Episode 33: Democratization in Microsurgery: The Proximie System

This episode of the DiepCJourney podcast is well-timed to publish on March 1, 2024, the first day of lymphedema awareness month. We hope you will share this in your community for breast cancer patients affected by lymphedema to provide them with the resources needed to treat this condition and let them know there are specialists in surgical treatment options as well.

My guest is one such specialist. Dr. Charles Anton Fries is Chief of Plastic Surgery and faculty surgeon at UT Health San Antonio and works as a microsurgeon with the team at PRMA, Plastic Reconstructive Microsurgical Associates, in San Antonio.

It is important for listeners to understand the function and importance of the lymphatic system. Dr. Fries begins by explaining this and what can happen during breast surgery of any kind. He describes how the pumping mechanism that is the lymphatic system is compromised with patients who present with lymphedema.

Anything that damages or interrupts the lymph circulation can cause lymphedema as in axillary dissection and breast cancer surgery. Radiation adversely affects the muscle of the lymphatic system and can also cause lymphedema.

Dr. Fries tells us some of the symptoms at the beginning are heaviness and swelling from the accumulation of fluid. This is the time to start intervening with treatments to prevent progression. Lymphedema is incurable and progressive. He shares with us that compression, massage, and pumps are affective in managing the progression of lymphedema and the burden of fluid that can accumulate.

He points out the importance of patients taking a holistic approach to the management of lymphedema including maintaining a healthy weight. One such study shows there is a real correlation between obesity and severity of lymphedema.

We continue our discussion with surgical options both in the office and in the surgical theater. Dr. Fries and I touch on issues with insurance coverage, and he proudly shares that one of his own patients was an advocate working for insurance coverage for the treatment of lymphedema.

Links we discussed in the podcast:

PRMA lymphedema measurement chart: https://prma-enhance.com/wp-content/uploads/2021/03/Lymphedema-Chart.pdf

YouTube video of the Podcast with Dr. Fries: https://youtu.be/PlY5lb14ovY?si=Jyr7v-p2RhYuDpSD

Dr. Fries Social Media Accounts:

Instagram: https://www.instagram.com/antonfriesplasticsurgery/

Facebook: https://www.facebook.com/AntonFriesMD

LinkedIn: https://www.linkedin.com/in/anton-fries-md-phd-a4167318/

Twitter (X): https://twitter.com/AntonFries

This episode of the DiepCJourney podcast shares a fascinating story of a young woman who graciously and professionally takes us through her Journey from being diagnosed with breast cancer, cold capping, the affect on her family and young daughters, and to the story of her DIEP flap breast reconstruction.

She never felt a lump. She was enrolled in a high-risk program based on her family history. Because of this, she found the cancer early.

My guest is Lacey Terpstra-Reid. She is a registered nurse residing in Guthrie Oklahoma. In November 2022 she was diagnosed with triple positive breast cancer at age 33. Lacey has over 10 years of bedside experience as a nurse from working in a cardiac ICU where she cared for countless ECMO patients to her current role as an outpatient surgery recovery RN. She is a young mom to 3- and 2-year-old girls. She has spent this past year navigating her cancer treatments while chasing toddlers.

Lacey was familiar with the science behind the T-Stat flap monitoring system. In her work as an ECMO nurse she understands the parralels and how the oxygenation and blood flow that the T-Stat monitor used to monitor her flaps. 

Links to other topics we discuss in the podcast:

ERAS Protocol in Breast Reconstruction with Dr. Minas Chrysopoulo

DiepCJourney Facebook Support Group

Dr. Nabil Habash

How to Prepare for and Have a Shared Decision-Making Conversation

With any type of surgery there are risks and possible complications. We are tackling a topic on this episode of the DiepCJourney podcast that is frequently discussed in the community served at DiepCFoundation. I reached out to an expert in the field for our discussion on fat grafting in breast reconstruction.

Dr. Emily A. Williamson founded Plastic Surgery Northwest in Spokane Washington in 2010 after completing her surgical training at the prestigious University of Washington Plastic Surgery Residency. She works with a group of five other surgeons performing various aesthetic and plastic surgery procedures including autologous breast reconstruction like DIEP flap.

Preoperative patient education and counseling is imperative to minimize fears about fat grafting. Dr. Williams discusses how a skilled surgeon minimizes the occurrence of fat necrosis for both implant-based and autologous breast reconstruction. She describes how fat is utilized to achieve symmetry but also signs and symptoms of fat necrosis and what can be done for patients who develop this after a fat grafting procedure.

Recent study from France: Oncological Safety of Autologous Fat Grafting in Breast Reconstruction after Mastectomy for Cancer: A Case-control Study

Article from the Cleveland Clinic: Autologous Fat Grafting For Breast Reconstruction: Safe but Worrisome to Patients

Social Media Links for Dr. Emily A. Williamson:

Facebook: Plastic Surgery Northwest

Instagram: emilywilliamsmd

There is hard science to support the benefits of exercise for those who are affected by cancer of any kind. We will discuss this on this episode of the DiepCJourney podcast. The good news is that now the National Accreditation Program for Breast Centers (NAPBC) introduced new standards in January of 2024 for exercise oncology. Supporting this initiative is Maple Tree Cancer Alliance.

