October 10, 2023 • 50 mins
When faced with my own double mastectomy, I was fortunate enough to find skilled and empathetic support from Dr. Tim Matatov, a highly regarded plastic and reconstructive surgeon at Southwest Breast and Aesthetics. This episode is an in-depth conversation about that journey, where we unpack the marvels and challenges of reconstructive surgery, the options available to breast cancer patients, and the anatomical and biological traits that play a critical role in the process.
Navigating the difficult choices that come with a breast cancer diagnosis can be overwhelming. That's why Dr. Matatov and I get candid about the importance of shared decision-making and how information overload can lead to 'choice paralysis.' We also talk about breast implant illness and the challenges in accommodating all types of reconstruction.
We round off this enlightening conversation by exploring the options for breast reconstruction using silicone implants, autologous tissue reconstruction, and other types of flap surgeries. We highlight the risks, particularly the risk of flap loss, and share how these can be minimized. The process of nipple reconstruction and the role of medical tattoos in creating an illusion of an areola are given their due attention. This episode is a valuable listen for anyone grappling with breast cancer and considering reconstructive surgery.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Hi there, welcome to Peace of Work the podcast.
I'm Danielle Tanton.
I'm a nurse, author, coach andsurvivor.
I love inspiring people to livetheir best life, reach for
those big dreams and find joyeven in the pain.
As I wrote my memoir over somany years, trying to make sense
of a story where I was way toooften the bad guy instead of the
(00:28):
hero, I came to understand thatwe are all a piece of work, but
we're also a work in progress,and even in our messiness we are
a work of art too.
All at the very same time, infact, we are all beautifully
unique pieces of one masterpiecewaves in the same ocean.
This podcast will explore thestories and struggles that make
(00:50):
us human, the miracles thatsurround us and all the ways we
work to make sense of it all.
Welcome to Peace of Work thepodcast.
Welcome back to Peace of Workthe podcast.
Today I'm here with someone veryspecial.
Dr Tim Mattoff is a plastic andreconstructive surgeon who
restores the form and functionof his patients at Southwest
(01:11):
Breast and Aesthetics.
I can tell you all about hisbio and credentials, but most
importantly, he is the plasticsurgeon who did my breast
reconstruction after I had adouble mastectomy three years
ago and he is like a craftsman,an artist, I mean, he really is
amazing at what he does.
(01:31):
So I'm really honored that youcame to be here with me.
He's in his scrubs.
He came right from surgery, sopretty awesome that you made
time to do this.
I really appreciate it and I'mexcited to chat with you and let
you share with us.
Speaker 2 (01:46):
Of course.
Thank you for having me.
Speaker 1 (01:48):
Yeah.
So Dr Mattoff, like I said, isa plastic and reconstructive
surgeon at Southwest Breast andAesthetics, servicing Phoenix
and Scottsdale, Arizona.
He believes that being asurgeon is a unique opportunity
to restore both form andfunction to his breast
reconstruction patients aftermastectomy and is honored to be
a part of their journey.
He is a highly skilled surgeonfor breast reconstruction,
(02:09):
having completed his rigoroustraining in plastic and
reconstructive surgery at TulaneUniversity in New Orleans,
Louisiana.
Dr Mattoff performs severalaspects of reconstructive
surgery, such as flapreconstructions, implant
reconstructions, correctivereconstructions, second stage
reconstructions and postmastectomy reconstructions.
Can we say reconstructions one?
Speaker 2 (02:29):
at a time.
Speaker 1 (02:31):
I guess they're working on the SEO in that
description.
Speaker 2 (02:35):
That's exactly what it is.
Speaker 1 (02:37):
Anyway, I'm so honored that you're here.
Tell me a little bit about Idon't know where to start.
Let's start with my experience,since we were both there.
I had really early stage breastcancer, but I made the decision
that I think was a verypowerful decision and a very
(02:59):
conscious decision to simplychop them off, as I like to say,
and get a full, radical, doublemastectomy and have two.
I did it for a lot of reasonspartially so that I didn't have
to worry about getting breastcancer again, but also because
of the cosmetic aspect.
I couldn't imagine having onebreast with an implant and one
(03:21):
without an implant and that theywould look anything similar.
I mean, I was 45 years old.
They were a little saggy.
That wasn't going to happen,right.
Speaker 2 (03:31):
The majority of women undergoing implant
reconstruction choose abilateral mastectomy.
Part of that is very personaldecisions, but of course one of
the most common reason is youchose not to worry about the
other side and not havepotential to get breast cancer
(03:54):
on the other side, even thoughthe statistics allow.
But still, women are worriedand they always know somebody
else who did not take the otherbreast off and ended up having a
recurrence.
It's obviously disproportionateas far as the reality.
Most people won't get thecontralateral breast cancer
(04:17):
again, based on statistics, butit is still scary to think about
that and not to take the otherbreast off, especially when
they're already undergoingmastectomy on the other side.
With implant reconstructionsalso very challenging to do one
breast only for the reasons thatyou've mentioned, it's not
(04:39):
possible to achieve symmetry.
You can achieve some symmetryin clothing, but nowadays women
want to be reasonably symmetricas possible whether they're
wearing clothing or not.
Very challenging to do with onebreast having an implant and
(05:00):
the other breast, being natural,feel completely different.
They hang completely different,correct, very, very different.
Speaker 1 (05:10):
That's one thing that I always like to point out is
that a reconstruction is verydifferent from a boob job, from
just a breast augmentation.
One thing that you liked topoint out all the time when I
was your patient was well, Iguess I still am your patient,
but was just how thin my skinwas, how little was left to work
(05:33):
with after they took all thatbreast tissue away, the implants
right there under the skin.
Speaker 2 (05:39):
Correct.
So as far as breastaugmentation or enlargement of
the breast, usually the breastis fairly healthy Replacing an
implant in a fairly not astraumatic field as with
reconstruction, since the breastis not being removed and
(06:02):
patients do better in the shortand long term with breast
augmentation versusreconstruction as far as
revisionary surgery or needingsomething else done.
So breast reconstructionobviously is more involved, a
little bit more highercomplication rates because of
traumatized tissue that's leftover and the thickness of the
(06:25):
breast skin and some of the fatunderneath the skin is different
for person to person.
So some people have a good bitof what's called subcutaneous
fat and you will be able tocover the implant a little bit
better with less visibility ofrippling.
And then some patients it'sextremely thin and that's just
(06:48):
what it is, and then mostpatients-.
Speaker 1 (06:49):
Yeah, I don't know.
I got plenty of subcutaneousfat in other areas, but for some
reason in that area.
It was all actually breasttissue, because I had large
breasts.
Speaker 2 (06:58):
I had like 34 double D yeah no, you did, and I think
part of the thinning out processof your breast skin is the fact
that you had larger breasts andthey tend to stretch out and
thin out the skin itself andsome of the fat.
So, yes, interesting.
Speaker 1 (07:15):
So that brings me to kind of another question that I
think I would always try toexplain to people, even though I
didn't quite understand itmyself, is why, if I had such
large breasts and you took outall that breast tissue, why did
I need expanders or tissueexpanders, what are some of the
names for them and what was theprocess for someone like me?
Why did we need that?
(07:36):
Two surgeries?
Speaker 2 (07:37):
Two stage Russian's bone stage.
So both of them are valid.
They have pros and cons in bothreconstructive types.
So if you'd go with two stagereconstruction, what you've had,
for my reason at least, in myhands, I wanted to make sure I
(07:58):
can control.
The expression is to controlthe pocket.
And since your skin was thinand your tissues are fairly
loose, meaning that your skinthere's some stretch to it, Sag.
Speaker 1 (08:12):
in other words, you're being nice.
Speaker 2 (08:18):
So I didn't want to put the whole implant then right
away, with all the weight beingavailable Makes sense.
And then we're at a higher riskof what's called an implant
malposition, meaning it hasmoved somewhere before the scar
tissue set in, before we wereable to get some sort of
stability.
The weight of the implant isgoing to bring it down and the
(08:42):
skin stretches a little bit more, as well as what we put to hold
the implant in place.
Speaker 1 (08:47):
And that was alloderm right Like a cadaver skin
Cadaver skin correct.
Pretty crazy that that's insidemy body.
Speaker 2 (08:55):
Right, these are patients that were people that
donated their tissue for breastreconstruction patients, so
that's also yeah, for me.
I try to use that with caution,really cautious about it,
because it is a gift.
So even though it just feelslike we're opening a package and
(09:17):
putting something else in thereto support the implant, but if
you think about where it camefrom and how people think about
giving that to perspective,patients is treated as a gift,
so I don't want to ruin it.
Speaker 1 (09:34):
That's really neat.
I hadn't really thought aboutthat.
That's neat that you thinkabout it like that.
Speaker 2 (09:43):
And then as far as there's other things available
to hold stuff in place.
But in your choice and in yoursituation it was alloderm, which
is human dermis skin.
Well, since skin can stretchand even that cadaver skin
stretches, and in the setting atleast the way we've done for
you, which is above the muscle,the downside of going above the
(10:07):
muscle is a little bit morestretched upside, less pain,
less movement of the implant,but the cadaver skin also
stretches.
So I've seen it in my ownexperience and then other
patients that came from otherplaces, experience with in some
patients going straight to animplant with cadaver skin it
(10:29):
stretches too far, too quick,interesting.
So in your situation I placedthe tissue expander to hold that
in place.
So therefore I don't have allthat weight availability right
away and the expander allows youto secure things a little bit
better.
Speaker 1 (10:45):
And one thing you did with me that I think is unique
you don't always do this is youpumped those expander's up with
air instead of saline orsomething heavier.
Speaker 2 (10:54):
Yeah.
So I've kind of go both waysbetween who I use it on and in
your situation again, just tonot weigh the skin, I used air.
There is literature to kind ofgo both ways.
But more recent literaturethat's fairly concrete says it
doesn't really matter.
I shouldn't say concrete,nothing's concrete in medicine,
but a little bit more defined itdoesn't really matter how.
(11:18):
Whether you put air or saline,they didn't notice any outcome
difference.
Speaker 1 (11:23):
Seems hard to believe .
It seems like it's a lotlighter with air.
Speaker 2 (11:27):
Right.
But I do think there's somealso downsides.
Sometimes when you deflate theair and you put saline in, you
can cause some sheer effect.
And in your situation again, Iknew I wanted to come back the
second time because how thinyour skin was to add additional
fat tissue.
So in that instance I alreadyin my mind I was thinking about
(11:50):
the skin stretch.
