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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 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 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? 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.

*****