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.
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.
Hi there, welcome to Peace of Work the podcast. I'm Danielle Tanton. I'm a nurse, author, coach and survivor. I love inspiring people to live their best life, reach for those big dreams and find joy even in the pain. As I wrote my memoir over so many years, trying to make sense of a story where I was way too often the bad guy instead of the hero, I came to understand that we 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, in fact, we are all beautifully unique pieces of one masterpiece waves in the same ocean. This podcast will explore the stories and struggles that make us human, the miracles that surround us and all the ways we work to make sense of it all. Welcome to Peace of Work the podcast. Welcome back to Peace of Work the podcast.
Speaker 1:Today I'm here with someone very special. Dr Tim Mattoff is a plastic and reconstructive surgeon who restores the form and function of his patients at Southwest Breast and Aesthetics. I can tell you all about his bio and credentials, but most importantly, he is the plastic surgeon who did my breast reconstruction after I had a double mastectomy three years ago and he is like a craftsman, an artist, I mean, he really is amazing at what he does. So I'm really honored that you came to be here with me. He's in his scrubs. He came right from surgery, so pretty awesome that you made time to do this. I really appreciate it and I'm excited to chat with you and let you share with us.
Speaker 2:Of course. Thank you for having me.
Speaker 1:Yeah. So Dr Mattoff, like I said, is a plastic and reconstructive surgeon at Southwest Breast and Aesthetics, servicing Phoenix and Scottsdale, Arizona. He believes that being a surgeon is a unique opportunity to restore both form and function to his breast reconstruction patients after mastectomy and is honored to be a part of their journey. He is a highly skilled surgeon for breast reconstruction, having completed his rigorous training in plastic and reconstructive surgery at Tulane University in New Orleans, Louisiana. Dr Mattoff performs several aspects of reconstructive surgery, such as flap reconstructions, implant reconstructions, corrective reconstructions, second stage reconstructions and post mastectomy reconstructions. Can we say reconstructions one?
Speaker 2:at a time.
Speaker 1:I guess they're working on the SEO in that description.
Speaker 2:That's exactly what it is.
Speaker 1:Anyway, I'm so honored that you're here. Tell me a little bit about I don't know where to start. Let's start with my experience, since we were both there. I had really early stage breast cancer, but I made the decision that I think was a very powerful decision and a very conscious decision to simply chop them off, as I like to say, and get a full, radical, double mastectomy and have two. I did it for a lot of reasons partially so that I didn't have to worry about getting breast cancer again, but also because of the cosmetic aspect. I couldn't imagine having one breast with an implant and one without an implant and that they would look anything similar. I mean, I was 45 years old. They were a little saggy. That wasn't going to happen, right.
Speaker 2:The majority of women undergoing implant reconstruction choose a bilateral mastectomy. Part of that is very personal decisions, but of course one of the most common reason is you chose not to worry about the other side and not have potential to get breast cancer on the other side, even though the statistics allow. But still, women are worried and they always know somebody else who did not take the other breast off and ended up having a recurrence. It's obviously disproportionate as far as the reality. Most people won't get the contralateral breast cancer again, based on statistics, but it is still scary to think about that and not to take the other breast off, especially when they're already undergoing mastectomy on the other side. With implant reconstructions also very challenging to do one breast only for the reasons that you've mentioned, it's not possible to achieve symmetry. You can achieve some symmetry in clothing, but nowadays women want to be reasonably symmetric as possible whether they're wearing clothing or not. Very challenging to do with one breast having an implant and the other breast, being natural, feel completely different.
Speaker 2:They hang completely different, correct, very, very different.
Speaker 1:That's one thing that I always like to point out is that a reconstruction is very different from a boob job, from just a breast augmentation. One thing that you liked to point out all the time when I was your patient was well, I guess I still am your patient, but was just how thin my skin was, how little was left to work with after they took all that breast tissue away, the implants right there under the skin.
Speaker 2:Correct. So as far as breast augmentation or enlargement of the breast, usually the breast is fairly healthy Replacing an implant in a fairly not as traumatic field as with reconstruction, since the breast is not being removed and patients do better in the short and long term with breast augmentation versus reconstruction as far as revisionary surgery or needing something else done. So breast reconstruction obviously is more involved, a little bit more higher complication rates because of traumatized tissue that's left over and the thickness of the breast skin and some of the fat underneath the skin is different for person to person. So some people have a good bit of what's called subcutaneous fat and you will be able to cover the implant a little bit better with less visibility of rippling. And then some patients it's extremely thin and that's just what it is, and then most patients-.
