Breast Reconstruction Choices Shine Bright

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Although breast reconstruction has been around for some time, it really wasn’t until 2008 that it received bright spotlight attention.

Well known actress, Christina Applegate, publically announced her decision to have a bilateral mastectomy followed by immediate breast reconstruction. She was diagnosed with breast cancer and also tested positive for the BRCA gene.

Many embraced Applegate’s strength when she underwent her reconstruction at 36 years of age.

A few years later, Angelina Jolie, who tested positive for the BRCA gene, made her decision on breast reconstruction, as well.

Although these two celebrities never meant to be spokeswomen for breast reconstruction, they certainly provided other women with immense education, dialogue, and hope.

Above all, they empowered women to take control.

Breast reconstruction is a personal decision. With the guidance of specialists, including a board certified plastic surgeon they will be able to recommend the best type of reconstruction surgery. Any cancer treatments including radiation is also part of the reconstruction assessment and consideration.

Different types of breast reconstruction may include:

• Tissue Expansion
• TRAM FLAP
• DIEP FLAP
• SGAP FLAP

Tissue Expansion offers an easier recovery, but the levels of reconstruction with frequent saline fills and implant exchange surgery will make it longer.

The various FLAP surgeries are utilizing a patient’s own muscle and tissue to recreate a breast, and if needed, to hold an implant. It is an in-depth, initial surgery with more recovery, but takes less time in the long run than Tissue Expansion.

Most women who have undergone breast reconstruction to either one or both breasts agree that it does not feel like their natural breast. It’s not an augmentation, it’s a reconstruction. While there will be some scarring, a portion of it will fade in time.

While advances in breast reconstruction continue to move forward, it’s still a journey which requires patience. And a support system will make the road much easier to travel.

Having a strong relationship with a plastic surgeon is critical. It’s encouraged to discuss what to expect before, during and after the procedure. Being well-informed is incredibly helpful.

Be assured that if a doctor has chosen this as their specialty, he or she is well-aware of the emotions surrounding this surgery, so they will be helpful throughout the entire process. Likewise, so will their medical support team in the office.

The signs and symptoms of breast cancer

Photo by Jessica Laike
Photo by Jessica Laike

As we near the end of Breast Cancer Awareness Month, it’s important to keep in mind that breast care health should be done every month, not just in October. And this begins with monthly breast-self exams.

According to statement made by the John Hopkins Medical Center, they estimate that 40 percent of diagnosed breast cancers are detected by women who felt a lump.

This startling percentage should make monthly breast self-exams a priority on the calendar.

While mammograms and other screenings can pinpoint cancer before a lump can be felt, don’t overlook a self-exam, because it allows women the ability to become familiar with her breasts and alert her if anything changes.

While all lumps are not cancer, if any of the below changes do occur, please schedule an appointment with a doctor.

• A breast lump(s)
• Rash around or on nipple(s)
• Lump(s) underneath the armpit
• Armpit or breast tenderness or swelling unrelated to a menstrual cycle
• A spot or area of thick breast tissue
• Nipple changes such as inverting, scaling or peeling

Stay diligent with breast health awareness and remind family and friends to do the same. By doing so, women can catch the disease early and more lives can be saved.

Dr. Bolitho Welcomes New Team Member

Karen
Dr. Bolitho is delighted to introduce his new Patient Concierge, Karen Martindale, at his La Jolla medical practice. Karen brings a wealth of knowledge and impeccable patient care.

Working in the cosmetic industry for the past 25 years, Karen has had the pleasure to know Dr. Bolitho. Over time, their mutual respect for one another has grown and Karen is thrilled to be part of Dr. Bolitho’s team.

Because of Dr. Bolitho’s loyal and wonderful patients, his practice has bloomed; and, Karen has arrived at the perfect time.

With Karen onboard, some exciting changes have taken place in the office.

For cosmetic cases, patients are no longer required to make a 50% deposit at the time of scheduling. Now, the required amount is only 10%, giving patients more financial flexibility.

Financing options are also abundant. Through Care Credit, they offer 6 months financing at a zero interest rate. Likewise, they also provide 24, 36, 48 or 60-month payment options at 14.9% percent interest.

Karen is on hand to answer all your questions and be your personal patient concierge.

While our team member, Kandie, expertly addresses any insurance preauthorization and scheduling for medically necessary procedures, Karen helps provide tailored care and guidance during the cosmetic surgical journey.

Please join us in giving Karen a warmhearted welcome.

Different types of breast cancer

Human Pink Ribbon
We are a little more than halfway through Breast Cancer Awareness Month and more education is still out there for all of us.

