Breast Reconstruction Options At A Glance

Here's a great infographic summarizing the breast reconstruction options available these days:

Some additional important points:

"Immediate" vs "delayed" breast reconstruction simply describes when the breast reconstruction process begins. Most approaches require more than 1 surgery and the whole reconstruction process can take several months to complete regardless of when it starts. The benefits of immediate reconstruction (same time as the mastectomy) include avoiding the experience of living without a breast, less scarring and better cosmetic results (especially when combined with nipple-sparing mastectomy). You can see patient before and after pictures here.

Many of the above procedures are often combined. For example, tissue expanders or implants can be used in conjunction with flaps. The most common combination is a tissue expander with a latissimus ("lat") flap. Fat grafting is also frequently used in combination with any of the above techniques to address contour deformities, hide implant rippling, add volume, or simply make the results more "natural".

Unfortunately, many of the above procedures are not offered by all plastic surgeons. I encourage all of you to do your own research, ask questions, and if at all possible, consult with plastic surgeons experienced in all types of breast reconstruction before making a final decision.

Dr C
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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 Dr C on Twitter and Facebook.

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What is Breast Reconstruction? What are your Options?

Breast reconstruction makes women whole again after breast cancer. It restores something that nature provided but cancer has taken away. It is covered by insurance in the majority of cases thanks to a 1998 Federal Mandate.

Unfortunately, many breast cancer patients who are facing or who have had mastectomy or lumpectomy are not offered all their reconstructive options.

Women have several breast reconstruction options. These include breast implants and "natural" techniques like flaps and fat grafting which use the patient's own tissue. The nipple and areola can also be recreated.

The animated presentation below provides an excellent overview for women interested in learning more about breast reconstruction and the options available.



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 Dr C on Twitter and Facebook.

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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 artery to the internal mammary artery in the chest under the microscope:

I hope this info helps!

Dr C

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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.

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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.

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Vascularized Lymph Node Transfer for Lymphedema

Vascularized lymph node transfer is the latest surgical option for the treatment of lymphedema. The procedure was first described several years ago and has continued to evolve since then. It is now gaining popularity for the treatment of arm lymphedema in breast cancer survivors that do not respond to conservative (non-surgical) therapy. The results have been quite exciting.


In the case of arm lymphedema caused by breast cancer surgery or radiation, a vascularized lymph node transfer moves healthy lymph nodes, usually from the upper-outer groin, to the underarm area (axilla). These healthy nodes compensate for the lymph nodes removed or damaged by the breast cancer treatment.

The lymph nodes from the upper-outer groin can be transplanted connected to a DIEP flap at the same time as breast reconstruction, or as a separate piece of tissue if DIEP flap breast reconstruction is not being performed at the same time. These lymph nodes are more superficial than the deeper groin lymph nodes that are important for lymphatic drainage of the leg.


Lymph node transfer is not the only surgical option for lymphedema. Other surgical options include soft tissue resection, liposuction, and lymphatico-venous or lymphatico-venule anastomoses (connecting the lymphatic system to the venous system to encourage drainage).

Of all the procedures described to treat lymphedema, vascularized lymph node transfer is showing the most exciting results in terms of decreasing swelling, preventing infections and reducing the need for compression therapy. Patients can experience improvement in their symptoms very quickly after surgery though it can take several months in some cases.

As with all surgery, there are risks too. In addition to the risks of any surgery (bleeding, infection, wound healing issues), the lymph nodes may not survive and the lymphedema can worsen because of further scarring created by the surgery. There is also a risk of creating leg swelling if deep groin lymph nodes are taken. Thankfully, the risk of these complications is very low.

Only patients that have exhausted all conservative therapy by certified lymphedema specialists are considered candidates for vascularized lymph node transfer.

Unfortunately, most insurance companies still consider the procedure experimental and do not currently cover the cost of lymph node transfer.

I hope this info helps.

Dr C

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Dr C is a board certified plastic surgeon and microsurgeon specializing in state-of-the-art breast reconstruction. In-Network for most US insurance plans. Patients 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.