Speaker 1:Yeah, I don't know. I got plenty of subcutaneous fat in other areas, but for some reason in that area. It was all actually breast tissue, because I had large breasts.
Speaker 2:I had like 34 double D yeah no, you did, and I think part of the thinning out process of your breast skin is the fact that you had larger breasts and they tend to stretch out and thin out the skin itself and some of the fat. So, yes, interesting.
Speaker 1:So that brings me to kind of another question that I think I would always try to explain to people, even though I didn't quite understand it myself, is why, if I had such large breasts and you took out all that breast tissue, why did I need expanders or tissue expanders, what are some of the names for them and what was the process for someone like me? Why did we need that? Two surgeries?
Speaker 2:Two stage Russian's bone stage. So both of them are valid. They have pros and cons in both reconstructive types. So if you'd go with two stage reconstruction, what you've had, for my reason at least, in my hands, I wanted to make sure I can control. The expression is to control the pocket. And since your skin was thin and your tissues are fairly loose, meaning that your skin there's some stretch to it, Sag.
Speaker 1:in other words, you're being nice.
Speaker 2:So I didn't want to put the whole implant then right away, with all the weight being available Makes sense. And then we're at a higher risk of what's called an implant malposition, meaning it has moved somewhere before the scar tissue set in, before we were able to get some sort of stability. The weight of the implant is going to bring it down and the skin stretches a little bit more, as well as what we put to hold the implant in place.
Speaker 1:And that was alloderm right Like a cadaver skin Cadaver skin correct. Pretty crazy that that's inside my body.
Speaker 2:Right, these are patients that were people that donated their tissue for breast reconstruction 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 feels like we're opening a package and putting something else in there to support the implant, but if you think about where it came from 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:That's really neat. I hadn't really thought about that. That's neat that you think about it like that.
Speaker 2:And then as far as there's other things available to hold stuff in place. But in your choice and in your situation it was alloderm, which is human dermis skin. Well, since skin can stretch and even that cadaver skin stretches, and in the setting at least the way we've done for you, which is above the muscle, the downside of going above the muscle is a little bit more stretched upside, less pain, less movement of the implant, but the cadaver skin also stretches. So I've seen it in my own experience and then other patients that came from other places, experience with in some patients going straight to an implant with cadaver skin it stretches too far, too quick, interesting. So in your situation I placed the tissue expander to hold that in place. So therefore I don't have all that weight availability right away and the expander allows you to secure things a little bit better.
Speaker 1:And one thing you did with me that I think is unique you don't always do this is you pumped those expander's up with air instead of saline or something heavier.
Speaker 2:Yeah. So I've kind of go both ways between who I use it on and in your situation again, just to not weigh the skin, I used air. There is literature to kind of go both ways. But more recent literature that'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 it doesn't really matter how. Whether you put air or saline, they didn't notice any outcome difference.
Speaker 1:Seems hard to believe. It seems like it's a lot lighter with air.
Speaker 2:Right. But I do think there's some also downsides. Sometimes when you deflate the air and you put saline in, you can cause some sheer effect. And in your situation again, I knew I wanted to come back the second time because how thin your skin was to add additional fat tissue. So in that instance I already in my mind I was thinking about the skin stretch. I was thinking about not having enough what's called an envelope coverage to cover the implant imperfection. So I knew I was gonna be coming back. So I figured I'll do something that I have more control with, like an expander, and have the opportunity to come back and add more fat so you don't see the ripples as much as you would otherwise.
Speaker 1:That's pretty amazing.
Speaker 1:I really love the way even I'm listening to you now, the way all this was happening in your head and you, just you take a look and you kind of touched my breast as if it was like, as if you were like an artist about to mold some clay or like an engineer, or it was a very scientific but artistic process and it's neat that you can just do all that and you just made those decisions.
