Breast Cancer Diagnosis: Breast Reconstruction Options with Whitney Collins, DNP

EP 15 - Breast Cancer Diagnosis - Now What ​[00:00:00] Bree Allred: [00:00:05] [00:00:10] [00:00:15] [00:00:20] [00:00:25] All right. Welcome to this episode of Healing at Your Core. Today we're [00:00:30] really gonna talk about breast cancer. We're gonna continue our series here in October, and you've heard my [00:00:35] story. You've now kind of learned a little bit about some methods that we have to, [00:00:40] diagnose, or maybe not diagnose, but kind of evaluate for breast cancer with the thermography, and I'm [00:00:45] really excited today. We're going to be talking about as a woman first gets her breast cancer [00:00:50] diagnosis, usually one of the first steps is with the surgeon. And Whitney Collins works with Two Plastic [00:00:55] Surgery Associates here in Logan, and we are going to be talking a little bit more about the [00:01:00] surgery journey and maybe helping make some of those decisions a little bit easier for women since you guys are [00:01:05] often at least one of the first stops- Yes for people. So Whitney, tell us a little bit [00:01:10] about you and kind of what got you into this line of work. Do you... [00:01:15] Like, it was always a passion of yours? Was it just something that you're like, "Oh, I want to work with women"? Was it a job [00:01:20] that fell in your lap? Tell us that story too. Yeah.  Whitney Collins : So I'm Whitney Collins. I'm a doctor nurse [00:01:25] practitioner, and I got my doctorate from the University of Utah [00:01:30] in 2020, and then I started working in plastic and reconstructive surgery, and I've done [00:01:35] that for the last six years. And then prior to that I was a nurse for about eight years. So [00:01:40] I just love the medical field in general, but then having my dad have [00:01:45] cancer, I think cancer hits close to home, and so honestly one of my favorite things [00:01:50] that I get to do in my job as a nurse practitioner is help women with breast cancer. Bree Allred: So [00:01:55] amazing. So,  Whitney Collins : yeah. Yeah. Bree Allred: How long ago did your dad have cancer?  Whitney Collins : He got diagnosed in [00:02:00] 2017, and then he passed away in 2018. Bree Allred: Oh, I didn't know that. Yeah. So-  Whitney Collins : [00:02:05] Brain cancer, Bree Allred: so ... you're like definitely hits close to home.  Whitney Collins : Yes. So it's- Yeah ... a passion of mine, and I [00:02:10] love what I do. Bree Allred: You've kind of been that, along that journey as a caregiver or a loved one- Yes as someone [00:02:15] that's been through the cancer journey.  Whitney Collins : Yes. I feel like I can sympathize somewhat with what they're going through. [00:02:20] Bree Allred: Yeah. Okay. Tell us, so you have a woman, she's just been [00:02:25] diagnosed with breast cancer, and now she ends up kind of in your guys' plastic [00:02:30] surgery o- um, office. What are some of the conversations that you guys are starting to have?  Whitney Collins : Um, [00:02:35] honestly, I think that that cancer diagnosis, as you well know, flips your world upside [00:02:40] down, and I think that it's so much unknown because [00:02:45] it's, this is not a super commonly known thing, all the options for [00:02:50] reconstruction. And so when they come and meet with me the first time, I just really try to educate them [00:02:55] on everything that is available to them. When they meet with me, there's still a lot of [00:03:00] unknowns. Yeah. Like, they might not have genetic testing done, they might not have d- done their M- MRI, you [00:03:05] know? Things like that that still need to be done and that help make the decision, [00:03:10] but Bree Allred: Or at least know your options- Yeah ... as you're going in, that it's like, "Okay, if we see this and this- Yes [00:03:15] it may lead us down this road, or if we see this and this- Yes ... it may let us, lead us down this road."  Whitney Collins : Yes. So [00:03:20] I think it's really important to educate them early. I think being able to make an [00:03:25] informed decision can relieve some stress for the woman. Bree Allred: I agree. I think it's that when you [00:03:30] get diagnosed, you're just looking down this endless road of like, whoa, there's tons of decisions [00:03:35] to make. Mm-hmm. And I think some of my best advice for women in this journey is like, what's the next thing [00:03:40] you need to know? Yeah. What's the next step? What's the next thing you need to know? And you just tackle that one, and [00:03:45] then you move on to the next one.  Whitney Collins : Yeah. Bree Allred: That's-  Whitney Collins : Yeah Bree Allred: Okay, so let's talk about, [00:03:50] okay, a woman comes in, she has positive breast cancer testing. Um- [00:03:55] And I know kind of the unique situations. It's also like, oh, we may have [00:04:00] options of a lumpectomy. And then, so maybe let's start there. Okay, we talk about a lumpectomy. [00:04:05] Like, what is that surgery, and what role does plastics have as far as, like, a [00:04:10] reconstruction standpoint have within a lumpec- lumpectomy?  Whitney Collins : Yeah. So lumpectomy is just [00:04:15] removing a small portion, just basically the cancer and the margins to make sure it's [00:04:20] clear. Um, and then that's usually acc- accompanied by radiation afterward. [00:04:25] Um, so typically plastic surgery doesn't get involved if the [00:04:30] lumpectomy has happened already, but something that people may not know is plastic surgery [00:04:35] can be involved in the lumpectomy itself in the cases of, like, a [00:04:40] woman has some drooping of her breast, the doctor can go in and do, like, a lift- Mm-hmm at [00:04:45] the time of lumpectomy so that then when the radiation occurs, it is [00:04:50] more likely to be able to match the other breast to that breast. And so we can even be [00:04:55] involved in that situation as well. Bree Allred: Yeah, which a lot of people don't know, but if you're having a [00:05:00] surgery for breast cancer, your opposite side can often be covered- Yes for [00:05:05] asymmetry surgery to make things look symmetrical as they were hopefully going into that surgery.  Whitney Collins : [00:05:10] Exactly. There was a law passed, I believe it was in 1998, that states [00:05:15] that insurance companies have to cover breast cancer surgery and reconstructive [00:05:20] surgery, so- Yeah ... most, most insurance companies. Bree Allred: And that includes the non-cancerous breast- Mm-hmm as well.  Whitney Collins : Yes. So- For [00:05:25] matching purposes. Bree Allred: Yep. Kinda cool. Do you guys ever do, like, fat grafting after [00:05:30] lumpectomies- Yes ... to kind of fill in spots that way too?  Whitney Collins : Yes. When there's been radiation damage, it [00:05:35] actually makes it a little tricky to operate on that breast as far as, like, cutting [00:05:40] into the breast, then the chance of infection and wound healing problems goes way up. And so we're a [00:05:45] little more limited after radiation. So fat grafting is typically what we do in that case [00:05:50] to just increase the size a bit, maybe do some, fix some [00:05:55] contour regularities or things like that. So- Bree Allred: So if they have a little divot- Mm-hmm ... you can kind of put some fat in there.  Whitney Collins : [00:06:00] Exactly. Bree Allred: Do women get to choose where the fat comes from?  Whitney Collins : Yes, yes. Yeah, I mean, in [00:06:05] most cases. If somebody is, you know, doesn't have a ton of fat on their body- Mm-hmm ... then it's a little [00:06:10] tricky. But most cases women can say, "Oh, I prefer my stomach," and that's honestly mostly where we take [00:06:15] it from majority of the Bree Allred: time. Yeah. And you get fat from liposuction?  Whitney Collins : Yes, [00:06:20] liposuction, and then the fat is processed to these micronized fat cells, and then it's injected into the breast, [00:06:25] and it's kind of a cool little tool. And- I love that ... it's your own tissue and- [00:06:30] Bree Allred: Yeah ...  Whitney Collins : yeah. Bree Allred: What would you say, um, 'cause I know when we talk about fat grafting, not [00:06:35] all of the fat will reestablish a blood supply in the new area. Yes. What would you say are [00:06:40] kind of typical, um- percentages, I guess? Is that how you guys report it? Yeah. Of [00:06:45] like, what, what percent of the fat that you graft in will actually  Whitney Collins : take? Usually the studies show about [00:06:50] 60 to 70% of the fat that's grafted will receive blood supply and survive. So, [00:06:55] you know, the rest of that will probably die off, and it is a, a fine balance of [00:07:00] injecting enough that it makes a good improvement, but not injecting too much 'cause then more fat cells [00:07:05] will die off. And so yeah, it's just that fine balance. Happy Bree Allred: medium. Mm-hmm. And [00:07:10] sometimes people will go in for repeat fat grafting- Yes ... throughout the process.  Whitney Collins : Yeah, that is something [00:07:15] that we do repetitively to do, like, touch-ups and get things more symmetric [00:07:20] after a lumpectomy and/or mastectomy, which we'll talk about Bree Allred: too. Okay. That's great. Yeah. All right. Is there anything [00:07:25] else you wanna say about a lumpectomy?  