Plastic Surgery Chin Tilt

If you are a woman facing mastectomy you have a decision to make: do you want breast reconstruction? If the answer is "yes", plastic surgery holds the key. Although reconstruction cannot replace the breast(s) you were born with or allow you to breastfeed, it can restore your natural silhouette and make you feel "whole" again following mastectomy.

Depending on your health, breast reconstruction can be performed immediately after your mastectomy surgery so you can wake up with new breasts already in place. While the cosmetic results with immediate reconstruction are generally superior, breast reconstruction can also be performed at a later time once the cancer treatment has been completed ("delayed reconstruction").

The DIEP procedure is today's gold standard in mastectomy reconstruction. Advances in breast reconstruction have made it possible to use excess skin and fat from the abdomen (rather like the tissue removed during a tummy tuck) to construct a new breast without the need for implants or the sacrifice of abdominal muscle. This procedure, known as the Deep Inferior Epigastric Perforator (DIEP) flap, is a sophisticated modification of an existing procedure known as the TRAM (Transverse Rectus Abdominus Myocutaneous) flap.

TRAM flap surgery is a common breast reconstruction technique that requires the rectus abdominus (sit-up) muscle to be sacrificed and relocated to the upper abdomen. Unfortunately, this technique can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or "pooching"), and even abdominal hernia.

DIEP flap surgery is similar to TRAM flap surgery but spares the rectus abdominus muscle. SKIN AND FAT ONLY are removed from the abdomen, transplanted to the chest and connected using microsurgery to create the new breast. NO MUSCLE is sacrificed. As the sit-up muscle is left behind in its natural place many of the above complications are avoided and the patient essentially receives a tummy tuck at the same time as the breast reconstruction. There also tends to be far less pain following the DIEP procedure, and a quicker recovery time.

Knowing the significant advantages of the DIEP flap it is easy to understand the reason for all the hype, especially for active individuals who don't want to sacrifice the strength of their abdomen. A breast that has been reconstructed with fat and skin will also look and feel more natural than an implant reconstruction and will last longer. Unlike an implant, the reconstructed breast also ages like a natural breast.

As with all types of breast reconstruction however, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. Unfortunately, due to the complexity of the DIEP procedure very few centers in the US perform the surgery so many patients will have to travel for the procedure. The good news is that many of these specialist centers will accommodate out-of-state and even international patients.

To learn if a breast center or plastic surgeon near you offers this advanced form of microsurgical breast reconstruction, please check the following websites:
www.diepbreastreconstruction.org, www.breastrecon.com and www.diepsisters.com

The lists on these websites seem fairly thorough but there are plastic surgeons out there who perform DIEP breast reconstruction that have not made the lists (for whatever reason). Having said that, currently there are only about 40 plastic surgeons in the US that routinely perform the DIEP flap procedure. Before choosing a plastic surgeon ensure that he/she is certified by the American Board of Plastic Surgery and has extensive experience with the procedure. Ask about the success rate of the procedure in their hands (most specialists boast a flap survival rate of at least 97%) and how many DIEP flaps they have performed.

Insurance companies are federally mandated to pay for the cost of breast reconstruction. Unfortunately, some patients will still face difficulties in gaining access to a DIEP flap surgeon and the procedure. Here again it pays to seek out plastic surgeons who specialize in the procedure as typically insurance specialists are available to help patients with insurance issues.

Minas T Chrysopoulo, MD.
Plastic, Reconstructive & Microsurgical Associates (PRMA),
9635 Huebner Road,
San Antonio, TX 78240.
Tel: (210) 692-1181,
Toll Free: (800) 692-5565.
http://www.prma-enhance.com
http://www.breast-cancer-reconstruction.blogspot.com Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in DIEP flap, SIEA flap and GAP flap breast reconstruction following mastectomy.

The other day I happened upon an article on my MSN homepage titled How To Have a Midlife Crisis, by Hugh ONeil. I invite you to read his article, as it is both enlightening and immensely entertaining. Then, just last night, our local news featured a story on the whole fact vs. myth of the dreaded midlife crisis. With so much media attention on this issue presently, plus the fact that I am staring 40 hard in the face, I couldnt help but take a few moments to ponder how I might be affected by a midlife crisis. Yes, I realize that I am a woman, and the midlife crisis is typified as a male affliction. Nevertheless, the experts (whoever they are) agree that anyone, women included, can experience a midlife crisis. So, bear with me.

My immediate response was the disquieting recognition that several people I know who, like the men ONeil characterized as suffering from the midway heebie-jeebies, are undoubtedly showing telltale signs of said affliction. I laughed heartily at his references to men in their 40s who think that owning a Ferrari (or Jaguar, and you know who you are) will remedy all their midlife woes. I actually know men who have succumbed to that very notion. A wise woman once told me that middle-aged men who obsess over fast, noisy cars are somehow trying to compensate for their diminutive anatomy. How sad!

What truly struck me from both the article and the news report was that not everyone who experiences a midlife crisis is the worse for it. In fact, and I was ever so glad to hear this, many people, particularly women, find that midlife is one of the best times of their lives. Indeed, many women seem to revel in the changes they experience and admit that they feel stronger and more sure of themselves than ever before. Likewise, not all men go seeking extra-marital affairs, have creepy plastic surgery or give in to the hideous comb-over. Some men seem to become more gentile and distinguished as time marches on. Whats more, they are far less concerned about keeping up with the Joneses than younger men and feel no need to embellish the details of their lives, nor do they tout expensive jewelry or stylin clothes as evidence of their purported success.

