Dr. David Light, MD, of NYBRA Plastic Surgery, is a board certified, fellowship trained plastic surgeon with a dual practice focused on breast reconstruction and aesthetic surgery. Our topic on Episode 19: delayed and revision breast reconstruction. Here is the summary of our conversation on the DiepCJourney podcast.
Telemedicine for Delayed and Revision Breast Reconstruction
Dr. Light performs over three hundred primary and revision breast surgeries per year. Besides DIEPflap, he also performs other microsurgical specialty flaps for breast reconstruction including the SIEA, PAP, LTP, and GAP flap. His practice also includes implant-based breast reconstruction.
Microsurgery is a unique subspecialty of plastic surgery requiring further training. It involves anastomosis or tying together of blood vessels among other skills. For this reason, access to microsurgeons is limited across the U. S. Many patients must travel to have autologous breast reconstruction, reconstruction using your own tissue with a blood source. Microsurgeons have been utilizing telemedicine far before the pandemic.
Dr. Light points out the silver lining of the pandemic is that patients realized the power of telemedicine. He consults with patients and gets to know them in the initial consult via their secure, HIPPA compliant portal. Here he begins to discuss options for delayed and revision breast reconstruction. Patients have been able to explore more possibilities who may have had failed reconstruction or prior complications. This has allowed them to research other specialists, like Dr. Light and his team, for telemedicine consults.
The Advantages of Telemedicine for Breast Reconstruction
Dr. Light is able to see patients for their initial consultation via telemedicine from up and down the East coast, the Midwest, and even international patients. This presents a huge advantage for patients during the initial consultation. Patients are able to save time and money away from work and family. The purpose is for an introduction, to get to know the patient and learn their medical history.
Patients can evaluate the personality of the surgeons and size this up during a consult. This begins the trust relationship between patient and surgeon. Dr. Light always encourages second opinions to make the patient more comfortable with their decision. He states it is a big leap of faith for an individual to put trust in someone you have never met. Telemedicine aids in establishing this trust.
There is also a level of comfort sitting in one’s own domicile. He welcomes them to have a family member, friend, and even more than one sitting in the room where the telemedicine consult takes place. This allows the patient to have that second set of ears to absorb all the information being given. Since many of Dr. Light’s consults are at the end of the day, it gives family the ability to participate without having to take the day off to be there to support the patient.
The In-Person Consult for Breast Reconstruction
After the initial telemedicine consultation and upon deciding to come to NYBRA, patients then have an in-person consult for their reconstruction surgery. Dr. Light always enters the room and gets to know the patient first before he asks them to disrobe for the physical exam. He points out this gives them more of a sense of comfort since they are already in a vulnerable situation. He examines available belly fat, skin laxity, and reviews medical history.
NYBRA practices the shared decision-making model with patients to honor the patient’s voice and decision for their breast reconstruction. He tells the patient there is no one wrong decision. He states he tells patients that together, in a collaborative conversation, we will guide you through what is the right decision for you.
The in-person visit with Dr. Light allows the patient to get to know the rest of the NYBRA support staff available. Their Patient Empowerment Program run by Mollie Sugarman focuses on what is going on in the person’s life, family, children. and how to discuss the diagnosis dealing with issues when there are young children at home.
ERAS Protocol in Breast Reconstruction
Dr. Light states that ERAS has been of great benefit to patients over the past ten years because it changes their post-operative recovery. Previously, patients used the PCA, patient-controlled analgesia, pain pump. Even though they were able to control their own pain, the reality is breast reconstruction patients do not need high volumes of narcotic pain.
Switching to ERAS eliminated unnecessary nausea, constipation, and extended hospital stays with patients being immobile and not up and moving a lot. ERAS has changed that. Instead of a three-to-four-day hospital stay many patients are now dismissed thirty-six to forty-eight hours after surgery with little or no narcotics. They are able to transition quickly to oral Tylenol written as a standing order to stay ahead of the pain. Narcotics would only be used for uncontrolled break through pain.
Dr. Light admits he had some butterflies before the podcast since he had a great desire to concisely discuss the topic we chose, delayed and revision breast reconstruction. Those butterflies fluttered away quickly because he nailed it! Thank you, Dr. Light, and for the listeners, enjoy the entirety of the podcast here to learn more.