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017: Holistic Breast Reconstruction - a Physician's Perspective

Updated: Jun 22, 2021


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Episode Summary:

What is a holistic approach to breast reconstruction? Tammey talks with Dr. Minas Chrysopoulo, a board-certified plastic surgeon, microsurgeon, President of PRMA Plastic Surgery, and founder of the Breast Advocate App. Together they cover a variety of topics, from the different types of breast reconstruction available to women, breast reconstruction options for men, nipple reconstruction, and the importance of shared decision making. They also discuss the loss of feeling that many women and men are left with post-mastectomy, options for retaining as much sensation as possible, and methods for restoring sensation. This is a powerful episode packed with information, resources, and tools, no matter where you are in your breast cancer journey.


Topics in this Episode:

  • Intro

  • Setting Expectations takes Communication from the Patient and the Surgeon

  • Reviewing Various Breast Reconstructive Options

  • Let’s Talk about Tissue Reconstruction

  • Loss of Sensation and Options

  • Choose Your Entire Team from the Beginning

  • Consider a Plastic Consult even for Lumpectomy or Aesthetic Flat Closure

  • Male Breast Reconstruction – Yes, it is an option

  • Men Need Mammograms. Men can be Gene Mutation Carriers. Men can be BRCA Carriers.

  • Nipple Reconstruction, Nipple Sparing, Nipple Tattoos

  • Self-Advocate for Greater Success

  • Sign off

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Transcript:

Intro

Tammey Grable-Woodford: Hello, and welcome back to Your Killer Life. I am so excited to have you joining us today. And I have an amazing guest, and we are going to be talking about some of the hot topics that we see oftentimes out in the Facebook group. And really, as we chat amongst ourselves, after our diagnosis. And I know that even though Dr. C just told me how to pronounce his name, the likelihood of me getting it correct is wrong. So he'll probably correct me, and that is perfectly okay. But we have with us today; a board certified plastic surgeon, breast reconstruction surgeon, and microsurgeon, all of those things very important.


I'm going to ask Dr. Chyrsopoulo to talk a little bit about that. His interests are state-of-the-art breast reconstruction techniques, short scar breast surgery, cosmetic surgery of the breast and body, and scar healing. Also, something that we all often are coaching each other through as we go through this.


And the thing I think I was most impressed with Dr. C is really your commitment to shared decision making between physician and patient and really your understanding of how crucial that is in achieving the best outcomes. And we talked a little bit in the green room about that accountability side of things, but you sold me with is holistic breast reconstruction.


And not that you were trying to sell me, I came across you doing my research, and I was like, I want to talk to that guy because that sounds right up... right up my alley. So, Dr. Chrysopoulo, would you please tell us a little bit more about you and your background and what the heck you mean by "holistic breast reconstruction?"


Dr. Minas Chrysopoulo: Yeah. So breast reconstruction is really the focus of my professional life, and it has been for a while. Now. I'm very lucky to be in a group that.... we're a big group. We've just hired our eighth physician. Who'll be starting with us in January, but we're seven surgeons all are very passionate about breast reconstruction, uh, all techniques.


Um, we have a phenomenal team. I'm really very, very lucky to be surrounded by people who share the same passions and goals. And you're only as good as your team. And I have a great one. So we're in San Antonio, Texas, because of what we do and the techniques we use, which aren't used or offered by every plastic surgeon because of our niche.


We do see a lot of people who travel specifically for breast reconstruction to our practice, PRMA, in San Antonio. In terms of things that people want to talk to me about, tap me on the shoulder about it's very much what you mentioned, actually. It's things like that holistic approach that includes shared decision making.


I also talk a lot about restoring sensation after mastectomies, because unfortunately, many women who have a mastectomy end up being numb, and to many, it's a surprise, which is difficult to believe that patients aren't told. But a lot of the time, unfortunately, they're not.


