Post-Breast Cancer Reconstruction Options Center Patient Preferences and Oncologic Expertise: With Sara Nunnery, MD, MSCI; Maelee Yang, MD; and Odette Abou Ghanem, MD

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Maelee Yang, MD, and Odette Abou Ghanem, MD. Dr Yang is a plastic surgeon with The Surgical Clinic in Nashville. Dr Ghanem is an assistant professor of plastic and reconstructive surgery, as well as a plastic and reconstructive surgeon, at Vanderbilt University Medical Center in Nashville.

In this episode, the experts discussed the breadth of breast reconstruction options available to patients who have had breast cancer, beginning with guidance on selecting a surgeon. Dr Yang stressed the importance of choosing a plastic surgeon who is board certified or board eligible, cautioning that cosmetic surgery certification does not confer equivalent training. Dr Ghanem explained that autologous reconstruction, which uses a patient's own tissue rather than a prosthetic, often relies on microsurgery, wherein tissue and its dedicated blood vessels are transplanted and reconnected under a microscope. She also noted that high-volume centers achieve superior flap success and have lower complication rates.

The conversation then addressed implant-based reconstruction. Dr Yang distinguished immediate approaches, including direct-to-implant and tissue expander placement, from delayed reconstruction, and explained that expanders allow gradual sizing and also protect skin that may be compromised following a mastectomy. She noted that she favors cohesive silicone implants over saline and described prepectoral placement, which reduces pain and avoids animation deformity.

Dr Ghanem characterized the deep inferior epigastric perforator flap procedure as the autologous gold standard using lower abdominal tissue. She also identified thigh, back, and buttock donor sites as alternatives and the Goldilocks procedure as a minimalist option. The experts reviewed candidacy considerations, including body mass index, smoking, and diabetes, and detailed surgical sequencing around chemotherapy and radiation.

Finally, the experts highlighted emerging techniques, including oncoplastic reduction, sensation-preserving mastectomy through nerve grafting, and procedures for lymphedema. They emphasized the importance of multidisciplinary communication, insurance barriers, and patient-centered choice throughout the reconstruction journey.