1 00:00:02,560 --> 00:00:08,400 Speaker 1: This is Let's Be Clear with Shannon Doherty. Welcome to 2 00:00:09,119 --> 00:00:12,000 Speaker 1: a new episode of Lesbie Clear with Shannon Doherty. And 3 00:00:13,039 --> 00:00:17,920 Speaker 1: I have on one of the loveliest, loveliest doctors I 4 00:00:18,079 --> 00:00:22,799 Speaker 1: have ever encountered, doctor j Oranger. He is a plastic surgeon. 5 00:00:23,560 --> 00:00:28,560 Speaker 1: He is also a reconstructive plastic surgeon, which is how 6 00:00:28,600 --> 00:00:34,640 Speaker 1: I know him because he reconstructed my breasts and then 7 00:00:34,680 --> 00:00:35,720 Speaker 1: the other one to match it. 8 00:00:36,440 --> 00:00:40,120 Speaker 2: Hi, Hello, Shannon, Hi doctor j. Great pleasure to be 9 00:00:40,159 --> 00:00:40,680 Speaker 2: here with you. 10 00:00:40,920 --> 00:00:44,080 Speaker 1: Good to see you. You really are one of those 11 00:00:44,120 --> 00:00:48,440 Speaker 1: doctors who takes so much time with your patients. You 12 00:00:48,560 --> 00:00:52,680 Speaker 1: don't overbook yourself. I just remember you drove to my 13 00:00:52,840 --> 00:00:56,240 Speaker 1: house constantly to check on me when I had the 14 00:00:56,280 --> 00:00:59,640 Speaker 1: expander in, and you know the drains all of that. 15 00:01:00,560 --> 00:01:03,840 Speaker 1: I'll get into everything that you did for me and 16 00:01:03,920 --> 00:01:06,560 Speaker 1: what you do for so many others, But can you 17 00:01:06,600 --> 00:01:10,320 Speaker 1: tell us how you started down this path? 18 00:01:10,720 --> 00:01:15,200 Speaker 2: Sure? So. Originally, Shannon, I was believing that I was 19 00:01:15,240 --> 00:01:19,800 Speaker 2: heading down the path of chest surgery thoracic surgery. And 20 00:01:19,880 --> 00:01:22,280 Speaker 2: I was in my general surgery training, which is one 21 00:01:22,319 --> 00:01:26,800 Speaker 2: of the prerequisites for that, and very early in that training, 22 00:01:26,840 --> 00:01:30,800 Speaker 2: I was on the oncology service, and we rounded on 23 00:01:30,880 --> 00:01:32,959 Speaker 2: a lovely young woman who had just had a mess 24 00:01:32,959 --> 00:01:38,080 Speaker 2: stect to me, and in those days, the reconstructions weren't 25 00:01:38,080 --> 00:01:41,200 Speaker 2: done immediately, if done at all, they were often done 26 00:01:41,319 --> 00:01:45,560 Speaker 2: as a subsequent stage following the mess stec to me, 27 00:01:46,080 --> 00:01:49,720 Speaker 2: as opposed to today, when we do the vast majority 28 00:01:49,720 --> 00:01:52,800 Speaker 2: of our reconstructions immediately, at least start them immediately so 29 00:01:52,880 --> 00:01:57,480 Speaker 2: that the patient wakes up with some form of breast 30 00:01:59,160 --> 00:02:02,320 Speaker 2: I felt so bad for this woman when I saw 31 00:02:02,520 --> 00:02:05,680 Speaker 2: how this affected her and how it would affect her. 32 00:02:06,160 --> 00:02:09,359 Speaker 2: It changed my life. That day changed my life when 33 00:02:09,400 --> 00:02:13,720 Speaker 2: I rounded on that patient and I just saw what 34 00:02:13,960 --> 00:02:19,040 Speaker 2: resulted from that life saving procedure, what she would face 35 00:02:20,840 --> 00:02:26,640 Speaker 2: unless her wholeness were able to be restored through a 36 00:02:26,680 --> 00:02:31,040 Speaker 2: good quality reconstruction. And I then said that day, that's 37 00:02:31,080 --> 00:02:32,480 Speaker 2: what I want to do for the rest of my life. 38 00:02:32,520 --> 00:02:36,520 Speaker 2: I want to help these people. And so I completed 39 00:02:36,520 --> 00:02:39,720 Speaker 2: my general surgical training. I feel that as a surgeon 40 00:02:39,720 --> 00:02:43,799 Speaker 2: who operates on the breast in any capacity, or any 41 00:02:43,840 --> 00:02:45,800 Speaker 2: part of the body for that matter, it's helpful to 42 00:02:45,840 --> 00:02:49,520 Speaker 2: be fully trained in general surgery. So I completed a 43 00:02:49,600 --> 00:02:54,960 Speaker 2: wonderful training and then my boards in general surgery and 44 00:02:55,000 --> 00:03:00,359 Speaker 2: then completed my plastic surgical residency in training, and then 45 00:03:00,400 --> 00:03:04,280 Speaker 2: following that, as if that weren't enough, I decided that 46 00:03:04,400 --> 00:03:10,000 Speaker 2: I wanted to do it super specialization in microsurgery. Microsurgery 47 00:03:10,160 --> 00:03:17,440 Speaker 2: is a subspecialty of plastic surgery where it's used by 48 00:03:17,440 --> 00:03:20,200 Speaker 2: others specialty as well, where we use the operating microscope 49 00:03:20,200 --> 00:03:25,239 Speaker 2: to reattach blood vessels or nerves, and we can transplant tissue. 50 00:03:25,480 --> 00:03:30,120 Speaker 2: And what's remarkable about it is we can take tissue, 51 00:03:30,200 --> 00:03:34,000 Speaker 2: let's safe from the tummy. A woman says, I have 52 00:03:34,120 --> 00:03:37,560 Speaker 2: excess tummy tissue. I don't like this extra skin in fat. 53 00:03:38,120 --> 00:03:40,760 Speaker 2: I've thought about having a tummy tuck, but instead now 54 00:03:40,840 --> 00:03:44,680 Speaker 2: I need a mast ectomy. We can take that tissue 55 00:03:45,360 --> 00:03:49,400 Speaker 2: and using techniques of microsurgery, reattached blood vessels so that 56 00:03:49,400 --> 00:03:53,320 Speaker 2: that tissue can be shaped to create a breast. It is, 57 00:03:53,360 --> 00:03:56,720 Speaker 2: in many instance is almost indistinguishable from a real brust 58 00:03:58,760 --> 00:04:04,600 Speaker 2: So said I wanted to acquire that expertise, and so 59 00:04:05,880 --> 00:04:11,240 Speaker 2: the microsurgery has been a very nice adgent to sort 60 00:04:11,240 --> 00:04:14,520 Speaker 2: of complete my armamentarium in terms of what we can 61 00:04:14,560 --> 00:04:21,159 Speaker 2: offer patients. In general terms, there are two ways we 62 00:04:21,200 --> 00:04:25,240 Speaker 2: can reconstruct the breast, one uses some form of implant, 63 00:04:26,080 --> 00:04:33,760 Speaker 2: one uses one's own tissues, and each has advantages and disadvantages. 64 00:04:34,440 --> 00:04:38,480 Speaker 2: The advantages of using an implant include the fact that 65 00:04:38,680 --> 00:04:45,040 Speaker 2: it is typically a shorter and simpler procedure associated with 66 00:04:45,360 --> 00:04:50,840 Speaker 2: a somewhat shorter recuperative period in most instances, and the 67 00:04:51,600 --> 00:04:56,760 Speaker 2: site of the surgery is limited to the chest using 68 00:04:56,839 --> 00:05:02,440 Speaker 2: one's own tissue. Where we transfer tissue, basically, we transfer 69 00:05:02,720 --> 00:05:05,560 Speaker 2: an orgon of fat to make a new breast and 70 00:05:05,600 --> 00:05:09,680 Speaker 2: it has its own blood supply, as opposed to situations 71 00:05:09,720 --> 00:05:13,680 Speaker 2: where commonly today surgeons will liposuction fat and injected to 72 00:05:13,760 --> 00:05:16,880 Speaker 2: the chestwell and hope that that fat will live. In 73 00:05:17,040 --> 00:05:20,800 Speaker 2: reality being that much of that fat will resorb when 74 00:05:20,839 --> 00:05:25,280 Speaker 2: we reattach blood vessels that are attached to this organ 75 00:05:25,320 --> 00:05:29,480 Speaker 2: of fat. It lives just like a kidney transplant. 76 00:05:29,120 --> 00:05:31,320 Speaker 1: Right because you're pumping blood. 77 00:05:31,160 --> 00:05:35,440 Speaker 2: Too into it and out of it. And so it's 78 00:05:36,120 --> 00:05:39,680 Speaker 2: quite a remarkable concept. And we can take tissue from 79 00:05:39,680 --> 00:05:41,600 Speaker 2: the tummy that again the tissue that would be the 80 00:05:41,640 --> 00:05:45,640 Speaker 2: scarter with a tummy tuck, we can revascularize, put it 81 00:05:45,760 --> 00:05:48,000 Speaker 2: under the skin, under the nipple, under the skin of 82 00:05:48,040 --> 00:05:52,080 Speaker 2: the breast, and when you feel it, it feels just 83 00:05:52,279 --> 00:05:56,480 Speaker 2: like a breast, because the breast is an organ largely 84 00:05:56,480 --> 00:06:00,000 Speaker 2: a fatty tissue, and there's fatty tissue now placed under 85 00:06:00,120 --> 00:06:03,320 Speaker 2: the skin. So it feels very much and looks very 86 00:06:03,360 --> 00:06:07,839 Speaker 2: much like a natural breast. Similarly, in a very thin woman. 