In 2009, Melanie Young was diagnosed with stage 2 breast cancer, estrogen-positive, HER2-negative. Following her double mastectomy, she underwent several months of chemotherapy and then immunotherapy. After genetic testing confirmed she was BRCA2 positive, Melanie chose to undergo a salpingo oophorectomy to remove her Fallopian tubes and ovaries. Initially, Melanie chose implants for her reconstruction, but developed complications in subsequent stages, including mobility issues and capsular contraction. In 2025, she came to the Center for Restorative Breast Surgery to have her implants removed and underwent DIEP Flap surgery to restore her breast using her natural tissue. Melanie says the results have exceeded her expectations, and she no longer experiences discomfort and mobility issues. Melanie continues to advocate for women with breast cancer and is the author of the award-winning navigational book, “Getting Things Off My Chest: A Survivor’s Guide To Staying Fearless & Fabulous in the Face of Breast Cancer” (available on Amazon). Follow @melaniefabulous.

Dr. M. Whitten Wise is a board-certified plastic and reconstructive surgeon at the Center for Restorative Breast Surgery in New Orleans, Louisiana. Since joining the center in 2005, he has performed over 2,500 microsurgical and reconstructive breast procedures. Dr. Wise specializes in microsurgical perforator flap reconstruction, nipple-sparing mastectomy reconstruction, revisional reconstruction, and implant-to-natural tissue conversion. His practice is built on offering patients options, honest recommendations, and a lifelong care relationship.

The Center for Restorative Breast Surgery, founded in 2003 and co-located with St. Charles Surgical Hospital in New Orleans, Louisiana, is the only hospital in the world dedicated exclusively to natural tissue breast reconstruction. The center offers more breast reconstruction options than any other facility in the world. More than 70% of patients travel from out of state or internationally to receive care here. The center specializes in immediate, delayed, and revisional natural tissue breast reconstruction, including DIEP flap, SGAP flap, APEX technique, stacked flap, and complex modular reconstructions for patients who have been told they are not candidates elsewhere.

Dr. Wise explains the team-based approach to breast cancer care, coordinating diagnosis, mastectomy, reconstruction, and adjuvant therapies with radiologists, breast surgeons, oncologists, and radiation oncologists to support patients from initial diagnosis through recovery. He emphasizes that most women should be referred to a plastic surgeon before mastectomy to understand choices such as lumpectomy versus mastectomy, the impact of radiation, and the full range of reconstruction or “going flat” options, including prostheses.

The center specializes in microsurgical, autologous (natural tissue) breast reconstruction using perforator flaps such as DIEP (from the abdomen) and SGAP (from the upper buttock), techniques largely pioneered in New Orleans that preserve muscle while transferring skin and fat with their blood supply. These methods offer advantages over older TRAM flap procedures, including less pain, quicker recovery, and lower risk of abdominal complications like hernias and bulges. Dr. Wise describes how candidate selection depends on body habitus, with tailored strategies for very thin and overweight patients, and notes that weight loss before surgery can reduce risk when cancer treatment timing allows. He also explains that autologous reconstructions typically involve a first major surgery followed by a smaller “fine-tuning” procedure after several months to optimize aesthetic results.

The discussion contrasts implants with natural tissue, including the evolution of silicone implants, the role and removal of capsules, and the possibility of converting from implants to autologous reconstruction years after mastectomy, as Melanie did when her implants failed. Dr. Wise notes that many decisions are reversible, including moving from implants to natural tissue or from a flat chest to later reconstruction, though secondary procedures may involve more scarring. He highlights that natural tissue breasts tend to feel warm, soft, and mobile, change with weight gain or loss in proportion to the rest of the body, and generally provide better return of sensation than implants because nerves can grow through living tissue but not through an implant.

The interview also covers nipple-sparing mastectomy, criteria for preserving or removing the nipple, and techniques for nipple reconstruction and 3D areola tattooing, including collaboration with specialized tattoo artists to achieve realistic color, size, and position. Donor-site outcomes are described as similar to a tummy tuck, with low, bikini-line abdominal scars and a small scar at the belly button designed to be hidden under normal clothing. Dr. Wise outlines a typical recovery: 4–8 hours of surgery, about two nights in the hospital and roughly a week in town, temporary drains, early ambulation, four weeks of activity restrictions and back-sleeping, gradual return to low-impact exercise at four weeks, and full activity by six weeks, with most patients resuming work between two and eight weeks depending on job demands.

Because two-thirds of patients travel from out of state, the center relies heavily on telehealth for preoperative consultations and follow-up, and provides nurse navigators and support staff to coordinate records, imaging, logistics, lodging, and post-operative care. The conversation underscores the importance of lifestyle and safety factors—avoiding nicotine, maintaining a high-protein diet, pacing alcohol intake, and being transparent about medications and supplements—to support healing and protect the microsurgical blood supply. Melanie and Dr. Wise also highlight the federal law requiring insurers that cover mastectomy to cover breast reconstruction, including for women who had mastectomies before 1998, and note that the center actively works to optimize insurance pathways, including through an additional office in Dallas.

Throughout, Melanie shares her personal journey—from initial implant-based reconstruction to later natural tissue restoration—and emphasizes patient empowerment: interviewing multiple surgeons, asking extensive questions, involving loved ones, and recognizing that reconstruction (or choosing not to reconstruct) is highly individual and not “one size fits all.” Dr. Wise closes by reflecting on the professional and personal fulfillment he finds in helping women regain a sense of wholeness, and on emerging advances such as nerve and lymphatic reconstruction for lymphedema, which promise further improvements in quality of life for breast cancer survivors.

