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drchrysopoulo
(Physician
- Surgery - Plastic
(Verified)
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| Communities: Breast Cancer | Thank You's: 8 |
| Member Since: Feb. 2011 | Questions: 1 |
| Answers: 35 |
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Professional Statement
Board certified plastic surgeon, specializing in advanced breast reconstruction including DIEP flap, stacked DIEP, SIEA flap, GAP flap, TUG flap, Alloderm one-step, and fat grafting (lipofilling).
Professional Info
Credential:
MD
Primary specialty:
Surgery - Plastic
State Licenses:
Texas
Languages:
English, Greek, French (non-fluent)
Medical school:
University College London
Residency:
University of Wisconsin, Madison, WI
Internship:
University of Texas Health Science Center, San Antonio, TX
Board certifications:
American Board of Plastic Surgery
Professional memberships:
ASPS (American Society of Plastic Surgeons), ASRM (American Society for Reconstructive Microsurgery), TSPS (Texas Society of Plastic Surgeons)
Areas of expertise:
Breast Reconstruction, Microsurgery, Cosmetic Surgery
Awards and publications:
Named one of "America's Top Surgeons"
San Antonio Business Journal "Top 40 Under Forty" Award, 2007
Strathmore’s Who’s Who Honors
Intern of the Year, General Surgery 1998-1999
First Place Winner of the ID. Ralph Millard, MD Investigator Award, Plastic Surgery Education Foundations (PSEF) Scholarship Contest (1998).
For publications: http://www.prma-enhance.com/index.cfm/PageID/3536
Named one of "America's Top Surgeons"
San Antonio Business Journal "Top 40 Under Forty" Award, 2007
Strathmore’s Who’s Who Honors
Intern of the Year, General Surgery 1998-1999
First Place Winner of the ID. Ralph Millard, MD Investigator Award, Plastic Surgery Education Foundations (PSEF) Scholarship Contest (1998).
For publications: http://www.prma-enhance.com/index.cfm/PageID/3536
Hospital affiliation:
Methodist Hospital
Practice name:
PRMA Plastic Surgery
Practice address:
9635 Huebner Rd
San Antonio, TX
78240
Practice phone number:
(800) 692-5565
Webpage:
http://www.PRMA-enhance.com
Twitter
http://twitter.com/mchrysopoulo
drchrysopoulo Activities
Preferably immediately after diagnosis. I feel it is very important for patients to learn about all their breast cancer treatment options, including breast reconstruction, at the very beginning of their journey. This is the only way to ensure they are truly involved in their treatment plan. It also allows those patients interested in immediate breast reconstruction to pursue it if they are candidates. For those that may not be candidates, knowing they will have the option once all their other breast cancer treatment is completed is often a huge source of strength.
Dr C
http://www.PRMA-enhance.com
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Cancer Patient Decisions, Determine Treatment Plan Options, Breast Reconstruction Timing, Breast Cancer, Breast Cancer Treatment Options, Breast Reconstruction Options, Breast Cancer Treatment Plan, Breast Cancer Treatment, Breast Reconstruction
1
Answer |
13 days ago
Please research all your options yourself, not just the ones presented to you by your physician(s). Just because your surgeon doesn't offer you a certain procedure, doesn't mean you're not a candidate. Unfortunately, some patients will have to travel for the procedure they feel most comfortable pursuing.
Dr C
http://www.PRMA-enhance.com
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
1
Answer |
13 days ago
Women that have had a previous TRAM flap, tummy tuck or very extensive abdominal wall surgeries (like complex repairs of huge hernias) cannot have a DIEP or SIEA flap reconstruction because the lower tummy tissue that is needed has already been removed, disconnected or moved around.
Having said that, most of the time previous abdominal surgery really isn't an issue.
Many women these days have had a previous c-section or hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery but this is rare. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having the procedure.
If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to examine the anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram.
While previous abdominal surgeries may not prevent DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and even hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery.
Some medical issues can make any form of microsurgical breast reconstruction (including the DIEP flap) more difficult and also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
Having said that, most of the time previous abdominal surgery really isn't an issue.
Many women these days have had a previous c-section or hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery but this is rare. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having the procedure.
If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to examine the anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram.
While previous abdominal surgeries may not prevent DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and even hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery.
Some medical issues can make any form of microsurgical breast reconstruction (including the DIEP flap) more difficult and also increase the risk of complications like flap loss. These include disorders that make the blood clot more easily (eg Factor V Leiden).