So holistic means complete. Right? So breast reconstruction isn't just about breast reconstruction options, right? There are a whole myriad of techniques. Some techniques are very complex. Others are very simple, and there is no best technique for everyone. So the holistic approach really needs to incorporate what the patient brings to the table because you can get a great breast reconstruction with any technique, but it's not up to the surgeon to define what great is. It's up to that collaboration between the patient and the surgeon. The patient needs to be happy, and the patient needs to feel that it's great. And for them to feel the result is what they wanted. It's got to jive with other things, other things in their lives, their situation, what they like to do, activities, all sorts of stuff.


So basically, holistic means considering whatever factors the patient brings that are important to the patient. So that's their decision making angle. And then obviously also, um, their medical status, uh, psychological status, emotional wellbeing, nutrition. All these things really play into a holistic approach.


So that's a long answer, but that's what holistic is in my eyes.


Tammey Grable-Woodford: I love that. And I really love what you said about the patient defining success. I know that with my plastic surgeon she was wonderful and how she phrased it. And what she said to me is that. She set an expectation, but gently in that I'm; I'm never going to look the way that I did that, that ship had sailed.


And for me, there's no way to get back to the same size and the whole bit, which actually was a bonus. That's not a bad thing. I was happy to have a little bit of a reduction as a side effect, but also just, she kind of set the tone of, of the goal being to get me to look as, as normal as possible, or as good as possible, with clothes on. Now, she met, she far, she met and beat that expectation, quite frankly, but could you talk with us a little bit, because that is a hard thing.


Every surgery is different; everybody is different. And so when it comes to kind of setting those expectations with your patients or giving patients tools for those conversations with providers, what tips would you have?


Setting Expectations takes Communication from the Patient and the Surgeon

Dr. Minas Chrysopoulo: Oh, you've gotta be blatantly honest. This isn't a vanity procedure; breast reconstruction for some women is important, very imp... it's crucial for some women because it defines them as a woman, as a woman, other women are defined at all by their breasts. It's a very personal thing, and there's no right or wrong. But what we need to do is learn, uh, where the patient stands and what her take is.


And then we need brutal honesty. Some women… they are at a point in their lives where looking good in clothes is very important to them. They want to look physically whole, but when they're naked, they don't care. Other women want to be able to wear a bikini and look phenomenal. You know, there are expectations that we all need to discuss, and sometimes they do need to be reigned in a little bit, depending on what the patient's expectations are.


But the time to do that is before surgery; there's a lot of emotion obviously, that comes with the breast cancer diagnosis. Um, a lot of the time, patients feel like they... that it's an emergency. They've got to take care of this today. Uh, sometimes they're made to feel that way by their healthcare teams, by their physicians, you know?


But the reality of the situation is that patients actually have more time than they think they do to make a decision. I'm not saying that you want to sit on, uh, a new invasive breast cancer diagnosis for six months while you look at all your options. That's not what I'm saying at all, but you don't need to rush into a mastectomy the day after tomorrow.


Okay? So you've got on a little bit of time. You've got, you've got a couple of weeks, a few weeks. It doesn't make a difference in terms of the longterm outcome, survival; the prognosis doesn't make a difference.


Some women, until they get the cancer taken care of, they can't even wrap their heads around breast reconstruction. They may know that they want it. But in terms of decision making, it's just way too much at that month. And, you know, reconstruction at the same time as the mastectomy gives you the best cosmetic results, but it can be performed at any time. So again, this is another conversation that patients need to have, and physicians need to have. Their plastic surgeons, we're all, you know, we want things to look great. We want the best cosmetic outcome; it's in our... it's ingrained in us obviously. And so if, if a patient's a really good surgical candidate for an immediate reconstruction, so that they go in for the mastectomy and they come out with breasts, their different breasts, but they go in whole, physically whole, they come out physically whole, and then they have less the scarring, and the cosmetic results are the best that you can get, you know, we tend to push for that.


