Thankful

Feeling just how much of an impact a friend can affect your life...what an inspiration to me as a person. Truly adoring her and thankful for having her in my life.

Breast CA/Reconstruction Radio Talk

Following is a link to a recent 4part series on Breast Cancer/Breast Reconstruction.  I was asked to discuss the topic of breast reconstruction on Main Street Out Loud with Rudi K hosted every Sat 3PM - KKNT 960AM radio.  See and listen to the 3rd Part of the Series of my discussion on breast reconstruction - implications/insurance/options/breast reconstruction/DIEP flaps.

http://www.mainstreetoutloud.com/id10.html

Hope this is helpful!

October 2013

Breast Cancer Patient Education Act introduced in Congress

During Women's Health Week (May 12-18), the Breast Cancer Patient Education Act (S.931/H.R. 1984) was introduced in both the Senate and House of Representatives.  This would direct the Health and Human Services to create an educational campaign to assist women understand their options for post-mastectomy breast reconstruction preoperatively.  As we know, a majority of women are unaware of this option, and thus, most women do not have reconstruction of the breast following mastectomy for that reason - because she is not aware of this option. 

This legislation would require the Health and Human Services Department to create information about reconstruction options for women.  Such educational materials would will hopefully inform women that breast reconstruction is possible at the time of their breast cancer surgery, or anytime after that.  It would also inform them of immediate, delayed, and no reconstruction.  Also, information will be given in regards to post-mastectomy breast prostheses, if no reconstruction is chosen.  Any educational materials will certainly inform breast cancer patients that federal law mandates the coverage of breast reconstruction in accordance with the Women's Health Rights and Cancer Act. 

We truly support and commend the Plastic Surgery Society in our efforts and hope that this will make a big impact on the breast cancer patients. 

Another FDA approval for a "gummy bear" implant

Recently, the FDA has approved the Mentor MemoryShape CPG implant.  This adds the 3rd company to have an anatomically-shaped breast implant in the U.S.  The "gummy bear" implant has been widely available worldwide for the past decade. 

With the approval of such form-stable, "gummy bear" implants, the use not only in breast augmentation, but also for breast reconstruction are heightened.  It gives another option for implant-based reconstruction to women, as each woman is different. 

Furthering awareness of breast cancer and breast reconstruction

The most prominent news in breast cancer today is the recent announcement by actress Angelina Jolie of her opting for bilateral prophylactic mastectomy (removal of both breasts) due to her high risk of developing breast cancer in the future, although she does not have breast cancer now.  It began with her mother's recent fight with ovarian cancer, which then led to testing for a gene linked to both of these cancers.  It ended up that she does have the BRCA1 gene, which poses approximately between 65-87% risk for developing breast cancer throughout the afflicted person's lifetime.  In addition, there is also an association with ovarian cancer. 

With this gene, it is recommended to have both breasts and ovaries surgically removed.  Angelina Jolie did undergo bilateral mastectomy, followed by immediate implant-based breast reconstruction.  She relates having a nipple-sparing mastectomy, in which the nipples are spared, as long as there was no diagnosed cancer in the ductal tissue when tested.  Breast reconstruction is certainly an option for any woman after a mastectomy.  She said that she hoped that other women would find encouragement from her story.

"I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer," Jolie said in the Times article. "It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options."

"I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options."

Here is the link to her New York Times op-ed piece:
http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=0

I would hope that this announcement by such a prominent figure helps even more in the fight against breast cancer, not only in awareness and options, but in research, funding, and eventual cure of this disease. 

Increase in breast reconstruction

A recent report which looked at the effect of legislation on breast reconstruction has recently been published.  There is a dramatic increase in those people who have not only been informed of their option for breast reconstruction after a mastectomy, but also in the number of people who underwent the procedure.  This does show the effect of legislation such as the Women's Health and Cancer Rights Act of 1998.

