Episode 57: Reclaiming Confidence: Surgical and Holistic Approaches at NYBRA w/ Dr. David Light

What if the key to reclaiming your body and confidence after a mastectomy lies in knowing your surgical options and the right support system? This episode of our podcast brings you an engaging conversation with Dr. David Light NYBRA , a renowned plastic surgeon specializing in breast reconstruction. Dr. Light shares his remarkable journey from aspiring neurosurgeon to expert in microsurgical breast reconstruction, shedding light on advanced surgical options like autologous tissue reconstruction. Discover why patient education is crucial and how finding the right surgical care can be an empowering journey for anyone considering breast surgery.

Join us as we also explore the holistic care philosophy at NYBRA, where patients are supported every step of the way by programs led by Mollie Sugarman NYBRA  From support groups to guided imagery, these programs are designed to enhance the overall well-being of patients. We emphasize the importance of a collaborative approach between doctors and patients to ensure the best outcomes. Listen to how second opinions can be a game-changer in making informed surgical decisions, tailored to each patient's unique circumstances.

Traveling out of state for breast reconstruction? We've got you covered with practical advice to ease your journey. This episode tackles the logistics and concerns of out-of-state surgery, offering crucial tips for travel, post-surgery care, and the role of local caregivers.

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I am not a doctor and not all information in this podcast comes from qualified healthcare providers, therefore may not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers .

Transcript

Speaker 1: 0:01

Welcome to Season 2 of Test those Breasts podcast. I am your host, jamie Vaughn. I am really excited to continue this journey and mission into 2024 to help shorten the overwhelming learning curve for those who are newly diagnosed, or yet to be diagnosed, with breast cancer. It has been such an honor and a privilege to be able to connect and interview many survivors, thrivers, caregivers, oncologists, surgeons, nurses, therapists, advocates and more, in order to provide much needed holistic guidance for our breast cancer community. Breast cancer has become such an epidemic, so the more empowered we are, the better. By listening, rating, reviewing and sharing this podcast, it truly does help bring in more listeners from all over the world. I appreciate your help in spreading this knowledge. My episodes are released weekly on Apple, spotify and other platforms. Now let's listen to this next episode of Test those Breasts. Now let's listen to this next episode of Test those Breasts. Hey, friends, welcome back to this episode of Test those Breasts.

Speaker 1: 1:12

I am your host, jamie Vaughn, and today I am so thrilled to have yet another amazing surgeon on my show. His name is Dr David Light, and Dr Light is a fellowship trained border certified plastic surgeon witha dual practice focused on breast reconstruction and aesthetic surgery. Dr Light completed his plastic surgery residency at the Cleveland Clinic, he went on to the University of Pennsylvania and Fox Chase Cancer Center to complete a reconstructive microsurgery fellowship. Dr Light's expertise includes microsurgical breast reconstruction techniques, including deep flaps, sensory restorations of the reconstructed breast and delayed breast reconstructions. Dr Light has authored numerous peer-reviewed articles, book chapters and lectured on breast reconstruction nationally. He is a founding board member for breastreconstructionorg and serves on the American Cancer Society Long Island Board of Advisors.

Speaker 1: 2:13

Well, dr Light, thank you so much for being here. I am so excited that we get to have this conversation. We did have a pre-conversation before and I just felt like we had a good connection. You were introduced to me through one of your surgeons, one of your patients, and she spoke very, very highly of you and I told her that one of my missions on my podcast Test those Breasts is to seek out where all of the really amazing plastic surgeons and microsurgeons to boot. So how are you today? I'm doing well.

Speaker 2: 2:49

I'm doing very well. Thank you for having me. I, too, enjoyed our chat. I think that we're very like-minded and I've been looking forward to our talk tonight, so I think we're going to have some fun and hopefully share some information that's useful to your audience.

Speaker 1: 3:03

That's awesome. That's exactly what we need. So most of my audience knows sometimes they kind of skip around and don't know my full story but my audience, a lot of them, know that I had to have a double mastectomy. I was supposed to only have my left breast removed but I never knew that there were any such thing as autologous surgeries for breast surgery. And I in my hometown I was going to the double mastectomy implant road and I honestly really had a difficult time wrapping my mind around that and I was very, very lucky to have three separate friends reach out to me and tell me hey, I have a friend who went to this place and had this breast surgery where they use your own tissue, and I'm like what, what on earth is that? I've never even heard of such a thing.

