That's hard in like two minutes, okay. That could be like a two-day conversation. Setting expectations with patients is probably the most important part of your consultation as a plastic surgeon. Breast reconstruction isn't really breast augmentation. It's a very different operation. So for those patients undergoing unilateral reconstruction, at the second stage operation when I take out a tissue expander and I place the implant, we often address the contralateral breast with a symmetry procedure. Asymmetry is incredibly common. Almost every patient has some degree of asymmetry. I don't want an overly thin capsule because that gives no support to the implant. I want a capsule. I prefer inframammary fold incisions. It gives me the most control in fold and appropriate release of my pec. I tend to prefer immediate staged reconstruction. Doing a staged reconstruction and putting the tissue expander in at the time of mastectomy allows the skin flaps to heal flat with less tension and the perfusion to reestablish in the mastectomy flaps. Managing complications is a part of everyone's practice. I think managing complications first comes through the honest communication with the patient. Asymmetry is present in every single patient and a majority of women don't see it. They're so used to it, they don't see it. But I'll tell you, after surgery, they will see everything. The benefit of fat grafting is that it's our own tissue and we can use it to sculpt as we wish. After a mastectomy has been completed, we'll really need to wash out that pocket. You can wash this out with a variety of different solutions. I'm going to reprep the skin, I'm going to change my gloves, nobody touches the implants except for myself. In the interest of preventing implant descent, I want some degree of capsular structure and stability in my breast pocket. We don't really understand why some patients are poor capsule formers and maintaining an implant position is a nightmare with a thin capsule. Device tracking is done by me. I'm generally entering them just as soon as a case is done. I don't leave an operating room without that done because I think that's so, so important. It's so easy to do. I think it's important that we have more and more women in plastic surgery leadership, especially for our medical students and our residents. I think they need to see it to be it.

breast reconstruction

asymmetry

fat grafting

patient communication

women in leadership