But we, we, we need to remember that sometimes people just aren't ready. And that has to be respected too. As long as the patient understands that, you know what, no cosmetic result may not be as good. That's okay. They may not care. Right? So honesty is really important, really important to both sides. Both sides. And patients can't be fearful of you know; they can't waste time. Uh, these days, we don't get enough time with your physician, as it is. You can't waste time working out what's appropriate, what isn't appropriate. If it's on your mind, it's important to you. So speak up, mention it.


Tammey Grable-Woodford: I love what you said about time. And I was very fortunate that I was able to actually attend a cancer retreat prior to even my mastectomies. Like timing just could not have been better. And I'll never forget the doctor at the retreat saying that you, you can take a breath. You have time to take a breath.


Everything is coming at you so quickly. And I call it the cancer train you get on, and it just takes off. And it's a bullet train and unless you slow it down and pull the brake yourself. You do kind of get shuttled along through the process, and that's not a bad thing unless you need to go through some, some research and breathing, and figure out what is best for you.


I know for, for me, I asked my general surgeon for a referral to a plastic surgeon. So I could have that conversation prior to the mastectomies. And for me, part of it was wanting to make sure that even though I had decided on delayed because I had so many unknowns that I was leaving the best, I guess, the landscape for the plastic surgeon to be able to do their job after the fact.


And that also helped me because I was able to ask about the different types of reconstruction and, and there were so many things I didn't know. I think that so often. As you said earlier, this isn't a vanity procedure, but a lot of times, the only thing we know when we're first diagnosed is about implants, and there are so many other reconstruction options that I had no idea about until I had the chance to have a conversation with a plastic surgeon. And that really opened my eyes in helping me make that decision for myself. Could you talk with us a little bit about the different types of reconstruction options that are available?


Reviewing Various Breast Reconstructive Options

Dr. Minas Chrysopoulo: Absolutely. So women actually have many options. Uh, implants are the option obviously most women know about already, and you can get a very nice reconstruction with a breast implant, but women need to know that it's not a boob job. Okay. So it's fundamentally very, very different. Uh, we use the same manmade materials - implants, saline-filled, or silicone gel-filled.


They're the same implants that we use in both cosmetic patients and breast reconstruction patients. But the main difference is this, even if your smaller breasted and that's why you want a cosmetic enhancement, you still have breast tissue. You have skin, you have fat underneath that skin. And even if you're in A cup and you feel like your flat, or however you describe yourself, you still have more tissue than a mastectomy patient has after the mastectomy is done.


And so generally speaking, the more padding you have over an implant. The better the result, the more cosmetic the result, the more natural the result, the less padding you have, the higher the risk, being able to see the implant through the skin. We call that rippling. Something called breast animation, which is what women experience when implants are put under the muscle, the implants are put under the muscle so that there's more padding and more protection, but then when the patient uses their chest, and the pec muscles are engaged, then they squeeze down on the implant, and it can actually make the breast look a little weird until you stop doing what you're doing and relax and then everything goes back to looking normal again. So. That's a big issue. We we've moved away. Many of us have moved away from putting implants under the muscle in reconstruction. And now there's prepec reconstruction, which is basically putting the implant on top of the muscle. And there are pros and cons to that, but a lot of us are doing that to avoid breast animation, and there are some pretty good data now to support doing that, even in ladies who are going to get radiation.


One point I'd like to make before we move away from implants and talking about the other techniques is, is this - for ladies who may be listening, who have friends who have a breast cancer diagnosis, one of the worst things I think you can tell a patient if you've had it cosmetic breast augmentation, and then you have a friend who's been diagnosed who hasn't had a cosmetic breast augmentation before, but maybe she was considering it, or maybe you guys were talking about it. Don't tell them that at least now they can get the boob job they always wanted. It's completely different. And I know it's coming from a position of love and support, but I think, you know, when I, when I have really honest conversations with my patients, in terms of things, you know, what not to say to someone or what they hate hearing the most, that's got to be in the top five things, right?