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) DIEP Flap Reconstruction Exclusion Criteria, Breast Cancer Surgery, Breast Cancer Treatment Options, DIEP Flap Reconstruction Eligibility, Breast Cancer Surgery Options, DIEP Flap Contraindications, DIEP Flap, DIEP Flap Breast Reconstruction
1
Answer |
13 days ago
This can vary based on the doctor and facility. At PRMA, follow up after DIEP flap surgery typically includes:
- 7-14 days after surgery for drain removal (usually 2 separate visits)
- 6 weeks after surgery to plan the next reconstructive stage (stage 2)
- pre-op visit 2 weeks before stage 2
Dr C
http://www.PRMA-enhance.com
- 7-14 days after surgery for drain removal (usually 2 separate visits)
- 6 weeks after surgery to plan the next reconstructive stage (stage 2)
- pre-op visit 2 weeks before stage 2
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
1
Answer |
13 days ago
No, breast reconstruction does not typically interfere with breast cancer treatment. Patients that are candidates for immediate reconstruction (reconstruction at the same time as mastectomy) proceed with the remaining recommended cancer treatment once they have healed from the mastectomy and reconstruction (usually about 4 weeks). That healing time is generally the same whether you have mastectomy alone or mastectomy and reconstruction.
A small percentage of patients develop wound healing problems after surgery and need slightly longer to heal. In these situations, it can take a little longer to start chemotherapy (if chemo is needed). Again, this situation can arise regardless of whether the patient is having reconstruction.
Patients that have delayed breast reconstruction (ie reconstruction some time after the mastectomy), complete all their breast cancer treatment prior to the reconstruction.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
A small percentage of patients develop wound healing problems after surgery and need slightly longer to heal. In these situations, it can take a little longer to start chemotherapy (if chemo is needed). Again, this situation can arise regardless of whether the patient is having reconstruction.
Patients that have delayed breast reconstruction (ie reconstruction some time after the mastectomy), complete all their breast cancer treatment prior to the reconstruction.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
1
Answer |
13 days ago
Yes I am. We perform a lot of fat grafting in our practice for breast reconstruction.
Fat grafting is a fairly new technique in breast surgery. Fat is liposuctioned from one part of the patient's body, purified and then injected into the breast.
Fat grafting can be used to fill-in partial breast defects after lumpectomy. It is also frequently used after mastectomy, mostly in conjunction with other reconstructive techniques, to optimize the breast contour and improve overall cosmetic results.
There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, storage, and transplantation of the fat cells and the fat stem cells must be optimized to obtain the best long-lasting results. Cell-assisted lipotransfer (CAL) is one approach to fat grafting in which the stem cells are separated from the liposuctioned fat, essentially concentrated, and subsequently re-attached to the fat that is going to be re-injected.
Studies have also shown that once the injected fat "takes", it can also help improve the thickness and quality of radiation-damaged tissue and skin.
Regardless of technique, some of the injected fat will be reabsorbed over time but this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.
Several independent studies that have evaluated patients over a few years after the procedure have shown that fat grafting is safe. However, because the technique is fairly new, no long-term safety data is currently available.
Unfortunately not all insurance companies cover the cost of fat grafting so the procedure can involve out of pocket expenses for some patients.
I hope this info helps!
Dr C
http://www.PRMA-enhance.com
Fat grafting is a fairly new technique in breast surgery. Fat is liposuctioned from one part of the patient's body, purified and then injected into the breast.
Fat grafting can be used to fill-in partial breast defects after lumpectomy. It is also frequently used after mastectomy, mostly in conjunction with other reconstructive techniques, to optimize the breast contour and improve overall cosmetic results.
There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, storage, and transplantation of the fat cells and the fat stem cells must be optimized to obtain the best long-lasting results. Cell-assisted lipotransfer (CAL) is one approach to fat grafting in which the stem cells are separated from the liposuctioned fat, essentially concentrated, and subsequently re-attached to the fat that is going to be re-injected.
Studies have also shown that once the injected fat "takes", it can also help improve the thickness and quality of radiation-damaged tissue and skin.
Regardless of technique, some of the injected fat will be reabsorbed over time but this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.
Several independent studies that have evaluated patients over a few years after the procedure have shown that fat grafting is safe. However, because the technique is fairly new, no long-term safety data is currently available.
Unfortunately not all insurance companies cover the cost of fat grafting so the procedure can involve out of pocket expenses for some patients.
I hope this info helps!
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Cell Assisted Liptransfer, Fat Grafting (Lipofiling), Breast Surgery, Breast Reconstruction, Surgery
1
Answer |
4 months ago
Yes, insurance usually pays for the cost of a breast prosthesis after mastectomy. You may need a prescription from your physician.