I was thinking about not havingenough what's called an
envelope coverage to cover theimplant imperfection.
So I knew I was gonna be comingback.
So I figured I'll do somethingthat I have more control with,
like an expander, and have theopportunity to come back and add
more fat so you don't see theripples as much as you would
(12:14):
otherwise.
Speaker 1 (12:15):
That's pretty amazing .
I really love the way even I'mlistening to you now, the way
all this was happening in yourhead and you, just you take a
look and you kind of touched mybreast as if it was like, as if
you were like an artist about tomold some clay or like an
engineer, or it was a veryscientific but artistic process
(12:38):
and it's neat that you can justdo all that and you just made
those decisions.
You know, sometimes as a patientI felt frustrated by that.
I felt like I wanted tounderstand more of what your
process and what you werethinking and I wanted you to
explain more.
But in the end Later I joinedsome forums and things about
breast cancer and people werelike, oh well, I'm wondering how
(13:01):
many ccs does everybody haveand what I like, what like?
And I it drives me crazybecause I'm like, oh my gosh,
you guys need a surgeon who,just who, knows what he's doing
and he can look at you in yourcase and you're, and know
exactly what, what will fit andwhat you need, based on what
your desire is and what you'reyou're going for and based on
your anatomy.
(13:21):
And you did that so naturallyand I felt very blessed that I
had you as my surgeon and notThank you somebody who was just
giving me like Lip-talk and likejust you know, letting me make
feel like I'm in control of thissituation, that I have no idea
what I'm doing right and I Thinkyou know I think about it in a
(13:42):
way of okay, we, this is ashared decision making, we're
making decisions together, butyou're just starting this.
Speaker 2 (13:50):
I've been doing this for a while.
Of course, I wanted to listenwhat your goals are and what,
how can I meet that?
And we discussed the optionsthat would you know the more
common pros and cons toeverything.
But in the setting of diagnosisnew diagnosis of breast cancer,
trying to figure out whatyou're gonna need after you know
some of the decision-making,decision-making is discussed and
(14:12):
and and, as long as we agree.
And then I try to establish areport with the patient that I
will do my best and and, inevery situation, and I'll help
you make the decision, decisionsfor you.
And I'm giving you some of theseanswers based on hundreds of
other women that have gonethrough the same thing.
(14:33):
So I'm just trying to give youa little bit of a crystal ball,
like, hey, this is what I'veseen happening to these type of
patients with this Choice ofreconstruction or with this
choice of cancer treatment.
It doesn't mean it's going tohappen to you, but I do think
that Too much information to thedegree of detail as can
(14:57):
sometimes give you choiceparalysis You're like am I
making the right decision I haveto do.
You know some patients coming inalready on chemotherapy and
Then we'll be going onundergoing radiation and
sometimes it's just, it's a lot.
Speaker 1 (15:11):
Yeah, it's a lot.
Speaker 2 (15:12):
It's a lot to go through and you know some
decisions can be made by, by thephysicians, with the, with the
patient.
But you know I try to lead theconversation versus being kind
of steered in the in the waythat I, at least in my
experiences.
(15:33):
Those decisions that patientsmake sometimes can be wrong and
I'll tell the people, I'll tellpatients this is a wrong
decision, but in your, in yoursituations, but and but
sometimes you can it's still notoutside of standard of care.
So some things I'm willing tobend on.
But if I feel like this isgoing to lead down a further
(15:54):
Complications and I know that Ijust like no, we can't do that
Like let me help you make thisdecision.
This is like there's no othergame, but just to help you like
this doesn't change anything.
So that's kind of how I I leadmost of my consultations.
You know, trying to Understandwhat the patient wants and
(16:14):
sometimes the understanding.
I'll have a conversation wherereal ask they don't want any
reconstruction.
But if you don't ask thosequestions, sometimes the second
you just gave somebody implantsor some sort of even like a flap
surgery that really didn't want.
They never need.
Yeah, I didn't need it and so,as it goes to the process, you
can pick a very, very rareoccasion.
(16:35):
You can pick those patients outand like you know what, I
didn't really want areconstruction.
I understand now, okay, that'sanother option.
There's nothing wrong with that.
Speaker 1 (16:43):
Do you do like a smooth Flat or whatever?
I know there's different namesfor things.
Oh, do you not?
Speaker 2 (16:50):
even we do it, we do so the the challenge for for us
right now.
Yes, we do some, but thechallenge for us right now is
mainly since we're we would, weare needed in a lot of
Reconstruction.
So as we're expanding ourpractice, they'll it will be
able to accommodate that more.
But right now, you know, in thereconstructive setting, like
(17:13):
you know, to do an implant, todo a flap surgery on Coplastic
reconstruction, then you reallyneed me or plastic surgeon,
right, and sometimes it's justnot even.
Just do that, like when, like alot of them do and along them do
, they do it and they do a goodjob.
Speaker 1 (17:33):
Maybe just a someone lower on the toe.
Speaker 2 (17:36):
No, of course, what I've noticed, at least in my
experience, a lot of times it'sit's not just, like you know,
going flat doesn't really meanto go flat.
It means no rest, but and somepatients, depending on the
amount of that store storagethey have, it can look very
(17:57):
concave.
So and that that is a challenge.
In those settings plasticsurgeons usually gets involved
could can be some fat graftingjust to make them smooth Right,
so that those are the cases thatwill will usually do something
that requires some kind of Skinover skin or adding more fat
(18:19):
just to make them flat.
Speaker 1 (18:21):
Okay, so I want to talk a little bit about some of
the other flap procedures, butbefore we go there, I just
wanted to to touch on some ofthe concerns with implants.
I know, when I was trying todecide, I did the deep flap that
the flap construction wasn't anoption for me at the time we
can talk about that later.
But so implants were really myonly option for reconstruction
(18:45):
and I was worried because I youknow, I heard about people that
were getting their implantstaken out because of breast
implant illness and you know, Ipeople were again with the
Facebook groups and, like youget, you start hearing people's
stories and I.
Another thing that I liked wasthat I could talk to you about
that.
First of all, I like thatyou're younger than me, so I
(19:06):
feel like you'll be, you'll bearound, you'll probably be
practicing until I die, but so,but you explained to me that
implants were never designed tobe a lifetime Thing.
They have a, they have a shelflife and can you talk?
Go into that a little bit likesure so.
Speaker 2 (19:24):
Every implant manufacturer recommends that
their implants that warrantiesfor ten years right.
Speaker 1 (19:29):
So the.
Speaker 2 (19:30):
FDA also recommends that you can keep them for ten
years because they're kind offollowing what the implant
manufacturer is saying, so, andin some patients a last longer
than that in some patients andwon't.
But that's kind of at least arecommendation, the the
recommendation from the FDAincluding our society, to
(19:50):
American side of plasticsurgeons.
Now, if you come ten yearsafter your implantation and your
implants are completely fine,based on physical exam or we can
also obtain an MRI, which isagain recommended by the FDA,
and it all looks fine, I don'tsee a reason of replacing
implants.
If it ain't broke, let's notfix it.
Well, there's a problem.
(20:11):
So Just because it's ten years,we shouldn't do that.
But I do feel like in areconstructive setting that a
Good bit of patients that I'vebeen treating Usually have their
implant original a bit earlierthan that, and it's not always
the implant that's the problem.
There's a, there's two sides tothis.
(20:32):
There's a patient issue andthen there is also an implant
issue.
Implant issue means implantrupture or, you know,
potentially breast implantillness or Alumform that's
related to the implant, or sothose are.
(20:52):
Those are the implant relatedissues and Patient related
issues that I do feel like ismore common than the implant
related issues.
You know, the tissue is toosoft, it doesn't hold the
implant or the scarring aroundthe implant gets too aggressive
and moves.
The implant causes pain.
Radiation makes thingssignificantly more challenging
(21:12):
in the setting of implants, soit is more common to have a
patient related problem as faras not being able to hold the
implant or we're getting tootight of a scar.
As far as you want to talkabout breast implant illness too
, yeah, yeah, I mean, tell yourthoughts, you know so no, for
(21:34):
sure I.
There's currently nothing.
There's nothing concrete inmedicine about this.
Um, did it?
Being looked at right now ismore of a patient complaint, and
complaints are very vague.
They're anything from it can bejust a aging process of a
(21:56):
person, be Very general, like mymuscle hurt, like my back hurts
, my joints hurt and stuff likethat.
So it's very hard to point outwhat, what the actual issue is.
So we don't have much concreteevidence, although there's some
(22:16):
Rules have been passed which Ithink are great, but in my
experience I'd say, small numberof patients get improved
improvement.
Whether it's going to be a longsustained improvement or
permanent improvement, we don'tknow yet.
Speaker 1 (22:34):
Well, it makes sense that some people might be real
sensitive to having rightsomething for and in your body,
I mean, like you know.
It Kind of makes sense.
But right, I haven't had anyissues and you know I think you,
you kind of set me at easebecause I felt like if I did,
then we'd we take them out.
But it was.
You didn't have any reason tosuspect that I would right.
(22:57):
I have a titanium plate in mywrist.
Broken wrist a long time ago,and that's hasn't ever caused me
any trouble either.
Speaker 2 (23:05):
All right, this can be looked at like you know, some
people allergic to peanuts,some people not allergic to
peanuts right, there is a work,in theory at least, that some of
these issues, and one of them,potentially some, can have back
bacterial contamination aroundthe implant and just like we
also Think in some infectiousprocess and some other processes
(23:26):
that cause them former fromimplants, from texture implants.
It also Not a far stretch tosay that some of these symptoms
can be related to Like anindolent or this quiet infection
that keeps irritating.
You're irritating, just likewhen people have, like certain
Tooth abscesses.
You know that you have it besome is different recurrent
(23:46):
bladder infections, right, youknow so, yeah, for some patient
that is what that is.
You'll take the implants out andsometimes it's like slime
around the implants or you'llyou'll culture and bacteria
comes back.
Oh, should, they shouldn't havebacteria in it, as far as we
think.
And there there's.
There's been bacteriadiscovered, there's an in
patients don't have symptoms,they have bacteria to, and there
(24:09):
is a Epistombi virus that beendiscovered within the capsule.
So and there's new, fairly newthing that was discovered about
having not squamous cellcarcinoma, which is usually
either skin or mucosal, likeyou're, the maligning of your
mouth cancer, and they'vediscovered some of them around
(24:32):
the capsules and it could bepotential from Epstein virus
because that's can lead to Tothose issues as well.
