DiepCJourney Podcast Terri Coutee

I have been fortunate to have discussions with surgeons in the U.S. on lymphedema. This is a topic I feel should be discussed with international surgeons as well. As part of my work with DiepCFoundation I am fortunate to meet surgeons from around the world at various plastic and microsurgical conferences. I will be talking to one of these microsurgeons on the DiepCJourney podcast. We need to know all we can about lymphedema, lymphedema surgery, how microsurgeons across the world are treating breast cancer patients for this condition, and so, this is our topic of discussion from a guest in London, in the United Kingdom.
Ms. Maleeha Mughal is a Consultant Plastic & Reconstructive Surgeon at Guy's & St. Thomas Hospital. She specializes in Breast cancer reconstruction, Head and Neck cancer reconstruction and lymphedema surgery. 
Ms. Mughal shares a personal story and why she made the decision to choose plastic reconstructive surgery as her profession. She describes the type of lymphedema she treats, the type related to cancer.
We discuss the causes, treatment, and surgical options for a condition that is not curable but treatable. One of the most important points in our discussion is early treatment and what symptoms to watch for. The sooner lymphedema is treated, the better the management of the conditions related to lymphedema. Lymphedema can affect a person's quality of life and ability to perform daily tasks and work.
Links to Important Resources and Ms. Mughal’s LinkedIn Account.
British Lymphology Society
Breast Cancer Now: A Research and Support Charity in the UK
Ms. Maleeha Mughal: LinkedIn
 
 
 

The two-surgeon model in microvascular breast reconstruction and concerns about insurance coverage is a topic we are tackling on the DiepCJourney podcast. I have NOT come to understand the complexities of insurance but have gained a great deal of empathy for those in the breast cancer community who deal with these complexities, and that includes patients and surgeons.
I was certain I needed to invite a guest I was completely comfortable discussing this topic with.
We go back a bit. I have built trust in his principles over time and his focused passion on patient education. You have heard him on the podcast before, but he has gained a great deal of respect in the global community of microvascular breast reconstruction. I honor our listeners by introducing a friend, a patient-advocate champion, and someone I know will help me feel more comfortable tackling the subject matter and discussion of the podcast.
Dr. Minas Chrysopoulo is the current president of PRMA in San Antonio Texas. He knows a thing of two about microvascular breast reconstruction having performed over twelve thousand various breast reconstruction flap procedures with his team of colleagues at his practice. He is the Founder and Developer of the award-winning Breast Advocate app, a free breast cancer healthcare app providing the user with all your surgical options, a plethora of evidence-based resources, and a customizable and adaptable patient experience through the wizard, along with a community feature of like-minded users to share information with.
I have chosen this topic not to appear to be controversial. It is a topic that can stir emotions, and I have seen it presented in what I can only describe as a dramatic way. That will not be the type of presentation on this podcast today. I am discussing this topic now because of a heightened sense of concern regarding insurance coverage using the two-surgeon model, sometimes referred to as co-surgeon model in DIEP flap and microvascular breast reconstruction.
Studies on the Co-Surgeon Model:
1.     https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.30191
2.    https://journals.lww.com/plasreconsurg/abstract/2022/02000/microvascular_breast_reconstruction_in_the_era_of.8.aspx
 Links to other topics we discuss in the podcast:
DiepCFoundation Video: The Value of a Consistent Breast Reconstruction Surgical Team
S-code issue of 2023: The Patient Voice Has Been Heard!
ERAS Protocol: ERAS Protocol in Breast Reconstruction
Dr. Chrysopoulo Social Media Accounts:
Instagram: https://www.instagram.com/mchrysopoulo
Facebook: https://www.facebook.com/DrChrysopoulo
LinkedIn: Minas Chrysopoulo, MD FACS
Twitter: @drchrysopoulo
 

