Harold Bafitis, D.O., M.P.H., F.A.C.O.S., F.A.A.C.S., has recently been named Medical Director for IntelliCell BioSciences of Palm Beach, a division of IntelliCell BioSciences Inc.

By early summer 2011 Dr. Bafitis will be offering stem cell therapy.

This process is FDA complient and only deals with the patient’s own fat. Harvested fat from patient’s bodies can be sent out and within 2-hrs a stem cell and growth factor mixture can be returned. This will provide a patient’s own stem cells to be used not only for better skin fat grafting improvement, but for anti inflammatory therapy i.e. arthritic joints etc. A true medical breakthrough finally approved in this country.

This process is compliant with the FDA 361 law that states that the stem cells from a patient must be used exclusively for that patient,

Dr. Harold Bafitis is also lecturer and trainer for fractional C02 laser, jet lavage and laser lipoplasty. This procedure is now available in South Florida. Look for this 2-page ad in the next Palm Beach Illustrated.

Learn more about this procedure.

You may not know that Dr. Bafitis has been a national spokesman for acellular dermal matrices (ADM) since September 2010.  He has spoken at numerous plastic surgical and general surgical enclaves and seminars, sharing his experience with ADMs, not only in breast reconstruction but in hernia repair and simultaneous body contouring and abdominoplasty (tummy tuck).

His lecturing has brought him into the forefront of the latest techniques in breast reconstruction and abdominal wall reconstruction as well as aesthetic balance with both these procedures.

Dr. Bafitis is presently working on significant publications involving studies with over 40 patients in breast reconstruction and 45 patients in abdominoplasty with the use of these acellular dermal matrices.  Dr. Bafitis feels that the use of an acellular dermal matrix has now revitalized the reconstructive aspects that are so integral to so many cosmetic procedures.

By Dr. Harold Bafitis, Double Board Certified Plastic Surgeon / Board Certified General Surgeon

Bafitis Plastic Surgery / The Plastic Surgery Center of The Palm Beaches, Inc.

Erica S. is a 29-year-old female who happens to be an extremely beautiful, happy, joyous individual. She felt a small lump in her right breast, and assumed it was an issue with her breast implant. Mammogram and ultrasound confirmed a lump but not suspicious for breast cancer. After thorough examination, her plastic surgeon referred her for an MRI, one of the new diagnostic tools in the war against breast cancer. The MRI found something different and warranted a breast biopsy, which came back early ductal cancer.

Erica now created a team that would help her take care of this life challenge. She consulted her plastic surgeon that works hand-in-glove with a general surgeon, and together they recommended an oncologist.

This beautiful woman had a mastectomy on the right side utilizing a new procedure called sentinel node detection, one positive lymph node. This necessitated removal of more nodes in her axilla (the armpit area where nodes are centered in breast cancer). She also had a simple mastectomy on the other side and breast implants were replaced with expanders. All of the breast tissues, including the nipple areolae complexes were removed. She then had chemotherapy with expanders in place.

What was not expected by her general surgeon, plastic surgeon, or oncologist was the fact that the patient also had a significantly invasive carcinoma located within several more nodes that were taken during the mastectomy. This necessitated not only chemotherapy but also significant radiation treatment (XRT). After completion of XRT, Erica had the expanders removed and the capsule. The capsule is the body lining that is formed after an expander or implant is placed, the capsule is utilized to create symmetrical and natural looking breasts.

Plans were set for third-stage reconstruction that would be to create nipple areolar complexes for her. Unfortunately, one of the complications of radiation (XRT) is poor wound healing. This continued to be an issue for Erica on the right breast and after being taken back to surgery for poor wound healing, having the area cleaned up and closed numerous times, it was deemed appropriate for her to have new tissue brought in to allow this radiated breast to heal. A latissimus dorsi flap (LD flap), tissue composed of a back muscle covered with its skin was brought in to reconstruct this poorly healing breast. Her recovery from this procedure was excellent. Subsequently, her nipple areolar complexes were reconstructed from tissue in the lower abdomen. Erica has gone back to being the joyous, inspirational woman that she was before. Her story is true; just one of many. All of this underscores the significant reconstructive options patients have, depending on the stage of their disease. (see table 1)

**Depends on stage of disease

Reviewing the options in table 1, many women opt for a lumpectomy or segmental resection, meaning part of the breast is removed, followed by radiation therapy. Some oncologists add chemotherapy, depending on the type of cancer that is present. This lumpectomy or segmental resection does leave some asymmetry of the breasts. What plastic surgeons have done is rearrange some of the tissue in the breast after lumpectomy to give the best looking shape and contour and then possibly go forward and work on the other breast (contralateral breast) for symmetry. (see row “A” in table 1)

When a patient chooses the option that includes mastectomy, then the reconstructive choices increase. More times than not, patients choose a reconstruction which involves the least downtime, least time in the operating room, and obviously the best aesthetic result. (see row “B” in table 1)

This usually involves reconstruction with tissue expanders that create the potential space for the permanent implant. Then during the second stage, working with that potential space, permanent implants are placed. The final stage would include nipple areolar complex reconstruction.

