Dr. Baltrusch (00:00):
My name is Kyle Baltrusch. I am a plastic surgeon at Portland Plastic Surgery Group in Portland, Oregon.

Eva Sheie (00:05):
So you mentioned a moment ago that radiation has to happen at a certain point while the expander is in this timeline. You go from diagnosis to mastectomy first usually, and then chemo?

Dr. Baltrusch (00:21):
Depending. So patients will undergo neoadjuvant chemotherapy, meaning prior to the mastectomy, if it's indicated. And that might be because of the genetic makeup of the tumor. It could be because of the size of the tumor. So, but then, yes, there are patients that undergo chemotherapy after reconstruction as well, which then does prolong the overall reconstructive process.

Eva Sheie (00:43):
How does radiation affect the quality of the skin and your ability to make this reconstruction kind of look aesthetically normal?

Dr. Baltrusch (00:51):
Radiation is kind of the nemesis of plastic surgeons. It's very hard to reconstruct after radiation. Basically, radiation at a cellular level causes fibrosis or scarring of the soft tissues, so not just the skin, but also of the breast tissue, the fat as well. And so the blood supply as well as the lymphatic system can become scarred or fibrosis. And so after radiation, we see increased risks of wounds, infections. And so I try to do all my soft tissue reconstruction prior to radiation. So it's also why we do the oncoplastic breast reductions and breast lifts prior to radiation at the time of lumpectomy. And it's also why I want to, in my mastectomy patients get my tissue expanders to volume before radiating, because it's going to contract and scar down tissues. Radiation can take a lot of long time to recover from radiation. So reconstruction is done even many months after the completion of radiation.

Eva Sheie (01:48):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.