drjamiezampell

Many women ask me if they can still have autologous tissue reconstruction after liposuction. The answer is… it may be possible depending on a few factors:

✨ If there is enough remaining volume, natural tissue would still be a good option.
✨ If vasculature is still intact and not injured by liposuction, natural tissue reconstruction is still an option.
✨ Some forms of liposuction can cause greater small vessel injury limiting natural tissue options.
✨ If scarring in the tissue is relatively minimal, natural tissue is generally still available.

Your reconstructive microsurgeon may mandate imaging to determine whether autologous tissue reconstruction is a safe option for your reconstructive procedure.

Follow along for some examples of autologous tissue reconstruction after prior liposuction!

Oncoplastic surgery is a type of reconstruction designed to restore or improve the appearance of the breast at the time of lumpectomy or partial mastectomy.

Once a tumor is removed by the oncologic surgeon, the residual native breast tissue is rearranged internally to fill the residual defect. Outwardly, the skin is re-draped and reduced to lift the breast.

It is ideal to perform this procedure prior to radiation to avoid contour deformities that may be difficult to correct after radiation. As always, be sure to discuss with your breast surgeon and board certified plastic surgeon whether this option is a good one for you!

Follow along for examples of this procedure. Tell us what questions you have below! ⬇️🤍

Today I am sharing before and after images of an extended abdomen flap, also known as a SHaEP flap (stacked hemiabdominal extended perforator flap). This is a variation of the DIEP flap and includes tissues from the hip for women who have limited volume in the central abdomen. This variation adds a neighboring blood vessel to extend the flap territory. Here, I used a vessel that travels only through fat, so additional muscle dissection is not required.

Important points for the SHaEP flap:
🤍 Abdominal scars are longer than for the DIEP flap since additional tissue is needed for volume.
🤍Operations may take longer since more microsurgery is required.
🤍This may be an excellent option for women who may not be ideal candidates for the traditional DIEP.
🤍Vessel mapping with imaging prior to surgery is critical and may be required by your surgeon for best planning.

What questions do you want me to answer about microsurgery and breast reconstruction? Tell us below! ⬇️

Thank you to our brave patient for her kind words. 🤍 Empathy and understanding is the least I can provide in a the complex battle with breast cancer that many of my patients experience. It is a true honor to be your doctor throughout your journey!

I still encounter a lot of misconceptions about autologous breast reconstruction. I wanted to address a few of the misconceptions I frequently encounter:

Anesthesia duration is unsafe.
✨Microsurgical cases can take a long time and anesthesia should be minimized for faster recovery; however, anesthesia is generally very safe and tolerated well since we are operating outside of the chest or abdomen.

Recovery involves being immobilized.
✨Women are encouraged to be active participants in their recovery before and after surgery. Frequent walking is encourage immediately after surgery and light exercise is recommended after a few weeks for best healing.

Length of recovery is too long.
✨I recommend 4-6 weeks to recover from most autologous tissue reconstructions. Some patients require more or less time depending on their unique circumstance.

The PAP flap is a secondary choice for natural tissue breast reconstruction if the DIEP is unavailable or you prefer to use thigh tissue for your reconstruction. This flap is taken from the inner thigh and results in a scar similar to that for a thigh lift.

The flap typically results in a smaller overall breast volume, given limitations of tissue available in the thigh; however, is it it is an excellent secondary choice for women who are unable to have reconstruction using abdominal tissue.

Follow for more insight into options for breast, reconstruction, both natural tissue and implant-based. 🤍

Many women seek consultation with me if they are not able to have DIEP flap reconstruction, but still desire natural tissue reconstruction. Reasons for this might include prior abdominoplasty (tummy tuck), other abdominal surgery, or simply their body habitus is not best suited for a DIEP flap.

What are the other options? This is best determined in consultation with your surgeon! In general, tissues can be utilized from the inner thigh, love-handle, buttock, or a combination of these regions. The names can be confusing but here is a quick breakdown:
✨PAP flap: derives from the inner thigh or under the buttock fold
✨Lumbar flap: derives from the lovehandle area
✨SGAP: derives from the buttock
✨Extended abdomen/SHAEP flap: derives from the abdomen and flank (similar to DIEP but more extended territory)

These flaps can be more complicated and are not correct for every patient. Your body habitus and reconstructive goals are important considerations, and your surgeon may require imaging studies to determine which option is most ideal.