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Prophylactic Mastectomy - is it right for you?

Having prophylactic mastectomy is a very personal choice. There is no "right answer", only what you consider is best for you.

Women who are at high risk of developing breast cancer have the option of prophylactic (preventive) mastectomy as a way of decreasing their risk. Factors that increase a woman’s chance of developing breast cancer include:

1. a genetic predisposition to breast cancer e.g. BRCA+, Cowden's Syndrome, Li-Fraumeni Syndrome
2. a strong family history of breast cancer
3. a breast cancer diagnosis at a young age
4. abnormal breast cells on biopsy that increase the risk of breast cancer, e.g. LCIS
5. a history of previous chest radiation, e.g. treatment for Hodgkin's Lymphoma

Prophylactic mastectomy decreases the risk of future breast cancer by 97-99%. Since the breast tissue is removed, the surgery also removes the need for regular screening mammograms/MRIs and preventive drugs like tamoxifen.

Surgery is not the only option however. Many women prefer close monitoring and preventive drugs (known as "chemoprophylaxis").

Regardless of other choices, all women should modify their diet wherever possible to decrease their risk. It is vital you discuss all your options and the pros, cons, and risks of each before making the best decision for you.

If you choose prophylactic surgery please remember that you can also have breast reconstruction at the same time as mastectomy. There is no need to experience having a flat chest unless you specifically decide you wish to remain without breasts.

You have several reconstructive options and the results can be very natural and cosmetic. If you choose to undergo breast reconstruction at the same time, a "skin-sparing" mastectomy is usually performed. This saves all the breast skin envelope which significantly adds to the cosmetic results without increasing your risk of cancer. In many cases, the nipple-areola can be saved too. This is known as a "nipple-sparing" mastectomy.

Thankfully, most insurance plans cover the cost of prophylactic mastectomy and reconstruction in high risk patients but you will have to check with your individual plan to make 100% sure.

I hope this info helps.

Dr C

*****

PRMA Plastic Surgery specializes in state-of-the-art breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. We are In-Network for most US insurance plans and routinely welcome patients from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Nipple Delay Surgery

Angelina Jolie recently shared her BRCA+ diagnosis and brave decision to undergo prophylactic nipple-sparing mastectomy and immediate breast reconstruction. As part of her surgery, she underwent a nipple delay procedure.

So what is a "nipple delay"?

Most patients do not need a delay procedure. It's actually performed quite rarely. It can however be a good option for patients who want nipple-sparing mastectomy but are at high risk for nipple necrosis. High risk patients include smokers, patients with moderate to significant breast ptosis (sagging), and patients with a history of previous breast surgery (eg breast reduction or lift).

Nipple delay is usually performed 7-21 days before the nipple-sparing mastectomy. The nipple-areolar complex and a rim of surrounding breast skin is elevated off the underlying breast gland. This disconnects all the ducts connecting the breast tissue to the nipple and also cuts off the blood supply to the nipple and areola from the underlying breast tissue. At this point, the nipple-areolar complex is only kept alive by the blood supply from the surrounding skin.

Over the next 1 - 3 weeks, this remaining blood supply becomes much more robust and the blood flow to the nipple-areola from the surrounding skin increases. This improved blood supply makes the subsequent nipple-sparing mastectomy safer and decreases the risk of nipple-areolar necrosis (tissue death) and wound healing complications.

The procedure is combined with a subareolar biopsy to ensure there are no cancer cells involving the nipple-areolar complex. If the subareolar biopsy reveals malignancy, the nipple and areoala are removed at the time of mastectomy. Sentinel lymph node biopsy is also usually performed at the same time as the nipple delay procedure if it is indicated.

Nipple delay does not decrease the risk of future breast cancer. As long as the subareolar biopsy is negative, the risk of future breast cancer is very low and is the same as with standard nipple-sparing mastectomy.

Nipple delay is usually covered by insurance if it is medically justified and the mastectomy is covered.