Whitney Collins : I don't think so. Bree Allred: Okay. Yeah. And lumpect- lumpectomies [00:07:30] often will require radiation, depending on the cancer type and what we're looking at, um, [00:07:35] as a cursor that it's like, okay, we think it was all in this one little spot, and we got it out, and we're gonna radiate [00:07:40] that tissue just to make sure that it's like if there was any little pieces that- Yes maybe we didn't see or that were [00:07:45] missed, that it gets that- Yes ... those cancer spots i- in a local area.  Whitney Collins : Yes. Bree Allred: [00:07:50] Okay. All right. Now let's talk mastectomy. So what leads people into [00:07:55] more of choosing a mastectomy over a lumpectomy?  Whitney Collins : I would say it's actually the cancer [00:08:00] type, the stage, where it's located, things like that w- make those [00:08:05] decisions. Um, but yeah, you can either do a unilateral, one-sided mastectomy, or [00:08:10] bilateral, both sides, and, um, those mastectomies can either be [00:08:15] nipple-sparing or skin-sparing. Nipple-sparing is where the nipple areolar complex is [00:08:20] preserved, and skin-sparing is where that nipple areolar complex is removed Um, and that just [00:08:25] depends on how close the cancer is to the nipple areola complex. Bree Allred: Yeah. And [00:08:30] so again, from my experience, my... So I've had actually two surgeries done. I did [00:08:35] one initially with my cancer, and I just had the right side removed, so I did a unilateral mastectomy. [00:08:40] Do you have people do unilaterals very often?  Whitney Collins : I, I think the bilateral tends to be more often, [00:08:45] because most women feel like they just don't ever wanna have to deal with this at all down the road.[00:08:50] Yeah. And I would say majority of people are past their childbearing years when we see them. There are [00:08:55] certainly some Bree Allred: that aren't. I was unique. I was young.  Whitney Collins : Yeah. And so, um, [00:09:00] majority I would say do bilateral, but again, it depends on the stage, location, type, things like [00:09:05] that. Yeah. Bree Allred: Okay. So- Um, are there increased challenges when you're looking at kind of [00:09:10] matching a s- a breast that's been surgically removed and now reconstructed with [00:09:15] an existing breast?  Whitney Collins : Yes. Yeah. A reconstructed breast, unfortunately, is never gonna [00:09:20] look exactly like you did before. Um, but so your natural [00:09:25] breast is gonna look a little bit more natural- Uh-huh ... you know, and the other one's gonna look a little bit more [00:09:30] reconstructed. But, uh, I think things can be made pretty close. Bree Allred: I'm like, [00:09:35] I'm like amazed at some of the things surgeons can do, and that you guys work with- Yeah that it's like they turn [00:09:40] out pretty good.  Whitney Collins : Yes. Bree Allred: And sometimes it can be a little more of a challenge where it's like we're working with fat [00:09:45] tissue and breast tissue versus we're working with a silicone implant or-  Whitney Collins : Right ... Bree Allred: doing maybe you've chosen [00:09:50] to do a transfer, doing it from somewhere else or things that way with some other procedures that we can talk about. Yeah. [00:09:55] Um, it's just an interesting thing where it's like, yeah, it can be a challenge. In my [00:10:00] case, one of the things that was interesting and also was a contributing factor when I decided to do, [00:10:05] um, a prophylactic or preventative mastectomy on the other side- Mm-hmm ... uh, it was [00:10:10] about 10 years later after my diagnosis.  Whitney Collins : Is that right? Bree Allred: 10, 12 years later, [00:10:15] something like that. Wow.  Whitney Collins : I don't think Bree Allred: I'd do that. Um, yeah. So one of the factors for me is I had [00:10:20] gained weight. I was 28, and- Postpartum from breastfeeding twins, [00:10:25] I was tiny  Whitney Collins : Mm-hmm ... Bree Allred: when I got my reconstruction, and then I was 10 [00:10:30] years later, two pregnancies later, and my breast tissue had changed. My, my [00:10:35] existing breast tissue had changed, and I was about a cup size different- Mm-hmm ... between my reconstructed breast that was [00:10:40] originally reconstructed to match my existing breast, and then was like, "Oh, like my real breast now [00:10:45] is a cup size bigger than my reconstructed breast." And so that was one of, one factor, not [00:10:50] the only factor, but one factor that was kind of led me to be like, "Okay, like I'm ready to [00:10:55] go in for..." Really, it was like asymmetry surgery.  Whitney Collins : Yeah. Bree Allred: And I was ready to be like, "Okay, I'm done having [00:11:00] babies. I wanna get rid of this, this breast again so we don't have issues [00:11:05] with it as well."  Whitney Collins : Yeah. Bree Allred: And so then I decided to go in and get that other mastectomy, and then I got asymmetry [00:11:10] surgery on the other side that was my original my original mastectomy [00:11:15] to allow asymmetry surgery there.  Whitney Collins : Yeah. Bree Allred: Kind of an interesting thing. It is. It's a [00:11:20] unique case. Yeah. Yeah, for sure. Okay. Now when somebody's like, "Okay, I'm going for a [00:11:25] mastectomy"-  Whitney Collins : Mm-hmm ... Bree Allred: um, and I'll even tell people, and like for me personally, I also [00:11:30] had some additional possible spots of cancer in my breast that it was like, it was a [00:11:35] millimeter, but it showed up on the MRI, and it's like to find a millimeter little tumor with a [00:11:40] biopsy is gonna be nearly impossible. Right. So it was like that made a decision where it's like there was a possible other cancer [00:11:45] site in my breast that was like, "Okay, we may wanna do a mastectomy." Um, some may [00:11:50] be looking at what's the outcome's gonna be like. I was very small chested, and they were like, [00:11:55] "Okay, if we take out your tumor, like you're gonna have a pretty significant defect in your breast- Right that's [00:12:00] going to be a little bit challenging to make it look good."  Whitney Collins : Mm-hmm. Bree Allred: So that was another decision that it's like if [00:12:05] you do the mastectomy, we're actually gonna have a better chance of reconstructing this breast to have it be something [00:12:10] that we think you'll be happy with.  Whitney Collins : And to look symmetric. Bree Allred: Yes.  Whitney Collins : Yeah. Yes. Bree Allred: Exactly. [00:12:15] Um, okay. So now they've decided genetic testing. Sorry, that was another thing that I might, might play a role. [00:12:20] Yes. If you have positive genetic testing-  Whitney Collins : Yes ... Bree Allred: it's very encouraged that you'll do- Both ... [00:12:25] both.  Whitney Collins : Yes. Bree Allred: Um, so that could be another factor on whether you're choosing single, bilateral [00:12:30] lumpectomy versus mastectomy.  Whitney Collins : Right. Bree Allred: Okay, so now we're moving into we've decided on a mastectomy.  Whitney Collins : Okay. [00:12:35] Bree Allred: What reconstruction options are people gonna be looking at? It's like, okay, we're [00:12:40] taking breast tissue off- Mm-hmm ... and we know there's some factors, like where's the cancer located? Can we save the [00:12:45] nipples? Are people wanting to go bigger or smaller? Because when you're taking off both boobs, you kind of get to choose [00:12:50] that as well, right? It's a clean canvas. You get to start where you want to.  Whitney Collins : Yeah. Bree Allred: [00:12:55] But what type of options for reconstruction are people looking at?  Whitney Collins : Um, there's two [00:13:00] types really. Uh, implant-based reconstruction and then tissue-based reconstruction.[00:13:05] Um, and every surgeon's gonna do things a little bit differently, [00:13:10] um, but typically we start with what's called a tissue expander, and- Doped ... I can [00:13:15] get right into that if Bree Allred: you like. Do it. Go for it. Okay. Yep, let's talk tissue expander. Okay, and will those be... [00:13:20] Those will mostly be used only if you're doing an implant-based.  Whitney Collins : Actually, both. Both. Mm-hmm. Bree Allred: Okay. I [00:13:25] learned something.  Whitney Collins : Yes. Um, and it's just to stretch out the tissue. So typically, [00:13:30] when all of the breast tissue is removed, there's, um, a, a tighter space than there [00:13:35] typically was prior. And so the tissue expander, it's kind of like- [00:13:40] To help people understand, it's like a deflated water balloon and it has a port inside [00:13:45] of it, and then that port can be accessed through the outside of your skin. We can then [00:13:50] insert or take out sterile saline from the tissue expander to slowly stretch [00:13:55] out the skin in a safe way. Um, anytime we're reconstructing a breast, our [00:14:00] biggest concerns are infection and wound healing problems because there is less tissue to [00:14:05] support the blood supply to the outer skin. And so when we do a tissue expander, [00:14:10] it makes the reconstruction process a little safer by going slowly increasing the [00:14:15] size to allow that blood supply to reestablish. And it also lets women kind of [00:14:20] look and see, "Do I like this size or do I wanna go a little bigger?" Yeah. Or things like that. Bree Allred: Yeah. So. I [00:14:25] often describe it, and I actually have never seen a tissue expander. I should look at it. Yeah. But what it felt like inside of me [00:14:30] is one of those old school, um, like ice packs where it's got like the lid on the [00:14:35] top- Oh, yes didn't it? And then like the bag underneath it- Yeah ... you would fill full of ice and water, or I think they could heat them up, too, in [00:14:40] the, like back before my time a little bit, but- That's kind of what it feels like ... I don't know, that's kind of what I felt like when it was [00:14:45] inside of me. I'm like, "Oh, well, like here's the port," but it's kind of like a firm little spot at the top- Mm-hmm so you guys could find [00:14:50] it and- Yes, and- ... be able to inject into it.  