To speed processing and arrangements for consultation, please follow our 3 simple steps.
Adobe Acrobat is required to open the .pdf file.
Fill out our basic screening Medical History form.
• Download History form and fax
• Fill in digital form and email
Send us a copy of your Health Insurance Card, Drivers License
and completed Medical History form*
• by email to email@example.com
• send by fax 504-899-2700
• send by postal mail:
1717 St. Charles Avenue
New Orleans, LA 70130
* please send your medical records with the form, including
copies of the back and front of your insurance card. All info
has to be received in order to process and schedule a date
for a consult or surgery.
Confirm we have your information and schedule time to speak to educator
• please call the Center at 888-899-2288 to confirm that your form and insurance card was received.
CENTER FOR RESTORATIVE BREAST SURGERY SERVICE INFORMATION: The Center for Restorative Breast Surgery was established to serve as a dedicated center of excellence for women seeking the most advanced methods of breast reconstruction. Craig A. Blum, MD; Frank J. DellaCroce, MD, FACS; Scott K. Sullivan, MD, FACS; Chris Trahan, MD, FACS; and M. Whitten Wise, MD are pioneers in the art of rebuilding breasts lost to cancer, preventive mastectomy, developmental defects, and deformities associated with previous surgery. Their sophisticated microsurgical techniques allow for recreation of the breast with natural tissue while preserving strength and restoring beauty. Together, with Board Certified Breast Surgical Oncologists W. Karl Ordoyne, M.D., FACS, and Alan Stolier, M.D., FACS they comprise a group of international leaders in breast cancer surgery options, pioneering groundbreaking procedures including nipple sparing mastectomy, the Stacked DIEP, the gluteal hip flap, and the BODY LIFT Flap®. They have performed thousands of breast reconstruction procedures for women facing breast cancer, seeking BRCA risk reduction, or searching for solutions to existing breast deformities. Their Center is tailored and staffed to cater to the needs of clientele who travel from all over the world for their services.