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

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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.

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Texas Plastic Surgeons Offer Innovative New TUG Flap Procedure to Recreate Natural Breasts After Mastectomy

San Antonio, TX (PRWEB) February 23, 2009 -- Plastic, Reconstructive & Microsurgical Associates (PRMA) of South Texas, a leading breast reconstruction surgery practice in San Antonio, is now offering women the Transverse Upper Gracilis (TUG) flap procedure to restore their breasts after mastectomy. PRMA plastic surgeons specialize in breast reconstruction after breast cancer, with particular expertise in advanced microsurgical techniques using the patient's own living tissue.

"Increasingly, women facing mastectomy prefer new breasts sculpted from their own skin and fat, thereby avoiding the problems that often occur with implants," says Dr Chrysopoulo. Breasts shaped from living tissue have a natural look and feel that can't be achieved using implants or temporary prostheses. "While most patients prefer the Deep Inferior Epigastric Perforator (DIEP) flap technique which uses a woman's lower abdominal tissue, it is a technique that may not be an option for those who have had previous tummy tucks, who don't have adequate abdominal fat, or who prefer not to scar their abdomens. TUG flap surgery is a viable option for these women; a way to restore their natural breasts with excellent results."

Both the TUG and DIEP flap procedures are complex, technically demanding microsurgical procedures requiring special skill and experience. During the TUG procedure, surgeons transplant a flap of skin, tissue and muscle from a woman's upper thigh to her chest. The process has distinct advantages compared to other types of natural tissue breast reconstruction: thigh tissue has superior contour, shape and projection; loss of the muscle does not inhibit an individual's mobility or function; scarring is not easily visible, and the procedure produces a cosmetic thigh lift as well as a new breast.

"TUG flap surgery allows a woman to come out of the operating room the same way she went in," says Chrysopoulo. "With nice-sized natural breasts in place." The TUG flap is an excellent post-mastectomy option for women who have mastectomy to either treat or prevent breast cancer.

Candidates for the TUG are women who:
• have small to medium-sized breasts.
• want to avoid an abdominal scar.
• lack sufficient abdominal tissue for DIEP breast reconstruction.
• have had a previous tummy tuck or other abdominal surgery.

PRMA board-certified surgeons routinely offer both reconstructive and cosmetic breast procedures, and perform more than 400 microsurgical breast reconstructions annually for patients from Texas and across the U.S. PRMA surgeons are in-network for most U.S. insurance plans. Visit www.prma-Enhance.com or contact 800-692-5565 to schedule a consultation or for more information about the TUG flap or any other reconstructive breast procedure.

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Plastic Surgeon using New Technology in Breast Reconstruction Surgery

Wendy Rigby- KENS 5 Eyewitness News

San Antonio's Methodist Hospital is one of only two facilities in the country offering a new technology to help in breast reconstruction surgery — a system that gives doctors a more precise way to see what they are operating on.

Plastic surgeon, Dr. Minas Chrysopoulo is a man on a mission. He wants more breast cancer patients to know that when they face a mastectomy, they can have their breast reconstructed at the same time. Dr. Chrysopoulo performs the new procedure at the Methodist Hospital.

It's a specialized form of breast reconstruction surgery called the "DIEP flap", where doctors take skin and fat from the patient's abdomen, and use it to form a natural-looking breast by using Novadaq's new imaging system called "SPY…" the doctor is able to preserve stomach muscles, while transferring skin and fat. The key is a special dye — a fluorescent agent injected into the body during the four hour operation.

"It's a bit like an angiogram but without exposing the patient to radiation," said Dr. Chrysopoulo. "The dye travels through the bloodstream and basically lights up the blood vessels. It provides a bit of a road map for us, and it helps us identify these vessels a little bit quicker. It helps us formulate the best surgical plan so that we can preserve the patient's abdominal muscle."

Dr. Chrysopoulo and his partners have used the SPY system on about 150 patients since February with great success. After time, the resulting breast is natural looking, and for the patient, a natural feeling.

While the abdomen is scarred like after a tummy tuck procedure, the abdominal muscles and core strength can be preserved. This tedious microsurgery is on the cutting edge of breast reconstruction. Doctors say waking up from cancer surgery with a new breast can make a big difference on a woman's outlook.