Speaker 1: 3:50

Ultimately, I ended up canceling my surgery here in Reno and ended up going to another location, and everybody knows I went to Center for Restorative Breast Surgery. But I also had heard that there was another place in I want to say it's somewhere in Washington DC, and so those were the only two places that I'd ever heard. After I got that done, I realized I need to find where the other breast surgeons are, because a lot of people have a hard time wrapping their mind around going out of their area to have breast surgery. I have sought out several and I've interviewed several on my podcast, some from Texas. I interviewed my own breast surgeon, dr Cabling, in New Orleans, but you're in New York and so I'm excited that I have leapt to another state.

Speaker 2: 4:36

Welcome to the East Coast.

Speaker 1: 4:39

Yeah, it's awesome. I love it because I want people and I'm going to house all of this information on my website once it's launched so that people have an understanding of where all the good surgeons are and the only way that we know where the good surgeons are are word of mouth from patients, and so that is how I find all of you. I would love to know who you are, what you do, how did you even get into this line of work? Let's just put it that way.

Speaker 2: 5:08

So my path was a little bit long and had a bunch of curves to it. I always thought that I would go to medical school. I always wanted to be a doctor. The idea of it was always sort of intriguing and thought it was a great profession, was pre -med as an undergrad and as I was finishing I was like I'm not sure if this is. I've had this idea in my head since I was a kid. I'm not sure if I'm doing it for the right reason, so let me take a few years off.

Speaker 2: 5:34

I took a few years off in between college and med school, worked for a healthcare company, then actually worked for Lehman Brothers doing finance for a couple of years and then went back to medical school for Lehman Brothers doing finance for a couple of years and then went back to medical school and I knew once I was in medical school that I was going to do something surgical. Initially, neurosurgery caught my eye and actually applied for a residency. Neurosurgery residency applications happen earlier than the other fields and along the way there was a few things that realized neurosurgery might not be the best fit for me. So then switched, went into general surgery, thought I was going to be a vascular surgeon. I love the sort of complexity, I love the procedures, I love the finesse of it, but realized again, patient population sort of wasn't ideal for what I was looking for. I really wanted to have highly successful procedures that I would really enjoy doing, and so I sort of fell into plastic surgery and did my plastics residency at the Cleveland Clinic and great programs like 19 plastic surgeons on staff did everything. So I was exposed to everything hand craniofacial and just really took a liking to microsurgery they had great microsurgeons there and sort of just fell in love with it and did a microsurgery fellowship at Penn and then went into practice.

Speaker 2: 6:55

I knew when I went into practice that I leaned more towards private practice and so found the group that I'm currently in in New York NYBRA, new York, breast Reconstruction and Aesthetic Plastic Surgery and my partners are. Basically we're all like-minded, we all do basically the same thing. We all do a smattering of aesthetic surgery and some more face, some more body, but then we all have very, very busy breast reconstruction practices. We're all microsurgeons and so it just, you know, the practice sort of clicked from both a procedural standpoint as well, as everyone was like-minded and I really liked the way that they practice. It's nice being in private practice because you still have control. The way we see patients who we hire, the sort of additional programs that we've added, like the patient empowerment program, to sort of support patients, you know, not only from the technical aspect but also socially and emotionally, I think is very unique and it's our patients love it and we love having happy patients that are sort of in our family, so to speak, for years and years, even beyond when they've had their reconstruction.

Speaker 1: 8:06

That just the mere fact that you just told me that about that program makes me so happy, because that's not something that you find at all facilities. It's not everyone values this idea of holistic care and having the doctors involved in that holistic care with a full on whole body experience. Because we know that women who have breast cancer who are told you have to get rid of your breast because they're trying to kill you, you know that that is something that's very difficult to wrap your mind around.

Speaker 1: 8:40

I definitely went into quite a depression, as a lot of people do. I don't know about your practice and you can let me know, but it is astounding that some of these procedures even mastectomy and reconstruction like with implants and things like that is outpatient. It's really bizarre to me. I was a little shocked about that and I'm hoping that most places are kind of starting to change that Cause. When I went and got mine, I was in the hospital for three days and I felt like I was being well taken care of. Now my second surgery, which was the revision, I was in there at least for one night and if I needed to stay another night, then I stayed another night. So I want to talk more about that program because people who are considering coming to your facility that that is something that they would consider as well.

Speaker 2: 9:25

Yeah, I mean, I think our patients love it and what we've learned and I've learned along the way from sort of having the program and speaking to patients afterwards you know to your point the entire process of getting the diagnosis, trying to manage all of the decisions like what type of surgery am I going to have? Am I going to do a mastectomy or a lumpectomy with radiation? What is chemo going to be like? How is that going to affect my body? How is it going to affect my relationships If you have kids worrying about if you're going to be there for your kids in both the short term and the long term, even afterwards?