Whitney Collins : Exactly. Yeah. We find it with a magnet and then you just [00:14:55] stick a needle in. It's actually really simple. It's Bree Allred: probably- Yes ...  Whitney Collins : my favorite thing I get to do. Bree Allred: Ooh, a kind of fun. [00:15:00] Yeah. And then, and like from, uh, just my perspective, it's pretty painless because- Yes you can't really... I'm like [00:15:05] there's been some nerve damage and you can't really sense things, and it's like it, it's weird to be [00:15:10] poked with a needle and not actually feel it. So. Yes.  Whitney Collins : It is a benefit. Yeah. For sure. And then the [00:15:15] tissue expander, we typically wrap it in AlloDerm, which then as it expands that [00:15:20] AlloDerm, it's a donor tissue from a deceased patient, um, and it then creates [00:15:25] a really solid, good pocket for the implant to then be placed into. Typically, the [00:15:30] tissue expander's gonna be in about three months, and then the implant gets placed into that [00:15:35] space after the tissue expander's removed. Bree Allred: Yeah. And some people think they're [00:15:40] uncomfortable. I didn't really experience that too much. Um- They weren't really that [00:15:45] uncomfortable. I mean, a little bit when you go through a stretch process. Mm-hmm. It's like yeah, I can feel some fullness there, like we're- Some pressure ... [00:15:50] yeah. Yeah. But generally speaking, it wasn't too uncomfortable for me. Yeah. I don't know, would you say that's [00:15:55] your patients' experience most  Whitney Collins : of the time? Yeah, most of the time, yeah. Some people say it's a little heavy, a little [00:16:00] bulky. Um, it doesn't look quite as beautifully round as an implant is gonna [00:16:05] look. So I just tell people to not pay attention so much to kind of [00:16:10] the, the little irregularities or imperfections, and just kind of pay attention to the size. [00:16:15] And then obviously the final implant is gonna be much lighter- Yeah ... smooth, round, things like that. Bree Allred: It's softer [00:16:20] too.  Whitney Collins : Yeah, for sure. And additionally, a tissue expander can just make space for the [00:16:25] flat procedure as well. Bree Allred: Okay. So. Very neat. I didn't know that they did that. Mm-hmm. So that's kind of neat. [00:16:30] Um, trying to think if there's anything along those lines. Oh, let's talk immediate, [00:16:35] like, after mastectomy. Yeah. Since we're just in this mastectomy realm. Yeah. Let's talk [00:16:40] immediately after mastectomy, like what can people expect? They wake up from surgery. Yeah. [00:16:45] What's happening there?  Whitney Collins : Yeah. Um, I've heard that it, that there's a quite a big [00:16:50] emotional, mental component- Yeah ... and you can probably speak to Bree Allred: that. Where it's like you look down and it's like, "Okay, what's [00:16:55] here?"  Whitney Collins : Yes. Yes. So definitely I think a therapist, a therapist that you trust to [00:17:00] talk to- Mm ... through those things is important. But as far as like medically what you can expect is [00:17:05] you can have s- you'll have some dressings on. Again, every surgeon's gonna do things a little bit differently, [00:17:10] but some dressings. You'll have tubes, uh, drains coming out of the sides And, [00:17:15] um, the drains stay in about two weeks. The first, um, couple weeks you kind [00:17:20] of need to take it easy. So you're gonna expect to be kind of sore, taking it easy. You [00:17:25] don't want to get your heart rate or blood pressure elevated for two weeks, and you don't want to lift anything more than [00:17:30] about 10 pounds. So, um, just no, like, exercising or things, but you can be [00:17:35] up and walking and trying to do things around the house. Yeah. Little things. Bree Allred: Yeah. And [00:17:40] for me, the drains were the most uncomfortable part of all of it. It is. Like not e- it sounds silly, but I'm [00:17:45] like I didn't even really have that much post-op pain because I feel like a lot of the nerves that [00:17:50] would be sore are actually gone. Yes. I don't know if that's the s- the case for everybody, but for me it was [00:17:55] like the pain was really not that bad. Mm-hmm. Granted, as long as I was good, I rested. Did anything [00:18:00] I was doing what I was supposed to be doing.  Whitney Collins : Yes. Bree Allred: Um, but for me the drains were so [00:18:05] uncomfortable. Yeah. And especially where they came out of my skin. Mm-hmm. 'Cause they stitched just a little bit right there, and I'm [00:18:10] like I had more sensation there where that was pulling- Than on the front ... than on the front. Yeah. Yep.  Whitney Collins : [00:18:15] Yeah. So. Which is typically the case, but they serve a really good purpose. Um, any time [00:18:20] after surgery your body's gonna build up fluid, and so getting that fluid out of there actually puts less [00:18:25] compression and pressure on those tissues so that we're not as concerned about the blood supply.[00:18:30] And then it actually reduces your risk of infection, um- 'Cause Bree Allred: you're getting... We don't want [00:18:35] stagnant fluid  Whitney Collins : in our body. Exactly. That's like the perfect reservoir for infection, and it actually helps to [00:18:40] reduce the swelling a little bit more quickly. So they serve a great purpose. Yeah. And yeah, they- Bree Allred: That's why we [00:18:45] do them.  Whitney Collins : They are a little uncomfortable- Yes ... out on the sides. Yeah. Bree Allred: And it's the weirdest feeling when they take them out, and [00:18:50] just like pulls out and you're like, "Oh my gosh, this is really weird." Little pressure. Yeah.  Whitney Collins : Yeah. Bree Allred: It is just pressure, but for me it's kind of [00:18:55] that same idea, like doing something moving inside of me. Kind of like a baby when you're th- I'm like it's kind [00:19:00] of cool, but on the flip side you're like- A little weird ... this is a little weird. Yeah, like something's moving inside of me that I'm not [00:19:05] moving, right? It's kind of a unique experience there. The drains actually most of the time will have a safety pin [00:19:10] on them- Yes so that you can, like, pin them to your clothes or you can move them so that they're not hanging and [00:19:15] pulling on those tissues. Yeah. I actually found wearing a fanny pack- Mm-hmm ... of all things, was super weird, but I'm [00:19:20] like I could just stick them in the fanny pack and they were there. I could move them around the back a little bit and put one in on [00:19:25] each side.  Whitney Collins : Yes. Bree Allred: Um, so those were some helpful tips for me- Mm-hmm ... on managing the [00:19:30] drains.  Whitney Collins : Yeah. And when you shower something you can, uh, w- wear something around your neck that can [00:19:35] get wet, like a shoelace, a string, a lanyard, something like that. Yep. And just pin it to it. And then pin the drains to that- Mm-hmm ... so that your [00:19:40] hands are free to shower and... So yeah, there's definitely some tips and tricks that I give patients. Bree Allred: Yeah. Yeah. [00:19:45] It's just one of those things that you navigate differently. Mm-hmm. Um, okay, [00:19:50] now let's go back into if we're choosing a silicone base. Do you feel like we covered [00:19:55] everything? Reconstruction there you're gonna get a tissue expander for both.  Whitney Collins : Mm-hmm. Bree Allred: Um, and then progressively [00:20:00] either increase or decrease- Mm-hmm ... kind of what's happening there as you're going through those initial healing [00:20:05] processes.  Whitney Collins : Yeah. Bree Allred: Um, then after that, now it's like, okay- [00:20:10] We're looking at a silicone-based reconstruction, and we get to choose size, shape, [00:20:15] right? I didn't really think that I'm like, there's different shapes of silicone implants. And it's like, [00:20:20] yes. Yeah. You can make them more teardrop, or you can make them more round, or you can do different things that way, right?  Whitney Collins : We [00:20:25] typically just use round. Okay. 'Cause it's gonna give the best appearance. Um, so [00:20:30] I, I don't think we even said this at the top, but I work, uh, at Logan Plastic [00:20:35] Surgery. I work with Dr. Eisen and Dr. McMullin, and they're phenomenal surgeons, and they typically [00:20:40] both use round, smooth implants. Bree Allred: Yeah. I remember going in for my second surgery, 'cause the [00:20:45] first one it was more like just whatever matches the other side. It was kinda easy decisions. But going in after the [00:20:50] fact I'm like, I didn't even know there were different options. So it was like, "What do you recommend? What do most people do?" And it was [00:20:55] like, "This is usually what we do." And I was like, "Okay."  