"Psycho-socially, it's a huge deal to wake up without a flat chest," Dr. Chrysopoulo said.

Only about 40 plastic surgeons in the country are using this particular procedure routinely. Patients come to San Antonio from all over the United States and even from some foreign countries to have the operation that promises less pain, a shorter hospital stay and a faster recovery.

Dr Chrysopoulo and his partners are breast reconstruction specialists and perform hundreds of DIEP flaps every year. Learn more about DIEP flap breast reconstruction surgery here.


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Breast Cancer patients may benefit from picking own breast surgeon

Women with breast cancer who are involved in the process of selecting their surgeon are more likely to be treated by more experienced surgeons and in hospitals with established cancer programs, according to a study published in the Journal of Clinical Oncology.

Surgeon and hospital characteristics can influence the outcomes of cancer treatments, the authors explain, but little is known about the factors that influence how referrals are made.

Dr. Steven J. Katz from the University of Michigan, Ann Arbor, and colleagues used survey data from women recently diagnosed with breast cancer and their attending surgeons to determine how surgeons are selected, and if there is any association between the referral process and characteristics of the surgeon and hospital.

Most women were referred to their surgeon by another doctor or by their health plan. They chose their surgeon for a number of reasons -- the surgeon's reputation, the institution's reputation, the recommendation of family or friends, or convenience of the location.

The investigators found that 54.3 percent of women were referred and did not select their surgeon; 21.9 percent were referred, but were also involved in selecting their surgeon; 20.3 percent selected their surgeon and were not referred by a provider or plan; and the rest of the patients had a prior relationship with their surgeon.

Women who selected their surgeon by reputation were twice as likely to have a surgeon who performed many procedures (high-volume surgeon) and to be treated at a cancer center designated by the National Cancer Institute or a program approved by the American College of Surgeons, the team reports.

Patients referred by another doctor or health plan were less likely to be treated by a high-volume surgeon or in hospitals with approved cancer programs, the researchers note.

Previous studies have shown that surgical patients often have better outcomes if they are treated by highly experienced surgeons and at hospitals that perform many similar procedures each year.

More research is needed to investigate the implications of the different referral patterns in this study, Katz and colleagues point out. "In the meantime, women with breast cancer should be aware that provider-based referral might not connect them with the most experienced surgeons or the most comprehensive practice setting in their community."

"Patients might consider a second opinion," the researchers suggest, "especially if they are advised to undergo a particular procedure without a full discussion of treatment options or a clear medical rationale for the recommendation."

SOURCE: Journal of Clinical Oncology; breastcancer.org

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Will Insurance Pay For My DIEP Flap Breast Reconstruction?

"Will insurance pay for my DIEP breast reconstruction?"

This is a question I am repeatedly asked. The easy answer is "they should". However, some women have experienced difficulties with their insurance companies in terms of getting their DIEP breast reconstruction covered. Women must also be aware of "balance billing".

The good news is that there are a handful of plastic surgeons across the country that do routinely offer these advanced procedures and many of them accept insurance. Unfortunately most women will have to travel to gain access to them. We have posted an article on our website about finding a DIEP flap surgeon near you and which questions to ask.

Our group, Plastic, Reconstructive & Microsurgical Associates (PRMA) is located in San Antonio, Texas. We perform over 350 DIEP breast reconstructions per year, the vast majority of which are covered by insurance. We are in-network for most major US insurance plans and do not balance bill. We have insurance specialists on staff so our patients typically do not need to worry about the insurance side of things themselves.

Answers to more DIEP insurance FAQs can be found here.

Answers to more general DIEP flap FAQ's can be found here.

Dr C

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Dr Chrysopoulo, board certified plastic surgeon, PRMA Plastic Surgery, San Antonio, TX. Specializing in breast reconstruction surgery after mastectomy for breast cancer. Over 350 DIEP flaps performed yearly. In-network for most US insurance plans. Toll Free (800) 692-5565. www.prma-Enhance.com. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.