Nationally there are around sixty-five hospitals and locations Maple Tree Cancer Alliance is partnering with to help patients and the medical community implement these changes to improve the lives of those affected by cancer.

I am speaking to the Founder and CEO of Maple Tree Cancer Alliance, Karen Wonders, PhD, and their Chief Medical Officer, Dr. Jay K. Harness. They discuss the origins of Maple Tree and how it has grown internationally to provide free exercise training to thousands of cancer survivors. Their program is based on science and evidence with more than seventy peer reviewed manuscripts on the topic of exercise and cancer recovery.

Leading organizations across the world are supporting these efforts. We discuss the following organizations in our conversation:

American Society of Clinical Oncology (ASCO)

American Cancer Society

American Society of Breast Surgeons

Clinical Oncology Society of Australia (COSA)

American College of Sports Medicine

You can reach out to Dr. Wonders an Dr. Harness on LinkedIn here:

Karen Wonders

Dr. Jay Harness

Maple Tree Cancer Alliance

Millions of women across the globe have undergone breast augmentation using a medical device called a breast implant. This is done for reasons such as cosmesis, sometimes called enhancement of the breast, but also for trauma to the chest wall or for oncological reasons meaning breast cancer.

Any surgery is not without risks. Using a medical device like a breast implant is not different. This is the focus of our discussion on this episode of the DiepCJourney podcast. My guest is a leading expert in the field. We are going to discuss the medical definition, symptoms, diagnosis, and treatment BIA/ALCL. This stands for breast implant associated anaplastic large cell lymphoma. It is an uncommon form of ALCL.

I am speaking to Dr. Mark Clemens. After receiving his Medical Doctorate from Pennsylvania State College of Medicine, Dr. Clemens completed his Plastic Surgery residency at Georgetown University. In 2010, he came to the University of Texas MD Anderson Cancer Center in Houston, Texas where he completed a fellowship in Microvascular Reconstructive Surgery. Dr. Clemens is an active researcher whose interests include BIA-ALCL, long term implant outcomes, robotic-assisted, microvascular, and reconstructive surgery of the breast.

He is the author of the book, Phoenix Rising: Empower & Transform Through Breast Reconstruction. I am honored to list this book on the DiepCJourney Resources tab under Books.

Links to Dr. Clemens social media links can be found here:

LinkedIn: Mark Clemens MD, MBA, FACS

Facebook: faceook.com/clemensmd

Instagram: instagram.com/mclemensmd/

Twitter: twitter.com/clemensmd

I feel twice fortunate to be speaking to my guest on this episode of the DiepCJourney podcast on two topics, her specialty of performing DIEP Flap breast reconstruction and her role as conference scientific chair for the London Breast Meeting. It was a phenomenal experience for me to meet her in person at the London Breast Meeting where I learned a great deal from the game-changers in breast surgery, oncology, and breast reconstruction. This gives me the ability to bring more in-depth information to the listeners and breast cancer community we serve at DiepCFoundation.

I am speaking with Marlene See, a consultant in plastic and reconstructive plastic surgery at Guys and St. Thomas Hospital, part of the NHS Foundation Trust in London. Marlene’s specialists interests are breasts and microsurgical breast reconstruction. She trained in London at East Grinstead before embarking on her plastic surgery training. She completed her training in microsurgery at Guys and St. Thomas Hospital. Marlene is a published author on the topic of breast reconstruction, facial analysis, and lower limb reconstruction.

Marlene shares with us the history of when DIEP flaps were introduced in microsurgery. She outlines the reason it is often called the “gold standard” in breast reconstruction, and what area of the body microsurgeons use to reconstruct the breast for those affected by breast cancer. Who is a candidate for DIEP flap and what concerns do patients have about recovery for this surgery? She shares with us the importance of using ERAS protocol to enhance recovery.

We then switch topics and discuss the origins of the London Breast Meeting. Marlene and I glimpse into the celebration of the tenth anniversary of the conference and what the focus will be. It all began ten years ago with an invitation from colleague and friend Jian Farhadi while she was completing her microsurgical fellowship. Jian wanted to begin a conference on breast cancer treatment, breast surgery, breast reconstruction, and aesthetic breast surgery. It has evolved into one of the premier breast meetings to attend and be part throughout the world.

With that, I invite you to listen to the podcast as Marlene shares the goals and theme of the London Breast Meeting 2024.

You can find Marlene See and her colleague Jian Farhadi on Social Media accounts here:

Marlene See:

Instagram: seemarlene

LinkedIn: Marlene See

Jian Farhadi:

Instagram: plasticsurgeryfroup_by_farhadi

LinkedIn: Jian Farhadi

In this episode of the DiepCJourney podcast I speak to Nikki and Sean, a married couple who share the poignant story of going through Nikki’s discovery of a genetic mutation and facing the shocking news of breast cancer.