87 00:06:07,960 --> 00:06:10,240 Speaker 2: You know, there's some people who are quite thin, and 88 00:06:11,040 --> 00:06:13,440 Speaker 2: you know, you're in you're in great shape. You didn't 89 00:06:13,440 --> 00:06:14,839 Speaker 2: have a lot of tissue to work with, and we 90 00:06:14,880 --> 00:06:17,360 Speaker 2: had to use, you know, everything we could from that 91 00:06:17,600 --> 00:06:21,440 Speaker 2: from that small tummy. There's some women that are simply 92 00:06:21,440 --> 00:06:24,120 Speaker 2: there isn't enough tissue on the tummy to even do 93 00:06:24,279 --> 00:06:29,279 Speaker 2: a single breast, and so then those women generally will 94 00:06:29,320 --> 00:06:33,080 Speaker 2: have enough tissue on the upper buttock or gluegal area 95 00:06:33,279 --> 00:06:38,880 Speaker 2: where we can in essence to a buttock lift and 96 00:06:38,960 --> 00:06:43,320 Speaker 2: take that tissue and transplant it to make the new breast. 97 00:06:44,640 --> 00:06:50,440 Speaker 2: The scar that results from that simulates a butt lift 98 00:06:51,360 --> 00:06:53,480 Speaker 2: on the upper buttocks. A bathing suit is sort of 99 00:06:53,560 --> 00:06:59,560 Speaker 2: high cut will cover that. And so the advantage of 100 00:06:59,640 --> 00:07:04,480 Speaker 2: using one's own tissue is that, unlike an implant, doesn't 101 00:07:04,520 --> 00:07:08,839 Speaker 2: require maintenance. Implants can be a great option for a 102 00:07:08,839 --> 00:07:14,840 Speaker 2: lot of women, especially if radiation hasn't taken place. Implants 103 00:07:14,840 --> 00:07:18,920 Speaker 2: can be a good option, but it must be understood 104 00:07:19,000 --> 00:07:22,680 Speaker 2: that they require maintenance. Implants are likely to need to 105 00:07:22,680 --> 00:07:26,040 Speaker 2: be replaced multiple times in the course of a young 106 00:07:26,120 --> 00:07:29,559 Speaker 2: patient's life. I don't really know exactly what the life 107 00:07:29,560 --> 00:07:34,120 Speaker 2: expectancy of an implant is, and it will vary from 108 00:07:34,120 --> 00:07:38,960 Speaker 2: the setting and from the individual, but it's commonly said 109 00:07:39,000 --> 00:07:42,680 Speaker 2: that an implant may last ten or fifteen years if 110 00:07:42,680 --> 00:07:46,679 Speaker 2: we're lucky. They then will often at to be replaced 111 00:07:46,760 --> 00:07:50,040 Speaker 2: either because of where and tear. Where the implant cracks, 112 00:07:51,160 --> 00:07:54,000 Speaker 2: in other words, it can leak. The newer implants are 113 00:07:54,040 --> 00:07:57,240 Speaker 2: more cohesive. We can talk about that cohesivety or the 114 00:07:57,240 --> 00:08:02,800 Speaker 2: gumming beer implants. If it cracks, you know, there's some 115 00:08:03,080 --> 00:08:06,120 Speaker 2: element of leakage, although it tends to be more contained 116 00:08:06,160 --> 00:08:10,320 Speaker 2: with the newer implants. So when they crack or leak, 117 00:08:10,400 --> 00:08:14,480 Speaker 2: we tend to replace them if they encapsulate or form 118 00:08:14,600 --> 00:08:16,640 Speaker 2: tight scar tissue around. 119 00:08:16,280 --> 00:08:19,760 Speaker 1: Them, which is when they get very hard and uncomfortable. 120 00:08:19,840 --> 00:08:25,440 Speaker 2: Often encapsulation is the formation of height or thick scar 121 00:08:25,600 --> 00:08:30,160 Speaker 2: tissue around the implant. It's the body's response to the implant. 122 00:08:30,200 --> 00:08:33,040 Speaker 2: It's tissue. It's not part of the implant, it's the 123 00:08:33,120 --> 00:08:38,400 Speaker 2: patient's own tissues. When that gets hard, then that scar 124 00:08:38,559 --> 00:08:43,439 Speaker 2: tissue will have to be released or removed in many instances, 125 00:08:45,000 --> 00:08:47,520 Speaker 2: and so the implant has to be replaced another operation. 126 00:08:48,600 --> 00:08:53,439 Speaker 2: The problem is that once encapsulation forms, an individuals prone 127 00:08:53,480 --> 00:08:55,960 Speaker 2: to have it occur again. There's just no guarantee that 128 00:08:56,000 --> 00:09:01,480 Speaker 2: it won't come back. As implants a oftentimes the tissues 129 00:09:01,520 --> 00:09:05,880 Speaker 2: overlying them thin, and implant imperfection such as implant edge 130 00:09:05,920 --> 00:09:10,959 Speaker 2: and implant rippling becomes more apparent. And so for cosmetic reasons, 131 00:09:11,400 --> 00:09:13,880 Speaker 2: particularly if we have a better quality implant that's been 132 00:09:13,920 --> 00:09:18,960 Speaker 2: developed since the implant was first placed, for cosmetic reasons, 133 00:09:19,000 --> 00:09:23,280 Speaker 2: we may want to replace the implant. So rupture, encapsulation 134 00:09:23,400 --> 00:09:27,840 Speaker 2: of scar tissue, and cosmetic modifications, those are all reasons 135 00:09:27,840 --> 00:09:31,800 Speaker 2: that an implant might be maintained. Use of your own 136 00:09:31,880 --> 00:09:38,600 Speaker 2: tissue is associated with a permanent reconstruction. It will droop 137 00:09:38,640 --> 00:09:42,880 Speaker 2: a bit over time, just like a normal breast, but 138 00:09:42,960 --> 00:09:47,080 Speaker 2: it's not going to encapsulate and it's not going to 139 00:09:47,840 --> 00:09:54,080 Speaker 2: rupture because it's your own tissue. Now, if you have 140 00:09:54,200 --> 00:09:58,000 Speaker 2: a young individual who's in wonderful shape and putting a 141 00:09:58,040 --> 00:10:00,760 Speaker 2: scar on the tummy is not going to be an 142 00:10:00,800 --> 00:10:05,200 Speaker 2: acceptable option. We have to really consider whether we should 143 00:10:05,200 --> 00:10:15,920 Speaker 2: do that. 144 00:10:18,760 --> 00:10:22,600 Speaker 1: Like you said, everybody's different. There are people that have 145 00:10:22,720 --> 00:10:27,760 Speaker 1: had the same implants for twenty twenty five years and 146 00:10:27,840 --> 00:10:33,120 Speaker 1: that when that scar tissue started forming, their doctor and yes, 147 00:10:33,480 --> 00:10:36,840 Speaker 1: you know, it doesn't necessarily feel good, but pushes and 148 00:10:37,000 --> 00:10:39,640 Speaker 1: breaks that scar tissue and go in over and over 149 00:10:39,679 --> 00:10:42,960 Speaker 1: and over again until that scar tissue forms way outside 150 00:10:43,800 --> 00:10:47,320 Speaker 1: of the implant. So it is possible. And I know 151 00:10:47,360 --> 00:10:51,280 Speaker 1: that you've done implants where it's possible. And so there's 152 00:10:51,520 --> 00:10:54,520 Speaker 1: the positive side of the implants and you get exactly 153 00:10:54,559 --> 00:10:58,160 Speaker 1: the size that you want and everything else, and there's 154 00:10:58,280 --> 00:11:01,120 Speaker 1: minimal scarring. Like you said, it's contained to like the 155 00:11:01,240 --> 00:11:07,360 Speaker 1: chest area. And with flop surgery, the positives are everything 156 00:11:07,360 --> 00:11:10,120 Speaker 1: that you mentioned, but there are some negatives. And those 157 00:11:10,160 --> 00:11:14,480 Speaker 1: negatives are the scars, right, because you know, if you're 158 00:11:14,520 --> 00:11:17,160 Speaker 1: taking from the belly, you have a scar from hipbone 159 00:11:17,240 --> 00:11:21,160 Speaker 1: to hip bone. And sure, you know you can drop 160 00:11:21,200 --> 00:11:24,360 Speaker 1: it a little bit lower. Hopefully you can, you know, 161 00:11:24,480 --> 00:11:26,800 Speaker 1: keep stretching that skin and go back in and get 162 00:11:26,840 --> 00:11:30,679 Speaker 1: that scar, you know, redone to drop even lower, but 163 00:11:30,720 --> 00:11:32,800 Speaker 1: it's only going to go so so low. 164 00:11:33,320 --> 00:11:38,160 Speaker 2: Yeah, there's there's no question Shannon that the heavier individual, 165 00:11:38,360 --> 00:11:41,240 Speaker 2: or the more weight fluctuation she's had, or the more 166 00:11:41,240 --> 00:11:44,280 Speaker 2: pregnancy she may have had, the lower you can place 167 00:11:44,360 --> 00:11:47,840 Speaker 2: that scar. It is a scar of a tummy tuck. 168 00:11:48,360 --> 00:11:51,240 Speaker 2: You have to decide, you know, if someone is thin, 169 00:11:52,559 --> 00:11:56,080 Speaker 2: the scar is going to be higher by definition because 170 00:11:56,120 --> 00:11:58,480 Speaker 2: you just can't get it quite as low if there 171 00:11:58,520 --> 00:12:01,360 Speaker 2: isn't the laxia of the skin, and that trade off 172 00:12:01,400 --> 00:12:03,360 Speaker 2: has to be weighed. You know, there are women who 173 00:12:04,360 --> 00:12:09,600 Speaker 2: simply would benefit asthetically in some regards from getting rid 174 00:12:09,600 --> 00:12:11,720 Speaker 2: of the excess skin and fat of the tummy, but 175 00:12:11,800 --> 00:12:14,240 Speaker 2: the scar simply isn't worth it to them. So we 176 00:12:14,320 --> 00:12:19,000 Speaker 2: always discuss that. You know, I spend typically an hour, 177 00:12:19,160 --> 00:12:21,640 Speaker 2: sometimes an hour and a half with patients. As you know, 178 00:12:23,000 --> 00:12:25,600 Speaker 2: there are a lot of options that are available, and 179 00:12:26,559 --> 00:12:28,560 Speaker 2: you know, it's a great honor and privilege to work 180 00:12:28,600 --> 00:12:31,360 Speaker 2: for the people that I take care of, and it's 181 00:12:31,400 --> 00:12:34,760 Speaker 2: really important that they know the options that we discuss them, 182 00:12:34,800 --> 00:12:38,600 Speaker 2: that they have an opportunity to ask questions and get 183 00:12:38,640 --> 00:12:44,800 Speaker 2: their questions answered. So those are the things we talk about. 