KG: There are various methods of reconstruction after a mastectomy. Is there a specific method you use more often, and if so, why?
DK: I perform numerous types of reconstruction, but far and away, the most common type of reconstruction that I perform is implant based. Over the years, I have found that reconstructing the breasts with implants is a very safe and reliable way to reconstruct the breasts with less risk, less recovery and more control over the final breast mound size than with several of the other methods available. I have had much success with using the implants. Therefore, I have gradually increased the number of cases of implant reconstruction that I perform each year. When complications do occur with autologous tissue reconstruction, such as TRAM flap reconstruction, they can be devastating. I also find that by starting with the more “basic” type of reconstruction with implants, one can always return to the more advanced techniques of reconstruction if for some reason the implant-based reconstruction is unsuccessful.
KG: What are the most important things that a patient should know about how she may look after reconstruction?
DK: I think it is important for the patient to understand that reconstructed breasts will not look exactly the same as a normal breast no matter which technique is performed. It should, however, always be acceptable in clothes and a bathing suit. Most of the time, it should be acceptable without clothes. There will always be some scar even if it is minimal. Thankfully, with improved techniques that are available today, almost all women can achieve a very acceptable aesthetic result after breast reconstruction.
KG: What are the most important lessons that you have learned from your patients?
DK: I have learned many lessons from my patients over the years. I have learned that the anxiety before surgery can be tremendous. I have also seen the dramatic transformation that occurs as the anxiety lessens and patients become more relaxed with both me and the reconstructive process. I have learned that all women have very different priorities in what is important to them with reconstruction. Often times, these priorities change as the time from the diagnosis increases. Thankfully, we can continue to work together and meet these changing needs.
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