In 2009, Melanie Young was diagnosed with stage 2 breast cancer, estrogen-positive, HER2-negative. Following her double mastectomy, she underwent several months of chemotherapy and then immunotherapy. After genetic testing confirmed she was BRCA2 positive, Melanie chose to undergo a salpingo oophorectomy to remove her Fallopian tubes and ovaries. Initially, Melanie chose implants for her reconstruction, but developed complications in subsequent stages, including mobility issues and capsular contraction. In 2025, she came to the Center for Restorative Breast Surgery to have her implants removed and underwent DIEP Flap surgery to restore her breast using her natural tissue. Melanie says the results have exceeded her expectations, and she no longer experiences discomfort and mobility issues. Melanie continues to advocate for women with breast cancer and is the author of the award-winning navigational book, “Getting Things Off My Chest: A Survivor’s Guide To Staying Fearless & Fabulous in the Face of Breast Cancer” (available on Amazon). Follow @melaniefabulous.

Dr. Scott Sullivan is a board-certified plastic and reconstructive surgeon and founding partner of the Center for Restorative Breast Surgery in New Orleans, Louisiana and an office in Dallas, Texas. He is one of the most experienced microvascular breast reconstruction surgeons in the world, with a specialty focus in perforator flap natural tissue reconstruction. With a background in biomedical engineering and over 25 years of dedicated practice in microsurgical breast reconstruction, Dr. Sullivan has pioneered multiple advanced surgical techniques, including the evolution of the SGAP (Superior Gluteal Artery Perforator) flap, the APEX technique for muscle-sparing deep inferior epigastric perforator (DIEP) flap reconstruction, and complex modular multi-flap reconstructions offered nowhere else in the world. The Center for Restorative Breast Surgery performs approximately 12–14% of all perforator flap procedures done annually in the United States.

The Center for Restorative Breast Surgery, founded in 2003 and co-located with St. Charles Surgical Hospital in New Orleans, Louisiana, is the only hospital in the world dedicated exclusively to natural tissue breast reconstruction. The center offers more breast reconstruction options than any other facility in the world. More than 70% of patients travel from out of state or internationally to receive care here. The center specializes in immediate, delayed, and revisional natural tissue breast reconstruction, including DIEP flap, SGAP flap, APEX technique, stacked flap, and complex modular reconstructions for patients who have been told they are not candidates elsewhere.

Dr. Sullivan reflects on the origins of the Center for Restorative Breast Surgery, tracing his path from biomedical engineering and general surgery to becoming one of the most experienced microvascular breast reconstruction surgeons in the world. He explains the evolution of perforator flap techniques, from early procedures that required sacrificing muscle to today’s muscle-sparing approaches, including the DIEP flap, the SGAP flap, and the APEX technique,  and describes how applying cosmetic and aesthetic principles to reconstruction elevated outcomes beyond what the field had previously accepted as standard.

The conversation covers how the center evaluates and guides newly diagnosed patients, including the role of nurse educators, virtual and in-person consultations, and a referral network of oncologists and physicians across the country. Dr. Sullivan discusses the three categories of patients the center serves: those seeking immediate reconstruction at the time of mastectomy, those pursuing delayed reconstruction, and those seeking revision of prior failed or unsatisfactory reconstruction. He walks through how body type, available tissue, cancer treatment history, and patient goals all factor into choosing the right approach. He also addresses the growing number of women seeking to convert from implants to natural tissue, and those who chose to go flat and later reconsidered, emphasizing that no woman is without options.

Additional topics include the importance of the federal law requiring insurance coverage for post-mastectomy reconstruction, the challenges of obtaining timely authorization, and how the center’s insurance advocacy team supports patients through that process. Dr. Sullivan also discusses lumpectomy and oncoplastic repair, the two-stage reconstruction process and what the fine-tuning procedure involves, how natural tissue breasts behave with weight changes, the role of GLP-1 medications before and after surgery, scar management strategies, flying and travel after surgery, and the center’s emerging fellowship program in coordination with LSU and Tulane. The episode closes with Dr. Sullivan urging women not to rush decisions made in the immediate shock of a diagnosis, and to take the time to understand their full range of options before proceeding.

Melanie Young (00:00:00):
Welcome to Restore and Reclaim, a podcast dedicated to the journey of women navigating breast cancer, reconstruction, and the road back to feeling whole again. I’m Melanie Young and I am a breast cancer survivor. I am committed to helping women make confident informed choices about their care and moving forward to have a fulfilled whole life again. We’re here at the Center for Restorative Surgery and St. Charles Surgical Hospital to discuss the many reconstruction options women have. Joining me is the esteemed founder of the Center for Restorative Breast Surgery co-founder, Dr. Scott Sullivan. He is a founding partner in the center and a sought after surgeon in the area of microvascular reconstructive surgery. Welcome.

Scott Sullivan, MD, FACS (00:00:53):
Well, thank you. Thanks for having me.

Melanie Young (00:00:54):
Well, this is the only hospital in the world dedicated specifically to natural tissue reconstruction and more reconstruction options than anywhere else in the world. In fact, I learned that over 70% of the patients come from out of state around the nation and around the world.

Scott Sullivan, MD, FACS (00:01:16):
Yeah, hard to believe. They come to New Orleans, the mecca of modern medicine and the hurricane.

Melanie Young (00:01:23):
Well, Dr. Sullivan, it’s an honor to have you not only as a founding partner, but also in a pioneer in the most revolutionary techniques in natural tissue breast reconstruction, which is a very specialized discipline involving microsurgery and advanced technology. We’re talking about deep flap, which we can explain. Stack flap, SCAP, which is one of your specialties and many other techniques that really help women feel whole and healthy and better about themselves. And I can speak from experience because I did come here as a patient for revision surgery after two different silicone and saline implant surgeries. So I can say it has been a transformative experience.

Scott Sullivan, MD, FACS (00:02:08):
Yep. It’s been nice. Our practice has evolved and people were seeking us out from all over the country and the world and I guess fortunate that we had the passion and attraction to microsurgical breast reconstruction, which way back when Frank and I started, it was in the real early stages of it. And there was the early adoption of perforator flap reconstruction. Perforator flap simply is where you can use your own tissue and preserve the underlying muscle. Historically, it had been where you take the tissue and you’re sacrificing the muscle, removing your gluteus muscle, your latissimus muscle, your abdominal muscles. And so that carried with it significant permanent disabilities as well as very difficult recovery. Dr. Kashima did the first periumbilical perforator flap and Dr. Allen is the one who adopted it for breast reconstruction and then it all evolved from there. Well,

Melanie Young (00:03:06):
I’m curious because you could have chosen any field and you chose one of the most demanding, technically demanding disciplines. As I said, microvascular reconstruction, it’s a mouthful and it involves a lot of, you wear your microscope on your head long hours standing and you’re dealing with blood vessels and reconnective. What drew you to this?

Scott Sullivan, MD, FACS (00:03:31):
I liked it back then because not many people did it.

Melanie Young (00:03:34):
How

Scott Sullivan, MD, FACS (00:03:34):
Back

Melanie Young (00:03:34):
Then are we talking

Scott Sullivan, MD, FACS (00:03:35):
About? So back then I finished general surgery in 96 and started plastic surgery in 97. So 1997. So this is the way, way back of microsurgery. There were very few people did it.

Melanie Young (00:03:49):
Yeah. And you originally studied biomedical

Scott Sullivan, MD, FACS (00:03:51):
Engineering. So you have an

Melanie Young (00:03:52):
Engineering background in the window medicine, which is an interesting combo.

Scott Sullivan, MD, FACS (00:03:55):
Right. I consider myself a gearhead. I’m more of an engineer mind. I like to think of … That’s how a lot of these techniques evolve. We had patients who would come in with unfortunate circumstances and failures and limitations in tissue and you had to be creative of how you can reconstruct them. So again, more the engineering mind. But back then it was only the abdominal or deep flap that was the beginning of things. And it took many hours to do. I mean, when we would do a bilateral, we’d do one side, which would take 14 or 16 hours, staple the other side shut or the other staple it closed, come back the next day and do the other side.