Melanie Young (00:00):
Hello, I’m Melanie Young. I am a writer who covers wine, food, travel, and health. I’m the host of two podcasts, and I am also a breast cancer survivor and author of the award-winning book, Getting Things Off My Chest, a Survivor’s Guide to Staying Fearless and Fabulous in the Face of Breast Cancer. We’re here today at the Center for Restorative Breast Surgery in New Orleans, Louisiana, my home, I’m proud to say. And I am here with one of my surgeons to talk about the wonderful work that the center does here in New Orleans for women around the world. My guest is the renowned surgeon, Dr. Whitten Weiss. Full disclosure, he was one of my surgeons. So this is a very intimate conversation. He has been with the center for quite some time. He has an amazing curriculum vitae. I won’t go into all the details, but he’s performed over 2,500 microsurgical and other reconstructive and aesthetic procedures in the New Orleans region since 2005.

(01:01):
This hospital specializes in a very specific type of breast reconstruction, and it is what brought me here. It’s world renowned, and we’re going to learn more about it because so many of you may be making important decisions about breast restoration and what to do, whether you’re facing it after a mastectomy or perhaps many years later, like in my case, you decided that you needed to have your breast implants removed and replaced. Hello, Dr. Wise. Hello, Melanie. Well, I’m always curious because when I was interviewing surgeons, when I was going through my first episode facing a double mastectomy several years ago, interviewing a surgeon and finding that right one for this very important relationship is so critical. What attracted you to this specific field of medicine?

M. Whitten Wise, MD (01:52):
Yeah, so it was a fairly direct route for me. You go to medical school knowing that you want to be a physician, and then in medical school you get exposed to lots of different specialties. And I liked all of the specialties that had sort of a very technical component to it. So it was a specialty that allowed us to use very fine instruments and fine blood vessels and then do something that was on the periphery of that. And then the second part of the puzzle for me was that plastic surgery had a sort of an art or architecture feel to it. There wasn’t a set way that everything had to be done. They allowed you to have a little bit of creativity in pursuing the way you pursued an operation and cut things to completion. And so it gave you a little bit of freedom to do things and change the way things are done, which is great.

(02:40):
And then the third part about it was it was, I got to deal with patients that were both lovely and in specific need. And so plastic surgeons, the vast majority of us deal with cosmetic patients, which are very high demand, but at the same time, the reconstructive patients can be that way too, but they’re coming from it from a different perspective. And it ends up being such a wonderful relationship to get to have with these patients that they’re grateful for being restored. And at the same time, we can practice that aesthetic side of our practice as well.

Melanie Young (03:12):
It’s so interesting that you say that because you work with women taking me back to when I was diagnosed with early stage breast cancer, you’re in a very vulnerable position. And the daunting thing is you’re making so many decisions about something you really don’t know anything about. I mean, we didn’t study breast cancer, we didn’t choose to have it. And yet here we are faced with multiple decisions that have to be made very quickly. I want to talk about that and how the center here works with oncologists and the medical team because it’s a team effort and you really underscore that. How does that work? Because you really do have a team of doctors when you’re going through mastectomy, oncology treatment, and of course ultimately breast restoration.

M. Whitten Wise, MD (03:58):
Absolutely. For the breast cancer patients, it often starts with a diagnosis. And so we have to work with the physicians or practitioners that are participating in diagnosing patients. And so that’s often a radiologist or an OB- GYN doctor or your family practice doctor that’s ordering a mammogram or doing the yearly breast exam or following up on those type of tests. And so we work closely with them. And certainly they then send us referrals for patients that come into the practice. That’s part one. And then part two is the cancer side of the surgery. And so breast cancer reconstruction involves essentially a two-part process. The breasts need to be removed. The cancer needs to be removed. The great breast surgeons then all remove the remaining normal portions of breast tissue as well as that we prevent any additional disease from developing in the future. And then they leave me with an envelope that we have to reconstruct.

(04:52):
And then so we’re the reconstructed part of the process. But then after that, we have to work with both the oncologist and radiation oncologist and the patient’s doctors to get them the appropriate adjuvant treatment, the treatments that they need, chemotherapy or radiation therapy after surgery to get them recovered and on and pass their cancer or prognostic diagnosis.

Melanie Young (05:11):
I understand that over 70% of the patients are from out of state. So you treat patients from all over the world.

M. Whitten Wise, MD (05:18):
We do. So about two-thirds of our patients, you’re correct, fly in for surgery. Say about a third of our patients, I call them local. Sometimes local is as far as Pensacola or Jackson, Mississippi, some people that drive in from that area, but the two-thirds of them are flying in and they’re coming in from out of town. It’s quite a bit of trust that they put in us. I’m really just very impressed with these patients when they come to me, that they’ve looked at the website, they’ve talked to our nurse navigators. They’ve on occasion had a telehealth medicine visit with me where we’ve talked in person, and then they’re putting their trust to come down from Michigan, Montana, wherever it may be to see us. And they typically arrive the day before surgery or two days before surgery. And they’re meeting me the day before surgery.

(06:02):
We have a nice initial consultation where we go over basically their entire medical history, how they got their diagnosis, how their treatments have progressed so far. And then we can organize different plans that are options for them. And then we do a good exam and a photographic review, and then the patients and I together come up with the surgical plan. And then that’s the next day. And then they stay with us a couple of nights in the hospital. If we’re doing an autologous reconstruction, which means using their own tissue, they then often spend an additional seven nights in town. And so most of them that are flying in from out of town are here in New Orleans for about 10 days around their surgery.

Melanie Young (06:40):
It’s interesting that do you do a lot of follow-up through telehealth?

M. Whitten Wise, MD (06:44):
Absolutely. So we have a whole team that does follow-up. Myself and the physician assistants and the nurses all follow the patients closely. Some of the patient follow-ups are just send us photographs, talk to us on the telephone, but on occasion, it does need to be a telehealth visit where we’re actually physically chatting and doing exams over the internet. Well,

Melanie Young (07:02):
I think that makes sense. And also just that burning question, how many times I have to get on a plane. So I think that’s comforting to know that you don’t have to always be traveling back and forth. A lot of it is telehealth. I think that’s very important. Also important as the Center for Restorative Breast Surgery has a very specific specialization in terms of breast restoration. And breast restoration is a big word because there’s also reconstruction. How would you define those two and the differentiate them? And let’s talk about the specialty here at the center.