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Insurance Coverage, Insurance, Breast Prosthesis, Mastectomy
2
Answers |
5 months ago
Unfortunately, reconstructed nipples do not behave like natural nipples. They typically do not harden or soften with temperature changes or touch. Most reconstructed nipples also lack sensation.
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Nipple Reconstruction, Breast Surgery, Nipples, Surgery
1
Answer |
6 months ago
Do you think that could be related to scar tissue stretching? I have used cocoa butter, and I hear that shea butter may help as well - to dissolve scar tissue internally. Might help.
drchrysopoulo (Physician - Surgery - Plastic (Verified)) voted for answer by annieappleseed (Survivor (10 - 20 years))
2
Answers |
6 months ago
You're right, the data collection process has certainly been far from complete in terms of % of patients followed.
Personally I prefer to use the patient's own tissue for the breast reconstruction whenever possible. In my opinion it provides the most "natural" reconstruction and avoids the long-term issues that have been associated with implants.
However, no single procedure is best for everyone and patients must choose what they feel most comfortable with. Our job as plastic surgeons is to ensure our patients have all the information they need to allow them to make that decision.
Dr C
http://www.PRMA-enhance.com
Personally I prefer to use the patient's own tissue for the breast reconstruction whenever possible. In my opinion it provides the most "natural" reconstruction and avoids the long-term issues that have been associated with implants.
However, no single procedure is best for everyone and patients must choose what they feel most comfortable with. Our job as plastic surgeons is to ensure our patients have all the information they need to allow them to make that decision.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Silicone Implants, FDA (Food And Drug Administration)
1
Answer |
6 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) began following the conversation.
1
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6 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) began following the conversation.
1
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6 months ago
HbA1c should be under 7. This is consistent with good long-term blood sugar control which is vital for minimizing complications. Uncontrolled diabetics do have a much higher risk of suffering a complication, especially in terms of poor healing after any surgery.
We routinely perform breast reconstruction on well-controlled diabetics. In our experience these patients have the same DIEP flap success rates as non-diabetic patients.
I hope that info helps.
Dr C
http://www.PRMA-enhance.com
We routinely perform breast reconstruction on well-controlled diabetics. In our experience these patients have the same DIEP flap success rates as non-diabetic patients.
I hope that info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Surgery, Breast Reconstruction, Surgery, DIEP Flap Breast Reconstruction, Diabetic
1
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6 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) began following the conversation.
1
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6 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) began following the conversation.
1
Answer |
6 months ago
Alloderm can be used to help improve projection and shape but based on your description of the degree of asymmetry, I dont know that Alloderm will get you to where you want to be.
It sounds as though you quite like the way the irradiated side has turned out and you are unhappy wth the appearance of the non-irradiated side (left). I would consider leaving the irradiated breast alone and adjusting the left breast. The risk of complications is always higher when operating on irradiated tissue.
Since you had a tissue expander and latissimus reconstruction, I presume the expander was replaced by an implant. It certainly sounds that way considering how "projecting" the left breast is. One option would be to downsize the implant on the left side. Using a smaller implant on that side (perhaps one with a slightly lower profile) would also help decrease the "over projection" you described. Any other adjustments that are needed in terms of shaping can be performed at the same time.
It is very difficult to say which is the best way forward for you, especially without examining you or knowing the exact details of your situation. Oftentimes there is more than one way to get the best result. I really encourage you to discuss all your options with your plastic surgeon to ensure you are as comfortable as possible with the plan moving forward.
I hope that helps.
Dr C
http://www.PRMA-enhance.com
It sounds as though you quite like the way the irradiated side has turned out and you are unhappy wth the appearance of the non-irradiated side (left). I would consider leaving the irradiated breast alone and adjusting the left breast. The risk of complications is always higher when operating on irradiated tissue.
Since you had a tissue expander and latissimus reconstruction, I presume the expander was replaced by an implant. It certainly sounds that way considering how "projecting" the left breast is. One option would be to downsize the implant on the left side. Using a smaller implant on that side (perhaps one with a slightly lower profile) would also help decrease the "over projection" you described. Any other adjustments that are needed in terms of shaping can be performed at the same time.
It is very difficult to say which is the best way forward for you, especially without examining you or knowing the exact details of your situation. Oftentimes there is more than one way to get the best result. I really encourage you to discuss all your options with your plastic surgeon to ensure you are as comfortable as possible with the plan moving forward.
