Topic: Going for my PS Consultation this week in Boston Area

Lizzy, I've heard very good things about both doctors and I think they are *it* in the Boston area for expertise and numbers of surgeries (autologous).

I don't know about these docs, but I have heard that you are better off getting your rads before recon as the new tissue may shrink or harden from the radiation.  Maybe others here who have had that sequence could chime in about it.

Good luck to you.

I hap DIEP recon with Dr. Tobias -- he is in the same practice as Dr. Lee -- very happy with my results.  What hospital is your breast surgeon at?   Dr. Lee/Tobias work as a team at BIDMC -- Caterson, I believe, is at Brigham and Womens.

Lizzygirl15: I have heard really good things about both these PS's, but so far from women who have had the DIEP recon.  I am in the same boat as you, I don't have enough tissue, unless I go to an A cup (currently a D)  I had a unilateral mx with rads and have had two implant exchanges and two lifts.  My symmetry is very bad and that is why I am looking for a new PS.  I am hoping to get an appointment with Dr. Lee and Dr. Caterson soon to see what they can do for me. My breast surgeon's nurse practioner recommended Dr. Lee to me today. I told her my concern about not knowing how he is with implants.  She said she has seen his work and she thinks it is very good. What's scary for me is that my first PS had a good reputation but he put my expander in too high which is contributing to my lack of symmetry.  Please let me know how you feel about Dr. Lee when you meet with him.  Good Luck!

 I would love to hear from ladies who have had implant recon with these doctors. Are there other good "implant" PS's in Boston area anyone could recommend?

Hi LizzyGirl,

I have made an appointment to see Dr. Lee in a couple of weeks but still plan on meeting Dr. Caterson as well.  After being disappointed with the outcome of my last two surgeries and PS's I have smartened up will seek more than one opinion.  Thanks for letting me know about your thoughts on Caterson.  I will let you know what I think of Dr. Lee. 

 I was just reading some posts from people who have had s-gap surgery.  I definitily have enough fat in my butt, but since I need a unilateral reconstruction, I don't know if my butt would look lopsided. Thats why I never really considered this kind of surgery before, but I haven't been happy with the implants and I may ask Dr. Lee about other options.  God I am so tired of all this.  I never thought that the reconstruction phase would be so difficult and require so many surgeries.   My husband is getting so tired of hearing me talk about it. My lopsidedness doesn't bother him and he thinks I should just let it go.  I can't do it.  I am anxious to meet with Dr. Lee to see what he can do for me.

 Hope all goes well with your MRI. I will keep in touch.

Patty and Lizzy, just want to wish both all the best in finding a surgeon and figuring out which surgery works best for you.  I had a unilateral DIEP with Dr. Caterson three months ago (also a reduction to my "good" side at the time of my mastectomy) and I'm very happy with the results.  I'm going to see her next week to discuss stage 2 revisions (just minor ones).

She was very adamant that she wouldn't do the recostruction until 6 months after radiation.  When I first found this out I cried (I was in the midst of chemo and very emotional) because I didn't want the process to be drawn out any longer.  As it turned out, the time after rads was a good opportunity to get healthy and strong -- I exercised a lot and was in good shape when it came time to have the surgery.

I was treated at Beth Israel Deaconess and had an excellent experience there. I did not have reconstruction, but I had several breast surgeries (had bc twice) and had a very positive experience. The nurses were caring and competent, the hospital was clean and well run. I consulted Dr. Tobias regarding reconstruction and would have used him if I'd decided to go ahead with recon. His nurse was terrific.

Thank you both for sharing your experiences.  I made a consult appointment with Dr. Tobias this morning, I'm seeing him Aug 18th.  The phone call I made to the office this morning was one of the easiest I've ever had, even though I called the wrong number--the assistant wa very cheerful and transferred me to the right place, Jean was just as cheerful and pleasant.  Took time to be sure I didn't have any more questions before transferring me to registration.  The man there was also very nice, if a bit formal--I'm not used to being called "ma-am" so much!  I'm going to spend a couple days in Beantown, sort of a mini-vacation before school starts Aug 31st.  So far, I'm pretty impressed with Beth Israel. 

Thank you for sharing your experience--it gives me more confidence. 

I had an extensive lumpectomy (really a partial mast) & radiation.  I consulted Dr. Eleanor Pitts at Faulkner (Dr. Susan Love's first hospital) about PS, and she also recommended waiting a year, but said with that kind of wait & my good healing from rads, I would be a great candidate for a simple implant.  It will be a year post-rads for me next October.  I liked her, she's a breast expert & has privileges at both Faulkner & at Newton-Wellesley Hospitals.  I'm undecided yet about recon, but I will go back to her if I decide to revisit the subject.

I have not been around for a while or I would have posted on this thread earlier. 

First, I had a bilateral with immediate reconstruction (expanders/implants) followed by radiation. My surgery was at Mass General, by Dr May. He has headed the MGH and Harvard reconstruction programs forever... was clear on the fact that irradiating new reconstruction isn't optimal, but sometimes we have to play the cards we are dealt. 

On me, we did fills during chemo, then exchange, then 35 rads... I am a year out and things look/feel pretty good. Slightly firmer on the rads side, but only I would notice.  

On Winograd-- I LOVE that man.

I live in Tulsa and ended up in Boston in a 'round-about way. Right after my dx, a friend of a friend got me into Dr Barbara Smith on very short notice. In my consult, she asked who I wanted to do reconstruction. Given that I just arrived in Boston, I said I wanted the surgeon SHE thought was the best... Next thing I knew, I was sitting in Dr May's office. 

