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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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!

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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 patients at facebook.com/PRMAplasticsurgery.

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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

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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 www.facebook.com/PRMAplasticsurgery.

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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.

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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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Are you a DIEP Flap candidate?

The DIEP flap procedure has rapidly become the "gold standard" in breast reconstruction today. While not every woman is a candidate for DIEP flap surgery, many are turned away when in fact they needn't be. The most common areas of confusion include:


1) Previous Abdominal Surgery

While some types of previous abdominal surgery can make the DIEP flap procedure impossible to perform, most of the time previous abdominal surgery really isn't an issue.

Many women these days have had a previous c-section or hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery, but this is rare. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having the procedure.

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

So which previous surgeries DO cause a problem? Women that have had a previous TRAM flap, tummy tuck or very extensive abdominal wall surgeries (like complex repairs of huge hernias) cannot have a DIEP or SIEA flap reconstruction because the lower tummy tissue that is needed has already been removed, disconnected or moved around.

While previous abdominal surgeries may not prevent DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and even hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery.


2) An Umbilical Hernia

It is very unlikely that an umbilical hernia would prevent DIEP flap surgery. Most umbilical hernias are small. A very large umbilical hernia can make the surgery harder but even this is not usually a contra-indication to having the procedure.


3) Previous Chest Radiation

One of the most important things for the reconstructive surgeon to achieve is to replace the damaged, firm irradiated tissue with normal, healthy, soft tissue. If the irradiated tissue is not healthy enough to be used as part of the reconstruction (as is the case in many instances), it will be removed and replaced by the healthy (DIEP) tissue.

I have visited with a fair number of patients who have previously been told they are not candidates for DIEP flap reconstruction because they received chest radiation after their mastectomy. I do not share this opinion.

Most of the time this advice seems to stem from fear that the radiation may have caused damage to the internal mammary vessels in the chest. These are the blood vessels that are usually used to connect the DIEP flap to the chest. In reality it is exceptionally rare for us to find these blood vessels are damaged and cannot be used.


4) Not the Right Amount of Tissue

You don't need to be overweight to be a candidate for a DIEP flap. What matters is the distribution of the fat. We have performed DIEP flaps on smaller breast, thin women with a BMI (body mass index) of 20 (and even less) because the fat that they did have was "in all the right places". Having said that, there is an upper limit beyond which the risks of surgery outweigh the benefits - At PRMA we set an upper BMI limit of 40 as we have found that performing the procedure on women with BMIs greater than this significantly increases the rates of complications (especially wound healing problems).



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Dr Chrysopoulo is a board certified plastic surgeon specializing in the latest breast reconstruction techniques . He and his partners 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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Impact of Radiation on Breast Reconstruction

Radiation therapy is often recommended as part of breast cancer treatment. Patients undergoing lumpectomy receive radiation routinely once they've healed from surgery. Some mastectomy patients also need radiation after surgery depending on the size and characteristics of the breast cancer.

I think it is fair to say that most reconstructive breast surgeons, myself included, are not particularly fond of radiation because of the way it can impact the patient's tissues and breast reconstruction in general. Nonetheless, it is important to remember that "life comes before breast" and in certain cases there is a definite benefit for the patient in having radiation therapy.

Radiation techniques have improved significantly over the years which has decreased the potential side effects. Having said that, it is important patients realize what these potential side effects are. Anyone who is facing radiation therapy must discuss all the potential risks with their their radiation oncologist beforehand.

So what's the problem with radiation therapy from a plastic surgeon's perspective?... It can cause toughening (fibrosis) and shrinking (contracture) of the patient's tissue which makes the tissue lose its elasticity - the skin can become more tough and rigid. Skin color changes are common, red at first turning more brown over time. Radiation can also cause mild, superficial burn injuries. More serious long-term risks include damage to underlying organs such as the lungs and heart.

Women undergoing lumpectomy are often told that most of their breast will be preserved and that radiation is given "as insurance" to decrease the risk of the cancer returning (ie recurrence). What many women don't appreciate is that the breast can end up looking vastly different after radiation (shrinking, firmness, etc), even though they chose treatment that would "save the breast". Many women end up going to see a plastic surgeon because of these changes and the resulting significant asymmetry.

