The DIEP flap physical care for has apace buy the farm the "gold standard" inwards pectus reconstruction today. While non every adult woman is a candidate for DIEP flap surgery, many are turned away when inwards fact they needn't be. The most mutual areas of confusion include:
1) Previous Abdominal Surgery
While to a greater extent than or less types of previous abdominal surgical physical care for tin brand the DIEP flap physical care for impossible to perform, most of the fourth dimension previous abdominal surgical physical care for actually isn't an issue.
Many women these days bring had a previous c-section or hysterectomy. It is possible for these procedures to drive impairment to the blood vessels needed for DIEP flap surgery, simply this is rare. Influenza A virus subtype H5N1 previous c-section, hysterectomy, or tubal ligation is non a contra-indication to having the procedure.
If your surgeon is worried well-nigh potential impairment from previous surgical physical care for in addition to thence for sure tests tin live performed to examine the anatomy to a greater extent than closely. This tin include a elementary doppler ultrasound assay inwards the component subdivision or a to a greater extent than involved assay similar a CT angiogram.
So which previous surgeries DO drive a problem? Women that bring had a previous TRAM flap, tummy tuck or really extensive abdominal wall surgeries (like complex repairs of huge hernias) cannot bring a DIEP or SIEA flap reconstruction because the lower stomach tissue that is needed has already been removed, disconnected or moved around.
While previous abdominal surgeries may non forbid DIEP flap reconstruction, women that bring had multiple previous abdominal procedures are at increased guide chances of abdominal complications similar bulging in addition to fifty-fifty hernia afterwards DIEP flap surgical physical care for when compared to women that bring never had prior abdominal surgery.
2) An Umbilical Hernia
It is really unlikely that an umbilical hernia would forbid DIEP flap surgery. Most umbilical hernias are small. Influenza A virus subtype H5N1 really large umbilical hernia tin brand the surgical physical care for harder simply fifty-fifty this is non commonly a contra-indication to having the procedure.
3) Previous Chest Radiation
One of the most of import things for the reconstructive surgeon to arrive at is to supervene upon the damaged, theatre irradiated tissue alongside normal, healthy, soft tissue. If the irradiated tissue is non good for yous plenty to live used equally component subdivision of the reconstruction (as is the instance inwards many instances), it volition live removed in addition to replaced yesteryear the good for yous (DIEP) tissue.
I bring visited alongside a fair number of patients who bring previously been told they are non candidates for DIEP flap reconstruction because they received pectus radiations afterwards their mastectomy. I do not portion this opinion.
Most of the fourth dimension this advice seems to stalk from fearfulness that the radiations may bring caused impairment to the internal mammary vessels inwards the chest. These are the blood vessels that are commonly used to connect the DIEP flap to the chest. In reality it is exceptionally rare for us to uncovering these blood vessels are damaged in addition to cannot live used.
4) Not the Right Amount of Tissue
You don't quest to live overweight to live a candidate for a DIEP flap. What matters is the distribution of the fat. We bring performed DIEP flaps on smaller breast, sparse women alongside a BMI (body volume index) of twenty (and fifty-fifty less) because the fatty that they did bring was "in all the correct places". Having said that, in that location is an upper boundary beyond which the risks of surgical physical care for outweigh the benefits - At PRMA nosotros laid an upper BMI boundary of twoscore equally nosotros bring institute that performing the physical care for on women alongside BMIs greater than this significantly increases the rates of complications (especially injure healing problems).
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Dr Chrysopoulo is a board certified plastic surgeon specializing inwards the latest pectus reconstruction techniques . He in addition to his partners are in-network for most the U.S. of A. insurance plans. Learn to a greater extent than well-nigh your breast reconstruction options in addition to connect alongside other pectus reconstruction patients here. You tin likewise follow Dr C on Twitter!
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Showing posts with label radiation. Show all posts
Showing posts with label radiation. Show all posts
Healty | Breast Reconstruction Timing: Immediate vs Delayed Reconstruction
With so much to mean value nearly afterwards a pectus cancer diagnosis, many patients facing mastectomy gain non fully sympathize how the timing of pectus reconstruction influences how the reconstructed breasts volition ultimately look.
