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):
How do you help people feel like they kind of know where things are going? I just get the sense that there's a lot happening and it's all kind of unpredictable.

Dr. Baltrusch (00:16):
There is a lot happening. Oftentimes patients come into my office already having had multiple discussions about their options with their surgical oncologist, which then does kind of direct my conversation with patients. But certainly patients have options as far as reconstruction, and so I sit down with my patients for an hour or even longer sometimes and kind of discuss what these timelines look like based on what their goals are, what operations that they're considering. I mean, the biggest thing here is to make our patients cancer free, but that requires the surgical oncologist, the medical oncologist, and then I just remind patients that I'm kind of just an ancillary person in all of this, that it's a blessing to be able to offer them reconstruction and to remind them that this is for the future as well moving forward. So with the Women's Health and Cancer Rights Act from the nineties, it's a federal mandate for insurance plans to cover reconstruction, not just of the cancerous breast, but also of the contralateral or other breast as well. We know symmetry is important, but it also covers the revisions moving forward as well as any future procedures that the patient wants to have with their breast reconstruction.

Eva Sheie (01:26):
In recent years, it seems like the option to go flat has become more of a realistic option where maybe it seemed very black and white or dogmatic in the past that you just get reconstruction and that's what you do. But I've heard a lot more about not doing reconstruction maybe in the last five years. Does that feel like about when it started for you two to hear that request more often?

Dr. Baltrusch (01:54):
Yeah. Yeah. I mean, I remember in my training seeing an increase in people asking for aesthetic flat closures or at least the discussion of it. And so there are certainly patients who don't want implant-based reconstruction and so decide to go flat, and that is certainly an option. So all the options that patients have are lumpectomies, mastectomies, implant-based reconstruction, aesthetic flat closures, but there's also other options as well that, like another, Goldilocks procedure, is another one that gained more popularity in recently, and I'm not even involved in those procedures. The surgical oncologist that I work with are great at those. So if a patient doesn't want implant-based reconstruction, has a larger breasts and just wants a really small breast mound, a Goldilocks where they just use basically the mastectomy flaps to reconstruct a small breast mound is also a great option.

Eva Sheie (02:46):
What are the reasons that you hear from women who decide that they might want to go flat? Why would someone not want implants?

Dr. Baltrusch (02:54):
I think some women are wary of having a foreign body inside them. Also, they're not forever models. There's also complications associated with having implants, and so some women don't want to incur those risks, ruptures, capsular contractures, breast implant illness is a more recent one. And then there's the other discussion of having autologous reconstruction or using your own tissue, and so some people just aren't a great candidate for that either. An aesthetic flat closure might be a good option for those patients.

Eva Sheie (03:23):
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.