Stay tuned for examples of each of these in my feed! Call 310-620-8750 or visit my website gallery to view options.

Women often ask me about hybrid reconstruction and when this might be a useful option. Hybrid reconstruction means we are combining the use of natural, or autologous, tissue with an implant to create the final reconstructive result. Using this option, the inner surface of the breast is restored with the patient's natural tissue and the remainder of the breast volume and projection is achieved from a breast implant buried below the natural tissue, much like a breast augmentation.

Who may be a good candidate for this option?
•Women who have smaller donor tissues available but desire the natural result of autologous tissue.
•Women who have experienced contour deformities with implant-based reconstruction.
•Patients who have had significant implant visibility or other irregularities from implant-only reconstruction.
•Women who desire smaller donor site scars or less visible donor sites.
•Breast cancer survivors who have had radiation and will benefit from natural tissue but still desire additional volume from an implant.

Follow along my Instagram or website for examples of this option!

To learn more about your options, call us for an in-person or virtual consultation at 310-620-8750.

Thanks to our patient for her kind words! Breast reconstruction is one of several components of your cancer journey and often is a journey in itself. I am humbled to guide my patients through this process and blessed to do this amazing work!

Women often ask me what they can do prepare themselves for their breast reconstruction surgery. Here's a few tips:
•The first and my personal favorite is EXERCISE. Thirty minutes of exercise daily leading up to surgery improves your ability to recover. Exercise is proven to reduce post-operative complications and decrease pain after surgery.

•Remember to consult with your medical team prior to surgery. Your medical oncologist, primary care doctor, and any other specialists involved in your care should be aware of upcoming surgery. They will provide your medical clearance, advise you on medications to hold or continue, and optimize your treatment plan before and after surgery. These physicians are often as important in this process as your reconstructive surgeon!

•Maintain a healthy and well balanced diet. It is important to stay hydrated and continue a balanced diet with adequate protein intake before and after surgery to promote best healing.

Remember that sleep, stress, and psychological support are critical components to manage in your healing journey.

I often am asked by women if they have enough tissue on their abdomen to undergo a DIEP flap breast reconstruction, including whether this would be enough volume to approach or match their current breast size.

In many cases the answer is yes. In some cases, however, I would need to take additional volume to match the current breast size. A SHAEP flap does just that, extending the territory of the DIEP. SHAEP or stacked hemi-abdominal extended perforator flap, uses the DIEP with additional territory carried on the hip or flank. Another blood vessel connection is added to do this. The abdominal scar is longer in this case but may provide improved abdominal and hip contour as an added benefit.

Women who desire or need additional volume beyond the traditional DIEP may be excellent candidates for a SHAEP flap.

Follow along in my feed and stories for examples of this work!

The options for breast reconstruction can be confusing. It is most important to identify a board-certified plastic surgeon specializing in reconstructive surgery and surgical oncologist specializing in breast to guide you based on your specific medical need, treatment plan, and reconstructive goals.

Once you've identified your team, evaluate each reconstructive option available. Options for breast reconstruction range from implant-based to natural (autologous) tissue. Implant-based reconstruction will use some form of breast implant to re-create the appearance of the breast. This is sometimes performed in stages for the best final result.

Autologous reconstruction utilizes your own tissue to reconstruct the breast. Tissues are transferred from one part of the body and shaped to re-create a natural appearing breast. Tissues are often taken from an area of excess including the lower abdomen, inner thigh, upper buttocks, or lovehandle area. It is important to be mindful of where the tissues are taken from, making sure that region can be closed in an asethetically beautiful way, as for a tummy tuck, thigh lift, or buttock lift.

Hybrid reconstruction combines these options, utilizing one's own tissue for a natural result and combining it with an implant for added volume or projection.

Remember, aesthetic flat closure and no reconstruction is an option and a choice as well! A plastic surgeon is often involved for best contour and appearance.

To learn more about your options, call us for in-person or virtual consultation at 310-620-8750.

What happens on the day of consultation?