M. Whitten Wise, MD (07:33):
Yeah. So I use those words almost synonymously, restoration and reconstruction. Restore, I think, often feels like something has been lost and is being rebuilt where reconstruction I feel more is that I’m putting back what was there, but very similar terms. And for us, that’s a combination of different modalities that we use to rebuild women’s breast, whether it be a patient’s natural tissue or an implant or a combination of their natural tissue and an implant. We can give them sort of a list of options that would fit their body shape and then go from there to see which works best for them.

Melanie Young (08:09):
Interesting. You know what really was daunting when I was diagnosed is that I had to make this decision fairly quickly. I had a double mastectomy. It was necessary to have a double mastectomy because I know some women have a single mastectomy, but the conversation, and I was at the time living in New York and I didn’t know about the center, but I was so lucky that a dear friend recommended me when I decided to make some changes many years later. When is the best time to address reconstruction? Because I actually was, it was like one of the questions I was asked at the very beginning and I was like, wow. For me, it was like breast shopping. It was great. But when is the best time to address it? Is it on a case by case situation?

M. Whitten Wise, MD (08:52):
For the most part, all patients should receive a referral to a plastic surgeon prior to their mastectomy. There are certainly patients that would benefit from not having any reconstruction. So if patients, for example, with aggressive cancers or some other medical problem that would preclude a longer surgery, ought to focus on their cancer surgery, but that’s the vast minority of patients. The majority of patients can benefit from an immediate reconstruction and reconstruction at the time of their surgery. And so a referral from the diagnosis from the radiologist that diagnoses the tumor or from the breast surgeon who is seeing the patient for the first time, planning what we call the extricative part of the procedure, the removal of the cancer, and send patients over to the plastic surgeon as well. And the first cancer surgery choice the patients typically get is, do I do a lumpectomy or do I do a mastectomy?

(09:46):
And it’s nice to meet with the plastic surgeon even if you are planning to do a lumpectomy because we can give you sort of insights into how the breast will look with a lumpectomy, what are the downsides and upsides of doing a lumpectomy? What effects will radiation therapy have on this breast compares to my other breasts? Should I have to have a lumpectomy, which is almost always the case with a lumpectomy is that patients will require radiation and the plastic surgeons can help sort of delineate what that’s going to look like for you and how those changes will affect your body shape and breast shape.

Melanie Young (10:19):
That is such an important point because I have friends who underwent radiation and it did change the shape of their breast afterward. And it’s important to know really you have a team, you have your breast surgeon who removes the breasts, you have your oncologist who is with you for a very long time, and it determines your course of treatment and you have your reconstruction surgeon. I suggest everyone should interview a number of surgeons. I had the rule of three, no more, and that’s what I did and asked for referrals, which I did, which is how I found you here in New Orleans. What are some key things that you would advise patients to ask if you have the top line things?

M. Whitten Wise, MD (10:59):
Yeah, you want someone that doesn’t essentially push you into a specific operation. You want to go to someone that gives you options for what both your cancer scare is going to be and your reconstruction is going to be. You also want though someone that will give you recommendations. And so it’s, as you sort of mentioned, it’s very daunting when you have all of these choices. And yes, it’s on you to make choices, but a lot of patients do need a little bit of guidance through those choices. And so you want options and you want recommendations, and then you want someone with experience. And so those were sort of the three things that I would look for when I was seeing someone that was a new consult for me that what I would look into going to see.

Melanie Young (11:40):
And I can tell you as a patient, don’t be shy. I mean, I’ll be honest with you, I met with women and I said, “Take your shirt off. I want to see your breasts.” Because I wanted to know what they looked like and felt like because I didn’t know. This is like an uncharted territory for me. I just knew I had the chance to get new breasts. That was exciting. That was a very positive outlook on the fact that I was having my real ones disappear. So it was very upbeat feeling to know that I could reconstruct. And I think it’s important for everybody watching this to know that there are many options to reconstruction, including the option not to reconstruct.

M. Whitten Wise, MD (12:16):
Correct. Yeah. Certainly that is an option as well is that’s one of the choices that we list for patients that there are breast prosthesis and other thing that can be worn under your shirt and bra to help mimic the breast shape, but you need to know about how they are going to feel, what kind of discomfort that they can cause as well. And so make sure that we talk about all of those with the patients.

Melanie Young (12:36):
Yeah. And also some decisions can’t be reversed.

M. Whitten Wise, MD (12:42):
Some concisions cannot be reversed. You’re absolutely correct. At the same time, a lot of them can.

Melanie Young (12:47):
Really?

M. Whitten Wise, MD (12:47):
And so for example, some patients have implant reconstructions and they change their mind and go to their own tissue reconstructions. And so what often seemed like a permanent choice at the start doesn’t always have to be. And even the women that choose to go flat from their original surgery can later on decide that they would like a breast cancer reconstruction and we have that ability to do it.

Melanie Young (13:08):
Wow.

M. Whitten Wise, MD (13:09):
It does cause a little bit more scarring because we have to then replace missing breast skin, which leaves a patch of skin on their breast that is maybe a little bit tiny bit different color and has a scar around the perimeter, but it can very ideally mimic the size and shape of the opposite breast if that one remains or both of them if we’re matching them both.

Melanie Young (13:28):
That’s amazing because I read somewhere that a larger percentage, and I even realized when I updated my book for the third edition, I actually did a section on choosing not to reconstruct because when I was diagnosed, I never thought that someone would ever consider not reconstructing, but apparently a lot of women don’t, or they’re not able to.