If a woman is diagnosed with breast cancer, typically, she will be diagnosed either with non-invasive breast cancer or invasive breast cancer.

The difference between the two is the following:

Non-Invasive Breast Cancer is when the cancer cells are in its starting point and have not moved out of that area. For those diagnosed with ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS), the “in situ” definition means “in its original place.”

In these instances, ductal carcinoma in situ has remained in the milk ducts, whereas lobular carcinoma in situ means the cancer is within the lobules.

When one is diagnosed with DCIS or LCIS, steps for surgery and/or treatment is dependent on a patient’s breast cancer family history and any genetic testing done. This is the earliest stage of cancer since the cancer has not broken out of its place of origin.

Depending on the patient and their genetic risk, some breast cancer surgeons and oncologists may agree that a lymph node should be tested and/or removed on the side where the breast cancer was detected. Ruling out cancer advancements and being extra cautious in certain patient cases is incredibly important.

Invasive Breast Cancer, on the other hand, means the cancer “broke out” from its place of origin be it in the ducts or lobules and advanced to other neighboring tissues. If one is diagnosed with invasive breast cancer, a number of lymph nodes will be removed and tested.

Because invasive cancer has the ability to get into the lymphatic system or the bloodstream, a breast cancer “stage” diagnosis will help determine the right course of surgery and or treatment.

A reconstructive plastic surgeon may also be part of the medical protocol.

Another type of breast cancer, considered rare, is inflammatory breast cancer (IBC).

Because IBC is a sheet-like structure, mammograms cannot pick it up because it’s not like a regular breast cancer tumor. There’s no nodule to detect, but there are different signs.

IBC blocks the skin’s lymph vessels which will cause breast inflammation, tenderness, warmth, and redness. At first, a woman may mistake it for a rash or infected bug bite. Of course, if these signs persist more than a week, do seek a breast health specialist or your doctor for their advice.

Monthly breast self-exams, regular mammograms, and other forms of breast health screenings empower mothers, sisters, daughters and friends to “fight the fight.”

National Mammography Day: October 17, 2014

National Mammogram Day
While in the midst of Breast Cancer Awareness month, National Mammography Day officially arrives tomorrow, October 17. The day is meant to “trigger” awareness for all women in hopes they pick up the phone and schedule their next digital mammogram.

For women who have a family history of breast cancer, please speak with a doctor to determine the best time for a baseline mammogram and the frequency of future ones.

Detecting breast cancer early is the ultimate goal.

This proclamation was signed in 1993, having this day fall on the third Friday during the month of October.

Provided by the Maurer Foundation and other excellent breast health resource agencies, here are some tips to help prepare a woman for their next mammogram appointment.

1. Timing means a great deal when scheduling a mammogram. If one is still having their menstrual cycle, make the appointment at the end of the cycle. Radiologists claim the readings are more accurate and compression levels are better tolerated since breasts are less tender. Comparison of films from previous years is also another great advantage.

2. If possible, schedule the mammogram at the same imaging center. If this is not an option, be sure to bring your disc of images or films to the appointment.

3. Go to an imaging center which is accredited by the American College of Radiology.

Don’t forget: “Mammograms save lives.”

Next Step: What to do after finding a breast lump?

By NailStorm1
By NailStorm1

October is Breast Cancer Awareness Month and a time for all women to be reminded of their breast care health. While pink ribbons abound, the opportunity for free or discounted mammograms span across state lines.

Literature and verbal reminders for monthly “Breast Self-Exams” is also echoed. Monthly self-exams keep a woman familiar with how her breasts look and feel. And if something changes, she will be alerted, immediately.

For women who perform their monthly exam, and in doing so find a lump, it can trigger immediate anxiety.

However, it’s important to remember that not every breast lump is cancer.

The Mayo Clinic recently reported that a large percentage of breast lumps discovered in women between their 20s to early 50s, are indeed, benign.

With that said, when a lump is found, one must contact their doctor immediately for an appointment to determine the root cause of the lump.

Always lean toward the side of caution.

A doctor will help evaluate the lump through a clinical breast exam, which also involves the armpit area. They will look for any skin areas of thickening and additional lumps.

If a closer look is warranted, a doctor will order one or more of the following:

• Diagnostic mammogram
• Ultrasound of the breast(s)
• Breast MRI (which may be ordered following a diagnostic mammogram for a clearer view)

If the lump in the breast contains liquid, generally, a fine-needle aspiration is used. An example of this would be a cyst which likely disappears once the fluid is removed.