Many of my new patients are anxious and overwhelmed with a deluge of new information after a diagnosis of breast cancer. However, the day of your consultation should be an informative time for you to gather information for how to proceed with the next steps in treatment and reconstruction.

What happens during the consultation?

•Oncologic diagnosis and information are reviewed together, including imaging and pathology
•Recommendations from the medical oncologist, surgical oncologist, tumor board and others are discussed
•Examination of the breast or defect is performed
•Reconstructive goals are established
•Personal aesthetic concerns and preferences are outlined
•Comprehensive information on flat contouring, breast conservation, implant-based, and autologous reconstruction are reviewed
•Reconstructive plan is formulated or started

Your journey is will undoubtedly be unique. Remember that your consultation is for informaton gathering and your specialists should guide you to the relevant information specific to your unique journey!

What happens on the day of consultation?

Many of my new patients are anxious and overwhelmed with a deluge of new information after a diagnosis of breast cancer diagnosis. However, the day of your consultation should be an informative time for you to gather information for how to proceed with the next steps in treatment and reconstruction.

What happens during the consultation?

•Oncologic diagnosis and information are reviewed together, including imaging and pathology
•Recommendations from the medical oncologist, surgical oncologist, tumor board and others are discussed
•Examination of the breast or defect is performed
•Reconstructive goals are established
•Personal aesthetic concerns and preferences are outlined
•Comprehensive information on flat contouring, breast conservation, implant-based, and autologous reconstruction are reviewed
•Reconstructive plan is formulated or started

Your journey is will undoubtedly be unique. Remember that your consultation is for informaton gathering and your specialists should guide you to the relevant information specific to your unique journey!

What happens on the day of consultation?

Many of my new patients are anxious and overwhelmed with a deluge of new information after a diagnosis of breast cancer. However, the day of your consultation should be an informative time for you to gather information for how to proceed with the next steps in treatment and reconstruction.

What happens during the consultation?

•Oncologic diagnosis and information are reviewed together, including imaging and pathology
•Recommendations from the medical oncologist, surgical oncologist, tumor board and others are discussed
•Examination of the breast or defect is performed
•Reconstructive goals are established
•Personal aesthetic concerns and preferences are outlined
•Comprehensive information on flat contouring, breast conservation, implant-based, and autologous reconstruction are reviewed
•Reconstructive plan is formulated or started

Your journey is will undoubtedly be unique. Remember that your consultation is for informaton gathering and your specialists should guide you to the relevant information specific to your unique journey!

Why is reconstruction sometimes staged? I often stage a reconstruction in order to shape the breast skin envelope, correct ni**le position, and correct underlying asymmetries. This helps achieve the best aesthetic outcome while avoiding complications.

I wanted to share an example of staging. This patient desired ni**le sparing mastectomy and reconstruction to maintain roughly the same volume. Her breasts significantly dropped after pregnancy, were uneven, and she desired autologous tissue to combat planned radiation. A lot to unpack here!

Here's what I planned:

*Ni**le delay: This procedure performed 1 week prior to mastectomy separates the skin and ni**le away from underlying breast tissue to reduce the chance that the skin or ni**le is injured with the mastectomy.
*Mastectomy and tissue expander insertion. The skin and ni**le are separated from breast tissue and tailored over a temporary tissue expander. This lifted the ni**le position and prepared the envelope for planned radiation.
*Radiation to the breast to complete her treatment course.
*Conversion to DIEP flap with implant 3 months after healed from radiation.
*Final revision with contouring, internal support, and fat grafting.

Her final result is shown. Her autologous tissue with DIEP flap is providing a soft and natural look while the addition of an implant, covered entirely by the natural tissue provides final projection. Follow for info to come on delay procedures!

Hi Everyone! Thank you for all of your hard work in supporting retention of broad insurance-based access to breast reconstruction services. CMS will reevaluate its decisions to drop the S-codes June 1 in a public meeting.

CMS administrators are asking to hear from individuals and groups regarding their experiences with the DIEP flap and other reconstructive flap operations. Please send your story and reasoning as to why this operation was beneficial or meaningful for your cancer journey.

Please visit my website- add advocacy tab link- or .org and for further information on advocacy efforts

Happy Cinco de Mayo! Have a safe night and always remember to take care of yourself.