Melanie Young (00:04:37):
Two days?

Scott Sullivan, MD, FACS (00:04:38):
Correct. But with time and the volume you do and the skills develop, now we’re able to do them, do the same case. It’ll take me four or five hours for a bilateral case that used to take four times that amount of time. Not to emphasize time, you wanted to be done safely, right? But with it then evolved the ability to do other areas when the abdomen wasn’t used. And what appealed to me, to answer your question, I thought I wanted to be a cosmetic surgeon. I think many people go into plastic surgery, think they want to be the cosmetic surgeon. But it intrigued me because very few people did this or knew how to do microsurgery. Very few people knew how to do it well. And so I saw it as an opportunity to stand out. Also, it turned out with not many people doing it, there wasn’t much competition that I didn’t realize.

(00:05:27):
So that was another advantage that I had. And then to be critical of the work that was being done, the aesthetic value was pretty poor. There was concentrating on just doing the microsurgery. So you’re putting this blob of fat up there, but it had no real great look of a breast. And so we would apply proven cosmetic techniques, aesthetic techniques to really shape the breasts and fix it up. So that’s how the practice evolved and that’s what our passions were, but it was something new and different and that not many that people thought was very difficult to do. So that was very appealing to me.

Melanie Young (00:06:06):
Well, the Center for Restorative Breast Surgery and St. Charles Surgical Hospital is located here in New Orleans.

Scott Sullivan, MD, FACS (00:06:11):
Correct.

Melanie Young (00:06:12):
And now has expanded to a clinic in Dallas.

Scott Sullivan, MD, FACS (00:06:15):
Yes.

Melanie Young (00:06:16):
When you first co-founded the center in 2003 and the hospital in 2009, not that long ago-

Scott Sullivan, MD, FACS (00:06:26):
Well,

Melanie Young (00:06:27):
I don’t like to fix

Scott Sullivan, MD, FACS (00:06:28):
It.

Melanie Young (00:06:28):
What was your vision at the time and what gap in care were you seeking to fill?

Scott Sullivan, MD, FACS (00:06:34):
Well, we thought New Orleans was a great destination city.

Melanie Young (00:06:39):
It is.

Scott Sullivan, MD, FACS (00:06:40):
Right And this is why people come back and people love it.

(00:06:44):
It stayed kind of lost, stuck in time. It hasn’t become the big metropolis with skyscrapers everywhere. It’s still this fun place with a lot of character and great food and friendly people. And so we thought this would be a good place to have its location. I’m not really thinking about people don’t think of New Orleans as the place to go for modern medicine. It was also where we had, we started with Dr. Allen, then we broke off. So we had a network of referring agents or other doctors here. I went through Tulane for undergraduate, then LSU New Orleans Med School, LSU residency. So I had also all of my friends who were sending patients to me. So it just seemed that that was the smarter thing to do than go to a location that we had no connections.

Melanie Young (00:07:33):
And

Scott Sullivan, MD, FACS (00:07:33):
This is

Melanie Young (00:07:33):
Your home.

Scott Sullivan, MD, FACS (00:07:34):
Turned out right. Also,

Melanie Young (00:07:35):
Which

Scott Sullivan, MD, FACS (00:07:35):
Is

Melanie Young (00:07:35):
Good.

Scott Sullivan, MD, FACS (00:07:35):
And we were initially located at Baptist Hospital, which historically was a fantastic hospital. And then Frank and I were like, okay, we need to find a more secure environment. And we wanted to be in one of the premier streets of St. Charles or down in the French Quarter.

Melanie Young (00:07:53):
Well, I think that’s interesting because secure, there’s security everywhere. It is discreet. It is a beautiful … You can’t see it from where we are, but it is a very beautiful building on the outside, but it doesn’t say hospital anywhere. It is just a beautiful building on the most elegant street in New Orleans and you go in and there’s security and it’s just a lot of space. You don’t feel you’re in a hospital in the waiting rooms. It’s very relaxing and that is comforting to the women and their companions, husbands, spouse, friend, who often accompany them. And many of the patients, as we noted, are from out of state or out of the country. And I understand you have relationships with hotels nearby so that when people come in, they are welcome with that New Orleans hospitality and they’re given this incredible professional expertise.

Scott Sullivan, MD, FACS (00:08:53):
Yeah. We have a number of patients that help with customer relation type stuff since most people travel in. Our executives and other affiliates have gone out and network with restaurants and hotels that are all very … And this is compliments to New Orleans and its personality, right? Everyone wants to help because everyone knows someone themselves included who may have had to deal with such a difficult time. And so God, probably have a dozen of them and it’s very good. It helps New Orleans as well. Because if you look at this, there’s probably of the amount of days of patients that come in annually for our practice, it is probably about 303,000 days of hotel rentals a year because come in for the first stage, they say about nine or 10 days. They come in for their second stage. They’ll say anywhere from three to seven days.

(00:09:57):
We do about 500 of the first stages and do another few hundred of the second stage that adds up. So it’s like a little breast conference that comes to town every year. Well,

Melanie Young (00:10:08):
I’ve been here and it’s been filled. I’ve been here when it’s quiet. It’s very calming. And I think it’s reassuring for anyone who is viewing or listening to this podcast to know that this is a discreet place. It’s a safe haven to care for you and that’s very important. You named it restorative, the Center for Restorative Breast Surgery versus Reconstruction. What does the word restorative mean to you?

Scott Sullivan, MD, FACS (00:10:35):
Well, I have to admit first that Dr. De la Crow is the wordsmith of that. He’s very smart and he writes all the papers. He said,” I went through engineering to avoid English and literature. So I was one advocating for reconstructive because it kind of said the thing. The idea was to make it just as we have here les offensive, less scary. And that’s the purpose is to restore you back to what you were, not to reconstruct. It was to restore. We were restoring the parts that had to be removed, that were threatening your life. The same way, as you pointed out here, we wanted to make this a very safe, secure, appealing location and it goes from the aesthetics of it. So there’s some limitations what you could do in the hospital because that’s impervious furnishings and such, but I wanted to make it look like a hotel type of atmosphere where hopefully it brings people’s stress levels down and help them feel comfortable and secure and recover better.

Melanie Young (00:11:36):
Yeah. It is really a game changer in that because many people are fearful of hospitals. They don’t want to go. They don’t want to go to the doctor and this center alleviates that fear in

Scott Sullivan, MD, FACS (00:11:48):
Any ways. That’s true. Most of them don’t want to check out. They’re like, “Stay here longer.” I think, “Well, we need to use this room.” I didn’t want to

Melanie Young (00:11:55):
Check out. I

Scott Sullivan, MD, FACS (00:11:55):
Felt very

Melanie Young (00:11:56):
Pampered

Scott Sullivan, MD, FACS (00:11:56):
When

Melanie Young (00:11:56):
I was here, to be honest, in the best turkey

Scott Sullivan, MD, FACS (00:11:59):
Sandwiches

Melanie Young (00:11:59):
Ever

Scott Sullivan, MD, FACS (00:11:59):
Served. We have our own chef that makes the meals that are good for the patients if they’re vegan or if they are gluten-free, all that is all important in helping them feel comfortable and heal.

Melanie Young (00:12:12):
As a food person, I thought that was a big deal because most hospital food is meh, but here it was delicious. Well,

Scott Sullivan, MD, FACS (00:12:19):
That’s why we wanted to control it because we were at some of these other hospitals and their first meal was like some fried pork chops and rice and it didn’t really work.

Melanie Young (00:12:29):
Okay. Let’s get down to the meat of the matter, natural tissue reconstruction or restoration. Many women are not presented with those options in other parts of the world. It could be because they live in a market where it’s just not available and people live in a little geography bubble. I lived in one in New York. It may be because there are not skilled surgeons, surgeons who have this expertise. I think it’s important that all women who are facing a mastectomy and breast cancer know what their options are and I know you agree. So for those women who are just newly diagnosed and already facing the shock of a cancer diagnosis and yet they’re also told about that same time, they should start exploring their options for reconstruction. Can you walk us through what the center does here to help those women who are trying to weigh those options and then we’ll talk about what natural tissue breast reconstruction is.