But I've definitely taken outcapsules, would back with an
implants, would bacteria aroundthose and I felt like, based on
patients response, that theyfelt better yeah, right away,
(24:54):
make sense yeah right.
So what's the correlation tothat is hard to say for sure,
but Sounds like that that's beena problem.
They feel better.
It was my job as a doctor makepeople.
Speaker 1 (25:07):
And that's what I like about.
What I loved about yourapproach, it was it wasn't like
you were discounting it as a, asa croc or, as you know, an
imagined thing, but you reallytook a very realistic approach
and you know the the numbers Proapproach, that it's not really
a huge percentage, even thoughit seems like it right if you're
on one of these forums whereEverybody's taking them out, you
(25:30):
know right and Also you knowthe way I look at a breast
implant and people can look atit in many ways the way I look
at it.
Speaker 2 (25:39):
It, it, it's nice to have one, it's nice to have a
breast in a reconstructivesetting or in cosmetic setting,
but you, you also can take itout and live.
May not be as right as a strongof a quality of life, but the
quantity shouldn't really change.
Speaker 1 (25:56):
I compare it to it's killing you take it out right,
and hurting you take it out.
Speaker 2 (26:00):
Right.
It's a little bit more of achallenge if you have, like, a
knee replacement that's infected, that prestige is you need for
function at least right, and ora valve in your heart that's
infected, you know, or some kindof problem with it.
It's really you really need it.
You're gonna replace it and notgonna think twice now.
Speaker 1 (26:18):
Just to like not make light of it.
You know, a day in the life ofsurgery is no big deal for you,
but it is kind of a big deal forthe patient.
Six weeks of awful work it'sit's you know possible
complications there are.
There is a little more to itthan just a day of work like.
Like it is for you, but sure.
But at the same time you'reright, and that that's why I
(26:39):
decided to go forward with it.
Speaker 2 (26:40):
Yeah, and then the big, the biggest problem for the
patients, though.
In order to find out if youhave to feel better, you have to
have surgery and take them out.
Speaker 1 (26:49):
Exactly so, then you're gonna feel worse before
you feel better.
Speaker 2 (26:52):
If you suspecting the like.
You know, some patients like Iknow these are my implants, so
the only way to find this out isto take him out.
And we may be wrong and theymay not be the thing I might
still feel this way, and I dofeel like that happens a lot.
And you almost don't want toadmit it more common than other
way, at least in my experience,and I'm sure some patients will
(27:15):
disagree and I'm sure someproviders may or may not
disagree, but you go based onyour experience and you keep
track of your information anddata so you can make some kind
of you know practice changes.
So so far I Haven't seen I'veseen more patients not having
any resolution of symptoms, thenhaving resolution of symptoms,
(27:38):
but there are people out therethat do have resolution of
symptoms.
So for that number, the only wayto find out is just take him
out to be whether you're gonnafeel better or not.
That reminds me of.
Speaker 1 (27:50):
I had, like I think it like six years ago, I had a
torn labrum in my hip and thesurgeon was Sort of he wasn't
really pushing for the surgerylike he really was.
Like you know, it may notResolve your symptoms because
you have some other inflammationand things like that going on,
it may help, it may not.
He ended up I ended up doing anarthroscopic surgery.
(28:11):
He debrided it and it was andand I, you know, had to recover
from the surgery.
So for a lot of weeks it wasworse, before it was better, and
then, if I'm really honest, itwas never really better from
like it's it's.
It's better now, years later,but it it never really got
better.
I don't think the surgeryactually did any good and he he
(28:31):
warned me that that might be thecase, but I think it's like you
want so bad to believe likethat it's gonna help because
they're in so much pain withthat situation.
Speaker 2 (28:39):
That's the way, yeah, yeah, no.
There, there's sometimesdefinitely going on negative
exploration.
Yeah, I really find anything,or if you know, found something
and treated it, but that wasn'tthe exact thing and it's it's a
small number of patients, butabsolutely does happen.
Speaker 1 (28:54):
Yeah, and unfortunately, as women, there's
a whole lot of things that cancause joint pain, and you know,
menopause, perimenopause.
Speaker 2 (29:02):
And those are the confounding Stuff.
Yeah, confounding factors.
Well, and then people say we'reUnis, related to the implant,
or my hormones are related tothe implant right, you're gonna
still have them, even if youdon't have the it's very hard to
say yeah, very challengingproblem for the, for the, for
patients that are in thatsituation and, you know, once
(29:25):
the most people sent their mindto, this is the issue.
It will be very challenging tochange the mind.
Yeah.
Speaker 1 (29:33):
So, real quick, before we talk about the flap,
what about saline versussilicone and under the muscle
versus over the muscle?
I had over the muscle, as yousaid, and I had silicone, but I
didn't really.
We didn't talk about choices,that was sort of just that's
what I had sure do you do thatwith all your patients or do you
do some of the other?
Speaker 2 (29:52):
no.
So I as far as reconstructionnot cosmetics, not cosmetic
surgery but as far asreconstruction I Routinely, for
Almost all patients since I'vebeen in practice, go above the
muscle For several reasons,significant less pain.
(30:14):
I don't have to sort of releaseor cut the muscle off the rib
cage to like I call it opening,like a book page, so I can put
something in between.
I also feel that animation,deformity, because you are
releasing the muscle but it'sstill attached to your arm.
(30:34):
With certain movements youimplement do move around and
they do cause sort of thisretraction out towards the
armpits.
Sounds awful.
A lot of patients are botheredby that and I've also changed a
good bit of patients from goingunderneath the muscle that I
(30:56):
haven't, you know, came for asecond opinion or revision or
reconstruction to above themuscle just to treat the pain
and it does work.
So some of that pain could bemuscle related.
So if you're leaving it on, ifyou're going up top, you're not
having those issues.
The downside to going above themuscle is that the implant
stretches a little bit.
(31:16):
The bottom of the breast skinstretches a little bit more
because the muscle is not reallysupporting it as much.
But that's where other deviceslike alloderm come in and you
can have a little bit moreripples at the top of the
implant.
So, but I do think I'm notinhibiting function in that
(31:37):
setting.
So function to me andreconstructive world comes
before aesthetics, althoughaesthetics right behind that.
So if you're thinking about thefunction of the chest wall and
the arms, going above the musclepreserves that, so I just feel
like there's a lot more benefitthan downsides to go above the
(32:02):
muscle.
Most patients get fag graftedanyway nowadays, so you can fill
some of these rippling issueswith it seems like if it was
under the muscle, I mean likewould you be able to lift
weights?
No, it'd be very challenging.
Plants are a little bitchallenging.
Speaker 1 (32:18):
I've started working out more lately and I'm like you
know I really have no, you know, lasting effects of my surgery.
I can do everything now.
Right it took a while, but Ofcourse.
Speaker 2 (32:31):
Of course there's a lot of scarring.
That goes on.
But yes, it's challenging to do, let's say, any kind of chest
exercises playing, sochallenging.
So I mean, not everyone doesthat.
So again, part of history taken, you know, if it's not.
I can imagine being able to soyeah, and in that setting that's
why I choose to go above themuscle.
(32:53):
As your second question toSalem, versus implants.
Human implants are, at least inmy practice, are not part of
the reconstructive modalitiesthat I use.
They just feel like more waterballoons, a little bit firmer,
they could ripple a little bitmore so and I and you have to
(33:18):
overfill them just so they canhold shape better.
So I just and an augmentationworld.
That makes sense in thereconstructive world.
The way they look and feel tome doesn't make sense as far as
safety profile sailing.
(33:38):
If they leak, you know, becauseyour body will absorb the water
.
So there's no such thing as asilent leak with silicone
implants.
There can be silent leaksbecause you just don't know if
it's ruptured or not.
And was it ruptured at the timeof the placement.
Speaker 1 (33:53):
They don't get ruptured yeah.
Speaker 2 (33:55):
And the newer implants actually are.
They call generation fiveimplants, the form stable, or
patients call them gummy bearimplants.
They very rarely leak of any.
Even if you cut the implant inhalf, it doesn't.
It doesn't usually leak as freeas previous implants.
So that's kind of my decisionprocess.
Speaker 1 (34:20):
Makes sense.
So you mostly use silicone andyou mostly do over the muscle,
over the muscle, the only one,the only instance that would go
under the muscle.
Speaker 2 (34:28):
If the tumor is too close to the muscle on the chest
wall, then in that setting Iwould go under the muscle, but
that's pretty rare.
So just so we don't hide thetumor, you know, with an implant
Makes sense so you can feel it.
You bring it closer to the skinand then if it recurs hopefully
not, but if that recurs you canfeel it catch it earlier.
Speaker 1 (34:51):
That makes sense, Very interesting.
So we've been talking.
We talked a lot about all theother flap reconstructions, so
tell us a little bit about thatwe don't have a whole lot of
time left but tell us some ofthe options and the benefits and
the drawbacks of those.
Sure so why you might do itversus not do it in my case.
Speaker 2 (35:12):
Yeah, our group specializes in microsurgery or
autologous breast reconstructionor your own tissue
reconstruction.
This is the material comes fromthe patient, so it is your body
.
The upside a big upside to itis usually it's a two stage
process and then for mostpatients you don't have to have
(35:35):
anything done after that for thelifetime.
So yeah, and you know, on someoccasions patients will lose
weight or gain weight and havesome other changes, but again,
that's part of the aging processor just life process, not
really the breast reconstruction.
For a majority of the timeyou're the patients off the
conveyor belt of breastreconstruction compared to an
(35:58):
implant that you just havehigher visions.
And I do tell patients if I'mputting an implant, I guarantee
one thing to you in yourlifetime you'll have another
breast surgery.
So, which is fine, same thing,you know, as long as patients
accepting that and understandingand you know we've discussed
this and there's no problem.
So that's a big upside tohaving your own tissue
(36:21):
reconstruction.
Also, the breast feels like alot like your body and it feels
a lot more like your breast thanan implant does and you can lay
on it.
Usually patients with implantshave a little harder time, like
getting a massage or laying aflat.
Speaker 1 (36:38):
Yeah, I was just going to say I got a massage a
couple weeks ago and I have tolike that to put this bunch of
things with pillows or towels orsomething.
Speaker 2 (36:45):
Yeah, you treat it like breast dude.
They do age a little bit andthey do droop a little bit, but
not as much as a natural breastwould, because, again, this is
where the scarring helps a bit,and so that's kind of been my
experience.
That's the major upside, and agood bit of patience.
(37:09):
There's also an improvement todonor side, meaning that, where
I take it from, so if I'moffering someone a DIP flap or
deep inferior perforated flap,that means they're also getting
a tummy tuck.