Insurance based access to reconstructive breast surgery is critical on the cancer journey for so many women diagnosed with breast cancer. I am grateful to share news that CMS will re-evaluate its decision to remove important codes that allow surgeons to perform Microsurgical breast reconstruction including DIEP flaps using health insurance benefits.

CMS acknowledges that removal of these important codes may reduce access to reconstructive services. The decision will be reviewed at a public meeting on June 1, 2023. Please follow my story and advocacy page for important updates on where to direct efforts. CMS is encouraging all groups and individuals to share their perspective on this issue.

🔗 http://cbralliance.org

Nothing reminds me of the power of microsurgery more than the words of a patient who has returned to normalcy in their life. I can't take away the trauma of breast cancer, but hopefully I can restore a sense of what was lost. Thank you for these kind words and a reminder of why I do this everyday.

Help preserve access to microsurgical breast reconstruction at cbralliance.org and .

Excited to share one of my most challenging cases, reconstruction with a "four flap." What on earth does this mean? Well, here I reconstructed the breast using tissue from both the abdomen and thighs.

This lovely lady developed a breast cancer and had prior breast implants resultant in a misshapen and saggy breast. She elected for double mastectomy, desired to retain her breast volume, and to use her own tissues rather than breast implants. She additionally had significant contour deformities on the abdomen from prior liposuction. This was a challenge!!

This reconstruction required a large amount of tissue volume and the abdominal tissue volume was already depleted by liposuction. So, I used both thigh (PAP flap) and abdominal tissues (DIEP flap) to create each breast; I term this a "four flap." This is a challengeing operation and used only for select candidates. Women with skin excess and laxity in the thigh and abdomen after weight loss are often the best candidates! Please remember she underwent several stages to achieve the final result safely! Follow along for details on how I stage these operations.

Hi ladies! Everyone knows that I am a plastic surgeon and we all have an idea what that means, but many people don't often realize that plastic surgery encompasses knowledge and skills far beyond cosmetics. Did you know that one of the first transplant surgeons was a plastic surgeon?! It's true!

So what is microsurgery and why do I keep talking about it?

Microsurgery is a form of reconstructive surgery used to move tissue around the body in order to restore deformities that occur after cancer operations or traumatic injury. Just as for a transplant operation, tissues are moved to the site of the deformity and the body's own blood vessels are connected to the new tissue to allow it to survive. It's called microsurgery, since the vessels are small, often 1-2 mm, and must be connected under a microscope.

What does this mean for breast cancer? It means we can transfer skin and fat alone from the tummy, thigh, hip, buttock, or other location to create a breast. Tissues aren't rejected since they originate in your own body. This powerful operation allows for (1) re-establishment of what was lost from cancer and (2) improvement of the donor site. This form of reconstruction is permanent and requires no long term maintenance. This is the power of microsurgery!

Always consult with board certified plastic surgeon with specialty training in microsurgery for the most educated knowledge of this subject! Microsurgical excellence requires years of dedication to the nuance and art of reconstruction.

Sharing a post-op result today from a right sided stacked DIEP reconstruction. This patient developed a right breast cancer and underwent mastectomy, previous breast implant removal, and reconstruction with a DIEP flap to her right breast. Her left breast was later lifted and her implant removed.
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What is unique in this case?
✨No more breast implants. Both breasts are completely natural and will age and change with her body.
✨Her right breast is entirely reconstructed from her abdominal tissue.
✨She had two surgeries to reach this result. No more future implant revisions, exchanges or updates will be needed.
✨Her operation was entirely covered using her health insurance benefits. Help us preserve access to safe and excellent outcomes such as these!
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This is the power of microsurgery! Call or visit us for more information or to schedule a consultation

Just a thank you to our amazing patients for their kind words and gratitude! It is the reason why I do this work ✨✨✨
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What is your inspiration today?
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So, I promised some amazing flap posts demonstrating the power of natural tissue! As you know, using natural tissue may require more than one operation to reach the final result. Patients often ask me, “what will I look like between stages?”
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Typically, after the first operation, in which tissue is transferred, we are close to final result but not entirely at our final goal.
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Here, a lumbar flap, using tissue from the lovehandle, was used to recreate the entire right breast and augment the left breast. She is just 10 days post-op in the first photo and 3 months post-op in the second photo.
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At her final revision, I will:
✨Perform fat grafting to the upper pole for volume.
✨Remove monitoring skin paddled along the breast fold.
✨Revise donor site scars from the lovehandle region
✨Symmetrize ni**le position.
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Her result is with her for life! I can’t wait to share her final result after revision.
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This operation was entirely performed using her health insurance benefits in her insurance network! Please join to protect access through health insurance to natural tissue reconstruction.