Whitney Collins : Which I think is the beauty of the tissue expander, because [00:21:00] you can slowly see what size works for you. Yeah. We increase it weekly, [00:21:05] um, until they get to the size that they like. So it gives them a week to go home, try on clothes, [00:21:10] swimsuits, bras, things like that, and be like, "Yeah, I think this is great." Bree Allred: This is  Whitney Collins : how it feels. So- Yeah ... and then [00:21:15] that helps us make the decision obviously. Yeah. Bree Allred: And I do feel like if you're struggling with like, I don't know, [00:21:20] like what do I want, sometimes I did even ask, um, Dr. Eisen was my surgeon. Mm-hmm. [00:21:25] And I asked him, I was like, "Okay, you see this a lot. Like for my body type," do you know what I mean? Mm-hmm. [00:21:30] "What do, what size do you typically recommend?" I also did the, I was like, "I don't wanna go [00:21:35] that much bigger," but I was like, "You tell me, like is it gonna look weird with my body size? Am I, do my [00:21:40] body type?" And they can make some recommendations a little bit  Whitney Collins : and guide you along the way as well. Absolutely. And I'm sure Bree Allred: you do the same. Yeah. [00:21:45]  Whitney Collins : Yeah. The surgeons are great. Bree Allred: Yeah. They do a really good job. Okay. So [00:21:50] outside, I guess there is silicone and saline options- Yeah ... for implants.  Whitney Collins : Yeah. Bree Allred: Although [00:21:55] saline aren't used very often  Whitney Collins : anymore. Not often, especially in reconstruction, just because saline is [00:22:00] heavier and so we really don't wanna put more undue pressure- Stress or strain on it or strain [00:22:05] on the s- Mm-hmm ... on the skin that we're already worried about blood supply. And so typically we're using [00:22:10] silicone. That's the most common. Bree Allred: Yeah. To where I'm like, I guess if you're really against it, we could talk about [00:22:15] saline, but it's not as common.  Whitney Collins : Yeah. And there are a lot of things that are- [00:22:20] Um, maybe mis- maybe misconceptions about silicone. So I talk through [00:22:25] those things with patients as well. Bree Allred: Yeah. Yeah. Okay. Maybe we'll go into those a little bit at the end. Mm-hmm. Tell [00:22:30] us, okay, now other options, and I know that sometimes you get creative so you're not going [00:22:35] over all of them, but what are some typical, if we're talking about, um, kind of [00:22:40] autografts, meaning they're coming from your own body- Mm-hmm that you're using to reconstruct the breast tissue? [00:22:45]  Whitney Collins : Yeah. So tissue-based reconstruction, um, it's definitely, uh, [00:22:50] a little bit bigger surgery. Um, we don't have the patient population to do it [00:22:55] here, so we actually just do implant-based in my clinic. But if somebody was [00:23:00] wanting a tissue-based reconstruction, we would refer them probably down to IMC to those [00:23:05] people who are there who are also phenomenal. Yeah. We really have a good group. Um, and so [00:23:10] tissue-based means using the patient's own tissue to reconstruct a breast mound, and the most [00:23:15] common one is called a D-I-E-P flap. It's also referred to as DIEP or free [00:23:20] flap, all kind of the same thing. Mm-hmm. And basically skin and tissue is taken [00:23:25] from the abdomen, attached to a bl- A vein and an artery, and then that's brought [00:23:30] up to the chest and attached to a vein and an artery in the chest. And so it receives blood [00:23:35] supply and, and should survive and things. The p- pro to that is that it's your own tissue, [00:23:40] shouldn't need to be replaced down the road, but, um, the recovery is just a little bit [00:23:45] more because you're recovering from the incision in the abdomen as well, so. Bree Allred: Yeah. [00:23:50] Um, and then I know in some instances, especially if there's radiated tissue, sometimes they'll take a [00:23:55] flap from the back, right? And can bring that forward.  Whitney Collins : It's actually a latissimus flap. Oh, okay. Yeah. And so [00:24:00] it's your latissimus muscle and they kind of rotate it around. Yeah. That tends to be kind [00:24:05] of a last resort if the implant-based or tissue-based reconstruction options [00:24:10] have failed, so. Bree Allred: So it's not a first line. No, it's a big- But usually you're gonna be looking... And when we're [00:24:15] talking about kind of using your own tissue-  Whitney Collins : Mm-hmm ... Bree Allred: some of it is you have to have adequate fat reserves [00:24:20] in your belly to be able... So if you're tinier going into it- Mm-hmm ... you may not have enough [00:24:25] adequate reserves or fat reserves in your own body to be able to use.  Whitney Collins : Yes, absolutely. [00:24:30] Or I'll have patients say they've been thinking about an abdominoplasty, and then it just is a, a nice [00:24:35] way to do both. Yeah. You know? So there's, there's pros and cons too. Bree Allred: Yeah, for sure. And you're [00:24:40] recovering from another site of surgery- Mm-hmm ... amidst who knows what your treatment things are [00:24:45] happening here. Yes. Although by the time they're getting to reconstruction, most women are [00:24:50] through kind of chemotherapy treatments, or are they still ongoing? Kind of at what point you're like, "Okay, [00:24:55] we're waiting three months in between at least with a tissue expander," right? Kind of what point are people [00:25:00] choosing to do these surgeries? Are they still undergoing treatments? At what point do they choose to do them?  Whitney Collins : Usually [00:25:05] still undergoing treatments- Okay actually. We get involved right away, um, and that's for immediate [00:25:10] reconstruction. Mm-hmm. Um, and so immediate reconstruction is done at the time of mastectomy, and [00:25:15] typically the tissue expander is placed, and then three months later the final implant is placed. Um, and [00:25:20] so sometimes that final implant surgery is delayed due to radiation or chemo treatment that's [00:25:25] needed. And so I think that's one thing that surprises a lot of women is just how long the [00:25:30] process can take. Mm-hmm. Um, and so just keeping that in mind that there are [00:25:35] things that could delay things. Bree Allred: Yeah. So. Based on how your body's handling everything.  Whitney Collins : Yes. Bree Allred: Yeah. [00:25:40] Then there's certain types of chemo that we're like, "We're gonna make sure you're through this chemo before we're going to [00:25:45] be doing any surgery." Yes. Allow your tissues to be able to rejuvenate and heal and-  Whitney Collins : Yeah ... do what they [00:25:50] need to. We want my patient to have the strength to undergo a s- you know, safely- Yeah ... another [00:25:55] surgery, so. Bree Allred: Yeah. Yeah, okay. Is there anything else we need to talk about from-  Whitney Collins : Yes ... [00:26:00] reconstruction standpoint? When I said, when I said abdominoplasty, I just wanna make it clear, you're not getting a full [00:26:05] abdominoplasty. It's just similar- Yeah ... 'cause you're removing the tissue, so. Yeah. Just wanted to make sure. It's Bree Allred: not the same [00:26:10] thing. Yeah, not the same thing. You're like, "Oh, I'm gonna get a tummy tuck at the same time." But  Whitney Collins : it does remove some tissue- Yeah ... so it's, [00:26:15] uh, similar Bree Allred: Very neat. And then along those processes, I just know for [00:26:20] me, like we did some fat grafting around my implant. Mm-hmm. I did a, a silicone implant, and we did [00:26:25] some fat grafting around the implant and, um, to make it to where it- wasn't [00:26:30] just a circle- Yeah ... underneath my skin, but had a little bit more of those gradual edges- [00:26:35] Mm-hmm ... um, for filling things in there. And, uh, people can do repeat surgeries that [00:26:40] way to where it's like, "Okay, we need some fat dyed here. We need to maybe replace it." We're maybe not [00:26:45] happy with contouring or things that way. So that can be another part of the process of like, okay, how many [00:26:50] fat grafts are we undergoing?  Whitney Collins : Mm-hmm. Bree Allred: How many, da-da, and then waiting for that to heal and seeing, okay, [00:26:55] do we need to do another? Would we like to do another?  Whitney Collins : Yes. So the first fat grafting that we do [00:27:00] is at that stage where the final implant is placed. Mm-hmm. Where the tissue expander comes out and the [00:27:05] implant goes in, typically they'll do some fat grafting at the time. And then [00:27:10] something cool to know is that each time you add a layer of fat in there, the next time you do some fat [00:27:15] grafting you can add a little bit more 'cause there's a little bit more space, so. Bree Allred: Interesting.  Whitney Collins : Yeah. Bree Allred: Okay. [00:27:20] Some good kind of little tidbits- Mm-hmm ... that are kind of fun. Um, fat grafting is typically done through [00:27:25] liposuction.  