Speaker 1:You know, sometimes as a patient I felt frustrated by that. I felt like I wanted to understand more of what your process and what you were thinking and I wanted you to explain more. But in the end Later I joined some forums and things about breast cancer and people were like, oh well, I'm wondering how many ccs does everybody have and what I like, what like? And I it drives me crazy because 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 your case and you're, and know exactly what, what will fit and what you need, based on what your desire is and what you're you're going for and based on your anatomy.
Speaker 1:And you did that so naturally and I felt very blessed that I had you as my surgeon and not Thank you somebody who was just giving me like Lip-talk and like just you know, letting me make feel like I'm in control of this situation, that I have no idea what I'm doing right and I Think you know I think about it in a way of okay, we, this is a shared decision making, we're making decisions together, but you're just starting this.
Speaker 2:I've been doing this for a while. Of course, I wanted to listen what your goals are and what, how can I meet that? And we discussed the options that would you know the more common pros and cons to everything. But in the setting of diagnosis new diagnosis of breast cancer, trying to figure out what you're gonna need after you know some of the decision-making, decision-making is discussed and and and, as long as we agree. And then I try to establish a report with the patient that I will do my best and and, in every situation, and I'll help you make the decision, decisions for you.
Speaker 2:And I'm giving you some of these answers based on hundreds of other women that have gone through the same thing. So I'm just trying to give you a little bit of a crystal ball, like, hey, this is what I've seen happening to these type of patients with this Choice of reconstruction or with this choice of cancer treatment. It doesn't mean it's going to happen to you, but I do think that Too much information to the degree of detail as can sometimes give you choice paralysis You're like am I making the right decision I have to do.
Speaker 2:You know some patients coming in already on chemotherapy and Then we'll be going on undergoing radiation and sometimes it's just, it's a lot.
Speaker 1:Yeah, it's a lot.
Speaker 2:It's a lot to go through and you know some decisions can be made by, by the physicians, with the, with the patient. But you know I try to lead the conversation versus being kind of steered in the in the way that I, at least in my experiences. Those decisions that patients make sometimes can be wrong and I'll tell the people, I'll tell patients this is a wrong decision, but in your, in your situations, but and but sometimes you can it's still not outside of standard of care. So some things I'm willing to bend on. But if I feel like this is going to lead down a further Complications and I know that I just like no, we can't do that Like let me help you make this decision. This is like there's no other game, but just to help you like this doesn't change anything.
Speaker 2:So that's kind of how I I lead most of my consultations. You know, trying to Understand what the patient wants and sometimes the understanding. I'll have a conversation where real ask they don't want any reconstruction. But if you don't ask those questions, sometimes the second you just gave somebody implants or some sort of even like a flap surgery that really didn't want. They never need.
Speaker 2:Yeah, I didn't need it and so, as it goes to the process, you can pick a very, very rare occasion. You can pick those patients out and like you know what, I didn't really want a reconstruction. I understand now, okay, that's another option. There's nothing wrong with that.
Speaker 1:Do you do like a smooth Flat or whatever? I know there's different names for things. Oh, do you not?
Speaker 2:even we do it, we do so the the challenge for for us right now. Yes, we do some, but the challenge for us right now is mainly since we're we would, we are needed in a lot of Reconstruction. So as we're expanding our practice, they'll it will be able to accommodate that more. But right now, you know, in the reconstructive setting, like you know, to do an implant, to do a flap surgery on Coplastic reconstruction, then you really need me or plastic surgeon, right, and sometimes it's just not even.
Speaker 2:Just do that, like when, like a lot of them do and along them do, they do it and they do a good job.
Speaker 1:Maybe just a someone lower on the toe.
Speaker 2:No, of course, what I've noticed, at least in my experience, a lot of times it's it's not just, like you know, going flat doesn't really mean to go flat. It means no rest, but and some patients, depending on the amount of that store storage they have, it can look very concave. So and that that is a challenge. In those settings plastic surgeons usually gets involved could can be some fat grafting just to make them smooth Right, so that those are the cases that will will usually do something that requires some kind of Skin over skin or adding more fat just to make them flat.
