Submitted by Twin City Plastic Surgery

Katie Bertsche is a survivor: after being diagnosed with Stage III B breast cancer in 2011, she underwent six months of chemotherapy followed by a double mastectomy. She began breast reconstruction procedures as part of the mastectomy surgery and has had several additional surgeries to complete the reconstruction.

But Katie isn’t a “typical” breast cancer survivor, for a lot of reasons.

Breast cancer wasn’t even on her radar when she was diagnosed. At the time, she and her husband were facing questions about infertility when she happened to notice a lump in her right breast. Following a gut feeling that it was important enough to have a general surgeon’s opinion probably saved her life: a diagnosis of Stage III B means that the cancer was advanced enough to include lymph nodes. She was only 28 years old.

Katie’s first surgery took place in February 2012, and included reconstruction, but subsequent radiation treatment had damaged one of the implants that had been used. In May 2013, she underwent a latissimus dorsi flap reconstructive surgery to repair the damage and further complete the contouring. She has also undergone additional less-invasive surgeries that involved fat grafting to fill in where the implants can’t reach. Thankfully, these procedures have smaller incisions and shorter recovery times.

 Katie now has been living with metastatic breast cancer since November 2015. That means her cancer has spread outside the breast, in her case, to her bones.

Katie’s experience with breast cancer and reconstruction, oddly enough, has a positive side. As the Spa Manager and Front Office Assistant at Twin City Plastic Surgery, her role gives her the opportunity to relate to the breast reconstruction patients. She is also involved in several breast cancer awareness programs, one of which recently took her to New York City during Fashion Week—to be a runway model.  

The event, organized and presented by #Cancerland, AnaOno, and sponsored by Eisai Pharmaceutical, Inc., benefits METAvivor Research and Support. This year’s theme was #fearLESS, and the intent was to join early stage patients with the metastatic community to make a difference for all. #Cancerland is a media platform that offers discussions of a variety of topics using the voices of real individuals who live with the disease every day, providing a platform to talk about often ignored realities.

METAvivor is an organization that focuses specifically on funding research for Stage IV metastatic breast cancer. The money raised during the New York Fashion Week fundraiser show will benefit METAvivor, and the runway featured not just breast cancer patients, but those affected by Stage IV metastatic disease. Drs. Paige Holt, Laura Randolph, and Chad Tattini of Twin City Plastic Surgery sponsored Katie’s participation in the event.

AnoOno creates bras and lingerie for women who have had breast reconstruction, breast surgery, mastectomy, or are living with other conditions that cause pain or discomfort. Their purpose is to provide women an option that focuses on more than surviving, but truly living after going through procedures that are very clinical and uncomfortable. Katie modeled the Melissa bra and lounge pants and said of the entire experience, “The thought of walking a runway in just lingerie was nerve-wracking, but it was the most fun, liberating feeling. Especially because I got to do it with my breast cancer sisters.”

Twin City Plastic Surgery has a long history of giving back, whether it’s on a local scale or a more national scale such as the METAvivor sponsorship. Whether it’s providing a spa experience or other gift for a local school auction or carnival, participating as a VIP/Sponsor in the annual St. Jude Research Telethon, the Susan G. Komen More Than Pink Walk, the Doctors in Concert event for the Children’s Discovery Museum, or as a sponsor for the American Red Cross Evening of the Stars event, the physicians and staff feel strongly about helping others and making a difference in their community.

“I am so incredibly thankful for the doctors at TCPS for this amazing experience. Yes, it was a fun and exciting event, but more importantly, it shines a light on metastatic breast cancer. Most organizations donate less than 5% of their funds to metastatic breast cancer research. With more funding, this disease could be treated as a chronic illness versus a terminal one. Stage IV deserves more.”

Written By: Twin City Plastic Surgery

A condition that plagues many men yet goes almost undiscussed in the media is Gynecomastia, otherwise known as enlarged male breasts. Gynecomastia occurs in 40 to 60 percent of men, sometimes as an on-going condition or may develop due to other medical changes.

While a man’s chest typically has some shape, many men find their chest has excess fat or contouring similar to women’s breasts. Gynecomastia doesn’t have a negative impact on a man’s overall health, but can cause social awkwardness or body image issues. And since it receives little public discussion, men facing this condition frequently don’t feel comfortable talking with their doctor or looking for solutions.

The size and shape of male breasts can vary. It’s not uncommon for men with breasts to hide their body by wearing loose clothing or developing a hunched-over posture. Sometimes the condition is noticeable only when a man has his shirt off, such as at the beach or pool. But the condition may be more pronounced on other men, with their breasts showing through shirts and clothing adding to the awkwardness they feel on a daily basis.

No one knows for sure what causes male breasts, but most doctors agree it appears to result from a hormone imbalance. All men have both androgens (hormones that create male characteristics) and estrogens (hormones that create female characteristics) in their bodies. Changes in the levels or in how the body uses or responds to these hormones may cause enlarged breasts in men.