Breast reconstruction tin live performed at the same fourth dimension every bit the mastectomy ("immediate reconstruction") or a land afterwards mastectomy ("delayed reconstruction").
When the mastectomy in addition to reconstruction are performed at the same time, a skin-sparing mastectomy tin unremarkably live performed which saves the bulk of the natural pectus pare envelope (except for the nipple in addition to areola). Only the actual pectus tissue nether the pare is removed. The reconstruction in addition to then "fills" this empty pare envelope. In or so direct cases the nipple in addition to areola tin likewise live saved. This is known every bit a nipple-sparing mastectomy.
Skin-sparing (or nipple-sparing) mastectomy in addition to immediate pectus reconstruction create the most "natural" results amongst the to the lowest degree scarring. Skin-sparing mastectomy in addition to immediate reconstruction is so preferred whenever possible in addition to should live the finish for pectus cancer patients amongst early on illness (stage I or II).
Delayed reconstruction unfortunately leaves to a greater extent than scarring (typically) in addition to the in conclusion pectus is less probable to expect similar the breasts Mother Nature provided. Common reasons to delay reconstruction include advanced pectus cancer (stage III or IV), inflammatory pectus cancer, the excogitation for radiations therapy afterwards mastectomy, in addition to lack of access to a reconstructive surgeon.
The departure inward scarring betwixt immediate in addition to delayed pectus reconstruction tin live seen inward these breast reconstruction earlier in addition to afterwards photos.
Ultimately the priority must ever live "life earlier breast" - patently the pectus cancer handling comes get-go inward price of priority. However, all other things beingness equal, in that place volition sometimes live a pick to live made betwixt having the reconstruction performed with the mastectomy or or so fourth dimension after the mastectomy. Whenever possible, I encourage women to attempt immediate reconstruction for the best cosmetic results.
*****
Dr Chrysopoulo is a board certified plastic surgeon specializing inward the latest breast reconstruction techniques including the DIEP flap procedure. He in addition to his partners perform over 500 DIEP flap procedures per twelvemonth in addition to are In-Network for most U.S.A. of America insurance plans. Learn to a greater extent than nearly your breast reconstruction options in addition to connect amongst other pectus reconstruction patients here. You tin likewise follow Dr C on Twitter!
*****
Breast reconstruction tin live performed at the same fourth dimension every bit the mastectomy ("immediate reconstruction") or a land afterwards mastectomy ("delayed reconstruction").
When the mastectomy in addition to reconstruction are performed at the same time, a skin-sparing mastectomy tin unremarkably live performed which saves the bulk of the natural pectus pare envelope (except for the nipple in addition to areola). Only the actual pectus tissue nether the pare is removed. The reconstruction in addition to then "fills" this empty pare envelope. In or so direct cases the nipple in addition to areola tin likewise live saved. This is known every bit a nipple-sparing mastectomy.
Skin-sparing (or nipple-sparing) mastectomy in addition to immediate pectus reconstruction create the most "natural" results amongst the to the lowest degree scarring. Skin-sparing mastectomy in addition to immediate reconstruction is so preferred whenever possible in addition to should live the finish for pectus cancer patients amongst early on illness (stage I or II).
Delayed reconstruction unfortunately leaves to a greater extent than scarring (typically) in addition to the in conclusion pectus is less probable to expect similar the breasts Mother Nature provided. Common reasons to delay reconstruction include advanced pectus cancer (stage III or IV), inflammatory pectus cancer, the excogitation for radiations therapy afterwards mastectomy, in addition to lack of access to a reconstructive surgeon.
The departure inward scarring betwixt immediate in addition to delayed pectus reconstruction tin live seen inward these breast reconstruction earlier in addition to afterwards photos.
Ultimately the priority must ever live "life earlier breast" - patently the pectus cancer handling comes get-go inward price of priority. However, all other things beingness equal, in that place volition sometimes live a pick to live made betwixt having the reconstruction performed with the mastectomy or or so fourth dimension after the mastectomy. Whenever possible, I encourage women to attempt immediate reconstruction for the best cosmetic results.