At a time when access to DIEP flap and other forms of natural tissue breast reconstruction is threatened, I want to spend several posts demonstrating the power of autologous tissue as a meaningful, durable, and beautiful form of reconstruction.
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This lovely lady had a right breast cancer treated by lumpectomy in addition to a left breast reduction for symmetry. Her cancer recurred, requiring right mastectomy and radiation.
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Following radiation, I rebuilt her right breast using a standard DIEP flap and restored the native volume of her left breast using a smaller DIEP flap. This was done witth the help of my talented cosurgeon . It was done using her insurance benefits entirely in network.
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What is critical about her case:
✨She is radiated, making implant reconstruction more likely to have short and long term complications. Natural tissue is safer.
✨She has a significant defect in the upper outer pole. An implant can’t get there! Only autologous tissue can fill out this area.
✨She had ONE operation followed by an outpatient revision surgery. She requires no maintenance, implant exchanges, or other operations for the rest of her life. This saves time for her and costs to her insurance company in the long term.
✨Her abdomen looks better, an added bonus for patients undergoing DIEP flaps!
✨She had full access to this operation through the use of her health insurance.
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I am honored to have treated this amazing lady and been a part of her journey! She is looking phenomenal and we are thrilled for her results!

At a time when the DIEP flap and other natural tissue reconstruction is most threatened in its availability to all women, I want to dedicate a series of posts to demonstrate the power of this important operation.
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This lovely lady was diagnosed with a right breast cancer for which she underwent right lumpectomy and left breast reduction. She then developed a recurrence, requiring right mastectomy and radiation. After a period of tissue expansion, I rebuilt the right breast using a standard DIEP flap and restored the left breast native volume using a smaller flap. This was all done with the help of my cosurgeon . The patient is looking and feeling phenomenal. This was all performed using her health insurance benefits in network.
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There are some critical things to recognize:
✨She is radiated, putting her at significant risk of implant complications for the rest of her life, making an implant a poor choice for the long term
✨Her defect is in the upper outer pole. An implant can’t get there!Natural tissue will mold into that sort of defect
✨She had ONE operation and a small revision and is finished with surgery, no need for exchanges or further surgery down the line, saving time for her and costs for her insurance company in the long term
✨Her abdomen looks better, the silver lining of a DIEP flap for many women
✨Her scars will soften and lighten with time
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I am honored to have treated this amazing and courageous survivor. We are thrilled for her final results.

Ladies, I just joined CBRAlliance and I am proud to support this nonprofit organization in its singular goal to preserve insurance-based access to breast reconstruction for all women. The ability for women to obtain access to all forms of reconstruction using their health insurance is protected by the Women’s Health and Cancer Rights Act but under constant attack by insurers.
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Patients, surgeons, and organizations can support the fight to preserve access for ALL women to breast reconstructive procedures by joining CBRA. Visit CBRAlliance.org to learn more, tell your story, and join the alliance.
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When it’s a random Tuesday and you walk in on your team building your superfine micro tray completely unsolicited..

Fridays are for flap revisions! Here’s one from my recent week. This is a breast reconstruction with free profunda artery perforator free flaps (PAP flaps). Her on table and one week follow up photos are shown.
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What is a PAP flap?! This is a reconstruction using tissue from the inner thigh. Excess tissue is removed from under the buttock fold or along the inner thigh as for a vertical thigh lift. I’ll show these donor sites in upcoming posts! Women with prior tummy tucks or without significant abdominal tissue may be good candidates for this option.
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What was done here?
✨Breast lift for proper skin envelope and ni**le position.
✨Ni**le and skin delay procedure.
✨Mastectomy with immediate PAP flaps.
✨Minor revisions with fat grafting, donor site contouring and scar revisions.
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Her result will be final in roughly 3 months. We are thrilled to share her result!