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FDA Approves Silicone Breast Implants

The American Society for Aesthetic Plastic Surgery and The American Society of Plastic Surgeons, the two largest plastic surgery membership organizations, applaud the FDA’s decision today to approve Allergan Corp. and Mentor Corp.'s silicone breast implants and return these devices to the U.S. market. This decision comes 14 years after the FDA restricted access to the silicone implants because of safety concerns.

“This is a great day for American women and the plastic surgeons who care for them,” said Roxanne Guy, MD, ASPS president. “Silicone breast implants have been scrutinized more than any medical device, and we applaud the FDA for making its well thought-out decision and allowing American women to make informed choices about their health care.”

Today’s FDA decision follows a lengthy process in which the agency sent “approvable with conditions” letters to the two silicone breast implant manufacturers in the second half of 2005. The approvable letter stipulated a number of conditions that the manufacturers needed to satisfy in order to receive FDA final approval to market and sell silicone breast implants in the United States. These letters came after an FDA advisory panel hearing in April 2005, in which the panel heard more than 20 hours of data presentations from the manufacturers and public comment.

Approximately 300,000 women chose breast augmentation in 2005, according to ASAPS and ASPS statistics. Nearly 58,000 women had breast reconstruction in 2005, according to ASPS. Both breast augmentation and reconstruction have been proven in numerous studies to have psychological and physical benefits for women who choose these procedures.

The ASPS and ASAPS will continue to offer their assistance to the manufacturers for the conditions set forth by the FDA related to physician and patient education. One comprehensive example of this assistance is a joint Web site, breastimplantsafety.org, which offers objective and science based information regarding saline and silicone breast implants.

The American Society for Aesthetic Plastic Surgery (ASAPS) is the leading organization of board-certified plastic surgeons specializing in cosmetic plastic surgery. ASAPS active-member plastic surgeons are certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada. www.surgery.org.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

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Minas T Chrysopoulo, MD
Board certified plastic surgeon specializing in microsurgical breast reconstruction after mastectomy including the DIEP flap operation.
Plastic, Reconstructive & Microsurgical Associates (PRMA) of South Texas,
San Antonio, TX
(210) 692-1181, Toll Free (800) 692-5565
www.prma-enhance.com
www.look-your-best.yourmd.com

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Age Not An Exclusion Criterion for Breast Reconstruction

Breast Reconstruction in Older Women: Should Age Be an Exclusion Criterion?

Plastic & Reconstructive Surgery. 118(1):16-22, July 2006.
Bowman, Cameron C. M.D.; Lennox, Peter A. M.D.; Clugston, Patricia A. M.D. +; Courtemanche, Douglas J. M.D., M.S.

Abstract:
Background: At present, breast reconstruction is undertaken by fewer than 10 percent of breast cancer patients undergoing mastectomy. Even though the benefits are numerous, this finding is even more notable among older women. Traditionally, women older than the age of 60 have been offered implant reconstruction or no reconstruction at all in hopes of minimizing potential morbidity. This practice may be due to a number of factors including a lack of patient education and information, as well as physician/surgeon bias regarding the safety or relevance of breast reconstruction in older women.

Methods: The authors undertook a retrospective study in which they surveyed 75 women (age range, 60 to 77 years) from two surgeons' practices who underwent various forms of breast reconstruction over the past 8 years. Type of reconstruction, recovery time, and complication rate were correlated with patient satisfaction, general health, and quality of life.

Results: An 81 percent response rate was obtained, yielding an average age of 66.6 years over a 3.8-year period. The overall rate of complications requiring operative intervention was 20.5 percent. When asked whether age should be a determining factor for breast reconstruction, more than 90 percent felt that it should not be. Only 16.1 percent of patients who had a delayed reconstruction stated that the option of breast reconstruction was presented to them at the time of their diagnosis, although 100 percent felt that it should have been. A significantly poorer physical health score was found among patients who experienced a complication, and lower mental health scores correlated with women who were less satisfied with their outcome.

Conclusions: The authors believe that all types of reconstruction should be an option for women older than 60 years of age and that age as an isolated factor should not deter physicians from offering these women the option of breast reconstruction.

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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

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