I hope this info helps.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. We are In-Network for most US insurance plans and routinely welcome patients from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Can Breast Cancer return in a Reconstructed Breast?

Some women are scared to consider breast reconstruction after a mastectomy because they think it will increase the risk of the breast cancer coming back. This is a common misconception. Thankfully, it's not the case.


Breast cancer can come back even after a mastectomy. However, the risk of the cancer returning (ie a "recurrence") after a mastectomy is very low and is the same whether you have breast reconstruction or not. Studies have compared patients with similar stage breast cancers and found no difference in recurrence between patients undergoing mastectomy alone (without reconstruction) and those having skin-sparing mastectomy and reconstruction.


When the patient's own tissue is used for the reconstruction (as in a "flap" procedure), only skin, fat, and (sometimes) muscle are used. This tissue is used to replace breast tissue and feels like a breast, but it never turns into real breast tissue. Since it isn't real breast tissue, the flap doesn't increase the risk of a new cancer forming. 


While it is possible for breast cancer to recur after a mastectomy, breast reconstruction (either with an implant or flap) does not increase the risk of a new cancer forming, or the previous cancer returning.


I hope this info helps.


Dr C


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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. We are In-Network for most US insurance plans and routinely welcome patients from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Considering Breast Reconstruction?

Are you considering breast reconstruction?

Would you like to know more about your reconstructive options?

Do you have questions about a specific procedure?

Two of my partners at PRMA, Dr Gary Arishita and Dr Oscar Ochoa will be available to answer your breast reconstruction questions live on Friday, April 5th from 10am-12pm central time.

You can submit your questions through Twitter, Facebook and our Google+ Hangout.

Mark your calendars and tune in to get your questions answered, live!

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. We are In-Network for most US insurance plans and routinely welcome patients from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Should I have Breast Reconstruction Now or Later?

With so much to think about after a breast cancer diagnosis, many patients facing mastectomy do not fully understand how the timing of breast reconstruction influences how the reconstructed breasts will ultimately look.

Breast reconstruction can be performed at the same time as the mastectomy ("immediate reconstruction") or a while after mastectomy ("delayed reconstruction").

When the mastectomy and reconstruction are performed at the same time, a skin-sparing mastectomy can usually be performed which saves the majority of the natural breast skin envelope (except for the nipple and areola). Only the actual breast tissue under the skin is removed. The reconstruction then "fills" this empty skin envelope. In some select cases the nipple and areola can also be saved. This is known as a nipple-sparing mastectomy.

Skin-sparing (or nipple-sparing) mastectomy and immediate breast reconstruction produce the most "natural" results with the least scarring. This should therefore be the goal for breast cancer patients with early disease (stage I or II) whenever possible.

Delayed reconstruction unfortunately leaves more scarring (typically) and the final breast is less likely to look like the breasts Mother Nature provided. Common reasons to delay reconstruction include advanced breast cancer (stage III or IV), inflammatory breast cancer, the plan for radiation therapy after mastectomy, and lack of access to a reconstructive surgeon.

The difference in scarring between immediate and delayed breast reconstruction can be seen in these breast reconstruction before and after photos.

Ultimately the priority must always be "life before breast" - obviously the breast cancer treatment comes first in terms of priority. However, all other things being equal, there will sometimes be a choice to be made between having the reconstruction performed with the mastectomy or some time after the mastectomy. Whenever possible, I encourage women to seek immediate reconstruction for the best cosmetic results.

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Dr Chrysopoulo is a board certified plastic surgeon specializing in the latest breast reconstruction techniques including the DIEP flap procedure. He and his partners perform over 500 DIEP flap procedures per year and are In-Network for most US insurance plans. Learn more about your breast reconstruction options and connect with other breast reconstruction patients here. You can also follow Dr C on Twitter!

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Nipple-Sparing Mastectomy

Nipple-sparing mastectomy in conjunction with immediate breast reconstruction is becoming more and more popular so I thought a blog post about it was in order...

What is a nipple-sparing mastectomy?