184 00:12:45,120 --> 00:12:48,480 Speaker 2: You know, yes, you have this extra tissue on your tummy. 185 00:12:50,679 --> 00:12:55,520 Speaker 2: Would you tolerate a scar? You know, and that really 186 00:12:55,600 --> 00:13:00,520 Speaker 2: has to be an individual decision. A couple things that 187 00:13:00,679 --> 00:13:05,280 Speaker 2: you mentioned that are relevant the concept of the close 188 00:13:05,400 --> 00:13:09,880 Speaker 2: capsule otomy. I just want to mention we no longer 189 00:13:10,040 --> 00:13:15,160 Speaker 2: accept the squeezing of an implant to treat a capsule 190 00:13:16,440 --> 00:13:18,680 Speaker 2: as a generally well thought of technique. 191 00:13:20,120 --> 00:13:22,079 Speaker 1: I'm talking about something that was done, you know, you 192 00:13:22,360 --> 00:13:24,120 Speaker 1: literally I'm in the nineties. 193 00:13:24,640 --> 00:13:26,000 Speaker 2: Sure is still being done. 194 00:13:27,000 --> 00:13:27,680 Speaker 1: There are doctors. 195 00:13:28,400 --> 00:13:31,400 Speaker 2: So I'm just telling the wonderful people that are that 196 00:13:31,880 --> 00:13:37,040 Speaker 2: may be enjoying this benefiting if that suggested, avoid that option. 197 00:13:38,679 --> 00:13:40,000 Speaker 1: Listen to the doctor, not s. 198 00:13:42,280 --> 00:13:44,400 Speaker 2: You. I don't think you're advocating for You're saying that 199 00:13:44,480 --> 00:13:45,000 Speaker 2: it's done. 200 00:13:45,160 --> 00:13:45,640 Speaker 1: It is done. 201 00:13:45,720 --> 00:13:49,320 Speaker 2: Yeah, that can rupture an implant, so yes, why you Well, 202 00:13:49,400 --> 00:13:55,840 Speaker 2: you might might break the capsule, the scar tissue. You 203 00:13:55,920 --> 00:14:01,239 Speaker 2: may also break plant the plants shell. Of course, sanon 204 00:14:01,360 --> 00:14:07,080 Speaker 2: in terms of more specifically what technique is appropriate for 205 00:14:07,200 --> 00:14:12,840 Speaker 2: what I think it's worthwhile mentioning the effects of radiation 206 00:14:14,440 --> 00:14:19,760 Speaker 2: and reconstructions, I think that's a very important point. One 207 00:14:19,800 --> 00:14:26,160 Speaker 2: must realize that while potentially life saving, life prolonging, radiation 208 00:14:26,560 --> 00:14:29,440 Speaker 2: is a double edged sword. In that it permanently damages 209 00:14:29,480 --> 00:14:34,000 Speaker 2: the tissue of the chest wall. That's permanent. Someone lives 210 00:14:34,000 --> 00:14:38,760 Speaker 2: to be one hundred microscopically. You'll see the changes of 211 00:14:38,880 --> 00:14:44,080 Speaker 2: radiation in the tissues as a result. When you place 212 00:14:44,120 --> 00:14:48,440 Speaker 2: an implant beneath radiated tissues, or you radiate an implant 213 00:14:48,520 --> 00:14:54,920 Speaker 2: after implant placement, the radiation incites a more vigorous cap 214 00:14:55,120 --> 00:14:59,520 Speaker 2: or response, a thicker or tighter capsule formation the scar 215 00:14:59,600 --> 00:15:03,840 Speaker 2: tissue around the implant. That's what radiation does. It incites 216 00:15:03,880 --> 00:15:08,720 Speaker 2: a vigorous reaction. And so it's a very very common 217 00:15:09,840 --> 00:15:14,680 Speaker 2: happening that if you radiate the chess wall that has 218 00:15:14,720 --> 00:15:18,440 Speaker 2: an implant, the patient will within a fairly short period 219 00:15:18,480 --> 00:15:22,080 Speaker 2: of time say, wow, this feels really tight. This feels 220 00:15:22,160 --> 00:15:28,560 Speaker 2: tight and uncomfortable. That's not every patient, but it's very common, 221 00:15:29,920 --> 00:15:35,520 Speaker 2: and it's common enough that I tell patients an implant 222 00:15:35,600 --> 00:15:42,480 Speaker 2: beneath your radiated tissues may not be a comfortable long 223 00:15:42,560 --> 00:15:47,120 Speaker 2: term option. I think in many instances it's not. It 224 00:15:47,240 --> 00:15:50,440 Speaker 2: might be an acceptable option in the short term, but 225 00:15:50,560 --> 00:15:56,440 Speaker 2: I think that over time the radiation induces increasing capsule formation, tightness, 226 00:15:56,600 --> 00:16:01,880 Speaker 2: perhaps discomfort, and so it's particularly the radiated patient or 227 00:16:01,920 --> 00:16:05,120 Speaker 2: the patient that has failed an implant, who just hasn't 228 00:16:05,120 --> 00:16:08,240 Speaker 2: done well with implants, even in the absence of radiation. 229 00:16:09,720 --> 00:16:12,440 Speaker 2: The use of your own tissue in that setting really 230 00:16:12,480 --> 00:16:16,720 Speaker 2: is often a blessing because it brings blood supply to 231 00:16:16,760 --> 00:16:20,560 Speaker 2: those radiated tissues. We hook up those blood vessels to 232 00:16:20,560 --> 00:16:25,080 Speaker 2: transfer that tissue from that tissue that is under the skin. 233 00:16:25,160 --> 00:16:27,960 Speaker 2: The tissue we transfer new blood vessels grow into the 234 00:16:28,000 --> 00:16:33,120 Speaker 2: surrounding chess wall tissues. It grows from the flat the 235 00:16:33,200 --> 00:16:36,680 Speaker 2: bony ay, into the muscle, into the overlying skin and fat. 236 00:16:37,480 --> 00:16:42,280 Speaker 2: It brings new blood supply to the radiated chest wall 237 00:16:42,320 --> 00:16:46,280 Speaker 2: and improves the quality of the radiated chess wall. So 238 00:16:47,400 --> 00:16:50,120 Speaker 2: in the setting of someone who has had an unfortunate 239 00:16:50,240 --> 00:16:54,640 Speaker 2: thinning of tissues from multiple implant operations, because each time 240 00:16:54,640 --> 00:16:59,120 Speaker 2: you remove that capsule, the tissues overlying the implant become thinner. 241 00:17:00,040 --> 00:17:04,960 Speaker 2: So someone who has had let's see, multiple AAP selectomies 242 00:17:05,080 --> 00:17:08,560 Speaker 2: or removal of implants, they may be referred to me. 243 00:17:08,600 --> 00:17:11,200 Speaker 2: They may come into my office and say, look, how 244 00:17:11,240 --> 00:17:16,120 Speaker 2: you can almost see my implant through the skin. That's 245 00:17:16,160 --> 00:17:20,119 Speaker 2: a very very difficult problem that I think is generally 246 00:17:21,240 --> 00:17:26,000 Speaker 2: generally best treated with the addition of healthy tissue. 247 00:17:26,119 --> 00:17:27,960 Speaker 1: Well, how often do you actually see that. 248 00:17:28,480 --> 00:17:34,440 Speaker 2: It's pretty common, really, it's pretty common. Not everyone does 249 00:17:34,440 --> 00:17:38,520 Speaker 2: well with implants, and you know, again it's hard to 250 00:17:38,680 --> 00:17:41,919 Speaker 2: accept the concept that they have to be maintained. But 251 00:17:42,040 --> 00:17:46,920 Speaker 2: I think in the last ten or fifteen years we've 252 00:17:46,960 --> 00:17:51,480 Speaker 2: really come to accept that it's not often a one 253 00:17:51,520 --> 00:17:54,359 Speaker 2: and done operation where you put an implant in. It's 254 00:17:54,400 --> 00:17:58,320 Speaker 2: pretty common that they'll have to at some point be replaced. 