Some young men form male breasts during puberty, but their chest returns to a normal appearance as they grow and mature. Other men find their breasts continue after puberty through the rest of their lives. Being overweight causes the body to develop more fatty tissue and may also aggravate the condition. Using certain prescription medications, steroids, or “street drugs” may also cause male breasts to develop.

Unlike Gynecomastia which results in enlargement in both breasts, some men notice enlargement in only one breast or that the breast has a hard or firm feel. Men who notice these types of changes should visit their doctor immediately to rule out breast cancer.

Currently, the only known treatment for Gynecomastia is breast reduction surgery, and a board-certified plastic surgeon can help a man suffering from this condition explore his options. One of the most rewarding parts of working in plastic surgery is helping people manage the special needs of their bodies.

The physician will conduct a thorough medical evaluation to confirm that the patient is in good health, review the patient’s weight and medication or drug use history, and determine if there are any other medical conditions contributing to the breast formation.

If breast reduction surgery is the right solution, the plastic surgeon will help the patient understand the procedure, any steps needed for preparation, and the potential side effects or complications. Although different techniques are performed depending on the severity, in most cases the surgery will include glandular tissue being surgically removed with simultaneous liposuction to contour excess fat.  Recovery time varies from person to person and depends upon the extent of the surgery. Patients often return home the same day, return to non-physically demanding work in less than a week, and resume normal activities including exercise in 4-6 weeks. 

But, the most important change a patient will experience is the new-found confidence and comfort with their physical appearance. Gynecomastia may not be discussed much in the media, but the only discussion that matters is one a man has with his plastic surgeon.

By Becky Wiese

Being diagnosed with breast cancer at the age of 28 was not on Katie’s radar. In fact, in May of 2011, she and her husband were facing questions caused by infertility when Katie found a lump in her right breast.

A visit to her obstetrician resulted in a sonogram that showed no abnormalities.

But a lump is a lump, and while she didn’t know exactly what it was, “I knew I didn’t want it to be there,” says Katie. She decided to go to a general surgeon who did a wedge biopsy of the golf ball size mass. The results were shocking, as she was immediately diagnosed with breast cancer.

Even more shocking was the randomness of her disease. Although her paternal grandmother had breast cancer which eventually took her life, Katie feels that she would have had a better outcome if she had been more proactive with monthly breast exams and had not waited so long to start cancer treatments.  Otherwise, Katie had no other direct female relatives with breast cancer. She was young and healthy. She simply didn’t fit the profile for a breast cancer patient.

Now Katie encourages all women, regardless of age, to be their own advocate. “Know your own body—if something doesn’t feel right, get it checked out. My test results (from the sonogram) didn’t show anything, but I felt like something wasn’t normal, so I pushed for more. I’m so glad I did that.”

In rapid succession of her diagnosis, Katie had an oncologist who performed several tests to determine how much, if at all, her cancer had spread. The results showed she was Stage IIIB, an advanced stage which included lymph nodes.  By the end of June, she had started six months of chemotherapy prior to surgery. After finishing chemo, she underwent a double mastectomy with reconstruction in January 2012.

“I knew I didn’t want to go through this again, and I wanted to be the same on both sides, so the double mastectomy decision was proactive,” Katie explains. She had time to think about the surgery and reconstruction options while she was undergoing chemo and had met with the general and plastic surgeons to decide what she wanted to do. “I was only 28 years old, so I knew I wanted to have something [in the way of reconstruction]. In the end, I went with my gut,” based on the information from the surgeons.

During her surgery, the surgeon inserted silicone implants. She chose not to use expanders, which would have been temporary until she finished with post-surgery radiation treatment. In hindsight, Katie says she might have done that differently, as the implant in her right breast was damaged from the radiation.

Before she could move forward with more reconstruction surgery, however, she was faced with even more trauma. Her husband, Ryan, passed away unexpectedly. At that point, she decided she wasn’t ready to make any decisions about more surgeries. “I needed to let things settle and let my body rest, both due to the chemo/surgery/radiation as well as the grieving process,” she says.

Finally, in May 2013, Katie underwent a latissimus dorsi flap reconstructive surgery during which her plastic surgeon took an oval flap consisting of muscle along with skin, fat, and blood vessels from her upper back and put it in the front where she had sustained damage from the radiation treatments. Another implant was added to help complete the contouring.

Katie has undergone numerous additional surgeries for “fine tuning” the reconstruction. “We’ve done some fat grafting to fill in spots where the implants can’t reach,” she explains. These surgeries are not as invasive as the mastectomies and original reconstructive surgeries—“the incisions are smaller and the recovery time is much shorter.”

Not all doctors do these procedures and not all patients choose to have it done. But for Katie, the decision was based on her age and the fact that she had decided from the beginning that she wanted to look and feel as “normal” as she could.