*****
Dr Chrysopoulo is a board certified plastic surgeon specializing inward the latest breast reconstruction techniques including the DIEP flap procedure. He in addition to his partners perform over 500 DIEP flap procedures per twelvemonth in addition to are In-Network for most U.S.A. of America insurance plans. Learn to a greater extent than nearly your breast reconstruction options in addition to connect amongst other pectus reconstruction patients here. You tin likewise follow Dr C on Twitter!
*****
Healty | Breast Reconstruction Can Be Performed Any Time
Did y'all know thorax reconstruction tin live performed at whatever time, fifty-fifty years after a mastectomy?
"Immediate thorax reconstruction" is performed at the same fourth dimension equally the mastectomy together with typically provides the most natural results alongside the to the lowest degree total of scarring. Unfortunately, for many women this but isn't an option....
For starters, 70% of women facing mastectomy aren't fifty-fifty told that reconstruction may live an choice for them. They undergo operation entirely to detect out about fourth dimension afterward that they could accept woken upward from their mastectomy alongside novel breasts instead of having to sense a apartment chest.
Of the women that are informed, about may non accept access to a reconstructive plastic surgeon where they alive together with accept to go for reconstruction.
Other women are non candidates for immediate reconstruction because unfortunately the affliction is also advanced at the fourth dimension of diagnosis.
Sometimes radiations therapy is recommended equally role of the thorax cancer treatment. Most plastic surgeons prefer to concord off on reconstruction until the patient is several months out from her terminal radiations therapy. This allows the tissues to recover together with soften upward equally much equally possible to amend the results of the subsequent reconstruction.
As y'all tin see, at that spot are several reasons why a women wanting breast reconstruction may non live able to accept it guide away, ideally at the same fourth dimension equally the mastectomy.
Whatever the argue for delay may be, it is of import to recall at that spot is no fourth dimension limit when it comes to thorax reconstruction - it tin live performed at whatever time, fifty-fifty years after mastectomy.
Like immediate reconstruction, delayed thorax reconstruction is also covered past times insurance regardless of how many years accept passed since the thorax cancer diagnosis.
Dr C
*****
"Immediate thorax reconstruction" is performed at the same fourth dimension equally the mastectomy together with typically provides the most natural results alongside the to the lowest degree total of scarring. Unfortunately, for many women this but isn't an option....
For starters, 70% of women facing mastectomy aren't fifty-fifty told that reconstruction may live an choice for them. They undergo operation entirely to detect out about fourth dimension afterward that they could accept woken upward from their mastectomy alongside novel breasts instead of having to sense a apartment chest.
Of the women that are informed, about may non accept access to a reconstructive plastic surgeon where they alive together with accept to go for reconstruction.
Other women are non candidates for immediate reconstruction because unfortunately the affliction is also advanced at the fourth dimension of diagnosis.
Sometimes radiations therapy is recommended equally role of the thorax cancer treatment. Most plastic surgeons prefer to concord off on reconstruction until the patient is several months out from her terminal radiations therapy. This allows the tissues to recover together with soften upward equally much equally possible to amend the results of the subsequent reconstruction.
As y'all tin see, at that spot are several reasons why a women wanting breast reconstruction may non live able to accept it guide away, ideally at the same fourth dimension equally the mastectomy.
Whatever the argue for delay may be, it is of import to recall at that spot is no fourth dimension limit when it comes to thorax reconstruction - it tin live performed at whatever time, fifty-fifty years after mastectomy.
Like immediate reconstruction, delayed thorax reconstruction is also covered past times insurance regardless of how many years accept passed since the thorax cancer diagnosis.
Dr C
*****
PRMA Plastic Surgery specializes inward advanced thorax reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap together with Alloderm One-Step. In-Network for most U.S. insurance plans. Patients routinely welcomed from across the USA. Please telephone phone (800) 692-5565 or e-mail patientadvocate@PRMAplasticsurgery.com to larn to a greater extent than nearly your thorax reconstruction options. Connect alongside other thorax cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.
