Mastectomy

Mastectomy and Reconstruction Options

When I had my mastectomy in 1999, an Aesthetic Flat Closure (AFC) was never presented as an option. In my early 30’s in a male dominated field of engineering, it wasn’t something I even knew to ask about or considered. Having been through both a bilateral saline implant reconstruction that went wrong in so many ways, and a DIEP flap tissue reconstruction, I’d encourage women to look into ALL of our options.

The Breast Implant Safety Alliance (BISA) regularly posts on flat closures and there are many reputable sites and groups now. These are just a few!

Your reconstruction surgeon may have conflicting interests, so it is worth exploring and asking a LOT of questions! This is your health, so have courage, stand tall and ask, even when it feels intimidating (and I know from experience that it is often intimidating)!!

Mastectomy & Reconstruction Options
Whether you are having a mastectomy, reconstruction, breast implants for any reason, or explant surgery, choosing a board-certified surgeon carefully can impact the rest of your life.  The decision to have surgery is emotional, physical, and financial.  Before deciding on which surgeon to entrust with your body, do your homework, ask questions, and take your time to get reliable answers.   It is important to consider both the surgeon’s qualifications and experience, but also understand the possible surgical options. Board Certification According to the American Society of Plastic Surgeons (ASPS), choosing a board-certified plastic surgeon is critical, no matter what country you choose for surgery. The Trust ASPS campaign shares the importance of thorough researching your surgical options and choosing a qualified plastic surgeon for the safest outcomes (ASPS, 2019). Both the ASPS and The American Board of Plastic Surgery provides a physician locator at their websites.  In Europe, check the European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) website for further information. American Society of Plastic Surgeons (ASPS) – also includes an international listing (https://find.plasticsurgery.org/)American Board of Plastic Surgery (https://www.abplasticsurgery.org/ModDefault?section=SurgeonSearch)Certification Matters – a grouping of multiple surgical specialties  https://www.certificationmatters.org/European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) http://www.ebopras.org/index.phpThere is also a comprehensive international list of explant surgeons recommended by other patients and carefully vetted by the authors at the Breast Implant Illness website https://www.breastimplantillness.com/explant-surgeons/ Breast Explant Surgeons Communicate BEFORE surgery Surgeons who believe in Breast Implant Illness (BII) and understand that implant removal can cause serious health complications will be more attentive to your wishes and careful during explant.  Get the entire surgical plan in writing and read it carefully. Check references and talk to former patients.Read their website, patient literature, and fine print.Ask the right questions (risks, benefits, insurance, procedure, testing for BIA-ALCL, legal chain of custody, etc.).Keep asking questions until you get answers, even if the surgeon and staff become annoyed. Speak to an attorney before surgery to ensure that all procedures, paperwork, and testing is done properly.If you feel uncomfortable about any aspect of the surgery, go elsewhere. There are numerous horror stories on the Internet of women who thought they were having a total capsulectomy only to find out later that the surgeon drained the implant first or left part of the capsule.  One blogger is faced with her third surgery (paying out of pocket) to remove pieces of the capsule left behind by her surgeon.  En Bloc and Insurance There is a much smaller pool of surgeons with the training, expertise, and experience to properly do an En Bloc implant removal.  Although many websites state that these surgeons do not take insurance, this is not necessarily true.  My surgeons at Midwest Breast and Aesthetic Surgery in Columbus, Ohio, take many insurance plans and are experts in En Bloc surgery.  Refer to the list at Breast Implant Illness website, which despite some disgruntled doctors’ complaints, is an impartial review of qualified explant surgeons.  Even if you are paying for explant surgery out of pocket, it is extremely important to consider the expertise of the surgeon.  You may be able to travel for surgery and still pay less than you would with a lesser trained surgeon who may cause you to have further complications following explant surgery. References American Society of Plastic Surgeons (ASPS). “Trust ASPS: Choose a board-certified plastic surgeon”. Retrieved July 15, 2019, from https://www.plasticsurgery.org/patient-safety/trust-asps American Society of Plastic Surgeons (ASPS). “Is your surgeon certified?” Retrieved July 15, 2019, from https://find.plasticsurgery.org/ Breast Implant Illness. “Explant surgeons.” Retrieved July 15, 2019, from https://www.breastimplantillness.com/explant-surgeons/ Certification Matters. “Is my surgeon board-certified?” Retrieved July 15, 2019 from https://www.certificationmatters.org/ National Center for Health Research. “Your guide to breast implants and your health: We’re quoted.” Retrieved July 15, 2019, from http://breastimplantinfo.org/newsroom-2/were-quoted/ European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS). “Welcome.” Retrieved July 15, 2019, from http://www.ebopras.org/index.php [...] Read more...
Dr. Ergun Kocak and Dr. Pankaj Tiwari, of Midwest Breast and Aesthetic Sugery in Columbus, Ohio, discuss breast reconstruction options after mastectomy. Drs. Kocak and Tiwari, my explant surgeons, share three breast reconstruction options. Flat closure, without reconstruction at the time, is detailed in a separate webinar by Dr. Tiwari. The second breast reconstruction option after mastectomy, breast implants, includes a frank discussion about the possibility of Breast Implant Illness. As Dr. Tiwari states in the video, the doctors prefer placing implants on top of the chest muscle. Many mastectomy and cosmetic implant patients had their implants placed behind the pectoral muscle. For some women, capsular contracture and Breast Implant Illness can occur. Dr. Kocak discusses several options for using natural tissue breast reconstruction options after mastectomy, including DIEP flap, the option they performed during my explant surgery. I would encourage women to also look into Aesthetic Flat Closure (AFC), which Drs. Tiwari and Kocak discouraged as an option at the time of my surgery in 2019. This is an older video and there are numerous reputable sites now to explore AFC. See the Mastectomy page for a list. Midwest Breast and Aesthetic Surgery, Columbus, Ohio [...] Read more...