Radiation after a tissue reconstruction (eg tram flap, diep flap) can cause the reconstructed breast to shrink and become more firm. Fortunately, recent advances in radiation technology have made it more "reconstruction friendly" and it is rare for us to see significant radiation damage to the reconstructed breast in patients treated in centers specializing in breast cancer care. However, patients facing radiation after flap breast reconstruction should know that there is still a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.

Tissue expander and implant reconstructions fair worse with radiation than tissue reconstructions. The complication rates in this setting are much higher than with flaps, including complete failure of the reconstruction altogether and removal of the implant. Some surgeons routinely offer implant reconstructions to patients that are either facing or have already had radiation therapy. There are articles published in the plastic surgery literature supporting it. I have to respectfully disagree (strongly). In my experience mixing implants with radiation typically ends badly. I will only offer this in very rare instances.

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction surgery after mastectomy. In-Network for most US insurance plans. For more information please call (800) 692-5565 or email patientadvocate@prmaplasticsurgery.com.

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Breast Reconstruction With Tissue Much Safer Than Implants When Radiation Planned After Mastectomy

A study published in the November issue of the International Journal of Radiation Oncology*Biology*Physics examined the effect of radiation therapy on different methods of immediate breast reconstruction surgery. For breast cancer patients who receive radiation therapy after a mastectomy and immediate breast reconstruction, autologous tissue reconstruction (ie reconstruction using their own tissue) provides fewer long-term complications and superior cosmetic results than breast reconstruction with a tissue expander and subsequent breast implant.

Many women choose to undergo breast reconstruction surgery at the same time as their mastectomy procedure (under the same anesthetic). This avoids many of the psycho-social issues women face when dealing with a flat chest after mastectomy alone. However, frequently radiation can negatively affect the outcome of reconstruction and increase the risk of long-term complications.

Radiation therapy is increasingly becoming the standard of care for high-risk breast cancer patients after mastectomy in an attempt to decrease local cancer recurrence. However, this can cause a problem for both patients and their radiation oncologists.

Researchers at the Department of Radiation Oncology at Long Island Radiation Therapy in Garden City, N.Y., the Department of Surgery at Long Island Jewish Hospital in New Hyde Park, N.Y., the Department of Surgery at North Shore University Hospital in Manhasset, N.Y., and the Department of Surgery at Winthrop University Hospital in Mineola, N.Y., looked at whether the type of reconstruction performed in women receiving radiation after a mastectomy had an impact on their long-term outcomes.

Two general types of breast reconstruction are available for patients facing mastectomy for breast cancer: autologous tissue reconstruction utilizing the patient's own tissue (eg DIEP flap, GAP flap, TRAM flap, or latissimus flap) transferred to the chest to recreate the breast(s); and tissue expander/implant reconstruction which involves placement of an inflatable tissue expander (temporary saline implant) and exchange for a permanent implant (saline or silicone) at a separate procedure later on.

This study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and postmastectomy radiation therapy. Ninety-two patients were observed for a period of 38 months following breast reconstruction and radiation therapy.

Researchers found that autologous breast reconstruction is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than tissue expander/implant reconstruction.

None of the 23 patients reconstructed with their own tissue required further surgery while 33% of tissue expander/implant patients needed surgery to correct a problem with their reconstruction. Eighty-three percent of autologous reconstruction patients reported acceptable cosmetic results, as opposed to only 54% of implant patients.

"This study is useful for patients who are candidates for either [method of reconstruction] and are making a decision with regards to reconstruction technique," Jigna Jhaveri, M.D., lead author of the study and a radiation oncologist at Advanced Radiation Centers of New York in Hauppauge, N.Y., said. "Our study provides evidence that patients who undergo autologous tissue reconstruction and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo tissue expander/implant reconstruction and radiation therapy."

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Here's my take....

While some plastic surgeons will disagree with this statement I strongly believe that breast implants and radiation therapy do not get along (at all). I feel the complication rate in implant-reconstructed women receiving radiation therapy is very high, particularly long-term. The handful of women that "do fine" in the short-term will very frequently end up with hard, uncomfortable breasts as the irradiated tissue firms-up over time and squeezes down on the implant. In my opinion the re-operation rate is too high for tissue expander/implant reconstruction to be offered as a routine option when radiation is on the table. This study confirms that breast reconstruction using the patient's own tissue is far safer than tissue expander/implant reconstruction in women facing radiation therapy after mastectomy.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction surgery after mastectomy, particularly advanced perforator flap techniques such as 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 The Breast Cancer Reconstruction Blog.