255 00:17:59,520 --> 00:18:02,400 Speaker 2: And there's some people who simply just don't do well 256 00:18:02,400 --> 00:18:05,200 Speaker 2: with them. The body just doesn't seem to tolerate them. 257 00:18:05,119 --> 00:18:09,600 Speaker 1: Right, rejects it and still identifies it as a foreign object, and. 258 00:18:09,560 --> 00:18:16,480 Speaker 2: They get recurrent encapsulation. You get recurrent encapsulation over and 259 00:18:16,520 --> 00:18:19,359 Speaker 2: over and over. There are certain things we can try 260 00:18:20,680 --> 00:18:27,359 Speaker 2: and sometimes it's beneficial. There's a material what's called a 261 00:18:27,480 --> 00:18:32,040 Speaker 2: cellular dermal matrix. It's a skin derived product and it's 262 00:18:32,080 --> 00:18:35,560 Speaker 2: a hammock that you can put in under the skin 263 00:18:35,680 --> 00:18:39,879 Speaker 2: to support the breast. Many surgeons use it as a 264 00:18:40,000 --> 00:18:45,760 Speaker 2: means of potentially diminishing recurrent encapsulation. In addition to supporting 265 00:18:45,800 --> 00:18:53,440 Speaker 2: the implant, it might decrease encapsulation either the first time 266 00:18:53,480 --> 00:18:59,520 Speaker 2: implantation or may prevent recurrent encapsulation. Studies are ongoing, but 267 00:19:00,000 --> 00:19:02,960 Speaker 2: there a number of studies that suggest that that might 268 00:19:03,000 --> 00:19:08,399 Speaker 2: be a benefit. But despite trying everything, we know still 269 00:19:08,440 --> 00:19:12,200 Speaker 2: there are patients who simply don't accept their implants well. 270 00:19:13,040 --> 00:19:17,159 Speaker 2: And it's in that patient besides the radiated patient, or 271 00:19:17,280 --> 00:19:21,600 Speaker 2: use of ones on tissues maybe especially beneficial. 272 00:19:23,119 --> 00:19:30,280 Speaker 1: So so with my surgery, you know, I had the surgery, 273 00:19:30,640 --> 00:19:34,760 Speaker 1: only one for us was removed, which is always so 274 00:19:34,920 --> 00:19:38,200 Speaker 1: funny when when you make these decisions and you think 275 00:19:38,200 --> 00:19:42,160 Speaker 1: you're making the right decision, and then later a couple 276 00:19:42,200 --> 00:19:45,040 Speaker 1: of years later, you're like, oh, I should have you know, 277 00:19:45,200 --> 00:19:50,399 Speaker 1: had both. And it's probably why this podcast is so 278 00:19:50,440 --> 00:19:53,880 Speaker 1: important to me, so that I can share my experiences, 279 00:19:53,920 --> 00:19:58,720 Speaker 1: the ones that I think were mistakes that still you know, 280 00:19:58,760 --> 00:20:01,639 Speaker 1: the outcome was still good, just maybe I would have 281 00:20:01,680 --> 00:20:06,280 Speaker 1: done things differently. So one of those was both breasts, goodbye, 282 00:20:06,359 --> 00:20:13,280 Speaker 1: see you later. And because then for my particular reconstruction 283 00:20:14,400 --> 00:20:17,040 Speaker 1: it I could have gone a lot smaller, I could 284 00:20:17,080 --> 00:20:20,439 Speaker 1: have you know, there's those things. So let's tune the 285 00:20:20,440 --> 00:20:24,040 Speaker 1: audience in for a second. And two, I had surgery, 286 00:20:24,720 --> 00:20:29,600 Speaker 1: I only had one breast, removed. And then what you did, 287 00:20:29,600 --> 00:20:32,440 Speaker 1: which was remarkable is you actually were in there with 288 00:20:33,160 --> 00:20:38,840 Speaker 1: again one of the best surgeons, doctor g. I remember 289 00:20:38,880 --> 00:20:41,199 Speaker 1: you did the final stitch. It was very important to 290 00:20:41,240 --> 00:20:43,440 Speaker 1: you that you did the final stitch because you like 291 00:20:43,560 --> 00:20:47,680 Speaker 1: the way that your stitches are. So you were literally 292 00:20:47,720 --> 00:20:50,520 Speaker 1: there during that entire surgery. And there's not a lot 293 00:20:50,560 --> 00:20:55,359 Speaker 1: of plastic surgeons for reconstruction that would actually be there 294 00:20:55,440 --> 00:20:58,199 Speaker 1: for a surgery that they don't even get paid for. 295 00:20:58,440 --> 00:21:01,359 Speaker 1: They don't have to be a part of You do that. 296 00:21:01,600 --> 00:21:09,439 Speaker 1: You're remarkable. And then you you did expanders because we 297 00:21:09,480 --> 00:21:12,639 Speaker 1: knew that I was getting chemo, and we knew that 298 00:21:12,720 --> 00:21:17,159 Speaker 1: I was getting radiation, and we wanted all of that 299 00:21:17,280 --> 00:21:22,000 Speaker 1: to happen right away. So you did expanders, which can 300 00:21:22,040 --> 00:21:25,359 Speaker 1: you explain exactly what an expander does? And how many 301 00:21:25,400 --> 00:21:28,480 Speaker 1: times I went back to see you and you sort of, 302 00:21:29,200 --> 00:21:32,760 Speaker 1: you know, pared them up or deflated. It's like a 303 00:21:32,800 --> 00:21:36,679 Speaker 1: balloon and where my breast was. 304 00:21:37,480 --> 00:21:42,280 Speaker 2: I'm happy to discuss that an expander shan as you know, 305 00:21:42,320 --> 00:21:47,560 Speaker 2: as a temporary adjustable volume implant. It has a port 306 00:21:47,640 --> 00:21:49,960 Speaker 2: within it where with a mag that we can pass 307 00:21:50,000 --> 00:21:52,639 Speaker 2: a magnet over the skin identify the center of that 308 00:21:52,800 --> 00:21:56,320 Speaker 2: port where we can put a small needle in safely 309 00:21:56,800 --> 00:22:01,480 Speaker 2: actually into the implant, into the expander, add salt water, 310 00:22:01,680 --> 00:22:05,879 Speaker 2: sterile salt water, and adjust the size as the boss. 311 00:22:05,920 --> 00:22:07,880 Speaker 2: You'll tell me, Jay, I want to be a little larger. 312 00:22:07,880 --> 00:22:09,199 Speaker 2: I want to be a little smaller, but we have 313 00:22:09,240 --> 00:22:10,520 Speaker 2: the capacity to do that. 314 00:22:10,680 --> 00:22:12,720 Speaker 1: I kept just saying I want Kate Moss boots. 315 00:22:15,920 --> 00:22:19,959 Speaker 2: By the way, Shannon, I don't disagree with anything that 316 00:22:20,040 --> 00:22:25,639 Speaker 2: you did from from your reconstructive perspective. I think I 317 00:22:25,680 --> 00:22:31,920 Speaker 2: think your thinking was was very reasonable. Each patient has 318 00:22:32,000 --> 00:22:35,960 Speaker 2: to really do it with their with their oncologists, with 319 00:22:36,119 --> 00:22:42,480 Speaker 2: their their metabal oncologists, their their oncologic surgeon, geneticist really 320 00:22:42,560 --> 00:22:46,200 Speaker 2: has to do a risk assessment. It's very important as 321 00:22:46,200 --> 00:22:50,600 Speaker 2: it pertains to the other breast. If they're gene negative 322 00:22:51,320 --> 00:22:55,160 Speaker 2: and they have no family history and lack of variety 323 00:22:55,200 --> 00:23:01,840 Speaker 2: of potential risk factors, leaving the other rest, it is 324 00:23:01,880 --> 00:23:06,480 Speaker 2: not unreasonable. Bat breast has a nipple that has sensation 325 00:23:06,680 --> 00:23:12,080 Speaker 2: and natural feel and natural shape, it's not unreasonable. I 326 00:23:12,119 --> 00:23:18,160 Speaker 2: think that it is also reasonable sometimes to remove both breasts, 327 00:23:18,359 --> 00:23:22,040 Speaker 2: especially if there's a very strong family history. If someone 328 00:23:22,080 --> 00:23:24,960 Speaker 2: has a bracket gene or other genes. Their genes called 329 00:23:25,040 --> 00:23:29,359 Speaker 2: check two PLB two, a variety of other genes that 330 00:23:29,560 --> 00:23:33,359 Speaker 2: may place somewhat it significantly increased risks for cancer, and 331 00:23:33,520 --> 00:23:37,240 Speaker 2: not just the involved breast, but the other breast. So 332 00:23:37,280 --> 00:23:40,880 Speaker 2: it's not unreasonable times to do that. Do you really 333 00:23:40,920 --> 00:23:46,199 Speaker 2: have to weigh that decision. I encourage patients not to 334 00:23:46,320 --> 00:23:49,800 Speaker 2: act reactively where they say, we'll dog on and I 335 00:23:49,800 --> 00:23:52,040 Speaker 2: got a cancer in this breast, I'm taking them both off. 336 00:23:53,760 --> 00:23:56,399 Speaker 2: The issue at that time is the cancer in that 337 00:23:56,600 --> 00:24:01,240 Speaker 2: breast that we have to deal with. It's very reasonable 338 00:24:01,240 --> 00:24:04,800 Speaker 2: to think about the other breasts and future risk, but 339 00:24:04,960 --> 00:24:08,159 Speaker 2: before you just reactively say let's take them both off, 340 00:24:08,880 --> 00:24:12,119 Speaker 2: I really strongly encourage patients to do an analysis of 341 00:24:12,160 --> 00:24:21,080 Speaker 2: their actual risk. It's important to understand that just because 342 00:24:21,160 --> 00:24:25,320 Speaker 2: we elect to have a breast removed profilatically, the Good 343 00:24:25,320 --> 00:24:28,119 Speaker 2: Lord doesn't necessarily smile upon us and say we're not 344 00:24:28,160 --> 00:24:30,399 Speaker 2: going to have any issues with that breast. There won't 345 00:24:30,400 --> 00:24:32,879 Speaker 2: be pain in that breast, there won't be healing issues, 346 00:24:32,880 --> 00:24:36,359 Speaker 2: there won't be any situations that arise that we don't want. 347 00:24:37,440 --> 00:24:41,000 Speaker 2: That press has the same risk of having pain issues 348 00:24:41,080 --> 00:24:45,239 Speaker 2: or any other issues. There's the cancer breast, right, so 349 00:24:45,280 --> 00:24:47,600 Speaker 2: you need to have a good reason for taking it off. 350 00:24:48,200 --> 00:24:51,520 Speaker 2: That doesn't mean that there aren't good reasons. And for 351 00:24:51,600 --> 00:24:54,560 Speaker 2: some people the reason to do it is peace of mind. 352 00:24:55,160 --> 00:24:58,679 Speaker 1: And I understand that right, because for some people it 353 00:24:58,760 --> 00:25:05,760 Speaker 1: becomes and even if in their heads or in reality, 354 00:25:05,880 --> 00:25:08,439 Speaker 1: like like you said, there's a lot of people with 355 00:25:08,840 --> 00:25:16,120 Speaker 1: different hereditary stuff, different genes that short, then you need 356 00:25:16,119 --> 00:25:22,199 Speaker 1: a double both gone, but also mentally, if it makes 357 00:25:22,280 --> 00:25:27,920 Speaker 1: you feel more secure in your future so that you're 358 00:25:27,960 --> 00:25:34,960 Speaker 1: not walking around simply scared and worried and obsessing, then 359 00:25:35,000 --> 00:25:37,240 Speaker 1: people do it for those reasons too, which is one 360 00:25:37,320 --> 00:25:39,520 Speaker 1: hundred percent valid absolutely. 361 00:25:40,119 --> 00:25:42,919 Speaker 2: I mean, there are certain findings on the pathology Shannon, 362 00:25:42,960 --> 00:25:49,000 Speaker 2: in addition that aren't cancer, but they're finding something for example, 363 00:25:49,040 --> 00:25:55,760 Speaker 2: called atypical lobular hyperplasia for example, which is a number 364 00:25:55,800 --> 00:26:02,560 Speaker 2: of long words meaning not cancer, but it's a sign 365 00:26:02,600 --> 00:26:06,120 Speaker 2: a marker that in the course of life that individual 366 00:26:06,840 --> 00:26:11,119 Speaker 2: is it an increased risk for developing a cancer in 367 00:26:11,280 --> 00:26:14,960 Speaker 2: that breast or the other breast, that breast or the 368 00:26:14,960 --> 00:26:18,880 Speaker 2: other breast. So there's certain findings that can be found 369 00:26:18,920 --> 00:26:24,600 Speaker 2: that aren't cancer. But besides a positive gene testing one 370 00:26:24,640 --> 00:26:28,520 Speaker 2: can have findings in their breast pathology, it would suggest 371 00:26:29,000 --> 00:26:35,200 Speaker 2: we might consider removing the other breast. So in your situation, 372 00:26:36,040 --> 00:26:41,639 Speaker 2: you are going to have radiation. I think that with 373 00:26:41,760 --> 00:26:44,439 Speaker 2: a desire to have a patient wake up with a breast, 374 00:26:44,440 --> 00:26:49,800 Speaker 2: and I think that's really important in my way of thinking, 375 00:26:50,400 --> 00:26:53,400 Speaker 2: having a patient wake up and look down and say 376 00:26:53,440 --> 00:26:57,520 Speaker 2: to me, looks pretty good right away. I mean, that 377 00:26:57,800 --> 00:27:02,280 Speaker 2: really makes me happy. That's my goal. And whether we 378 00:27:02,359 --> 00:27:03,960 Speaker 2: do it by putting your tissue up there or a 379 00:27:03,960 --> 00:27:06,560 Speaker 2: tissue expander, or go directly to an implant, that's my 380 00:27:06,720 --> 00:27:08,960 Speaker 2: goal that someone wake up or leave the hostel at 381 00:27:09,000 --> 00:27:12,480 Speaker 2: least saying okay, you know, I can't can see where 382 00:27:12,520 --> 00:27:13,600 Speaker 2: this is going to look pretty good? 383 00:27:13,680 --> 00:27:18,280 Speaker 1: Yeah, because having cancer is traumatizing enough. Absolutely, there are 384 00:27:18,320 --> 00:27:23,719 Speaker 1: some of us, me specifically, that the idea of waking 385 00:27:23,800 --> 00:27:27,440 Speaker 1: up with no breast at all and just this sort 386 00:27:27,440 --> 00:27:35,320 Speaker 1: of horizontal scar that was really I thought for me 387 00:27:35,359 --> 00:27:39,520 Speaker 1: it would mentally be even more damaging. Absolutely, and there's 388 00:27:39,840 --> 00:27:44,080 Speaker 1: probably large percentage of women out there who who feel 389 00:27:44,160 --> 00:27:44,560 Speaker 1: that way. 390 00:27:45,280 --> 00:27:51,200 Speaker 2: So in your situation, we were able to preserve the tissues, 391 00:27:51,920 --> 00:27:57,399 Speaker 2: nipple skin by using that expander and even though we 392 00:27:57,480 --> 00:28:00,000 Speaker 2: knew that the radiation acts almost like a shrink wrap 393 00:28:00,040 --> 00:28:03,120 Speaker 2: up on the tissues, it would tighten that the fact 394 00:28:03,160 --> 00:28:06,000 Speaker 2: that the expander was in there to hold the mold, 395 00:28:06,080 --> 00:28:09,760 Speaker 2: so to speak, to hold a position of the soft tissues. 396 00:28:10,840 --> 00:28:15,119 Speaker 2: I then knew that after initial healing from the radiation, 397 00:28:15,640 --> 00:28:18,840 Speaker 2: usually wait at least six months. You waited a little longer, 398 00:28:18,880 --> 00:28:23,920 Speaker 2: which it was even better, but at least six months 399 00:28:24,000 --> 00:28:27,360 Speaker 2: typically after the final radiation treatment, when the tissues are 400 00:28:27,600 --> 00:28:30,880 Speaker 2: a bit more normalized. I knew then that we could 401 00:28:30,920 --> 00:28:34,439 Speaker 2: take out that expander, take out the capsule, put in 402 00:28:34,480 --> 00:28:37,920 Speaker 2: your own tissue to bring new blood supply and a breast. 403 00:28:38,320 --> 00:28:43,800 Speaker 2: It would much better match the opposite lifted breast than 404 00:28:43,840 --> 00:28:48,880 Speaker 2: an implant. I will tell you that your own tissue 405 00:28:49,120 --> 00:28:54,560 Speaker 2: will virtually always match an opposite breast of normal tissue 406 00:28:54,680 --> 00:28:58,480 Speaker 2: than an implant. There is no implant that looks exactly 407 00:28:58,600 --> 00:29:03,960 Speaker 2: or feels exactly like one zone tissues. So if someone 408 00:29:04,080 --> 00:29:07,840 Speaker 2: makes the decision based upon analysis of their risk factors, 409 00:29:07,960 --> 00:29:11,560 Speaker 2: their own worries, their concerns, that they're going to keep 410 00:29:11,680 --> 00:29:15,480 Speaker 2: the opposite breast, and again, in many instances, it's entirely reasonable. 411 00:29:16,520 --> 00:29:19,240 Speaker 2: I feel that your own tissue in that setting will 412 00:29:19,280 --> 00:29:24,760 Speaker 2: typically match much better than an implant. Okay, let's talk 413 00:29:24,800 --> 00:29:28,200 Speaker 2: a little bit about scarring. Let's talk let's talk about 414 00:29:29,080 --> 00:29:32,840 Speaker 2: incisional approaches. And I think that's really important. You really 415 00:29:32,840 --> 00:29:39,080 Speaker 2: touched upon something that was so important. I've spent many 416 00:29:39,160 --> 00:29:45,720 Speaker 2: years of my practice analyzing incisional approaches. What is socially acceptable, 417 00:29:45,760 --> 00:29:51,520 Speaker 2: what is most cosmetically pleasing, and how can we use 418 00:29:51,640 --> 00:29:56,480 Speaker 2: the scars that are associated with cosmetic surgery. For example, 419 00:29:56,520 --> 00:29:59,240 Speaker 2: a scar that's in the fold, which is commonly done 420 00:29:59,240 --> 00:30:04,800 Speaker 2: for a breast augmentation, or the common breastlift incision. You know, 421 00:30:04,840 --> 00:30:07,360 Speaker 2: there's a scar that may go around the nipple, or 422 00:30:07,400 --> 00:30:09,400 Speaker 2: it may go under the nipple and down like an 423 00:30:09,480 --> 00:30:12,120 Speaker 2: inverted t or an anchor that we think of as 424 00:30:12,120 --> 00:30:17,600 Speaker 2: a lift scar. Lift scars are something that are somewhat 425 00:30:17,680 --> 00:30:23,400 Speaker 2: socially known and socially accepted. If someone has a droopy breast, 426 00:30:24,640 --> 00:30:27,920 Speaker 