Dr. Randall Feingold of Aesthetic Plastic Surgery, PC, discusses breast reconstruction on Heath Matters, a show that allows doctors to share their experiences with patients. He discusses his practice's unique approach to breast reconstruction procedures that includes comprehensive treatment. Aesthetic Plastic Surgery, PC, has started an initiative to teach advanced techniques to surgeons across the country and improve available care for women with breast cancer.
Julie: Thanks to groundbreaking initiatives and public awareness, like Breast Cancer Awareness month which we celebrate every October, many women know the basics about breast cancer itself but you might be shocked to find out how many women still don't know anything about breast reconstruction.
If you're one of those women we are thrilled to have one of the foremost breast reconstructive surgeons and breast cancer patient advocates in the United States here with us today, Dr Randall Feingold. Welcome. We are so glad you're here with us today.
Dr. Feingold: Thank you, Julie, happy to be here this morning.
Julie: It's great. You know, I know that it seems shocking to me and I think it will to others, that so many women don't know about breast reconstruction. Why is that?
Dr. Feingold: Well, seven out of ten women in this country are not even aware that breast reconstruction exists as an option.
Julie: Wait, that shocks me. Seven out of ten women don't know about . . .
Dr. Feingold: Twenty percent of women who undergo mastectomy go on to reconstruction. Only 20%
Julie: Only 20%.
Dr. Feingold: That's correct.
Dr. Feingold: I think that traditionally medicine has focused on disease management as opposed to restoring a woman's wellness and wholeness. And there are certainly communities where general surgeons operate on women and they don't have access to plastic surgeons.
Dr. Feingold: Also, I don't think many women know that breast reconstruction is covered by health insurance. In 1998, the federal government passed the Woman's Health Care Rights Act that mandates health insurance coverage for all breast reconstruction of the patients choosing in all 50 states.
Julie: That is, that fact alone is going to change some lives today here. You know, I know you pioneered some groundbreaking new reconstruction techniques. I want you to tell me about that.
Dr. Feingold: First, people should know that the mastectomy itself has been simplified. Instead of removing all of the breast skin as it had been in the past which was disfiguring . . .
Dr. Feingold: . . . now with skin sparing mastectomies and nipple sparing mastectomies we get to keep the entire original skin envelope which facilitates the reconstruction.
Dr. Feingold: We can go directly to a final breast implant in just one operation which we couldn't do before. And now there are great advances in microsurgery that allow us to transplant natural tissue such as body fat to create a new breast for a woman. A DIEP flap or D-Flap uses fat from the abdomen which can be removed.
Julie: Let's get the fat out of the abdomen.
Dr. Feingold: We can remove it and then we can drop it back into the original breast form, reattach it with a microscope, and then the patient wakes up from her mastectomy with two warm living breasts that grow with her, develop some feeling and this is a very elegant, beautiful way to wake up from a mastectomy.
Julie: Oh, my gosh, that's groundbreaking, Doctor. I mean, I know you're passionate about reconstruction, but I know that patient care has been a big part of your journey. Tell me about that.
Dr. Feingold: Patients with good looking breast reconstructions might still be uncomfortable with themselves or even depressed. When you consider that a woman's breast is her symbol of femininity and sensuality, you come to the conclusion that it's going to take more than an operation to restore her sense of well-being. So we embarked upon a program of initiatives that would allow us to provide more holistic care that went beyond what a traditional plastic surgery practice would offer, and we call our program New York Breast Reconstruction Alliance or NYBRA.
Julie: NYBRA. I mean, that's a great acronym I love that. And we'll find out all about this right after the break, so don't go anywhere.
Julie: Welcome back. We've been speaking with Dr. Feingold a foremost breast reconstructive surgeon, and now we're joined by Kim Dresher. Kim, you're a breast cancer survivor and I just want to thank you for being with us today. I know that you have the BRCA gene. First of all, how are you doing?