Speaker 1:Okay, so I want to talk a little bit about some of the other flap procedures, but before we go there, I just wanted to to touch on some of the concerns with implants. I know, when I was trying to decide, I did the deep flap that the flap construction wasn't an option for me at the time we can talk about that later. But so implants were really my only option for reconstruction and I was worried because I you know, I heard about people that were getting their implants taken out because of breast implant illness and you know, I people were again with the Facebook groups and, like you get, you start hearing people's stories and I. Another thing that I liked was that I could talk to you about that. First of all, I like that you're younger than me, so I feel like you'll be, you'll be around, you'll probably be practicing until I die, but so, but you explained to me that implants were never designed to be a lifetime Thing. They have a, they have a shelf life and can you talk? Go into that a little bit like sure so.
Speaker 2:Every implant manufacturer recommends that their implants that warranties for ten years right.
Speaker 1:So the.
Speaker 2:FDA also recommends that you can keep them for ten years because they're kind of following what the implant manufacturer is saying, so, and in some patients a last longer than that in some patients and won't. But that's kind of at least a recommendation, the the recommendation from the FDA including our society, to American side of plastic surgeons. Now, if you come ten years after your implantation and your implants are completely fine, based on physical exam or we can also obtain an MRI, which is again recommended by the FDA, and it all looks fine, I don't see a reason of replacing implants. If it ain't broke, let's not fix it. Well, there's a problem. So Just because it's ten years, we shouldn't do that.
Speaker 2:But I do feel like in a reconstructive setting that a Good bit of patients that I've been treating Usually have their implant original a bit earlier than that, and it's not always the implant that's the problem. There's a, there's two sides to this. There's a patient issue and then there is also an implant issue. Implant issue means implant rupture or, you know, potentially breast implant illness or Alumform that's related to the implant, or so those are. Those are the implant related issues and Patient related issues that I do feel like is more common than the implant related issues. You know, the tissue is too soft, it doesn't hold the implant or the scarring around the implant gets too aggressive and moves. The implant causes pain. Radiation makes things significantly more challenging in the setting of implants, so it is more common to have a patient related problem as far as not being able to hold the implant or we're getting too tight of a scar. As far as you want to talk about breast implant illness too, yeah, yeah, I mean, tell your thoughts, you know so no, for sure I.
Speaker 2:There's currently nothing. There's nothing concrete in medicine about this. Um, did it? Being looked at right now is more of a patient complaint, and complaints are very vague. They're anything from it can be just a aging process of a person, be Very general, like my muscle hurt, like my back hurts, my joints hurt and stuff like that.
Speaker 2:So it's very hard to point out what, what the actual issue is. So we don't have much concrete evidence, although there's some Rules have been passed which I think are great, but in my experience I'd say, small number of patients get improved improvement. Whether it's going to be a long sustained improvement or permanent improvement, we don't know yet.
Speaker 1:Well, it makes sense that some people might be real sensitive to having right something for and in your body, I mean, like you know. It Kind of makes sense. But right, I haven't had any issues and you know I think you, you kind of set me at ease because I felt like if I did, then we'd we take them out. But it was. You didn't have any reason to suspect that I would right. I have a titanium plate in my wrist. Broken wrist a long time ago, and that's hasn't ever caused me any trouble either.
Speaker 2: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 around the implant and just like we also Think in some infectious process and some other processes that cause them former from implants, from texture implants. It also Not a far stretch to say that some of these symptoms can be related to Like an indolent or this quiet infection that keeps irritating. You're irritating, just like when people have, like certain Tooth abscesses. You know that you have it be some is different recurrent bladder infections, right, you know so, yeah, for some patient that is what that is.
Speaker 2:You'll take the implants out and sometimes it's like slime around the implants or you'll you'll culture and bacteria comes back. Oh, should, they shouldn't have bacteria in it, as far as we think. And there there's. There's been bacteria discovered, there's an in patients don't have symptoms, they have bacteria to, and there is a Epistombi virus that been discovered within the capsule. So and there's new, fairly new thing that was discovered about having not squamous cell carcinoma, which is usually either skin or mucosal, like you're, the maligning of your mouth cancer, and they've discovered some of them around the capsules and it could be potential from Epstein virus because that's can lead to To those issues as well. But I've definitely taken out capsules, would back with an implants, would bacteria around those and I felt like, based on patients response, that they felt better yeah, right away, make sense yeah right.
Speaker 2:So what's the correlation to that is hard to say for sure, but Sounds like that that's been a problem. They feel better. It was my job as a doctor make people.