The underlying seminal factor for weathering the midlife storm with grace appears to be an inherent desire for what is real and meaningful, not perceived or contrived. Similarly, people who find at least some degree of contentment in their less than perfect lives are more accepting of the inevitable failures we all experience in life and seem better able to bounce back from times of tribulation. I have watched far too many narcissistic people fall apart when the superficial bubble of perfection they worked so hard to build bursts, leaving them shocked, angry and bitter. Whats worse, some of them lash out at the world determined to place blame wherever it will stick to avoid having to look within themselves for the root of their problems. Its a shame, really, because if these same individuals would somehow find it within themselves to cast aside their overwhelming desire for attention and perfection and closely examine their lives as they really are, they would realize that what they have is more than acceptable. So what if you are bald, overweight and a member of the middle-class? Is that really all that defines us as human beings? For some, indeed, it does. Sadly, insecurity and envy are nearly always the driving force behind intolerance for the ordinary. Thus, those individuals who will never be satisfied being average or living a simple life will never escape the perpetual treadmill of craving. They will always run after more, bigger, faster and pricier things or, even worse, fabricate outrageous stories or exaggerate their experiences and successes to alleviate their supposed insignificance.

Personally, I think the Shakers had it right all along. They lived very simple lives and abhorred the opulence of modern society. That is not to say, however, that they were a backwards people. They were brilliant inventors and businesspeople and are credited for developing many of the necessary tools we use today, including furniture, brooms and washing machines. Nevertheless, they chose to live uncluttered, unpretentious lives. My family and I visited one of the still functioning Shaker villages in New Hampshire a few years ago. I was amazed to see such meager furnishings in the various dwelling houses. The Shakers took great pride in tidiness and efficiency. In fact, they are famous for their motto a place for everything and everything in its place, as well as for the celebrated song Simple Gifts. The Shakers were a deeply devout people, embracing with great fervor their rich, faith-filled culture and beliefs. They earned their name from their energetic and convulsive movements during their religious ceremonies. Sadly, the Shaker way of life is no more. All the brothers and sisters have passed on, leaving behind a legacy of honesty, simplicity, brotherhood and innovation. I somehow doubt that the Shakers ever experienced anything akin to a midlife crisis. They were too happily grounded in a simplistic yet fulfilling lifestyle. In my opinion, modern society could benefit tremendously from the lessons learned by the Shakers.

We truly are an overindulgent society obsessed with excess wealth, social status and superficial beauty. No wonder, then, that so many people self-implode when they crest the midlife hill and collide headlong into the brutal reality that they failed to achieve all the unrealistic goals they imposed on themselves in their 20s. I must sheepishly admit that I, too, once subscribed to the notion that success was measured in terms of material possessions, ones professional title and the enormity of ones mortgage. I was just another rat in an endless maze, putting on airs so I could hobnob with the socially elite. Then a series of unexpected events in my life helped me to see how truly pointless those efforts were.

Now, I focus more on the things that really matter my health, my family, my spiritual and community values and pursuing my true passions in life despite the disapproval of others. I have never been preoccupied with looks or fashion. One look in my closet will certainly confirm that. Even in high school when all the other girls were getting up at 5 a.m. to fix their hair, I chose to sleep as long as I could before getting out of bed. Oh, and by the way, I have a head full of prematurely gray hair. I used to color it because I was embarrassed by it. Not anymore. It is what it is. I dont wear much, if any, makeup. I own a grand total of 5 pairs of shoes and 2 purses (none of which cost me more than $20). Anyone who knows me at all will agree that I tell it like it is, and what you see is what you get from me. I have no hidden agenda, nor do I put on airs to impress people. I could care less about owning expensive cars or a vast estate. I wear very little jewelry other than my wedding ring. My favorite outfit consists of a well-worn pair of jeans and a sweatshirt. Our home is average sized with modest and comfortable furnishings. Thats just me. I like simple things. I enjoy watching a beautiful sunset. I love reading the paper on Sunday mornings. I look forward to movie and game night at home, especially when my husband and kids help me make a savory dish straight from the Food Network. I enjoy watching our Boston Terrier, curled in a ball with one paw on my leg, snooze on the couch beside me as I write. I love to hike and camp with my family and go kayaking with my daughter. I love to be creative and spontaneous. I love photography and writing. I find peace and higher meaning when trekking through the mountains or in the desert. I will never be rich, nor do I wish to be. I will never look like Cindy Crawford, much to my dismay. I value compassion, kindness and generosity. In fact, I have been repeatedly told that I do too much for people and have difficulty saying no. And, as already established in a previous post, I am a sap (or, as I prefer to call it, a highly sensitive person). I like to get things done right and must admit that I am not exactly noted for being the most patient person, though I am working on that. I have no problem admitting my character flaws or owning up to my mistakes just ignore the red face. Despite all my flaws, and there are many, I like who I am and feel secure in where I am going with my life.

Having realized all that about myself, I am not afraid of midlife, nor of any crisis it may bring. My husband and I have faced our fair share of tragedy and difficulty, which has made us both stronger. My husband, though very intelligent, is simple by nature. He has a delightful sense of humor and is about as unpretentious as a man can be. He keeps me grounded when I start to falter.

The truth is that I have always been a big picture person, so I seldom allow myself to get too mired in trivial details. Rather, I like to focus more on the end result. As Hugh ONeil put it, At midlife, it helps to start working on what you'll leave behind. He mentions that a good natured child is a great legacy. I would have to agree. Thus, I feel truly blessed, as both of my children are good-natured, compassionate and genuine. If that is all I leave behind, then I feel I have contributed significantly to making the world a better place.

So, to midlife I say welcome. Ive been expecting you!

Kim Balsman is a professional photographer, writer and owner of Balsman Photography, LLC. Kim offers real stories, anecdotes, advice and humorous thoughts about life in her personal blog, http://www.balsmanfamily.wordpress.com