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Minas Chrysopoulo, MD
drchrysopoulo (Physician - Surgery - Plastic (Verified) )| Communities: Breast Cancer | Answers: 45 |
| Member Since: Feb. 2011 |
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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
Fellowship: Microsurgery, Hand Surgery, Burns
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
Research interests: Breast reconstruction
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
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
Vitals.com page
http://www.vitals.com/doctors/Dr_Minas_Chrysopoulo
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drchrysopoulo Activities
Radiation therapy is often recommended as part of breast cancer treatment. Patients undergoing lumpectomy receive radiation routinely once they've healed from surgery. Some mastectomy patients also need radiation after surgery depending on the characteristics of the tumor.
I think it is fair to say that most reconstructive breast surgeons, myself included, are not particularly fond of radiation because of the way it impacts the patient's tissues (and breast reconstruction in general). Nonetheless, it is important to remember that "life comes before breast" and in certain situations several studies have shown there is a definite benefit for the patient in having radiation therapy.
Radiation therapy has come a long way over the years but it can still be associated with significant side effects. Radiation can cause toughening (fibrosis) and shrinking (contracture) of the patient's tissue which makes the tissue lose its elasticity and become more firm. Skin color changes are common, red at first turning more brown over time. Radiation can also cause burn injuries as well as damage to underlying organs such as the lungs and heart. Anyone who is facing radiation therapy must discuss all the potential risks with their their radiation oncologist extensively beforehand.
Radiation after a tissue reconstruction (eg diep flap, tram flap) can cause the reconstructed breast to shrink and harden. Unfortunately, this is a fairly common scenario. Less frequently (more so with with heavy radiation doses), new wounds can develop in the reconstructed breast which need wound care. Patients facing radiation after flap breast reconstruction should know that there is a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.
Tissue expander / implant reconstructions fair even worse with radiation. The complication rates in this setting are much higher than with flap reconstructions. Some surgeons routinely offer implant reconstructions to patients that have had radiation therapy. There are even articles published in the plastic surgery literature supporting it. I have to respectfully disagree. In my experience mixing implants with previous radiation often ends badly; the complication rate is high (eg thinning of the overlying skin, implant hardening, pain, implant exposure, need for removal of the implant) and the cosmetic results are typically unfavorable.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
I think it is fair to say that most reconstructive breast surgeons, myself included, are not particularly fond of radiation because of the way it impacts the patient's tissues (and breast reconstruction in general). Nonetheless, it is important to remember that "life comes before breast" and in certain situations several studies have shown there is a definite benefit for the patient in having radiation therapy.
Radiation therapy has come a long way over the years but it can still be associated with significant side effects. Radiation can cause toughening (fibrosis) and shrinking (contracture) of the patient's tissue which makes the tissue lose its elasticity and become more firm. Skin color changes are common, red at first turning more brown over time. Radiation can also cause burn injuries as well as damage to underlying organs such as the lungs and heart. Anyone who is facing radiation therapy must discuss all the potential risks with their their radiation oncologist extensively beforehand.
Radiation after a tissue reconstruction (eg diep flap, tram flap) can cause the reconstructed breast to shrink and harden. Unfortunately, this is a fairly common scenario. Less frequently (more so with with heavy radiation doses), new wounds can develop in the reconstructed breast which need wound care. Patients facing radiation after flap breast reconstruction should know that there is a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.
Tissue expander / implant reconstructions fair even worse with radiation. The complication rates in this setting are much higher than with flap reconstructions. Some surgeons routinely offer implant reconstructions to patients that have had radiation therapy. There are even articles published in the plastic surgery literature supporting it. I have to respectfully disagree. In my experience mixing implants with previous radiation often ends badly; the complication rate is high (eg thinning of the overlying skin, implant hardening, pain, implant exposure, need for removal of the implant) and the cosmetic results are typically unfavorable.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Radiation, Breast Surgery, Radiation Treatment, Breast Reconstruction, Surgery, Radiation Oncology
1
Answer |
9 months ago
There should be no risks of new circulatory problems with the flap years after surgery.
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) Circulatory Problems, Breast Surgery Side Effects, Breast Cancer, Breast Surgery, Breast Reconstruction, DIEP Flap, Side Effects, Surgery, Breast Reconstruction Side Effects, DIEP Flap Breast Reconstruction, Surgery Side Effects
1
Answer |
9 months ago
This depends on the severity of the wounds.
Mild wound healing issues are usually treated with local wound care which includes dressing changes several times a day.
