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FABULOUS FIND: SPONSORED BY WESTON GALLERY

SPECTACULARCRAFT SHOWEVENT: In celebration of American Craft Week (throughOct. 12), Weston Gallery is hosting a trunk showof Zachary Bloom’s fabulous, one-of-a-kind necklaces,bracelets and earrings. Bloom will be at the gallery from10 a.m. to 5 p.m. Friday, Oct. 10, and his pieces will remainon display through Oct. 11.

WHAT MAKES IT FABULOUS: “With any purchase between now and Oct. 12, you can enter to win a veryspecial and beautiful necklace made by Bloom,“ saysKathy Weston of Weston Gallery. “It’s sensational! Join uson Oct. 10 for a ‘pleasure-to-the-senses’ kind of show.”

GET THERE: Weston Gallery, 79 Main St., Manasquan;732-292-1664 or www.westongalleries.com

SATURDAY 10.04.14

Editor’s Note: Today’s story is the first in a monthlong series on cosmetic surgery procedures.Beauty most certainly comes from within, but in honorof Breast Cancer Awareness Month, we wanted to takethe opportunity to celebrate self-empowerment — fromthe inside out.

Growing up, women’s health issues surrounded Dr.Michael Rose.

“My mother’s best friend had breast cancer and diedof it subsequently,” says Rose, a member of The Insti-tute for Advanced Reconstruction at The Plastic Sur-gery Center in Shrewsbury, and chief of the division ofplastic surgery at Jersey Shore University MedicalCenter for Meridian Health. “And my mother is a huge(Susan G.) Komen supporter — that’s her life, sort ofcharity goal, and to raise as much money for cancer re-search, and sort of avenge her best friend’s demise. Iwas brought up in a household where this whole aspectof women’s health was talked about all the time.

So when it became a part of my career, it was naturalthat I would gravitate toward doing as much of this aspossible.”

Breast reconstruction surgeriesheal the mind and bodyGINA COLUMBUS @GINACOLUMBUSAPP

See BREAST, Page D2

Page D2 Saturday, October 4, 2014 Asbury Park Press APP.COM

The Jersey Shore Premium Outlets,1 Premium Outlets Blvd., Tinton Falls,will be joining forces with the Susan G.Komen nonprofit organization in sup-port of programs designed to raiseawareness about breast cancer, whichaffects one in every eight women.

Throughout October, shoppers canget 25-percent off a single item for eachdonation of $10 or more at participatingstores. Profits will go toward breastcancer research and community out-reach initiatives. The savings card isredeemable at designer storefronts, in-cluding Michael Kors and 7 For AllMankind.

A Komen representative will be atthe outlets Saturday, Oct. 25, to respondto inquiries about general breast healthas well as prevention efforts that arecurrently in place.

Donors can visit the on-site Informa-tion Center to make a cash or credit do-nation that will go directly to the Cen-tral and South Jersey Affiliate of Ko-men.

Susan G. Komen for the Cure wasfounded in 1982 by Nancy G. Brinker,sister to Susan herself. It aims to savelives and put a permanent end to breastcancer by providing monetary grantsto impacted families. For more infor-mation, visit ww5.komen.org/.

Outlets team with Komen foundationCASSIDY DESTEFANO CORRESPONDENT

FILE PHOTO

Throughout October, shoppers at Jersey Shore Premium Outlets can get 25-percent off a singleitem for each donation of $10 made to the Susan G. Komen organization.

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Rose has been performing breast re-construction surgeries, among others,for the last 15 years. And the proceduresfor it are more innovative than ever, headds.

Breast reconstruction surgery is des-ignated for women who have lost one orboth of their breasts due to a mastecto-my, injury or an inherited physiologicalproblem, Rose says.

Also, if a woman tests positive for agene that may lead to breast cancer, shemay opt for a mastectomy — similar to amove made by actor Angelina Jolie in2013, when she underwent a double mas-tectomy.

“Most commonly, it’s from breast can-cer or the threat of breast cancer with(the) gene,” says Rose as to why womenchoose breast reconstruction.

With the surgery’s advancements inrecent years, the procedure also servesas a feminine rebirth and does wondersfor a woman’s body image.

“In many cases, after we’re all done,we can reconstruct them a breast thatthey can feel even better about them-selves than they did before,” Rose says.“The breast doesn’t have the same sensi-tivity as before — but the form is stillthere, and the way they look in clothingand even out of clothing. They can forgetabout the scarring a little bit, and justlook at the shape, and the position of thebreast and the size of the breast — theycan look fabulous. I can honestly say, 50percent of the time, me and the patientagree that they look better after recon-struction than they did before recon-struction.”