2: I'll often try to simulate the scar of a breast 427 00:30:28,040 --> 00:30:31,040 Speaker 2: lift to do the mastectomy. And oftentimes we can lift 428 00:30:31,040 --> 00:30:35,840 Speaker 2: the nipple that we keep by using certain nuanced techniques, 429 00:30:35,920 --> 00:30:38,680 Speaker 2: I think we can we can get the nipple into 430 00:30:38,720 --> 00:30:42,400 Speaker 2: a more youthful position save the nipple in many instances 431 00:30:43,680 --> 00:30:47,040 Speaker 2: and do the whole procedure, the mestetomy and the reconstruction 432 00:30:47,960 --> 00:30:54,920 Speaker 2: through incisions that in many ways mimic traditional known cosmetic approaches, 433 00:30:55,800 --> 00:31:01,960 Speaker 2: and that's that's always my approach. In the now fairly 434 00:31:02,080 --> 00:31:06,920 Speaker 2: rare situation where we have to remove the nipple, sometimes 435 00:31:06,960 --> 00:31:11,040 Speaker 2: I will do that again using the breastlift incision and 436 00:31:11,160 --> 00:31:13,880 Speaker 2: make the nipple on the top of that of that 437 00:31:14,280 --> 00:31:17,920 Speaker 2: inverted T shaped scar. That breastlift scar will make the 438 00:31:18,000 --> 00:31:19,680 Speaker 2: nipple on the top of that so that it looks 439 00:31:19,720 --> 00:31:24,000 Speaker 2: like the patient had a lift or a reduction. If 440 00:31:24,000 --> 00:31:26,880 Speaker 2: the nipple has to be removed in a transverse fashion 441 00:31:26,880 --> 00:31:29,440 Speaker 2: because we can't use the breastlift scar because she doesn't 442 00:31:29,440 --> 00:31:32,560 Speaker 2: have droopy skin of the breast, the scar can be 443 00:31:32,720 --> 00:31:37,400 Speaker 2: limited in its inner extent, keeping the scar whenever possible, 444 00:31:37,480 --> 00:31:41,120 Speaker 2: off the ascetically important duclette area, the center area that chose. 445 00:31:42,240 --> 00:31:47,640 Speaker 2: So I think it's very important that we as surgeons, 446 00:31:48,000 --> 00:31:54,000 Speaker 2: cosmetic surgeons, discuss with our patients a variety of incisional 447 00:31:54,040 --> 00:31:59,520 Speaker 2: approaches and arrive at the one that, while being oncologically sound, 448 00:31:59,600 --> 00:32:03,280 Speaker 2: is most cosmetically pleasing. I think that's very important. 449 00:32:03,560 --> 00:32:06,120 Speaker 1: I mean it for sure. Is because again I don't 450 00:32:06,280 --> 00:32:10,320 Speaker 1: I don't think women really want a lot of scars. 451 00:32:10,920 --> 00:32:14,080 Speaker 1: And when we put on a bikini or when we 452 00:32:14,240 --> 00:32:18,040 Speaker 1: find some one worthy of seeing as nude, we don't 453 00:32:18,040 --> 00:32:21,600 Speaker 1: want them to focus on scars all over the body. 454 00:32:21,760 --> 00:32:24,760 Speaker 1: And so it is important to think of those scars 455 00:32:24,800 --> 00:32:28,480 Speaker 1: and where they are hidden. In my case, you did 456 00:32:28,560 --> 00:32:33,440 Speaker 1: the expanders. I was able to heal from radiation, and 457 00:32:34,000 --> 00:32:37,840 Speaker 1: then you did in the breast that was still left 458 00:32:37,960 --> 00:32:40,960 Speaker 1: that didn't I just you know, didn't get chopped off 459 00:32:40,960 --> 00:32:46,560 Speaker 1: by doctor g it. You know, we didn't you do 460 00:32:46,920 --> 00:32:50,640 Speaker 1: a little bit of a reduction and a lift so 461 00:32:50,680 --> 00:32:53,800 Speaker 1: that it would match. So, guys, I I obviously had 462 00:32:53,800 --> 00:32:59,120 Speaker 1: the flap surgery. So he took fat and tissue from 463 00:33:00,080 --> 00:33:05,640 Speaker 1: my stomach and created a breast out of that. He 464 00:33:06,600 --> 00:33:10,560 Speaker 1: didn't you also take a blood vessel from there? Absolutely, yeah, 465 00:33:10,760 --> 00:33:13,880 Speaker 1: in order to pump sure blood like we talked about. 466 00:33:13,640 --> 00:33:16,920 Speaker 2: Right, So we use the techniques of microsurgery where we 467 00:33:16,960 --> 00:33:21,480 Speaker 2: identified an artery in vein going to that and you 468 00:33:21,520 --> 00:33:23,440 Speaker 2: didn't have a lot of fat. We had to really 469 00:33:23,520 --> 00:33:28,080 Speaker 2: kind of work hard. That defined the sufficient volume fortunately, 470 00:33:28,120 --> 00:33:33,160 Speaker 2: you know, yeah, just so that was helpful too. We 471 00:33:33,280 --> 00:33:36,080 Speaker 2: identified an artery in vein that went to that fat. 472 00:33:37,520 --> 00:33:41,400 Speaker 2: We took that up off the tummy. Normally that tissue 473 00:33:41,400 --> 00:33:45,760 Speaker 2: and a tummy tuck would just be discarded. Because we 474 00:33:46,040 --> 00:33:49,360 Speaker 2: had that artery in vein going to that tissue. We 475 00:33:49,440 --> 00:33:51,560 Speaker 2: could plug that artery and vein into an artery and 476 00:33:51,640 --> 00:33:55,200 Speaker 2: vein on the chest wall, and we would have, as 477 00:33:55,240 --> 00:33:58,680 Speaker 2: you mentioned earlier, blow into that tissue and flow out 478 00:33:58,720 --> 00:34:01,880 Speaker 2: of It's just like a normal organ that. 479 00:34:02,520 --> 00:34:03,720 Speaker 1: So the tissue didn't die. 480 00:34:04,000 --> 00:34:05,160 Speaker 2: Yeah, it's remarkable. 481 00:34:05,200 --> 00:34:06,560 Speaker 1: The skin didn't die nothing. 482 00:34:07,080 --> 00:34:11,040 Speaker 2: It's remarkable. You know. Having done this now for so 483 00:34:11,200 --> 00:34:17,080 Speaker 2: many years, I still am excited by the amazing nature 484 00:34:17,080 --> 00:34:22,560 Speaker 2: of that technology. It's really it's really something amazing. The thing, 485 00:34:22,800 --> 00:34:27,359 Speaker 2: as we were talking about incisional approaches, one thing that 486 00:34:27,440 --> 00:34:30,680 Speaker 2: I want people to be aware of about women to 487 00:34:30,680 --> 00:34:33,279 Speaker 2: be aware of, I want colleagues to be aware of, 488 00:34:34,320 --> 00:34:37,880 Speaker 2: is that if a woman has had previous surgery around 489 00:34:38,000 --> 00:34:44,960 Speaker 2: her nipple or around her areola, that doesn't necessarily preclude 490 00:34:45,640 --> 00:34:48,400 Speaker 2: the saving of a nipple at the time of the mastectomy. 491 00:34:49,760 --> 00:34:56,400 Speaker 2: Unlike twenty years ago, the concept of preserving the nipple 492 00:34:57,760 --> 00:35:03,080 Speaker 2: at the time of mastectomy is now quite quite often 493 00:35:03,200 --> 00:35:06,520 Speaker 2: done you know, if the tumor is a prophylatic setting, 494 00:35:07,239 --> 00:35:10,760 Speaker 2: or the tumor is remote sufficiently remote from the nipple, 495 00:35:11,640 --> 00:35:16,040 Speaker 2: we often save the nipple, which is really really an 496 00:35:16,080 --> 00:35:17,160 Speaker 2: aesthetic benefit. 497 00:35:17,400 --> 00:35:19,160 Speaker 1: Can I interrupt you? I feel like this is going 498 00:35:19,200 --> 00:35:22,440 Speaker 1: to become a drinking game with this, with this episode, 499 00:35:22,600 --> 00:35:25,200 Speaker 1: where every single time you say nipple, somebody's going to 500 00:35:25,239 --> 00:35:26,000 Speaker 1: take a drink. 501 00:35:27,360 --> 00:35:29,319 Speaker 2: It's part of dress surgery. What can I tell you? 502 00:35:29,480 --> 00:35:30,560 Speaker 1: I know, right, I'm like. 503 00:35:30,600 --> 00:35:33,280 Speaker 2: That it's an integral and important part of the break. 504 00:35:34,520 --> 00:35:37,399 Speaker 2: It is an important part of the brains and. 505 00:35:37,320 --> 00:35:39,000 Speaker 1: So well, you saved mine. 506 00:35:39,480 --> 00:35:44,839 Speaker 2: Yes, there there are times when if there's certain techniques, 507 00:35:45,440 --> 00:35:48,080 Speaker 2: there's something called a nipple delay, the E l A 508 00:35:48,239 --> 00:35:52,759 Speaker 2: Y E E l A Y procedure delay procedure, we 509 00:35:52,840 --> 00:35:56,600 Speaker 2: are ten to fourteen days before the mass stectomy, we 510 00:35:56,719 --> 00:35:59,960 Speaker 2: divide some of the underlying blood supply to the nipple 511 00:36:00,680 --> 00:36:04,840 Speaker 2: so that that which remains gets heartier. Okay, that's just 512 00:36:04,920 --> 00:36:10,480 Speaker 2: the concept. And so patients who have had radiation or 513 00:36:11,160 --> 00:36:16,440 Speaker 2: prior surgery around the nipple and still often keep their nipple. 