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Breast Cancer Recurrence Not Related To Method Of Breast Reconstruction

One of my breast cancer patients called me today. She recently underwent bilateral mastectomies and immediate breast reconstruction with DIEP flaps. She recovered very well from the surgery but unfortunately her pathology results showed that she had cancer extending almost to the edge of the mastectomy specimen. The exact medical jargon used by the pathologist was.... "invasive carcinoma extending to 1mm from the margin". She also had DCIS (ductal carcinoma in situ) "extending to 0.2mm from the margin."

From a purist's perspective, these results still represent "clear margins". In other words, no tumor was found at the edge of the mastectomy specimen so there is no reason to believe there is any cancer left in my patient's breast. BUT, it's very close and that is certainly worrisome.

She called me today because she visited with her oncologist (cancer doc) and a radiation oncologist (cancer doc specializing in radiotherapy) and radiation therapy was recommended (in addition to the planned chemotherapy).

She explained to the radiation oncologist that she was worried the radiation therapy would ruin her DIEP flap reconstruction. She is right to be fearful of this - patients undergoing radiation therapy after an autologous reconstruction (ie a reconstruction using their own tissue) have a 28% risk of needing further surgery to correct asymmetry caused by the radiation changes (usually firming and shrinking) of the irradiated breast.

The response she received from the radiation oncologist baffled me (and is actually the reason behind this blogpost)...... "DIEP flap? What's a DIEP flap?.... if you'd had a TRAM flap then you wouldn't be needing radiation".

What?

This is a ridiculous statement. Let me clarify why...

This lady is being recommended radiation therapy as an insurance policy to decrease the risk of local recurrence (cancer coming back in the same breast). This is a consequence of her "near margins" which in turn are a result of the mastectomy specimen. Obviously the mastectomy was completed before the reconstruction was even started. If this lady had only had the mastectomy (without reconstruction) the margins would be the same. The breast reconstruction, and moreover, the type of breast reconstruction has absolutely nothing to do with it. The margins, the pathologist reading and the recommendation for radiation therapy would have been exactly the same whether reconstruction was performed or not.

So what's the take home message if you're considering breast reconstruction surgery? Choose whichever method of reconstruction is best for you. Your decision will not influence the likelihood of your cancer coming back in any way. The risk of cancer recurrence is related to the characteristics of the cancer itself and the mastectomy margins, not the method of reconstruction.

Dr C

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Dr Chrysopoulo is a board certified breast reconstruction surgeon specializing in DIEP flap breast reconstruction surgery. He and his partners perform over 350 DIEP flap procedures each year with a success rate of over 99%. 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 Cancer Reconstruction Blog.

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One-Third of Breast Cancer Patients Unhappy with Outcome of Lumpectomy

Women with breast cancer often undergo a lumpectomy and radiation to save their breasts and avoid the need for additional reconstructive surgery. However, approximately one-third of all patients are unhappy with how their breasts look after undergoing breast conservation therapy and many would consider reconstruction, according to a study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco.

“I have patients walking into my office saying lumpectomy was supposed to save their breast but what’s left doesn’t look like a breast to them,” said Howard Wang, ASPS Member Surgeon and co-author of the study. “Conservation is believed to be an acceptable way of saving a woman’s breast. But many of these women are coming to plastic surgeons for help, saying it isn’t so.”

In the study, 28 percent of the breast cancer patients stated they were dissatisfied with the cosmetic result of their lumpectomy. Of those patients, 46 percent stated their physical appearance was worse or much worse after the surgery and were considering reconstruction. Only nine percent of patients who were satisfied with the outcome, however, would consider reconstruction if it were offered.

Approximately 26 percent of patients were unhappy with their physical appearance after the lumpectomy but had an improved sense of body image. Plastic surgeons believe this disparity occurred because many patients felt relieved to be free of the cancer, leading them to feel better about their bodies even though they were not happy with how their breasts looked.

According to the American Cancer Society, almost 213,000 women will be diagnosed with breast cancer this year. Almost 58,000 women underwent breast reconstruction surgery in 2005, according to ASPS.

“Patients should know their options and understand that just because they undergo a lumpectomy to save their breast does not mean they will be happy with the cosmetic outcome,” said Dr. Wang. “Oncologists need to work with patients to help them understand the potential physical outcomes and refer them to a board-certified plastic surgeon to consider all of their choices.”

For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.

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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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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