Scott Sullivan, MD, FACS (00:13:38):
Well, it probably first starts with the website. It’s very informative.

Melanie Young (00:13:43):
Yes, it is.

Scott Sullivan, MD, FACS (00:13:44):
We include all types of stuff, of course, even pre and post-op pictures, medical journals and such. The internet also provides all of the collective blogs or support groups and they vary from Komen’s to, you name it, the force or a variety of them- Restoration. Restoration that also provide very, very good and accurate information and it’s good that patients help are sharing their own experiences as well. So they have the ability to call in and we have nurse educators that tell them what we can do to help them understand their situation and what’s available to them. And we also have both virtual and in- person consultations with physicians to further that as well.

Melanie Young (00:14:32):
Well, this is important. We’re here in New Orleans and you have a clinic in Dallas who knows in the future, but do you have a referral network and relationships with other hospitals and clinics around the country or world? So they know that when a patient wants to know all her options, they know to refer them to the center here.

Scott Sullivan, MD, FACS (00:14:55):
Those organizations don’t refer to us. I guess they think of us as competitors like MD Anderson or Sloan Kettering, many of those bigger organizations. We interestingly enough have a strong referral network from physicians and oncologists. We had a Dr. Welk that was up in Seattle that probably sent us 20 or 30 patients a year. We have Dr. Washington, Tiki Washington’s over in Mississippi that probably sends us another 30 patients a year and other locations well in Miami Rosenbaum. So we really appreciate we’re quite flattered and some of these are not just oncologists. Some of these are plastic surgeons that send us these referrals. We feel quite honored that they’re doing that. And of course, they’re very nice to help follow them up when they go back home. In regards to our expansion, we have an office in LA that we’ve had for the last eight years as well.

(00:15:52):
We have the office in Frisco, North Dallas. We’ll be opening up the office in Fort Worth probably before the end of the year, opening office in Nashville as well, probably before the end of year. My home

Melanie Young (00:16:02):
State.

Scott Sullivan, MD, FACS (00:16:02):
Great state. And then over in Tampa.

Melanie Young (00:16:05):
Oh, wow.That’s a lot.

Scott Sullivan, MD, FACS (00:16:07):
That is. Got a lot on the plate.

Melanie Young (00:16:10):
Well, unfortunately, one in eight women are still diagnosed with breast cancer. The reality is the meter hasn’t changed, and those women are faced with the options of treatment as well as lumpectomy, single mastectomy, double mastectomy, and then will you or will you not reconstruct? And that is a lot to digest.

Scott Sullivan, MD, FACS (00:16:30):
Correct. But we go to these places, not because they’re good cities in great states, but when we do, we’re able to now accumulate some data that determines how many women get immediate autologous reconstruction. For example, in Nashville, only 3% of the women who get reconstruction get immediate autologous reconstruction. 3% of their own tissue. So at the time a mastectomy have their own tissue to reconstruct them. 3%. 3%. So 97% only get an implant reconstruction or no reconstruction at the time of treatment of their cancer in Nashville. Nashville. Why is that?

(00:17:13):
Well, that is. That’s a good question. So why is that? And the thing is, as you referred earlier, it’s maybe the skills of the surgeon. There may be some economic pressures that insurance companies, for example, in Florida, Blue Cross reimburses extraordinarily poorly for autologous reconstruction where Cigna and Aetna do a very good job with it. So they start to control the flow of the spic. So you can dictate what can be done. When it goes to only 3% in Nashville, it tends to be it’s the skill of the surgeon, it’s the tendencies that they have. It’s that this is the algorithm they follow to put an implant or expander in. So we go into those communities and we’re able to kind of break things up and start something new. Dallas was a little bit of the same. There was not that much of immediate reconstructions that were going on in Dallas.

(00:18:05):
They were doing more putting an expander in and then later taking the expander out and using their own tissue. We’ve provided the service now that we can provide the reconstruction with your own tissue at the time of mastectomy. We’ve been incredibly busy.

Melanie Young (00:18:19):
It’s interesting you mentioned insurance. I wrote a book on navigating breast cancer and insurance was a big part of the front because I was fearful about paying for, and many women are fearful about paying for their treatment and surgery, but there is the, and correct me if I’m wrong, the Women’s Cancer Rehabilitation Act of 1998. As I understood it was a federal mandate that women who are diagnosed with breast cancer and undergo a mastectomy or a lumpectomy or any kind of treatment, their reconstruction should be covered by insurance. Is

Scott Sullivan, MD, FACS (00:18:55):
That

Melanie Young (00:18:55):
Correct?

Scott Sullivan, MD, FACS (00:18:56):
Now before that time, this is one of the most political or not, this is out of the Clinton administration and it was a profoundly important piece of federal legislation that was passed, Women’s Healthcare Act because it required federally across the United States for insurance companies to cover reconstruction of choice of the patient’s choice post-mastectomy and it required coverage of whatever needed to be done to the other breast for symmetry. Prior to that, that was not being done. So it was huge. Huge. Now we still need to do some refinements to insurance, right? For example, some of our latest frustrations have been that it still takes 15 days or more to get authorization even when you have cancer. And as you know, the period from, I think I may have something to when the tissue’s removed is months, months and months already. And so that needs to be compressed into something that’s a little bit more conscious of the patient’s wellbeing.

Melanie Young (00:20:04):
Well, I think what’s important to underscore as a patient is that you want to choose a hospital and a team, your team, your surgeons, your oncologists, your reconstructive surgeons that have a patient advocacy department, navigator department advocacy to help you so that you do not have to feel the fear and anxiety of how you’re going to pay for your treatment and insurance. And that is something that this center provides and is very upfront about and is very calming and soothing because we as patients, we want to focus on our health

Scott Sullivan, MD, FACS (00:20:48):
As you should, but then there are many of the insurance distractions that

Melanie Young (00:20:52):
Of course- Of course. Let’s get back to what this center provides and what makes it unique as opposed to just other amazing clinics around the United States has many amazing breast centers. What sets the Center for Restorative Breast Surgery in St. Charles Surgical Hospital apart? And let’s deep dive into natural tissue breast reconstruction and the options offered here because there are many that you pioneered.

Scott Sullivan, MD, FACS (00:21:25):
Correct. Many are only offered here because we’re the only ones that do them. Very complex, very sophisticated, modular reconstructions where you’re taking a couple of different flaps, pieces of tissue from different locations and you could put them together. And these techniques were developed from certain situations of unfortunate situations for patients where we had to be creative like that. It helps to be a specialist, right? And it helps to be a specialist and a specialty field. That’s what we do. And our surgeons are all very sophisticated. They’re all very well trained. We have the best equipment here. We have the best nursing care. So what’s really important in the success of the patient and recovery is the women on the frontline, the nurses because they’re the ones who know just how the patient’s supposed to feel, how everything’s supposed to sound, how their mobility is supposed to be all of it because it’s all we do here.

(00:22:26):
We do probably 12 to 14% of the perforator flaps done in the United States are done here and it’s all we do. We’re one trick show. And so they do such a great job in not only representing us working on our behalf just to make sure that hopefully we have an uneventful recovery. And what’s important in the recovery, and not every flap is successful. Sometimes we have to go back to reoperate for a problem. What you get here that you can’t get anywhere, we could get back in the OR within about an hour. This isn’t a trauma center where we have someone who’s a gunshot wound and they’ve taken up the OR so they have any other multi-specialty thing that has to go back to the ORs and clog it up or delays of hours, which you have at every other facility, the hours and hours of delay.

(00:23:16):
Every hour of delay is a greater probability that you won’t be able to fix the problem. And here when you get back within an hour, hour and a half, that’s a huge advantage. Then on top of that, like I said, the nurses and their recovery, they have to be the surveillance. We do implantable Doppler monitoring. It’s a small little miniaturized Doppler that we listen to the blood vessels because everything’s concealed and buried. Often you can’t see the flaps because we’re able to save all the breast skin. So they have to pick up the audible changes, subtle changes that may suggest something worth investigating. So many reasons besides just it looks nice and we have the aromatherapy and we have certain Emory Clark with beautiful arts. He’s known for art and healing. It’s beautiful. And with John Crestia, who did all these great hotels, it’s the other little worker bees of the nurses and nurse educators and it goes to the physical therapist and lymphedema therapist.

