Monday, October 29, 2018
Saturday, October 7, 2017
Breast Cancer Awareness -Advances you need to know
October always brings more awareness to women in the "breast cancer fight" and to those with increased risk. The risk is increased when close family members have had a diagnosis of breast cancer or when BRCA genes are detected. A team approach is common now,but not all teams are experienced in advanced procedures.
As discussed in previous blogs, nipple sparing mastectomy has been shown to be an excellent option in carefully selected patients. This option can be combined with a single operation that rebuilds the breast at one time. Many teams are not experienced in this combined technique and have a higher complication risk when compared to experienced teams. Newer technology can help,but improper dissection and patient selection can add problems. This results in increased complications and longer recovery with more time off work.
Many patients who opt for implant type of reconstruction have a staged approach. This is commonplace now. Women have a mastectomy and temporary expander placed initially. They have to return for a permanent implant which adds another surgery,time away from work and family activity. This adds expense and more recovery, but is an excellent option when added risk is present or when teams are not experienced in a single stage operation.
Fortunately, many experienced teams are training others. However,experience matters. Your surgeon should be able to show you similar cases and allow you to talk to women who have walked this unique path. I understand privacy issues,but these women want to share their experience. We have many women who will share their experience and have had the pleasure of helping many women over the past 10 years. Ask your team hard questions. Can they perform these advanced techniques? Are you a candidate for one stage operation? Why not? If you do not get satisfactory answers,seek another consultation with an experienced plastic surgeon.www.abcsurg.com
As discussed in previous blogs, nipple sparing mastectomy has been shown to be an excellent option in carefully selected patients. This option can be combined with a single operation that rebuilds the breast at one time. Many teams are not experienced in this combined technique and have a higher complication risk when compared to experienced teams. Newer technology can help,but improper dissection and patient selection can add problems. This results in increased complications and longer recovery with more time off work.
Many patients who opt for implant type of reconstruction have a staged approach. This is commonplace now. Women have a mastectomy and temporary expander placed initially. They have to return for a permanent implant which adds another surgery,time away from work and family activity. This adds expense and more recovery, but is an excellent option when added risk is present or when teams are not experienced in a single stage operation.
Fortunately, many experienced teams are training others. However,experience matters. Your surgeon should be able to show you similar cases and allow you to talk to women who have walked this unique path. I understand privacy issues,but these women want to share their experience. We have many women who will share their experience and have had the pleasure of helping many women over the past 10 years. Ask your team hard questions. Can they perform these advanced techniques? Are you a candidate for one stage operation? Why not? If you do not get satisfactory answers,seek another consultation with an experienced plastic surgeon.www.abcsurg.com
Sunday, July 2, 2017
Nipple preserving mastectomy with Hidden scar
Advances in women's breast cancer care have come along way in the past 25 years. Techniques using silicone implants and expanders have improved as well. Using Acellular dermal matrix (ADM) to support the implant has improved longterm results and decreased the frequency of hardness around the implant.
When a woman chooses a surgeon to perform nipple sparing surgery, the patient needs to be an ideal candidate herself. Previous biopsy scars can compromise healing and need tot be carefully considered. Smoking, high blood pressure,diabetes add risks as well. An experienced surgeon should be able to show you many before and after cases. You should be given the opportunity to talk to prior patients who are willing and HIPPA consented for patient education. We truly want to know your options, recovery, and expected outpatient care.
Multiple opinions can be helpful,especially when considering bilateral breast surgery with reconstruction. Patients need to understand that delayed, immediate reconstruction can be a valuable option. Although, I like to perform nipple sparing mastectomy with immediate silicone implants, most plastic surgeons use expanders when working with other breast surgeons. 10-15% of those patients can have slow healing skin complications. Yes, there are many causes of healing problems in the skin and nipple. This is why experience matters. See several similar cases and review other options. Before and after photos showing a staged or delayed approach can help women understand their choices.
My ideal candidate is a women with positive BRCA testing or other precancerous disease that is healthy and active. A thorough medical evaluation and exam with breast and chest measurements will help plan our implant, ADM selection. We use several approaches to minimize scarring and hide from frontal view whenever possible. Intraoperative nerve blocks and advanced preoperative protocol make outpatient care efficient. Careful office follow up for shoulder activity and motion after reconstruction is critical for resuming full activity. Do your home work and investigate your options.
When a woman chooses a surgeon to perform nipple sparing surgery, the patient needs to be an ideal candidate herself. Previous biopsy scars can compromise healing and need tot be carefully considered. Smoking, high blood pressure,diabetes add risks as well. An experienced surgeon should be able to show you many before and after cases. You should be given the opportunity to talk to prior patients who are willing and HIPPA consented for patient education. We truly want to know your options, recovery, and expected outpatient care.