*****Healty | Fat Grafting inward Breast Reconstruction - What's the Scoop?
Fat grafting has been inward the intelligence a fair sum so I idea I'd give yous a brief run-down of what's involved....
Fat grafting is a fairly novel technique inward pectus surgery. Fat is liposuctioned from i purpose of the patient's body, purified too and so injected into the breast.
Fat grafting tin live used to fill-in partial pectus defects afterwards lumpectomy. It is likewise often used afterwards mastectomy, unremarkably inward conjunction amongst other reconstructive techniques, to optimize the pectus contour too better overall cosmetic results.
There are several fatty grafting techniques that are used past times plastic surgeons. There is no "set way" that has been shown to live the best inward terms of long-term results. However, studies receive got shown that regardless of the technique used, the collection, storage, too transplantation of the fatty cells (and fatty stalk cells they contain) must live optimized to obtain the best long-lasting results.
Studies receive got likewise shown that in i lawsuit the injected fatty "takes", it tin likewise assist better the thickness too character of radiation-damaged tissue too skin.
Regardless of technique, roughly of the injected fatty volition live reabsorbed over fourth dimension but this tin vary depending on the exact clinical situation. Patients must thus live prepared to ask to a greater extent than than i physical care for for the best results.
As for the risks.... For women all the same undergoing regular mammograms, it is likewise of import to know that fatty grafting tin likewise displace calcifications known equally "MACRO-calcifications". As many of yous receive got already unfortunately experienced, pectus cancer tin likewise displace calcifications, known equally "MICRO-calcifications". According to the American Society of Radiology, these dissimilar types of calcifications are easily distinguishable. Having said that, I all the same tell my patients that fatty grafting tin atomic number 82 to the recommendation for farther tests inward the time to come because of this calcification issue.
Injected fatty tin likewise acquire trouble solid or exercise "oil cysts". Fortunately these are becoming much less frequent equally techniques are refined but again, both of these tin displace "unnecessary" stress.
Several independent studies that receive got evaluated patients over a few years afterwards the physical care for receive got shown that fatty grafting is safe. However, because the technique is fairly new, no long-term security information is currently available.
Unfortunately non all insurance companies encompass the terms of fatty grafting so the physical care for tin involve out of steal expenses for roughly patients.
I promise this information helps.
Dr C
*****
PRMA Plastic Surgery specializes inward advanced pectus reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step too fat grafting. In-Network for most U.S. insurance plans. Patients routinely welcomed from across the USA. Please telephone phone (800) 692-5565 or electronic mail patientadvocate@PRMAplasticsurgery.com to larn to a greater extent than close your pectus reconstruction options. Connect amongst other pectus cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.
*****
Healty | My DIEP Flap Journey - Why I traveled from California to San Antonio for my Breast Reconstruction
A big "thank you" to Sharon Pira from Monterey, California for sharing her DIEP flap journeying amongst us....
"I was diagnosed amongst thorax cancer inwards September 2011 too underwent the whole routine of chemo-therapy, radiations too a total mastectomy of my left thorax inwards March 2012. After all of my handling was consummate I began looking into my options for thorax reconstruction. My local MD advised against an implant (because of the lawsuit of radiations on the area) too thence he suggested the TRAM flap every bit the best selection for me which I agreed.
In May 2012 I attended a women's conference inwards Scottsdale, AZ which was life-changing inwards itself, nevertheless I had no consider only how incredible this trip was going to plough out. On sun I got on a shuttle to the Phoenix drome along amongst unopen to other adult woman too every bit the driver pulled away I turned to her too asked, "Were yous hither for the women's conference?" She said, No, I am a thorax cancer surgeon from San Antonio, TX too was hither for a thorax cancer symposium. I removed the chapeau I was wearing to expose my soundless really bald caput too she proceeded to enquire me questions virtually my treatment. She asked what variety of reconstruction I was having too I told her virtually the Tram flap. She asked if I knew virtually the DIEP flap? I explained that I had a friend inwards San Jose who was having the DIEP flap functioning but that no 1 inwards my expanse performed this procedure. She gave me her carte du jour amongst the information virtually PRMA too said I should at to the lowest degree cheque out their website. We hugged at the drome too I thanked her for the info!