Speaker 1:And that's what I like about. What I loved about your approach, it was it wasn't like you were discounting it as a, as a croc or, as you know, an imagined thing, but you really took a very realistic approach and you know the the numbers Pro approach, that it's not really a huge percentage, even though it seems like it right if you're on one of these forums where Everybody's taking them out, you know right and Also you know the way I look at a breast implant and people can look at it in many ways the way I look at it.
Speaker 2:It, it, it's nice to have one, it's nice to have a breast in a reconstructive setting or in cosmetic setting, but you, you also can take it out and live. May not be as right as a strong of a quality of life, but the quantity shouldn't really change.
Speaker 1:I compare it to it's killing you take it out right, and hurting you take it out.
Speaker 2:Right. It's a little bit more of a challenge if you have, like, a knee replacement that's infected, that prestige is you need for function at least right, and or a valve in your heart that's infected, you know, or some kind of problem with it. It's really you really need it. You're gonna replace it and not gonna think twice now.
Speaker 1:Just to like not make light of it. You know, a day in the life of surgery is no big deal for you, but it is kind of a big deal for the patient. Six weeks of awful work it's it's you know possible complications there are. There is a little more to it than just a day of work like. Like it is for you, but sure. But at the same time you're right, and that that's why I decided to go forward with it.
Speaker 2:Yeah, and then the big, the biggest problem for the patients, though. In order to find out if you have to feel better, you have to have surgery and take them out.
Speaker 1:Exactly so, then you're gonna feel worse before you feel better.
Speaker 2:If you suspecting the like. You know, some patients like I know these are my implants, so the only way to find this out is to take him out. And we may be wrong and they may not be the thing I might still feel this way, and I do feel like that happens a lot.
Speaker 2:And you almost don't want to admit it more common than other way, at least in my experience, and I'm sure some patients will disagree and I'm sure some providers may or may not disagree, but you go based on your experience and you keep track of your information and data so you can make some kind of you know practice changes. So so far I Haven't seen I've seen more patients not having any resolution of symptoms, then having resolution of symptoms, but there are people out there that do have resolution of symptoms.
Speaker 2:So for that number, the only way to find out is just take him out to be whether you're gonna feel better or not. That reminds me of.
Speaker 1:I had, like I think it like six years ago, I had a torn labrum in my hip and the surgeon was Sort of he wasn't really pushing for the surgery like he really was. Like you know, it may not Resolve your symptoms because you have some other inflammation and things like that going on, it may help, it may not.
Speaker 1:He ended up I ended up doing an arthroscopic surgery. He debrided it and it was and and I, you know, had to recover from the surgery. So for a lot of weeks it was worse, before it was better, and then, if I'm really honest, it was 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 surgery actually did any good and he he warned me that that might be the case, but I think it's like you want so bad to believe like that it's gonna help because they're in so much pain with that situation.
Speaker 2:That's the way, yeah, yeah, no. There, there's sometimes definitely going on negative exploration. Yeah, I really find anything, or if you know, found something and treated it, but that wasn't the exact thing and it's it's a small number of patients, but absolutely does happen.
Speaker 1:Yeah, and unfortunately, as women, there's a whole lot of things that can cause joint pain, and you know, menopause, perimenopause.
Speaker 2:And those are the confounding Stuff. Yeah, confounding factors. Well, and then people say we're Unis, related to the implant, or my hormones are related to the implant right, you're gonna still have them, even if you don't have the it's very hard to say yeah, very challenging problem for the, for the, for patients that are in that situation and, you know, once the most people sent their mind to, this is the issue. It will be very challenging to change the mind. Yeah.
Speaker 1:So, real quick, before we talk about the flap, what about saline versus silicone and under the muscle versus over the muscle? I had over the muscle, as you said, 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 that with all your patients or do you do some of the other?
Speaker 2:no. So I as far as reconstruction not cosmetics, not cosmetic surgery but as far as reconstruction I Routinely, for Almost all patients since I've been in practice, go above the muscle For several reasons, significant less pain. I don't have to sort of release or 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's still attached to your arm. With certain movements you implement do move around and they do cause sort of this retraction out towards the armpits. Sounds awful.
