Several interesting topics were discussed at the Breast Surgery Symposium in Atlanta, GA at the Southeastern Society of Plastic and Reconstructive Surgeons Meeting.  A panel discussing Oncoplastic Breast Conservation Surgery & Nipple Preserving Mastectomy was extremely interesting.   For decades Plastic Surgeons have provided reconstructive options for women undergoing partial and complete mastectomy which are included but not limited to the permanent silicone gel implant, tissue expanders that are later exchanged for implants, expanders and or implant in addition to a latissimus flap, and the now various forms of flap from the lower abdomen and thighs such as the TUG flap, Free TRAM, Pedicled TRAM, and the increasingly popular DIEP flap. Despite all of the options less than 30 percent of women get a reconstruction.  This leads to finger pointing on both sides.  The plastic surgeons think the general or breast surgeons are not referring or discussing breast reconstruction in their initial consultation with the patients and the general surgeon or breast surgeons feel like they cannot get a plastic surgeon to see the patient.  Sometimes because of location there may not be a plastic surgeon nearby.  This is becoming less the case with the aid of the internet.  Finding physicians and surgeons is becoming easier.  There can be hurdles with insurance after that with respect to the providers.  Fortunately it is a Federal Law that women have the ability to under reconstruction after mastectomy and any symmetry procedures on the opposite breast.

One of the take home points from the panel to me was that great reconstruction outcomes can only  happen with great mastectomies.  That means the general or breast surgeon has to do a great job performing the mastectomy in order for the plastic surgeon to then perform the best reconstruction.  In cases of nipple sparing mastectomy the general or breast surgeon performs the mastecomy and sentinel lymph node biopsy and then performs a biopsy of the tissue behind the nipple to confirm there is not cancer.  At this point the plastic surgeon can perform the reconstruction with a comination of expanders and acellular dermal matrix.  The techniques can very among the plastic surgeons who perform the procedure but the outcomes should be great if the mastectomy was done well.  The final product shold look like a breast augmentatin rather than a breast reconstruction.

Fat grafting lips, fat grafting cheeks, fat grafting buttocks, fat grafting breasts have all been described over long periods of time.  Recently I attended the Southeastern Society of Reconstructive Surgeons Meeting in Altanta.  One of the Hot Topics was fat grafting.  In particular autologous fat grafting for breast augmentation.  There are numerous cosiderations with breast augmentation including breast augmentation cost, breast augmentation recovery time, breast augmentation risks, breast augmentation size as well as concerns of the patient on how they will look after breast augmentation.  Concerns over the natural appearance have led many, but most notably, Board Certified Plastic Surgeons, to seek out new avenues to provide durable, natural results with fat.  Liposuction surgery or liposuction plastic surgery allows a Board Certified Plastic Surgeon to harvest fat from the abdomen, flanks, hips and thighs in order to provide fat to augment a breast.  This process can be seen in liposuction surgery video or liposuction surgery pictures on websites and on television.  The majority of patients can be seen and examined to determine whether or not they are good candidate for liposuction surgery and autologous fat grafting breast surgery.  Liposuction procedures and liposuction prices will vary according to the region of the country where you are located.  Many times liposuction can be performed with the use of local anesthesia and sedation.  Liposuction plastic surgery for fat grafting lips, fat grafting cheeks, fat grafting buttocks, and fat grafting breasts can performed safely by Board Certified Plastic Surgeons.

It’s reported that in the United States an estimated 11.7% percent of the population (5.6% male and 17.1% female) is directly affected by chronic migraine headaches.  Chronic migraines are more common than asthma and diabetes combined.  Up until now there have been very few treatment options for patients who suffer from chronic migraines.

Recently it has been shown that the use of Botulinum toxin injected into muscles in the back of the neck, the temple area and the forehead can provide relief from chronic migraines.  In many instances there will be an elimination of the migraine.  If the patient responds to Botulinum Toxin they can be evaluated for the surgical treatment of Chronic Migraines.

Surgical treatment involves the release of the nerves in the back of the neck, the greater occipital, the nerves in the temple area, zygomaticotemporal, and the nerves in the forehead, supraorbital and supratrochlear nerves.  In addition several patients report headaches or symptoms related to the sinuses.  Each patient is evaluated for sinus issues as well as airway issues.  Patients can have problems within their nose that can actually cause a migraine such as a septal spur.  If appropriate patients with septal problems can undergo a procedure to correct this at the same time of at a later date.

I feel fortunate to be able to offer this as another alternative to patients with Chronic Migraines.   It is my hope that I will be able to help as many patients as possible by giving them back the quality of life they’ve lost due to chronic migraines.