When I returned habitation I went online to the PRMA website too was amazed past times the earlier too after pictures too genuinely flora a painting of a adult woman who looked only similar me too I could non acquire over how keen she looked 1 yr later. So I called the hospital too scheduled an appointment...
After sending my paperwork for insurance approving I was able to schedule my surgical physical care for for August. Everything from offset to halt went incredibly polish too I am too thence grateful to the staff of PRMA for their amazing back upwards too tending during my infirmary remain too my follow upwards appointments. I experience too thence blessed... too am thrilled amongst my results! It feels too thence adept to bring my novel thorax created from my really ain trunk too my friends are all jealous of my incredible tum tuck - Wow, what a bonus!"
Thanks over again Sharon!
*****
"I was diagnosed amongst thorax cancer inwards September 2011 too underwent the whole routine of chemo-therapy, radiations too a total mastectomy of my left thorax inwards March 2012. After all of my handling was consummate I began looking into my options for thorax reconstruction. My local MD advised against an implant (because of the lawsuit of radiations on the area) too thence he suggested the TRAM flap every bit the best selection for me which I agreed.
In May 2012 I attended a women's conference inwards Scottsdale, AZ which was life-changing inwards itself, nevertheless I had no consider only how incredible this trip was going to plough out. On sun I got on a shuttle to the Phoenix drome along amongst unopen to other adult woman too every bit the driver pulled away I turned to her too asked, "Were yous hither for the women's conference?" She said, No, I am a thorax cancer surgeon from San Antonio, TX too was hither for a thorax cancer symposium. I removed the chapeau I was wearing to expose my soundless really bald caput too she proceeded to enquire me questions virtually my treatment. She asked what variety of reconstruction I was having too I told her virtually the Tram flap. She asked if I knew virtually the DIEP flap? I explained that I had a friend inwards San Jose who was having the DIEP flap functioning but that no 1 inwards my expanse performed this procedure. She gave me her carte du jour amongst the information virtually PRMA too said I should at to the lowest degree cheque out their website. We hugged at the drome too I thanked her for the info!
When I returned habitation I went online to the PRMA website too was amazed past times the earlier too after pictures too genuinely flora a painting of a adult woman who looked only similar me too I could non acquire over how keen she looked 1 yr later. So I called the hospital too scheduled an appointment...
After sending my paperwork for insurance approving I was able to schedule my surgical physical care for for August. Everything from offset to halt went incredibly polish too I am too thence grateful to the staff of PRMA for their amazing back upwards too tending during my infirmary remain too my follow upwards appointments. I experience too thence blessed... too am thrilled amongst my results! It feels too thence adept to bring my novel thorax created from my really ain trunk too my friends are all jealous of my incredible tum tuck - Wow, what a bonus!"
Thanks over again Sharon!
*****
PRMA Plastic Surgery specializes inwards advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step too fat grafting. In-Network for most USA insurance plans. Patients routinely welcomed from across the USA. Please telephone phone (800) 692-5565 or e-mail patientadvocate@PRMAplasticsurgery.com to larn to a greater extent than virtually your thorax reconstruction options. Connect amongst other thorax cancer patients at facebook.com/PRMAplasticsurgery.
*****
Healty | Vascularized Lymph Node Transfer for Lymphedema
Vascularized lymph node transfer is the latest surgical pick for the handling of lymphedema. The physical care for was commencement described several years agone together with has continued to evolve since then. It is directly gaining popularity for the handling of arm lymphedema inwards pectus cancer survivors that create non reply to conservative (non-surgical) therapy. The results possess got been quite exciting.
In the instance of arm lymphedema caused past times pectus cancer surgical operation or radiation, a vascularized lymph node transfer moves good for yous lymph nodes, unremarkably from the upper-outer groin, to the underarm surface area (axilla). These good for yous nodes compensate for the lymph nodes removed or damaged past times the pectus cancer treatment.