Between 2000 and 2009, >168,000 women in the database of this study underwent mastectomy and 35,000 of them had breast reconstruction immediately following their cancer treatment.  Roughly 13% in 2000 had breast reconstruction as opposed to 36% in 2009.  While these with health insurance still had high numbers, the greatest increase in reconstruction rates over this decade was among women covered by MediCare and MedicAid.  In 2000, just ~5% of women on MedicAid had breast reconstruction performed, whereas 20% had it done in 2009 - approximately a 4-fold increase!  Along similar lines, those on MediCare also tripled from 4.3 to 12.3% during the same time span.  Women with private insurance more than doubled their rate of reconstructions from 22.1-57.1%.

The option and knowledge of breast reconstruction is certainly rising as shown.  Strives still need to be made to educate the physician and patient alike, about this option and the effect that it has on women both mentally and psychologically, along with the physical aspects.

Oncoplastic breast cancer resection

Many people have inquired about lumpectomy and the potential defect or contour deformity following this type of breast-conserving therapy for breast cancer.  Sometimes after a lumpectomy, women complain of significant breast asymmetry after the excision and radiation therapy that follows.  Depending on the tissue resected and location, there is also a potential for concavity at the site of the lumpectomy.  Certainly there is a potential for plastic surgery during the lumpectomy as an oncoplastic procedure. 

A very gratifying procedure for women opting for breast conserving therapy is to perform an oncoplastic cancer resection in combination with your breast surgeon, so as to remove the cancer as a lumpectomy, while also reducing/lifting the breast at the same time.  By including the cancer specimen within the tissue that would already be excised in a breast reduction or a breast lift, it would not only remove the cancer, often times giving even larger margins than by lumpectomy alone, and then rearranging the tissue in a standard breast reduction/breast lift fashion to contour the breast at that time.  This same pattern is usually performed on the opposite breast to also reduce/lift the breast creating perky, lifted breasts - as is the goal in a breast reduction and breast lift.  There would be no difference in the manner in which this procedure is performed nor in the way that the cancer is excised.  Simply, the cancer would be excised in tissue that would already be removed during the breast reduction or breast lift procedure anyhow. 

Women with larger breasts or needing a breast lift are the ideal candidates for this procedure.  This procedure is done in conjunction with a breast surgeon and the plastic surgeon would design the incisions and areas to be excised in order to have adequate margins with the cancer removal as well as create the most aesthetically-appearing breasts afterwards.  This may be discussed with your breast surgeon if you are interested in in such a procedure for your breast-conserving therapy.

Another "gummy bear" implant approved

Last week, the FDA approved the use of the silicone "gummy bear" implant.  The 410 implant by Allergan is an anatomically-shaped, textured, silicone cohesive gel implant that is much firmer than the previous silicone gel implants.  This new generation of implants have been shown in previous to have decreased complication rates, such as rupture and capsular contracture.

During the time of investigation, in addition to breast augmentation, they have been used in breast reconstruction with some excellent results.  The "tear-drop" shape of the implant may potentially give a more aesthetically-pleasing and more natural appearance of the breast.  There is a potential for rotation of the implant within the pocket, which has been shown to significantly decrease with experience with their use.  Surgeons were chosen to participate in the investigational trial in order to use these implants during their several years of trial.  We have used, and have been using such implants as the Allergan 410, Mentor CPG, and Sientra implants for several years during training as well as in practice, with excellent results.  We have significant experience with all of these implants.

We hope that the approval of these implants will significantly make a dramatic difference for the breast reconstruction patients in the future with the development of these excellent implants.

Additional information on the Breast Reconstruction Center

We have had several inquiries regarding our services at the Breast Reconstruction Center in regards to immediate breast reconstruction, delayed breast reconstruction, and second opinions.  We wold be honored to provide consultations regarding anything related to these or breast surgery.   Some additional information that people requested are noted below.  Thank you for your interest and we look forward to assisting you in any way that we are able.

We have privileges and work out of:
John C. Lincoln - North Mountain and Deer Valley
Scottsdale HealthCare - Thompson Peak, Shea, and Osborn
Banner - Good Samaritan and Thunderbird
Abrazo - Paradise Valley, Phoenix Baptist, and Arrowhead
Scottsdale Surgery Center
Many outpatient surgery centers throughout the Valley

We are contracted with all of the major health insurance plans as well as many others.  Our office would be happy to help you determine your benefits and contract status.