M. Whitten Wise, MD (13:48):
Or they’re not offered.

Melanie Young (13:49):
Or they’re not offered. Well, you have to ask. I mean, when you’re a patient, be empowered and ask questions, even the crazy … I mean, I have lists here and lists here because I want people to know that you do not choose to have breast cancer, but you have many choices on how you want to proceed with the journey to win your road to wellness and becoming whole again. Yeah. It’s really, really important. So let’s talk about your area of expertise. This center is a pioneering in the area of natural tissue breast restoration. It was not really an option for me when I was going through my mastectomy and not encouraged. So I was kind of steered toward implants, which I later had removed, as you know, because you removed them and replaced into new surgery. What is natural tissue restoration as a surgical procedure to recreate breasts?

M. Whitten Wise, MD (14:48):
Yeah, certainly. So New Orleans as a city is a kind of a unique place in the heck that a lot of the techniques that are used for what we call microsurgical breast reconstruction were pioneered here in this city. And so some of them under this very roof where we have done operations that were essentially unthought of beforehand are now very commonplace, not only here, but now have spread across the world.

Melanie Young (15:09):
Incredible.

M. Whitten Wise, MD (15:10):
And so the two most common sites that we use for rebuilding patients’ breasts using their own tissue or their tummy or their upper buttock. And those operations are called either a DIEP flap or an SGAP flap and an SGAP flap. And they both are what we call perforator flaps, which means that they involve blood vessels that come through the surface of the muscle. The older operations that used the blood vessels also sacrificed the muscle too. And so there’s an older operation called a TRAM

(15:42):
Where they would cut the muscle and transplant it up there. Well, evolution in that techniques has evolved. And we have then come to this process where we can follow those blood vessels through the muscle without having to cut any of the muscle and still have the same success rates as transplanting the entire muscle up there. And so it offers a bunch of advantages that cutting the muscle does not. It’s less painful. The recovery time is quicker. There’s less chance for complications in the abdominal area, mainly hernias and bulges by not disturbing the muscle as much. And so you’re able to give patients the same quality reconstruction as a tram flap reconstruction, but without the morbidity of that operation, so a quicker recovery time and less pain and less discomfort.

Melanie Young (16:28):
I think that’s important because I think what daunted me when I was facing my decisions was I was running a company, I had a very full life, I was athletic and I was like, “What? I may not have stomach muscles.” I worked hard to get those stomach muscles. So I went implants. It’s a whole nother procedure and it all takes time. There is no easy, quick road to reconstruction. It is a road. I think my implants took about a year because you blown up, blown up, blown up, and the process for natural tissue reconstruction is also a process and it’s a two-part surgery, right?

M. Whitten Wise, MD (17:07):
Correct. Yeah. We try to get patients restored as much as possible in a first-stage surgery, but invariably, we and the patients feel like we can do some fine-tuning of the results with the second operation. And we typically stagger those surgeries by a three-month or longer interval to allow some healing processes to go, to allow some settling to go, and so that we can really get a second operation that can end up with a beautiful aesthetic final result.

Melanie Young (17:36):
So is there a candidate to become a candidate for this type of surgery, do you need a lot of fat? I had people offering me their fat. No, that doesn’t work. We’ll talk about that. But do you need to have enough fat and tissue to do this successfully? What makes a great candidate?

M. Whitten Wise, MD (17:56):
Absolutely. So certainly there are patients that are more difficult candidates, and oftentimes those are ones that are a little bit heavier set.

Melanie Young (18:05):
Really?

M. Whitten Wise, MD (18:06):
The overweight patients are a little bit more challenging. At the same time, these patients are at a difficult spot because implant reconstructions are even worse in the heavyset patients, and so they are better off using their own tissue. The ideal patient is someone that has put on a little bit of weight and then lost a little bit of weight. Sometimes that’s through pregnancies or weight gain where you’ve just gained a little bit. What that has done is it’s stretched out your abdominal skin. Menobize. And so all of these things that can help us just a little bit that makes the surgery easier. But even in patients that are extremely thin or patients that are very overweight, we still have options for those patients. We have to sort of modify our techniques. For the very, very thin patients, we’re often looking at tissue from their upper buttock.

(18:55):
They often will not have enough tissue on their tummy to rebuild rest. And so we start looking for alternative spots. And thankfully, there’s usually a little bit of volume in the upper buttock that we can use instead. And then for the patients that are a little bit thicker, sometimes it could be a roll of fat that’s in the bra roll that traces onto the back or a portion of the tummy where we don’t have to use the entire portion, but we can then trim it down and use it that way. And so certainly there will be options as well. For the patients that are a little bit overweight and have the ability not to do their surgery right away, losing weight is helpful. And so we can often work with some medical doctors around us or our colleagues that are in the weight loss field and help patients start on that path to a little bit of weight reduction, which can lower their risks associated with surgery.

(19:45):
If they’re dealing with an active cancer, we can’t push that off. And so the patients that are doing reconstruction who are also getting their cancer treatment at the same time, certainly whatever body shape you come in is going to be what we have to work with.

Melanie Young (19:58):
But you could do it while you’re going through chemotherapy. Wow.

M. Whitten Wise, MD (20:01):
Absolutely. And so we do have to take a pause for chemotherapy for the reconstruction, but if it’s chemotherapy, it’s typically … For example, if chemotherapy is typically done before or after the surgery, and so it’s rare that patients are in the middle of chemotherapy during surgery, but there can be some of these long-term chemotherapy agents that some of the breast cancer patients are

Melanie Young (20:24):
On.

M. Whitten Wise, MD (20:25):
The hormone manipulations that go along with post-cancer care that need to be stopped for a short amount of time around surgery.

Melanie Young (20:32):
Yeah, because it would be a taxing on the body. It really is. And of course, you can’t just use other people’s fat. Let’s just clarify that now because boy, a lot of people told me that.

M. Whitten Wise, MD (20:42):
It would be great. So if you’re using fat from someone else, it would essentially be a transplant and transplants are successful.

Melanie Young (20:49):
Really?

