Armor Men's Health Show

Booby Buffet: Dr. Eggleston on the Variety of Post-Breast Cancer Reconstruction Options

• Dr. Sandeep Mistry and Donna Lee

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Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in medical and urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee ire joined by friend of the practice, Dr. Eggleston of Breast Reconstruction Associates. Dr. Eggleston performs complicated microsurgical reconstructions for women recovering from breast cancer. Today, Dr. Eggleston describes several surgical options for women diagnosed with breast cancer. Among these are the choice to have implants, the choice to have a "diep flap" breast reconstruction which uses the patient's own tissue to create a "living breast" with intact blood vessels, and the choice to eschew breast reconstruction entirely in favor of a "flat chested" look. No matter your age or your cancer, Dr. Eggleston and his colleagues at Breast Reconstruction Associates want you to know that you have a range of options. 

Dr. Eggleston is also incredibly skilled at helping women and their partners navigate the emotional rollercoaster that accompanies a breast cancer diagnosis and the resulting surgical reconstruction. With compassionate guidance, both women and their partners are encouraged to explore the expectations they have for breast look, feel, and sensation after surgery. If you or someone you know has been recently diagnosed with breast cancer or is interested in learning more about the reconstructive surgeries possible at Breast Reconstruction Associates, please give Dr. Eggleston a call today at (512) 763-4545 or online at txdiepflap.com.

If you enjoyed today’s episode, don’t forget to like, subscribe, and share us with a friend! As always, be well!

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!

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Speaker 1:

Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry:

Hello, I'm Dr. Mistry, your host here as always with my incredibly helpful, very friendly and awesome practice manager slash co- host, Donna.

Donna Lee:

Wow, so many compliments jam packed.

Dr. Mistry:

I am a board certified urologist. This is a men's health show. And this show is brought to you by the urology practice that I started in 2007, NAU Urology Specialists.

Donna Lee:

That's right. And NAU stands for North Austin Urology!

Dr. Mistry:

But we're all worldwide now. So I had to like get rid of it. It's like how KFC doesn't stand for chicken anymore.

Donna Lee:

That doesn't stand for Kentucky Fried Chicken does not.

Dr. Mistry:

It does not. It's just KFC. Yeah, I think their branding people need some help.

Donna Lee:

I don't think so. I don't think they're in India quite yet.

Dr. Mistry:

This is the men's health show. It is in India, in fact. And this, what we talk about our men's health issues and issues that are otherwise important to men, even if it doesn't pertain to their health exactly.

Donna Lee:

That's right. Nipples to knees!

Dr. Mistry:

Nipples to knees--that's what a urologist takes care of.

Donna Lee:

That's right. In case you ever wonder, my mom keeps asking.

Dr. Mistry:

We wipe down everything for free, but you get a special Donna wipe down for an extra copay.

Donna Lee:

Hey, hey now.

Dr. Mistry:

You know, Donna, you know what I love?

Donna Lee:

Your guests?

Dr. Mistry:

Surgeons. If you haven't been able to tell.

Donna Lee:

I can tell. And Baylor.

Dr. Mistry:

I love operating. I was telling people, I love the smell of the operating room. I love operating with other surgeons.

Donna Lee:

Really.

Dr. Mistry:

I love surgeons.

Donna Lee:

Like cutting?

Dr. Mistry:

I love surgeons. We have a sense of humor. We have a certain, you know, rapport, and I love when I have a guest as a surgeon. Now, I love it when they're a Baylor-trained surgeon. So we don't have that today, but I do have, I do have, I do have one of my really good friends from around town, Dr. John Eggleston with Breast Reconstruction, Associates. Thank you so much for joining us today, John.

Dr. Eggleston:

You're welcome. It's my pleasure.

Dr. Mistry:

I really wanted to talk to you about kind of what you do and an interesting phenomenon when it comes to boys and girls, when it comes to cancer. So we diagnose prostate cancer all the time. And when we diagnose prostate cancer, the wife is right there. She's writing notes. She is intimately involved in the questioning. She knows exactly what I'm going to do, she wants to know all the answers. How many cases did I do? Where'd I train? And you feel like the couple's leaving with a really good understanding of what they're about to get into, right? But not with women. When it comes to breast cancer, my sense is that a lot of this is driven by the patient and their husbands tend to be a little bit more on the backseat. Is that right?