Whether the scar placement,depending on how much we're
removing, may not be as ideal asa tummy tuck, but most of the
(37:31):
time we can get patients thereat the second stage surgery to
where it looks like a tummy tuck.
So that's also a potentialupside.
The key here obviously is, ifyou're doing something like this
, to preserve the core muscle,which is directus abdominis, and
that muscle is involved inpretty much everything that you
(37:54):
do.
I mean, I'm speaking to you,I'm using it a little bit just
to expel some of the air right.
Speaker 1 (38:01):
So, yeah, I'll get out of bed.
Speaker 2 (38:06):
So if we're doing something like that again, to
preserve function, which isafter treatment of breast cancer
, is second most important thing, at least in my reconstructive
ladder, is to preserve function.
But then patients get thatimprovement as well.
Speaker 1 (38:23):
So now that's the most common is to take that
tummy area.
Speaker 2 (38:28):
Correct.
Speaker 1 (38:29):
Is there some other areas that you do as?
Speaker 2 (38:30):
well they are.
The inner thigh areas or theupper buttock area is another
thing that we offer.
So there are secondary options,for the reason being they're
not exactly as ideal as the deepflap, because of the way that
abdomen is shaped and the sizeof the blood vessels.
Speaker 1 (38:52):
Kind of like to squeeze there.
It's kind of like a breastRight.
Speaker 2 (38:56):
Exactly, and it just covers also a little bit bigger
footprint, and then the recoveryis a little bit easier compared
to something with the innerthighs or the upper buttock.
So but they're all options.
Again, this is something thatyou discuss with the patient
first of all, before evenoffering.
You know we all look, okay,where is the, where is the
(39:18):
excess?
And then it's like what onwhich part you don't like?
Speaker 1 (39:20):
right.
Speaker 2 (39:21):
So and from there you can figure out like, what will
I offer to this patient?
Some patients have tummy tissue.
Just enough time to tissue ifthey do thigh tissue.
But some of them will say likeI don't want these cars on my
abdomen.
Okay, then that's a potentialthing.
Or, you know, talk about animplant in that patient if they
choose to.
But at least for my, from myexperience, most of the patients
(39:44):
that come see me they come forfor for a flap surgery.
So those are the other options,for more common options that
you would offer to patients ifthe abdominal area is not
available.
Speaker 1 (39:56):
And that's another area where I started doing some
research recently, because wewere talking about maybe maybe
doing it on me, and I think thatthere are surgeons across the
country that may or may not beas as skilled at it as you and
your practice are, and I've seensome horrible pictures, Like
(40:16):
I've seen horrible pictures ofthe whole thing.
I am just like I can't believethat that's the end product that
they're like happy with that.
I'm lucky in my body scarsreally well and I.
But oh my gosh, like I thinkthat that's.
It's a very micro, like yousaid, microsurgery.
Speaker 2 (40:38):
Yes, I believe the breast reconstruction is like.
You know you have to dedicateyourself to get consistently
good outcomes and there are alsoplastic surgeons here that do
fantastic work within thecommunity.
You know the issue I have withsome of these posts and, yes,
absolutely, patients should behave an avenue to vent.
(41:00):
But you know it creates alittle bit of misinformation
because you don't know the wholestory right, is it patient?
Is that a patient that hadradiation or recent chemotherapy
or some other things thatthings can arise from?
We don't always know the fullstory but, yeah, absolutely,
this is part of the risk.
Like breast reconstruction is achallenge and I tell my
(41:23):
patients if you want the leastamount of complications, choose
no breast reconstruction.
Yeah, because we're.
I'm not adding anything when Ido anything except the removal
that usually doesn't have asmany complications can, but most
of them are small and there'snot much of an investment that
(41:44):
comes from the patient.
You know, when somebody'sinvesting, I'm like, okay, I'm
going to, I'm going to give partof my body to rebuild my breast
and it doesn't work.
You know people can, you know,very easily feel bitter about it
and angry about it.
This whole process and theyshould, it happens in.
Our flat loss rate is, as youknow, below the national average
(42:06):
and actually at the level ofwhat other groups like us across
the country have, which is 0.8%.
But you know that's one in 100patients and that's still feels
like a lot Because that's reallyhard for for, for, for the
patient to go through.
Speaker 1 (42:22):
Yeah, sure.
Speaker 2 (42:23):
So I'm mostly not saying an implant is an easier
thing to lose because you're arestill having more surgery,
discomfort, being sick and allthat and that comes with all
with all of this.
But it's a little bit more withwith flap surgery if you, if
you've lost the flap becauseagain you gave just something up
to rebuild kind of a major losshere and there.
(42:46):
Two part surgery yeah correctand for us again that even that
0.8%.
You know we constantly alllisten to group trying to figure
out how to bring that downfurther.
So and yeah, just it's a lotfor patients to go through.
Speaker 1 (43:02):
So what about nipples ?
I like to talk, we like to topit off.
You said something to me onceabout like there was some
statistic about, and that if awoman doesn't have the nipples,
she won't feel like complete,like something like that?
Speaker 2 (43:16):
Yeah, there's some, there's some reports of that.
That.
It's, you know, centerpiecesort of and takes all your eye
gaze towards the nipple, is thatyou tend to be in the darkest,
most darkest area anyway.
So there is, there was a goodstudy done by a group of plastic
surgeons.
They had this eye trackingdevice.
(43:36):
So you look, whatever you look,you're looking at the tracks,
where you're looking on on thepicture or wherever that could
be, and they've, you know, hadpatients or other people
non-plastic surgeons looking at,and plastic surgeons look at
pictures of breasts and they've,then they've timed how much
time they've spent looking atcertain part of the breast, and
(43:57):
nipple was number one commonarea that people spend the most
amount of time.
So, and it also makes sense thatyou know we all pre-program to
know what the nipple is probablyfor breastfeeding, right.
Speaker 1 (44:10):
So it's like a baby a baby goes right there Girls
right.
So I see newborn babies to taketheir first, you know, every
day at work.
Speaker 2 (44:20):
So it's.
It is sort of very much goeswith the breast, right the
nipple goes with the breast, andfor people that have scars on
their breasts that are visible,if you have something darker
that's pigmented usually youreyes, I get drawn.
Speaker 1 (44:38):
It takes the eyes away.
Speaker 2 (44:39):
It takes the wide part of the disguise, right.
It's sort of a disillusion,whatever that is that works in
your brain to to accept a breastas yours.
Because we do see some peopledon't accept it, even if it
looks great.
You know there's somedissociation, right.
So I've had very few patientsbut their reconstruction are and
(45:00):
I'm again, most plasticsurgeons self-critical extremely
and we're all self-criticalbecause then there's no other
way to get better.
And I tell the patients likeyou look fantastic and like this
is a very great reconstruction,they have nipples and stuff
like that, but they just don'tsee it.
So if that doesn't connect,it's very hard to have them
(45:21):
accept a breast.
Speaker 1 (45:23):
So I think it's hard.
I think I realized at somepoint during my whole process
that it was like a grieving ofsorts because I realized I'm
never going to have, they'renever going to be beautiful Like
, like a natural breast isbeautiful, like they're.
They may be pretty good or theymay be, you know, but they're,
they're always going to be likethis, this wannabe.
(45:44):
Right now they're minor, likeBarbie boobs, I like to call
them, just like a Barbie dollhas those cute, minor, nice,
they're perky, they're a goodshape.
You did a great job but theyhave no nipples.
It's like because I haven'tdone anything with that yet.
I know you can do tattoos, youcan do.
Speaker 2 (45:59):
So you can do tattoos , and only tattoos, which had
three, three tattoos, andthere's actually a whole field
in this and they're trying thismedical tattoo artist they're
actually trying to getaccreditation to where you have
should have specific trainingfor this, which I do agree,
because people will go to someof these tattoo parlors and they
have come out with purplenipples and they're like how do
(46:19):
you fix that?
Speaker 1 (46:20):
And I've had patients do that.
Speaker 2 (46:24):
So but yeah, tattoos usually done in both settings.
So one setting is to gostraight to tattoo.
The other setting is to createa nipple with the surrounding
tissue and then have the tattooartist go over it to give an
illusion of an areola andpigment and or, ideally, if it's
(46:45):
possible and patients, to savetheir own nipples.
Most people accept that better,but in some settings it's not
possible.
It's just not possible andcancer comes first, or in some
patients the nipples are way toolow and it's not going to work.
Speaker 1 (47:00):
Yeah, that was my case.
It was not so much the dangerof cancer, it's just, and I had
really large areolas, justwasn't going to look good.
I was like don't even bothertrying it.
Speaker 2 (47:10):
But the good part about all we've been discussing,
you know, that's how goodmedicine got.
We're talking about this.
Speaker 1 (47:17):
I feel very blessed that I yeah the experience I was
able to have from having youknow several decades ago, breast
cancer is this deal likeradical mastectomies don't know
if you're going to survive towhere the chemotherapy got so
long ago.
Speaker 2 (47:30):
The radiation is targeted, the immunotherapy that
we're targeting.
We studying tumor biology,figuring out what this tumor is,
this biology or DNA is making,and try to target against it.
And now to a degree to where Iwas like we're saving nipples.
We don't take nipples andeverybody were used to routinely
would take nipples off right.
So and then you know doing skin, sparing on nipples, sparing
(47:53):
mastectomies, and now talkingabout like I want to have nipple
this and this and that, whichis amazing.
I think that's how I look at it.
But yeah, certainly forpatients that's going through,
that it's been taken away.
Speaker 1 (48:05):
Well, it's really special what you do.
I think it's a very unique rolein the process in the.
You know, in this thing thatcan be such a dark time in
people's lives and you bringingbeauty to it and completing it
is important.
I mean, it's one thing to saveyour life and take the cancer
out.
It's really beautiful to have areconstruction, like you do.
(48:27):
I wish we could talk more.
We have to wrap up, but thankyou for being here and talking
to to whoever might be listening, and give us some information
about where people can find you,and then I'll put all the
details in the show notes too.
But like what's your website?
And?
Social media yeah you're like,do I even know my website?
Speaker 2 (48:50):
Yeah, I do is brush your constructionazcom to social
media.
I don't know.
I refuse to have an Instagramapp or Facebook app.
So I don't know, Smart man.
Smart man, but you do have apresence, even though you're not
the one there.
Yet the office is managing.
Speaker 1 (49:04):
And it's if you just search Southwest Breast and
aesthetics you'll find it andI'll put the links in the show
notes.