Larger wounds can be treated with a special dressing called a "VAC". This is a sponge dressing that is replaced every few days (typically 3 times per week). The sponge encourages healing by applying mild suction pressure to the wound. The pressure is generated by a small purse-like device that the patient carries around with them.
More severe wounds can require hyperbaric therapy. This essentially pushes more oxygen in to the wounds to encourage healing.
Surgery can also be required to ensure any unhealthy tissue that is preventing healing is removed from the the wound. Surgery is often performed prior to VAC or hyperbaric therapy.
Any identifiable contributing factors must also be addressed e.g. smoking, malnutrition, uncontrolled diabetes.
Smoking of course is an absolute "no-no". Regardless of the severity of the wound, it is important the patient's diet is optimized to ensure the patient is eating enough of the nutrients required for normal healing (like protein, zinc, vitamins A and C). Diabetic patients must also be re-evaluated to ensure their blood sugar levels are under good control.
Here's a blog post that may also be helpful:
http://breast-cancer-reconstruction.blogspot.com/2010/11/how-to-boost-healing-after-surgery.html
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
Mild wound healing issues are usually treated with local wound care which includes dressing changes several times a day.
Larger wounds can be treated with a special dressing called a "VAC". This is a sponge dressing that is replaced every few days (typically 3 times per week). The sponge encourages healing by applying mild suction pressure to the wound. The pressure is generated by a small purse-like device that the patient carries around with them.
More severe wounds can require hyperbaric therapy. This essentially pushes more oxygen in to the wounds to encourage healing.
Surgery can also be required to ensure any unhealthy tissue that is preventing healing is removed from the the wound. Surgery is often performed prior to VAC or hyperbaric therapy.
Any identifiable contributing factors must also be addressed e.g. smoking, malnutrition, uncontrolled diabetes.
Smoking of course is an absolute "no-no". Regardless of the severity of the wound, it is important the patient's diet is optimized to ensure the patient is eating enough of the nutrients required for normal healing (like protein, zinc, vitamins A and C). Diabetic patients must also be re-evaluated to ensure their blood sugar levels are under good control.
Here's a blog post that may also be helpful:
http://breast-cancer-reconstruction.blogspot.com/2010/11/how-to-boost-healing-after-surgery.html
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
1
Answer |
9 months ago
Most plastic surgeons agree the safest time is AFTER completion of the radiation therapy. Radiation after a tissue reconstruction (eg diep flap, tram flap) can cause the reconstructed breast to shrink and harden. Unfortunately, this is a fairly common scenario. Less frequently (more so with with heavy radiation doses), new wounds can develop in the reconstructed breast which need wound care. Patients facing radiation after flap breast reconstruction should know that there is a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.
Some surgeons will offer immediate DIEP flap reconstruction (i.e. DIEP at the same time as the mastectomy) even though radiation is planned after the mastectomy. I would only consider this if your surgeon has a very good working relationship with a radiation oncologist experienced with radiating flaps. Even though radiation protocols are the same throughout the country, some radiation oncologists have more experience with radiating flaps than others and can deliver the radiation in a more "flap friendly" way to decrease the risk of complications without compromising cancer treatment.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
Some surgeons will offer immediate DIEP flap reconstruction (i.e. DIEP at the same time as the mastectomy) even though radiation is planned after the mastectomy. I would only consider this if your surgeon has a very good working relationship with a radiation oncologist experienced with radiating flaps. Even though radiation protocols are the same throughout the country, some radiation oncologists have more experience with radiating flaps than others and can deliver the radiation in a more "flap friendly" way to decrease the risk of complications without compromising cancer treatment.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
2
Answers |
9 months ago
I think patients should hear and be able to consider all reconstructive options. Most plastic surgeons perform breast reconstruction but not all offer the whole spectrum of reconstructive options. It is important to establish what kind of procedures your surgeon performs routinely to ensure you will be able to undergo the reconstruction you 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 |
9 months ago
Two factors...
The first is the type of procedure. Immediate breast reconstruction, at the same time as a skin-sparing or nipple-sparing mastectomy, is associated with the least amount of scarring. These types of mastectomies preserve all the natural breast skin envelope and minimize the amount of scarring. Nipple-sparing mastectomies also preserve the nipple and areola.
The second factor is the patient. Some patients simply heal with nicer scars than others. This is due to factors such as age, genetics and other medical conditions.
I hope this info helps.