Dr. Eggleston:

For sure.

Dr. Mistry:

Now, now I think it's because, I think it's a number of things. I think it's because women traditionally handle medical issues for the family. But I think that sexual organ-related cancers are a special kind of thing that make men feel uncomfortable. When we talk about breast cancer surgery, maybe you could walk me through how do most women get diagnosed with breast cancer and how did they end up needing breast reconstruction?

Dr. Eggleston:

Sure. So most women either find out that they have cancer because they feel a lump when they're doing their monthly exams, like they're supposed to, or sometimes it's their physician or their gynecologist who feels a lump. More often than that, we find them on screening mammograms. Women start getting their screening mammograms around 40 earlier if they have a family history. And that is the source of most of our diagnoses. Typically tends to be a better prognosis because it means that the tumor didn't get so big, you could feel.

Dr. Mistry:

Right, right. If you can feel it, it's a worse thing.

Dr. Eggleston:

It's, it's a little bit further along than maybe a mammogram would have, would have picked it up. So that's usually, gynecology offices, primary care doctor's offices, you know, a woman doing her own exam. And then she gets sent to usually a breast surgeon. A breast surgeon is usually not a plastic surgeon like I am. It's somebody who comes up in the general surgery residency systems and then may or may not do additional training or fellowship in breast cancer surgery.

Dr. Mistry:

So in a town like Austin, you could get your breast biopsied or cancer diagnosed by a general surgeon in many cases or somebody who specifically focuses on doing breast cancer type surgery. Right?

Dr. Eggleston:

That's right. Some, some people's entire career is just taking care of breast cancer. Some surgeons are still truly general surgeons, so they'll treat your colon cancer, but they'll also do your mastectomy or do your biopsy.

Dr. Mistry:

And then once they're diagnosed, they usually get consulted with an oncologist to give them the best treatment option. Sometimes they're either, they either undergo a partial breast removal or a total breast removal, right?

Dr. Eggleston:

Yeah. So, they'll need, they usually get a biopsy. So once there's this suspicious mass, they usually get a biopsy. They'll either get that from the surgeon or they'll get that from a radiologist who does it under some sort of radiographic guidance--either an ultrasound or a CT or MRI guided. Got it. And then you'll get tissue and then you'll figure out,"Okay, I, this, this lesion is, is truly cancerous. What do I do next?" And so then you'll see the breast surgeon. And sometimes that's the only person you need if your cancer is really straightforward. Sometimes it's a little bit more advanced, it's a higher stage. And then you'll get an oncologist. Sometimes you need a radiation oncologist. All of that is depending on the individual cancer that a woman has at diagnosis. Then she'll get either what they now call breast conserving therapy--what, when I was a kid, we just called lumpectomies. But basically it means a woman doesn't need to have a prosthesis, like a, like a breast implant or some sort of large reconstruction. She keeps her own breast tissue, but she loses a chunk of it, which includes the cancer. And that's virtually always accompanied by radiation, sort of with radiation it has a very good prognostic or sort of expectation for the future. Alternatively, she could get a complete removal of the inside part of her breast, and that's called a mastectomy.

Dr. Mistry:

So when that happens, obviously it causes a physical deformity. And I guess I would speak to over the years, it has changed how we kind of repair that physical deformity. But just speak to the idea of why women would choose to get it reconstructed versus just kind of just leave it as it is after surgery?

Dr. Eggleston:

First of all, at all ages, we see all decisions made by different women. Usually younger women--and that means sort of anything 60 and younger--want to get reconstruction. They want to be pretty, they want to maintain their breasts, but not every woman. Some women want to go flat-chested. And there's sort of a movement of women who say,"Look, you know, we're still women. We're still powerful. We're still feminine. We still are everything we used to be. We just don't have breasts anymore." And that used to be kind of her only choice, because there wasn't good reconstruction and there wasn't insurance coverage for reconstruction. Now there's much better options and also through a federal mandate, it's mandated that insurance companies pay for that reconstruction. Older women--and that, by that, I mean, sort of, you know, late seventies, eighties, nineties--may tend more to not get a reconstruction. They'll say, you know,"Just make my cancer go away. That's all I really need. I don't want to have any more complicated surgery than I need to." We're surprised all over the place. You'll have somebody that seems older and she's really keen on getting a proper reconstruction. And you know, they're, they're, they're delightful. Sometimes we'll get a woman that's in her thirties and she doesn't want reconstruction. So I've learned long ago, not to assume anything.