Thank you for listening topiece of work.
The podcast.
If you'd like to read my bookwhere I talk about I have a
little scene where I'm goinginto Dr Mattoff's office.
He has a different name, Ithink it's Petroff.
I was like trying to think ofsomething that was like a
(49:26):
similar origin.
Speaker 2 (49:27):
Yeah, Eastern European Keep it that way.
Speaker 1 (49:32):
I anyway highly recommend if you are facing
breast cancer and needreconstructive surgery, to go
talk to Dr Mattoff.
Thanks for listening and have agreat day.
Hi there, welcome to Peace of Work the podcast.
I'm Danielle Tanton.
I'm a nurse, author, coach andsurvivor.
I love inspiring people to livetheir best life, reach for
those big dreams and find joyeven in the pain.
As I wrote my memoir over somany years, trying to make sense
of a story where I was way toooften the bad guy instead of the
(00:28):
hero, I came to understand thatwe are all a piece of work, but
we're also a work in progress,and even in our messiness we are
a work of art too.
All at the very same time, infact, we are all beautifully
unique pieces of one masterpiecewaves in the same ocean.
This podcast will explore thestories and struggles that make
(00:50):
us human, the miracles thatsurround us and all the ways we
work to make sense of it all.
Welcome to Peace of Work thepodcast.
Welcome back to Peace of Workthe podcast.
Today I'm here with someone veryspecial.
Dr Tim Mattoff is a plastic andreconstructive surgeon who
restores the form and functionof his patients at Southwest
(01:11):
Breast and Aesthetics.
I can tell you all about hisbio and credentials, but most
importantly, he is the plasticsurgeon who did my breast
reconstruction after I had adouble mastectomy three years
ago and he is like a craftsman,an artist, I mean, he really is
amazing at what he does.
(01:31):
So I'm really honored that youcame to be here with me.
He's in his scrubs.
He came right from surgery, sopretty awesome that you made
time to do this.
I really appreciate it and I'mexcited to chat with you and let
you share with us.
Speaker 2 (01:46):
Of course.
Thank you for having me.
Speaker 1 (01:48):
Yeah.
So Dr Mattoff, like I said, isa plastic and reconstructive
surgeon at Southwest Breast andAesthetics, servicing Phoenix
and Scottsdale, Arizona.
He believes that being asurgeon is a unique opportunity
to restore both form andfunction to his breast
reconstruction patients aftermastectomy and is honored to be
a part of their journey.
He is a highly skilled surgeonfor breast reconstruction,
(02:09):
having completed his rigoroustraining in plastic and
reconstructive surgery at TulaneUniversity in New Orleans,
Louisiana.
Dr Mattoff performs severalaspects of reconstructive
surgery, such as flapreconstructions, implant
reconstructions, correctivereconstructions, second stage
reconstructions and postmastectomy reconstructions.
Can we say reconstructions one?
Speaker 2 (02:29):
at a time.
Speaker 1 (02:31):
I guess they're working on the SEO in that
description.
Speaker 2 (02:35):
That's exactly what it is.
Speaker 1 (02:37):
Anyway, I'm so honored that you're here.
Tell me a little bit about Idon't know where to start.
Let's start with my experience,since we were both there.
I had really early stage breastcancer, but I made the decision
that I think was a verypowerful decision and a very
(02:59):
conscious decision to simplychop them off, as I like to say,
and get a full, radical, doublemastectomy and have two.
I did it for a lot of reasonspartially so that I didn't have
to worry about getting breastcancer again, but also because
of the cosmetic aspect.
I couldn't imagine having onebreast with an implant and one
(03:21):
without an implant and that theywould look anything similar.
I mean, I was 45 years old.
They were a little saggy.
That wasn't going to happen,right.
Speaker 2 (03:31):
The majority of women undergoing implant
reconstruction choose abilateral mastectomy.
Part of that is very personaldecisions, but of course one of
the most common reason is youchose not to worry about the
other side and not havepotential to get breast cancer
(03:54):
on the other side, even thoughthe statistics allow.
But still, women are worriedand they always know somebody
else who did not take the otherbreast off and ended up having a
recurrence.
It's obviously disproportionateas far as the reality.
Most people won't get thecontralateral breast cancer
(04:17):
again, based on statistics, butit is still scary to think about
that and not to take the otherbreast off, especially when
they're already undergoingmastectomy on the other side.
With implant reconstructionsalso very challenging to do one
breast only for the reasons thatyou've mentioned, it's not
(04:39):
possible to achieve symmetry.
You can achieve some symmetryin clothing, but nowadays women
want to be reasonably symmetricas possible whether they're
wearing clothing or not.
Very challenging to do with onebreast having an implant and
(05:00):
the other breast, being natural,feel completely different.
They hang completely different,correct, very, very different.
Speaker 1 (05:10):
That's one thing that I always like to point out is
that a reconstruction is verydifferent from a boob job, from
just a breast augmentation.
One thing that you liked topoint out all the time when I
was your patient was well, Iguess I still am your patient,
but was just how thin my skinwas, how little was left to work
(05:33):
with after they took all thatbreast tissue away, the implants
right there under the skin.
Speaker 2 (05:39):
Correct.
So as far as breastaugmentation or enlargement of
the breast, usually the breastis fairly healthy Replacing an
implant in a fairly not astraumatic field as with
reconstruction, since the breastis not being removed and
(06:02):
patients do better in the shortand long term with breast
augmentation versusreconstruction as far as
revisionary surgery or needingsomething else done.
So breast reconstructionobviously is more involved, a
little bit more highercomplication rates because of
traumatized tissue that's leftover and the thickness of the
(06:25):
breast skin and some of the fatunderneath the skin is different
for person to person.
So some people have a good bitof what's called subcutaneous
fat and you will be able tocover the implant a little bit
better with less visibility ofrippling.
And then some patients it'sextremely thin and that's just
(06:48):
what it is, and then mostpatients-.
Speaker 1 (06:49):
Yeah, I don't know.
I got plenty of subcutaneousfat in other areas, but for some
reason in that area.
It was all actually breasttissue, because I had large
breasts.
Speaker 2 (06:58):
I had like 34 double D yeah no, you did, and I think
part of the thinning out processof your breast skin is the fact
that you had larger breasts andthey tend to stretch out and
thin out the skin itself andsome of the fat.
So, yes, interesting.
Speaker 1 (07:15):
So that brings me to kind of another question that I
think I would always try toexplain to people, even though I
didn't quite understand itmyself, is why, if I had such
large breasts and you took outall that breast tissue, why did
I need expanders or tissueexpanders, what are some of the
names for them and what was theprocess for someone like me?
Why did we need that?
(07:36):
Two surgeries?
Speaker 2 (07:37):
Two stage Russian's bone stage.
So both of them are valid.
They have pros and cons in bothreconstructive types.
So if you'd go with two stagereconstruction, what you've had,
for my reason at least, in myhands, I wanted to make sure I
(07:58):
can control.
The expression is to controlthe pocket.
And since your skin was thinand your tissues are fairly
loose, meaning that your skinthere's some stretch to it, Sag.
Speaker 1 (08:12):
in other words, you're being nice.
Speaker 2 (08:18):
So I didn't want to put the whole implant then right
away, with all the weight beingavailable Makes sense.
And then we're at a higher riskof what's called an implant
malposition, meaning it hasmoved somewhere before the scar
tissue set in, before we wereable to get some sort of
stability.
The weight of the implant isgoing to bring it down and the
(08:42):
skin stretches a little bit more, as well as what we put to hold
the implant in place.
Speaker 1 (08:47):
And that was alloderm right Like a cadaver skin
Cadaver skin correct.
Pretty crazy that that's insidemy body.
Speaker 2 (08:55):
Right, these are patients that were people that
donated their tissue for breastreconstruction patients, so
that's also yeah, for me.
I try to use that with caution,really cautious about it,
because it is a gift.
So even though it just feelslike we're opening a package and
(09:17):
putting something else in thereto support the implant, but if
you think about where it camefrom and how people think about
giving that to perspective,patients is treated as a gift,
so I don't want to ruin it.
Speaker 1 (09:34):
That's really neat.
I hadn't really thought aboutthat.
That's neat that you thinkabout it like that.
Speaker 2 (09:43):
And then as far as there's other things available
to hold stuff in place.
But in your choice and in yoursituation it was alloderm, which
is human dermis skin.
Well, since skin can stretchand even that cadaver skin
stretches, and in the setting atleast the way we've done for
you, which is above the muscle,the downside of going above the
(10:07):
muscle is a little bit morestretched upside, less pain,
less movement of the implant,but the cadaver skin also
stretches.
So I've seen it in my ownexperience and then other
patients that came from otherplaces, experience with in some
patients going straight to animplant with cadaver skin it
(10:29):
stretches too far, too quick,interesting.
So in your situation I placedthe tissue expander to hold that
in place.
So therefore I don't have allthat weight availability right
away and the expander allows youto secure things a little bit
better.
Speaker 1 (10:45):
And one thing you did with me that I think is unique
you don't always do this is youpumped those expander's up with
air instead of saline orsomething heavier.
Speaker 2 (10:54):
Yeah.
So I've kind of go both waysbetween who I use it on and in
your situation again, just tonot weigh the skin, I used air.
There is literature to kind ofgo both ways.
But more recent literaturethat's fairly concrete says it
doesn't really matter.
I shouldn't say concrete,nothing's concrete in medicine,
but a little bit more defined itdoesn't really matter how.
(11:18):
Whether you put air or saline,they didn't notice any outcome
difference.
Speaker 1 (11:23):
Seems hard to believe .
It seems like it's a lotlighter with air.
Speaker 2 (11:27):
Right.
But I do think there's somealso downsides.
Sometimes when you deflate theair and you put saline in, you
can cause some sheer effect.
And in your situation again, Iknew I wanted to come back the
second time because how thinyour skin was to add additional
fat tissue.
So in that instance I alreadyin my mind I was thinking about
(11:50):
the skin stretch.
I was thinking about not havingenough what's called an
envelope coverage to cover theimplant imperfection.
So I knew I was gonna be comingback.
So I figured I'll do somethingthat I have more control with,
like an expander, and have theopportunity to come back and add
more fat so you don't see theripples as much as you would
(12:14):
otherwise.
Speaker 1 (12:15):
That's pretty amazing .
I really love the way even I'mlistening to you now, the way
all this was happening in yourhead and you, just you take a
look and you kind of touched mybreast as if it was like, as if
you were like an artist about tomold some clay or like an
engineer, or it was a veryscientific but artistic process
(12:38):
and it's neat that you can justdo all that and you just made
those decisions.