Speaker 2:A lot of patients are bothered by that and I've also changed a good bit of patients from going underneath the muscle that I haven't, you know, came for a second opinion or revision or reconstruction to above the muscle just to treat the pain and it does work. So some of that pain could be muscle related. So if you're leaving it on, if you're going up top, you're not having those issues. The downside to going above the muscle is that the implant stretches a little bit. The bottom of the breast skin stretches a little bit more because the muscle is not really supporting it as much. But that's where other devices like alloderm come in and you can have a little bit more ripples at the top of the implant.
Speaker 2:So, but I do think I'm not inhibiting function in that setting. So function to me and reconstructive world comes before aesthetics, although aesthetics right behind that. So if you're thinking about the function of the chest wall and the arms, going above the muscle preserves that, so I just feel like there's a lot more benefit than downsides to go above the muscle. Most patients get fag grafted anyway nowadays, so you can fill some of these rippling issues with it seems like if it was under the muscle, I mean like would you be able to lift weights?
Speaker 2:No, it'd be very challenging. Plants are a little bit challenging.
Speaker 1: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 Of course.
Speaker 2: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, so challenging. So I mean, not everyone does that. So again, part of history taken, you know, if it's not.
Speaker 2:I can imagine being able to so yeah, and in that setting that's why I choose to go above the muscle. As your second question to Salem, versus implants. Human implants are, at least in my practice, are not part of the reconstructive modalities that I use. They just feel like more water balloons, a little bit firmer, they could ripple a little bit more so and I and you have to overfill them just so they can hold shape better. So I just and an augmentation world. That makes sense in the reconstructive world. The way they look and feel to me doesn't make sense as far as safety profile sailing. If they leak, you know, because your body will absorb the water. So there's no such thing as a silent leak with silicone implants. There can be silent leaks because you just don't know if it's ruptured or not. And was it ruptured at the time of the placement.
Speaker 1:They don't get ruptured yeah.
Speaker 2:And the newer implants actually are. They call generation five implants, the form stable, or patients call them gummy bear implants. They very rarely leak of any. Even if you cut the implant in half, it doesn't. It doesn't usually leak as free as previous implants. So that's kind of my decision process.
Speaker 1:Makes sense. So you mostly use silicone and you mostly do over the muscle, over the muscle, the only one, the only instance that would go under the muscle.
Speaker 2:If the tumor is too close to the muscle on the chest wall, then in that setting I would go under the muscle, but that's pretty rare. So just so we don't hide the tumor, you know, with an implant Makes sense so you can feel it. You bring it closer to the skin and then if it recurs hopefully not, but if that recurs you can feel it catch it earlier.
Speaker 1:That makes sense, Very interesting. So we've been talking. We talked a lot about all the other flap reconstructions, so tell us a little bit about that we don't have a whole lot of time left but tell us some of the options and the benefits and the drawbacks of those. Sure so why you might do it versus not do it in my case.
Speaker 2:Yeah, our group specializes in microsurgery or autologous breast reconstruction or your own tissue reconstruction. This is the material comes from the patient, so it is your body. The upside a big upside to it is usually it's a two stage process and then for most patients you don't have to have anything done after that for the lifetime. So yeah, and you know, on some occasions patients will lose weight or gain weight and have some other changes, but again, that's part of the aging process or just life process, not really the breast reconstruction.
Speaker 2:For a majority of the time you're the patients off the conveyor belt of breast reconstruction compared to an implant that you just have higher visions. And I do tell patients if I'm putting an implant, I guarantee one thing to you in your lifetime you'll have another breast surgery. So, which is fine, same thing, you know, as long as patients accepting that and understanding and you know we've discussed this and there's no problem. So that's a big upside to having your own tissue reconstruction. Also, the breast feels like a lot like your body and it feels a lot more like your breast than an implant does and you can lay on it. Usually patients with implants have a little harder time, like getting a massage or laying a flat.
Speaker 1:Yeah, I was just going to say I got a massage a couple weeks ago and I have to like that to put this bunch of things with pillows or towels or something.
