Sponsored by Cancer
Rehab Austin
Presented by Christine Fisher, M.D., board certified plastic surgeon.
We had a great turn out at Sushi Zushi in Austin for Dr.
Fisher’s presentation, “Breast Reconstruction: Your Options.” She was
incredibly informative and interactive. For those seeking in-depth understanding
of the surgical procedures and choices available, presented in layman’s terms
with lots of Q & A, this was the ticket! (A link to the slide presentation
can be found at the bottom of this article.) Dr. Fisher opened with the
benchmarks of a successful surgery plan:
1) Safety
2) What is
appropriate for the individual patient
3) Design choice
4) A procedure that heals well and stands the test of
time
Symmetry is a prime concern, because we all want to feel
good about what we see in the mirror and how we, the patients, feel about our
appearance. Dr. Fisher is a perfectionist and plans the reconstruction design
keeping in mind that encapsulations often cause a breast to be “tight and high.”
She uses minimal touch, and no powdered gloves, to avoid any unnecessary
adhesions.
Dr. Fisher explained living tissue (autologous)
reconstruction, which generally involves taking adipose tissue from the lower
abdomen, and using it to reconstruct the breast, such as the DIEP flap. This
procedure reduces edema in the breast region by 30%. It is easier to create symmetry with
autologous reconstruction, but a longer operative time and patient stay are
generally required.
“We do gene testing before living tissue surgery,” Dr.
Fisher explained, “and certain conditions such as being morbidly obese, having
diabetes, using nicotine or multiple medical problems could exclude an
individual from being a candidate for this particular approach.”
Dr. Fisher is very visual and employs slides and a
drawing board as well as metaphors, which the audience found quite useful. One
analogy compared a stretch of vessel walls to bumps in a side walk, which would
be felt if one were skateboarding, and which a good surgeon wants to minimize
the impact on, as the cells moves through newly sewn channels.
Teamwork is critical, and surgeries are more successful
when the patient can make informed choices with the doctor, having a clearer
understanding of what to expect. Dr. Fisher is a natural when it comes to
teaching and sharing with others what she knows and has a passion for.
Nipple sparing, and Nipple-Aereola Complex (NAC) were
also addressed. The nipple does not need to be resected. 3D tattooing is
available to recreate, through micro-pigmentation, the look of the nipple
before surgery or with any modification in appearance one might desire! Nipple
skin origami involves excising a small piece of skin and twisting it to create
a nipple. These were great innovations to learn about and see, in the slide
show. The results look very natural.
In the lymphatics presentation, participants gleaned
answers that many had sought from specialist after specialist with little or no
success. We walked away with a clear understanding of what lymph looks like,
how it reacts, what helps and what impedes its flow and what can be done to
support it. Lymphatics that are damaged impair immunity because white blood
cells can’t reach their target area. We
learned how radiation and trauma damage lymphatics.
Dr. Fisher explains, in laymen’s’ terms, scientific
concepts about lymphatics. She shared
the “east” vs. “west,” beliefs about lymph transfers; Asian surgeons embrace
the stump theory, believing that the implanted lymph tissue soaks up chyle,
(lymph fluid,) like stumps, while European surgeons generally go with the bulb
theory…over time from one (trans)plant many could grow.
Dr. Fisher has
passion for her work. Her reputation as a stellar surgeon is established. She performed lymph node transfer and anastomies (reconnecting lymphatic channels and
bypassing damaged lymph) in Paris, learning from Dr. Corinne Becker, a pioneer in her
field.
Dr. Fisher is deeply involved in research and
communication with other lymphatic surgeons around the world about the latest
techniques and technologies. She is enthusiastic and shares at a galloping pace
while employing clear and simple terms, ensuring that her audience “gets” it. She
is supremely approachable. Her audience engagement represents a paradigm shift
that is desperately needed.
It is apparent that Dr. Fisher loves her work. She was
very animated while describing sewing lymph with needles so tiny and light that
they float. She works with a microscope to sew lymph, under high
magnifications.
The lecture was punctuated with evidence-based research
and interesting statistics:
Having a partner decreases the severity of lymphedema.
Having a high socio-economic status increases the
severity.
The dominant arm is less impacted, and, repetitive
muscular compression, moving the chyle, is always beneficial.
The bad news is that there is no perfect treatment or
cure for lymphedema, but research and innovative methods that help are ongoing.
Lymphedema and lipedema negatively
impact quality of life for millions of women, worldwide.
Here is the link to the breast reconstruction lecture by
Dr. Fisher: https://drive.google.com/file/d/0B7JIG1zLgqtoT3VjTGxQZm5KMHc/view
There are many resources in Austin for women with
lymphedema. Dr. Angela Wicker-Ramos, PT, DPT, CLT-LANA is the owner, physical
therapist and lymphedema therapist at Cancer
Rehab Austin. She and her staff offer PT, manual lymphatic drainage,
massage, dietary consults, acupuncture and more, to reduce pain and swelling
and enhance range of motion and comfort. Their patients are not limited to
oncology patients; they also treat those with primary and secondary lymphedema
and lipedema as well as providing pelvic floor rehabilitation. They are highly
skilled and informed, helping the patients educate themselves while supporting
them with modalities that work.
www.cancerrehabaustin.co 512 524 0964
1517 W.Koenig Lane, Bldg A
Contact Christinefishermd.com (512) 815-0123
Specializing
in breast reconstruction/aesthetic surgery/lymphatic surgery/microsurgery
WE would
also like to thank Art Bra Austin for their incredible helpfulness in
increasing awareness of breast cancer and treatments, and for their support, in
the annual June event. It was a great success. Join us next year.
https://bcrc.org/events/art-bra-austin/
by Christine
Maynard, medical journalist
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