You know, sometimes as a patientI felt frustrated by that.
I felt like I wanted tounderstand more of what your
process and what you werethinking and I wanted you to
explain more.
But in the end Later I joinedsome forums and things about
breast cancer and people werelike, oh well, I'm wondering how
(13:01):
many ccs does everybody haveand what I like, what like?
And I it drives me crazybecause I'm like, oh my gosh,
you guys need a surgeon who,just who, knows what he's doing
and he can look at you in yourcase and you're, and know
exactly what, what will fit andwhat you need, based on what
your desire is and what you'reyou're going for and based on
your anatomy.
(13:21):
And you did that so naturallyand I felt very blessed that I
had you as my surgeon and notThank you somebody who was just
giving me like Lip-talk and likejust you know, letting me make
feel like I'm in control of thissituation, that I have no idea
what I'm doing right and I Thinkyou know I think about it in a
(13:42):
way of okay, we, this is ashared decision making, we're
making decisions together, butyou're just starting this.
Speaker 2 (13:50):
I've been doing this for a while.
Of course, I wanted to listenwhat your goals are and what,
how can I meet that?
And we discussed the optionsthat would you know the more
common pros and cons toeverything.
But in the setting of diagnosisnew diagnosis of breast cancer,
trying to figure out whatyou're gonna need after you know
some of the decision-making,decision-making is discussed and
(14:12):
and and, as long as we agree.
And then I try to establish areport with the patient that I
will do my best and and, inevery situation, and I'll help
you make the decision, decisionsfor you.
And I'm giving you some of theseanswers based on hundreds of
other women that have gonethrough the same thing.
(14:33):
So I'm just trying to give youa little bit of a crystal ball,
like, hey, this is what I'veseen happening to these type of
patients with this Choice ofreconstruction or with this
choice of cancer treatment.
It doesn't mean it's going tohappen to you, but I do think
that Too much information to thedegree of detail as can
(14:57):
sometimes give you choiceparalysis You're like am I
making the right decision I haveto do.
You know some patients coming inalready on chemotherapy and
Then we'll be going onundergoing radiation and
sometimes it's just, it's a lot.
Speaker 1 (15:11):
Yeah, it's a lot.
Speaker 2 (15:12):
It's a lot to go through and you know some
decisions can be made by, by thephysicians, with the, with the
patient.
But you know I try to lead theconversation versus being kind
of steered in the in the waythat I, at least in my
experiences.
(15:33):
Those decisions that patientsmake sometimes can be wrong and
I'll tell the people, I'll tellpatients this is a wrong
decision, but in your, in yoursituations, but and but
sometimes you can it's still notoutside of standard of care.
So some things I'm willing tobend on.
But if I feel like this isgoing to lead down a further
(15:54):
Complications and I know that Ijust like no, we can't do that
Like let me help you make thisdecision.
This is like there's no othergame, but just to help you like
this doesn't change anything.
So that's kind of how I I leadmost of my consultations.
You know, trying to Understandwhat the patient wants and
(16:14):
sometimes the understanding.
I'll have a conversation wherereal ask they don't want any
reconstruction.
But if you don't ask thosequestions, sometimes the second
you just gave somebody implantsor some sort of even like a flap
surgery that really didn't want.
They never need.
Yeah, I didn't need it and so,as it goes to the process, you
can pick a very, very rareoccasion.
(16:35):
You can pick those patients outand like you know what, I
didn't really want areconstruction.
I understand now, okay, that'sanother option.
There's nothing wrong with that.
Speaker 1 (16:43):
Do you do like a smooth Flat or whatever?
I know there's different namesfor things.
Oh, do you not?
Speaker 2 (16:50):
even we do it, we do so the the challenge for for us
right now.
Yes, we do some, but thechallenge for us right now is
mainly since we're we would, weare needed in a lot of
Reconstruction.
So as we're expanding ourpractice, they'll it will be
able to accommodate that more.
But right now, you know, in thereconstructive setting, like
(17:13):
you know, to do an implant, todo a flap surgery on Coplastic
reconstruction, then you reallyneed me or plastic surgeon,
right, and sometimes it's justnot even.
Just do that, like when, like alot of them do and along them do
, they do it and they do a goodjob.
Speaker 1 (17:33):
Maybe just a someone lower on the toe.
Speaker 2 (17:36):
No, of course, what I've noticed, at least in my
experience, a lot of times it'sit's not just, like you know,
going flat doesn't really meanto go flat.
It means no rest, but and somepatients, depending on the
amount of that store storagethey have, it can look very
(17:57):
concave.
So and that that is a challenge.
In those settings plasticsurgeons usually gets involved
could can be some fat graftingjust to make them smooth Right,
so that those are the cases thatwill will usually do something
that requires some kind of Skinover skin or adding more fat
(18:19):
just to make them flat.
Speaker 1 (18:21):
Okay, so I want to talk a little bit about some of
the other flap procedures, butbefore we go there, I just
wanted to to touch on some ofthe concerns with implants.
I know, when I was trying todecide, I did the deep flap that
the flap construction wasn't anoption for me at the time we
can talk about that later.
But so implants were really myonly option for reconstruction
(18:45):
and I was worried because I youknow, I heard about people that
were getting their implantstaken out because of breast
implant illness and you know, Ipeople were again with the
Facebook groups and, like youget, you start hearing people's
stories and I.
Another thing that I liked wasthat I could talk to you about
that.
First of all, I like thatyou're younger than me, so I
(19:06):
feel like you'll be, you'll bearound, you'll probably be
practicing until I die, but so,but you explained to me that
implants were never designed tobe a lifetime Thing.
They have a, they have a shelflife and can you talk?
Go into that a little bit likesure so.
Speaker 2 (19:24):
Every implant manufacturer recommends that
their implants that warrantiesfor ten years right.
Speaker 1 (19:29):
So the.
Speaker 2 (19:30):
FDA also recommends that you can keep them for ten
years because they're kind offollowing what the implant
manufacturer is saying, so, andin some patients a last longer
than that in some patients andwon't.
But that's kind of at least arecommendation, the the
recommendation from the FDAincluding our society, to
(19:50):
American side of plasticsurgeons.
Now, if you come ten yearsafter your implantation and your
implants are completely fine,based on physical exam or we can
also obtain an MRI, which isagain recommended by the FDA,
and it all looks fine, I don'tsee a reason of replacing
implants.
If it ain't broke, let's notfix it.
Well, there's a problem.
(20:11):
So Just because it's ten years,we shouldn't do that.
But I do feel like in areconstructive setting that a
Good bit of patients that I'vebeen treating Usually have their
implant original a bit earlierthan that, and it's not always
the implant that's the problem.
There's a, there's two sides tothis.
(20:32):
There's a patient issue andthen there is also an implant
issue.
Implant issue means implantrupture or, you know,
potentially breast implantillness or Alumform that's
related to the implant, or sothose are.
(20:52):
Those are the implant relatedissues and Patient related
issues that I do feel like ismore common than the implant
related issues.
You know, the tissue is toosoft, it doesn't hold the
implant or the scarring aroundthe implant gets too aggressive
and moves.
The implant causes pain.
Radiation makes thingssignificantly more challenging
(21:12):
in the setting of implants, soit is more common to have a
patient related problem as faras not being able to hold the
implant or we're getting tootight of a scar.
As far as you want to talkabout breast implant illness too
, yeah, yeah, I mean, tell yourthoughts, you know so no, for
(21:34):
sure I.
There's currently nothing.
There's nothing concrete inmedicine about this.
Um, did it?
Being looked at right now ismore of a patient complaint, and
complaints are very vague.
They're anything from it can bejust a aging process of a
(21:56):
person, be Very general, like mymuscle hurt, like my back hurts
, my joints hurt and stuff likethat.
So it's very hard to point outwhat, what the actual issue is.
So we don't have much concreteevidence, although there's some
(22:16):
Rules have been passed which Ithink are great, but in my
experience I'd say, small numberof patients get improved
improvement.
Whether it's going to be a longsustained improvement or
permanent improvement, we don'tknow yet.
Speaker 1 (22:34):
Well, it makes sense that some people might be real
sensitive to having rightsomething for and in your body,
I mean, like you know.
It Kind of makes sense.
But right, I haven't had anyissues and you know I think you,
you kind of set me at easebecause I felt like if I did,
then we'd we take them out.
But it was.
You didn't have any reason tosuspect that I would right.
(22:57):
I have a titanium plate in mywrist.
Broken wrist a long time ago,and that's hasn't ever caused me
any trouble either.
Speaker 2 (23:05):
All right, this can be looked at like you know, some
people allergic to peanuts,some people not allergic to
peanuts right, there is a work,in theory at least, that some of
these issues, and one of them,potentially some, can have back
bacterial contamination aroundthe implant and just like we
also Think in some infectiousprocess and some other processes
(23:26):
that cause them former fromimplants, from texture implants.
It also Not a far stretch tosay that some of these symptoms
can be related to Like anindolent or this quiet infection
that keeps irritating.
You're irritating, just likewhen people have, like certain
Tooth abscesses.
You know that you have it besome is different recurrent
(23:46):
bladder infections, right, youknow so, yeah, for some patient
that is what that is.
You'll take the implants out andsometimes it's like slime
around the implants or you'llyou'll culture and bacteria
comes back.
Oh, should, they shouldn't havebacteria in it, as far as we
think.
And there there's.
There's been bacteriadiscovered, there's an in
patients don't have symptoms,they have bacteria to, and there
(24:09):
is a Epistombi virus that beendiscovered within the capsule.
So and there's new, fairly newthing that was discovered about
having not squamous cellcarcinoma, which is usually
either skin or mucosal, likeyou're, the maligning of your
mouth cancer, and they'vediscovered some of them around
(24:32):
the capsules and it could bepotential from Epstein virus
because that's can lead to Tothose issues as well.
But I've definitely taken outcapsules, would back with an
implants, would bacteria aroundthose and I felt like, based on
patients response, that theyfelt better yeah, right away,
(24:54):
make sense yeah right.
So what's the correlation tothat is hard to say for sure,
but Sounds like that that's beena problem.
They feel better.
It was my job as a doctor makepeople.
Speaker 1 (25:07):
And that's what I like about.
What I loved about yourapproach, it was it wasn't like
you were discounting it as a, asa croc or, as you know, an
imagined thing, but you reallytook a very realistic approach
and you know the the numbers Proapproach, that it's not really
a huge percentage, even thoughit seems like it right if you're
on one of these forums whereEverybody's taking them out, you
(25:30):
know right and Also you knowthe way I look at a breast
implant and people can look atit in many ways the way I look
at it.