M. Whitten Wise, MD (20:50):
Kidney transplants, heart transplants, but the side effects of the immune suppression medicines aren’t worth the risks of that surgery. And so for that reason, we don’t offer transplants to patients from another person’s body with the rare exception of an identical twin, which wouldn’t need any immunosuppression.

Melanie Young (21:08):
Which I found fascinating when you told me that. Identical twins, who knew? But back to making this decision, it is a process. I have now gone through my surgeries and I’m in the end part of the recovery. And I can say that it is something that you need to realize it does take time. Recovery takes time. If I did anything, I would’ve done differently from the very beginning. I wish I had done natural tissue restoration from the beginning because I could have done it with my mastectomy. But as I said, I chose implants. So I want to just touch on that. In my case, I came to you because my implants were leaking or something. I mean, they were like half the size of what they had been, and that was a concern. And so is the process for removing an implant and recreating breasts different or similar to doing it after a mastectomy?

(22:03):
Because you have that flappy skin.

M. Whitten Wise, MD (22:05):
Yeah, it’s very similar. And so the first part when we take out patient’s implants is we really want to recreate where the breast was. And that’s often where the implant is. And so we will take out patient’s implants, we will take out the majority of the capsule around the implant, which is the body’s response to an implant. Your body recognizes the implant is a foreign material

(22:27):
And when it’s there, it decides it wants to form a scar around it, what’s what we all call a capsule. And then over time, those capsules can change and shape as the body contracts in relation to the capsule and then can deform the implant as well. The implants aren’t perfect devices. They’ve gone through quite a bit of evolution. We’re on generation five or six silicone breast implants and they’re much better than they were in the past. The older silicone breast implants were filled with a silicone liquid. The new ones are filled with what they call a cohesive silicone gel, meaning it looks a lot like the inside of a gummy bear. And so if you slice the implants open, it typically look like those.

Melanie Young (23:05):
It has those round one, but for some reason mine were called, but now they get new ones. I feel like I’m a patient expert on breast restoration because I’ve had three different surgeries. My first ones I had to have now because there was a risk. We replace them with saline. They were lovely, but then they started to maybe over time get capsular contraction. And that’s when I said, “I want to have real breast mint.” I have to say, I can’t keep my hands off my breasts. I mean, they’re just so natural feeling. It’s unbelievable. I have cleavage again and sensation, which I want to talk about two things. A lot of questions are, will I ever have sensation? Because with implants, you really don’t have sensation. Actually, you’re cold, but it’s cold, or I was, but it seems like I’m having more sensation. Is that typical or am I just having euphoria?

M. Whitten Wise, MD (23:52):
No, it is typical. So whenever there’s a mastectomy done, whenever the breast is removed, you can expect a degree of sensory loss in the breast, which is definitely one of the downsides from a mastectomy. And our breast surgeons that work with us here are fantastic breast surgeons. They’re able to preserve the nerves for an appropriate amount, which means that our sensation returns fairly quickly, but it doesn’t ever get quite back to normal. And so people often lose some of the sensitive feelings around the nipple that would typically be a part of an experience, but you can’t expect it to get better. And then the nerves do regrow with time. They regrow very slowly and the younger patients regrow nerves faster than older patients do, but the nerves cannot grow through an implant. And so if you’re trying to get sensation around an implant that the nerves really have to grow around the implant, whereas the nerves do an autologous reconstruction using patient’s own tissue can grow through the surface of that tissue because it’s a natural tissue.

(24:53):
And so you get a little bit better return of sensation with a natural reconstruction than you do with an implant reconstruction. Well,

Melanie Young (24:59):
I think it’s interesting because might feel natural and warm and they move. I mean, that’s a big one, move. And that’s wonderful. Let’s talk about nipples because that wasn’t even an option offered to me. So mine went in the garbage or something, but you can have nipple sparing surgery.

M. Whitten Wise, MD (25:19):
Absolutely. So-

Melanie Young (25:21):
Talk to us about that.

M. Whitten Wise, MD (25:22):
The vast majority of patients are candidates for nipple sparing mastectomies, and we need to work very closely with our breast surgeons to sort of determine those. And I typically will see patients and we’ll come up with reasons for saving and not saving the nipples. And the vast majority of them are candidates for saving the nipples. And there’s sort of three reasons that occasionally you can’t save the nipples is number one, the most common is that the cancer is too close. And so if the cancer is too close to the nipple, the nipples would need to be removed. And our breast surgeons, when they do the mastectomy, will sample the tissue directly below the nipple to ensure that there is no tumor encroaching upon the nipple. The second most common reason that we would need to remove the nipple is in my purview, which is that the nipples are just too saggy, toototic, which is the medical term for just hanging a little bit too low.

(26:10):
And we want to return women to a more youthful look, but you can’t really do a lift on a patient whose nipples are too low. If they’re a little bit low, yes, we can lift them after the surgery, but if they’re extremely low, then they may be better off having them removed, partially because of the way that they would look, but partially because that the blood supply to them might be compromised by the mastectomy and they could turn into a little piece of scab at the end of the surgery, which we don’t want to happen and they don’t either.

Melanie Young (26:40):
So you can also recreate nipples.

M. Whitten Wise, MD (26:42):
Correct. And so we can rebuild nipples at that revisional surgery. Nipple reconstruction is a little bit like origami. It’s you actually take the tissue and you twist it upon itself. And so you create a couple of minor scars and use those little scars as projections that then get rotated upon themselves and rebuild the papilla, the bump of the nipple. All nipple reconstructions will involve an aerial tattoo, which

Melanie Young (27:06):
Is

M. Whitten Wise, MD (27:07):
Sort of the fantastic part of the surgery. Had a lot of women that thought they would never get a tattoo, and here they are meeting with our tattoo artist. And there are some great tattoo artists around the country. We have one that we have worked with very closely, a guy named Vinny Myers, who is out of Baltimore. He does some of the best nipple tattoos that we’ve ever seen.

