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

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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 others touched by breast cancer on Facebook.

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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

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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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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 skin-sparing mastectomies and DIEP flaps

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

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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.

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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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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.

*****

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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Breast Reconstruction Can Be Performed Any Time

Did you know breast reconstruction can be performed at any time, even years after a mastectomy?

"Immediate breast reconstruction" is performed at the same time as the mastectomy and typically provides the most natural results with the least amount of scarring. Unfortunately, for many women this simply isn't an option....

For starters, 70% of women facing mastectomy aren't even told that reconstruction may be an option for them. They undergo surgery only to find out some time later that they could have woken up from their mastectomy with new breasts instead of having to experience a flat chest.

Of the women that are informed, some may not have access to a reconstructive plastic surgeon where they live and have to travel for reconstruction.

Other women are not candidates for immediate reconstruction because unfortunately the disease is too advanced at the time of diagnosis.

Sometimes radiation therapy is recommended as part of the breast cancer treatment. Most plastic surgeons prefer to hold off on reconstruction until the patient is several months out from her last radiation therapy. This allows the tissues to recover and soften up as much as possible to improve the results of the subsequent reconstruction.

As you can see, there are several reasons why a women wanting breast reconstruction may not be able to have it straight away, ideally at the same time as the mastectomy.

Whatever the reason for delay may be, it is important to remember there is no time limit when it comes to breast reconstruction - it can be performed at any time, even years after mastectomy.

Like immediate reconstruction, delayed breast reconstruction is also covered by insurance regardless of how many years have passed since the breast cancer diagnosis.

Dr C

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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.

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Breast Reconstruction Timing: Immediate vs Delayed Reconstruction

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. Skin-sparing mastectomy and immediate reconstruction is therefore preferred whenever possible and should be the goal for breast cancer patients with early disease (stage I or II).

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.

*****

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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Tammy's Breast Reconstruction Journey. Part 2 - Making The Decision

by Tammy Carrington

After getting over the shock of hearing the “C” word, I began my quest for knowledge. I went into research mode, reading and devouring everything I could lay my hands on. I literally spent the next 30 days reading and gathering all the information that I could find. I found it almost impossible to sleep (getting maybe 2-3 hours sleep each night) because I knew I needed to gather the information to make the “right” decision because I have a special needs child who relies on me.

I spoke to many other women both in person and in online in some of the breast cancer forums. I found myself on the PRMA website many times during my search for information and I was impressed with the amount of information there.

I discovered that Dr. Chrysopoulo had written a great deal of information on breast cancer and reconstruction and I read all of it that I could find.  He was able to explain things in a way that was easy to understand. I also listened to a one-hour radio interview that he did on breast cancer and reconstruction. He really impressed me with his compassion and he seemed to understand what a difficult and emotional decision that this was for all women.  He seemed to “get it”.

I made the decision to have a bilateral mastectomy because I wanted (and needed) peace of mind and I knew that I would worry every year that I could get it again in my other breast.  I decided to take away that risk now. I absolutely did not like the way I felt with this breast cancer diagnosis and I knew that I never wanted to be in this “place” again and didn’t want to have to have this worry again. The stress, the tears, the fear, and the unknown were traumatic enough, but also coupled with emotional upset… I just wanted to get through this and move on with living my life again.  One of my doctors told me that by doing the bilateral mastectomy, it would get me cancer free and keep me that way for a very long time. I needed that kind of peace of mind.

Everything that I read said that when a woman has a mastectomy and wakes up and still has breasts, it is emotionally and psychologically so much better than waking up without breasts. I felt that it would be important for me to have reconstruction immediately following the mastectomy. I didn’t want to wait to have it done later. I also knew that not many places offered immediate reconstruction following mastectomy and I realized as I spoke with other women that not many realized immediate breast reconstruction was even an option. I felt blessed to have found this out.

(more to follow on The Breast Cancer Reconstruction Blog)

Tammy's Breast Reconstruction Journey. Part 1 - My Breast Cancer Diagnosis

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Keep up to date with the latest news in breast cancer reconstruction at The Breast Cancer Reconstruction Blog. Also join us on Facebook and Twitter!

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Immediate Breast Reconstruction After Mastectomy is Safe, ASPS Study Says

Breast Reconstruction Does Not Impede Chemotherapy, Recovery or Diagnosis of Breast Cancer Recurrence.

Debunking the myth that women with locally advanced breast cancer must wait until after chemotherapy to have their breast reconstructed, a study presented at the Annual ASPS/PSEF/ASMS Meeting found that immediate free flap breast reconstruction for women with breast cancer is safe and psychologically beneficial.

The study, which followed 170 patients with locally advanced breast cancer, found that immediate reconstruction did not delay post-operative chemotherapy, prolong recovery or hinder the diagnosis of local cancer reccurrence.

"Losing a breast is traumatic," said ASPS Member James Watson, MD, and participating surgeon in the study. "As a board-certified plastic surgeon, I wanted to ensure that immediate breast reconstruction was safe for my patients and would make the healing process easier. The findings in this study will allow women to start healing sooner psychologically, knowing that their decision will not impede their physical progress against breast cancer."

The paper states that women participating in the study were pleased with their immediate reconstruction experience, indicating an immeasurable emotional benefit patients gain by having the reconstruction right away.

According to the findings, the majority of patients were either satisfied or very satisfied with their reconstruction and, if they had to, would have it done immediately after their mastectomy again. Also, the majority of women agreed they would recommend immediate reconstruction to a friend or colleague.