A nipple-sparing mastectomy preserves the nipple,  areola and all the surrounding breast skin which is then used for the breast reconstruction. Unlike the traditional "modified radical mastectomy", nipple-sparing mastectomy only removes the breast tissue ("parenchyma") under the skin.

What are the benefits?

Studies show that nipple-sparing mastectomy provides the same level of surgical treatment as a modified radical mastectomy in appropriate candidates. Preserving the nipple-areola complex adds to the quality of the reconstruction making the results even more "natural". It also means the patient avoids having to go through the additional steps of nipple reconstruction and tattooing.

Who is a candidate?

Nipple-sparing mastectomy is an option for many patients with a small cancer located several centimeters away from the nipple-areola complex. Patients with ductal carcinoma in situ (DCIS) can also be candidates, again depending on the location and distance from the nipple-areola.

During the surgery, a biopsy ("frozen section") is taken from behind the nipple-areola complex and sent to pathology to make sure there is no cancer under the nipple or areola. If this biopsy is negative then the area can be preserved. If it is positive for cancer cells, the nipple and areola are obviously removed.

Patients at high risk of breast cancer (eg BRCA+, strong family history, Cowden's syndrome) choosing to undergo prophylactic (preventive) mastectomy and immediate breast reconstruction are the best candidates.

Patients who do not need a signficant breast lift will have the best cosmetic results.

What are the risks?

Nipple sensation is usually significantly reduced. Sometimes feeling is lost completely. Even in cases where some nipple-areola sensation is maintained, it is very unlikely the feeling will be as Mother Nature provided.

The underside of the nipple and areola is "shaved down" to remove as much of the breast tissue as possible. This can sometimes compromise the blood supply to the tissue which can then cause healing problems. If the blood supply is damaged too much by the mastectomy, part or all of the nipple-areola can die. Thankfully this is uncommon.

At PRMA we check the blood flow intra-operatively to ensure the nipple-areola will survive. In the unlikely event that the nipple-areola cannot be saved, it is removed to prevent wound healing complications and a new nipple and areola are reconstructed at a later time.

Where will the scars be?

This depends on the size and shape of the breast, whether a small "lift" is needed, patient preference and surgeon preference. Scars can be placed around part of the areola and extended outwards or downwards, or completely away from the areola at the breast crease ("inframmamary fold incision").


I hope this info helps!

Dr C

*****

Dr Chrysopoulo specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. He is in-Network for most US insurance plans. Patients are routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Who is NOT a DIEP flap candidate?

With more women becoming aware of DIEP flap breast reconstruction as an option, the question of who is and who isn't a good DIEP flap candidate is coming up more often.

As a general rule, women that have had extensive abdominal surgery like a previous TRAM flap, tummy tuck or a complex hernia repair cannot have a DIEP or SIEA flap breast reconstruction. This is because the lower tummy tissue that is needed has usually been removed or moved around, and the necessary blood supply has been disrupted.

Having said that, most of the time previous abdominal surgery isn't an issue in experienced hands.

Many women these days have had at least one previous c-section or another gynecologic procedure like a hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery but fortunately this is unusual. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having a DIEP or SIEA flap. Previous liposuction is not usually a problem either unless this was extensive.

If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to evaluate your anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram. Unfortunately, the CT scan does involve radiation.

While previous abdominal surgeries may not prevent you having DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery, even though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened by the previous surgeries.

Some medical issues can make any form of microsurgical breast reconstruction (like the DIEP flap) more difficult and they can also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).

I hope this info helps.

Dr C

*****

Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, Texas 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.

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Breast Reconstruction Before and After Pictures

As this video of before and after pictures shows, breast reconstruction has come a long way over the last few years. When breast cancer is diagnosed at an early stage and immediate reconstruction is an option, the results can look very natural indeed.

Thanks to all the PRMA breast reconstruction patients that contributed their before and after photos to make this video possible!

