The value of a 2nd opinion for breast reconstruction is fortunately something that has the potential to give women hope if they have been turned down at an initial consult for autologous breast reconstruction. I had the fortune to talk with two board certified microsurgeons, Dr. David Song of MedStar Georgetown and Dr. Minas Chrysopoulo of PRMA in San Antonio. Both plastic surgeons successfully and routinely perform a variety of autologous flap surgeries with great success.
What is autologous breast reconstruction?
Autologous breast reconstruction is using another area of the patient’s body using the tissue and underlying blood vessels to create a soft, warm, new breast after a mastectomy.
Why are women sometimes turned down by plastic surgeons or told they are not good candidates for autologous breast reconstruction? Here are some of the reasons Dr. Song and Dr. Chrysopoulo mention in the video:
- Well trained colleagues in plastic surgery are not comfortable or simply haven’t had the additional training in microsurgery or haven’t done a lot of autologous flaps.
- A local surgeon tells them they are not a candidate for autologous breast reconstruction. Some patients don’t think about the value of traveling for breast reconstruction. There are centers who accommodate those who need to travel for autologous breast reconstruction who perform various procedures frequently.
- Patients might be told they are too thin. Dr. Chrysopoulo points out, “It’s not your weight. Ultimately it’s how you carry the tissue you have and where it’s located and what the goals are.”
- You’ve had previous abdominal surgery. Yes, if you’ve had a full abdominoplasty, you will not qualify to be a DIEP flap candidate. However, even a Caesarean section does not preclude having DIEP flap. Pre-operative CT angiograms and further testing will tell the microsurgeon if you’re a candidate ahead of time.
- Some patients are discouraged from having DIEP flap by other plastic surgeons because they are told it is a very long surgery. This is often not the case in the hands of a skilled microsurgeon. Read this blog to find out about myths of how long a breast reconstruction actually takes.
What kind of autologous flaps are available using different donor sites?
I had DIEP flap breast reconstruction using my own tummy tissue. However, there are several alternate sources and methods of autologous breast reconstruction besides DIEP flap. Here are some of the methods discussed in the video:
- Stacked flaps
- Four flaps or multiple flaps for two breast reconstructions
- Use one flap and going back and injecting fat into it to achieve greater volume.
- Some surgeons will go back and insert an implant under a DIEP flap. Here is a blog from his group explaining why patient information is key if using this method.
There are several areas of the body that have good blood source other than your tummy. The key, as Dr. Song pointed out is, “Seek the answers and do your homework.” Find a board certified plastic surgeon who is trained in multiple microsurgical procedures. I am grateful to both Dr. David Song and Minas Chrysopoulo for their time and interest in educating patients about breast reconstruction.