Whitney Collins : Yes. Bree Allred: And so I will say my experience there, I did have some fat [00:27:30] grafting, um, just circumstantially I chose to only do it once, uh, with that original [00:27:35] reconstruction surgery. That was the most sore part for me- Yes ... of my recovery was the, the [00:27:40] liposuction. Yeah.  Whitney Collins : It is. Bree Allred: Yeah. Yeah. And then again, some more mental side of [00:27:45] things, um, the way Dr. Isom had me, my surgeries done two and a half years ago now, [00:27:50] my most recent one- Mm-hmm ... um, but I was bandaged, da-da-ding, right after- Mm-hmm that first surgery. And it, so I [00:27:55] remember like coming in for my first visit like, "Okay, what we gonna see down here?" Yeah. "How's it all gonna [00:28:00] look?" And that was kind of another little mental game. Mm-hmm. Just a bit of like, okay, what's my [00:28:05] tummy gonna look like? What's my boobs gonna look like after all of this? And-  Whitney Collins : Yeah. Bree Allred: Yeah.  Whitney Collins : Yeah, [00:28:10] so liposuction, typically we're going, we're gonna have you do compression for about six weeks [00:28:15] afterward. Yes. And so the liposuction areas are by far the most painful part [00:28:20] of the whole thing. Your breasts are not nearly as- Yeah ... painful as you would probably say so as well. [00:28:25] And so, um, yeah, just knowing that you'll have some compression garments on for about six weeks, [00:28:30] that can get a little annoying, but most people tolerate it quite well. Bree Allred: Yeah. I ended up, and [00:28:35] I don't know if you guys have recommendations, but I ended up going through several different [00:28:40] compression garments to find ones that I liked after surgery. And on my Instagram, I actually have a little [00:28:45] highlight level of like- Oh, good ... my post-mastectomy and I did a, like a review on my, on the compression garments and [00:28:50] which ones were most comfortable, which ones didn't work as well for me. Um, things that I liked. [00:28:55] Da-da, I didn't love a lot of seams in them. Like a lot of them will have kind of crisscross seams [00:29:00] to help kind of create a little bit more compression, but those were uncomfortable for me. I preferred more [00:29:05] what was smooth and, than other ones that's like, okay, this band was really tight at the top. I didn't love [00:29:10] that. Mm-hmm. So just some reviews on there that's kind of fun to look at.  Whitney Collins : And that, you bring up a good point. We don't [00:29:15] want any creases or lines or anything 'cause if there are like [00:29:20] creases and it sits there for a long time, you could have a contour irregularity, so you do want it to be as [00:29:25] smooth as possible Bree Allred: Yeah. So there's some good recommendations That's cool. That's awesome. Yeah. You get to be [00:29:30] kind of a unique piece in this healing process, surgery process [00:29:35] because you're seeing patients a lot for first visits. Mm-hmm. You're seeing them a lot for their post-op [00:29:40] visits. Mm-hmm. Um, what types of emotional things have you seen in your patients that [00:29:45] come up?  Whitney Collins : All types, and honestly, that truly, like, is what [00:29:50] I love about my job. I love being there for the patients, um, and [00:29:55] it's a safe place. I want them to know that when they're in with me, they can cry, they can feel [00:30:00] all the emotions. I'll talk with them through whatever I can. Yeah. But yeah, there's a whole range of [00:30:05] emotions. It comes, obviously as you know, with grief, and those stages of grief are gonna repeat [00:30:10] and wax and wane, and you go through them a lot. Um, I always thought of grief [00:30:15] as just a one-time thing- Yes, so, yeah ... and you go through this stage, this stage, this stage. But it's just you jump [00:30:20] from one to another, and it can be any time, any day, and repeat. So it [00:30:25] is a wa- a range of emotions, but, um- ' Bree Allred: Cause you guys are often there for the first look [00:30:30] too- Mm-hmm ... right? The first time that you're seeing yourself afterwards. Sometimes. Depending on-  Whitney Collins : Yeah ... Bree Allred: I don't know if they've left bandages [00:30:35] on or-  Whitney Collins : Yeah, and depending on- Yeah ... the surgeon and the bandages and things that are there, yes, Bree Allred: sometimes. Yeah, to [00:30:40] be able to see what things look like. I know that was a big thing for me right after. Um, there [00:30:45] was a mourning process 'cause it's like you are amputating a part of your body. Yeah. For a good [00:30:50] reason. It was trying to kill me.  Whitney Collins : Yes. Bree Allred: But it was still that emotion of it, of like, [00:30:55] "Am I still gonna feel like me?"  Whitney Collins : Mm-hmm. Bree Allred: And the breast tissue is very tied to femininity- [00:31:00] Mm-hmm ... and motherhood, and do you know what I mean? Life and different things that way. Um, it's very tied [00:31:05] to our sexualal- sexuality- Mm-hmm ... sexual responses. Um, so it was definitely an [00:31:10] interesting ride as you navigate all of those emotions and-  Whitney Collins : Yeah Bree Allred: for me, after my first [00:31:15] surgery, um, I remember looking down, I'm like, "Oh, good, my nipple's still there." Like, it was just, it [00:31:20] just made it be like it still looked like me, even though it wasn't, right? That underneath it was [00:31:25] completely a tissue expander.  Whitney Collins : Yeah. Bree Allred: But seeing my nipple there, I was very grateful after that first [00:31:30] surgery to still be able to have it. My second surgery, I did a reduction on [00:31:35] my breast that had grown a cup size bigger, and so in order to get a good outcome [00:31:40] there, we actually did take the nipple tissue. And so it was an interesting experience there. [00:31:45] Um, I wasn't as emotionally tied. I don't know, because it may have been 10 years removed, and it's like, "Good [00:31:50] job, you served me well-" Mm-hmm "and I'm ready to get rid of you now." But it was not as much of an emotionally [00:31:55] charged thing for me to be like, "Oh," like, "the nipple's gone," and it's fine. Yeah. But it was still an [00:32:00] interesting thing, and we'll talk about this in a later episode, but when I did have my nipple tattooed back [00:32:05] on-  Whitney Collins : Mm-hmm ... Bree Allred: it still felt, it was like, "Oh, now I'm whole." Yes. Like, there was that restoration of [00:32:10] like, "Okay, I'm me again."  Whitney Collins : Yeah. Yeah. Bree Allred: So it's interesting. 'Cause that's a real  Whitney Collins : loss. Yeah. You know? It [00:32:15] is a loss, and so I think people need to give themselves grace and, and [00:32:20] feel the emotions that they need to feel, and that's why I think therapy is so important. Yeah. Bree Allred: Okay, let's talk just a [00:32:25] little bit about the process afterwards. We talked a little bit to where it's like okay, for the first two weeks- You're gonna wanna [00:32:30] take it pretty easy.  Whitney Collins : Mm-hmm. Bree Allred: Um, generally pain control, what kind of [00:32:35] medications or pain control can people expect?  Whitney Collins : Yeah. Um, our [00:32:40] doctors, I, I talk them up a lot- 'cause I really think they're incredible. But they both actually do [00:32:45] nerve blocks as part of the surgery, and not every surgeon will do that. So you typically get one [00:32:50] to three days of some good pain relief initially. Um, and then some people [00:32:55] can just get away with ibuprofen and Tylenol, but, you know, pain tolerance is very [00:33:00] different in people, and so some people do need some narcotic pain medications initially, and, [00:33:05] um, as soon as they're off narcotics they can drive and- Yeah and things. But, um, [00:33:10] hard, hard to say exactly what to expect because everyone's Bree Allred: so different. Everybody's so individual. [00:33:15] Yeah.  Whitney Collins : Yes. But yeah, it's, it's manageable. Bree Allred: Yeah. See, um, like I said, mine was not too [00:33:20] bad. Um, I did have some pain after my second surgery, mostly just because [00:33:25] kind of standard procedure- Mm-hmm I guess, was a little bit different [00:33:30] from the time I went through 10 years earlier to where we initially thought that putting the pec muscle over top of [00:33:35] the implant- Yes ... do you know what I mean? Would be- Yes ... beneficial. And so my first surgery, um, my [00:33:40] pec, pec muscle was actually over top of my implant, and the second surgery we actually decided to go [00:33:45] back because I didn't love it. Any time I'd pick something up my pec muscle would activate, and it would pull my breast tissue away [00:33:50] from the swimsuit or whatever I was- Mm-hmm ... wearing, and I'm like, "I'm giving everybody a show, but all I did was just pick something [00:33:55] up." Um, so that was something for me that was interesting my second surgery, is just how [00:34:00] sore my pec muscle was from it being maneuvered and changed- Yes in different ways. But-  Whitney Collins : Yes [00:34:05] Bree Allred: I don't remember that being the case. Do you know what I mean? On actually my, [00:34:10] my just first side that was just having the general mastectomy done on it.  