Kim: I'm doing well and I'm whole again. I'm healed, active, involved with advocacy for BRAC, a proactive previvorship. I have two sisters who have gone through prophylactic mastectomies with reconstruction as well, one being my identical twin sister. So you can imagine my anguish at waiting for my twin sister to do this.
Julie: Can you bring us back to that time after your diagnosis and when you were making that life-changing decision.
Kim: I was a deer in the headlights. Upon hearing the word cancer I chose Dr Feingold because he has this well-rounded holistic practice with all the support that I needed psychologically, and I was able to get involved in the larger breast cancer community because of his practice and be an advocate and encourage support and inspire other women.
Julie: That's great. Dr. Feingold, how does the Breast Reconstruction Alliance help patients like Kim?
Dr. Feingold: Well, our program begins before the consultation with patient education. We all go to the internet for information. Some of it's good, some of it's bad, right? So we created an educational website called BreastReconstruction.org where patients can get fair, accurate information and read about patient stories and connect with them before the consultation.
At the time of the first consultation our patients are introduced to our innovative patient empowerment program, or PEP as we call it, and our clinical coordinator meets with them, assesses their emotional needs, meets with their spouses, gets an understanding of their family situation, connects them with other patients who have had the same operation they're headed for, through our sisterhood of support, and then prepares them with guided imagery for stress relaxation before surgery.
Julie: That does sound unique. Now Kim, based on what you went through, how important is this patient empowerment concept of pre-surgery counseling?
Kim: Very impactful. I was able to go to surgery understanding how this was going to affect me. I was able to speak to someone regarding my feelings about my husband and my children and my friends and how they're dealing with what I'm going through. So I went in prepared for the next big experience which was the major surgery.
Julie: That's amazing. Doctor, what about post surgery?
Dr. Feingold: Our holistic approach starts with support groups after surgery of women that are helping other women through the recovery phase. We have support groups for patients, support groups for couples, support groups . . .
Julie: Couples. That's very important.
Dr. Feingold: . . . spouses only. So the men get together and talk about the issues that impact them when they see their wife going through this process. We even have a support group for men with breast cancer, which is a rare diagnosis but neglected in the community. Then we have monthly workshops where we bring in experts certified mastectomy bra fitters, lymphedema management specialists, dieticians, nutritionists, exercise physiologists. We hold yoga workshops and writing workshops. So our patients are able to recover in an environment that's warm and nurturing.
Julie: Kim, how did you do after surgery?
Kim: I was able to go into the support system with Dr. Feingold's office, and by the way, I'm one of the patients that had that miracle surgery where I left the hospital whole again. And that made a tremendous difference to my self-esteem.
Julie: And you also wrote a book, right?
Kim: Yes. I'm a portrait photographer. I photographed all the women in my support group, and then I created an exhibit which lasted two months, and then I published the book for a keepsake of the memory, of the event and the memory of the support that I had.
Julie: Well, Dr. Feingold, it's called The New York Breast Reconstruction Alliance, but it's also for women outside of New York, right?
Dr. Feingold: Well, we're trying to have an impact across the country. We have a microsurgery training program where plastic surgeons come to us for advanced training in microsurgery so they can bring these techniques to other parts of the country. We're also very active in community service, fund-raising for entities such as the American Cancer Society to help find a cure, but we're also proud sponsors of the BRA Day USA initiative of the American Society of Plastic Surgeons.
Julie: BRA Day. I love it. What is it?
Dr. Feingold: BRA Day stands for Breast Reconstruction Awareness day. It occurs during Breast Cancer Awareness Month. Its inaugural event was last October. Its goal is to increase awareness about breast reconstruction and teach the team approach, and our national spokesman is that beautiful and talented singer/songwriter Jewel.
Julie: You know what, Dr. Feingold, you rock. You rock.
Dr. Feingold: Thank you.
Julie: Thank you for all that you're doing for women and Kim, beautiful, gorgeous, whole again. I just wish you great health. It was great having you both here today. All right. And if you're a breast cancer patient looking for some of these groundbreaking resources, head straight to the BalancingAct.com, and don't forget to follow us on Facebook and Twitter.