Dr C
www.PRMA-enhance.com
The first is the type of procedure. Immediate breast reconstruction, at the same time as a skin-sparing or nipple-sparing mastectomy, is associated with the least amount of scarring. These types of mastectomies preserve all the natural breast skin envelope and minimize the amount of scarring. Nipple-sparing mastectomies also preserve the nipple and areola.
The second factor is the patient. Some patients simply heal with nicer scars than others. This is due to factors such as age, genetics and other medical conditions.
I hope this info helps.
Dr C
www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Reconstruction Scarring, Breast Cancer, Breast Reconstruction Experiences, Breast Reconstruction, Side Effects, Breast Reconstruction Side Effects, Scarring
1
Answer |
11 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) asked the question in topic(s) Breast Reconstruction Scarring, Breast Cancer, Breast Reconstruction Experiences, Breast Reconstruction, Side Effects, Breast Reconstruction Side Effects, Scarring
1
Answer |
11 months ago
Most flap procedures require similar recovery time (4-6 weeks) in terms of resuming most activities and returning to work. In terms of the initial hospital stay after surgery, microsurgical procedures (eg perforator flap) typically need a couple of days longer compared to non-microsurgical procedures (eg lat flap).
Dr C
www.PRMA-enhance.com
Dr C
www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified)) in topic(s) Breast Reconstruction Recovery, Flap Reconstruction Recovery Time, Breast Reconstruction Experiences, Flap Reconstruction, Autologous Breast Reconstruction, Breast Reconstruction, Autologous Breast Reconstruction Recovery Times
1
Answer |
11 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) asked the question in topic(s) Breast Reconstruction Recovery, Flap Reconstruction Recovery Time, Breast Reconstruction Experiences, Flap Reconstruction, Autologous Breast Reconstruction, Breast Reconstruction, Autologous Breast Reconstruction Recovery Times
1
Answer |
11 months ago
At PRMA, GAP flap patients typically stay in the hospital for 3 or 4 days after their initial reconstructive surgery. Recovery is 4-6 weeks in terms of returning to most activities.
Three months later, a second surgery is performed known as "stage 2" or the "revision stage". This includes optimizing breast symmetry and buttock contour, scar revision and nipple-areola reconstruction (if needed). Stage 2 is performed as an outpatient procedure for local patients. Out of town patients usually stay overnight. Recovery is a few days.
The final stage involves tattooing of the reconstructed nipple-areola. This is an office procedure which requires an hour or so out of your day.
All stages are performed 3 months apart.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
Three months later, a second surgery is performed known as "stage 2" or the "revision stage". This includes optimizing breast symmetry and buttock contour, scar revision and nipple-areola reconstruction (if needed). Stage 2 is performed as an outpatient procedure for local patients. Out of town patients usually stay overnight. Recovery is a few days.
The final stage involves tattooing of the reconstructed nipple-areola. This is an office procedure which requires an hour or so out of your day.
All stages are performed 3 months apart.
I hope this info helps.
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
1
Answer |
11 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) asked the question
1
Answer |
11 months ago
We typically have patients wear a surgical bra for 3 weeks after surgery.
Dr C
http://www.PRMA-enhance.com
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
1
Answer |
11 months ago
drchrysopoulo (Physician - Surgery - Plastic (Verified)) asked the question
1
Answer |
11 months ago
The medication Gabapentin can help some patients with persistent hypersensitivity after breast surgery. I would look into that if you haven't tried that already.
Dr C
http://www.PRMA-enhance.com
Dr C
http://www.PRMA-enhance.com
New answer by drchrysopoulo (Physician - Surgery - Plastic (Verified))
2
Answers |
11 months ago
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, Breast Cancer, Breast Reconstruction Timing, Determine Treatment Plan Options, Breast Reconstruction Options, Breast Cancer Treatment Options, Breast Cancer Treatment Plan, Breast Cancer Treatment, Breast Reconstruction
1
Answer |
1 year 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 |
1 year 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) Breast Cancer Treatment Options, DIEP Flap Reconstruction Eligibility, DIEP Flap Contraindications, Breast Reconstruction Contraindications, Breast Reconstruction, DIEP Flap, DIEP Flap Breast Reconstruction
1
Answer |
1 year 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)) in topic(s) What To Expect, Next Steps, DIEP Flap Reconstruction Treatment Process, Breast Reconstruction Treatment Process, DIEP Flap Patient Experiences, DIEP Flap Reconstruction Follow-up, Breast Reconstruction, Breast Reconstruction What To Expect, Autologous Breast Reconstruction, DIEP Flap, Breast Cancer What To Expect, DIEP Flap Breast Reconstruction
1
Answer |
1 year ago
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