However, if the lump is solid, there are usually two options. Either the lump will be closely monitored in the months ahead for any changes, or, a biopsy is performed.

Undergoing testing and biopsy procedures is undeniably unnerving. It’s important to remember to take one step at a time and know there is support at every turn.

The most common question remains, “What are breast cancer symptoms?”

In addition to a specific lump, these additional symptoms may also be present:

• Swelling around the breast area
• Swelling around the armpit
• Swelling around the collarbone
• Nipple discharge
• Nipple appears thicker or scaly
• Warm or itchy sensation in the breast

If cancer is discovered, a breast cancer team including a breast cancer surgeon, oncologist, radiologist, and if needed, a reconstructive surgeon, will support a woman through this journey.

Such a team will help a woman cross the finish line of “Hope.”

November 7: Special Pre-Holiday Event

Woman Christmas anankkml
Dr. Bolitho will be hosting a special event on Friday, November 7, 2014!

Don’t miss out on these amazing promotions for your
pre-holiday season!

* Juvederm: $50 off 1st syringe, $150 off 2nd syringe (Reg. $600/1cc syringe)
* Botox: $10 per unit (Reg. $12.50/unit)
* Botox/Juvederm Combo: $9 unit for Botox & $75 off Juvederm
* Latisse: $120.00 for 5ml vial (Reg. $150.00)
* Voluma: $100 off each syringe. (Reg. $1,000/1cc syringe)
* Skin Medica: Free 3ml Latisse, a value of $90.00, with a purchase of TNS Essential Serum

Please arrive 15 minutes prior to your appointment to receive a complimentary skin evaluation with the “Reveal Imager” and consultation for developing a customized skin care regimen, regularly priced at $75.00. It’s our pre-holiday gift to you!

Call or e-mail to schedule your appointment at 858-458-5100 or info@bolithomd.com

We look forward to seeing you!

*Save Money every time with Brilliant Distinctions! If you do not have a Brilliant Distinctions account and would like to learn more about the loyalty program and how to earn coupons please call our office.

Dr. D. Glynn Bolitho voted as 2014 “Top Doctor” in San Diego Magazine

Dr. Bolitho
Annually, the San Diego County Medical Society invites votes from its peers to choose the best physicians in San Diego. In tandem with the physicians, residents from the county also await the vote calculation results published in the “Top Doctor List,” a special edition of San Diego Magazine.

Dr. D. Glynn Bolitho, a board certified plastic surgeon, has received this honor for three consecutive years, beginning in 2012. He is both honored and humbled that his colleagues continue to recognize his medical contributions.

According to the data, more than 1,300 physicians, both members and nonmembers of The San Diego Medical Society, took part in the voting process. In the “Plastic Surgery Category,” Dr. Bolitho was 1 of the 10 doctors celebrated in their specialty.

Included in this 11th annual “2014 Top Doctors” special edition, a total of 732 physicians were highlighted as “Physicians of Exceptional Excellence” in their chosen healthcare fields.

Dr. Bolitho has practiced cosmetic surgery for more than 20 years. He describes this field of medicine as one which affords patients an array of options they never thought possible through cosmetic and reconstructive surgeries.

Dr. Bolitho completed his plastic surgery fellowship training at Emory University in Atlanta. After leaving his full time faculty position at Emory, he opened the doors to his La Jolla private practice in 2000.

Serving as the current Chief of Plastic Surgery at Scripps Memorial Hospital, La Jolla, Dr. Bolitho also fulfills a non-salaried appointment as Associate Professor of Plastic Surgery at the University of California, San Diego.

Dr. Bolitho is an active member of the American Society of Aesthetic Plastic Surgery, the American Society of Plastic Surgeons, and the International Society of Aesthetic Plastic Surgeons.

Adjacent to Dr. Bolitho’s medical practice located at the Scripps Memorial La Jolla campus is his private operating
suite, accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

In addition to surgical procedures, Dr. Bolitho’s office is committed to providing a range of non-operative facial rejuvenation services such as fillers, skin resurfacing and laser treatments.

Chemical peels compliment surgical facial rejuvenation

FreeDigitalPhotos.net by Marin
FreeDigitalPhotos.net by Marin

The world of cosmetic surgery offers so many avenues for facial rejuvenation. And the strides made in this field of medicine have been immense.

Surgical facial rejuvenation also referred to as facelifts, offers wonderful results. From full to limited procedures, years can be removed from an individual’s facial features.

As well, even incorporating fat transfers in the procedure to add youthful volume is another excellent option.