Whitney Collins : Yeah, and we [00:34:15] do all of the reconstruction above the muscle now. Yeah. That was something that they did in the past, [00:34:20] but we do not do that now. Bree Allred: No. I think they found probably complaints similar to what I have of-  Whitney Collins : Yeah ... Bree Allred: [00:34:25] and they determined that it's not as necessary. Initially I think they were thinking it would protect the skin layers a little bit [00:34:30] more from the implant. But yeah, so just some unique things there. [00:34:35] Um, is it still pretty standard to have people stay overnight?  Whitney Collins : Yes. After the mastectomy [00:34:40] surgery, you always stay one night. Um, and then after any subsequent surgeries [00:34:45] that we do, you get to go home the same day. Bree Allred: So outpatient there. So- Yeah ... if you're choosing a mastectomy, that's [00:34:50] kind of one of those- Standards ... standard protocols is that you'll be staying the night in the hospital. I think a lot of it's just making sure, [00:34:55] like, did everything go well?  Whitney Collins : Mm-hmm. Bree Allred: It's usually a pretty decent length of time [00:35:00] surgery, so making sure you come out of anesthesia well. Yes.  Whitney Collins : Um, all of that. Making sure pain's controlled, all those Bree Allred: things. [00:35:05] Yes. Yep. So first two weeks after surgery, mitigating pain- Mm-hmm resting, recovering, [00:35:10] walking, maybe limiting exer- well, for sure limiting- Yes ... exercise and getting your heart rate [00:35:15] up. Um, after those two weeks- Yeah ... then what then can people expect?  Whitney Collins : You [00:35:20] can start to get back into cardio type activities. Um, I'm a big fan of weight training, so you [00:35:25] could probably start to weight train some of your lower body. Bree Allred: Mm-hmm.  Whitney Collins : But I wouldn't do any upper body for at [00:35:30] least four to six weeks, depending on the surgeon, depending on what was done, things like that. Bree Allred: [00:35:35] Yeah. Yeah. So they'll give you recommendations- Mm-hmm ... 'cause they want... There are- [00:35:40] This is a distinction I think I make in the therapy world a lot, that it's like there is biology- Mm-hmm and we can't [00:35:45] speed up how quickly tissue heals. Right. And so that's where it's like we generally get lifting restrictions for about [00:35:50] six weeks afterwards because that's where we get good muscle and tissue healing and recovery that it can [00:35:55] withstand having some pressures and pulls on it in different directions.  Whitney Collins : Yeah. So six- Six weeks is kind of [00:36:00] the magic number- Bree Allred: Yeah ...  Whitney Collins : where people start to feel more like themselves. Bree Allred: Yeah. And it's, you're just- [00:36:05] because your tissues are healing- Yes ... and that biology is there. So even if you do amazing and you're feeling [00:36:10] great, it's like we're still relying on biology to do its work- Right and the healing times to do what they [00:36:15] need to do. Um, from a rehab standpoint, we'll do a further visit on this later, but [00:36:20] I remember for me, it's like I just started even, like, putting a little bit of pressure just, like, on all [00:36:25] fours, right? Mm-hmm. And seeing, like, okay, how do we do? And getting some movement happening just a little bit.[00:36:30] Um, around two weeks, depending on how healing is going, we may start some gentle [00:36:35] range of motion stuff as well. Yeah. Right? Most definitely. Moving your arms overhead, and we're not lifting or putting a [00:36:40] lot of pressure, but we're just starting to get some mobility happening and some use there so that we're not getting things tighten [00:36:45] up-  Whitney Collins : Yes too Bree Allred: much- Yes ... that we're losing range of motion there,  Whitney Collins : so. And the general surgeon's typically gonna give [00:36:50] you some restrictions with that. We tend to say that you can start moving things body weight- [00:36:55] Mm-hmm ... right away. Um, and then yeah, you can get a little more into it after two weeks and- Bree Allred: Yeah. [00:37:00] So where it's just you kind of progressively increase. And I really do feel that most of the time people around [00:37:05] six weeks afterwards are feeling pretty good.  Whitney Collins : Pretty good, yeah. Bree Allred: They're not really feeling like they have to limit [00:37:10] things generally. Um, there can be some other random things that start to [00:37:15] happen, whether it's lymphedema or cording or different things based on if lymph nodes were [00:37:20] involved with things and how extensive surgery was for having to chase cancer cells and whatnot. [00:37:25] Yeah. So if there's some point where maybe somebody's struggling with [00:37:30] healing or we're needing to delay options, like, what would lead to that?  Whitney Collins : Yeah. So we [00:37:35] talked about immediate reconstruction, placing the tissue expander at the time of the mastectomy. But in some [00:37:40] cases we need to delay the reconstruction, meaning the patient would just undergo the [00:37:45] mastectomy, heal from that, and then six months to a year down the road we could then start the reconstruction [00:37:50] process, and things that would delay it would be, um, if a patient has an autoimmune [00:37:55] condition or they have a higher BMI or things that would hinder their healing.[00:38:00] Bree Allred: Mm-hmm.  Whitney Collins : And so we do that just- We want the surgery to be as safe for the patient [00:38:05] as possible and for them to heal as well as possible. So in those cases, we would delay it. Bree Allred: Do you feel like [00:38:10] recovery is a little bit harder as you go into a delayed reconstruction?  Whitney Collins : Not necessarily. Okay. [00:38:15] Bree Allred: No,  Whitney Collins : the tissue, if you do go flat with a mastectomy, which is a perfectly reasonable [00:38:20] option, um, and in the delayed case you would be flat initially, the tissue [00:38:25] expander is just gonna have to expand maybe a little slower than it maybe would- So they Bree Allred: still place the tissue [00:38:30] expander- Mm-hmm it's just you're stretching things slower?  Whitney Collins : Yes. Bree Allred: Okay. Do they put the tissue expander in right after [00:38:35] or is it like you put the tissue expander in after that six months to a year?  Whitney Collins : Yeah, that's our first [00:38:40] surgery that we do after they've healed from the mastectomy. Okay. Okay. So the mastectomy happens, [00:38:45] nothing's placed in, the patient just heals, and then- Bree Allred: And then you start that whole process- [00:38:50] Mm-hmm a year, six months to a year later?  Whitney Collins : Yeah. Bree Allred: Okay.  Whitney Collins : Depending on how the patient's doing. Bree Allred: [00:38:55] Yeah. Let's talk possible complications.  Whitney Collins : Yeah. Bree Allred: So just things that [00:39:00] it's like, not that these go wrong or things happen very often, but what are some [00:39:05] possible complications?  Whitney Collins : Obviously the most common thing and the thing that we worry the [00:39:10] most about is infection and wound healing problems because, like I said, when you're removing all of that [00:39:15] breast tissue, it's removing the blood supply that would heal- Bring Bree Allred: all the  Whitney Collins : healing and the [00:39:20] good, the food- Yes Bree Allred: to that area ... to the  Whitney Collins : outside skin. Yeah. Yeah, and so removing that [00:39:25] puts you at a little higher risk. So there's a lot of things that we do to mitigate that. [00:39:30] Um, we do Antibiotics at the time of the surgery, antibiotics [00:39:35] after the surgery. They're actually using antibiotic beads as part of the surgery, so they're these cool [00:39:40] beads that slowly release some antibiotics for about two months after the surgery. So they're doing that, [00:39:45] and that has greatly reduced infection. Um, we do a wash and an [00:39:50] ointment in your nose before, and that also reduces the risk. And so there's lots of things that we're gonna [00:39:55] do from our perspective, but things that the patient can do to reduce the risk of infection, [00:40:00] um, it sounds interesting, but protein actually, protein helps you heal. And so [00:40:05] I always encourage patients to increase their protein intake prior and after surgery. [00:40:10] Um, and then an active lifestyle can really help. It helps prepare [00:40:15] the heart and lungs for surgery. It really does make the healing process a lot easier. [00:40:20] So, um, as much as you can get out and do beforehand, not only will it help your [00:40:25] mental health, but it will help you physically heal. Bree Allred: So great. Um, if there [00:40:30] is complications with wound healing, meaning, do you know what I mean, things are not coming [00:40:35] together the way that we want them to- Yeah ... there's something interfering with those two ends of a surgical site [00:40:40] coming together and, and healing into a beautiful scar.  Whitney Collins : Mm-hmm. Yeah, [00:40:45] um, different options for different cases, right? Sometimes they can cut out the part [00:40:50] of the tissue that's not surviving and try to salvage it. Bree Allred: Mm-hmm.  