I hope that helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast, Breast Surgery, Breast Reconstruction, Breasts Do Not Match, Breast Shape, Alloderm
2
Answers |
6 months ago
Microsurgery involves disconnecting tissue from one part of the body and transplanting it to another.
There are several microsurgical procedures used for breast reconstruction. The most advanced procedures transfer only fat and skin while preserving underlying muscles. These are known as "perforator flaps". These procedures use the patient's own tissue to recreate a "natural", warm, soft breast while preserving all the patient's muscle function.
The most commonly performed perforator flap techniques include the DIEP/SIEA and GAP flaps:
http://www.prma-enhance.com/index.cfm/PageID/4113
The DIEP flap is now widely accepted to be the gold standard in breast reconstruction:
http://www.prma-enhance.com/index.cfm/PageID/1754
There are several microsurgical procedures used for breast reconstruction. The most advanced procedures transfer only fat and skin while preserving underlying muscles. These are known as "perforator flaps". These procedures use the patient's own tissue to recreate a "natural", warm, soft breast while preserving all the patient's muscle function.
The most commonly performed perforator flap techniques include the DIEP/SIEA and GAP flaps:
http://www.prma-enhance.com/index.cfm/PageID/4113
The DIEP flap is now widely accepted to be the gold standard in breast reconstruction:
http://www.prma-enhance.com/index.cfm/PageID/1754
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Surgery, Breast Reconstruction, Surgery, Microsurgery
1
Answer |
6 months ago
Great question!
In fact, I've posted on my blog about this very topic:
http://breast-cancer-reconstruction.blogspot.com/2008/11/avoiding-denervation-of-abdominal.html
The DIEP flap procedure preserves all the abdominal muscle. However, preserving all the muscle won't matter if all the motor nerves supplying it have been cut during the surgery. A muscle without a healthy nerve supply will lose it's tone, strength and function.
If the DIEP surgeon does not take great care to identify and preserve motor nerves supplying the abdominal muscle then the benefits of the DIEP can be lost: the abdominal muscle can become weak, lose its tone, and the risk of abdominal bulging or even hernia increases. Occasionally a nerve has to be cut because it interferes with the blood supply of the flap (eg travels between 2 necessary perforators). In these instances the nerve should be repaired at the end of the procedure. Typically, damage to 1 motor nerve will not cause any issues long term; it's damage to multiple nerves that leads to muscle problems.
I hope that helps.
Dr C
http://www.PRMA-enhance.com
In fact, I've posted on my blog about this very topic:
http://breast-cancer-reconstruction.blogspot.com/2008/11/avoiding-denervation-of-abdominal.html
The DIEP flap procedure preserves all the abdominal muscle. However, preserving all the muscle won't matter if all the motor nerves supplying it have been cut during the surgery. A muscle without a healthy nerve supply will lose it's tone, strength and function.
If the DIEP surgeon does not take great care to identify and preserve motor nerves supplying the abdominal muscle then the benefits of the DIEP can be lost: the abdominal muscle can become weak, lose its tone, and the risk of abdominal bulging or even hernia increases. Occasionally a nerve has to be cut because it interferes with the blood supply of the flap (eg travels between 2 necessary perforators). In these instances the nerve should be repaired at the end of the procedure. Typically, damage to 1 motor nerve will not cause any issues long term; it's damage to multiple nerves that leads to muscle problems.
I hope that helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Movement Problems, Breast Surgery Side Effects, Breast Surgery, Muscle Problems, Surgery Side Effects, DIEP Flap Breast Reconstruction, Nerve Problems
1
Answer |
6 months ago
Unfortunately, the best time to do that is at the time of the reconstruction.
The nerve to the muscle can also be cut at the time of the reconstruction so that the muscle no longer "flexes". This does also cause the muscle to partially waste away though and lose bulk. For this reason, many surgeons don't cut the nerve routinely.
Dr C
http://www.PRMA-enhance.com
The nerve to the muscle can also be cut at the time of the reconstruction so that the muscle no longer "flexes". This does also cause the muscle to partially waste away though and lose bulk. For this reason, many surgeons don't cut the nerve routinely.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Surgery, Lat Flap, Breast Reconstruction, Surgery, Plastic Surgery
1
Answer |
9 months ago
Absolutely.
Nipple-sparing mastectomy can be performed in conjunction with any type of breast reconstruction.
Dr C
http://www.PRMA-enhance.com
Nipple-sparing mastectomy can be performed in conjunction with any type of breast reconstruction.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Nipple Sparing Mastectomy, Flap Reconstruction, Nipples, Breast Reconstruction, Surgery, Plastic Surgery
1
Answer |
9 months ago
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