Speaker 2: 10:01

It's very common, I think, for women to they don't really wrap their heads around what has happened until two months, three months, six months, nine months after surgery, because you're so preoccupied with making these decisions and sort of just next hurdle, overcome it, next hurdle, overcome it. That, once things have sort of calmed down, is when you can really process what actually just happened, which is it's life shattering, life altering, and it's not only supporting the patient before surgery but continuing to support them and provide resources afterwards.

Speaker 1: 10:40

Yeah, and it's interesting that you say that because I was not expecting it was nine months after my first surgery it was October of just this last year September into October I was realizing I was feeling really strange and I had already started my podcast and that was going really well and all that. But I went through some PTSD and I figured out why, yes, I'd gone through such a crazy whatever you want to call it. I don't know, it's just all been so crazy. But October is a really interesting month for me. October has always been my favorite month of the whole entire year. Why?

Speaker 1: 11:16

Because, number one, I was born in October and the fall colors here and I'm sure in New York it's beautiful too, but in Reno it's just insanely beautiful. My mother always loved October and the fall season and then she goes and dies in October, right, so we have that. That was already difficult enough. And then I get breast cancer and it's Breast Cancer Awareness Month, so it's like all these things in October and I still my favorite month. So you mentioned that your facility is called in New York is called breast reconstruction and aesthetic plastic surgery, nybra, like New York bra. I mean that's really clever.

Speaker 2: 11:59

Who came up with it sort of was pre existed in another form and the practice actually was originally called Aesthetic Plastic Surgery, pc. And then we had NYBRA as a second thing and maybe about seven or eight years ago we were like this doesn't make sense. We sort of have two names and are living like an alter ego here. So we just went with the NYBRA and changed that a little bit to include the aesthetic part and it fits and it's sort of you know you can abbreviate it it's Nibra, it's got the bra in it, which is sort of a cute play. It has New York. So so far it's worked. I love it.

Speaker 1: 12:35

It's perfect. I was like looking at the going. Oh, I just noticed that that's really cool. On your website it says with decades of collective experience, cutting edge surgical expertise and a commitment to whole patient well-being, we're ready to support you at every step. You already told me pretty much what that means to you with that holistic care. I just think that having that piece in there and even knowing people who have gone there, it makes it more appealing to go there and having all the doctors and the staff and faculty, all everybody on board with that and having these programs. What other programs do you have? Is there anything else that you can share? That kind of fits into that, sure the program that we have.

Speaker 2: 13:21

It was actually developed by Molly Sugarman. She sort of founded it and still runs it as the clinical director. She provides a number of different services. She's got a number of different support groups. So support groups for women with metastatic cancer, for women with genetic mutations. She's actually got a spouse support group as well. So there's multiple different support groups for different patients with different diagnosis, because they're sort of their experience and basically their experience is a little bit different depending on the diagnosis. She does guided imagery to help calm patients prior to surgery. Patients prior to surgery. She will introduce current patients to previous patients who had the same procedure so that the patient it can be a patient to patient discussion so they have a little bit more of an understanding of you know we can provide them the clinical information but the patient can provide, I think, very valuable insight as well. The support groups and everything continue on. You know she has patients that are the support groups and everything continue on. She has patients that are in her support groups that have been coming for 15, 20 years.

Speaker 1: 14:30

I think that's amazing and to have somebody who can help with helping people who are looking into coming to your facility know exactly what kind of things they'll be supported with. Thank you for sharing that. That's amazing.

Speaker 2: 14:43

Yeah, what we realized is that we're very good at the technical part and when we need a patient we're so focused on getting the medical history, doing a physical exam, making sure that we're explaining all of the options and educating the patient on the reconstructive aspect to it we usually don't have the time to get into like what's home like like what kind of have the time to get into? Like what's home? Like like what kind of support are you going to have afterwards? Who's going to help you with surgery afterwards? Who's going to be home? What are the other stressors in your life right now? What are the other challenges you know? Is now the right time to have a larger procedure, like a deep flap, or are there other issues that we need to sort of manage and resolve so that you don't come home from a procedure and you know don't have the help that's needed? And so the Molly in the program is excellent at sort of filling in that gap in the care that usually surgeons are not experts at doing.

Speaker 1: 15:38

I really love that because that goes along with one of the questions I wanted to ask you about this idea of shared decision-making.

Speaker 1: 15:46

I know that that term and we talked about this before that term I learned from, actually, Dr Crisopolo.