Speaker 2:Yeah, you treat it like breast dude. They do age a little bit and they do droop a little bit, but not as much as a natural breast would, 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 a good bit of patience. There's also an improvement to donor side, meaning that, where I take it from, so if I'm offering 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 as a tummy tuck, but most of the time we can get patients there at the second stage surgery to where it looks like a tummy tuck. So that's also a potential upside. The key here obviously is, if you're doing something like this, to preserve the core muscle, which is directus abdominis, and that muscle is involved in pretty much everything that you 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:So, yeah, I'll get out of bed.
Speaker 2:So if we're doing something like that again, to preserve function, which is after treatment of breast cancer, is second most important thing, at least in my reconstructive ladder, is to preserve function. But then patients get that improvement as well.
Speaker 1:So now that's the most common is to take that tummy area.
Speaker 2:Correct.
Speaker 1:Is there some other areas that you do as?
Speaker 2:well they are. The inner thigh areas or the upper 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 deep flap, because of the way that abdomen is shaped and the size of the blood vessels.
Speaker 1:Kind of like to squeeze there. It's kind of like a breast Right.
Speaker 2:Exactly, and it just covers also a little bit bigger footprint, and then the recovery is a little bit easier compared to something with the inner thighs or the upper buttock. So but they're all options. Again, this is something that you discuss with the patient first of all, before even offering. You know we all look, okay, where is the, where is the excess? And then it's like what on which part you don't like?
Speaker 1:right.
Speaker 2: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 if they do thigh tissue. But some of them will say like I don't want these cars on my abdomen. Okay, then that's a potential thing. Or, you know, talk about an implant in that patient if they choose to. But at least for my, from my experience, most of the patients that come see me they come for for for a flap surgery. So those are the other options, for more common options that you would offer to patients if the abdominal area is not available.
Speaker 1:And that's another area where I started doing some research recently, because we were talking about maybe maybe doing it on me, and I think that there are surgeons across the country that may or may not be as as skilled at it as you and your practice are, and I've seen some horrible pictures, Like I've seen horrible pictures of the whole thing. I am just like I can't believe that that's the end product that they're like happy with that. I'm lucky in my body scars really well and I. But oh my gosh, like I think that that's. It's a very micro, like you said, microsurgery.
Speaker 2:Yes, I believe the breast reconstruction is like. You know you have to dedicate yourself to get consistently good outcomes and there are also plastic surgeons here that do fantastic work within the community. You know the issue I have with some of these posts and, yes, absolutely, patients should be have an avenue to vent. But you know it creates a little bit of misinformation because you don't know the whole story right, is it patient? Is that a patient that had radiation or recent chemotherapy or some other things that things can arise from? We don't always know the full story but, yeah, absolutely, this is part of the risk. Like breast reconstruction is a challenge and I tell my patients if you want the least amount of complications, choose no breast reconstruction. Yeah, because we're. I'm not adding anything when I do anything except the removal that usually doesn't have as many complications can, but most of them are small and there's not much of an investment that comes from the patient.
Speaker 2:You know, when somebody's investing, I'm like, okay, I'm going to, I'm going to give part of 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 they should, it happens in. Our flat loss rate is, as you know, below the national average and actually at the level of what other groups like us across the country have, which is 0.8%. But you know that's one in 100 patients and that's still feels like a lot Because that's really hard for for, for, for the patient to go through.
Speaker 1:Yeah, sure.
Speaker 2:So I'm mostly not saying an implant is an easier thing to lose because you're are still having more surgery, discomfort, being sick and all that and that comes with all with all of this. But it's a little bit more with with flap surgery if you, if you've lost the flap because again you gave just something up to rebuild kind of a major loss here and there.
Speaker 2:Two part surgery yeah correct and for us again that even that 0.8%. You know we constantly all listen to group trying to figure out how to bring that down further. So and yeah, just it's a lot for patients to go through.
Speaker 1:So what about nipples? I like to talk, we like to top it off. You said something to me once about like there was some statistic about, and that if a woman doesn't have the nipples, she won't feel like complete, like something like that?
Speaker 2:Yeah, there's some, there's some reports of that. That. It's, you know, centerpiece sort of and takes all your eye gaze towards the nipple, is that you tend to be in the darkest, most darkest area anyway. So there is, there was a good study done by a group of plastic surgeons. They had this eye tracking device. So you look, whatever you look, you're looking at the tracks, where you're looking on on the picture or wherever that could be, and they've, you know, had patients 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 at certain part of the breast, and nipple was number one common area that people spend the most amount of time.