Whitney Collins : Um, sometimes they can [00:40:55] insert some cleaning solution in there and try to salvage it. But [00:41:00] if ultimately the implant or the tissue flap fails, and the flap would fail if the blood supply doesn't [00:41:05] reestablish, then you look at starting over or doing a latissimus flap or [00:41:10] things like that. Bree Allred: Yeah. Look at the options, and there may be some wound healing, wound care type [00:41:15] of stuff. Mm-hmm. Hyperbaric oxygen. Yeah. Those are always treatments opti- treatment options- Yes ... to help [00:41:20] with wound healing as well.  Whitney Collins : Yes. So. Bree Allred: So for people that are in an intimate [00:41:25] relationship, let's talk about the effect that this may have on their partners, or maybe what do you wish [00:41:30] somebody's partner knew With, you know, maybe your patient that's going through, they [00:41:35] have a spouse, they have, you know, a significant other that's coming in with them, what do you wish that they knew from a [00:41:40] support aspect?  Whitney Collins : Yeah. I always encourage the partner to be there when we [00:41:45] have the discussion about everything, all the options, because it's so much to take in. Bree Allred: [00:41:50] Mm-hmm.  Whitney Collins : And when you're overwhelmed with the diagnosis and you're feeling all the emotions, [00:41:55] retention, you know, may not be- Is not the best. Yeah. And so little tips, I, I think [00:42:00] that having a partner there, I think writing down questions that you might have before coming in is really [00:42:05] helpful. Yeah. And then you can always ask the provider if it's okay if you record the session. [00:42:10] I'm always okay with that. I touched the mic. Okay. And I'm always okay if [00:42:15] patients ask me if they record it. I think that helps a lot. Um, so what I wish partners [00:42:20] knew is just how emotional this is going to be [00:42:25] in addition to how hard physically it is. Bree Allred: Yeah.  Whitney Collins : And just to give them some grace [00:42:30] with that. Yeah. And just be as helpful and a- as loving and supportive as possible. Bree Allred: Yeah. [00:42:35] And I do say, this was my experience, um, I wanted my husband's [00:42:40] input. You know, when we were talking about like, well, what should these look like? And I'm not saying that you should defer to [00:42:45] your partner- Yeah to that by any means, but I'm like, "Yes, this is my body and I'll make the, the final [00:42:50] decision," but I'm also like, "What do you think?" Like- My body is mine, [00:42:55] and I'm choosing to share it with you, and I'd like your inputs- Yeah ... on what's happening a little bit as well. Yes. [00:43:00] And so that was helpful for me. Um, but it might be worth a discussion with your significant other.[00:43:05] Mm-hmm. Of like, would you like my input on this, or would you rather that I just, do you know what I mean, let you [00:43:10] make all the decisions here based on those comfort levels? 'Cause for me, my husband was nervous [00:43:15] to kind of state an opinion. Mm-hmm. But I was... I'm like, I am so decision fatigued- [00:43:20] Yeah ... that I'm like, I want somebody to kind of help me make this decision a little bit, and it was very helpful.[00:43:25] And just those ideas of like, I think this is what I want. What do you think about that? And having another person's [00:43:30] opinion with it was really, really helpful.  Whitney Collins : Yeah, 'cause it's support. Yeah. And I think in this case, any support is helpful. [00:43:35] Yeah. Bree Allred: And sometimes it is good to be like, what kind of support do you want here? Do you want my opinion- Yes ... on what they look [00:43:40] like? Yes. Do you want me to just, do you know what I mean, being like, no, I really think you've got [00:43:45] this and you're doing good? Yes. And whatever makes you happy makes me happy. Yes. A little bit there, but just that [00:43:50] little bit of understanding.  Whitney Collins : Yeah, absolutely. More, more guidance on support is always [00:43:55] helpful. Yeah. Especially with men. Bree Allred: Yes. I agree. From my experience, you do know that you can repeat [00:44:00] these things.  Whitney Collins : Mm-hmm. Bree Allred: Um, but what kind of maintenance is [00:44:05] required or encouraged when we're talking about, specifically, I, we could kind of go [00:44:10] with tissue-based reconstruction or implant-based reconstruction. Yeah. Like, what can people expect as far as like [00:44:15] follow-up? Do I need to get them switched out? Is there things that I should be watching for or [00:44:20] concerned about?  Whitney Collins : Yeah. And where we don't do tissue-based in our clinic, I won't know [00:44:25] exactly the- Yeah ... ins and outs of everything they recommend- Yes ... as follow-up, so [00:44:30] take it with a grain- Kind of defer to your provider Yeah, defer to your provider. Yes. Yes. But I think that once they've had the [00:44:35] blood supply reestablish into the flap and it's pretty solid, I don't think there's much maintenance that [00:44:40] needs to be done. Certainly they can come back for like touch-ups with fat grafting or things like that like we [00:44:45] do with others, but yeah, stuff, I think that's mostly what they would be following up [00:44:50] on. Great. And then with the implant, um- Implant companies say they don't [00:44:55] need to be replaced unless there's a problem with the implant such as a leak or rupture, or [00:45:00] maybe the capsule around the implant gets hard or firm. Um, so maintenance, [00:45:05] they just recommend that after they're placed, five years later you get an MRI, and then just [00:45:10] every so often you get them checked. Um, but you can also just check them if there's [00:45:15] a change or an issue that you notice. A Bree Allred: concern that  Whitney Collins : you Bree Allred: have. Yeah.  Whitney Collins : Um, Bree Allred: if we were [00:45:20] concerned about a leak-  Whitney Collins : Mm-hmm ... Bree Allred: w-  Whitney Collins : or a rupture- Bree Allred: Mm-hmm ... to, what would we be watching for? What [00:45:25] is maybe, like, some signs or symptoms or a red flag of that?  Whitney Collins : Yeah. Well, using silicone it's, [00:45:30] it's not going to deflate like it would the saline. Um, so symptoms that you could [00:45:35] watch for is just a thickening of the tissue around the implant, and that's a pretty good indicator that [00:45:40] something could be different in there. Oh, wow. Yeah, and it's not an emergent situation. It's not [00:45:45] dangerous for it to happen, um, but it is just something that would need to be replaced. Okay. Bree Allred: So looking for [00:45:50] firmness around the tissue- Mm-hmm ... is really around the breast tissue.  Whitney Collins : Yeah, and but MRIs, [00:45:55] um, and ultrasounds can certainly detect it. Bree Allred: Let's do some myth busters. Okay. Okay. So just kind [00:46:00] of, like, is it true or false? And if you want to expand on it, you can, but we don't have to.  Whitney Collins : Okay. Bree Allred: [00:46:05] Um, breast reconstruction is basically an augmen- augmentation.  Whitney Collins : I feel like that's a [00:46:10] myth. Yeah, there's so many different ways to reconstruct a breast that it [00:46:15] really isn't like a breast aug, and you have none of your tissue there, and so it's, it's [00:46:20] different. Bree Allred: Yeah. Yeah. Um, I have to decide about reconstruction immediately. [00:46:25]  Whitney Collins : A myth in a way. Um, I don't feel like you have [00:46:30] to decide immediately, but doing an immediate reconstruction can save you a [00:46:35] surgery, you know, down the road. And so that's why I think it's so important for plastic [00:46:40] surgery to get involved as soon as possible- Early on ... because, like I said, you're [00:46:45] taking in so much information. You're meeting with general surgery, oncology, plastic surgery, [00:46:50] and just having all of that information really helps people decide. So, so yeah. Bree Allred: A little [00:46:55] easier if you choose to do it earlier on- Earlier on, yeah ... but you can always change your mind.  Whitney Collins : [00:47:00] Absolutely. Yeah. Yeah. Bree Allred: Um, reconstruction will make my breasts look exactly like they [00:47:05] were before cancer. Myth. Yeah.  Whitney Collins : They'll never be the same, and I think that's [00:47:10] what's so hard with, like, the loss and the Bree Allred: grief and the mourning process. They're never gonna look like they did, [00:47:15] but they can look quite good. Yeah.  Whitney Collins : Um, something that I would maybe recommend to patients [00:47:20] if they're feeling like they're in a healthy enough mental space is maybe to Google [00:47:25] post-operative images of breast reconstruction patients, and if they feel [00:47:30] up to looking at that, I think it's really helpful to have a realistic expectation, 'cause [00:47:35] expectations are really what let us down- Yeah and make it harder. And so having a realistic [00:47:40] expectation going in of what it probably will look like or could look like is helpful. Bree Allred: Yeah. [00:47:45] Um, if the cancer is gone, I should just be happy and move on. [00:47:50] Uh, myth. I, I don't believe in that. I, I know that a lot of women [00:47:55] feel  Whitney Collins : guilty, you know, in this case of like, "Okay, well I'm, [00:48:00] I'm cancer-free so I shouldn't complain." But a- again, it's still a loss. You're still [00:48:05] grieving, and you're still probably going through treatment. Bree Allred: Mm-hmm.  