Through the study, Dr. Watson found that immediate free flap reconstruction - where the patient's own tissue is removed from the abdomen, buttocks or thigh regions and reattached in the breast using microsurgical techniques - resulted in similar complications and delays of post-operative chemotherapy to patients who delayed reconstruction. The most common postponement for patients was waiting for the wound to heal. However, the maximum delay was only three weeks, which did not have significant oncological impact on their post-operative therapy.

Also, while there were local recurrences of the cancer, physicians were able to diagnose the cancer's return quickly, resulting in no delay for additional treatment. Most local recurrences were located at the mastectomy scar or in the mastectomy flaps, which could be diagnosed by a physical exam and biopsy.

"An added benefit to reconstructing the breast immediately is that it's easier for the oncology surgeon to complete the mastectomy. Often, the breast cancer is so large or involves so much skin that the surgeon has to remove additional skin in the region, making it difficult to reserve enough tissue to close the wound," stated Dr. Watson. "With immediate reconstruction, the oncologic surgeon can eliminate more breast skin to ensure the cancer is removed and use the skin from the free flap procedure to close the wound."

According to ASPS 2001 statistics, more than 190,000 women were diagnosed with breast cancer and more than 80,000 women opted for breast reconstruction following a mastectomy.

Access to breast reconstruction following a mastectomy has increased due to the passage of the Women's Health and Cancer Rights Act 1998, proudly supported by ASPS, which mandated insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.

"With the finding that reconstruction right after mastectomy is safe, women can maximize their opportunity to not only heal physically but also psychologically right away," said Dr. Watson. "Before, women had to wrestle with their changed body image after losing a breast while physically recovering from their battle with cancer. Now, they don't have to delay the psychological healing process of beating breast cancer and celebrating that victory."

*****

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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DIEP Flap Reconstruction And Breast Cancer Recurrence

Can DIEP flap breast reconstruction prevent detection of breast cancer recurrence? This is a very important issue that is often not discussed.

A handful of studies have shown that breast reconstruction (with any reconstructive technique) does not impact local recurrence or long term survival in patients with early breast cancer (stage I and II). The rate of local recurrence and length of survival is the same in patients with stage I and II disease whether they undergo immediate breast reconstruction (ie reconstruction at the same time as mastectomy) or not. For this reason most institutions (including ours) offer breast cancer patients with early disease immediate breast reconstruction whenever possible.

Patients diagnosed with advanced disease are more likely to be candidates for delayed breast reconstruction once they have undergone mastectomy, completed their cancer treatment and remained disease free for several months.

Breast reconstruction (with a DIEP flap or any other method) does not encourage or enhance breast cancer recurrence or shorten long term survival in any way.

Dr C

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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 DIEP flap reconstruction. 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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Immediate Breast Reconstruction After Mastectomy is Safe, ASPS Study Says

Debunking the myth that women with locally advanced breast cancer must wait until after chemotherapy to have their breast reconstructed, a study presented today at the ASPS/PSEF/ASMS 71st Annual Scientific Meeting in San Antonio found that immediate free flap reconstruction for women with breast cancer is safe and psychologically beneficial.

The study, which followed 170 patients with locally advanced breast cancer, found that immediate reconstruction did not delay post-operative chemotherapy, prolong recovery or hinder the diagnosis of local cancer reoccurrence.

"Losing a breast is traumatic," said ASPS Member James Watson, MD, and participating surgeon in the study. "As a board-certified plastic surgeon, I wanted to ensure that immediate breast reconstruction was safe for my patients and would make the healing process easier. The findings in this study will allow women to start healing sooner psychologically, knowing that their decision will not impede their physical progress against breast cancer."

The paper states that women participating in the study were pleased with their immediate reconstruction experience, indicating an immeasurable emotional benefit patients gain by having the reconstruction right away.

According to the findings, the majority of patients were either satisfied or very satisfied with their reconstruction and, if they had to, would have it done immediately after their mastectomy again. Also, the majority of women agreed they would recommend immediate reconstruction to a friend or colleague.

Through the study, Dr. Watson found that immediate free flap reconstruction - where a section of muscle, fat and skin are removed from the abdomen, buttocks or thigh regions and reattached in the breast using microsurgical techniques - resulted in similar complications and delays of post-operative chemotherapy to patients who delayed reconstruction. The most common postponement for patients was waiting for the wound to heal. However, the maximum delay was only three weeks, which did not have significant oncological impact on their post-operative therapy.

Also, while there were local reoccurrences of the cancer, physicians were able to diagnose the cancer's return quickly, resulting in no delay for additional treatment. Most local reoccurrences were located at the mastectomy scar or in the mastectomy flaps, which could be diagnosed by a physical exam and biopsy.

"An added benefit to reconstructing the breast immediately is that it's easier for the oncology surgeon to complete the mastectomy. Often, the breast cancer is so large or involves so much skin that the surgeon has to remove additional skin in the region, making it difficult to reserve enough tissue to close the wound," stated Dr. Watson. "With immediate reconstruction, the oncologic surgeon can eliminate more breast skin to ensure the cancer is removed and use the skin from the free flap procedure to close the wound."

Last year, more than 190,000 women were diagnosed with breast cancer. More than 80,000 women opted for breast reconstruction following a mastectomy, according to ASPS 2001 statistics.

Access to breast reconstruction following a mastectomy has increased due to the passage of the Women's Health and Cancer Rights Act 1998, proudly supported by ASPS, which mandated insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.

"With the finding that reconstruction right after mastectomy is safe, women can maximize their opportunity to not only heal physically but also psychologically right away," said Dr. Watson. "Before, women had to wrestle with their changed body image after losing a breast while physically recovering from their battle with cancer. Now, they don't have to delay the psychological healing process of beating breast cancer and celebrating that victory."

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.

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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 DIEP flap reconstruction. 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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