Sometimes, the best thing a doctor can tell you is what she won’t do. Such was my experience today. I’ve returned from my consult with the plastic surgeon I vetted recently per my previous post, Private Parts: Breast Recon Without Surgery. Dr. S turned out to be a delightful, intelligent, conscientious person, and she said no.
Yes, she does do lipotransfer — but only for patients who’ve had full mastectomies, and hence, no breast tissue left that might develop a recurrence. She does it to help correct imperfections resulting from reconstructive flap graft and/or implant surgeries. In fact, she is hoping to participate in a clinical trial of the BRAVA technique, a post-mastectomy reconstruction option that uses autologous fat transfer to construct an entire breast, thereby eliminating the need for surgery altogether. It’s still complicated, and Dr. S explained that she is not without her reservations about BRAVA. But that perhaps makes her the ideal type of surgeon to explore a new procedure, because she’s got a healthy dose of skepticism and thus doesn’t have an agenda to prove that it’s safe.
From the get-go, Dr. S acknowledged that lipotransfer is a hot topic in breast recon, but a controversial one. Many more types of research studies, she felt, including longitudinal ones, are needed about simple lipotransfer in general, and stem-cell boosted lipotransfer in particular. She referred to recent studies that question the safety of both. Of particular concern is the use of lipotransfer in women who’ve had partial mastectomies or lumpectomies or radiation. Fat grafts can lead to abnormal mammograms and the development of calcifications, even in women who have lipotransfer as part of non-cancer-related breast augmentation. There is also concern that the stem cells in any fat transfer might facilitate the growth of new breast tumors. “The thing is,” she said, “stem cells can turn into anything.”
So, for someone like myself, with a partial mast and radiation, then, no, Dr. S would not perform lipotransfer. “I know plastic surgeons who’d do it, who’ll try anything,” she said, “but I’m not one of them. I don’t want to contribute to a possible recurrence.”
“Well,” I said, “that actually makes me like you more as a surgeon.”
We discussed clinical trials, and she gave me a few names of plastic surgeons who might be able to tell me more about research and the state of lipotransfer safety. We agreed about my decision to avoid flap surgery and implants, about the long-lasting effects of breast radiation, and how unarguably nasty radiation can be. We talked about my area of expertise — post-op rehab. She told me about her office partner, who is a specialist in hand surgery and restoration. Their office employs a group of rehab therapists who do nothing but work with post-op patients who’ve had hand surgery to help them restore their fine motor function. I told her about the Monday night #bcsm (breast cancer social media) Tweetchats. She took my email address and we promised to stay in touch.
It’s reassuring to feel like I talked to the right person, a doctor whose primary concern was doing the right thing for me, which meant not doing the wrong thing.
If her surgical technique and her patient care are as conscientious as the conversation we had today, I’ll bet Dr. S is a great recon doc. If you live anywhere near Providence, RI, and you’re looking for someone, send me an email at firstname.lastname@example.org, and I’ll give you her contact info.
As fate would have it, when I returned home, I found that a blog sister had posted a link about something called the Breast Cancer Patient Education Act. From the link: “Bipartisan legislation introduced in the House of Representatives on June 8 would require the Department of Health and Human Services (HHS) to plan and implement an education campaign aimed at informing mastectomy patients of breast reconstruction availability and coverage, and of prostheses and other replacement options.”
On the face of it, I think this is a good thing, although I hope this campaign is going to include those of us whose options may also include lumpectomy or partial mastectomy. According to studies, “only 33 percent of eligible women with breast cancer undergo breast reconstruction – and published research shows that nearly 70 percent of women are not informed of their care options.” I was certainly one of those women who was not told about all my treatment options or their risks and side effects. It’s sad that we have to consider legislating something like this at all, because one would hope that doctors know they’re supposed to adhere to the principle of informed consent by providing full info in the first place. Except that all too often, they don’t. One of the first posts I wrote about this thorny subject was called Blind-Sided: Cancer 101 & Informed Consent.
However, in the ‘No good deed goes unpunished’ category, well-intentioned legislation often leads to unintended consequences. The breast cancer awareness behemoth has amply demonstrated over and over how many groups and corporations are ready to make a buck off breast cancer. Let’s not forget that National Breast Cancer Awareness Month was launched largely by AstraZeneca, maker of several breast cancer drugs. Thus, it should come as no surprise whatsoever that the American Society of Plastic Surgeons has hopped right on this potential gravy train. Together with the Plastic Surgery Foundation, the ASPS plans to launch the first-ever National Breast Reconstruction Awareness Day, on October 17th of this year. Naturally, this inexorably led to a handy acronym, which is — yes, you guessed it — National BRA Day. The performer Jewel has agreed to serve as the spokesperson for this event, and has reportedly written a song about breast recon patients. She plans to premier it on October 29th, at a charity event to be held in New Orleans during the annual meeting of the ASPS, otherwise known as Plastic Surgery 2012.
From the many, many stories I’ve heard, and the post-op patients I’ve treated, some of the worse offenders in the lack-of-full-disclosure sweepstakes are plastic surgeons. For my previous thoughts on this subject, here’s my post, Under Construction: An Alternate View. So, no, despite Dr. S, I do not trust the ASPS to provide full and complete info about recon and its risks. My fantasy guerilla action would be to show up at Plastic Surgery 2012 with Florence Williams, and hand out copies of her chapter on the ugly history of breast implants and augmentation surgery, from her book, Breasts — A Natural and Unnatural History. [My review of Williams’ book is here.] Or maybe force the attendees to watch Pink Ribbons, Inc. while they’re noshing on tidbits prepared by Emeril Lagasse.
Already, I’m having nightmares that National BRA Day will encourage more of those coy, idiotic Facebook memes about bras that purport to raise breast cancer awareness. If you’re among the two or three women on the planet who don’t know what I’m talking about, I describe them in my post The Pink Elephant.
No accident that Plastic Surgery 2012 is being held in New Orleans, the home town of the storied Center for Restorative Breast Surgery, often referred to simply as NOLA by recon patients. NOLA is where a friend of mine had her recon, and developed seemingly every post-op recon complication known to exist. Had I known about BRA Day before I saw Dr. S, I might have asked her what she thought about it. Nothing like having your professional organization make a circus out of the prime focus of your surgical practice. Nothing like making more of a circus out of breast cancer, or a marketing opp out of patient education.
Postscript: wanted to add a few links here. I’ll give the ASPS credit for this link to a decent outline on what you need to know before having breast recon. The issue is, as always, how does this get put into practice?
I’ll also repeat the link for some recent research about lipotransfer and its risks.
Lipotransfer and Safety Concerns
Finally, these are the questions I assembled from the wonderful advice and comments on my previous post:
Lipotransfer: Questions for your plastic surgeon