Sometimes patients choose the use of their own tissue, (see row “C” in table 1) and this would include tissue from the abdomen (TRAM flap) or tissue from their back inclusive of the muscle (LD flap reconstruction). Other options even include taking tissue from other parts of the body, the gluteal area or abdomen, and utilizing a microscope to place this tissue and connected to nourishing blood vessels.

What is important to note is that if, in fact, the stage of the breast cancer is known ahead of time and the team knows without question that the patient will have radiation, it is best to utilize the patient’s own tissue, be it with or without a tissue expander. This is because radiation does cause changes in the skin and in the capsule unless you have the patient’s own tissue. These changes include hardening and distortion of the final implant and/or distortion and hardening of the skin.

There is a gray zone where the final pathology report may change the oncologist’s plan. The addition of radiation therapy adds additional complications to the plans of the reconstructive surgeon. It would be much more straightforward if the reconstructive surgeon knew ahead of time that radiation was planned. He or she would then choose a reconstructive technique utilizing the patient’s own tissue to give the patient the best overall chance of soft, natural breasts. Please note that radiation has been utilized with straightforward tissue expansion, but again, the complication rate of hardening and distortion rises when you are not using the patient’s own tissue.

The Intricate Dance Among Medical Professionals Is Essential

It is important and significant for breast cancer survivors to know their reconstructive options. It is also important for them to comprehend and be responsible for creating their team. Besides having the challenge of just dealing with the diagnosis of breast cancer, a patient must also create a team that consists usually of a general surgeon, a plastic surgeon who is well versed in reconstruction, and of course, an oncologist who will improve and monitor the immune function of the patient. The intricate dance among these three medical professionals is essential for optimal outcomes. Furthermore, the mindset of the patient is equally important for healing no matter what stage of the disease.

What Works?  What Doesn’t Work?

Sally B. is a 38-year-old woman who had stage I breast cancer and opted for the use of her own tissue for reconstruction. Her surgeon utilized a TRAM flap and she had an uplift procedure with an implant on the other side for symmetry. Sally B. complained about a hernia and a pooching of the lower abdomen after her TRAM flap.

She came to see me because of the significant loss of volume and projection on the side of the TRAM flap. We opted to revise her reconstruction and place implants on both sides to give her as much symmetry as possible. This underscores yet another important fact. Many times, the use of TRAM flap or microvascular transfer of tissue may over time lend itself to lack of projection and often-unhappy patients.

The use of the latissimus dorsi myocutaneous flap (LD flap) with a tissue expander and subsequent permanent implant seems to give the patient protection against radiation, a natural looking breast, and the volume and projection that they desire. The scar on the back is usually in the bra line or in a natural crease, which becomes imperceptible over time. The use of the latissimus dorsi flap is reliable, works well, and does not cause any issue with loss of function, pain, or distortion of the abdomen.

As far as microvascular tissue transfer is concerned, this is usually a university-based endeavor and one that is more of a salvage procedure than a standard reconstructive option.

The Truth About Reconstruction:  Why Patients Find It Difficult To Find A Reconstructive Surgeon

During the Clinton administration, breast cancer became an important health issue. The President mandated that all insurance carriers cover breast reconstruction. Because of the fact that insurance carriers are involved in the “business of health,” they now had to pay for reconstruction. In turn insurance companies lowered the fees for reconstruction to levels that were almost prohibitive for reconstructive surgeons who were not on salary at university programs.

This unfortunate truth underscores the fact that it is very difficult for most patients in large metropolitan areas to find plastic surgeons well versed in reconstructive breast cancer surgery who are not affiliated with a university. This also trickles down to the general surgeons who in the absence of a qualified reconstructive surgeon will, many times, do a mastectomy and then have the patient live with the mastectomy defect.

Reconstruction in 2011 and beyond, for the most part, should be done at the same time as mastectomy. There are few real indications for waiting and creating another surgery, another anesthetic, and even more anxiety for patients.

What Is New In Reconstructive Breast Surgery

For close to a decade now, technology has brought us a literal biologic scaffold for our own tissue to grow into. These ACELLULAR TISSUE MATRICES have expanded their use and are now an important part of breast reconstruction. They literally allow the patient’s own tissue to grow into them, and by six months, they degenerate and are absorbed by the body, leaving behind new, viable, strong tissue, which gives a much more natural look to the reconstruction.