It is who we meet through our own breast cancer Journey that has a profound impact on a person’s personal life. Nikki and Sean are two of those people in my life. We experience a range of emotions together throughout the podcast because we have known each other for some time. This story needs to be shared in as much as it was difficult at times for us all.

Nikki and Sean give us an honest, raw, touching account of not only learning she had a genetic mutation putting her at high risk of getting breast cancer but also finding out after prophylactic DIEP flap breast reconstruction she found her own breast cancer. What is it like as a couple to hear the news, share it with two young sons, find the humor in life while facing breast cancer, and how they pulled each other through it all. They talk about surgery, chemotherapy, radiation, and recovery and survivorship.

There are valuable resources we wish to share with you that we spoke about in the podcast. You can gain access to all of them in the following links.

Outdoor Adventure for Young Adults Living with Cancer and MS

Yoga With Leona: Overcoming Breast Cancer Through Yoga

Harmony Hill Healing Retreat

Northwest Hope and Healing: Providing Financial Assistance to breast and gynecologic cancer patients.

Genetic Support Foundation

Mammograms are known to be the most common form of breast imaging to screen for breast cancer. This form of breast imaging is known to some to be uncomfortable and for some women culturally unacceptable. So, this DiepCJourney podcast interview sparked great interest in the work my guest is doing.

Professor Simona Francese, Professor of Forensic and Bioanalytical Mass Spectrometry at Sheffield Hallam University is my guest. Her work and interest in forensic science lead her to a serendipitous discovery published in a paper she authored with others entitled, “Non-invasive screening of breast cancer from fingertip smears – a proof of concept study”.

Professor Francese and I met at the London Breast Meeting this year where she opened the conference with her presentation on this topic. I was keen to follow up on an interview with her.

This interview along with slides she shares on the study can be viewed on the DiepCFoundation channel.

Research requires funding. As one who has had numerous mammograms, I am taking it upon myself to share information to reach out to Professor Francese for anyone interested in contacting her to bring financing to this project. It is a favor I am happy to do for her and to the breast cancer community I serve.

Simona Francese

Biomolecular Sciences Research Centre, Sheffield Hallam University

Howard Street S1 1WB, Sheffield, UK

Email: s.francese@shu.ac.uk

Tel: 0044 114 2256165

You can find links to her social media accounts here:

Instagram: forensic_geek

LinkedIn: Simona Francese

DIEP flap breast reconstruction most often requires surgical drains for post operative care. Patients often mention to me they are awkward, can become infected at the suture site where they are attached to the skin, and are cumbersome to hide under clothing after surgery when going out in public.

My guest on this episode of the DiepCJourney podcast has been in communication with me over the past year in anticipation of his recently published paper, Are Surgical Drains Needed in DIEP Flap Surgery? The Drain-Free DIEP Flap Concept.

Mr. Theo Nanidis, is a Consultant Plastic and Reconstructive surgeon with the NHS and private practice at The Royal Marsden. He graduated with distinctions from University College London Medical School in 2003 and completed his general surgical and higher plastic surgery training in London. Mr. Nanidis was awarded specialist fellowships at the Royal Marden and Queen Victoria Hospitals, where he spent two years specializing in microsurgery with a focus on breast reconstruction.

He has a special interest in surgical innovation and was awarded The Life Sciences Entrepreneur of the Year Award from Cambridge University in 2013.

His research interests include meta-analytical outcomes research, volumetric analysis of flaps and patient enhanced recovery pathways. He has published and presented his work nationally and internationally.

We reference a paper by Ms. Anita Mohan, Modified aesthetic abdominoplasty approach in perforator free-flap breast reconstruction: Impact of drain free donor site on patient outcomes. This was the impetus for further work and the recently published paper by Mr. Nanidis.

You can find his work on the following social media channels:

LinkedIn: Theodore Nanidis

Twitter: @drplas

Instagram: drtheonanidis

Facebook: Theo Nanidis Plastic Surgeon

Dr. James Craigie from The Center for Natural Breast Reconstruction in Charleston, South Carolina, discusses the use of clips, mesh, and sutures used in breast reconstruction surgery on this episode of the DiepCJourney podcast.

Many patients ask about these tools and devices. The information Dr. Craigies provides helps the listener understand their use and function in procedures like DIEP flap breast reconstruction.

This podcast cast is a remake of the DiepCFoundation video. We want to present platforms to watch and listen for patients as they reserach options for surgery after mastectomy. Our aim is to provide this information so the listener can takes notes, pause, rewind and replay the episode to prepare questions in order to have a shared decision-making conversation at their surgical consult for breast reconstruction for those affected by breast cancer and facing mastectomy.

You can reach out to their office on the account of their COO (chief operating officer):

Gail Lanter on LinkedIn