VA NY Harbor Healthcare System

A plastic surgeon at VA’s Manhattan Campus, Dr. Daniel Ceradini was part of the transplant team at NYU that recently performed the landmark face transplant for a firefighter who had suffered devastating burns. He performs many types of intricate operations, but in five years as Chief of Plastic Surgery at VA New York Harbor Healthcare System, there is an ever increasing number of woman patients who require his clinical expertise.

His patients are in luck, because Dr. Ceradini studied with the best and is experienced in performing highly complex microsurgeries developed at NYU by many faculty, including Dr. Robert Allen, one of his mentors. Showing examples of before and after breast reconstructions on a computer screen, Dr. Ceradini commented on the natural quality of the reconstructions demonstrated by Dr. Allen. “This is what we strive for,” says Dr. Ceradini, noting that preserving as much tissue as possible is a goal for all cancer surgeries and reconstructions. “I always want my patients to feel happy about the results,” Dr. Ceradini says. Patients usually make their decisions about reconstruction with Breast Cancer Surgeon Dr. Heuldine Webb and Dr. Ceradini.

Dr. Ceradini first discussed DIEP flap reconstruction, an option that uses the patient’s own tissue, what is referred to as autologous breast reconstruction. Basically, a DIEP procedure involves surgical removal of a section of the patient’s abdominal tissue, along with an artery and a vein which are then reconnected to the patient’s circulation at the site of the breast reconstruction. Dr. Ceradini says there are pros and cons to any surgical option. The pros of this procedure are that the “reconstructed breast looks and feels natural, is soft to the touch. “Sometimes,” says Dr. Ceradini, “sensation is retained.“ The cons are that “it is a large operation that can take six hours under anesthesia,” explains Dr. Ceradini.” Hospital stay usually lasts 5-7 days, with progressive recovery over the ensuing months.

The main alternative to undergoing the DIEP procedure is having a shorter but staged reconstruction done at the time of the surgery to remove the cancer. Plastic surgeons perform this kind of impant-based reconstruction using a silicone prosthetic which is inserted at the time of surgery, and patients usually only stay 1-2 nights in the hospital. The prosthetic is then expanded in an outpatient setting over a month or two with the use of saline. And in a second short surgery, the temporary prosthetic is replaced by a more permanent breast implant. Doctors and patients may chose this option if, for example, the patient is too thin to have enough tissue for the DIEP procedure.

Because cancer surgery in general and breast cancer surgery in particular is a source of enormous anxiety to patients, Dr. Ceradini is proud to offer women patients not only cutting edge microsurgical breast reconstruction, such as the DIEP procedure, but many other surgical options as well. High risk women may prefer including prophylactic mastectomy of both breasts.