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Sunday, January 18, 2015

What is a Microsurgery?

Microsurgery is a very intricate, specialized type of plastic surgery performed using delicate instruments, sutures finer than human hair and high powered magnification provided by either a microscope or high-powered loupes. Microsurgeons can repair and reconnect very small blood vessels and nerves less than 1mm in diameter.

Microsurgery has allowed significant advances in many surgical fields. Breast reconstruction has been transformed completely.

We can now replace tissue removed by a mastectomy with the patient's own tissue transplanted from another part of their body. Unlike conventional tissue reconstruction techniques (like the TRAM flap), the latest microsurgical techniques ("perforator flaps") carefully preserve the patient's underlying muscles. The tissue is disconnected from the body, transplanted to the patient's chest and reconnected using microsurgery.

Preserving underlying muscles lessens postoperative discomfort making the recovery easier and shorter. It also helps the patient maintain muscle strength long-term which is particularly important for active women.

Below is a video of microsurgery performed during a DIEP flap breast reconstruction. Here we are connecting the DIEP flap vein to the internal mammary vein in the chest under the microscope:


I hope this info helps!

Dr C

*****

Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, Texas and an active member of the American Society for Reconstructive Microsurgery. He specializes in DIEP flap breast reconstruction and other state-of-the-art breast reconstruction procedures. He is in-network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to schedule a consultation.

*****

Monday, December 22, 2014

When should you see a Breast Reconstruction Surgeon?

It is very important for patients to learn about all their breast cancer treatment options, including breast reconstruction, as soon as possible after the initial breast cancer diagnosis.


It should go without saying that the top priority is always going to be to treat the cancer first, to try to cure the patient. However, treatment decisions early on in the process often determine the physical results the patient has to live with for the rest of her life.

If you think you may be interested in reconstruction, it is very important to see a breast reconstruction surgeon before any breast cancer surgery is scheduled. Of course this needs to be in a timely manner so as not to delay your cancer care. This is the only way to ensure you are truly involved in your treatment plan.

Seeing a reconstruction specialist very early on also allows patients interested in immediate breast reconstruction, (reconstruction performed at the same time as the mastectomy), to pursue it if they are candidates. Immediate reconstruction typically provides the best results and avoids the experience of living without a breast. For those who are not candidates, knowing they will have the option of reconstructive surgery once all their other breast cancer treatment is completed, (known as "delayed reconstruction"), is often a huge source of strength and relief.

Learn more about the differences between immediate and delayed breast reconstruction here.

I hope this info helps!

Dr C

*****

Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

*****

Monday, November 24, 2014

Tattoos to Cover Mastectomy and Breast Reconstruction Scars on the Rise

For years, tattoos have been used to apply the finishing touches to breast reconstruction. A form of medical tattooing is used to add color to the reconstructed nipple and areola as the final stage of the reconstructive process. Recently, 3D tattooing has also become available to add even more life-like results.

Some breast cancer patients are now turning to more "traditional" ink-based tattoos to cover their mastectomy or breast reconstruction scars in more elaborate ways.

If you've ever considered getting an elaborate tattoo to hide your breast cancer scars, rest assured you're not alone! I'm seeing more and more breast cancer patients doing just that. Here are some examples:

mastectomy scar tattoo
Tattoo over right mastectomy scar
Source: iconosquare.com

breast reconstruction scar tattoo
Tattoo over left breast reconstruction scar
Source: launchboulder.pmpblogs.com

If you're considering a tattoo yourself, here are some more examples of tattoos used to cover mastectomy and breast reconstruction scars.

From a surgical standpoint, I don't see a problem with patients choosing to go this route. It's a very personal decision. Tattooing won't "ruin" a breast reconstruction. However, tattooing of course does have its risks including skin infections (e.g. MRSA), allergic reactions to the dyes, additional scarring, and even blood borne diseases (e.g. tetanus, hepatitis B and C). Tattoo pigments can also occasionally interfere with MRI exams and decrease the quality of the images.

Like anything, doing your research is crucial. Please make sure you choose a reputable and experienced artist and review examples of their previous work ahead of time.

Dr C

*****

Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

*****

Wednesday, October 22, 2014

Does Immediate Breast Reconstruction Delay Chemotherapy?

Many patients think or are told they cannot have immediate breast reconstruction (reconstruction at the same time as mastectomy) because it will significantly delay chemotherapy. In reality, breast reconstruction very rarely interferes with chemotherapy.