Whether you have had a breast cancer diagnosis, have a genetic mutation placing you at high risk of getting breast cancer, have had or are facing a mastectomy due to either of these situations you will want to listen to this episode of the DiepCJourney podcast.
The time has come to share a personal story of a woman I interviewed twice about her decision to have a prophylactic mastectomy and implant reconstruction. This is the continuation of her Journey. She came to a decision to exchange the implants she never quite felt comfortable in and transition to DIEP flap breast reconstruction and use her own tissue this time around.
Margaret Tueller Proffitt has a delightful Instagram account and describes herself as a lover of books, learning and travel. She is a Mom to four, wife to one, and friend to all. I am honored to have my friend Margaret on the podcast.
On a recent trip to San Antonio to do advocacy work for DiepCFoundation, I visited PRMA where I had my own reconstruction. I received a text from Margaret mentioning her desire to transition from implants to DIEP flap. More importantly, she told me she was considering PRMA and wanted to know who I would recommend. Knowing Margaret as I do, I gently guided her to contact Dr. Lauren Whipple.
In the weeks following that text, I watched and waited until her surgery date, answering more questions, and guiding her through a very familiar experience to me, traveling for DIEP flap. There are so many similarities to our story. We had the same breast surgeon perform our mastectomy in Tucson where both of us lived at the time and Margaret still does. The similarities grew when I found out who would be the co-surgeon with Dr. Whipple the day of Margaret’s DIEP flap. Dr. Minas Chrysopoulo, the surgeon who performed my DIEP flap, would be working alongside Dr. Whipple that day. PRMA uses the two-surgeon model for all their patients that have autologous breast reconstruction.
I am delighted to share Margaret’s story with the listeners. She discusses preparations, traveling to and from her surgery, her support, and caregivers, where she stayed, recovery, and what she is looking for to for phase two surgery.
Learn more about resources mentioned and topics related to the podcast:
Video tour with Dr. Chrysopoulo of Methodist Landmark where Margaret had surgery.
First video with Margaret: A BRCA Story of Surveillance Through Prophylactic Mastectomy.
Second video with Margaret: Two days before Margaret’s implant-based prophylactic mastectomy.
Connect with those mentioned in the Podcast:
Margaret’s Instagram account
PRMA’s Instagram account
Dr. Minas Chrysopoulo on LinkedIn
 

Have ever been you curious about the networking, conversations, and education that happens among colleagues at medical conferences? Or are there topics you see online but are not aware of the stories behind the social media posts from these conferences?
I invite a returning guest to give you a behind the scenes look at one such conference, the annual conference of The American Society of Reconstructive Microsurgery. We chose a few highlights and topics from the conference to share our experience so you can learn more about these rich learning events.
Here to share the highpoints and a few of our favorite topics is one of the presenters at the conference himself, Dr. Minas Chrysopoulo. He is the current president of PRMA in San Antonio, Texas who works with a team of nine microsurgeons that perform primarily tissue-based breast reconstruction for those affected by breast cancer. He is a welcome returning guest to the DiepCJourney podcast.
In addition to his microsurgical prowess, he is an entrepreneur. Dr. Chrysopoulo founded Toliman Health and is the creator of Toliman’s flagship award winning app, Breast Advocate app, the first shared decision-making app for breast cancer surgery and breast reconstruction.
He begins by highlighting the diversity of global skill represented at the conference sharing the moving moment when the “Best Case/Best Save” presentations were made. This is the most attended session at the meeting. It is a packed room. This year’s winner was an especially inspiring case of a young Ukrainian woman whose lower face was reconstructed due to a horrific shrapnel injury and repaired by Dr. Adam Maciejewski of Poland.
We touch on the keynote address from CEO and Founder of the Proximie Surgical Learning Platform System, Nadine Hachach-Haram. Dr. C points out the mission of the Proximie system is to expand surgical education and improve patient access to surgical expertise.
We revisit other topics like breast sensation, shared decision-making, and patient advocacy. Links to these topics can be found below.
Dr. C congratulates the ASRM team for putting together another impressive conference from global leaders in microsurgery. We are happy to share our experience.
Learn more about resources mentioned and topics related to the Podcast:
JAMA article on AI and chat box responses
Shared Decision-Making blog with Dr. Chrysopoulo
DiepCJourney podcasts on Breast Sensation
Connect with those mentioned in the Podcast:
Dr. Minas Chrysopoulo on LinkedIn
Dr. Nadine Hachach-Haram (Plast) BEM on LinkedIn
American Society of Reconstructive Microsurgery: Instagram
 

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