Multiple opinions can be helpful,especially when considering bilateral breast surgery with reconstruction. Patients need to understand that delayed, immediate reconstruction can be a valuable option. Although, I like to perform nipple sparing mastectomy with immediate silicone implants, most plastic surgeons use expanders when working with other breast surgeons. 10-15% of those patients can have slow healing skin complications. Yes, there are many causes of healing problems in the skin and nipple. This is why experience matters. See several similar cases and review other options. Before and after photos showing a staged or delayed approach can help women understand their choices.
Sunday, June 25, 2017
Teaching Young Plastic Surgeons
This weekend we got to celebrate with Dr Max Malotky. He finished Plastic Surgery Residency during the last 6 years with Wright State University in Dayton, Ohio. He is returning to Redding, California this month to interview office staff, get settled in their new home, and yes. there is a wedding to Kristine this Summer. Congratulations to you both from Kathy and I. Kathy "fixed" the couple up while Max was rotating with me in the Summer of 2013.
Let us get back to Teaching. I get the pleasure of working with a truly skilled, but diverse, volunteer faculty. These plastic surgeons and related specialists help cover the trauma hospitals twenty-four, seven days,all year, and again for hand,maxillofacial, burn,and other plastic surgery problems. The residents help us with this care and learn plastic surgery as the community benefits. The great knowledge and blessings God gave us,We can pass on, and on. Thanks Max, you will be a tremendous addition to the medical community. These relationships keep us engaged in our service and accomplishments. Under the direction,of a very talented team, Dr Michael Johnson oversees the 6 year program and improves our community by adding board,certified plastic surgeons to our region. To date, five new plastic or hand surgeons have been added in 9 years. The group is engaged in teaching and in the community. Their education is vital to the high level of medical care in our region. We have witnessed the growth over the past 35 years. Has medicine changed.
We not only teach plastic surgery, we have to teach some healthcare business. That has changed a little as well. Social media,Google searches,video have changed marketing rapidly and information is vital. Electronic records and government mandates have added complexity and expense.
Plastic Surgery is one of the true love's of my life. The other is Kathy, My Nurse, My Partner since 1988! Thank you for your love and support. You helped Max more than you could imagine. We wish you and Kristine all the BEST.www.abcsurg.com
Let us get back to Teaching. I get the pleasure of working with a truly skilled, but diverse, volunteer faculty. These plastic surgeons and related specialists help cover the trauma hospitals twenty-four, seven days,all year, and again for hand,maxillofacial, burn,and other plastic surgery problems. The residents help us with this care and learn plastic surgery as the community benefits. The great knowledge and blessings God gave us,We can pass on, and on. Thanks Max, you will be a tremendous addition to the medical community. These relationships keep us engaged in our service and accomplishments. Under the direction,of a very talented team, Dr Michael Johnson oversees the 6 year program and improves our community by adding board,certified plastic surgeons to our region. To date, five new plastic or hand surgeons have been added in 9 years. The group is engaged in teaching and in the community. Their education is vital to the high level of medical care in our region. We have witnessed the growth over the past 35 years. Has medicine changed.
We not only teach plastic surgery, we have to teach some healthcare business. That has changed a little as well. Social media,Google searches,video have changed marketing rapidly and information is vital. Electronic records and government mandates have added complexity and expense.
Plastic Surgery is one of the true love's of my life. The other is Kathy, My Nurse, My Partner since 1988! Thank you for your love and support. You helped Max more than you could imagine. We wish you and Kristine all the BEST.www.abcsurg.com
Sunday, June 18, 2017
Prepectoral breast reconstruction
In the last few years,preceptorial(in front of the pectoral muscle) breast reconstruction has evolved into another option for women who dealing with breast cancer or high risk for breast cancer. Research and published journal articles are demonstrating excellent results with high patient satisfaction at 3 years. Yes, that means the current literature is only looking at a relatively short time period.
Prior to this time breast tissue expanders or implants were placed underneath the pectoral muscle because plastic surgeons felt the extra muscle tissue over the implants helped maintain softness over time. This allowed patients who had risks of healing problems an option for reconstruction after mastectomy. When skin flaps left after mastectomy healed slowly, the muscle added an extra healthy layer to limit exposure of expanders or implants. This technique is still commonly used since some patients have healing risks. These risks are related to smoking, diabetes, obesity, and many other systemic issues.