(00:24:19):
It’s all …

Melanie Young (00:24:20):
Yeah. The responsiveness is important because any surgery is risky.

Scott Sullivan, MD, FACS (00:24:24):
Correct.

Melanie Young (00:24:24):
So it’s really important as the patient to have a team that prepares you well for the surgery so your body is in the best shape as well as your mind and that your postoperative care is managed and monitored, which is very well done here speaking from experience. I had the deep flap and it was a two-part process. Many women do not understand the length of time it takes for reconstruction. Let’s talk about the process and then I also want to discuss some of the areas that you pioneered. You’ve got a new patient. I say I’m a new patient and I come in and in my case, it was revision surgery. I had breast implants. One was kind of going this way and going this way and I knew there was a problem, but I wasn’t sure what could be done about it or if I even was a candidate.

(00:25:15):
There may be another patient who’s facing a mastectomy and making that decision of doing immediate reconstruction, or in my case, delayed … Well, not delayed revision. There’s immediate, there’s delayed and there’s revision. Talk to us about how you assess, you work with the patient to assess when is the best time for her to have her surgery.

Scott Sullivan, MD, FACS (00:25:36):
Well, that’s different. So if you have active cancer, it’s going to be sooner than better. If you have those people who are having preoperative chemotherapy, they have a very specific time to have their reconstruction, mastectomy reconstruction, which is about three to five weeks after conclusion of the series of chemotherapeutics. So that is very defined in that window. When someone is newly diagnosed, well, how aggressive is your cancer? Is it ductal carcinoma in situ where they could wait a few months where it’s more convenient to fit in their busy work or social schedule or is it something that’s a little more aggressive when we want to get it done promptly? Part of it as well is the person being comfortable with who their chosen team’s going to be. And I encourage everyone to go get second or third opinion, educate yourself the best you can. And that is a real focus here that we try to educate the patients about what their diagnosis is, about what it means, about what some of the oncologic therapies will be, possibly some of the chemotherapy or radiation, how the surgeons will remove the tissue.

(00:26:41):
Can they save the nipple or can they not save the nipple? How does it affect the reconstruction? What types of reconstruction would you like? Gold standard is usually your own tissue. Where do you have some extra fat hanging around we could borrow from and reposition? Or do they have radiation problems, radiation wounds? Do they have limitations of a frozen shoulder from the radiation? All of that. So there is a wide spectrum of patient types that come in. And like you said as well, there’s some that unfortunately call them botched. There’s botch where there’s botch mismanaged and there’s botch where it wasn’t the intent of anyone. Just the course of therapy, particularly when you start to integrate radiation into their care on the oncologic side, it just makes things much more difficult and a physical impairment for the patient that you need to address and fix.

Melanie Young (00:27:36):
Well, I read that 40% of women who undergo breast reconstruction are dissatisfied with the results and so they were also under prepared for the process and the amount of time it takes. And speaking from experience having both implants and natural tissue, it is a time process and you must make the time. If you think you’re going to zip through this, I tried. No, you got to take care of yourself. This is a major, major surgery.

Scott Sullivan, MD, FACS (00:28:07):
It is. But this is where I think the guilt of the woman and the mom play an unfortunate role. And anyone, when you hear you have cancer and you’re like, “Okay, get this thing out. I don’t care. Let’s do it tomorrow. I don’t care if I’m flat closed. I don’t care for an implant. I just want to get on with my life and forget about my mortality, enjoy my family.” So there’s often a rush to do some things that unfortunately that many of them regret doing. Just like I had earlier in the week, a woman who had a flat closure that she regrets doing. She thought she would’ve liked it. She just didn’t want to take a pause and really think about the consequences of it. She’s able to reconstruct her. She has a very nice result, but it would’ve been nice to have saved all the breast skin and nipple, which she could have had an opportunity to do.

(00:28:57):
You have others that they’re just limited to what’s available in their community and they say, “Well, it’s just the ease of going and it’s less expense and less interruption in my life to do it. ” We have women who’ve unfortunately gotten in this terrible cycle of doing kind of the same thing to fix the same problem that never goes anywhere. Somebody lady a couple weeks ago had had a dozen operations.

Melanie Young (00:29:21):
Really?

Scott Sullivan, MD, FACS (00:29:22):
Wow. Many of these can be implant-based

(00:29:25):
And then some they’ll cascade into implant-based, then they go to someone who may not be as skilled to use their own tissue and have flat failures, et cetera. Some of very sad stories. Unfortunately, like you, I’ve been a patient, but only for some orthopedic injuries that tendon repairs that I just want … The surgery wasn’t too bad. It wasn’t anything like a deep flap or a gap flap, right? Having an extensor tendon, have tricep repairs, nothing like that. And I’m good doing nothing for about a week, week and a half, and then I go crazy. And so I can understand how you’re like, okay, I can commit to this period of time, but really your full recovery I would say takes a year. And when patients say, I start to feel like myself, they say it took about a year.

(00:30:11):
When I can only tell them what I think they’re experiencing and they’ll say, “Yeah, you’re restricted for four weeks, maybe six weeks. It depends.” Then you do whatever you want. But then that’s the rehabilitation recovery. And then if they decide to do a revisional surgery, which isn’t mandatory but covered by your insurance where you fine tune things, in my opinion, it’s worthwhile doing because you could really put an exclamation point on the result. But this is just a continuation of operations you just want to get out of. I want to get on with my life. You get

Melanie Young (00:30:44):
Surgeries weary

Scott Sullivan, MD, FACS (00:30:46):
When you have breast cancer. Yeah, be weary. So that’s the bad thing about it. It’s just part of recovering from surgery in a big operation. I think if you go to places that are skilled and do a lot of this, then they’re able to preserve the muscle the best. They preserve the sensation the best. They’re able to facilitate your recovery at the fastest.

Melanie Young (00:31:10):
Well, I want to talk about the preserving the muscle. Again, I’m going to underscore for everyone watching and listening. Once you make your choice and your team and the process, embrace the process. Take care of yourself and understand that your health and you are the most important thing right now, your recovery. And it’s perfectly okay to be selfish about it.

Scott Sullivan, MD, FACS (00:31:35):
Right. Many times women are not. They have the guilt or the guilt from their spouse or they’re going to have little kids. I got to tend to them. This is when everyone needs to go, “Take time out. We got to keep out. Take care of them all.

Melanie Young (00:31:49):
” So let’s talk about some of those terms you’ve kind of mentioned. Let’s

Scott Sullivan, MD, FACS (00:31:52):
Dig

Melanie Young (00:31:53):
Deep into, you mentioned DPLAP and the SGAP and a lot of these you developed. I’m a patient. Let’s say I’m not … Does weight and body mass matter? I mean, when I had my initial mastectomy, I was kind of a skinny mini and didn’t think I had enough fat anywhere to do anything. So I had implants, but does it matter

Scott Sullivan, MD, FACS (00:32:17):
Fat? So it does. If someone has an abundance of fat, then there are abundance of places you can get it from and then they still have a nice complementary result. If you have a belly, how it goes is you find out, okay, what size do you want to be? I want to be a B cup or a Cup or a certain volume.

Melanie Young (00:32:34):
You can pick.

Scott Sullivan, MD, FACS (00:32:35):
The patient can pick whatever size they want and say, “How do you want to do it? Do you want to incorporate an implant or not? “

(00:32:41):
Because you could subsidize the volume of your own tissue with an implant. Many of them don’t want an implant. And then you decide, okay, I look at their pictures and talk to the patient and I say, “This is where I think you can get the best complementary result of your body.” You have a little bit of laxity skin on your belly. There’s enough volume in your belly. Belly would be great. Second stage, you’ll suction your hips, you have a great body. Or you have insufficient on your belly or you’ve been suctioned on your belly or you’ve had prior abdominal surgery. You have a little bit of action on your hips. You’ll get a butt lift with a gap flap and a thigh lift. That turns out nice. There’s some people who more of an androgynous figure where they’re broader chested narrow pelvis and they may have these big bra rolls.

