[00:00:10] Hi, I’m Dr. Elisabeth Potter, I am a board-certified plastic surgeon based in Austin, Texas, and my specialty is breast reconstruction. As a DIEP flap surgeon, I have the privilege of being able to help women on their journey to reconstruction feel more confident and whole in their skin. In honor of Breast Reconstruction Awareness Month, today, we thought we would debunk a few common myths that I find my patients encounter when they’re first starting to consider breast reconstruction. I hope this is helpful.
[00:00:54] First myth I wanted to talk about is that some women think that flap reconstruction, like DIEP flap reconstruction, is only available in a few places in the country and academic centers. We are so fortunate now that this is just not true. So, you can receive a wonderful breast reconstruction – so many cities and towns and hospitals around the country, certainly beautiful breast reconstruction that is oncologically and from a reconstructive standpoint, excellent is being performed throughout the country, including here in Austin, Texas. I myself operate at St. David’s Medical Center in Austin, and we are not part of an academic program. I’m proud that I trained at some of the strongest academic programs in the country, but we’ve carried those skills out into the community to help as many women as possible.
[00:02:03] Another myth that I think is really important that we talk about has to do with insurance. So, it’s important that women understand that there is a federal act called the Women’s Health and Cancer Rights Act of 1998, which states that if your insurance covers your mastectomy, they have to cover your reconstruction and symmetry procedure. So, the myth that I’d like to address is that you have to pay out of pocket or go out of network to receive a beautiful breast reconstruction. When I was training, one of my mentors challenged me to make sure that I offered breast reconstruction through insurance throughout my career. And I think that that is an important thing to do if you are going to serve women with breast cancer. The Women’s Health and Cancer Rights Act provides for reconstruction and various other treatments for women and DIEP flap reconstruction as well as implant reconstruction are covered as reconstructive procedures.
[00:03:20] So, I and hundreds of other plastic surgeons around the country participate with insurance, accept insurance and do excellent breast reconstructions in-network. So, if you are looking for breast reconstruction and you encounter a situation where you’re being asked to pay out of pocket or cash or go out of network to do your breast reconstruction, reach out to me or my office, we’re happy to help you find somebody who is well-trained and will deliver a great result in-network.
[00:03:59] I think another myth that we can talk about is whether radiation and chemotherapy treatments mean that you can’t have breast reconstruction. So, I think there’s a misunderstanding among many people that if you need to have chemotherapy or radiation, that you can’t have breast reconstruction or that you should delay breast reconstruction. It’s a hard situation to talk about in general but let me just say that all women who have breast cancer should sit down and talk with a board-certified plastic surgeon about their options for breast reconstruction.
[00:04:46] It’s important to gather as a treatment team, including your oncologist, your breast surgeon, your radiation oncologist, if you need one, and even sometimes physical therapists or nutritionists, and come up with a plan. So, many women will require surgery and chemotherapy and radiation as part of their treatment and reconstruction fits very nicely into those treatment plans. In my own practice, we talk a lot about something called the sister test, which basically just means that I try to treat my patients as though they’re family. And in making decisions, I always want to make a decision that doesn’t interfere with cancer treatment. So, that often means that we really get into detail regarding the timing of breast reconstruction and ways to make it safe. So, oftentimes at the time of a mastectomy, I’ll place a tissue expander so that the entire team can get information back from pathology to find out that we have negative margins, to find out if we need chemotherapy and to determine if we need radiation therapy. Having the tissue expander in place helps me begin the process of breast reconstruction to lay the framework for doing a breast reconstruction. But it also helps me acknowledge that I don’t know everything going into surgery. By placing the expander, we are able to stop and pause if a patient needs chemotherapy or radiation and then resume our breast reconstruction once radiation is complete. There’s a lot more to talk about along that topic, and we’ll leave that for another time, but I think in general, just knowing that my approach to breast reconstruction is that I want to do things for my patients that I would want for my own sister, and I can safely do a breast reconstruction if you need chemotherapy or radiation, we just have to be smart and plan ahead.
[00:07:19] Okay, I think another myth that I wanted to talk about was related to something that I heard when I was in training. So, the myth is that women will not like the way their breasts look after breast reconstruction. And I do think that’s a myth. I remember very clearly in training when a plastic surgeon who was older and who was training me told me that the goal of breast reconstruction is for a woman to feel balanced in clothing, but that out of clothing he couldn’t make any promises. And I just felt like that wasn’t good enough. So, I think that we’ve come a long way and that we can achieve results that are beautiful. Every week I meet patients who are facing their journey for the first time. I meet patients that I’m following up six months or a year or two years after they’ve had surgery, and I am so impressed by how much we are able to do to achieve beautiful results. It is not uncommon for women to tell me that they do feel beautiful after breast reconstruction. So, I just want you to know that out there, reach out to some of our patients, reach out to patients around the country and talk about that. I don’t want you to be scared that there aren’t options for you to feel beautiful and whole in your skin.
[00:09:04] Another myth that I’d like to kind of wrap up on is that if you have metastatic breast cancer, you can’t have breast reconstruction. So, that’s just not true. You know, sometimes breast cancer becomes metastatic, the stage is higher, and women live for many years full and productive lives with metastatic breast cancer. It is very possible with the coordination of a good treatment team to achieve a safe breast reconstruction for a woman who wants that. Now, I’m not saying that every woman with metastatic breast cancer wants to have breast reconstruction, but I am saying that for women who have metastatic disease and want to have a breast, that that’s not unreasonable and we can do it very safely. So, I hope that some of those myths and talking about them today has been helpful. Please, do reach out to a board-certified plastic surgeon to talk about breast reconstruction. If you have any questions, call us in Austin, Texas. You can visit us online at DrPotter.com and we look forward to continuing the conversation.