Melanie Young (27:25):
They’re very realistic. And you could pick your color. It’s like picking blush, I’m telling you.

M. Whitten Wise, MD (27:30):
Yes. Start picking colors, picking sizes, picking shapes, and picking positions.

Melanie Young (27:34):
It was very daunting for me when I was doing all that. I had my husband with me. And I do encourage anyone, if you have a significant other, make them part of the process because it’s important for them to understand what you’re going through. And my husband got into the selection process with me. We were like, oh wow. And he’s been with me this whole time with my current journey going through natural tissue breast restoration. I think it’s important. What happens? This is a big one with natural tissue because with implants, you gain weight, your breasts are the same. You lose weight, your breasts are the same. What happens if you gain or lose weight when you have natural tissue restoration?

M. Whitten Wise, MD (28:15):
Yeah. So if we have used transplanted abdominal fat or buttock fat, it retains the memory of what it was and it will behave exactly like your abdomen did when you gained weight in the past. And so if you’ve rebuilt breast with abdominal tissue and if you normally put on weight in your abdomen with weight gain, you will now put it on in your breast. And the same if we’d use buttock tissue and that’s the case. The good news is that most women, when they gain weight, do tend to get a little bit more volume in their breast in addition to their tummy, and so it tends not to act out of proportion. And so I very rarely have had to adjust patients’ breasts for size related to weight gain, because it typically tends to mimic the rest of their body. And it’s also the same for losing weight though.

(28:59):
And so if you lose weight afterwards and you lose weight in your breast and we’ve transplanted or you tell me we’ve transplanted that up to your breast, you will lose volume in there. But again, it tends to be very proportional and feels very natural. The big downside from losing weight is they will sag a little bit again,

(29:14):
But part of the reconstructive process is that you’re our patient for lifetime and we can bring you back in at your convenience and do a lift on you. And it’s still part of your cancer care surgery. And even five to 10 years later, it is usually still covered under insurance. Well,

Melanie Young (29:29):
I think that’s important because there was a federal act that was the government passed in, I think 1998, that the Women’s Cancer Restoration Act, I think is what it’s called, where insurance must pay for restoration after mastectomy, whether it’s implants or prosthesis or any kind of restoration. And I thought that was major when I was writing my book because I’m like, “What happened to the women before 1998?”

M. Whitten Wise, MD (29:58):
It is retro Proactive, so those women that had surgery before 1998 can still come in and have reconstruction later on. So it’s still possible for them to come back and get it now, which is great. But yes, it mandates that if your insurance carrier care provides coverage for mastectomy services, that they have to provide coverage for breast reconstruction as well.

Melanie Young (30:19):
That’s important. A lot of women do not know that. I did not know that. Boy did I do not know that now. I went through the whole insurance thing when I was doing this. One of the things I’m very impressed with is that the hospital here really does have patient advocates and people to help you all along the way with those daunting issues as well. And I was really impressed by that because it can be very scary when you get in there and you were like, “Well, what happens? It’s going to cost me anything. What’s going to happen?” It’s nice to know you have people in place to help the patients. It’s really, really important.

M. Whitten Wise, MD (30:51):
Yeah, it’s important for us. For our patients from out of town, we have to gather all of these records. And so we need copies of their pathology reports. We need discs from their mammography. We need discs from their MRIs so we can review those and provide the appropriate care from them. And then when the patients come, we have this great team that both helps the patients navigate the hospital complex, but also around town as well. We find accommodations for patients, help them with travel and really get patients back home as quick as possible.

Melanie Young (31:20):
Although New Orleans is a great place. If you’re going to have surgery, come to New Orleans, it’s great. I encourage it. So we haven’t talked about the tummy or the butt or the places where the fat comes from. Mine came mainly from my tummy and some thighs. What happens to your tummy and thighs? It’s like a tummy tuck. Yeah.

M. Whitten Wise, MD (31:37):
Part of the operation has evolved quite a bit over time too. So when people first started doing the surgery, the scars did not look quite like a tummy tuck. They were fairly high, meaning they were closer to the belly button. Well, what we’ve learned is we can lower that scar and really make it look exactly like a tummy tuck. So we want to keep it under underwear line, under a bikini line. And so the final scar for what’s our standard operation, which is the DIEP flap, should be a fairly lengthy bikini line incision like a tummy tuck, and then a small little circular scar inside your belly button. And so everything that should be very well hidden under all normal clothing.

Melanie Young (32:16):
I think that’s interesting. And it’s encouraging because you do worry, your body is transformed. I mean, it’s a transformative process because you also have to wait for swelling to go down to figure out where you are. I’m in that process right now. Let’s talk about patient recovery because a lot of women are going to want to know how long is this going to take and what do I need to do? Well, to prepare for the surgery, let’s talk about that and to recover from it.

M. Whitten Wise, MD (32:43):
Yeah. So the surgeries themselves take somewhere in the range of four to eight hours.

Melanie Young (32:48):
Right.

M. Whitten Wise, MD (32:48):
So a fairly lengthy surgery. Most of our patients for what we call a stage one or a first stage surgery are spending two nights in the hospital with us. They’re spending additional five nights in a hotel in town nearby. There are drains involved. Drains are little plastic tubes that come out the skin. There’s typically one at each breast and one at each donor site where the tissue has come from. So if it’s the tummy, it would be two drains in the tummy. The drains typically are ready to come out somewhere between a week and two weeks. So most of our patients from out of town, we can usually get three of their four drains or two of their four drains out before they go back home. Wow. We have videos on how to take them out on their own. We often have family members. It’s very common that somebody has a nurse or a physician friend that’s willing to take their drains out as well, or their family practice doctor will often take their drains out back home, but usually it’s a family member to take their remaining drain out.