(00:33:25):
Back

Melanie Young (00:33:25):
In

Scott Sullivan, MD, FACS (00:33:25):
Here. Back there. There’s some people that want to be supersized with their own tissue and that’s where we do a body lift where you take the belly and the behind and put it together. So there’s all kinds of stuff to do and creativity as you do these modular reconstructions. And again, I like to look at the patient’s body and say part of it is, where can I get the volume I can get and where can I give them a complimentary body result with a concealed scar?

Melanie Young (00:33:51):
Well, it’s interesting. First of all, my restoration came all from my menopausal belly. I was grateful because I have this amazing hard flat tummy now. It’s awesome. And these nice soft pillowy breasts, which I didn’t have with implants. I was curious about the SCAP because that would have been my … If I had not had enough fat, I have plenty back there. But my big concern, it’s called SCAP. I want you to explain what that means, but also where do you get the fat from? Because I thought, well, how do you sit down afterwards?

Scott Sullivan, MD, FACS (00:34:22):
Right. So the SGAP is superior gluteal artery perforative flap. And we’re really poor at coming up with names of flaps. We just use an acronym for the blood vessels we use.

Melanie Young (00:34:35):
So what is a flap?

Scott Sullivan, MD, FACS (00:34:37):
So flap is a slang for the tissue that we transplant. Okay. So a flap can be the belly flap or butt flap or thigh flap or arm flap or whatever. So like this. Right. But we then as on the surgeon’s side, how we identify it with the patient, but with other colleagues.

(00:34:55):
So I did a deep flap, deep infrarepigastric perforator, and those are the blood vessels on the abdomen that are used. Superior gluteal artery perforator, that’s the behind blood vessels. We innovated and evolved the SGAP flap was thought to be the second choice. We still, for us, that’s first or second choice. We do more of it than anywhere in the world. It used to be centrally in the butt and it was on patients who were lean. They didn’t have enough abdominal tissue. So you take it from the behind, but it’s in the central part of the behind and it flattened their behind and I could not fix it to my satisfaction. So about 16 years ago, started to change it a bit where it became more similar location to a behind lift or thigh lift for a cosmetic case. And so you have a nice high location scar off the butt where you get more butt lift and you’re able to capture some of that flank love handle fat that brings your waist in.

Melanie Young (00:35:55):
So kind of like in the upper dairyer

Scott Sullivan, MD, FACS (00:35:57):
What you grab and you say, “God, I wish I can get rid of this.

Melanie Young (00:36:00):
” Yeah.

Scott Sullivan, MD, FACS (00:36:00):
Well, that’s a breast right there, baby.

Melanie Young (00:36:03):
Yeah, it sure is. And you can sit. Really, that was my concern.

Scott Sullivan, MD, FACS (00:36:06):
How do you sit down? Because it’s not in an area that it’s a pressure point.

Melanie Young (00:36:11):
Well, I know a lot of women like to have a butt lift. I mean, I had a lot of women said, “Man, aren’t you lucky? You’re getting a tummy tuck.” I’m like, “Well, I had cancer, so

Scott Sullivan, MD, FACS (00:36:19):
Let’s start with

Melanie Young (00:36:19):
That.

Scott Sullivan, MD, FACS (00:36:19):
” Right. It’s a hard way to get it.

Melanie Young (00:36:22):
Sure. It was a long road, but it is a nice bonus to have beautiful breasts and then a flat tummy.

Scott Sullivan, MD, FACS (00:36:31):
It’s a good way to think of it as a bonus. It’s a bonus. Most women though, when you talk to them, they weren’t in the market for a tummy tuck or a boob job. And that was one of the things I liked about plastic surgery, particularly reconstructive surgery compared to when I was doing general surgery. I hated telling people they had cancer. I hated it.

Melanie Young (00:36:52):
I hate to do that too.

Scott Sullivan, MD, FACS (00:36:53):
Yeah. Now with reconstruction, it’s very common that as we start to talk about their results and what could be done, even we show them pictures. You have a body type like this, similar diagnosis, similar location to tumor. This is what can we expect your outcome to be and show them a number of patients. They’re very encouraged and it’s not uncommon. They say, “This is so great. This is the first time I’m hearing good news because they’re thinking the worst.”

Melanie Young (00:37:23):
Let’s talk about the important collaboration between the breast surgeon who removes the breast, the oncologist who treats the cancer and it could be many types of, it could be chemo, it could be radiation, it could be immunotherapy and then the reconstruction surgeon who helps make the woman feel whole again. We briefly touched on timing, which is everything, but what are some of the other factors that come into consideration and what part of that teamwork is here at the center versus having to go elsewhere for other things?

Scott Sullivan, MD, FACS (00:38:00):
Right. Well, we found it to be very advantageous for ourself in treating the patient and for the patient to have everything under one roof with Dr. Arnon who’s great. We work with a number of other very capable breast surgeons, selective breast surgeons in the community that are very good that we also collaborate with, we’re in communication with when we’re talking about patients, a number of them will come over here to see patients as well. It’s just an added benefit besides being convenient for the patient. You’re able to sit down or examine the patient at the same time and say, “Look, this is where the tumor is. I think it’s close to the skin. We may have to take skin or whatever.” That communication with the surgeons is great. It doesn’t happen in some of the bigger institutions because they’re completely different departments in different areas of the big building, one-stop

Melanie Young (00:38:50):
Shop. So does that include the oncology part? I mean, do

Scott Sullivan, MD, FACS (00:38:52):
You have a

Melanie Young (00:38:53):
Chemotherapy suite here?

Scott Sullivan, MD, FACS (00:38:55):
We don’t. We talked about that a while back, but then- Because

Melanie Young (00:38:58):
That’s a big radiation.

Scott Sullivan, MD, FACS (00:38:59):
It’s already got more unaffordable than we could handle already. No. I mean, that’s a

Melanie Young (00:39:04):
Big-

Scott Sullivan, MD, FACS (00:39:05):
Yeah, it becomes a whole different animal. We communicate with the oncologist also can refer patients if they want to know oncologists. A lot of them come from out of state as well. So they have the oncologist already selected and there’s the communication with them of what the plan is and also we communicate what the final pathology is with the patient and coordinate with the patient and the oncologist when is the right time either to have the mastectomy if they’re having preoperative chemotherapy or when is the best time to have a revision surgery if they then post-surgically require chemotherapy or radiation.

Melanie Young (00:39:45):
And when you’re talking about revision surgery, because I want to clarify something I said earlier, there’s the first step, which is the first surgery where the tissue is removed and the fat and you come out of that and you have new breasts, but the revision is what you said is the fine tuning where there’s some liposuction. And like my case, it came from my thighs as well as my stomach.

Scott Sullivan, MD, FACS (00:40:11):
Right. Revision surgery is where we do all the fine tuning and it’s different for different people. So if you have someone, for someone who is 5’7″ and 190 pounds, they’ll probably have four or five or six liters of fat suctioned out at the second stage to try to balance the body, because you do a deep lap, they have a flat belly, nice breast, then you want to bring the rest down. Some people would benefit from a lift. A lift is done at the second stage. You can’t do a lift at the first stage. People are very lean, don’t need much done. They’re a little touch up. But the conversation is I give them my suggestions for the best overall result. First, I want to hear from them what is their perspective? What do you think about the breast? What do you think about the size?

(00:40:54):
What do you think about things? And then I give them some thoughts for them to consider. Most of them will say, “Let’s do it. Let’s do all of that stuff.” And on occasion, some will just say, “I just want a little a la carte here or there.” But it’s whatever they want to do. And again, we want the best aesthetic outcome for us. That’s how we kind of establish what our mission was going to be besides sophisticated cutting edge, microsurgical breast reconstruction. It was taking it to a different level because these women deserve to have a good result. They deserve to feel good about themself. Incorporating liposuction in the second stage, this is where the insurance companies said we’re not paying for it. Liposuction’s a technique. Liposuction isn’t cosmetic surgery. Lyposuctionally is a minimally invasive technique that you can remove fat. Now a lot of the fat we capture, we use it for fat injections and volume fill, but we just incorporate it on most all of our second stage and it’s just a much better result.

