It's very surprising. There's been a lot of research done on the best satisfaction of patients who have reconstructive surgery and the two factors that correlate with the highest level of patient satisfaction are number one, being involved in the decision making process; and number two, the relationship that they have with their plastic surgeon. You would really think it has more to do with skill or outcomes.
I think in this day and age, most of us who are recognized in large institutions as reconstructive surgeons, we're going to have a certain baseline of competence, but it's really fitting the patient to the doctor that creates satisfaction because that relationship is, at minimum, a year of a very active relationship, and then lifelong after that. So it's surprising, but very, very important.
All patients are candidates for immediate reconstruction until proven otherwise. So you might say, "Well, what's that basket Dr. Vaniver?" And actually it's grown a little bigger. The patients that I don't recommend for immediate reconstruction are those who have other medical problems such as diabetics, smokers, people who have a really aggressive cancer and need to get directly to chemotherapy. A lot of my patients who go for delayed reconstruction haven't been able to really wrap their hands around the whole situation. They aren't ready to make that decision and they don't have to. A new area that I've really learned, and I think we've all learned is very high risk are the obese patients. They have a much higher risk of both operative and surgical complications, so I actually delay them and I ask them, if they can, to really try and lose weight and gain their health, because the healthier the start is, the healthier the result is.
For the right patient, we do an immediate implant reconstruction. That's a very small selective group, and they do look like they've had breast augmentation. We've really evolved with both skin sparing, especially now, more and more. Patients who can undergo nipple sparing mastectomies and the incisions are placed very similarly to a breast augmentation. They become essentially a breast augmentation who doesn't have very much tissue at all. So it is almost identical to doing an augmentation in a very thin-skinned patient. So as we increase our aesthetic knowledge, as we increase our scientific knowledge of tissue interactions and wound healing, we're going to come together with the very best options for our patient.
So you want to be able to ask what I call the five questions, okay? So number one is are you a candidate for nipple sparing mastectomy? Number two, are you a candidate for unilateral mastectomy or perhaps would bilateral mastectomy be more in your interests? Number three, are you a candidate for an immediate reconstruction? Number four, are you a candidate for immediate implant reconstruction? And number five, what type of reconstruction is best suited for you? And when I say that, not just me as a surgeon looking at your body, but me as a woman looking at you as another woman who has a job, and perhaps children and responsibilities and questions about downtime and tolerance for complications and what your expectations are, all of those things have to be included. So for me, the journey is really personalizing that experience so that every woman has a plan that's singled out to her needs. All of them.

These Two Surprising Factors Ensure the Happiest Breast Reconstruction Patients

Dr. Karen Vaniver talks about the two surprising factors that lead to happy patients when it comes to a breast reconstruction.