At that point, having spent a couple of weeks on these boards, I thought that DIEP was the ONLY way to go. That if a surgeon recommended something else, it ws only because he/she couldn't do DIEP...

Anyway, Dr May, in that first meeting, suggested I consider Pedicle TRAM and I freaked out. I hadn't traveled all the way from Oklahoma for a Pedicle TRAM!  He doesn't think that DIEP is worth the substantial risk of flap loss. The better option, he believes, is MS TRAM. He no longer preformed them because he doesn't have the time for long-term follow-up of microsurgical patients, but if I wanted to learn about the procedure from the best, he would set it up... 

The next morning, I was in Dr Winograd's office.

I was still under the impression that DIEP was the "Gold Standard" and all such stupidity. The evening before our meeting, alone in my hotel room, I spent hours on this board asking questions which made me more and more confused as to WHY they would recommend such a "draconian" surgery as a TRAM.

I was pretty worked up by the time I got into Winograd's office. I didn't think they UNDERSTOOD that I was a very active, athletic mother of 3 small children. I couldn't take 6 months off of life to recover! I couldn't lose my ab strength! I was in quite a state of panic.  

On Dr May's request, Winograd came into the office when he wasn't seeing patients just to talk to me. He was open and engaging and spent over an hour talking to me about all my options. He correctly read my apprehension. 

 He is the guy who brought me to see that all forms of reconstruction from Implants to Pedicle TRAM to DIEP have their pros and cons. None are perfect. All have risks. One isn't any "better" than another... it is all just a matter of balance. 

Anyway, up to this point, I would ask every doctor I saw (in Tulsa, in Boston) what they would recommend if their sister/mother was in my position. To a man (and woman) they said; "I would tell them they had to learn about their options and weigh them carefully to make the best educated choice for themselves." Ugh. Such a cop out. 

At the end of my hour with Winograd, I asked him The Question, expecting the same answer everyone else gave me.

He listened, considered and said "Implants." 

 Implants!

Somehow, in all my obsession about DIEP, I never even considered implants. Now, here I was in the office of one of he country's best microsurgeons who COULD do whatever he wanted and, for me, he is recommending implants. 

He was totally 100% correct. It was one of those moments when it all comes together and I realized that sometimes the simplest path is the best. 

A month later, Drs Smith and May did my mastectomies and reconstruction.

I still ask all my doctors the question about what they would do--- To date, Winograd is the ONLY one who has given me a straight answer.  

If I ever have trouble with my implants I will, in a heartbeat, have Winograd do a MS TRAM.  

Also, since that initial meeting, I met another young woman (who happens to be a MD/PhD) who has breast Cancer. She is very aware of the "best" options in Boston. She also plans to use Winograd for a MS TRAM when she does her reconstruction. 

I think he is considered to be among the best microsurgeons out there, period.

Hope this helps,  

 Stephanie 

Steph, thanks for the awesome feedback.  That's one of the most helpful posts I've read on all this.  You're a doll for taking the time to write it.

First, hi Stephanie!!  Hope all is well.

Lucy,

In my experience, Dr. Lee doesn't talk people through all of the options thoroughly like Dr. Caterson does.  I got the impression that he had a strong preference for doing DIEP.  I like Dr. Caterson's style better (I always felt rushed in my consults w/Dr. Lee) but Dr. Lee has more experience (though Dr. Caterson is catching up quickly).

Debbie   

Hi Native,

I am glad that Dr. Tobias takes his time w/you.  As I mentioned, I always felt rushed w/his partner, Dr. Lee.  Are you having surgery w/him?  I'm trying to get approval to go to NOLA but I think it is a long shot since I have an HMO.  If I don't, I will end up w/Dr. Lee.  I know he is good but I wish they didn't jam so many appts together (probably why you had an hour and a half wait).  They schedule appts in 15 minute intervals.  My first one was less than 1/2 hour (though they say the first appt is supposed to be an hour).  I'd be curious to know how you do w/Dr. Tobias.  I have't met him.

Debbie 

Just thought I'd jump in to give some insight. I live South of Boston and had  my surgery at Mass Gen with Dr Gadd as my breast surgeon (excellent surgeon and so compassionate) and she recommended Dr Winograd for my Plastic Surgeon. On June 26th I had Bilat Mx. with Diep on left with node dissection and pmx on R with silicone Gel implant. The surgey was 9 hrs but felt I was in the best hands and all the nurses on the PS post op floor said he was the BEST. The Diep came out perfect with the implant side a little smaller but you really can't tell with support bra's. He suggested a slightly bigger implant but going through Chemo now and the thought of more surgery doesn"t appeal to me right now so I'll decide after Chemo. I think when dealing with a life threatening disease like Cancer you want the best and most experienced. Good Luck to all!!

I just wanted to throw another name out there.  I had a consult with Dr. Robert Allen a few weeks ago in NYC.  He was the pioneer of many of surgeries that use your own tissue and the guys from NOLA were his students.  He has done almost 2000 surgeries.  I went to see him about getting a stacked DIEP because I don't have enough tissue for a regular DIEP.  I had already met with Dr. Lee and he was pushing the GAP.  Dr. Allen spent over an hour with me about all the options I had available to me. I found him to be modest, honest and such a gentleman.  I decided that very day to have him perform my stacked DIEP at the end of September. What is also great is that we were able to drive to NYC to see him, but it was a LONG drive. My husband and I have booked tickets on AMTRACK for $200 round trip for both of us for the surgery.  Can't beat that.

Dr. Allen's website is www.diepflap.com if you are interested.