Melanie Young (00:41:52):
So two things. What if you have a lumpectomy? What can be done for a woman who’ve had … I did not have a lumpectomy, so I have no context at a double mastectomy. But with a lumpectomy, a piece of breast is removed as I understand. What happens? Can you fill in there?

Scott Sullivan, MD, FACS (00:42:08):
So this is the couple of things. I’m going to give you my bias, but lumpectomy is a tried and true manner of treating breast cancer. There has to be a limitation in the size. It can’t be a massive breast cancer. So typically they want to remove the mass, the lump. It’s a partial mastectomy often about golf ball size, but depends upon the lesion. Then you’re required to have radiation. If you don’t have radiation, there’s over 50% recurrence rate. So you have to have radiation with it. It’s important to understand and for the treating physician to be candid with them about what the impact of the lumpectomy is going to do to their breast. So if you have a decup breast and you’re taking golf ball size lesion out almost anywhere in the breast, you’re not going to really see it. If you have a B or small C or smaller and you take that size lump out of anywhere in an exposed area of the cleavage, you’re going to create a deformity that you can’t fix because it’s going to be even emphasized with radiation.

(00:43:13):
Radiation causes contraction, more scar definition. There are some newer techniques over the last decade that they call oncoplastic. So oncoplastic is where you have the breast surgeon will go in and remove the lump and then you have the plastic surgeon, or there’s some breast surgeons that are trained this way that can then rearrange the inside. They do a lift to it. So with the lift, they’re able to reposition tissue where that void would be and then they will get radiation.

Melanie Young (00:43:45):
Before radiation.

Scott Sullivan, MD, FACS (00:43:46):
Before radiation, correct. So lumpectomy, do the lift, do the adjustment, and often do something to the other side for symmetry.

Melanie Young (00:43:54):
Right, because

Scott Sullivan, MD, FACS (00:43:55):
Symmetry’s important. And then the patient would have their five weeks of radiation. Oh,

Melanie Young (00:43:58):
That’s interesting. I always thought you had to wait until after radiation because the radiation could change the

Scott Sullivan, MD, FACS (00:44:03):
Shape of your breasts. It’s better to do it before because what happens, and we just talked to a young lady, I’m going to do that on actually, she has a recurrence right here. They’re going to do a lumpectomy and then radiate. But if she just has a lumpectomy here, when you radiate someone, that indentation gets more pronounced and that radiated tissue is very stiff, hard to move around.

Melanie Young (00:44:27):
Right. I’ve heard that.

Scott Sullivan, MD, FACS (00:44:27):
So it’s better to do it before radiation. When you take the lump out, then you have well vascularized non-radiated tissue that has normal ability to heal. You could rearrange that how you want. And then about six weeks later, they do radiation.

Melanie Young (00:44:43):
Now after the radiation, if there’s any changes, can you do

Scott Sullivan, MD, FACS (00:44:47):
Anything to address

Melanie Young (00:44:48):
That?

Scott Sullivan, MD, FACS (00:44:48):
You could tweak that, yes.

Melanie Young (00:44:49):
Because that’s what I’ve heard, that it can change things, particularly I know the texture of the skin as

Scott Sullivan, MD, FACS (00:44:56):
Well as the-

Melanie Young (00:44:57):
Correct. Interesting, because that’s a concern for a lot of women going through radiation. I didn’t go through radiation because I was afraid of a lot of things like that. So I came in for, I guess it’s really not revision surgery, it was replacement surgery where I had my saline implants. I had silicone. I had those replaced. I had saline. And then I came here to had those replaced and underwent, I believe it was a deep flap. You also have one called apex

Scott Sullivan, MD, FACS (00:45:24):
Apex is just an iteration of the deep flap.

Melanie Young (00:45:27):
Right. It’s a

Scott Sullivan, MD, FACS (00:45:28):
Big deal. Right. It preserves muscle. Yes. So you have two rows, the deep inferior epigastric bifurcates into a medial and lateral row. Often you could find one or two blood vessels in each row close to one another and that’s all you need. So you do minimal muscle separation. There’s some cases when you don’t have adequate siz perforators. There may be one medial and one lateral, so you’re separated by four centimeters, two inches of muscle. Traditionally, people would just cut through the muscle, so that’s no different than a tram. The muscles transected, you can’t sew it back together. And that was in order to maintain the connection of the blood vessels. So what apex is a method to disassemble the blood vessels under the muscle so the muscles left completely intact. You separate the muscle like opening a curtain. So you separate the muscle here and there, track the blood vessel underneath, disassemble it so you preserve the muscle, then reassemble it as you’re connecting it to the patient.

Melanie Young (00:46:33):
That’s really important for any woman who is worried about how they’re core and of course that was a big consideration for me why I chose implants. I was afraid I would lose my core, which is so critical for everything. And that advancement’s huge. Sure. It really is apex. So I came in to have my implants removed and replaced with very positive results. What percentage of, do you know what percentage of your patients are what we call initial reconstruction with breast cancer nearly diagnosed versus coming back for replacement?

Scott Sullivan, MD, FACS (00:47:16):
We have half or a little bit more of that are immediate reconstructions that we diagnose with breast cancer but also include the genetic predisposition. So now it’s great. The test now will test for 29 genes and every couple of years that expands as I understand that. And with each of those, they’re able to define the risk profile for the patient and the patient. So that’s a large portion of our business. Then we’ll have probably one quarter of those who haven’t been reconstructed or complications and other implant-based failures.

Melanie Young (00:47:50):
So we talked about replacement of an implant with natural tissue. You mentioned women who did not have any reconstruction, so going flat. So going flat is kind of a big trend. However, some women decide later on down the road that they don’t want to be flat anymore. How can you help those women and what would you advise women that are going flat initially, but maybe down the road they want to have breasts again? I mean, how do you work with these women? Because I think it’s special.

Scott Sullivan, MD, FACS (00:48:23):
This is where I want to emphasize, just take a timeout and think about what it’s going to be. Almost everyone, and I can’t tell you one that comes to mind that was happy they made that decision, that wish they wished they would have just taken a moment and think about it.

Melanie Young (00:48:43):
Well, the women I’ve interviewed have done it, they’re surgery shy. They’re just done. That’s one. Or maybe they didn’t feel that there was an issue at the time and they were not a candidate. I would think every … Is there a woman who is anyone not a candidate for reconstruction?

Scott Sullivan, MD, FACS (00:49:01):
In some people’s hands because their skillset is poor that they don’t offer, but in our opinion, there’s no one who is not a candidate for reconstruction. So

Melanie Young (00:49:11):
Any woman is a candidate for

Scott Sullivan, MD, FACS (00:49:13):
Reconstruction.

Melanie Young (00:49:15):
And it’s a matter of deciding what type of reconstruction you want and then working with a surgeon like you to decide the best procedure on where to harvest

Scott Sullivan, MD, FACS (00:49:27):
The fat and the

Melanie Young (00:49:28):
Tissue.

Scott Sullivan, MD, FACS (00:49:28):
Yeah. And for example, some people were told they’re not a candidate. Some people who do some of these flaps, they don’t want them to get radiated. And so if someone needs radiation, they’ll tell them just to go flat closure, get radiated, and then we’ll reconstruct you. We don’t believe that. The flaps hold up very well with radiation. So to be able to preserve your skin and probably the nipple as well, replace it with the flap, it holds up very well and they have very nice results.

Melanie Young (00:49:58):
Well, even though the center was built in 2003, which I think is yesterday because I’m trying not to feel old, it seems like natural tissue reconstruction in my mind is still developing and evolving versus the traditional implant, which is

Scott Sullivan, MD, FACS (00:50:19):
Silicone,

Melanie Young (00:50:20):
Saline, gummy bears, whatever. They’re small.