Speaker 2:So, and it also makes sense that you know we all pre-program to know what the nipple is probably for breastfeeding, right.
Speaker 1:So it's like a baby a baby goes right there Girls right. So I see newborn babies to take their first, you know, every day at work.
Speaker 2:So it's. It is sort of very much goes with the breast, right the nipple goes with the breast, and for people that have scars on their breasts that are visible, if you have something darker that's pigmented usually your eyes, I get drawn.
Speaker 1:It takes the eyes away.
Speaker 2: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 breast as yours. Because we do see some people don't accept it, even if it looks great. You know there's some dissociation, right. So I've had very few patients but their reconstruction are and I'm again, most plastic surgeons self-critical extremely and we're all self-critical because then there's no other way to get better. And I tell the patients like you look fantastic and like this is a very great reconstruction, they have nipples and stuff like that, but they just don't see it. So if that doesn't connect, it's very hard to have them accept a breast.
Speaker 1:So I think it's hard. I think I realized at some point during my whole process that it was like a grieving of sorts because I realized I'm never going to have, they're never going to be beautiful Like, like a natural breast is beautiful, like they're. They may be pretty good or they may be, you know, but they're, they're always going to be like this, this wannabe. Right now they're minor, like Barbie boobs, I like to call them, just like a Barbie doll has those cute, minor, nice, they're perky, they're a good shape. You did a great job but they have no nipples. It's like because I haven't done anything with that yet. I know you can do tattoos, you can do.
Speaker 2:So you can do tattoos, and only tattoos, which had three, three tattoos, and there's actually a whole field in this and they're trying this medical tattoo artist they're actually trying to get accreditation to where you have should have specific training for this, which I do agree, because people will go to some of these tattoo parlors and they have come out with purple nipples and they're like how do you fix that?
Speaker 1:And I've had patients do that.
Speaker 2:So but yeah, tattoos usually done in both settings. So one setting is to go straight to tattoo. The other setting is to create a nipple with the surrounding tissue and then have the tattoo artist go over it to give an illusion of an areola and pigment and or, ideally, if it's possible and patients, to save their own nipples. Most people accept that better, but in some settings it's not possible. It's just not possible and cancer comes first, or in some patients the nipples are way too low and it's not going to work.
Speaker 1:Yeah, that was my case. It was not so much the danger of cancer, it's just, and I had really large areolas, just wasn't going to look good. I was like don't even bother trying it.
Speaker 2:But the good part about all we've been discussing, you know, that's how good medicine got. We're talking about this.
Speaker 1:I feel very blessed that I yeah the experience I was able to have from having you know several decades ago, breast cancer is this deal like radical mastectomies don't know if you're going to survive to where the chemotherapy got so long ago.
Speaker 2: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 I was like we're saving nipples. We don't take nipples and everybody were used to routinely would take nipples off right. So and then you know doing skin, sparing on nipples, sparing mastectomies, and now talking about like I want to have nipple this and this and that, which is amazing. I think that's how I look at it. But yeah, certainly for patients that's going through, that it's been taken away.
Speaker 1:Well, it's really special what you do. I think it's a very unique role in the process in the. You know, in this thing that can be such a dark time in people's lives and you bringing beauty to it and completing it is important. I mean, it's one thing to save your life and take the cancer out. It's really beautiful to have a reconstruction, like you do.
Speaker 1:I wish we could talk more. We have to wrap up, but thank you 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:Yeah, I do is brush your constructionazcom to social media. I don't know. I refuse to have an Instagram app or Facebook app. So I don't know, Smart man. Smart man, but you do have a presence, even though you're not the one there. Yet the office is managing.
Speaker 1:And it's if you just search Southwest Breast and aesthetics you'll find it and I'll put the links in the show notes. Thank you for listening to piece of work. The podcast. If you'd like to read my book where I talk about I have a little scene where I'm going into Dr Mattoff's office. He has a different name, I think it's Petroff. I was like trying to think of something that was like a similar origin.
Speaker 2:Yeah, Eastern European Keep it that way.
Speaker 1:I anyway highly recommend if you are facing breast cancer and need reconstructive surgery, to go talk to Dr Mattoff. Thanks for listening and have a great day.