how do I choose the “right” perforators and minimize fat necrosis? I use an acoustic Doppler to identify the perforators and mark their location on the skin the night before surgery. I use the results of a CT angiogram to understand the size, course and communication with other vessels to further narrow down my perforator selection. Lastly, I use my clinical judgment. Having performed over 1000 DIEP flap breast reconstruction procedures, I have an understanding of the anatomy, interrelationships, and artistry to harvest a DIEP flap with an excellent blood supply to create a soft, natural breast.

If you’re feeling confused about when and how often you should have a mammogram, you’re not alone. Since new mammogram guidelines were released this fall by the U.S. Preventative Services Task Force, many patients and personal acquaintances have asked my advice because they’re confused about whether to change their current routine—or when to begin a new one.

The new U.S. Preventative Services Task Force guidelines recommend that women of average risk for breast cancer wait until age 50 to begin getting regular mammograms, and that they do so biannually instead of annually. Their research concludes that there isn’t a clear benefit to earlier or more regular screening for women in their 40s. They also recommend that screening stop after age 74.

However, in response to these guidelines, the American Cancer Society, the American College of Radiology, and the Society of Breast Imaging have announced that they will continue to advise women to begin screening at age 40 and to have annual mammograms after that. They believe that early screening saves lives because the earlier the disease is diagnosed, the more effectively it can be treated.

If you are at high risk for breast cancer or have a history of the disease in your family, screening should begin much earlier, and it might also involve other imaging or diagnostic procedures. Your best course of action would be to begin discussing breast health with your doctor when you are in your 20s.

Here’s the bottom line: if you’re concerned about breast cancer, you should discuss your situation with your doctor or other health care provider, who can help you determine your risk factors and customize a personal plan for you.

This post addresses three common questions my patients have following breast cancer reconstruction:

1. Will breast reconstruction hide other tumors that may later appear in the breast tissue?
2. Will breast reconstruction encourage the growth of new cancerous cells?
3. Should I continue with regular mammograms and breast self-exams?

Does breast reconstruction hide subsequent tumors?

During a mammogram, implants can occasionally interfere with obtaining a good picture, so your technologist must be trained at positioning the implant to enable the best possible image. In a flap reconstruction, the mammogram image may reveal surgical clips or scars, or the breasts might appear fatty, but an experienced technologist will be able to detect any abnormality. Breast reconstruction rarely, if ever, hides a return of breast cancer, so you shouldn’t consider this a significant risk when deciding to have breast reconstruction after mastectomy.

Will breast reconstruction encourage the growth of new cancerous cells?

No research has shown that reconstruction, either with implants or tissue flaps, increases the risk of the breast cancer returning or of a new cancer forming.

What about mammograms and breast self-exams?

After your reconstruction, whether it involves implants or tissue flap reconstructions, it is important to have regular mammograms at an experienced facility. I also encourage you to keep performing breast self-examination on both breasts as soon as you are fully healed from your surgery. This will enable you to notice and report any changes you feel. You should expect your reconstructed breast to feel different, and your doctor or nurse can help you understand the changes.

One year ago DIEP flap breast reconstruction became available at Huntington Hospital when Drs. Keller and Yoon-Schwartz joined the staff. DIEP flap breast reconstruction utilizes sophisticated microsurgery to reconstruct the breast after a mastectomy from excess abdominal fat. As a side benefit, the patient also ends up with a tummy tuck. The result is the most natural and soft breast reconstruction available. Unlike other techniques, the abdominal muscles are not sacrificed. Dr. Keller has been a pioneer in this type of reconstruction and has been performing DIEP flap breast reconstruction for over 15 years.

There are very few places in the country where this type of reconstruction is available. Huntington Hospital is now on that list and is the only hospital in Suffolk County where this procedure is available. Huntington Hospital has made the commitment to support this service by purchasing a new operating microscope that is ideal for successfully performing this procedure.

If you’re planning a single-side mastectomy and breast reconstruction, you probably have plenty of questions about and how your surgeon will make sure your results “match.” You expect your breast reconstruction surgery to restore your shape and some of your self-confidence after your mastectomy, so it only makes sense that your results should look as natural as possible.

Most of the time I will be able to recognize from the beginning when a patient will need to have the other breast lifted or reduced so that both breasts match each other as well as possible, but sometimes I won’t know for sure until she has healed. Here are a few of the most common reasons why you may need follow-up surgery:

• Larger, saggier breasts: Women with very large breasts will often need to have their natural breast reduced. I am able to get very good results matching even larger breasts during breast reconstruction surgery in New York. Sometimes thinner women with larger breasts pose a particularly challenging case, and I may recommend a reduction or a lift with reduction to ensure balance following their procedures.
• Small or unevenly positioned breasts: Many women are happy with a reconstruction procedure that matches a smaller breast, but some will choose their reconstruction as an opportunity to fill out their breast volume on both sides. I have found that the results are usually much better when the patient receives the breast augmentation at the same time as her breast reconstruction on Long Island, New York.
• Downward-pointing nipples: Unless you received a nipple-sparing mastectomy, your initial surgery probably left you without either nipples or areolas on that breast. I can place the reconstructed nipple and areola at any position, but in most cases patients will want some lift to give both breasts a more shapely and perky appearance.

The major trend in breast reconstruction surgery right now is toward reconstructing the breast immediately. If you’ve waited some years after your mastectomy before you started to consider breast reconstruction, you might be worried that you’ve missed your chance for this procedure, but I can reassure you that this isn’t the case.

In my experience there are a few clear advantages to having your breasts reconstructed immediately, but there are also plenty of benefits for women who choose delayed reconstruction, and there is no reason to worry that you’ve somehow lost out on your opportunity to benefit from breast reconstruction just because you waited.

Immediate Reconstruction: The Advantages

For most patients, the biggest benefit of having breast reconstruction immediately after mastectomy is that you will wake up from surgery and still have breasts. For most women this benefit alone is a significant reason to have immediate reconstruction, but as a recognized authority on breast reconstruction procedures I can tell you that breast reconstruction has plenty of other benefits even if you wait years for your procedure.

Look at the Bigger Picture

No matter what your age, your breasts can have a profound impact on your self-image and sense of femininity, and that relationship doesn’t change just because your body does. Studies have found that both immediate and delayed breast reconstruction can benefit women in areas such as:

• Body image
• Self image
• Mood, emotion, and positivity
• Sexual satisfaction

Ultimately, the choice to undergo breast reconstruction after mastectomy on Long Island, New York should be yours and yours alone. But I think it’s important for patients not to feel that they have “missed out” on their chance to gain better self confidence and complete the healing process just because it’s been some time since their mastectomy.