Scott Sullivan, MD, FACS (00:50:23):
There’s very little change in the implant-based or appliance-based world of reconstruction. Now the deep flap is being taught to the residents widely in all of the university settings. So that’s good. You’re getting people who are coming out somewhat trained in it for that didn’t happen. They were taught to do trams, latissimus flaps that’s barbaric and far outdated. It’s hard to dedicate yourself to something that is sophisticated like this, that you have to be ready and alert and aware to go back to surgery at any time.

Melanie Young (00:51:00):
So realizing the pool is still comparatively smaller, are you and the center doing anything to help with the training process to bring on more skilled, qualified, trained surgeons like internship programs or education programs?

Scott Sullivan, MD, FACS (00:51:14):
We are. We have started our own fellowship in coordination with LSU in Tulane. Good. That will help train them. We’re also participating in other fellowships. If people want to come down, we’ve always welcomed them to come down. If they have time … So in some plastic surgery programs, they allow electives and we’ll have young men and women plastic surgeon residents that will come down for a month or so and operate with us. So we welcome that.

Melanie Young (00:51:43):
And I do want to underscore that the center has women surgeons and men surgeons. I had both. Yes. I had two different surgeons and I think that’s really important because some people just naturally want a woman or a man or whatever to whomever to … It’s important to have that connection.

Scott Sullivan, MD, FACS (00:52:01):
Sure.

Melanie Young (00:52:02):
When you have a patient, how long do you stay in touch with them and your team through the process and after?

Scott Sullivan, MD, FACS (00:52:09):
So all my patients have my number. They don’t always call me and I prefer them to call me if there’s any problem, because it’s all new to them. Many things would be handled over the phone. Besides myself, we have our physician assistants. We have 10 of them here that participate in doing routine calls and follow-ups. We also have the nurses on the floor do follow-ups to check on the patients after discharge person in pre-op recovery will also call the patients during their recovery. So there’s a barrage of calls that they get to make sure they’re doing fine.

Melanie Young (00:52:49):
I was in touch a lot with mine. And when I had something that was a concern, I just popped a photo and sent it on and came in literally the next morning to address it. So it’s very efficient. And if you are out of town, you work with Zoom so that you can stay in touch that way. Geography should not be a barrier to really great cancer care and reconstructive care.

Scott Sullivan, MD, FACS (00:53:13):
Right. I mean, we feel it’s worthwhile. There’s no question it’s a very difficult decision. It’s incredibly difficult when you’re told you have this medical problem. And then try to sort out the emotion first and sort through the information and then figure out where is the best place for care. We think that we stand out, certainly with our dedication that we have, with our performance level, with our success rate and with the aesthetic outcome.

Melanie Young (00:53:44):
Well, we talked about the physical outcome and we’ve touched on the emotional. What other ways does your team support the emotional recovery for patients?

Scott Sullivan, MD, FACS (00:53:56):
Yeah, that’s a good question. That’s where I feel we’re still a little inadequate. We affiliate with other groups that are run by psychiatrists that help with it with that. The dialogue of sexuality- Yeah, it’s a big one. … of reintegration,

(00:54:16):
Physical therapy, all that’s the easy part to do. There are many more things that are behind the curtain that are difficult for patients to talk about. We don’t here at the center have that geneticist as well. We talked about having that. That’s another thing that we lack. So there are things that would benefit the patients. It’s a little harder, I guess, since we have so many who are out of state to provide some of those services because it will be counseling that needs to be integrated in their life for a period of time to overcome some of these issues, but that would be worthwhile continuing to develop.

Melanie Young (00:54:57):
Definitely an opportunity for the horizon. Curious, given that you’re behind many pioneering techniques, what are you really excited about? What do you see in the advancements for reconstruction?

Scott Sullivan, MD, FACS (00:55:09):
The latest probably is nerve grafting. So we did this a long time ago. We’ve gotten consistently now we get very nice aesthetic breast outcomes. They look very youthful. They have great shape. They’re nice and soft and natural,

(00:55:28):
But we still don’t have all the return and sensation. It’s pretty hard to get full return of sensation with whatever you do. But now with integration of some of the nerves and nerve grafts, and in fact, unfortunately, the insurance companies do not cover the nerve grafts. The nerve grafts are very expensive. They’re $7,000 per graft, but there are techniques with where you can find your own nerve graft within your own tissue, within your own deep flap, or within your own gluteal flap and use it to connect to one of your nerves. The nerves that go and serve the central part of the breast run underneath the fourth and fifth rib. And they get cut, of course, going through the breast tissue when you take the breast tissue out. You can still define a little stump of it and put a nerve graft to it with the hope that the nerve will regenerate back to the central part of the breast.

(00:56:17):
There’s some articles, since this is kind of the hottest thing over the last probably five or six years, some articles that suggest there are some advantages to it that there’ve been some good results, but also it still has to be reviewed, defined, and improved on. So that is the thing. As far as making a breast in a 3D printer, that’s not really going to happen. What will also be pretty good down the road will be some of these fillers. So instead of do fat grafting to improve some thickness over an implant or your own tissue, if you have a deficiency there, they’re making some good natural body fillers that should stay longer and be more affordable. Like hyduronic

Melanie Young (00:56:58):
Acid type or is that what you put in your face?

Scott Sullivan, MD, FACS (00:57:01):
It would be decellularized products. So hyaluronic acid is one of them. It’s one of the early ones, but this is a few more iterations down the road that it has a better feel to it, stays around better, and it’s not $1,000 per cc.

Melanie Young (00:57:15):
Is fat a lot of us girls worry that the fat’s going to disappear.

Scott Sullivan, MD, FACS (00:57:23):
Well, the fat injections don’t all take some portion of the fat injections, but the fat that you have. So we’re born with a certain distribution of fat cells. When you gain weight, they expand. When you lose weight, they go weight. They don’t multiply in different places. Hormones can affect the distribution of it and then the emphasis of it. But what you’ll find is if you gain weight, things are going to get bigger. If you lose weight, they’ll get smaller. As we get older, our frame, our body reduces in size and so that can be a perception that some people may have to. Yeah,

Melanie Young (00:58:01):
Because a lot of women, when they go through lipopsis, some of it gets absorbed.

Scott Sullivan, MD, FACS (00:58:05):
It does. So that’s with the fat grafting because it is a free graft. So you suck the fat out, it comes out a little glob, so we centrifuge it to concentrate it, then you’re injected in wherever. It’s good for small volume fill. It’s good for three ccs in the cheek or two ccs in the lip, but when you need 40 ccs in the breast, since it has no blood supply, it has to absorb nutrients to survive and not all of it has the ability to absorb that. So there’s a variation intake of 10% to 30% or whatever when you’re using it for a breast implant fill. So the skin and soft tissue over an implant reconstruction is anywhere from four millimeters to 10 millimeters thick. It’s very, very thin so you can’t layer your fat grafts as opposed to if you have a flap that’s six centimeters thick, I can do layers and columns of fat grafts, increase the surface area, the increases of the take.

Melanie Young (00:59:01):
It’s really interesting. And the results are lasting. Do you ever have a situation where someone has to come back and have a redo or a-

Scott Sullivan, MD, FACS (00:59:09):
Some do. The ones that … So this is a common question, if I lose weight, do I need to get them redone? When you lose weight in my perception is that the breasts go down the size, but also the body goes down in size. So they go from a size six to a size four, size two. The breasts seem to still be similar in volume or size to the frame of the body. Those women who do massive weight loss, 80 pounds-thicker, one of those

Melanie Young (00:59:37):
GLPs.

Scott Sullivan, MD, FACS (00:59:37):
80 pounds, 100 pounds, 120 pounds, they end up coming back and they would benefit from a lift because their breasts look deflated, but at the same time, then we do these other body sculpting stuff too as well.