(33:39):
Recovery time starts immediately after surgery. And so we start helping the patients recover. Some of that is lymphatic massage to the arms, getting the patients sitting up in a chair the day after surgery, getting them walking the halls the day after surgery. After discharge, we ask the patients to walk and shower. So I want you to shower daily and walk certainly.

(34:01):
Really, we don’t let you do much more than that until about four weeks after surgery. And so we have some big restrictions that last the first four weeks. And for me, the two that I tell the patients the most commonly is we’re going to ask you to sleep on your back for four weeks after surgery, which often sounds difficult to the patients, but it’s fairly comfortable position because if you roll onto your side, you’ll put a little pressure on the breast and you’ll feel it. And so laying on the back ends up being one of the more comfortable spots for them. And then we have them doing showers only for four weeks after surgery, which means no baths. And so no soaking around the water in a bathtub until the incisions are a little bit further healed. There may be some minor restrictions on the range of motion to your arms, meaning we don’t want you purposefully stretching very high for four weeks after surgery.

(34:47):
My patients that love exercise and want to start exercising, we encourage that, but at the same time, I do have to limit it. And so the first thing that I’ll let them do is walk, which is the day after surgery. At four weeks, if they want to do some low impact aerobic activity, they can. And for me, that’s things like a stationary bike and a lifticle machine or a stair climber. And then at six weeks, all the restrictions lift. You can do really anything you want. So patients that want to get back into the gym can do that. Patients that are working should plan on taking about four weeks off of work if it’s easy. If you need to get back at two weeks and you have a desk type job, that certainly is possible as well. If you feel like it’s going to be difficult for you to do anything that’s not manual labor, certainly we’re happy to write for six plus weeks off without any questions at all.

(35:34):
If patients need that to recover. I would expect most of my patients to try to get back to work at somewhere between six and eight weeks at the longest. We want them to return to a normal life.

(35:43):
I feel like it helps their mental recovery and they can get back into their life.

Melanie Young (35:48):
But you also have to listen to your body.

M. Whitten Wise, MD (35:50):
Absolutely.

Melanie Young (35:51):
Because general anesthesia, which is what this is, it can really be exhausting as well. As I learned, I mean, the surgery that I had when I was at 50 and now 67, I’m a different person and I take longer to heal. And I know that from my experience. And I also jumped back into work probably too quickly when I had my first surgery, and that was very difficult. Some other really important things that you underscore everyone, do not smoke. Sure. Be very open and honest about what medications, prescription medications, and supplements you’re taking, because everything can impact the surgery. I mean, I might get off as much as you can to have your body ready for the surgery and don’t rush into doing things. Get permission before you go back to the prescription medications that you’ve been taking. As you said, exercise, take it easy and listen to your body.

(36:45):
I think that’s really important. I’m very impressed with the follow-up here. The physician’s assistants have been very good at checking in and calling to see how I’m doing, and I’m very, very impressed by that. One last question is you said I was the lifetime, you’re a patient for lifetime. So if something happens down the road and, God forbid, another cancer, or you need to make changes, you can come back. Absolutely. That’s so reassuring. So let’s talk about stamina. I mean, the patient has to understand that she’s going to need time to recuperate. Don’t be a hero on that one. Trust me, I tried. It is so good to be kind to your body and to listen to it and to listen to your team. And also make sure your primary care physician knows what’s going on as well. So it’s all a team approach to your board of directors, the board of directors of your body, right?

(37:41):
So let’s talk about stamina because this is a lot of stamina on you. I mean, how many surgeries do you perform in a week or a day?

M. Whitten Wise, MD (37:48):
I typically, if I’m doing this type of surgery, we’ll do one to two at the most. I guess it’s on occasion, we can do two of them, but that’s a rare basis. And so most of the time it’s one of these a day. And then again, we talked a little bit about that they often involve a touch-up surgery, and the touch-up surgery takes about three hours, and I can do two or three of those in a day.

Melanie Young (38:08):
Wow. So how do you keep your salmon up?

M. Whitten Wise, MD (38:11):
Coffee and-

Melanie Young (38:13):
Oh no,

M. Whitten Wise, MD (38:14):
Coffee. Coffee and snack breaks. So it sparks perfect. So I definitely have a moderate little sweet tooth, so I have to watch out for- I remember that. … for cookies and cupcakes and donuts and that kind of thing.

Melanie Young (38:25):
Because you’re wearing … I mean, not that I would know because I was unconscious, but you have a lot of headgear on in the photos.

M. Whitten Wise, MD (38:31):
Yeah. So when we’re in surgery, we have the surgical mask and a surgical hat, but we also wear a pair of magnifying glasses. Magnifying glasses are 4.3x magnifying, and so they get you quite fine detail. And then when we’re doing the surgery itself, we end up bringing in what’s called an operating microscope, and that operating microscope can get us up to a 20X magnification field so we can really see those small vessels. The headpiece does weigh a little bit. And so yeah, the worst part about it is just you have to watch your posture because you’re constantly leaning over and so it can cause some neck and back discomfort. So I have to work with my partners to make sure that the bed height is an appropriate level for both of us so that somebody’s not bending over or stooping because that can cause us to have some discomfort.

Melanie Young (39:15):
That’s interesting. As I lay in bed recovering, I thought about those core puzzles and how amazing it is that you’ve basically took from here and up here and they all got reattached. I mean, I was like, praying, please don’t reject me, please don’t reject me. But if you really better can’t reject your fat, it’s already part of your body.

M. Whitten Wise, MD (39:34):
Correct. So it’s you. So we think of rejection as a term related to a transplant usually from somewhere else. And what that means is the body is recognized that material is not its own and is sending these chemicals and other cells to attack it. But for you, it’s your own tissue. And so it doesn’t really undergo a process of rejection, but there is a blood supply that needs to stay open. And so we’re hooking up very small arteries and veins. And if those blood vessels don’t stay open, then that transplant can have a very similar effect to a rejection, but it’s not truly a rejection. It’s just an inadequacy in the blood supply.