Speaker 2 (25:39):
It, it, it's nice to have one, it's nice to have a
breast in a reconstructivesetting or in cosmetic setting,
but you, you also can take itout and live.
May not be as right as a strongof a quality of life, but the
quantity shouldn't really change.
Speaker 1 (25:56):
I compare it to it's killing you take it out right,
and hurting you take it out.
Speaker 2 (26:00):
Right.
It's a little bit more of achallenge if you have, like, a
knee replacement that's infected, that prestige is you need for
function at least right, and ora valve in your heart that's
infected, you know, or some kindof problem with it.
It's really you really need it.
You're gonna replace it and notgonna think twice now.
Speaker 1 (26:18):
Just to like not make light of it.
You know, a day in the life ofsurgery is no big deal for you,
but it is kind of a big deal forthe patient.
Six weeks of awful work it'sit's you know possible
complications there are.
There is a little more to itthan just a day of work like.
Like it is for you, but sure.
But at the same time you'reright, and that that's why I
(26:39):
decided to go forward with it.
Speaker 2 (26:40):
Yeah, and then the big, the biggest problem for the
patients, though.
In order to find out if youhave to feel better, you have to
have surgery and take them out.
Speaker 1 (26:49):
Exactly so, then you're gonna feel worse before
you feel better.
Speaker 2 (26:52):
If you suspecting the like.
You know, some patients like Iknow these are my implants, so
the only way to find this out isto take him out.
And we may be wrong and theymay not be the thing I might
still feel this way, and I dofeel like that happens a lot.
And you almost don't want toadmit it more common than other
way, at least in my experience,and I'm sure some patients will
(27:15):
disagree and I'm sure someproviders may or may not
disagree, but you go based onyour experience and you keep
track of your information anddata so you can make some kind
of you know practice changes.
So so far I Haven't seen I'veseen more patients not having
any resolution of symptoms, thenhaving resolution of symptoms,
(27:38):
but there are people out therethat do have resolution of
symptoms.
So for that number, the only wayto find out is just take him
out to be whether you're gonnafeel better or not.
That reminds me of.
Speaker 1 (27:50):
I had, like I think it like six years ago, I had a
torn labrum in my hip and thesurgeon was Sort of he wasn't
really pushing for the surgerylike he really was.
Like you know, it may notResolve your symptoms because
you have some other inflammationand things like that going on,
it may help, it may not.
He ended up I ended up doing anarthroscopic surgery.
(28:11):
He debrided it and it was andand I, you know, had to recover
from the surgery.
So for a lot of weeks it wasworse, before it was better, and
then, if I'm really honest, itwas never really better from
like it's it's.
It's better now, years later,but it it never really got
better.
I don't think the surgeryactually did any good and he he
(28:31):
warned me that that might be thecase, but I think it's like you
want so bad to believe likethat it's gonna help because
they're in so much pain withthat situation.
Speaker 2 (28:39):
That's the way, yeah, yeah, no.
There, there's sometimesdefinitely going on negative
exploration.
Yeah, I really find anything,or if you know, found something
and treated it, but that wasn'tthe exact thing and it's it's a
small number of patients, butabsolutely does happen.
Speaker 1 (28:54):
Yeah, and unfortunately, as women, there's
a whole lot of things that cancause joint pain, and you know,
menopause, perimenopause.
Speaker 2 (29:02):
And those are the confounding Stuff.
Yeah, confounding factors.
Well, and then people say we'reUnis, related to the implant,
or my hormones are related tothe implant right, you're gonna
still have them, even if youdon't have the it's very hard to
say yeah, very challengingproblem for the, for the, for
patients that are in thatsituation and, you know, once
(29:25):
the most people sent their mindto, this is the issue.
It will be very challenging tochange the mind.
Yeah.
Speaker 1 (29:33):
So, real quick, before we talk about the flap,
what about saline versussilicone and under the muscle
versus over the muscle?
I had over the muscle, as yousaid, and I had silicone, but I
didn't really.
We didn't talk about choices,that was sort of just that's
what I had sure do you do thatwith all your patients or do you
do some of the other?
Speaker 2 (29:52):
no.
So I as far as reconstructionnot cosmetics, not cosmetic
surgery but as far asreconstruction I Routinely, for
Almost all patients since I'vebeen in practice, go above the
muscle For several reasons,significant less pain.
(30:14):
I don't have to sort of releaseor cut the muscle off the rib
cage to like I call it opening,like a book page, so I can put
something in between.
I also feel that animation,deformity, because you are
releasing the muscle but it'sstill attached to your arm.
(30:34):
With certain movements youimplement do move around and
they do cause sort of thisretraction out towards the
armpits.
Sounds awful.
A lot of patients are botheredby that and I've also changed a
good bit of patients from goingunderneath the muscle that I
(30:56):
haven't, you know, came for asecond opinion or revision or
reconstruction to above themuscle just to treat the pain
and it does work.
So some of that pain could bemuscle related.
So if you're leaving it on, ifyou're going up top, you're not
having those issues.
The downside to going above themuscle is that the implant
stretches a little bit.
(31:16):
The bottom of the breast skinstretches a little bit more
because the muscle is not reallysupporting it as much.
But that's where other deviceslike alloderm come in and you
can have a little bit moreripples at the top of the
implant.
So, but I do think I'm notinhibiting function in that
(31:37):
setting.
So function to me andreconstructive world comes
before aesthetics, althoughaesthetics right behind that.
So if you're thinking about thefunction of the chest wall and
the arms, going above the musclepreserves that, so I just feel
like there's a lot more benefitthan downsides to go above the
(32:02):
muscle.
Most patients get fag graftedanyway nowadays, so you can fill
some of these rippling issueswith it seems like if it was
under the muscle, I mean likewould you be able to lift
weights?
No, it'd be very challenging.
Plants are a little bitchallenging.
Speaker 1 (32:18):
I've started working out more lately and I'm like you
know I really have no, you know, lasting effects of my surgery.
I can do everything now.
Right it took a while, but Ofcourse.
Speaker 2 (32:31):
Of course there's a lot of scarring.
That goes on.
But yes, it's challenging to do, let's say, any kind of chest
exercises playing, sochallenging.
So I mean, not everyone doesthat.
So again, part of history taken, you know, if it's not.
I can imagine being able to soyeah, and in that setting that's
why I choose to go above themuscle.
(32:53):
As your second question toSalem, versus implants.
Human implants are, at least inmy practice, are not part of
the reconstructive modalitiesthat I use.
They just feel like more waterballoons, a little bit firmer,
they could ripple a little bitmore so and I and you have to
(33:18):
overfill them just so they canhold shape better.
So I just and an augmentationworld.
That makes sense in thereconstructive world.
The way they look and feel tome doesn't make sense as far as
safety profile sailing.
(33:38):
If they leak, you know, becauseyour body will absorb the water
.
So there's no such thing as asilent leak with silicone
implants.
There can be silent leaksbecause you just don't know if
it's ruptured or not.
And was it ruptured at the timeof the placement.
Speaker 1 (33:53):
They don't get ruptured yeah.
Speaker 2 (33:55):
And the newer implants actually are.
They call generation fiveimplants, the form stable, or
patients call them gummy bearimplants.
They very rarely leak of any.
Even if you cut the implant inhalf, it doesn't.
It doesn't usually leak as freeas previous implants.
So that's kind of my decisionprocess.
Speaker 1 (34:20):
Makes sense.
So you mostly use silicone andyou mostly do over the muscle,
over the muscle, the only one,the only instance that would go
under the muscle.
Speaker 2 (34:28):
If the tumor is too close to the muscle on the chest
wall, then in that setting Iwould go under the muscle, but
that's pretty rare.
So just so we don't hide thetumor, you know, with an implant
Makes sense so you can feel it.
You bring it closer to the skinand then if it recurs hopefully
not, but if that recurs you canfeel it catch it earlier.
Speaker 1 (34:51):
That makes sense, Very interesting.
So we've been talking.
We talked a lot about all theother flap reconstructions, so
tell us a little bit about thatwe don't have a whole lot of
time left but tell us some ofthe options and the benefits and
the drawbacks of those.
Sure so why you might do itversus not do it in my case.
Speaker 2 (35:12):
Yeah, our group specializes in microsurgery or
autologous breast reconstructionor your own tissue
reconstruction.
This is the material comes fromthe patient, so it is your body
.
The upside a big upside to itis usually it's a two stage
process and then for mostpatients you don't have to have
(35:35):
anything done after that for thelifetime.
So yeah, and you know, on someoccasions patients will lose
weight or gain weight and havesome other changes, but again,
that's part of the aging processor just life process, not
really the breast reconstruction.
For a majority of the timeyou're the patients off the
conveyor belt of breastreconstruction compared to an
(35:58):
implant that you just havehigher visions.
And I do tell patients if I'mputting an implant, I guarantee
one thing to you in yourlifetime you'll have another
breast surgery.
So, which is fine, same thing,you know, as long as patients
accepting that and understandingand you know we've discussed
this and there's no problem.
So that's a big upside tohaving your own tissue
(36:21):
reconstruction.
Also, the breast feels like alot like your body and it feels
a lot more like your breast thanan implant does and you can lay
on it.
Usually patients with implantshave a little harder time, like
getting a massage or laying aflat.
Speaker 1 (36:38):
Yeah, I was just going to say I got a massage a
couple weeks ago and I have tolike that to put this bunch of
things with pillows or towels orsomething.
Speaker 2 (36:45):
Yeah, you treat it like breast dude.
They do age a little bit andthey do droop a little bit, but
not as much as a natural breastwould, because, again, this is
where the scarring helps a bit,and so that's kind of been my
experience.
That's the major upside, and agood bit of patience.
(37:09):
There's also an improvement todonor side, meaning that, where
I take it from, so if I'moffering someone a DIP flap or
deep inferior perforated flap,that means they're also getting
a tummy tuck.
Whether the scar placement,depending on how much we're
removing, may not be as ideal asa tummy tuck, but most of the
(37:31):
time we can get patients thereat the second stage surgery to
where it looks like a tummy tuck.
So that's also a potentialupside.
The key here obviously is, ifyou're doing something like this
, to preserve the core muscle,which is directus abdominis, and
that muscle is involved inpretty much everything that you
(37:54):
do.
I mean, I'm speaking to you,I'm using it a little bit just
to expel some of the air right.