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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My DIEP Flap Journey - Why I traveled from California to San Antonio for my Breast Reconstruction

A big "thank you" to Sharon Pira from Monterey, California for sharing her DIEP flap journey with us....

"I was diagnosed with breast cancer in September 2011 and underwent the whole routine of chemo-therapy, radiation and a full mastectomy of my left breast in March 2012. After all of my treatment was complete I began looking into my options for breast reconstruction.  My local doctor advised against an implant (because of the effect of radiation on the area) so he suggested the TRAM flap as the best option for me which I agreed.

In May 2012 I attended a women's conference in Scottsdale, AZ which was life-changing in itself, however I had no idea just how incredible this trip was going to turn out. On Sunday I got on a shuttle to the Phoenix airport along with another woman and as the driver pulled away I turned to her and asked, "Were you here for the women's conference?"  She said, No, I am a breast cancer surgeon from San Antonio, TX and was here for a breast cancer symposium. I removed the hat I was wearing to reveal my still very bald head and she proceeded to ask me questions about my treatment. She asked what kind of reconstruction I was having and I told her about the Tram flap. She asked if I knew about the DIEP flap? I explained that I had a friend in San Jose who was having the DIEP flap operation but that no one in my area performed this procedure. She gave me her card with the info about PRMA and said I should at least check out their website. We hugged at the airport and I thanked her for the info!

When I returned home I went online to the PRMA website and was amazed by the before and after pictures and actually found a picture of a woman who looked just like me and I could not get over how great she looked one year later. So I called the clinic and scheduled an appointment...

After sending my paperwork for insurance approval I was able to schedule my surgery for August. Everything from beginning to end went incredibly smooth and I am so grateful to the staff of PRMA for their amazing support and care during my hospital stay and my follow up appointments. I feel so blessed... and am thrilled with my results! It feels so good to have my new breast created from my very own body and my friends are all jealous of my incredible tummy tuck - Wow, what a bonus!"

Thanks again Sharon!

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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BRA Day SA - Join us!

I have to say, it's about time. Finally, there is a national push to increase awareness about breast reconstruction.

For years I have had to console ladies who were upset they weren't offered reconstruction at the time of their mastectomy. To this day, 70% of women facing mastectomy for breast cancer are not informed about their reconstructive options. Many have lived for years without a breast only to find out much later that they could have avoided the psychological and social impact of living without a breast altogether.

Now, the American Society of Plastic Surgeons (ASPS) is trying to change that terrible statistic with a national Breast Reconstruction Awareness campaign centered around "BRA day" on October 17th.

Thank you ASPS!

We'll be doing our utmost to help out... PRMA will be hosting the first ever "BRA Day SA" on October 17th at the Witte Museum. It's going to be a phenomenal event full of fun, food, and of course the latest info on breast reconstruction. 

Admission is free and all proceeds will go to WINGS, a 501(C)(3) charity which provides comprehensive breast cancer treatment services to uninsured women in Texas. 

Please join us! More details here.

Hope to see you there!

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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One-Step Breast Reconstruction with Implants and Alloderm

Implant breast reconstruction is the most common method of breast reconstruction currently performed in the US. There are two main approaches: the "Alloderm one-step" (also referred to as "single stage" or "direct to implant" reconstruction), and the two-stage reconstruction with tissue expanders. To easier explain the ins-and-outs of the one-step procedure, I first need to summarize the more traditional two-stage approach...

Tissue expanders essentially act as "spacers". They can either be placed at the same time as the mastectomy or some time later. They are inflated with saline injections to recreate the desired breast size. This expansion process can take several weeks depending on the amount of expansion required to reach the optimal cup size. Once the expansion process is completed, the tissue expanders are removed and the final implants are placed. Reconstruction with breast implants is therefore usually performed as a multiple-step process and can take several months.