While these surgical advancements lift, reposition, and renew, what it does not address is a patient’s skin texture.

And that’s when a chemical peel can be of great benefit.

While every patient’s aesthetic needs differ, undergoing chemical peels about six months following a surgical procedure will inevitably provide an additional renewal boost.

For example, during a surgical facial rejuvenation, oftentimes areas around the mouth cannot be addressed. But it can be dealt with a peel.

Chemical peels compliment the surgical procedure and redefines one’s skin texture in a variety of ways such as reduces fine lines; improves skin texture; evens out skin tone; fades age spots and freckles; and, boosts collagen which promotes younger looking skin.

By way of a chemical peel, the top layers of dead skin cells are buffed away. And a series of these offer wonderful results.

A facelift and chemical peel offer two separate benefits. Each serve their own rejuvenation role, and by combining them, the outcome can be quite significant.

Many plastic surgeons like offering chemical peels because they are well-tolerated and patients do not require general anesthesia.

A chemical peel lasts around 45 minutes. And while each layer is applied, any discomfort is minimized with a fan to cool off the treated area.

Most San Diego plastic surgeons typically use an AHA or TCA gel peel. A series include either five or six sessions. And each one is done a few weeks apart in order for the skin to be prepared for the next rejuvenation round.

Patients can expect some minimal side-effects such as:

*Flaky skin
*Redness
*Skin sensitivity

A hydrating moisturizer will help with these side-effects, and the medical office will have the right products in their inventory for a patient to take home with them.

As well, wearing a broad spectrum is essential when outdoors following a chemical peel.

Be sure to follow a plastic surgeon’s advice following this treatment to ensure the most optimal outcome.

Typically, a skin savvy team recommends a chemical peel series every year to help keep skin look its very best.

And following a facelift, these peels will provide a lovely facial canvas.

The Right Pain Management Eases Mommy Makeover Recovery

Moms see positive improvements with rejuvenation surgery.
Moms see positive improvements with rejuvenation surgery.

A Mommy Makeover is a term used by many people for women wanting body rejuvenation after having their babies. This surgery is recommended when a mother has decided she has completed her family.

According to percentages by the American Society of Plastic Surgeons (ASPS), Mommy Makeovers are steadily increasing. In the lead, is a tummy tuck increase of more than 80 percent since 2000, followed by breast lifts in the same timeframe at around 70 percent.

San Diego Mommy Makeovers are a popular procedure.

While mothers adore their children, many yearn to have their pre-pregnancy day physique back.

And they can, with a mother rejuvenation procedure which includes a tummy tuck, breast lift and/or breast augmentation surgery.

Generally, these rejuvenation surgeries for the abdomen and breasts are combined during one procedure.

While women adore the idea of having these areas of their bodies renewed, naturally, they are concerned about their recovery time.

A board certified San Diego plastic surgeon will tell patients that recovery varies with each patient.

For those who only require a breast lift or breast augmentation, recovery may last about 7 to 10 days. However, if a tummy tuck is included, recovery may take two to four weeks.

Also known as an abdominoplasty, healing could vary, as well. Some patients may only need redundant skin removed, while others, may need muscle repair which takes more recovery time.

In any event, pain management is the most important role in recovery, especially regarding a tummy tuck.

The good news is pain management has vastly improved. Conversely, when pain management starts in the operating room, it has a direct correlation in terms of patients doing well in the long term.

There are three top-tier management methods which are being utilized:

One-Stick: This long-lasting opiate is injected into the spine, via a one-stick. For up to 18 hours pain is well managed. A one-stick requires less general anesthesia during the course of the surgery which means patients awaken more lucid, less nauseated, and are in limited discomfort. Hospitalization for one night is required with the one-stick.

TAP Block: A TAP Block delivers local anesthesia into the abdominal wall, thereby anesthetizing the intercostal nerves. This anesthesia can be administered during or immediately after the surgery. A TAP Block can last up to a few hours, however, if Exparel is utilized, pain management may last a few days.

Local Anesthetic Pump: Local anesthesia is administered by a catheter and directly to the surgical site. Typically, these pumps are used for a few days.

Do discuss pain management options with a board certified plastic surgeon, and by doing so, choose the best one for a particular procedure.

It’s also important to point out that if liposuction was used during the tummy tuck, a compression garment will be worn for a few weeks.

During the recovery phase, it’s highly recommended for mothers to get the assistance they need by means of a certified nurse’s assistant, friend, or family member for a few days. Proper healing will allow a patient to make great strides in their recovery.