We have also seen the use of a patient’s own fat to fill in contour defects in breast reconstruction. Furthermore, I have personally used patient’s fat to permanently improve some of the changes seen in the skin after radiation. A thick, leathery, often painful appearance of the skin has been improved dramatically, and this has been documented not only photographically but also histologically (at the cellular level) at one year.

Other surgeons are doing this all over the world. The advantages of fat may lie in the fact that one gram of the patient’s own fat has over 5,000 stem cells versus one milliliter of bone marrow having only 100 to 1,000 stem cells. These stem cells are literally building blocks of new tissue. The use of stem cell technology will definitely bring us a new age in bioengineered medicine and will significantly improve breast reconstruction.

Finally, the use of nipple-sparing mastectomy (NSM) has gained acceptance as a viable option in breast cancer management and obvious breast reconstruction. The patient satisfaction rate is comparable to traditional reconstructive techniques, although revision rates seem to be slightly higher. Nipple sensation is diminished, but the patient’s own nipple areolar complexes are present. This is certainly something to be discussed with your reconstructive surgeon.

Revision Reconstruction: The Most Important Goal Feeling Like A Woman Again

Finally, is the fact that patients do not have to settle for less than acceptable breast reconstruction. The use of some of the new concepts in reconstruction (see table 2) have allowed plastic surgeons to redo poor results and significantly influence the patient’s self-esteem, improving the patient’s emotional outlook, and even spiritual wellbeing, all contributing to a longer survival.

Table II  NEW POSSIBILITIES FOR RECONSTRUCTION A. Use of acellular tissue matrix in reconstruction (all types) B. Use of fat transfer (from patients own fat stores) C. Preservation of nipple / areola complex in mastectomy (nipple sparing mastectomy)

Every Woman Deserves To Feel Whole Again

Mary B photos above:

Mary B. above has lived a long time with a less than optimal reconstruction. Her reconstructive surgeon told her that this is the best that can be done, and she would just have to live with this (above “before” photos on left). She was told to be grateful for at least the time being, she is free of cancer. I utilized the concept of revision reconstruction where we employed acellular tissue matrices, removing redundant tissue, placing new gel implants as well as the patient’s own fat to give the patient a more natural, softer breast, and ready for nipple placement (above “after” photos on right).

Maria X photos above:

Numerous general and plastic surgeons told Maria X. that her result after mastectomy was very difficult to alter. The general surgeon made incisions that were not symmetrical and removed a significant portion of the patient’s muscle, leaving her feeling emotionally as well as physically disfigured. Because the patient had previous abdominal surgery, we utilized both latissimus dorsi skin and muscle flaps with tissue expanders and then a significant amount of the patient’s own fat as well as an acellular matrix and high profile cohesive gel implants to give her a result which was acceptable to her on many levels.

The patient is planning to have both nipple areolar complexes reconstructed, and we are thrilled that her entire outlook has changed. Maria X. feels that she is a woman again and able to be herself instead of hiding in embarrassment. In the year 2011, no woman should feel any different after having breast cancer.

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BIBLIOGRAPHY

• Clinics in Plastic Surgery, July 2009, volume 36, no. 3.
• Plastic and Reconstructive Surgery, March 2010, volume 125, no. 3.
• Portions of this article were published in VIVE Magazine, “Vive’s Special Medical Update”, Nov. 2010.

ABOUT Dr. Bafitis
www.drbafitis.com

Dr. Harold Bafitis is a Double Board Certified Plastic Surgeon with over 20 years of experience. He has completed undergraduate, graduate and medical schools all Cum Laude. He is a clinical associate professor of plastic surgery at Nova University Medical School, and Lake Erie College of Osteopathic Medicine. He has lead teaching conferences at national cosmetic plastic surgery meetings, and has performed live surgery on closed circuit TV with literally hundreds of cosmetic surgeons and resident plastic surgeons in attendance. Bafitis has shared his technique of abdominoplasty as well as rhinoplasty for over 15 years. He also hosts local teaching seminars that include techniques that have lead to the integrated liposculpture abdominoplasty “BILA”.

The Plastic Surgery Institute of the Palm Beaches is a professionally credentialed surgical center comprised of fully trained and highly skilled professionals. The center focuses on a comprehensive approach to cosmetic and reconstructive procedures.

This center provides the highest safety, privacy and warm environment for any cosmetic procedure.

Quality patient care will be optimized before, during, and after surgery through our dedication to personalized patient care along with adherence to a quality system of insuring patient dignity, safety, and comfort. The entire staff pledges to remain dedicated both professionally and personally to those who have chosen The Plastic Surgery Institute of the Palm Beaches assuring a positive outcome of the surgical experience.