Patients that have immediate reconstruction and need chemotherapy can start their treatments once they have healed from their surgery. This usually takes about 4 weeks. The healing time required before chemotherapy is about the same whether patients have mastectomy alone or mastectomy and reconstruction.

A small percentage of patients develop wound healing problems after their cancer surgery and may need slightly longer to heal completely. Even in these situations, studies have shown there is typically no delay in starting chemotherapy. Patients must also realize that wound healing problems can also happen after mastectomy alone.

In addition to the psycho-social benefits, immediate breast reconstruction is associated with less scarring and better cosmetic results. Patients that have delayed breast reconstruction, ie reconstruction some time after the mastectomy, complete all their breast cancer treatment before proceeding with reconstruction.

I hope this info helps.

Dr C

*****

Dr Chrysopoulo is a board certified plastic surgeon and microsurgeon in San Antonio, TX specializing in state-of-the-art reconstructive breast surgery. He and his partners at PRMA are in-network for most major US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients on Facebook.

*****

Tuesday, August 12, 2014

What Does Flap Breast Reconstruction Involve?

If you're considering breast reconstruction using your own tissue (a "flap" procedure), it's important to know that achieving the best results usually involves several stages and takes time.

BEFORE bilateral skin-sparing mastectomy and DIEP flap breast reconstruction
BEFORE skin-sparing mastectomies and DIEP flaps
AFTER bilateral skin-sparing mastectomy and DIEP flap breast reconstruction
AFTER skin-sparing mastectomies and DIEP flaps

The patient in the pictures above required the following stages to complete her breast reconstruction:

Stage 1: The Initial Breast Reconstruction
Whenever possible, breast reconstruction should be performed at the same time as the mastectomy. This is known as "immediate breast reconstruction". This allows for less scarring because the natural breast skin envelope can usually be preserved ("skin sparing mastectomy"). Only the nipple, areola and breast tissue under the skin is removed. The patient above had bilateral skin-sparing mastectomies and DIEP flap reconstruction using tissue from her lower abdomen.

In some cases, the nipple and areola can also be preserved. This is called a nipple-sparing mastectomy.

Immediate reconstruction enables the patient to wake up from the surgery "complete" and avoid the experience of a flat chest altogether. Most women with early breast cancer (stage I or II) are candidates for this approach.

If immediate reconstruction isn't an option, or the patient prefers to wait, the reconstruction can be performed "delayed", any time after the mastectomy. Patients having radiation are often advised to delay reconstruction. Other reasons for delaying reconstruction include advanced breast cancer (stage III or IV) and lack of access to a specialist surgeon.

Stage 2: Revision
This is the "fine-tuning" phase and is usually performed as an outpatient procedure. This stage involves shaping the breasts and making them as symmetric as possible. Fat injections can be used to address any contour deformities and make the breasts look and feel even more natural. The donor site scar (scar from where the flap tissue was taken) is revised to make the area look as good possible. Nipple reconstruction is also usually performed at this stage if the patient did not have a nipple-sparing mastectomy.

Stage 3: Micro-pigmentation/Tattooing
This office procedure applies the "finishing touch". Color is added to the reconstructed nipple-areola complex to make the results even more natural. Women now also have the option of a 3D tattoo which can look very life-like, with or without a surgically reconstructed nipple-areola.

Each stage is performed 3 months apart which means that the entire reconstructive process can take several months. Insurance authorization is also required before each stage.

I hope this info helps.

Dr C

*****

Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. He and his partners at PRMA are In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

*****

Sunday, April 13, 2014

PRMA performs 5,000th Microsurgical Breast Reconstruction


Congratulations PRMA!

5,000 microsurgical breast reconstructions... and counting.

I couldn't be more proud of the team!

Dr C

*****

PRMA specializes in state-of-the-art breast reconstruction. We routinely welcome patients from across and outside the US and are are In-Network for most US insurance plans. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients in our breast reconstruction community on Facebook.

*****

Friday, January 31, 2014

BRCA 1 & 2 Gene Testing: What Does A Positive Test Mean And Should You Get Tested?



The BRCA 1 and 2 gene mutations, and a handful of other (rarer) gene mutations, account for about 10% of all breast cancer cases. The abnormal genes affect about 1 in 400 people and can be inherited from either or both parents.

BRCA gene mutations increase the lifetime risk of breast cancer in women to between 50 and 87% (depending on the study). The lifetime risk of breast cancer in the general population is about 12%.