Whitney Collins : And so I don't think it's a just [00:48:10] be happy thing. Yeah. I think you are entitled to your feelings, and they're all [00:48:15] valid. Bree Allred: Yeah. And then you choose what you do with them.  Whitney Collins : Right. Yeah. I think so. That's great. [00:48:20] Bree Allred: Um, once surgery heals, recovery is finished.  Whitney Collins : Myth. [00:48:25] Yeah, I think that recovery is all-encompassing. We want whole [00:48:30] body wellness, right? Mm-hmm. Mind, body, everything, and that can take some time. And I think [00:48:35] physical therapy's a good way to, to get back to your normal self, and again, [00:48:40] therapy. Yeah. It sounds like I'm just a big therapist - Bree Allred: But it goes back- But- ... to the like it's a [00:48:45] bio-psychosocial approach It really is ... it's like w- how we're interacting with our family and our friends, it's how our mental health is [00:48:50] doing, and it's how our biology and physical self is doing.  Whitney Collins : Absolutely. So I think recovery's a, a long- [00:48:55] a longer term thing. Bree Allred: Yeah. I agree. And then even just from a tissue healing, it's been [00:49:00] interesting as I've gone through my own recovery journey, um, a little bit older this time, I was in [00:49:05] my 40s when I had my second reconstruction, and there are still times when I'll feel some scar [00:49:10] tissue, then I kind of go through another healing process and hug down and have to go through and be like, "Okay, I gotta do [00:49:15] my rehab exercises a little bit more right now." Mm-hmm. Because I feel those changes there. And our [00:49:20] bodies do change. Like, I definitely notice like my ribcage mobility was different- Mm ... after [00:49:25] having a lot of reconstruction- Yeah ... and, and surgeries there. So I'm like there is some lifelong healing just [00:49:30] from a physical side that keeps- Yeah ... happening and growing as well.  Whitney Collins : And even just recovery from surgery [00:49:35] itself, you d- typically don't see your final result until you're about a year out from surgery, 'cause [00:49:40] that's how long it takes for scar tissue to soften and everything to settle. And so, I [00:49:45] mean, even just the physical aspect- Yeah ... is quite long as well, and so. Bree Allred: What do you wish [00:49:50] every woman facing a mastectomy knew as she walked into surgery?  Whitney Collins : It [00:49:55] sounds kinda corny, but I do wish that every woman knew that she's not alone, that she [00:50:00] has a big support system around her even if she doesn't have, you know, the family [00:50:05] support that she might want. She has general surgery, oncology, us, and [00:50:10] we're absolutely there to support her and help her through this. Bree Allred: Yeah.  Whitney Collins : So. Bree Allred: You're an [00:50:15] advocate for them as well.  Whitney Collins : Absolutely, yeah. Bree Allred: Uh, and I love that, and I felt that totally through my journey. Like, everybody was there [00:50:20] advocating, wanting to help me, giving me the best information that they could so that I could make a [00:50:25] decision. And I just loved it, that it's like, "Okay, these are my buddies, and they're really wise buddies." Yeah. [00:50:30] So, like, "Give me all your wisdom," and then I get to take all of that wisdom and make a final decision on my own.  Whitney Collins : Yeah, we become [00:50:35] really close friends- Yeah ... because I see them all the time. Yeah. And so, yeah, you're gonna [00:50:40] be my good friend through this. By the end of treatment. Yes. Bree Allred: Okay, what's one [00:50:45] question women almost never ask about reconstruction that you think they should?  Whitney Collins : I [00:50:50] don't know. I- we've kinda covered, like, all the options, and so I think women know now kind of [00:50:55] what to ask for, for options. Mm-hmm. But I do think that the tips I can give of, like, [00:51:00] writing down questions, having someone there potentially recording it, um, [00:51:05] I think those things are really important. And then something that I think a lot of people are surprised [00:51:10] about is insurance coverage. So I like to make sure that they know that that's- Bree Allred: Yeah ...  Whitney Collins : that [00:51:15] that's there for them and advocate for them in that way as well. Bree Allred: Yeah. And I would say just from my [00:51:20] perspective, I do think the expectation going in is huge. Like, I wish every woman knew that it's-  Whitney Collins : [00:51:25] Yes ... Bree Allred: it can be really good, and it's never gonna be the same.  Whitney Collins : Yes. Bree Allred: So that [00:51:30] idea of, like, if you're feeling comfortable looking at examples of reconstructive breasts, I think [00:51:35] can be so different and so healing and so helpful so that when you come out of [00:51:40] surgery, that your expectations will match what you're seeing on your own body. Yes. 'Cause those meta [00:51:45] expectations create a totally different experience than if you're going into it's like, "Oh, yeah, it's never gonna look [00:51:50] the same as it was before."  Whitney Collins : Absolutely, and I really try to do that with patients when they come in for [00:51:55] first-time consults. So hopefully- Bree Allred: Yeah ...  Whitney Collins : hopefully that's helpful. Bree Allred: Yeah. What would you tell the [00:52:00] woman who's terrified that she's never going to feel comfortable in her body again?  Whitney Collins : I would [00:52:05] encourage her that she will, it- and she'll get there. Um, like I said, [00:52:10] you may want to involve physical therapy and other, you [00:52:15] know, treatment options, whole body wellness. But I think eventually [00:52:20] you can feel fairly normal. Bree Allred: Yeah.  Whitney Collins : You know? Bree Allred: I always made a distinction. It was an [00:52:25] interesting thing, and I think somebody told it to me, and I was like, "Oh, I'm gonna adopt that." Mm-hmm. But it was like I went from being a [00:52:30] cancer patient to I went to being a survivor. Yes. You know? And it's that idea of like there's a new [00:52:35] identity, and I take the hard and the good and the ugly parts of it all because they're part of [00:52:40] who I am, and now I get to take that into my survivorship. Um, because there is an [00:52:45] identity somewhat that comes up, you know, as you're... And like especially with chemo, like you're bald, you're [00:52:50] wearing wigs, or you're doing... It, it changes who you are. And, and I aligned [00:52:55] with I'm a cancer patient versus now it's like, oh, I'm a survivor. Mm-hmm. And what does that mean [00:53:00] for me? Yeah. And you get to redefine what that means for you. What does successful reconstruction mean [00:53:05] to you?  Whitney Collins : That the woman feels confident in her body, [00:53:10] good about what she looks like, happy with the result, and confident. Bree Allred: [00:53:15] We really also look beyond that too, that it's like she feels informed. She felt empowered by [00:53:20] all the information that she had to make decisions. Mm-hmm. She felt she had her support staff behind her and her [00:53:25] good friends, that it's like, "Oh, I'm kind of sad to stop treatment- Yeah because I get to know you guys so well." [00:53:30] Um, she feels good in her body. She can move confidently. She's back to feeling like [00:53:35] herself a little bit more. Something I hope women take away from this discussion is that you can [00:53:40] leave a cancer diagnosis and a mastectomy surgery still feeling empowered- [00:53:45] Mm ... still feeling informed, still feeling whole and confident and like yourself [00:53:50] again. And yes, we will always forever be changed by cancer. It [00:53:55] changed your life. It's changed my life, and I don't think there's anyone that it touches that it [00:54:00] doesn't change in some way. Right. Um, so you will leave cancer a different person, [00:54:05] and you can make it better, and it can be still so whole [00:54:10] and so much like yourself, just a different version of yourself.  Whitney Collins : An empowered version of yourself. Bree Allred: [00:54:15] Yes. Yes, exactly. And I think that kind of going through the reconstruction process can be a part of [00:54:20] that journey in restoring that wholeness and healing and being able to be like, "Oh," like, "Okay, I [00:54:25] feel more like myself again." Um, it gives back somewhat what cancer has [00:54:30] taken and can be a really neat, um, aspect of the process of being able to be like, [00:54:35] "Okay, I am empowered and I'm making decisions and I'm restoring my body to what it [00:54:40] once was, a new version of what, what it once was."  Whitney Collins : So- Which is why I love my job. Bree Allred: Yes. So great. [00:54:45] Well, thanks so much for joining us today, and I hope if you are a breast cancer [00:54:50] patient or survivor or you know someone in your life that this can give you some just [00:54:55] added information, um, to empower you and help you along your journey, and know [00:55:00] that it's like it will change you, but it can make you a stronger and better version of yourself. Yeah. Thanks [00:55:05] for tuning in to this episode of Healing At Your Core. We'll catch you next time. ​[00:55:10] [00:55:15] [00:55:20] [00:55:25] [00:55:30] [00:55:35]