514 00:36:17,680 --> 00:36:22,120 Speaker 2: It's really very valuable. So I just mentioned that, so 515 00:36:22,200 --> 00:36:25,200 Speaker 2: that if people are told that their nipples have to 516 00:36:25,200 --> 00:36:27,799 Speaker 2: come off because they've had a previous breast lift or 517 00:36:27,800 --> 00:36:32,720 Speaker 2: a previous breast reduction, that may not necessarily be true. 518 00:36:32,760 --> 00:36:34,720 Speaker 2: And so just just be aware of that. 519 00:36:35,640 --> 00:36:38,160 Speaker 1: Right, maybe go see another doctor get a. 520 00:36:38,160 --> 00:36:40,400 Speaker 2: Second opinion of their opinions in that regard. 521 00:36:54,040 --> 00:36:56,120 Speaker 1: I mean, I think that that's what I sort of 522 00:36:56,280 --> 00:37:00,800 Speaker 1: encourage on the podcast and on my Instagram is it's 523 00:37:01,520 --> 00:37:05,040 Speaker 1: the white coat does not always know everything absolutely, and 524 00:37:05,080 --> 00:37:09,080 Speaker 1: it's really important to go get a second opinion, even 525 00:37:09,080 --> 00:37:11,600 Speaker 1: a third opinion. I mean, you weren't you weren't I 526 00:37:11,719 --> 00:37:15,239 Speaker 1: met with I think four different plastic surgeons, just like 527 00:37:15,280 --> 00:37:19,640 Speaker 1: I met with multiple oncologists. I don't think doctor G 528 00:37:21,000 --> 00:37:24,360 Speaker 1: was my only meeting for you know. I just always 529 00:37:24,480 --> 00:37:28,080 Speaker 1: thought I need to meet different people, see what different 530 00:37:28,080 --> 00:37:31,120 Speaker 1: people say, and also find the person that I connect 531 00:37:31,160 --> 00:37:31,719 Speaker 1: the most with. 532 00:37:31,960 --> 00:37:35,479 Speaker 2: Absolutely, I couldn't agree more with that, And I think 533 00:37:35,520 --> 00:37:40,520 Speaker 2: that unlike many areas of medicine, and medicine is an art, 534 00:37:40,800 --> 00:37:46,880 Speaker 2: but sixth surgeon really is an art. And what you 535 00:37:46,920 --> 00:37:50,000 Speaker 2: said about connecting, yeah, that's true. I mean the surgeon 536 00:37:50,040 --> 00:37:52,520 Speaker 2: should be able to show you examples of his or 537 00:37:52,560 --> 00:37:57,120 Speaker 2: her work, some examples, you know, I mean, just to 538 00:37:57,120 --> 00:38:02,319 Speaker 2: get a sense of do you like they're aesthetic? Do 539 00:38:02,400 --> 00:38:08,319 Speaker 2: you like what they see as beautiful? You know, there's 540 00:38:08,360 --> 00:38:14,439 Speaker 2: some people, for example, who surgeons and find surgeons who 541 00:38:14,600 --> 00:38:17,360 Speaker 2: like placing very large implants, so that. 542 00:38:19,600 --> 00:38:23,200 Speaker 1: It's the same thing with you, like with people who 543 00:38:23,200 --> 00:38:25,480 Speaker 1: do facelift. I mean, I know you do facelift. But 544 00:38:25,560 --> 00:38:29,960 Speaker 1: there's this doctor that several women I personally know have 545 00:38:30,080 --> 00:38:34,080 Speaker 1: gone to and they all look the same because that's 546 00:38:34,160 --> 00:38:38,080 Speaker 1: his aesthetic. So you know, the mouth is always, you know, 547 00:38:38,160 --> 00:38:43,480 Speaker 1: a little bit wider, it's a very specific eyebrows are 548 00:38:45,320 --> 00:38:47,760 Speaker 1: and I see them and I'm like, uh huh, Okay, 549 00:38:47,920 --> 00:38:49,080 Speaker 1: that's who your surgeon is. 550 00:38:49,120 --> 00:38:52,359 Speaker 2: So you may not feel that that was that's how 551 00:38:52,400 --> 00:38:55,560 Speaker 2: you're aesthetic, right, I mean that's important to they look beautiful, 552 00:38:56,320 --> 00:39:00,640 Speaker 2: but but that beauty may not be optimal beauty for you, correct, 553 00:39:00,640 --> 00:39:02,680 Speaker 2: And so that's what that's what I think has to 554 00:39:02,719 --> 00:39:07,320 Speaker 2: be determined. And I think that if if the plastic surgery, 555 00:39:07,360 --> 00:39:09,640 Speaker 2: I think that if someone can't show you their results, 556 00:39:10,920 --> 00:39:15,319 Speaker 2: that's of concern. That's that to me. I think of 557 00:39:16,800 --> 00:39:20,640 Speaker 2: as if you were to work with an artist and 558 00:39:21,440 --> 00:39:24,759 Speaker 2: you said, I'm going to commission you to make a 559 00:39:24,800 --> 00:39:29,279 Speaker 2: beautiful painting. You'd have to see their work to some. 560 00:39:29,280 --> 00:39:33,680 Speaker 1: Extent for sure. Are they impressionists? Are they modern? Of 561 00:39:33,760 --> 00:39:34,880 Speaker 1: course you want to know. 562 00:39:35,760 --> 00:39:39,560 Speaker 2: Now, with that said surgeon may show you pictures and 563 00:39:39,600 --> 00:39:42,200 Speaker 2: should show you pictures that get you some sense, give 564 00:39:42,280 --> 00:39:47,280 Speaker 2: you some sense of what she he or she does. 565 00:39:49,840 --> 00:39:53,040 Speaker 2: That obviously doesn't say that you're going to get that 566 00:39:53,120 --> 00:39:57,840 Speaker 2: same result. Each patient is different, the body is different, 567 00:39:57,880 --> 00:40:02,160 Speaker 2: the situation is different. At least she have the opportunity 568 00:40:02,160 --> 00:40:06,719 Speaker 2: to get a sense of the artistry of that individual. 569 00:40:06,960 --> 00:40:09,480 Speaker 2: I really think that's what you're doing. You're getting a 570 00:40:09,520 --> 00:40:13,600 Speaker 2: sense of the artists the individual. Do you like the individuals? 571 00:40:13,600 --> 00:40:14,960 Speaker 2: It's someone you can get along with. 572 00:40:15,120 --> 00:40:17,439 Speaker 1: It's also somebody you want to find a surgeon who 573 00:40:18,719 --> 00:40:25,720 Speaker 1: adjust to your desires, right because one of the plastic 574 00:40:25,760 --> 00:40:31,120 Speaker 1: surgeons I met with for reconstruction was a big boop guy. 575 00:40:31,960 --> 00:40:38,720 Speaker 1: He put big implants in and I'm five to four 576 00:40:39,120 --> 00:40:43,880 Speaker 1: and one hundred and four pounds. I can't like big 577 00:40:44,000 --> 00:40:48,560 Speaker 1: huge knockers. Is not my personal sthetic. Other people, it 578 00:40:48,560 --> 00:40:52,279 Speaker 1: looks great on do whatever pleases you. I'm all for it. 579 00:40:52,360 --> 00:40:55,760 Speaker 1: But for me, and it didn't really matter how much. 580 00:40:55,880 --> 00:41:00,200 Speaker 1: I just kept on showing him a picture of Kate Moss, like, 581 00:41:00,320 --> 00:41:02,360 Speaker 1: do you see how small her boobs are? Like? This 582 00:41:02,520 --> 00:41:03,600 Speaker 1: is perfection to me. 583 00:41:04,440 --> 00:41:05,759 Speaker 2: He it. 584 00:41:07,400 --> 00:41:15,319 Speaker 1: Just wasn't resonating with him, and whereas with you. You know, 585 00:41:15,800 --> 00:41:18,040 Speaker 1: maybe that's not even your personal style. Outher but you 586 00:41:18,239 --> 00:41:22,279 Speaker 1: looked at me and you said, beautiful breast, let's try 587 00:41:22,320 --> 00:41:27,000 Speaker 1: to get as close as possible. Just you know, because 588 00:41:27,080 --> 00:41:32,920 Speaker 1: I opted to only have one removed, it was you know, 589 00:41:32,960 --> 00:41:36,560 Speaker 1: you're still working with a real one. There's got to 590 00:41:36,600 --> 00:41:39,719 Speaker 1: be symmetry, because that's what I would want. So ultimately, 591 00:41:39,880 --> 00:41:43,839 Speaker 1: did I get tiny A's No? Am I happy or 592 00:41:43,880 --> 00:41:48,919 Speaker 1: that I didn't? Yes, Like, I'm pretty happy with your work. 593 00:41:50,600 --> 00:41:54,239 Speaker 2: It's important to determine if the surgeon hears you. 594 00:41:55,120 --> 00:41:55,359 Speaker 1: Yeah. 595 00:41:55,400 --> 00:41:57,839 Speaker 2: I mean, I'm sure that surgeon who made the large 596 00:41:57,880 --> 00:42:02,480 Speaker 2: rest he or she might have been of find. But 597 00:42:02,600 --> 00:42:05,080 Speaker 2: if he didn't hear what you were saying, you know 598 00:42:05,160 --> 00:42:09,440 Speaker 2: that that's more of an issue. I think that the 599 00:42:09,520 --> 00:42:13,840 Speaker 2: plastic surgeon, after a message a reconstruction, tends to follow 600 00:42:13,880 --> 00:42:17,040 Speaker 2: you the most, you know, certainly among the surgeons. The 601 00:42:17,080 --> 00:42:22,920 Speaker 2: general surgeon does his job or job, then the plastic 602 00:42:23,000 --> 00:42:25,840 Speaker 2: surgeon really has to help you with the healing process 603 00:42:25,920 --> 00:42:30,200 Speaker 2: and follow scars and uh, you know, make certain that 604 00:42:30,280 --> 00:42:34,439 Speaker 2: you maintain a good path, you know. So I think 605 00:42:34,480 --> 00:42:37,520 Speaker 2: it's important to like your doctor. 