“You know it’s not you—the original you,” she explains. “I feel like I’m still getting used to it—it won’t feel like it did before, but eventually, it’ll feel like the new me.”

Written by Twin City Plastic Surgery

In today’s society, it’s easy to get carried away. And, the more money you have, the easier it can be to blow it on purchases or pursuits that you think will give you pleasure; but in the end, doesn’t make you any happier. When it comes to plastic surgery, some individuals tend to go overboard. They start with something small like a filler and then continue to seek more “improvement” by undergoing more and more facial and body reconstructive surgeries. If you’re considering getting plastic surgery, make sure that you have a healthy approach.

What You Want

Before you go into the plastic surgeon’s office or before you even discuss the prospect of plastic surgery with anybody you know or love, be honest with yourself.  Why do you want surgery and what do you expect the surgery to do for you? Determine what things about yourself you would like to change or enhance and why. For example, have you always wanted a smaller nose and larger breasts? By understanding what you personally want, you can help to ignore any outside voices telling you to make a change that may be unwanted or needed. Although for some it might be difficult to stand firm in regards to sticking to only the procedures you want, you will end up with the results that matter and that you are happy with.

 Start Small

If you’re worried about the aging appearance of your face, the best thing to do is start small. You don’t want to start off with a full-blown face lift if something more subtle like facial fillers might do the trick. By starting small, you might be so impressed with the results of something like BOTOX or Juvederm that you might completely forego the idea of a more invasive procedure. 

Take Your Time

One of the biggest mistakes that people make when it comes to plastic surgery is that they rush into the whole process. What’s the rush? Make sure that you are taking enough time to really digest the prospect of surgery, think about why you’re getting the surgery done, and if the outcome will make you happier. Plastic surgery procedures can be somewhat addictive for some people.  The goal is for you to look and feel better about yourself.  Plastic surgery can most certainly increase self-esteem and confidence, but plastic surgery will not solve the problems or challenges that you may be having in your life.  According to the American Society of Plastic Surgeons, good candidates for plastic surgery include people with a strong self-image who are bothered by a physical characteristic that they’d like to improve or change; or patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time.

If you are seeking surgery with the hope of influencing a change in someone other than yourself, you’ll likely end up disappointed.

Written By Twin City Plastic Surgery

Your skin. It protects your body’s internal organs. It keeps infections and harmful materials out of your system. It regulates your temperature and keeps you cool in the summer. Your skin does a lot.

However, if you’re like most women, in the winter your skin is as dry as a desert. All that hard work takes its toll. During the summer, the skin builds up extra skin cells to protect itself from the damaging rays of the sun. The extra build up leaves our skin looking dull and dry.

Exfoliation is a highly effective way to remove dead skin cells and revitalize your glow. Many people try scrubs or surface exfoliation treatments. But, chemical exfoliation frequently generates the best results and comes in two forms: in-office treatments and take-home self-applied products.

In-office chemical exfoliation is commonly called a chemical peel. These treatments can be applied to the face, neck, or hands and typically result in:

• Smoothed lines and wrinkles and a softer appearance of mild scars
• Reduction in age spots, freckles, and dark blemishes
• Improved skin health when managing certain types of acne
• Enhancement in the overall texture and surface of the skin

Chemical peels use alpha hydroxy acids and beta hydroxy acids such as salicylic and lactic acid to loosen the top layers of dead skin cells. Sometimes the skin may be slightly red after a treatment. However, the underlying healthy skin cells then show as the new, refreshed surface is revealed. These acids prevent the buildup of dead skin and promote the growth of healthy skin cells. They also help with collagen production helping skin to look full and healthy.

Some patients also use take-home self-applied products such as the Retinol Complex by SkinMedica® to help speed up the cell turnover rate, so there is not as much skin cell build up.  We work with each patient to determine the best treatments for his/her skin.

After removing those dry skin cells, hydration is one of the most important things for people to consider for their skin in winter time care. It’s critical for all of us to drink a lot of water especially during the winter. But, you also need to make sure you’re using an effective moisturizer to rehydrate your skin and counteract the ongoing demands of the cold, dry weather.

Hyaluronic acid is an important ingredient to look for in a skincare product. Hyaluronic acid is a substance your body produces naturally, which can also be manufactured and applied to the skin’s surface. This type of acid has been shown to keep water in your skin more effectively than other products and can “plump” fine lines and wrinkles after continued use. Some people even use hyaluronic acid for healing wounds and burns, but those decisions are best made under a doctor’s supervision.

While there are numerous moisturizing products on the market, our favorite is HA5 Rejuvenating Hydrator from SkinMedica. HA5 uses five different forms of the acid to keep the skin hydrated and helps the skin to create more hyaluronic acid naturally.

After all, there’s a lot of skin out there that needs a little tender loving care this time of year, whether after surgery or just trying to survive the cold, dry winter.