Alloderm One-Step / Single Stage / Direct to Implant Reconstruction

Some patients are candidates for a "One-Step" procedure whereby the permanent implant is inserted at the time of the mastectomy. A cadaveric implant known as Alloderm is also used to provide extra implant coverage and support. By going direct to the final implant in a single stage, the patient has only one procedure and avoids the use of a tissue expander (and the whole expansion process) altogether. The scar can also be placed in the inframammary fold (at the breast crease) which makes it much easier to hide. The One-Step procedure is also referred to as "direct to implant" or "single stage" reconstruction.

This procedure is obviously very appealing to many women, including those that may not be candidates for perforator flaps. The down time in terms of recovery is also much shorter than most of the alternatives (2-4 weeks).

There are some caveats though.... I used to offer this procedure to most patients. Some One-Step surgeons still do. Personally, I don't anymore - "the perfect candidate" for the procedure has evolved in my eyes. Experience (and grey hair) has a tendency of doing that.

So who is the "ideal candidate"?

1) Patients that do not have a current breast cancer diagnosis

2) Patients that are having prophylactic mastectomy only, e.g. for BRCA1 or BRCA2

3) Patients that are having nipple-sparing mastectomy

4) Patients that do not need a significant breast lift

5) Patients that have not had previous breast/chest radiation


By limiting the procedure to women who fulfill these strict criteria the surgical results are far more predictable and very cosmetic. The risk of further revision or "touch up" procedures is also very low.

PRMA patient Mrs Michelle Coben kindly shares her experience with the One-Step procedure in the video below. You can also see before and after pictures here.

I hope this info helps.

Dr C

*****

Dr Chrysopoulo specializes in advanced breast reconstruction techniques including perforator flaps, Alloderm One-Step and fat grafting. He is In-Network for most US insurance plans. Patients are routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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BRCA Testing: What it means for you

By: Brandy Korman

If you have a family history of breast cancer, chances are that you have been BRCA tested or are considering it.

BRCA is an acronym for BReast CAncer. Carrying the BRCA 1 or BRCA 2 gene mutation can ultimately help determine a woman’s lifetime risk of developing breast or ovarian cancer. The likelihood that a breast and or ovarian cancer is associated with a BRCA 1 or 2 gene mutation is highest in families with a history of multiple cases of breast cancer.

Being a carrier of BRCA 1 or 2 however does not always mean that a woman will develop cancer, although research has shown that chances are five times higher in women who do carry the mutation. According to estimates of lifetime risk, about 12 percent of women (120 out of 1000) in the general population will develop breast cancer during their lives compared to about 60 percent of women who have inherited a BRCA 1 or 2 mutation.

BRCA testing is performed by blood tests which look for changes in DNA, as well as changes in proteins produced by these genes. Positive results generally indicate that a person has inherited a known harmful mutation and therefore has an increased risk of developing an associated cancer.

If you have received a positive BRCA test, you may be looking into options to help prevent cancer. Surveillance is extremely important even if you have not received a positive test result. Staying on top of mammograms and self-screening is crucial.

Some women may opt for prophylactic surgery which involves removing any at-risk tissue in order to reduce the chance of developing cancer. The option for immediate breast reconstruction has made prophylactic mastectomy a more desirable choice for some women.

Another option may be chemoprevention which essentially involves taking medication to reduce the risk of developing cancer. For example, the drug Tamoxifen has been shown in clinical trials to reduce the risk of developing breast cancer by about 50 percent in women who are at increased risk of developing cancer.

If you have tested positive for BRCA, or are interested in receiving more information on genetic testing, please visit www.cancer.gov. Learn more about reconstruction after prophylactic breast surgery here.

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Thank you Brandy for this excellent article. Some great info here.

I'd like to add a couple of points...

BRCA gene mutations are associated with other forms of cancer too, not just breast and ovarian. Affected women can also have an increased risk of developing melanoma as well as cervical, uterine, pancreatic, gallbladder, stomach, and colon cancer (depending on the type of mutation).

BRCA gene mutations can also affect men and increase the risk of breast cancer, pancreatic cancer, testicular cancer, and prostate cancer. When it comes to testing other family members, I strongly recommend the men/boys are BRCA tested too.

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at facebook.com/PRMAplasticsurgery.

