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Dr Mossi Salibian, Breast Reduction Awareness Day, October 15

BRA DAY USA

BRAVE FACES OF BREAST CANCER

October 2014

This year’s BRA DAY USA celebrates the Brave Faces of Breast Cancer: BRAve Faces.

My staff and I feel both privileged and humbled by the courage and personal experiences of each and every one of our patients facing breast cancer and breast surgery. It is a privilege to take care of our patients on a daily basis and we take that calling to heart.

This year’s theme of BRAve Faces is to share in our patients’ diverse experiences and allow that earnest exposure to be a catalyst to educate and inform the rest of our community. As physicians and health care professionals, we are all touched by breast cancer, not only by caring for our patients, but also in knowing loved ones who had the disease. We are always reminded that the scary diagnosis affects not just the patient, but their circle of close family members and friends as well.

This year we are grateful to have an amazing cadre of my friends and colleagues who will be present at our event to discuss the important tit-bits and aspects involved in the multidisciplinary care approach to the treatment of breast cancer. We will have experts in the fields of Surgical Oncology, Radiation Oncology, Medical Oncology, OB/GYN, Internal Medicine, Genetic Counseling, Physical Therapy, and Plastic Surgery to discuss their individual roles in the multidisciplinary team approach to breast cancer treatment.

We thank our sponsors in making this special event possible and for their generous support, talents, and tireless efforts.

Sincerely,

Mossi Salibian, M.D., F.A.C.S.
Plastic and Reconstructive Surgeon


The Panel Members:

Dr. Youram Nassir specializes in the field of Hematology / Oncology. Dr. Nassir is prepared to diagnose and provide treatment for blood-related disorders and all types of cancer, which can range from the common to the very rare and complex. Dr. Nassir is trained to provide care as part of a multidisciplinary treatment team, working in conjunction with other physicians and specialists to ensure the highest possible standard of care. Dr. Nassir is also trained to practice Internal Medicine.

Dr. Rosalyn Morrell is American Board Certified Radiation Oncologist at Advanced Radiation Center in Beverly Hills. She received her Radiation Oncology training at the University of Arizona and completed her fellowship at the Mayo Clinic. She has extensive experience treating all types of cancer including, breast, gynecologic, prostate, lung, and head and neck. Dr. Morrell has extensive expertise in IMRT, 3-D conformal, IGRT, and LDR Brachytherapy for gynecological cancer and HDR brachytherapy for breast and gynecological cancer.

Leslie Memsic, MD, FACS is an elite surgical specialist with excellent medical training and broad clinical experience grounded in academic research. In addition to a fellowship in Surgical Oncology and Immunology, she received advanced training in Liver Transplantation. She has a special expertise in breast cancer and has pioneered skin sparing, nipple preserving total mastectomies and nerve sparing axillary sentinel lymph node biopsies and dissections as well as breast lumpectomies that provide appropriate oncologic therapy without sacrificing function or cosmesis.

Dr. David Ahdoot specializes in the field of OBGYN / Obstetrics & Gynecology. Dr. Ahdoot is prepared to provide comprehensive care for the reproductive system in women. Obstetrics is the term for women's care during the prenatal and pregnant states, while gynecology covers care for general women's health in a non-pregnant state.

Mossi Salibian, MD, FACS is a board-certified Plastic Surgeon in private practice at the Sunset Medical Tower located on Sunset Boulevard at the cusp of Beverly Hills and West Hollywood. Dr. Salibian specializes in aesthetic and reconstructive plastic surgery of the face, breast/chest and body for women and men. He has special interest and expertise in breast cancer reconstruction and is an active member of the multidisciplinary breast teams at several hospitals in the community. He is a Fellow of the American College of Surgeons.

Kimberly Childers, MS, LCGC is a board certified and licensed Genetic Counselor in the Genetics Department at the Disney Family Cancer Center of Providence St. Joseph Medical Center in Burbank. Prior to joining Providence in June 2014, she co-founded the Familial Breast Cancer Program at the University of Illinois Chicago Hospital. She received her bachelor’s degree in Biology from the University of California San Diego and her master’s degree in Human Genetics and Genetic Counseling from Stanford University. She is a diplomat of the American Board of Genetic Counseling and an active member of the National Society of Genetic Counselors.

As a genetic counselor, she strives to empower individuals with the information that they need to take steps in reducing inherited cancer risks. She has been an integrative part of several research studies on hereditary breast cancer syndromes and the psychosocial impact of learning about hereditary cancer risks. She is also heavily involved in genetics education of both the medical and lay communities.


Dr Salibian

Lori Stapp, Practice Manager

Cinthya Castro, Secretary

Dr Leslie Memsic and Dr Salibian

Dr Salibian under the microscope

Dr Liza Capiendo with Dr Salibian

BRA Day 2012 - Karina's Cake House

BRAve Faces

BRAve Faces

BRAve Faces

BRAve Faces

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BRAve Faces

BRAve Faces

BRAve Faces

BRAve Faces

BRAve Faces

BRAve Faces

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BRAve Faces

Team Approach to Breast Cancer

October 15 - 6:00 - 8:00 PM

Hosted by Dr. Mossi Salibian

Christopher Guy Showroom

8900 Beverly Boulevard, Suite 106
West Hollywood, CA 90048

www.map-embed.com

BRA DAY USA

2014

Dr. Salibian and Team


Breast Reconstruction is an option

  • 70 % of breast cancer patients are not informed of this choice
  • Congress passed 1998 law to cover breast reconstruction
  • NY State mandates in 2013 option for recon if mastectomy is planned be discussed by the care team. The concept of “closing the loop” on breast cancer
Although this fact may seem obvious to us as plastic surgeons who perform these procedures on a daily basis, approximately 70 % of breast cancer patients in the United States are not informed of the availability of breast reconstruction after mastectomy as part of their treatment and healing process yet in 1998 congress had passed the federal law that breast reconstruction is a covered benefit by government insurance and therefore all commercial insurance companies were also required to offer coverage and for any procedure required for symmetry for the contralateral breast.