Dr. Mistry:

Now, why can't you just throw some silicone implants in for everybody? Why do there have to be more complex reconstruction options available? Because what you do is so complex and so complicated,--I mean, a urologist could do it--but I mean, but it's, it's, it's kinda nice they're specially trained breast reconstruction, doctors like yourself. So, so tell me why can't can't you just throw an implant in all the time.

Dr. Eggleston:

You're speaking also to the alternative to the silicone implant, which is natural tissue reconstruction. So it doesn't make sense why you wouldn't just do implant unless you knew kind of what the other thing is. The other option is that we use tissue from some other body part. Usually it's the belly because a lot of us have a little more belly than we want, and there's a little extra fat there. And so we can take that and you do, what's called a flap or in this case, a DIEP flap, which is where we remove sort of a tummy tuck amount of tissue, but we remove it with the blood vessel that feeds it attached to it and slightly long before we disconnect it from the body. Then we bring that up to the chest and we hook that blood vessel to vessels in the chest, and then you have a living, breathing breast, as opposed to just a, a silicone implant. In some cases, we will nudge a woman towards one reconstruction or another. Earlier today, I had a double mastectomy on a woman who had, she was, she's a runner, she runs five days a week and she had zero body fat. So to do...

Donna Lee:

Like me.

Dr. Eggleston:

Like you, exactly.

Dr. Mistry:

And me.

Dr. Eggleston:

So to do a tissue-based reconstruction would it wouldn't make any sense. There's, there's nothing there. It'd be a long run for a short slide. We would push her if she wanted breast reconstruction towards an implant. Also, she didn't need radiation, which makes implants not well tolerated by the body. Another woman who has a little bit more of a belly, she'd be excited to have tissue reconstruction because it would sort of give her pretty breasts and also a prettier belly. She kind of gets an insurance covered tummy tuck, if you will. Some women don't see the benefit of that. They'd rather not have extra surgery if they could just pop in a couple of implants. Honestly, both women are right. As long as it's appropriate for them, and you know, again, I learned long ago, don't assume that somebody wants this or wants that. It's, you know, people will come to it from very different approaches and some would say,"Gosh, why would I ever do more surgery than I absolutely need when I can just use implants?" And other people will say,"Why on earth would I put something artificial in my body when I'm going to have a natural reconstruction with tissue from elsewhere?" And they're both right. In a woman who, to your question of, you know, when would, why, why can't we just pop in implants? So I've, I've spoken to that some people don't prefer that that's just not their, their sort of inclination, in some instances it would be inappropriate. And those instances would be, for example, if you've had radiation, you tend not to tolerate implants very well. Your body builds up a strong capsule of scar around the device that squeezes it, infection rates are higher, satisfaction rates are lower. Sometimes the incisions don't stay closed. It can be difficult. There are patients who do well with implant reconstruction after radiation, but we just need this sort of set expectations for,"Hey, this saves you from having a bigger surgery, but here's what you can expect as we march into the future." So we would nudge those patients towards a tissue reconstruction, because it's much better tolerated in a body that's been radiated, or maybe if there's been infection or other complications in the past, in the, in the breast area.

Dr. Mistry:

So what our, what our listeners should really realize is that the idea of what kind of reconstruction or what happens after your breast is removed is not a simple one. And there are options available to you. And just because you ended up with one type of doctor or one type of scenario, make sure you stay informed on what those other options are. And for the men out there--don't leave it up to your wife. She is the one that has to go through the breast cancer. Don't leave all the support and strategy of what to do completely up to her. Play an active role, stay informed, and it's going to be better off for the both of you. Would you agree, John?

Dr. Eggleston:

Oh for sure! Well, that's great.

Dr. Mistry:

Well, thank you so much for coming and talking to us about breast reconstruction. Donna...

Donna Lee:

Thank you Dr. Eggleston!

Dr. Eggleston:

You're very welcome.

:

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We'll be right back with the Armor Men's Health Hour.