Explore the cutting-edge breast re-construction procedures available to-day.

An overview

Thanks to the Women’s Health andCancer Rights Act — passed in 1998 —women are protected by their choice,and right, to have breast reconstruction.The law mandates that insurance pro-vides coverage for breast reconstruc-tion following a mastectomy surgery, ac-cording to The Institute for AdvancedReconstruction.

Under the law, mastectomy benefitsmust cover, according to the AmericanCancer Society:

» Reconstruction of the breast thatwas removed by mastectomy

» Surgery and reconstruction of theother breast to make the breasts looksymmetrical or balanced after mastec-tomy

» Any external breast prosthesisbreast forms that fit into your bra need-ed before or during the reconstruction

» Any physical complications at allstages of mastectomy, including lym-phedema (fluid build-up in the arm andchest on the side of the surgery)

Breast reconstruction surgery can bedelayed until a patient is ready, but is

more effective immedi-ately following a mastec-tomy.

“The breast surgeonwill do the removal of thebreast, and then I will bethere,” Rose says. “Thenwhatever method of re-construction (we choose),we will get the ball roll-

ing, we will get started. Then, they’llwake up with part of the reconstructiondone or the whole thing, for the mostpart, done.”

Rose understands why some womenmight not want to rush for reconstruc-tion.

“I could understand — why a woman’sfirst concern, and it should be, is ‘just getthis cancer off of me, I just want it off’ ...‘why should I worry about my figure andmy femininity,’ ” Rose says. “I get that —but it is much harder to build a breast lat-er than it is at the time of the mastectomysurgery. It also is never quite as good, be-cause the tissue has undergone a lot ofshrinkage, and maybe radiation treat-ments. There is a very significant psy-chological advantage — to waking upfrom an operation as traumatic as hav-ing your breasts removed, and still hav-ing either a breast already reconstruct-ed or halfway into the process. You feellike you’re not just skin and ribs. It’s ahuge, psychological advantage.”

There are three basic types of recon-struction procedures: implants, pedicled(attached) or free flaps, or latissimusflaps, Rose says. The latter two groupsare part of a process where the breast isreconstructed using the patient’s owntissue.

“It really does depend on the patient,”says Dr. Denise Johnson Miller, directorof breast surgery at Jersey Shore Uni-versity Medical Center for MeridianHealth. “Patients are going for the flapsbecause they give a better cosmetic ap-pearance. But more elderly women, theyprefer the tissue expander (implants).”

All methods can be used alone or incombination with other procedures, Mil-ler adds.

Patients may go for an implant-basedreconstruction right after a mastectomy,then later reconstruct with their own tis-sue.

“This allows people to think aboutwhat they want,” Miller says. “It’s a lot ofdecisions to make.”

One of the latest advances in breastreconstruction is a microsurgical proce-dure, called the Deep Inferior EpigastricPerforator (DIEP) flap.

“They take the tissue from the abdo-men, and reconnect it to blood vessels upin the chest area,” says Rose. “They fig-ured out a way where they don’t have totake any muscle. It used to be you’d haveto sacrifice your abdominal muscle toget the tissue out.”

What other advances in breast recon-struction could we one day see?

“I think as they perfect tissue engi-neering techniques, at some point,they’re going to probably take some partof the mold of your breast,” Rose says.“They’re going to take a vile of bloodfrom the arm, and they’re going to use

some technique with stem cells to growyou another breast and it’s going to gettransplanted in there somehow.”

Reconstructing with tissue

In flap procedures, breast recon-struction surgery patients are able to usetheir own tissue from another part oftheir body — often the abdomen — alongwith its blood supply, to form a breast.

“Those are where we use other partsof your body, a little excess tissue, verycommon, from the abdomen — to natu-rally reconstruct the breast with it,”Rose says, adding such microsurgicalprocedures can take anywhere fromnine to 14 hours. “What women loveabout that is, there’s not too many womenout there who wouldn’t want to get rid ofa few extra pounds around the middle.And that goes along with the whole con-cept of feeling better about themselvesafter surgery than they did before. Theirtummies are nice and flat, and theirbreasts are full and perky, and what’sbetter than that?”