Options for Breast Reconstruction

  • Not all patients are candidates for the same breast reconstruction technique. The type of breast reconstruction chosen depends on several factors:
    • Extent of breast tissue removed (can the nipple be spared? How much breast skin needs to be removed?)
    • If radiation treatment is a possibility after mastectomy
    • Patient choice of autologous or implant or a combination of implant and own tissue
    • Patient’s lifestyle and aesthetic expectations
    • Body morphology and limitations (previous surgeries, co-morbidities, availability of donor sites)
  • Recent clinical advances in same time implant based single stage breast reconstruction with the use of ADM and permanent implant.
  • Two stage implant based reconstruction. Use of Tissue expander first and later exchange to permanent implant.
  • Total autologous reconstruction in same time as mastectomy or delayed fashion with use of a separate body part that can be spared for breast reconstruction, most commonly the tummy area.
  • Combination of autologous and implant based reconstruction as latissimus flap with an implant.

Will briefly discuss the indications for choices of breast reconstruction given the clinical setting of type of breast cancer, the possibility of radiation and each individual patient’s personal desire and aesthetic sensibility in how to best restore the breast given their body habitus, lifestyle and medical and surgical histories.

The role of ADM – Acellular Dermal Matrix such as companies like MTF (Musculoskeletal Transplant Foundation), AlloDerm, AlloMax, FlexHD – that manufacture human dermal products that can be used as supporting structures to enable same time single stage implant alone breast reconstruction which was not available in our armamentarium of breast cancer reconstruction post mastectomy a decade ago. The clinical safety and efficacy of same time single stage breast reconstruction with implant will be briefly discussed. The differences in two stage tissue expander and implant reconstruction and its indication will be discussed as well as TRAM and DIEP flap and microvascular reconstruction and its indications. The use of the latissimus flap with or without an implant and the latissimus flap with a tissue expander will also be discussed as well as its indications and limitations.


Breast conservation therapy has been the cornerstone of the surgical treatment of breast cancer for the last 20 years; however, recently, the use of mastectomy has been increasing. Mastectomy is one of the most frequently performed breast operations, and with newer surgical techniques, preservation of the skin envelope and/or the nipple-areolar complex is commonly performed. The first half of this talk will discuss the oncologic safety of SS and NS mastectomies and the second half will discuss the technical nuances and advances that have contributed to the realization of these procedures.

Since the advent of Halsted’s radical mastectomy in the 1800’s, the surgical treatment of breast cancer has become increasingly refined. Today, the radical mastectomy is rarely performed, however, with breast cancer affecting nearly one in eight women (life time risk to age 85), it remains an important part of breast cancer treatment, especially for more advanced or locally aggressive tumors. Since the increasing trend towards breast conservation therapy (BCT), the surgical literature has focused on the predictors of locoregional recurrence (LR) after BCT. However, there has been a recent swing on the pendulum back towards a higher rate of mastectomy, utilizing new surgical techniques where the skin and/or nipple-areolar complex (NAC) can be preserved. These techniques are being used to improve postoperative cosmesis, and it is important to understand how these procedures differ from the basic modified-radical mastectomy (MRM), and how important particular demographic, technical, and tumor-specific factors are at predicting LR and oncologic safety with these various techniques.

Collaboration of Breast Surgeon and Plastic Surgeon is most intimate with the techniques of SSM and NSM.


The anatomical or architectural limiting factor in all of these different types of breast surgery is the degree of skin envelope that is safely preserved or left intact after the removal of the diseased breast tissue. Therefore the reconstruction becomes inherently dependent first on how much volume and skin surface needs to be replaced and then the other factors as patient desires, donor site availability, lifestyle and comorbidities.


BRCA gene mutations

  • 15 – 25 % of breast and colon cancers are at risk for hereditary cancer syndromes
  • Guidelines for testing: Personal or Family hx. of hereditary cancers.
  • High suspicion if FMHx: Breast / Ovarian Colon / Pancreas / Prostate
  • GINA: Genetic Information Non-Discrimination Act (4 Yrs ago) - Federal law that prohibits use of genetic results for job or health insurance discrimination but not for life insurance!
  • 1:40 Ashkenazi Jews and 1:800 of women + BRCA

Single Stage Breast Reconstruction with Implant

Silicone

  • Smooth Round
  • Textured Round
  • Textured Shaped

Saline

  • Smooth Round
  • Textured Round
  • Textured Shaped
Sizes - Shapes - Projections

Allergan ( gel and 410 )

Mentor (Memory Shaped PCG)

Sientra C3


Single Stage Breast Reconstruction with Implant

Acellular Dermal Matrix (ADM)

AlloDerm / AlloMax / FlexHD / NeoForm

Alternatives : Autodermis / Porcine (some are antibiotic impregnated ) / Bovine Pericardium / Silk


Breast Reconstruction Recovery Guide

#MSBRADay