WEBINAR TRANSCRIPT Breast Reconstruction Series, Part 2: Using Your Own Tissue to Rebuild Your Breast Karen M. Horton, MD, MSc, FACS, FRCSC February 25, 2015 OPERATOR programs and strategic initiatives at LBBC. I’m very privileged to Greetings, ladies and gentlemen, and welcome to the Living serve as your moderator. Beyond Breast Cancer webinar. At this time, all participants are in a listen-only mode. A brief question-and-answer session will At LBBC, we know that for some women, breast reconstruction follow the formal presentation. plays a very important role in your emotional recovery from breast cancer treatment. We also know that many If anyone should require operator or technical assistance during women have a hard time getting timely, useful and practical the conference, please press “star, 0” on your telephone keypad. information about making what can be very complicated As a reminder, this conference is being recorded. decisions about rebuilding your breast or breasts, whether you’re choosing to do that at the time of your breast cancer It is now my pleasure to introduce your host, Ms. Janine surgery or in the months and years afterward. Our goal today Guglielmino. Thank you. You may begin. is to give you some background to help inform these important and complicated decisions. JANINE E. GUGLIELMINO, MA Thanks, Diego, and hi, everyone. Welcome to part 2 of Living Just to give you a sense of what we’re hoping to cover today, Beyond Breast Cancer’s February webinar series focusing on we’ll talk about rebuilding the breast using your own body breast reconstruction. Today we’ll discuss using your own tissue tissue after mastectomy. This will include things like the DIEP to rebuild your breast. [deep inferior epigastric artery perforator], TRAM [transverse rectus abdominis myocutaneous], latissimus dorsi flap and I want to thank all of you for taking time out of your day to join other free-flap procedures, the impact these surgeries can have us. Again, my name is Janine Guglielmino and I’m director of on your recovery, your long-term physical strength and range of Connecting you to trusted breast cancer information and a community of support Breast Reconstruction Series, Part 2: Using Your Own Tissue to Rebuild Your Breast motion, a bit about rebuilding the nipple and areola, and some results, requires an artistic talent of your surgeon — a vision. decision-making tips you can take with you moving forward. They need to be concerned with body image and self-esteem. And they also need to consider what I call the fourth dimension, For those interested in implant reconstruction, I would which are time, gravity, aging and then effects of radiation. So, encourage you to listen to the podcast from the first part of this when we think about breast reconstruction, we really want to series. We won’t be speaking at length today about implants, consider all of those things. but the podcast should answer many of your questions about it. You can find that on LBBC.ORG. Now, I have developed a pamphlet that educates about advanced breast reconstruction techniques. We’re going to So we’ll start our program today with a presentation by our be talking about some of those things today, because, really, speaker, Dr. Karen Horton, followed by time for you to ask all women, either who are facing breast cancer or who are questions by phone or computer. We’ll provide instructions for considering a prophylactic mastectomy for risk reduction, they how to do that after Dr. Horton’s presentation. I’d like to thank deserve the very best results. Mentor and The Plastic Surgery Foundation for the financial support that made this important webinar possible, and [I’d What’s new in breast reconstruction? You may or may not have like to] very much thank Dr. Horton for being with us today, heard a little bit about nipple-sparing mastectomy [during] for sharing her expertise with you and for donating her time as the implant reconstruction section. I’m going to mention it a speaker. just very briefly today. Single-stage implant reconstruction [is something that] hopefully you learned about [during the Just a couple of housekeeping notes before we get started: If first webinar]. And you can always go to my website as well for you need to leave the program early or are just joining us, please some additional information. visit LBBC.ORG to listen to the full podcast. … But today I’m going to be talking about flap reconstruction. So without further ado, just a couple of words of introduction I’m also going to touch on using your own tissue, meaning if about Dr. Horton: Dr. Horton is internationally board certified you only need a lumpectomy and radiation, we can still do a in plastic surgery with both the American Board of Plastic reconstruction just by rearranging the rest of your tissue. We’ll Surgery and the Royal College of Surgeons of Canada. Her talk a little bit about nipple reconstruction as well and then, private practice specializes in breast cancer reconstruction and again, review talking about aesthetics. cosmetic surgery for women. Her goal is to provide beautiful, natural and long-lasting results using the most advanced So, No. 1: Why do we reconstruct the breast? When the breast is microsurgical techniques that spare major muscles of the body, gone, you can no longer breastfeed and you may lose erogenous nipple preservation and implants in a single stage. sensation. But the breast still serves a function in terms of body image, self-esteem, feeling feminine [and] feeling complete. And So without further delay, I’m honored to welcome Dr. Horton. if you have been going without breast reconstruction, you know that wearing that prosthetic in your bra — it’s heavy, it can be KAREN M. HORTON, MD, MSc, FACS, FRCSC sweaty; if you go swimming you worry about it floating away in Thank you, and thank you, everybody, for listening today. Today the pool. So by using your own tissue, you can throw away that I’m going to be talking [as part of] “Part 2: Using Your Own prosthesis forever, which is another benefit. Tissue to Rebuild Your Breast.” So the goals of breast reconstruction are to recreate the I’m going to start just by mentioning that plastic surgery, and in breast form considering four things. Aesthetics is No. 1 particular breast reconstruction, it really is equal parts art and for me. It has to look good. It should be symmetric. The science. Surgeon[s], of course, [are scientists]. They are critical reconstruction should have longevity — meaning we want thinker[s]. They have analytical mind[s]. They have perfectionist you to be around for a long time; we want your breast attention to detail. But they also really need to be artist[s], reconstruction to look amazing forever —with minimal because breast reconstruction, if it’s going to have beautiful morbidity. Now, morbidity is opposite from mortality. It LIVING BEYOND BREAST CANCER LBBC.ORG 02 Breast Reconstruction Series, Part 2: Using Your Own Tissue to Rebuild Your Breast means giving up function. So we don’t want to sacrifice any if you gain weight, or if you lose weight it shrinks a little bit, and major muscles of the body. it ages with you. However, it’s not going to droop like a natural breast because all the suspensory ligaments that go out from When I meet a new patient, I ask, “OK, if we could just wave a the chest wall, out to the skin, and they get stretched out as you magic wand, how would you want your breasts to be? Would age, they’re not there. So you actually don’t even need a bra if you want them to be larger, smaller, fuller, lifted?” Because if you don’t want to wear a bra anymore. And it does last forever, you need to have breast reconstruction, you should really use as opposed to implants, where you might need more surgeries it as an opportunity. And as one of my patients said, “OK. Let’s in your lifetime. And one other thing that’s great about doing make some lemonade out of lemons.” So we consider all of a flap is that if you have had radiation, if you have had implant those things. And I tell patients, “I can really make you look any complications, if you’ve lost skin, if you’ve had trouble with way you want to be.” … And if you goal is to be very full and the healing, when we move new tissue into the area, it brings voluptuous, we can do that. So we really take our patients’ goals a whole new blood supply and new life to the area. And it can in mind in planning their surgery. help to counteract some radiation and infection damage. I just want to mention that if the reconstruction is only on one The only disadvantage of doing a flap is that we do create side, which is covered by insurance by law, so is a balancing what’s called a donor site. So we have to take the tissue from procedure for the other side. And it’s often done at the same somewhere. And that means additional scars, usually in the time as the reconstruction. And the balancing procedure could belly or sometimes in the thigh area. It is a slightly longer include a breast lift, a breast reduction, an augmentation surgery. It’s usually 4 hours for one side and 6 to 8 hours for a and any other procedures down the road.