Melanie Young (40:09):
It’s really important for a patient and doctor to stay in touch and to monitor, to look for any unusual changes in the body or in the incision to make sure you’re on top of it and don’t do too much.

M. Whitten Wise, MD (40:21):
Absolutely. And I love that you brought up the smoking part too. So definitely we want our patients to certainly avoid all nicotine products altogether. And then the other part is eating a healthy diet afterwards. And for me, it’s you need to keep up a fairly high protein intake after surgery so that you can heal.

Melanie Young (40:35):
Oh, I am. My husband’s chasing me around with plates of protein all the time. He’s like, “You’re not eating enough protein right now.” I mean, I’m sucking it down, but the diet is so critical and don’t smoke ever, just period. But I’m a wine writer and I mean, I couldn’t wait to get back into wine, but I’ve really paced myself. Just take it easy and sleep. Sleep is great. Walking is great. You want to recover fully. So what keeps you motivated to do this? And is there anything else on the horizon that you see happening that will benefit patients?

M. Whitten Wise, MD (41:09):
Yeah. So certainly what keeps me doing this is just the joy of getting to interact with all of you people. So it’s really fantastic that I get to meet so many neat and wonderful people from around the world that I feel like I can help, which is very rewarding to me professionally and personally. And so I really enjoy that. And then as far as things on the horizon, certainly some minor new techniques that are coming around. So certainly working with things on both nerve preservation and nerve reconstruction, lymphatic reconstruction for the unfortunate women that have lymphedema after surgery. So on occasion, women will develop swelling in an arm related to their cancer care. And it’s typical if they’ve had a very aggressive cancer that’s had to have both lymph nodes removed and been radiated afterwards. And there are some alternative treatments now, some surgical treatments to restore lymphatic flow in the arm as well, which can be very helpful.

(42:03):
And then for us, we are working at trying to optimize the patient experience in relation to their insurance plan. And so how can we make everybody a candidate? And for us recently, it’s been transitioning from bringing everybody here to possibly bringing other people to other sites that we are involved with. So we have an office in Dallas now. And occasionally if patients don’t qualify for an insurance procedure here, perhaps they qualify for an insurance procedure in Dallas.

Melanie Young (42:33):
Wow. Well, I think that’s, to underscore, you’ve got to ask a lot of questions. Don’t take over an answer. When it comes to insurance, always be on your guard. I mean, I think it’s important. I think the lymphedema thing is really exciting because for many years, I would wake up in the middle of the night like this and stare at my arms in the middle of the night because I had a lot of lymph nodes taken from here and I had this fear of lymphedema. And literally every night, are they just saying? Not what they are, but I’m always like, when someone wants to take my blood pressure, I’m like, “Touch my left arm.” I’m very protective, but that’s very encouraging that there is much more on the horizon. I think in summary, I think it’s important that as a patient, when you hear the word you have breast cancer, get a great team, ask a lot of questions, talk to other survivors, talk to people that have been through the journey so that you know, but also listen to your own body and your gut and know what’s right for you because it’s not cookie cutter.

(43:27):
There are certain treatments that work for some people, but not others. I mean, I’m always there to help people who are going through it, but everyone is different. And the great thing about reconstruction is you have that choice too to reconstruct or not, but also the kind of reconstruction you want. I’ve been very happy with my natural tissue because I finally feel like I’m a natural woman again and I have sensation in my upper body. It’s awesome.

M. Whitten Wise, MD (43:49):
It’s warm, it’s soft, it’ll change just with you, so it’s perfect.

Melanie Young (43:52):
Yeah, it’s great. I just got to stop touching myself in front of people. But anyway, other than that, it’s been great. Oh, good. Thank you so much, Dr. Weiss. Again, we’ve been talking to Dr. Whitten Wise and we’re at the Center for Restorative Breast Surgery in beautiful New Orleans, Louisiana. This is a pioneer in natural tissue restoration.

What topics does Restore & Reclaim cover?

Restore & Reclaim features conversations with the surgeons, specialists, and patients at the Center for Restorative Breast Surgery in New Orleans. Episodes explore the full range of breast reconstruction options, the surgical and emotional journey of recovery, advances in microsurgical technique, insurance and logistics for out-of-town patients, and what it means to feel whole again after breast cancer. New episodes are added regularly.

What types of breast reconstruction surgery are available after a mastectomy?

Women have more options today than ever before. Natural tissue reconstruction uses the patient’s own skin and fat, commonly from the abdomen or upper buttock, to rebuild the breast without implants. Implant-based reconstruction is also an option, as is a hybrid approach combining natural tissue with an implant. Some women choose not to reconstruct at all. The right path depends on body type, cancer treatment, personal goals, and timing, and the surgeons at the Center for Restorative Breast Surgery help each patient understand every option available to her.

Does insurance cover breast reconstruction after a mastectomy?

Yes. Federal law requires insurance carriers that cover mastectomy to also cover breast reconstruction, including immediate, delayed, and revisional procedures, as well as any procedures on the opposite breast for symmetry. This applies to both natural tissue and implant-based reconstruction. Women who had mastectomies before the law took effect in 1998 may still be eligible for coverage today.

Who is a candidate for breast reconstruction surgery?

Most women are candidates for some form of breast reconstruction, regardless of age, body type, or prior treatment. Even women who were told they are not candidates elsewhere, due to prior radiation, failed implant reconstruction, or having chosen to go flat, may have options. Timing, technique, and the order of procedures all vary by patient, which is why a consultation with an experienced reconstructive surgeon is the most important first step.

When should a woman start thinking about breast reconstruction?

Ideally, before a mastectomy. Meeting with a reconstructive surgeon early, even before deciding between a lumpectomy and mastectomy, allows women to understand how different treatment paths will affect their reconstruction options. That said, reconstruction is possible at many stages: immediately at the time of mastectomy, months or years later, or as a revision of prior reconstruction.