Due to the publicity BRCA has received in the media lately, most people think it only affects women. That's not true. Men can be affected too. Men carrying an abnormal BRCA gene have a 5-10% risk of getting breast cancer at some point in their lives. Unaffected men only have a 0.1% lifetime risk.

Families carrying the abnormal genes also have more than breast cancer to worry about. BRCA mutations significantly increase the risk of several other types of cancer in the family including ovarian, fallopian tube, peritoneal, pancreatic, colon, prostate and melanoma.

Anyone who has a strong family history of breast cancer should consider having a BRCA test. Those who are also of Ashkenazi Jewish descent are at particularly high risk of being affected; Ashkenazi Jews have a much higher prevalence of the BRCA1 and 2 mutations than the general population (1 in 40).

It's also important to consider the implications of a positive test before actually having it. What would you do if you found out you're affected? How would it affect your kids? The rest of your family? Would you consider having prophylactic (preventive) mastectomy?

I strongly recommend genetic counseling before having any genetic test. Only then can you truly understand the implications of the test and what a positive result could mean for you and your family.

I hope this info helps.

Dr C

*****

Dr C is a board certified plastic surgeon and microsurgeon specializing in state-of-the-art breast reconstruction. He and his partners at PRMA are In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer in our Facebook community.

*****

Monday, December 16, 2013

Has Your Partner Been Diagnosed With Breast Cancer?

In the vast majority of cases, a breast cancer diagnosis affects more than one person. All the focus understandably centers around the patient in formulating the best treatment plan. However, as physicians, I feel we generally do a bad job of considering the patient's support system, and the primary caregiver in particular.

Following one of my patients' breast cancer diagnosis, mastectomy and reconstruction, I asked her husband how he was coping and if there was any way we could be of more help.

He told me: "You're the first one who's even asked me how I'm doing. There's no manual. I can't fix this. I have a million thoughts but no words to express them".

His last comment really hit the nail on the head.

Please know you are not alone...


Here are some other credible resources that may help.

I wish you all the best.

Dr C

*****

Dr C is a board certified plastic surgeon and microsurgeon specializing in state-of-the-art breast reconstruction. He and his partners at PRMA are In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer in our Facebook community.

*****

Wednesday, October 9, 2013

How Is Nipple Reconstruction Done?

Nipple reconstruction is offered as part of the breast reconstruction process, unless of course the patient has undergone a nipple-sparing mastectomy. Reconstructing the nipple and areola helps make the reconstruction appear more "natural" and usually also hides some of the scarring.

There are several ways to reconstruct a nipple. Some techniques rearrange the tissue that is part of the reconstructed breast (a bit like "origami"). "Nipple-sharing" can also be preformed which uses part of the patient's opposite nipple if it is large enough.

The areola can be created either through tattooing or grafting skin from the groin area. The groin area is used as this tends to be a closer match to the natural areola in terms of color and tone than skin from any other part of the patient's body.

At PRMA we prefer to reconstruct the nipple using a "bow-tie" technique which rearranges tissue in the planned location of the new nipple. The areola is then tattooed to recreate the best tone.

The video below shows our "bow-tie" technique which can be used to reconstruct nipples of various sizes based on patient preference. It is also important to know that the reconstructed nipples also shrink by 50% over the first couple of months after reconstruction.

I hope this video helps (thanks Dr L!)...


Dr C

*****

Dr C is a board certified plastic surgeon and microsurgeon specializing in state-of-the-art breast reconstruction. He and his partners at PRMA are In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options.

*****

Friday, September 27, 2013

Are you a BRCA Patient Interested in Prophylactic Mastectomy & DIEP Flap Breast Reconstruction?

Angelina Jolie's decision to have prophylactic mastectomies and immediate breast reconstruction earlier this year has prompted women across the country to look into their hereditary breast cancer risk.

We're kicking off Breast Cancer Awareness month on Wednesday, October 2nd with a live tweet event about this very topic.

One of our BRCA+ patients has kindly agreed for our staff to tweet during her surgery - bilateral prophylactic mastectomies and immediate DIEP flap breast reconstruction.

Please join us live in the OR to learn more about these procedures!

You can learn more about the Live Tweet Event here.

Dr C

*****

Dr C is a board certified plastic surgeon and microsurgeon specializing in state-of-the-art breast reconstruction. He and his partners at PRMA are In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options.

*****