Monday, June 6, 2011

Q: Any Recommendations for the Best Reconstructive Plastic Surgeons Who Do DIEP?

A: Find a plastic surgeon who has done a fellowship in microsurgery and/or who currently does high volume reconstructive microsurgery.

You can usually find a small number of plastic surgeons in a major city, often times at an academic medical center, who perform the DIEP operation or other complex microsurgical procedures on a regular basis.   Having a microsurgery fellowship means that the plastic surgeon spent an additional year (after their usual 6-8 years of training) performing high volume, complex microsurgical cases.  Very often, these reconstructive microsurgeons are members of the American Society for Reconstructive Microsurgery (ASRM) in addition to the American Society of Plastic Surgeons (ASPS)
It is very rare when a DIEP cannot be performed, but it is ultimatley an intraoperative decision as to whether you end up with a DIEP or some variance of a TRAM.   New imaging modalities with CT Angio or Duplex ultrasound can help "map" these vessels and delineate the anatomy better, but there is no guarantee.   Your surgeon will always perform the operation that best suits you and your anatomy, to give you the safest and best result.

The best plastic surgeon for you is the one who is qualified and who understands your individual needs and presents the best options for you.   I welcome you to contact our office at 415 933 8330 to discuss DIEP breast reconstruction, and/or other autologous (self) tissue options.

Do Breast Reconstruction Tissue Expanders Cause Pain As They Expand?

A: Tissue expansion can be uncomfortable, but should not be painful

Tissue expansion of any type can cause some amount of discomfort and is highly dependent upon the volume and the rate of the expansion.    Pain should be a guide as to when the expansion should stop and allow your tissues catch up to the amount of expansion that can be tolerated.  50cc is an average volume of expansion for breast expanders and is usually well tolerated.

Q: Mastectomy and Breast Reconstruction - Can the Procedures Be Combined

A: Combined mastectomy and breast reconstruction is possible

This is similar to the idea of "immediate vs. delayed breast reconstruction."

The combined procedure is possible, and often times, the preferred method of breast reconstruction.   This "immediate" reconstruction allows for the best aesthetic result because the skin of the breast is saved and an implant or "self tissue" (DIEP, TRAM, etc) can be placed inside the original breast pocket.   The general surgeon and plastic surgeon work together with the first surgeon removing the breast tissue and the second surgeon reconstructing the breast in a single stage.  This is the key advantage.  The disadvantage can be wound issues from thin mastectomy flaps and/or unresolved oncologic issues at the time of reconstruction. 

Can Inverted Nipple After Lumpectomy Be Repaired?

A: An inverted nipple can be corrected

The short answer to your question is yes.  Nipple inversion can occur for several reasons after your lumpectomy.  This includes the "inner" scarring that occurs that likely brough part of the nipple with it, causing an inversion.  To fix this, it is important to figure out which parts of the breast caused this:  loss of skin, skin contracture, fat necrosis, infection, radiation, etc.   Once this has been evaluated, then the principle of treating any nipple inversion are used:  release the scar, add more tissue, etc.   Recurrence can be common, so it is best to see a plastic surgeon with significant experience in this area.