Prepectoral breast reconstruction is available for healthy women with minimal risks. Newer cohesive gel breast implants have less risk of hardening than older implants. The use of ADM (dermal matrix) has also blessed the risk of hardening and has provided a softer scar capsule around the implant. This type of surgery is less painful and allows patients to leave hospitals earlier. Recovery and return to activity is typically easier.
www.abcsurg.com This type of reconstruction is technically easier for your plastic surgeon,but careful patient selection is still critical. Your plastic surgeon must assess the quality and health of the remaining skin after your mastectomy when immediate breast reconstruction is planned.This is not always easy. The breast surgeon plays a large role in keeping these skin flaps healthy and not all breast surgeons or plastic surgeons are the same. Experience in patient selection and surgical dissection is important to obtain excellent results and minimize recovery. This option can be used in nipple sparing mastectomy,skin sparing mastectomy, and delayed reconstruction of the breast.
Prior to this time breast tissue expanders or implants were placed underneath the pectoral muscle because plastic surgeons felt the extra muscle tissue over the implants helped maintain softness over time. This allowed patients who had risks of healing problems an option for reconstruction after mastectomy. When skin flaps left after mastectomy healed slowly, the muscle added an extra healthy layer to limit exposure of expanders or implants. This technique is still commonly used since some patients have healing risks. These risks are related to smoking, diabetes, obesity, and many other systemic issues.
Prepectoral breast reconstruction is available for healthy women with minimal risks. Newer cohesive gel breast implants have less risk of hardening than older implants. The use of ADM (dermal matrix) has also blessed the risk of hardening and has provided a softer scar capsule around the implant. This type of surgery is less painful and allows patients to leave hospitals earlier. Recovery and return to activity is typically easier.
www.abcsurg.com This type of reconstruction is technically easier for your plastic surgeon,but careful patient selection is still critical. Your plastic surgeon must assess the quality and health of the remaining skin after your mastectomy when immediate breast reconstruction is planned.This is not always easy. The breast surgeon plays a large role in keeping these skin flaps healthy and not all breast surgeons or plastic surgeons are the same. Experience in patient selection and surgical dissection is important to obtain excellent results and minimize recovery. This option can be used in nipple sparing mastectomy,skin sparing mastectomy, and delayed reconstruction of the breast.
Sunday, June 11, 2017
Advances in Breast Surgery for Women facing cancer
New techniques that minimize scars and preserve the nipple have excellent aesthetic outcomes. Recent studies in plastic surgery have shown excellent oncologic results when compared to regular mastectomy. Quality of life studies have shown that patients feel the benefits of nipple preservation and their overall satisfaction is better. When the overlying skin is nicely preserved, plastic surgeons can provide patients with an immediate reconstruction. This means that women do not need 2 or more surgeries. Two more anesthetics and recovery periods add risk. Many times, patients can have a permanent implant placed which minimizes subsequent operations. This makes recovery simpler and lessens costs. An experienced plastic surgeon can help you understand these options. http:/www.abcsurg.com
Scars can be hidden around the pigment of the nipple-areola complex or placed at the bottom of the breast in the fold. Our website has many examples to show our results. Obtaining another opinion when a woman is facing a difficult decision can be helpful. Experience can be demonstrated by educational photos of similar cases.We strive to make patients understand their options in detail, especially when 3-4 weeks are needed to get back to routine daily activity. Some physicians will enable you to talk to other patients who have had similar procedures.Hearing the recovery first hand from another patient is helpful.
When the team is ready for surgery, incision placement should be reviewed to optimize healing and thorough removal of the breast and tumor. Choices of under the pectoral muscle or above are showing similar results. Placing the implant under the skin and surrounding the implant with a dermal sheets have been producing excellent results at 2 years in many institutions. Fat grafting is commonly done to allow better soft tissue over the implant. Fat grafting can be repeated and is covered by most insurance plans but not all as I have learned. Despite several letters and an appeal with several references from our society,we had a persistent denial. Fortunately,this is uncommon in Ohio currently. These advances are available to patients around Dayton, Ohio
www.abcsurg.com
Scars can be hidden around the pigment of the nipple-areola complex or placed at the bottom of the breast in the fold. Our website has many examples to show our results. Obtaining another opinion when a woman is facing a difficult decision can be helpful. Experience can be demonstrated by educational photos of similar cases.We strive to make patients understand their options in detail, especially when 3-4 weeks are needed to get back to routine daily activity. Some physicians will enable you to talk to other patients who have had similar procedures.Hearing the recovery first hand from another patient is helpful.
When the team is ready for surgery, incision placement should be reviewed to optimize healing and thorough removal of the breast and tumor. Choices of under the pectoral muscle or above are showing similar results. Placing the implant under the skin and surrounding the implant with a dermal sheets have been producing excellent results at 2 years in many institutions. Fat grafting is commonly done to allow better soft tissue over the implant. Fat grafting can be repeated and is covered by most insurance plans but not all as I have learned. Despite several letters and an appeal with several references from our society,we had a persistent denial. Fortunately,this is uncommon in Ohio currently. These advances are available to patients around Dayton, Ohio
www.abcsurg.com
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