Breast Reconstruction



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According to the American Cancer Society, the lives of nearly 269,000 people in the United States will be disrupted this year by a diagnosis of invasive breast cancer. Most of those individuals (99 percent) will be women. With advances in oncology, prognosis continues to improve. Yet the emotional impact is significant. Dr. Nirmal Nathan works to restore pre-diagnosis normalcy for women in the Miami, FL area, using leading-edge techniques in breast reconstruction.


Returning to good health is job number one after cancer diagnosis and treatment, and emotional wellbeing plays an essential role in recovery. For most women, breast appearance is intertwined with confidence and self-image. Just knowing that a plan is in place to restore it is vitally helpful in balancing tumultuous feelings associated with breast cancer. That’s why Dr. Nathan encourages patients to contact him early in the process – ideally as soon as they find out they have breast cancer.

Dr. Nathan has a vast and extensive experience in breast reconstruction. During his training at the University of California – San Francisco, he performed both implant based and microsurgical reconstruction. He now brings the latest techniques from the West Coast’s busiest breast reconstruction center to Miami.

While Dr. Nathan brings a wealth of artistic and refined surgical techniques from cosmetic procedures to breast reconstruction, the two areas of plastic surgery are very different. Breast reconstruction surgery is highly individualized and involves a number of complex aspects not present in cosmetic techniques such as breast augmentation. Dr. Nathan has a great deal of experience in re-creating shapely, natural looking breasts for cancer patients.


There is no pat description of “normal” for breasts – they are unique in shape and size, symmetry and position, color and skin texture.


  • Mammary glands comprised of lobules that produce milk.
  • A system of ducts which carry milk to the nipple.
  • Modified sweat glands called Montgomery’s tubercules which lubricate nipples during lactation.
  • Subcutaneous fat for cushioning and as a stored energy source.
  • Connective tissues which stabilize and support breast structure.
  • Blood vessels.
  • Lymphatic vessels (which drain to lymph nodes nearby).

Breast anatomy does not include muscle. Rather, breast tissue sits on top of muscles of the chest wall.

Cancer, in general terms, refers to abnormal cells that multiply quickly, usually forming a lump or tumor. Cancer is said to metastasize when abnormal cells invade tissues surrounding the original site, or spread to other areas of the body.

Breast cancer can originate in various parts of breast anatomy, but milk ducts and glands are the most common sites, known as ductal and lobular cancers respectively. Many breast lumps are benign, not cancerous, but without treatment may increase a woman’s risk of developing cancer. Early detection is vital for successful treatment of breast malignancies.

Upon diagnosis, your surgical oncologist determines the most appropriate treatment plan, depending on the stage of cancer, your age and health status, and other factors.


  • Lumpectomy – Removal of the malignancy and some non-cancerous tissue around it.
  • Lymph node dissection – Removal of a piece of lymph node (under the arm) for biopsy.
  • Partial or segmental mastectomy – Another tissue conservation procedure where only the cancerous portion of breast and some surrounding tissue is removed.
  • Modified radical mastectomy – Removal of the entire affected breast, as well as lymph nodes and possibly some chest wall muscle.
  • Total or simple mastectomy – Similar to a modified radical mastectomy, but a separate incision is made to collect lymph node samples for biopsy.
  • Nipple-sparing mastectomy – Preservation of the natural nipple and areola during removal of cancerous breast tissue. When feasible, this benefits the aesthetic outcome of reconstruction.

Women with a family history of breast cancer, or those carrying the BRCA1 or BRCA 2 gene mutation, may opt for prophylactic mastectomy. This involves full mastectomy for removal of both breasts to virtually eliminate risk of developing breast cancer.

Regardless of the technique used, there is some level of disfigurement to the breast. It ranges from minor contracture of breast tissue as a result of scarring, to change in overall size or shape of the breast, asymmetry (compared to the unaffected breast), displacement of the nipple and areola, or absence of the breast.  With Dr. Nathan’s expertise in reconstructive breast surgery, breast aesthetics can be improved, restored, and even enhanced. While it is virtually never too late to consider plastic surgery for breast reconstruction, sooner is better for your peace of mind and healing.


When feasible, Dr. Nathan recommends integrated care for a combination procedure. He works closely with your oncology team, beginning as soon as possible after diagnosis, to coordinate reconstruction surgery with the mastectomy. This avoids the need for a second surgery and associated risks of anesthesia and infection. The most important benefit of a combination procedure, though, is that breast mounds are intact when you awake from surgery. You are spared the shocking experience of seeing no breast or breasts. If your treatment plan calls for radiation therapy, or for personal reasons, you may choose to have breast reconstruction completed at a later date.

In Dr. Nathan’s care, a great deal of attention is given to tailoring treatment for natural-looking results. This may involve use of a tissue expander, a silicone bladder inserted then gradually expanded with saline solution to create space in the surgical site for a breast implant.

With the TRAM (transverse rectus abdominal muscle) flap technique, Dr. Nathan uses tissues – fat, skin, and muscle – harvested from your abdomen to reconstruct the breast. You get the benefits of abdominoplasty or tummy tuck, and avoid the need for an artificial breast implant. Deep inferior epigastric perforator (DIEP) flap and superficial inferior epigastric perforator (SIEP) flap reconstruction are similar, but take no muscle from the abdominal area. The breast is reconstructed with tissue taken from the patient’s back, with the latissimus muscle flap method.

Dr. Nirmal Nathan is a skilled plastic surgeon in Miami, Florida. He received his medical degree through the Honors Program in Medicine at the University of Miami. Dr. Nathan is among the most sought after plastic surgeons in Miami due to his expansive knowledge, skill and method of treating patients. In his practice, The Nathan Clinic Plastic Surgery and Aesthetics, he provides the excellence that comes from experience.

Dr. Nathan may use fat grafting, with fat taken from your own body, along with any of these techniques to create a softer, more feminine breast shape.

When only one breast is removed, reconstruction may include enhancement – augmentation, lift, or reduction – of the remaining breast for optimal aesthetics.

An appreciation of body shape is deeply rooted in our national culture. In the warm climate of Miami, FL, where swimwear and cool, summary fashions are worn year ‘round, there is additional emphasis on breast aesthetics. Dr. Nathan understands, and he is here to help your self-image stay strong after a breast cancer diagnosis. Call (305) 530-8880 to schedule a breast reconstruction consultation at The Nathan Clinic in Miami, FL.


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