Speaker 1 (38:01):
So, yeah, I'll get out of bed.
Speaker 2 (38:06):
So if we're doing something like that again, to
preserve function, which isafter treatment of breast cancer
, is second most important thing, at least in my reconstructive
ladder, is to preserve function.
But then patients get thatimprovement as well.
Speaker 1 (38:23):
So now that's the most common is to take that
tummy area.
Speaker 2 (38:28):
Correct.
Speaker 1 (38:29):
Is there some other areas that you do as?
Speaker 2 (38:30):
well they are.
The inner thigh areas or theupper buttock area is another
thing that we offer.
So there are secondary options,for the reason being they're
not exactly as ideal as the deepflap, because of the way that
abdomen is shaped and the sizeof the blood vessels.
Speaker 1 (38:52):
Kind of like to squeeze there.
It's kind of like a breastRight.
Speaker 2 (38:56):
Exactly, and it just covers also a little bit bigger
footprint, and then the recoveryis a little bit easier compared
to something with the innerthighs or the upper buttock.
So but they're all options.
Again, this is something thatyou discuss with the patient
first of all, before evenoffering.
You know we all look, okay,where is the, where is the
(39:18):
excess?
And then it's like what onwhich part you don't like?
Speaker 1 (39:20):
right.
Speaker 2 (39:21):
So and from there you can figure out like, what will
I offer to this patient?
Some patients have tummy tissue.
Just enough time to tissue ifthey do thigh tissue.
But some of them will say likeI don't want these cars on my
abdomen.
Okay, then that's a potentialthing.
Or, you know, talk about animplant in that patient if they
choose to.
But at least for my, from myexperience, most of the patients
(39:44):
that come see me they come forfor for a flap surgery.
So those are the other options,for more common options that
you would offer to patients ifthe abdominal area is not
available.
Speaker 1 (39:56):
And that's another area where I started doing some
research recently, because wewere talking about maybe maybe
doing it on me, and I think thatthere are surgeons across the
country that may or may not beas as skilled at it as you and
your practice are, and I've seensome horrible pictures, Like
(40:16):
I've seen horrible pictures ofthe whole thing.
I am just like I can't believethat that's the end product that
they're like happy with that.
I'm lucky in my body scarsreally well and I.
But oh my gosh, like I thinkthat that's.
It's a very micro, like yousaid, microsurgery.
Speaker 2 (40:38):
Yes, I believe the breast reconstruction is like.
You know you have to dedicateyourself to get consistently
good outcomes and there are alsoplastic surgeons here that do
fantastic work within thecommunity.
You know the issue I have withsome of these posts and, yes,
absolutely, patients should behave an avenue to vent.
(41:00):
But you know it creates alittle bit of misinformation
because you don't know the wholestory right, is it patient?
Is that a patient that hadradiation or recent chemotherapy
or some other things thatthings can arise from?
We don't always know the fullstory but, yeah, absolutely,
this is part of the risk.
Like breast reconstruction is achallenge and I tell my
(41:23):
patients if you want the leastamount of complications, choose
no breast reconstruction.
Yeah, because we're.
I'm not adding anything when Ido anything except the removal
that usually doesn't have asmany complications can, but most
of them are small and there'snot much of an investment that
(41:44):
comes from the patient.
You know, when somebody'sinvesting, I'm like, okay, I'm
going to, I'm going to give partof my body to rebuild my breast
and it doesn't work.
You know people can, you know,very easily feel bitter about it
and angry about it.
This whole process and theyshould, it happens in.
Our flat loss rate is, as youknow, below the national average
(42:06):
and actually at the level ofwhat other groups like us across
the country have, which is 0.8%.
But you know that's one in 100patients and that's still feels
like a lot Because that's reallyhard for for, for, for the
patient to go through.
Speaker 1 (42:22):
Yeah, sure.
Speaker 2 (42:23):
So I'm mostly not saying an implant is an easier
thing to lose because you're arestill having more surgery,
discomfort, being sick and allthat and that comes with all
with all of this.
But it's a little bit more withwith flap surgery if you, if
you've lost the flap becauseagain you gave just something up
to rebuild kind of a major losshere and there.
(42:46):
Two part surgery yeah correctand for us again that even that
0.8%.
You know we constantly alllisten to group trying to figure
out how to bring that downfurther.
So and yeah, just it's a lotfor patients to go through.
Speaker 1 (43:02):
So what about nipples ?
I like to talk, we like to topit off.
You said something to me onceabout like there was some
statistic about, and that if awoman doesn't have the nipples,
she won't feel like complete,like something like that?
Speaker 2 (43:16):
Yeah, there's some, there's some reports of that.
That.
It's, you know, centerpiecesort of and takes all your eye
gaze towards the nipple, is thatyou tend to be in the darkest,
most darkest area anyway.
So there is, there was a goodstudy done by a group of plastic
surgeons.
They had this eye trackingdevice.
(43:36):
So you look, whatever you look,you're looking at the tracks,
where you're looking on on thepicture or wherever that could
be, and they've, you know, hadpatients or other people
non-plastic surgeons looking at,and plastic surgeons look at
pictures of breasts and they've,then they've timed how much
time they've spent looking atcertain part of the breast, and
(43:57):
nipple was number one commonarea that people spend the most
amount of time.
So, and it also makes sense thatyou know we all pre-program to
know what the nipple is probablyfor breastfeeding, right.
Speaker 1 (44:10):
So it's like a baby a baby goes right there Girls
right.
So I see newborn babies to taketheir first, you know, every
day at work.
Speaker 2 (44:20):
So it's.
It is sort of very much goeswith the breast, right the
nipple goes with the breast, andfor people that have scars on
their breasts that are visible,if you have something darker
that's pigmented usually youreyes, I get drawn.
Speaker 1 (44:38):
It takes the eyes away.
Speaker 2 (44:39):
It takes the wide part of the disguise, right.
It's sort of a disillusion,whatever that is that works in
your brain to to accept a breastas yours.
Because we do see some peopledon't accept it, even if it
looks great.
You know there's somedissociation, right.
So I've had very few patientsbut their reconstruction are and
(45:00):
I'm again, most plasticsurgeons self-critical extremely
and we're all self-criticalbecause then there's no other
way to get better.
And I tell the patients likeyou look fantastic and like this
is a very great reconstruction,they have nipples and stuff
like that, but they just don'tsee it.
So if that doesn't connect,it's very hard to have them
(45:21):
accept a breast.
Speaker 1 (45:23):
So I think it's hard.
I think I realized at somepoint during my whole process
that it was like a grieving ofsorts because I realized I'm
never going to have, they'renever going to be beautiful Like
, like a natural breast isbeautiful, like they're.
They may be pretty good or theymay be, you know, but they're,
they're always going to be likethis, this wannabe.
(45:44):
Right now they're minor, likeBarbie boobs, I like to call
them, just like a Barbie dollhas those cute, minor, nice,
they're perky, they're a goodshape.
You did a great job but theyhave no nipples.
It's like because I haven'tdone anything with that yet.
I know you can do tattoos, youcan do.
Speaker 2 (45:59):
So you can do tattoos , and only tattoos, which had
three, three tattoos, andthere's actually a whole field
in this and they're trying thismedical tattoo artist they're
actually trying to getaccreditation to where you have
should have specific trainingfor this, which I do agree,
because people will go to someof these tattoo parlors and they
have come out with purplenipples and they're like how do
(46:19):
you fix that?
Speaker 1 (46:20):
And I've had patients do that.
Speaker 2 (46:24):
So but yeah, tattoos usually done in both settings.
So one setting is to gostraight to tattoo.
The other setting is to createa nipple with the surrounding
tissue and then have the tattooartist go over it to give an
illusion of an areola andpigment and or, ideally, if it's
(46:45):
possible and patients, to savetheir own nipples.
Most people accept that better,but in some settings it's not
possible.
It's just not possible andcancer comes first, or in some
patients the nipples are way toolow and it's not going to work.
Speaker 1 (47:00):
Yeah, that was my case.
It was not so much the dangerof cancer, it's just, and I had
really large areolas, justwasn't going to look good.
I was like don't even bothertrying it.
Speaker 2 (47:10):
But the good part about all we've been discussing,
you know, that's how goodmedicine got.
We're talking about this.
Speaker 1 (47:17):
I feel very blessed that I yeah the experience I was
able to have from having youknow several decades ago, breast
cancer is this deal likeradical mastectomies don't know
if you're going to survive towhere the chemotherapy got so
long ago.
Speaker 2 (47:30):
The radiation is targeted, the immunotherapy that
we're targeting.
We studying tumor biology,figuring out what this tumor is,
this biology or DNA is making,and try to target against it.
And now to a degree to where Iwas like we're saving nipples.
We don't take nipples andeverybody were used to routinely
would take nipples off right.
So and then you know doing skin, sparing on nipples, sparing
(47:53):
mastectomies, and now talkingabout like I want to have nipple
this and this and that, whichis amazing.
I think that's how I look at it.
But yeah, certainly forpatients that's going through,
that it's been taken away.
Speaker 1 (48:05):
Well, it's really special what you do.
I think it's a very unique rolein the process in the.
You know, in this thing thatcan be such a dark time in
people's lives and you bringingbeauty to it and completing it
is important.
I mean, it's one thing to saveyour life and take the cancer
out.
It's really beautiful to have areconstruction, like you do.
(48:27):
I wish we could talk more.
We have to wrap up, but thankyou for being here and talking
to to whoever might be listening, and give us some information
about where people can find you,and then I'll put all the
details in the show notes too.
But like what's your website?
And?
Social media yeah you're like,do I even know my website?
Speaker 2 (48:50):
Yeah, I do is brush your constructionazcom to social
media.
I don't know.
I refuse to have an Instagramapp or Facebook app.
So I don't know, Smart man.
Smart man, but you do have apresence, even though you're not
the one there.
Yet the office is managing.
Speaker 1 (49:04):
And it's if you just search Southwest Breast and
aesthetics you'll find it andI'll put the links in the show
notes.
Thank you for listening topiece of work.
The podcast.
If you'd like to read my bookwhere I talk about I have a
little scene where I'm goinginto Dr Mattoff's office.
He has a different name, Ithink it's Petroff.
I was like trying to think ofsomething that was like a
(49:26):
similar origin.
Speaker 2 (49:27):
Yeah, Eastern European Keep it that way.
Speaker 1 (49:32):
I anyway highly recommend if you are facing
breast cancer and needreconstructive surgery, to go
talk to Dr Mattoff.
Thanks for listening and have agreat day.
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