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Abdominal Muscle - Why Save It?

Most women that have looked into breast reconstruction know about the TRAM flap. The TRAM uses lower abdominal skin, fat, and varying amounts of abdominal muscle to reconstruct a "natural", warm, soft breast after mastectomy. The TRAM used to be the gold standard in breast reconstruction, but not anymore.

Over the years, the TRAM flap procedure has evolved into two more advanced procedures that decrease the risk of abdominal complications: the DIEP flap and the SIEA flap. Both use the same lower tummy skin and fat but unlike the TRAM, both SAVE all the abdominal muscle and leave it in place.

The SIEA flap differs from the DIEP flap only in terms of the blood vessels that supply the tissue. While the surgical preparation is slightly different, both procedures spare the abdominal muscle completely and only use the patient's skin and fat to reconstruct the breast. 

All three procedures provide the added benefit of a flatter abdomen with results that mimic a “tummy tuck”. However, because the TRAM flap sacrifices abdominal muscle, the risk of a hernia or abdominal bulging is signifantly higher than with the DIEP or SIEA procedures.

Since the DIEP and SIEA flaps preserve all the abdominal muscles, patients experience less pain than after TRAM flap surgery, enjoy a faster recovery and also maintain their abdominal strength long-term.

I hope this info helps.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

*****

Fat Grafting in Breast Reconstruction - What's the Scoop?

Fat grafting has been in the news a fair amount so I thought I'd give you a brief run-down of what's involved....

Fat grafting is a fairly new technique in breast surgery. Fat is liposuctioned from one part of the patient's body, purified and then injected into the breast.

Fat grafting can be used to fill-in partial breast defects after lumpectomy. It is also frequently used after mastectomy, usually in conjunction with other reconstructive techniques, to optimize the breast contour and improve overall cosmetic results.

There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, storage, and transplantation of the fat cells (and fat stem cells they contain) must be optimized to obtain the best long-lasting results.

Studies have also shown that once the injected fat "takes", it can also help improve the thickness and quality of radiation-damaged tissue and skin.

Regardless of technique, some of the injected fat will be reabsorbed over time but this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.

As for the risks.... For women still undergoing regular mammograms, it is also important to know that fat grafting can also cause calcifications known as "MACRO-calcifications". As many of you have already unfortunately experienced, breast cancer can also cause calcifications, known as "MICRO-calcifications". According to the American Society of Radiology, these different types of calcifications are easily distinguishable. Having said that, I still tell my patients that fat grafting can lead to the recommendation for further tests in the future because of this calcification issue.

Injected fat can also become firm or create "oil cysts". Fortunately these are becoming much less frequent as techniques are refined but again, both of these can cause "unnecessary" stress.

Several independent studies that have evaluated patients over a few years after the procedure have shown that fat grafting is safe. However, because the technique is fairly new, no long-term safety data is currently available.

Unfortunately not all insurance companies cover the cost of fat grafting so the procedure can involve out of pocket expenses for some patients.

I hope this info helps.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

*****

Reconstructing Breasts with Sensation

Most women facing mastectomy and breast reconstruction want to know what kind of feeling their new breast(s) will have.

Unfortunately mastectomy leaves many women with very little feeling long term (if any), regardless of whether they have breast reconstruction or not.

There is some good news though.... Most women undergoing DIEP or SIEA flap breast reconstruction are also candidates for reconstruction of the sensory nerves in the breasts that provide feeling. The feeling in the new breast won't be as good as what Mother Nature provided but it's certainly a lot better than the alternative. A nice bonus at the very least.

Once the tummy tissue (flap) is moved up to the breast, a sensory nerve in the flap is connected microsurgically to a breast nerve in the chest that was cut by the mastectomy. New nerve cells grow from the chest nerve into the flap nerve over time allowing the reconstructed breast to develop feeling.

If you're feeling brave, here's a short video clip of how the two nerves are connected. You can also see the pulse in the blood vessel connections to the new breast:

I hope this info helps.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

*****