The lymph nodes from the upper-outer groin tin live transplanted connected to a DIEP flap at the same fourth dimension every bit pectus reconstruction, or every bit a kind slice of tissue if DIEP flap pectus reconstruction is non beingness performed at the same time. These lymph nodes are to a greater extent than superficial than the deeper groin lymph nodes that are of import for lymphatic drainage of the leg.
Lymph node transfer is non the solely surgical pick for lymphedema. Other surgical options include soft tissue resection, liposuction, together with lymphatico-venous or lymphatico-venule anastomoses (connecting the lymphatic organisation to the venous organisation to encourage drainage).
Of all the procedures described to care for lymphedema, vascularized lymph node transfer is showing the most exciting results inwards terms of decreasing swelling, preventing infections together with reducing the necessitate for compression therapy. Patients tin sense improvement inwards their symptoms real rapidly afterwards surgical operation though it tin possess got several months inwards or thus cases.
As amongst all surgery, at that spot are risks too. In add-on to the risks of whatsoever surgical operation (bleeding, infection, injure healing issues), the lymph nodes may non last together with the lymphedema tin worsen because of farther scarring created past times the surgery. There is also a conduct chances of creating leg swelling if deep groin lymph nodes are taken. Thankfully, the conduct chances of these complications is real low.
Only patients that possess got exhausted all conservative therapy past times certified lymphedema specialists are considered candidates for vascularized lymph node transfer.
Unfortunately, most insurance companies yet watch the physical care for experimental together with create non currently encompass the terms of lymph node transfer.
I promise this information helps.
Dr C
*****
Dr C is a board certified plastic surgeon together with microsurgeon specializing inwards state-of-the-art pectus reconstruction. In-Network for most U.S. insurance plans. Patients welcomed from across together with exterior the US. Please telephone telephone (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to larn to a greater extent than close your pectus reconstruction options.
*****
In the instance of arm lymphedema caused past times pectus cancer surgical operation or radiation, a vascularized lymph node transfer moves good for yous lymph nodes, unremarkably from the upper-outer groin, to the underarm surface area (axilla). These good for yous nodes compensate for the lymph nodes removed or damaged past times the pectus cancer treatment.
The lymph nodes from the upper-outer groin tin live transplanted connected to a DIEP flap at the same fourth dimension every bit pectus reconstruction, or every bit a kind slice of tissue if DIEP flap pectus reconstruction is non beingness performed at the same time. These lymph nodes are to a greater extent than superficial than the deeper groin lymph nodes that are of import for lymphatic drainage of the leg.
Lymph node transfer is non the solely surgical pick for lymphedema. Other surgical options include soft tissue resection, liposuction, together with lymphatico-venous or lymphatico-venule anastomoses (connecting the lymphatic organisation to the venous organisation to encourage drainage).
Of all the procedures described to care for lymphedema, vascularized lymph node transfer is showing the most exciting results inwards terms of decreasing swelling, preventing infections together with reducing the necessitate for compression therapy. Patients tin sense improvement inwards their symptoms real rapidly afterwards surgical operation though it tin possess got several months inwards or thus cases.
As amongst all surgery, at that spot are risks too. In add-on to the risks of whatsoever surgical operation (bleeding, infection, injure healing issues), the lymph nodes may non last together with the lymphedema tin worsen because of farther scarring created past times the surgery. There is also a conduct chances of creating leg swelling if deep groin lymph nodes are taken. Thankfully, the conduct chances of these complications is real low.
Only patients that possess got exhausted all conservative therapy past times certified lymphedema specialists are considered candidates for vascularized lymph node transfer.
Unfortunately, most insurance companies yet watch the physical care for experimental together with create non currently encompass the terms of lymph node transfer.
I promise this information helps.
Dr C
*****
Dr C is a board certified plastic surgeon together with microsurgeon specializing inwards state-of-the-art pectus reconstruction. In-Network for most U.S. insurance plans. Patients welcomed from across together with exterior the US. Please telephone telephone (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to larn to a greater extent than close your pectus reconstruction options.
*****
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