Thank you all for the inquiries and glad that this information has been helpful!

Scottsdale/Phoenix Breast Reconstruction Center

We have had made inquiries regarding breast reconstruction, opinions regarding reconstructive procedures that one was offered, and questions on results following breast reconstruction.  Just like with any other procedure in plastic surgery, it may be in one's best interest to go to a place that specializes in that procedure.  Looking at education, training, recommendations, researching your surgeon, and having a comfort level with him/her should help in your decision making for choosing your surgeon.  Your consultation should include ALL breast reconstructive procedures, as there is not only one type of reconstruction.  You should be offered implant-based reconstruction, flap-based reconstruction including latissimus flaps and microsurgical flaps such as the DIEP, SGAP, SIEA, TUG, etc., as well as fat transfer procedures.  These are a collection of breast reconstruction and together, you and your surgeon should decided together which breast reconstructive procedure is right for you.

At the Scottsdale/Phoenix Breast Reconstruction Center, we focus entirely on breast reconstruction.  Hopefully, this passion for breast reconstruction and our breast reconstruction patients carries over to your level of care.  We perform nearly 200-250+ breast reconstructions annually.  We have completely the highly-competitive integrated general/plastic surgery residency and chosen to garner further training specifically in breast cancer/breast reconstruction and microsurgery, including flaps such as the DIEP and others.  We are skilled in all types of breast reconstruction and able to perform other reconstructive procedures if you so require them in the future.

All in all, we now offer second opinions for breast reconstruction and will be honored to educate on all types of breast reconstruction and our opinion on reconstructive procedure offered to you, prior to having your breast reconstruction performed.  Also, we look to give opinions on revisionary breast reconstruction and give our thoughts and options for your breast reconstruction, if already completed.  Feel free to contact our Center for a consultation regarding immediate breast reconstruction, delayed breast reconstruction, second opinion, or options for revision.

480.752.7874
www.phoenixbreastreconstructioncenter.com
www.scottsdalebreastreconstructioncenter.com

New Legislation for Breast Cancer Awareness!

We are pleased with the efforts of our Society, the American Society of Plastic Surgeons, in gaining legislation to empower women with breast cancer to better understand their care choices.  2012 alone saw the new diagnosis of >220,000 new cases of invasive breast cancer in the United States, not to mention the new diagnoses of in situ types such as DCIS and LCIS.  We are in full support of  H.R. 5937, the "Breast Cancer Patient Education Act", which was introduced through legislation this past year.

Since 1998 with the Women's Health & Cancer Rights (WHCR) Act, health plans that allow for breast cancer coverage are required to provide coverage for prostheses and breast reconstruction as well.   However, of all women diagnosed with breast cancer in the United States, only 1/3 of these women will undergo breast reconstruction.  Moreover, nearly 7 of every 10 women are not even informed of the options for breast reconstruction.  The most common reasons being that they were not informed of their option to pursue such or they were not referred to a plastic surgeon to discuss the options available.

This "Breast Cancer Patient Education Act" requires the Secretary of Health and Human Services to plan and implement a campaign for education of patients for the purpose of providing breast cancer patients with information about the availability and options for breast reconstruction as well as coverage for such.  Also, it will provide information on prostheses, prosthetic garments, and other options available to them.  The Secretary is to develop information for distribution or have others produce for distribution, which would include the information above such as timing, options, and available clothing/prosthetic options.  It will also include information about the previously enacted WHCR Act.   Several states have already enacted laws to require women to receive such information.

ASPS president Dr. Malcolm Roth stated, "The Breast Cancer Patient Education Act will get the best information in the hands of women and their families to empower them in making the best choice for their care...Knowledge is power.  Federal law has long required coverage for reconstruction and prostheses and no woman should be denied the right to choose the care they need just because they were not aware of their choices."

We are very proud of the efforts of our Society and hope that this will assist others in making fully informed decisions in regards to their health care.

Happy New Year!

To all...a happy, joyous, and healthy 2013!!!