Beverly Hills plastic surgeon Jaime Schwartz, MD, has focused much of his career on helping breast cancer survivors complete their journey with reconstruction.
Schwartz’s interest in breast cancer care dates back to his days in medical school at Georgetown University in Washington, DC, where he studied tumor biology and the molecular basis of cancer at the Lombardi Cancer Center. After completing the integrated plastic surgery training program at Georgetown, he pursued fellowship training in facial and body aesthetic surgery at the Cleveland Clinic Foundation in Ohio.
PSP spoke with Schwartz about the latest advances in breast reconstruction.
1) How much of your practice is devoted to breast reconstruction?
Approximately 50%. Also, a significant number of women seek out my practice for restorative surgery following previously “botched” breast surgery, and the approach for these surgeries is comparable to that of a reconstruction. (Ed note: Speaking of “botched,” he works with one of the stars of E!’s Botched—facial plastic surgeon Paul Nassif, MD—at Spalding Plastic Surgery.)
2) Do you see many prophylactic mastectomy patients in your practice?
Yes. Many of these patients have an identified genetic marker for increased risk of developing breast cancer (and often other types of cancers as well), such as the BRCA mutation. They have grown up witnessing their mother and/or other loved ones go through breast cancer treatment, and now have decided that surgical prophylactic treatment is the right choice for them, as opposed to high-risk screening. The key point here is that there are options—no one option is right for everyone.
3) Did Angelina Jolie’s revelation cause this uptick?
I think it certainly raised public awareness regarding surgical options for high-risk patients, which is incredibly important. I am a strong advocate of empowering patients with education so they can make truly informed decisions.
4) Is single-stage breast reconstruction a real trend?
It is certainly a great option for the right patient. However, it’s not really “one-and-done” in all cases. The need for minor revision procedures to achieve the patient’s ideal is always a possibility. It is important to strive for optimal results without compromising safety, which in some cases means staging the procedure.
5) What has been the biggest paradigm shift in breast reconstruction since you started practicing?
Since I started practicing, I have noticed an increase in patients wanting to be educated and more involved in their own care.
6) What role does fat grafting play in breast reconstruction in your practice?
Fat grafting is a great tool to fill contour irregularities or disguise a palpable implant. This is usually done as a second- or third-stage operation, and helps to provide a really nice result and a beautiful breast shape.
7) Do the new form-stable implants have a role in breast reconstruction?
Absolutely! The highly cohesive, form-stable gel implants maintain their shape, which is really great when that is exactly what you are trying to restore. In fact, I am currently swapping a good number of my previous breast cancer reconstruction patients’ round gel implants for these, since they were unavailable at the time of their initial surgery.
8) Do you recommend nipple reconstruction?
I offer it in my practice, but it is completely up to the patient.
9) Have any of your breast cancer patients inspired you?
All of my patients inspire me. Each patient’s journey brings something unique to my practice, and I am truly just happy and honored that they have chosen to share that journey with my practice.
10) Tell us about your holistic approach to breast cancer reconstruction.
I evaluate my patients beyond their specific surgical areas of concern to ensure they have an appropriate care team following them—whether that means a complete cancer care team or simply making sure the patient has a primary care provider. If I believe a patient should be seen by an additional type of specialist, I will have my staff make the necessary appointments.
William Payton is a contributing writer for Plastic Surgery Practice magazine. He can be reached via [email protected].