606 00:42:37,560 --> 00:42:41,919 Speaker 1: I mean, well, you've visited me over the weekend at 607 00:42:41,920 --> 00:42:43,480 Speaker 1: my house. You would drive all the way out to 608 00:42:43,520 --> 00:42:48,919 Speaker 1: Malibu and you would check the drains see how much 609 00:42:49,000 --> 00:42:53,200 Speaker 1: was draining before we could actually take the drains out. 610 00:42:53,400 --> 00:42:56,440 Speaker 1: You you just you wanted to make sure the skin was, 611 00:42:56,719 --> 00:42:59,960 Speaker 1: you know, staying alive, that there was no issues there. 612 00:43:01,000 --> 00:43:07,359 Speaker 1: And you were really really very very very hands on. 613 00:43:07,480 --> 00:43:12,400 Speaker 1: And I know that some people who have heard conversations 614 00:43:12,480 --> 00:43:18,440 Speaker 1: between myself and my doctors have made a comment of well, 615 00:43:19,000 --> 00:43:21,560 Speaker 1: you know, you're Shannon Doherty, so you're getting special treatment 616 00:43:22,560 --> 00:43:25,000 Speaker 1: or maybe it's your insurance. And I'm just going to 617 00:43:25,040 --> 00:43:28,560 Speaker 1: tell you guys that I know that doctor J does 618 00:43:28,600 --> 00:43:31,200 Speaker 1: this for every single one of his patients. It doesn't 619 00:43:31,239 --> 00:43:35,719 Speaker 1: matter if they're famous or not. You do this for 620 00:43:35,920 --> 00:43:40,960 Speaker 1: every single one. And to just chalk off sort of 621 00:43:41,160 --> 00:43:44,520 Speaker 1: my experience as well, you're famous, so you get extra 622 00:43:44,600 --> 00:43:47,719 Speaker 1: it's incredibly unfair. It's not unfair to me because I 623 00:43:47,760 --> 00:43:51,600 Speaker 1: don't really care what people say. It's unfair to my 624 00:43:51,760 --> 00:43:58,160 Speaker 1: doctors because I know for a fact that you are 625 00:43:58,320 --> 00:44:04,360 Speaker 1: this meticulous and hold your every single one of your patients. 626 00:44:04,400 --> 00:44:07,759 Speaker 1: You literally hold our hands through all of this. And 627 00:44:08,760 --> 00:44:14,560 Speaker 1: even after I was totally cleared by you, everything was fine. 628 00:44:15,080 --> 00:44:17,960 Speaker 1: You know. We went to the Greek theater together with 629 00:44:18,000 --> 00:44:20,680 Speaker 1: my mom and your wife jo Lynne, like you know, 630 00:44:20,880 --> 00:44:24,799 Speaker 1: and then we went to the Italian place together. It's 631 00:44:24,880 --> 00:44:30,160 Speaker 1: a relationship. You build relationships with your patients and you 632 00:44:30,239 --> 00:44:33,440 Speaker 1: constantly check in with them, even years and years and 633 00:44:33,520 --> 00:44:36,560 Speaker 1: years and years later, like when was when were we 634 00:44:37,920 --> 00:44:40,480 Speaker 1: probably done with everything? Like twenty seventeen? 635 00:44:40,520 --> 00:44:43,480 Speaker 2: I think I think that's I think it's about right. 636 00:44:44,360 --> 00:44:48,520 Speaker 1: We still check in and there's a true you just 637 00:44:48,600 --> 00:44:52,000 Speaker 1: you care. And it goes back to that story you 638 00:44:52,040 --> 00:44:56,719 Speaker 1: told in the beginning. It does of seeing that young 639 00:44:56,760 --> 00:45:00,480 Speaker 1: woman and wanting to help her and what that did 640 00:45:00,520 --> 00:45:05,400 Speaker 1: to you mentally, that you want people to at least 641 00:45:05,440 --> 00:45:10,000 Speaker 1: have as good of an experience through something like this 642 00:45:10,200 --> 00:45:11,200 Speaker 1: that they possibly can. 643 00:45:12,719 --> 00:45:17,080 Speaker 2: Thank you, Shan. I appreciate your kind words. Yeah, I think, 644 00:45:17,440 --> 00:45:21,480 Speaker 2: you know. I often often tell my staff that we're 645 00:45:22,800 --> 00:45:25,600 Speaker 2: we should be like like family for as long as 646 00:45:25,600 --> 00:45:30,800 Speaker 2: we're needed, you know. And I had a young patient 647 00:45:30,960 --> 00:45:38,279 Speaker 2: recently who I had wonderful young woman who I had 648 00:45:38,800 --> 00:45:42,080 Speaker 2: reconstructed her breasts, who had a bad congenital problem which 649 00:45:42,160 --> 00:45:49,319 Speaker 2: was born with very very asymmetric press and she she 650 00:45:49,440 --> 00:45:56,000 Speaker 2: had she had her reconstruction completed, was thrilled, thankfully thrilled. 651 00:45:56,880 --> 00:45:59,879 Speaker 2: And she said, so, so am I going to see 652 00:45:59,880 --> 00:46:02,520 Speaker 2: you guys anymore? And I joked it, I said, no, no, 653 00:46:02,600 --> 00:46:05,920 Speaker 2: we're done, and she started crying, you know, I mean, 654 00:46:05,960 --> 00:46:08,160 Speaker 2: it was like and I said, of course you're going 655 00:46:08,239 --> 00:46:10,160 Speaker 2: to see this. You'll see us for as long as 656 00:46:10,200 --> 00:46:12,120 Speaker 2: you need us, and we're going to continue to make 657 00:46:12,120 --> 00:46:14,840 Speaker 2: sure your scars you know well that everything is great, 658 00:46:14,880 --> 00:46:17,919 Speaker 2: you know, in the coming months and years. I said, 659 00:46:19,080 --> 00:46:21,600 Speaker 2: You're never done with us, you know, we're always here 660 00:46:21,680 --> 00:46:26,000 Speaker 2: for you. But it made me feel great because you know, 661 00:46:26,040 --> 00:46:30,719 Speaker 2: I tell my staff, look, as long as they need us, 662 00:46:30,760 --> 00:46:33,480 Speaker 2: as long as they want us as both part of 663 00:46:33,520 --> 00:46:36,759 Speaker 2: their extended family, as people who are really meaningful in 664 00:46:36,800 --> 00:46:41,120 Speaker 2: their lives, that's a blessing. And when they're happy and 665 00:46:41,160 --> 00:46:44,919 Speaker 2: we no longer hear from them, that also means we've 666 00:46:44,960 --> 00:46:47,879 Speaker 2: done our good job because they no longer need us, 667 00:46:48,640 --> 00:46:54,319 Speaker 2: you know, And so it's a very wonderful opportunity to 668 00:46:54,400 --> 00:46:57,360 Speaker 2: help people. I every day in my life. I feel 669 00:46:57,360 --> 00:47:01,520 Speaker 2: immensely grateful and honor to do what I do. It's 670 00:47:01,600 --> 00:47:06,640 Speaker 2: really a privilege. And yes, Shannon, I mean, you're very important. 671 00:47:06,719 --> 00:47:12,400 Speaker 2: You're a very wonderful person. I have so many patients 672 00:47:12,520 --> 00:47:16,080 Speaker 2: who are also wonderful people who I deeply care about, 673 00:47:16,120 --> 00:47:18,640 Speaker 2: and that's just the way it should be. You know, 674 00:47:18,760 --> 00:47:22,879 Speaker 2: Medicine is it's very different, I think than anything else 675 00:47:22,920 --> 00:47:26,880 Speaker 2: in society that near their job, so to speak. I 676 00:47:26,880 --> 00:47:31,360 Speaker 2: think it's very different. And I grew up in a 677 00:47:31,400 --> 00:47:36,040 Speaker 2: family of doctors, and you know, my dad instilled in 678 00:47:36,120 --> 00:47:39,000 Speaker 2: me the concept that what we do really is a 679 00:47:39,080 --> 00:47:44,160 Speaker 2: privilege and an honor, and I've never not felt that. 680 00:47:44,160 --> 00:47:48,839 Speaker 2: That's always been my feeling from day one. And once 681 00:47:48,880 --> 00:47:53,920 Speaker 2: I saw that patient and directed my life's professional path 682 00:47:54,200 --> 00:47:58,399 Speaker 2: where I wanted it, it's really been just such a 683 00:47:58,400 --> 00:48:03,000 Speaker 2: privilege and great honor to hear from people that I 684 00:48:03,080 --> 00:48:07,759 Speaker 2: made a positive difference, you know, Shanneon we don't always succeed. 685 00:48:08,040 --> 00:48:13,080 Speaker 2: We're not perfect, We certainly are not perfect, but by 686 00:48:13,200 --> 00:48:16,520 Speaker 2: when we do succeed, it's the greatest feeling in horror. 687 00:48:17,320 --> 00:48:21,760 Speaker 1: Right, Yeah, I know, I'm sure, I'm sure that feels 688 00:48:21,840 --> 00:48:26,600 Speaker 1: amazing There's a lot more you guys with Doctor j Oranger, 689 00:48:27,080 --> 00:48:30,000 Speaker 1: so stay tuned for part two.