Breast Reconstruction Surgeon: Dr. Jugenburg
Dr. Jugenburg has sub-specialization in cancer reconstruction, and has trained at the world-renowned Memorial Sloan-Kettering Cancer Centre in Manhattan. Upon returning to Toronto, Dr. Jugenburg has worked at the Toronto General Hospital and Mt. Sinai Hospital in Toronto, providing some of the most sophisticated care to his patients. Currently, Dr. Jugenburg practices out of the Humber River Regional Hospital in Toronto offering patients implant-based breast reconstruction, pedicled flap reconstruction, and new advances in reconstructive surgery such as single stage implant reconstruction procedures.
Dr. Jugenburg actively supports Breast Cancer Research, as all our consultation fees are donated to Breast Cancer Foundation.
Prior to any Breast Reconstruction Consultation, we need a referral letter from your doctor. Please ask them to simply fax a referral to 647-436-6969.
Breast Reconstruction Advocacy
Breast cancer is one of the most common cancers in women and affects about 11% of Canadian women. For women who require a mastectomy, a breast reconstruction helps to restore their body image, self-esteem and has been shown to improve survival rates. Breast cancer reconstruction helps to close the loop on breast cancer.
90% of mastectomy patients never get breast reconstruction after breast cancer because they either do not know that this is available to them or do not realize that this is a service that is OHIP covered. Dr. Jugenburg would like this number to decrease dramatically. Women shouldn’t just survive breast cancer. With breast reconstruction you can go on living, not just surviving.
Reconstructive Surgery Following Mastectomy
For women who have had all or a portion of a breast removed due to cancer, Dr. Jugenburg offers breast reconstruction surgery. Rebuilding and reshaping the look of the breast following cancer surgery is common, and there are many new and improved surgical options available to women today.
Whether you have had a mastectomy, or have had a lumpectomy or a segmental mastectomy, reconstructive breast surgery can help you not only regain your shape, but your self-confidence as well. Breast reconstruction offers women:
- A balanced chest look when wearing a swimsuit or bra
- An opportunity to regain the shape of their breast
- The ability to avoid using a form or other external prosthetic device that fits inside the bra
When to Have Reconstructive Surgery
Breast reconstruction can be done or started immediately at the time of the mastectomy, or delayed until later. The delayed breast reconstruction is usually done for women who will need radiation after the mastectomy, as radiation given after breast reconstruction can cause delayed healing and scarring.
There are other factors that can play into the decision to have reconstructive breast surgery, including:
- Your health
- The type and stage of your breast cancer
- The amount of donor tissue you have available; women who are extremely thin may not have enough extra tissue to enable a flap graft
- The type of surgery you are planning
- The size of the implant or reconstructed breast
Some women prefer not to have to make the decision about reconstruction while dealing with the breast cancer diagnosis. If you find that you are in the same situation, it is probably best to wait until after the breast cancer surgery is completed to make decisions about reconstruction.
However, the more you know about the reconstruction options available to you before a mastectomy can help you approach your surgery with a more realistic outlook about the outcome. It is best to discuss your concerns with Dr. Jugenburg at the time of your consultation.
Types of Breast Reconstruction Surgery
There are several different types of surgery used to reconstruct the breast. These include using a breast implant, and your own tissue flap using a section of your own skin, fat and even muscle taken from your stomach, back or other area of your body, or a combination of the two.
There are a variety of breast implants that are available to be use for breast reconstruction. Dr. Jugenburg uses saline filled implants as well as silicone implants. We offer the newest silicone (gel) implants with thicker cohesive gel, which are often called “gummy bear” implant because of their texture. There are also different types of implant surgery, including:
- One-stage, or immediate breast reconstruction is performed at the same time as the mastectomy. This may require extra support to hold the implant in place. Unlike traditional tissue expanders, there are new, single stage breast implants that can be left in place and expanded, without having to remove them during another surgery. This procedure uses Alloderm, a substance that acts as a muscle substitute to provide coverage over the implant.
- Two-stage, or delayed reconstruction is the most often used procedure. It involves an implanted tissue expander that helps stretch the skin and muscle, which is removed and replaced with an implant during a second surgery at a later time.
Tissue Flap Procedures
Women who have sufficient excess skin and fat can have breast reconstruction using their own tissues. These skin flaps are used to recreate the breast as it was before the cancer. There are several different types of flap procedures, including:
- TRAM Flap Breast Reconstruction The Transverse Rectus Abdominis Myocutaneous flap (TRAM), uses belly skin, fat and muscle to reconstruct the breast. This procedure is used in order to have visible breast symmetry when unclothed. However, using the rectus (six-pack muscle) does create additional risks, including, hernia, abdominal bulge and weakness. In addition, this procedure requires significant recovery time.
- DIEP Flap Breast Reconstruction This is a variation of the TRAM flap that eliminates using the rectus muscle. This is a skin transplant, and includes blood vessels. It requires microsurgery, and includes the risk of total flap failure. (Please note at this time Dr. Jugenburg does not offer DIEP flaps)
- Latissimus Flap Breast Reconstruction This procedure uses the latissimus back muscle to reconstruct the breast. Because the back has less fat than the abdomen, the latissimus flap reconstruction usually requires a breast implant to achieve aesthetic results.
- TUG Flap Breast Reconstruction This is a newer alternative to the TRAM or DIEP flap surgery that utilizes fatty tissue and muscle from the bottom fold of the buttock that extends to the inner thigh. It requires microscopic surgery as it utilizes skin, muscle and blood vessels.
- Gluteal Flap Breast Reconstruction Using a flap from the gluteal area of the buttocks to reconstruct a breast is a complicated procedure and is considered the last resort for reconstructive surgery.
Once the breast has been recreated (the breast mound), women can choose to have the nipple and areola reconstructed as well. This usually takes place some time after the breast mound re-creation in order to allow the newly reconstructed breast to settle in before the nipple/areola are planned. The nipple is created by using the existing breast tissue and wrapping it together into a small ball of tissues. The areola is recreated by either using a skin graft, a tattoo or both. Learn more about nipple reconstruction here.
What to Expect Following Breast Reconstruction
Breast reconstruction is a remarkable procedure to rebuild your breast following mastectomy. Results vary by individual and by procedure, but there are some things you should know about breast reconstruction:
- A reconstructed breast will not have the same sensation as the original breast
- You will always have visible incision lines on the breast, whether from reconstruction or from the mastectomy
- Certain surgical techniques will leave incision lines at the donor site, usually located in less exposed areas like the back, abdomen or buttocks
- If only one breast is involved, it can be reconstructed. But you may consider a breast lift, reduction or augmentation for the opposite breast in order to improve symmetry in size and position of both breasts.
When it comes to breast reconstruction, each patient has a unique set of circumstances and needs. A consultation with Dr. Jugenburg will provide you with the opportunity to discuss your options, answers and questions you have and learn how breast reconstruction will help you go on living your life, and not just surviving your cancer.