Melanie Young (00:59:49):
So I’m wondering, because GLPs are such a big deal right now and they’re affecting everybody, I mean restaurants, life, how does it impact and what should a woman can sitter, if she is thinking about taking a GLP prior to surgery or after surgery knowing that it could result in significant weight loss and volume loss

Scott Sullivan, MD, FACS (01:00:13):
Well, we encourage to try to be in the best shape you can. We also will help direct people and prescribe for them the GLPs postoperatively. I think again, refines it for some people who are overweight, heavier, direct them in that. How it affects your surgery is you need to discontinue it three weeks before surgery because it caused stasis of your stomach, of food in your stomach. So you want to make sure that’s well clear. Historically, it’d been two weeks and we moved it to three weeks to just make it super safe. Then I’ll have patients continue it. They choose after about four weeks of recovery because typically in your recovery, you’re not eating very much anyway. No,

Melanie Young (01:00:54):
You’re not.

Scott Sullivan, MD, FACS (01:00:55):
So you end up losing a bit of weight. So it’s when they start to feel they’re getting back to a normal diet or getting close to it that then they can recover. They’re a great category of drugs and they’re only going to get better because they’re having these newer ones that are going to preserve more muscle mass. So it’s a fabulous drug.

Melanie Young (01:01:15):
So you can have integration with … I was curious about that because your body really does change so much and it’s important to try … Well, it’s always important to maintain a normal body weight that doesn’t have wide swings for your overall health, but it’s also important in terms of your reconstruction.

Scott Sullivan, MD, FACS (01:01:37):
Correct. And we have a nurse practitioner here that’s her specialty. So she helps guide them. She does all the profile of the labs, make sure it’s not your thyroid or not in other issues. That’s interesting. Not a hormone. Talked about hormone balance as well. That’s safe in the post-cancer patient as well as those that are going to be a genetically predisposition. Incorporation of weight reduction therapies or diets, something like that, many of them incorporate the GLPs where you have the proper management of it that you can be followed. So this is not something you should just do on your own because you want to make sure that some of them do have some complications. You want to make sure that you’re being managed properly and could overcome those and do the right lab. So we do incorporate that a bit in our patient population. What it does as they lose the weight, it makes them look like their surgeon was much more skilled than they really were.

Melanie Young (01:02:30):
Wow. That’s so interesting. I’ve never considered it, but that’s good to know because it is such a big topic right now. The other topic that is big, and I’m actually working on it right now is scar reduction

Scott Sullivan, MD, FACS (01:02:41):
And

Melanie Young (01:02:41):
How to minimize … You do have a scar. It’s very low so you don’t see it. It’s the bikini scar. I’ve been told it’s like a C-section. I didn’t have one, but you do have that. And here, what are some scar techniques or revisions that you’re working on?

Scott Sullivan, MD, FACS (01:02:59):
So we help guide them in that there’s a wide variety of scar therapies. One of the simplest ones that’s very effective is just the silicone tape. It’s easy to apply. It doesn’t leave a residue. It’s reusable. The tension of it, being a semi-adhesive, it helps support the scar. It works very well by itself and it’s used early on. All the other ones have a silicone base and then they have some proprietary whatever in it. And they’re all for the most part similar. We have a number of them here. You can get all variety of them at many stores, drug stores or on Amazon. The people who scar very poorly, that keloid, what we do with them is we’ll prescribe for them a compounded scar cream that has not only silicone gel based, it has anti-estrogen, has antihistamine, it has a small steroid and it has five or six different pharmacological components that help with that.

(01:03:58):
And we monitor them for quite a while and educate them. This is what you need to look for when you have this itching symptoms. This is a prodrome for your keloid or hypertrophic scar, and this is what we need to do to try to intervene and reduce it.

Melanie Young (01:04:14):
It’s important to note that when you do go in and do your surgical pre-surgery, you get a list of questions that you’re asked. Correct. And one of them is, do you tend to get keloid scars because it needs to be treated differently? The other one is, which is super important, do you smoke? And I think we need to underscore the importance of not smoking before surgery and how they can impact the reconstruction.

Scott Sullivan, MD, FACS (01:04:36):
A much higher risk of wound breakdown of skin loss and all of that stuff.

Melanie Young (01:04:41):
Well, that’s important.

Scott Sullivan, MD, FACS (01:04:43):
Yeah. Avoiding skin loss and avoiding wound breakdowns are not sold. Why smoke?

Melanie Young (01:04:48):
I guess vaping’s in the same section.

Scott Sullivan, MD, FACS (01:04:49):
It is. Same.

Melanie Young (01:04:50):
Yeah. Alcohol.

Scott Sullivan, MD, FACS (01:04:51):
But it’s alcohol thins your blood, alcohol. So you have to be careful with that, particularly if you’re taking post-surgical, the narcotic medications, it amplifies the effects of it. So it’s just taking care. I think

Melanie Young (01:05:03):
It’s a great time. If you’re going to have the surgery, it’s a great time to treat yourself to a self-spa treatment. Don’t smoke, period. Do not smoke. Lay off the alcohol, eat really healthy, get your exercise in so your body is prepared for surgery and then it will really help with the healing process.

Scott Sullivan, MD, FACS (01:05:21):
I thought differently. I just thought drink the fine alcohol and eliminate the bad stuff.

Melanie Young (01:05:26):
Well, I believe in that every day. The other things I’m curious about, because this happened to me, what about flying or because a lot of your patients fly. Is there any risk of getting on a pressurized cabin airplane right before or after surgery? Should you allow a period of time?

Scott Sullivan, MD, FACS (01:05:47):
So majority, 70%, 75% come from out of state. Majority of them fly home. The same with driving, even they drove home. When you’re sedentary is when you have the risk of getting the DVTs.

(01:06:02):
Now we don’t commonly put everyone on an anticoagulant. We put those on it who are at risk, who’ve had DVTs before, or who have maybe a gene for elevated clotting or a clotting factor problem. We get them in, they have the little tights, the TED hose, and they also go home with the SCD, the sequential compression device hose that helps them as well. So we encourage them to use it and we encourage mobility. There’s some people, and I don’t think this is wrong because there’s medical data to support this, that are put on an anticoagulant for four to six weeks. Just found that also has risks of hematomas, delayed bleeding and so forth.

Melanie Young (01:06:46):
The less pills, the better.

Scott Sullivan, MD, FACS (01:06:47):
Correct. The

Melanie Young (01:06:48):
More movement, the better, the more natural eating, movement, sleeping, resting and self-care is critical.

Scott Sullivan, MD, FACS (01:06:55):
Correct.

Melanie Young (01:06:56):
So is there anything else you’d like to share with our vast audience here about the center or your own area of expertise or you?

Scott Sullivan, MD, FACS (01:07:06):
It’s the same thing I shared with you earlier. It’s a devastating event. It’s life altering. There’s the natural feel for urgency in getting something done, getting the cancer out. It’s most important to take a moment and understand what’s going on. There was a campaign 10, 12 years ago, and it was a national campaign. Now, do women, do they understand their choices? There’s only about 20% of them did. And these were for failure of education by their caregiver. And now it’s much more widely available with the blog support groups. Internet sites are so much more informative. But just take a few minutes and just try to figure out what is best for you. Talk it over with your loved ones so everyone’s on the same page. Get them lined up as well and then figure out … We’re always flattered people travel for care. This is also why we’re opening up other locations that’ll be in proximity and maybe easier for them.

(01:08:11):
There are many qualified people that are out there doing this and there are a number of them that are very good that are dedicated to this. You deserve the best care. So take a moment to plan it out.

Melanie Young (01:08:21):
Absolutely. And don’t rush the process. Don’t be afraid to ask questions. There are no stupid questions. I asked about 150. And as you said, you’re not alone. Talk over with your family, talk to peers. Don’t get lost in the internet. Go to people who are leaders in their field in what they do for the best care, which is what is offered here at the Center for Restorative Breast Surgery.

Scott Sullivan, MD, FACS (01:08:47):
Right. Come get some beignets.

Melanie Young (01:08:49):
Yeah. And you get to come to New Orleans. It’s a bonus. Dr. Scott Sullivan, thank you so much for your time. Unrestoring a claim. It’s been so great to sit down. I know you’re incredibly busy, so thank you for taking time out.

Scott Sullivan, MD, FACS (01:09:02):
Thank you. Wonderful podcast. Thanks.