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  • Dr._LiDr. Linda Li specializes in aesthetic and reconstructive surgery, utilizing a rich surgical background guided by a gentle, feminine touch. In this interview, Dr. Li, the only female plastic surgeon that has her own surgery center in the highly competitive area of Beverly Hills, explains the different techniques involved when performing a breast reconstruction process, and why, although not always possible, a patient should consider a breast reconstruction before considering a mastectomy procedure.

    What is breast reconstruction and how is it different from other breast procedures?

    Dr. Li: Breast reconstruction occurs after a woman loses her breast, usually due to breast cancer or a high risk for breast cancer. It differs from breast augmentation in the sense that usually we are trying to match the loss of a breast to a breast that has a natural appearance and shape.

    MMH: Who is an ideal candidate for breast reconstruction?

    Dr. Li: An ideal candidate for breast reconstruction is someone who has a realistic expectation of what can be achieved with reconstruction. While it is possible to create a breast mound, the goal is to match the breasts with as much symmetry. Exact symmetry is difficult to achieve.

    MMH: Is breast reconstruction performed only after Mastectomy has been performed? Are there any other situations in which breast reconstruction is undertaken?

    Dr. Li: Breast reconstruction is usually performed after a mastectomy, but there are situations where there is a lack of development of a breast, such as in Poland syndrome. Reconstruction may also be required in the case of trauma such as a burn that inhibits the normal growth of the breast

    MMH: How many techniques or options can be used to perform breast reconstruction?

    Dr. Li: One can break down reconstruction into two areas: (1) Autologous: reconstruction in which the person’s own tissues are used to reconstruct the breast via skin/muscle flaps and (2) Implant reconstruction.

    MMH: If implants are used to perform a breast reconstruction procedure how does the procedure differ from a traditional breast augmentation procedure?

    Dr. Li: If implants are used for reconstruction, the procedure often differs because after a mastectomy there is not enough skin to allow for the placement of a volumetrically symmetrical implant. A tissue expander is often initially placed, expanded, and the exchanged for a permanent implant. As well, depending upon the shape of the native breast, an anatomic implant may be an appropriate choice for the patient.

    MMH: Should the patient consider a breast reconstruction before or after Mastectomy? What implications or differences might be involved?

    Dr. Li: A patient should consider reconstruction before undergoing the mastectomy. Often the best time to reconstruct is at the time of the mastectomy as the surgical planes are already exposed and scar tissue has not had a chance to build. However, if the patient is planning to have radiation therapy after the mastectomy, consideration may be given to doing the reconstruction after the treatment has been completed.

    MMH: What are the main risks when conducting a reconstructive breast surgery?

    Dr. Li: The risks of reconstructive breast surgery are that of any other surgery, including bleeding, infection, and anesthetic complications. As well, there is the possibility of loss of the flap used in the reconstruction, exposure of the implants used in reconstruction, and a poor aesthetic result.

    MMH: If a patient lost the nipple and areola due to a Mastectomy, how can breast reconstruction give her back these body features?

    Dr. Li: With modern surgical techniques it is possible to reconstruct the nipple/areola complex. A local flap is raised to reconstruct the nipple and either a tattoo or skin graft is used to reconstruct the areola.

    MMH: What is the ideal time frame to conduct a breast reconstruction after a patient have experienced a Mastectomy?

    Dr. Li: The ideal time frame for reconstruction after a mastectomy is dependent upon each patient. Reconstruction is an elective procedure that some patients choose to undertake at the time of mastectomy while others choose to never undertake.

    MMH: How will the reconstructed breast feel to the touch? Will the patient have any feeling in the reconstructed breast?

    Dr. Li: A reconstructed breast may feel completely natural to the touch if it is reconstructed with a patient’s own tissues. It the breast is reconstructed with a saline implant, it will feel more like an implant. A silicone implant will feel closer to natural tissues.

    MMH: What implications will gaining or loosing weight have to the patient? Can that affect the results of the reconstructive procedure?

    Dr. Li: Gaining or losing weight can impact the non-reconstructed breast, causing it to become larger or smaller. This will cause a change in symmetry and may or may not be corrected with further surgery.

    MMH: What can a patient expect after 5-10 years of undertaking a breast reconstruction procedure? How lasting are the results and what follow up process must there be after this procedure has been performed?

    Dr. Li: A patient can expect an autologous reconstruction to potentially last a lifetime. If the breast is reconstructed with an implant, the implant has the chance of failure/rupture that would require removal and replacement of the implant.

    MMH: A study from ASPS recently revealed possible complication for breast reconstruction on obese women. What are the risks and what options do obese women have?

    Dr. Li: Obese women have an increased risk of complication from breast reconstruction especially when the breasts are reconstructed with their own tissues. Fat necrosis and flap failure are increased in these women.

    MMH: What are the main challenges throughout the recovery process?

    Dr. Li: The main challenges during recovery are dependent upon the mode of reconstruction the patient undertakes. With autologous reconstruction, there is the recovery from the harvesting of the flap from either the abdomen, back, or buttock. With implant reconstruction, there is the discomfort of the surgical site.

    MMH: Which healing and recovery products do you recommend after the procedure?

    Dr. Li: Arnica may help with bruising and swelling.

    MMH: What type of wound care will the patient need to do at home?

    Dr. Li: The patient should have to do minimal wound care at home. There are no open wounds to take care of and the patient should be able to shower/bath soon after the surgery.

    MMH: What is the average cost of each type of reconstructive procedure? Do insurance companies cover these procedures?

    Dr. Li: The federal government has mandated that insurance companies cover all breast reconstruction post-mastectomy.

    MMH: What innovations are present in this area that can impact the products or techniques used to conduct breast reconstruction?

    Dr. Li: Microsurgery has allowed us to reconstruct breasts using autologous tissues while sparing the rectus muscle.

    MMH: Do you think that as a woman you have a unique perspective and advantage compared to other male plastic surgeons? Are there some procedures in which this advantage is more relevant?

    Dr. Li: I believe that as a woman that I do have a different empathy as compared to a male plastic surgeon, however, a competent caring physician is what each patient requires in a time of breast reconstruction.

    MMH: Do you think patients understand and consider these possible advantages when choosing a plastic surgeon?

    Dr. Li: I believe each patient chooses their physician based upon their faith and belief in that doctor’s technical abilities and understanding of the patient’s needs

    Dr. Linda Li attended Boston University where she obtained her undergraduate and medical degrees through an elite six-year program. After completing her surgical residency at Los Angeles County/University of Southern California Medical Center, she extended her skills with a plastic surgical fellowship at New York Presbyterian/Cornell University Medical Center. Now the only Board Certified female plastic surgeon with her own surgery center in the Beverly Hills area, Dr. Li specializes in aesthetic and reconstructive surgery, utilizing a rich surgical background guided by a gentle, feminine touch. Dr. Li believes in individualizing the care for each patient in order to achieve their desired goals in the comfort of her own surgery center.

    Dr. Li is a member of the American Society of Plastic Surgery, the California Society of Plastic Surgeons and the Society of Graduate Surgeons of the Los Angeles County/University of Southern California Medical Center.

    Dr. Li is currently appearing on the E! Television Network series, Dr. 90210. She has been featured in Cosmopolitan, Complete Woman, W Magazine, Life & Style Weekly, The New York Times, Plastic Surgery Products Magazine, Los Angeles Business Journal, Child Magazine and many other publications.

    Visit Dr. Li’s site: www.aestheticperfection.com

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