The pedicled transverse rectus ab-dominis myocutaneous TRAM flap isone of the most common methods ofbreast reconstruction, The Institute forAdvanced Reconstruction at The PlasticSurgery Center states online. Pedicle re-fers to the part of a skin graft that re-mains attached to the original donor site,so it transfers the tissues of the lower ab-domen and rectus muscle to where thenew breast will be constructed. It helpsto provide blood flow to the skin and fatthat composes most of the flap, the Cen-ter adds.

There are also free flap reconstruc-tions, which are described as a microsur-gery that uses miniaturized instrumentsand a microscope. Here, the flap of skin,fat, muscle and blood vessels are cutfrom its original location and attached tothe chest’s blood vessels, according tothe Center.

Free TRAM flaps connect veins andarteries to the new breast tissue. Howev-er, they can result in the weakening ofthe abdominal muscles.

DIEP flaps are the newest advance,touted earlier by Rose.

“A DIEP flap does not disrupt or useany of the abdominal muscle, it only usesthe skin and the fat,” says Rose, explain-ing it does not weaken the abdominalmuscles.

Superficial Inferior Epigastric Ar-tery (SIEA) flaps are a variation of DIEPflaps, Rose says, but use more superfi-cial arteries and a smaller section of skinand fat to reconstruct a breast.

Latissimus dorsi myocutaneousflaps, also known as latissimus flaps, usetissue from a patient’s back — just belowthe shoulder and behind the armpit —and are rotated around to the chest to re-construct a breast. However, Rose saysin most cases, an implant is also used inthis procedure.

“It’s a hybrid, a little bit of both,” Rosesays.

If for some reason a patient’s abdomi-nal tissue can not be used for the recon-struction, they can go for what is called anon-abdominal free flap. Instead, sur-geons will pull tissue from the hips, glu-teal area, and posterior thigh.

“Those are some other donor areas,they’re not commonly done, but we do dothem,” Rose says.

“They’re great when you don’t haveabdominal tissue available.”

Implant-based reconstruction

If a patient vies for implants as abreast reconstruction method, it seemsto be the quickest process. On top of amastectomy, an implant procedure takesroughly one and a half hours.

“If we’re using implants to recon-struct the breast, that’s the simplestway,” says Rose, who has been a boardmember of the Cancer Support Commu-nity of The Wellness Community of theJersey Shore since 2008.

However, there are multiple phasesof this reconstruction process.

Implant-based reconstruction, whichis a one- to two-month process, is dividedinto two steps: tissue expansion andplacement of a permanent implant, ac-cording to the Center. The two types ofimplants, which can come in variousshapes and sizes, are saline-filled, sili-cone gel-filled, or both, Miller says.

“There are a lot of options for people,”Miller says.

In tissue expansion, a pocket of skin isformed under the chest wall muscle.This is done in order to fit a tissue expan-der, which is a silicone balloon filled withsaline. The expander is then inserted, ac-cording to the Center.

Gradually, additional saline is addedweekly or bi-weekly during outpatientvisits, until the desired volume isreached in order to stretch the muscleand skin to the desired size. Patients thenundergo an outpatient surgery to re-move the tissue expander and insert thepermanent implant, the Center states.

Regardless of which reconstructionmethod a patient goes with, there arerisks to keep in mind, Rose explains.

“With any procedure, there’s alwaysthe risk of infection, bleeding, scarring.Even though we’re trying to tease out themuscle, they could have some muscledamage, weakness of the abdominalwall,” Rose says. “With the microsurgi-cal (procedure), there is the possibilitythat the body won’t restore the bloodflow to that ... artery. But that only hap-pens a couple percent of the time.”

It’s helpful, Miller says, for people toknow their expectations prior to sur-gery.

“It’s a good idea that if they knowsomeone who’s had breast reconstruc-tion,” says Miller, “talk to patients whohave had those experiences.”

Nipple/areola reconstruction

A nipple/areola reconstruction fol-lows that of the breast for a patient, Roseexplains. There are also various proce-dures for this.

Said to be a separate, minor surgerydone as an outpatient, the procedure isoften done after the reconstructedbreast has had roughly three to fourmonths to heal, he says.

“Once the reconstruction is done, usu-ally we wait a few months,” Rose says.“We see how the breasts are going to be,and how they’re sitting on the chest wall.We can figure out where the nipple andareola are going to go, and we can con-struct from there.”

Tattooing is a different process, and isusually done between three and sixmonths of breast reconstruction. It canalso be done either in conjunction with orinstead of having the nipple/areola re-construction, the Center states. The tat-tooed nipples and/or areolas are de-signed to match the skin’s pigment andhave a 3-D appearance.

BreastContinued from Page D1

Dr. MichaelRose