Speaker 1: 15:51

I had never heard that before, but that shared decision-making is kind of a term that was sort of coined back in the 80s and there was this idea of doctor and patient sitting down together and talking about what might be best for them and just asking those questions like what's going on at home, kind of really digging into how this is going to affect the patient and giving them options on what they can do and to remedy certain things, to me is a no brainer. But I know that not all doctors are like that. They're kind of like, well, you need to do this, you need to do that whatever. And there are patients alike that will be like you know what, I trust my doctor, and which is fine. I mean, there's a myriad of different reasons why you're going to trust your doctor, of course, but just having that sitting down and having that conversation with the doctor and feeling like, hey, this guy really cares for me, or this girl really cares for me, this doctor and actually even going and getting a second opinion is fine too.

Speaker 1: 16:54

Absolutely Always encourage it I think that any doctor who actually encourages it is great because in the end the patient is going to go into that surgery more compliant and understanding it better and feel better about themselves. And I just had this conversation with one of my friends here in Reno. She chose a certain route and she researched as much as she could and she feels really good going into the surgery that she decided on. And I said that is exactly what people need to do Honestly look at their options and then go from there.

Speaker 2: 17:27

Yeah, yeah, I mean, I think shared decision making is a little bit of an older term, but I think it's still accurate and it's still in sort of our common vernacular. If you go back 30, 40, 50 years, patients used to just walk into their doctor's office and it was a little bit more of a paternalistic approach where the physician would just say, okay, this is what we're going to do, and there wasn't as much sort of questioning of the doctor, who sort of you listen to what they had to say. You took their advice and you just went with it. And there's still a little bit of an element of that as far as taking the advice. But I think that the world is a different place.

Speaker 2: 18:05

There's a tremendous amount of information at everyone's fingertips. Sometimes it's helpful, sometimes it's not, but it allows patients to begin to educate themselves. And then I think it's our job to review all of those options, make sure the patient understands it, and I usually try and start off sort of just presenting the data. You know, what are the pluses of doing an implant reconstruction, what are the pluses of doing an autologous reconstruction and allowing the patient to sort of get a feel for what's right for them and, to your point, doing a little bit of a deeper dive. This is what it's like to five years down the road, 10 years down the road, 20 years down the road, to have this reconstruction. This is what it's like to live with it. This is what it's like. This is how it might affect your activities, your daily living, whatever it may be, and that really gives them the opportunity to sort of pick what's right for them, and when a patient does that, they're just so much more comfortable with their decision and going into surgery.

Speaker 1: 19:06

There's just a sense of tranquility that you know this is yeah, and my biggest mission is to make sure that people understand there are options. I didn't know my, I didn't even know that, and so I want people to understand it. I would love for all doctors to say, hey, this is another option, I don't do this, but you might want to look into this, or something like that. That would be the perfect world. It's interesting that you mentioned that kind of patriarchal type system where I don't know if you ever saw the movie Maestro. No, I do not.

Speaker 1: 19:37

There's a scene in there where this woman and her husband are sitting in the office at the doctor's office, and the doctor comes in and he sits down in his chair he's got wheels on the chair and he rolls up to the bed and both husband and wife are sitting there Rolls up to the bed and says so, you have breast cancer and here's what we're going to do. We are going to take your breasts and we're going to do mastectomy and then we're going to do chemo. And he's telling all the things that they're going to do and they're sitting there going wait, wait, what, what, what. And it was like, oh my God, and that was it.

Speaker 2: 20:15

And that was like exactly what they're going to do, and no talking, you see, probably rolled back out and went on to the next patient. Old visit probably took three minutes and I got a little trick there.

Speaker 1: 20:21

I was like, no, to be fair, it took place back in the eighties. So so, traveling to another state to get the mastectomy reconstruction and all that, how can we put people at ease traveling? Because one of the things that my surgeon said here was hey, I haven't heard much about that type of surgery, but my biggest concern is that it's there's no local care. And at first I was kind of like, okay, well, that makes sense. You know, of course you want local care. But then I found out later that, you know, I called up the center and they said, well, world renowned hospital, so we have people coming from all over the world, including, like Australia, and we do have connections with medical centers everywhere. And so that put me more at ease.

Speaker 1: 21:09

And because at first I was thinking to myself, well, you wouldn't have heart surgery here in Reno, you would go somewhere else to get that right. And then, of course, when you come back, there's local care, you would be able to go to the hospital if there's an infection or whatever. How do you put people at ease? Because we still on Facebook groups, because we talk about you doctors, by the way, and people ask all the time. It's like, oh my God, I don't know like going out of town to do this. How do we put people at ease?

Speaker 2: 21:41

Yeah, people who are traveling for reconstruction. They're usually traveling for an autologous, a natural tissue reconstruction like a deep flap there's. Usually you can find a plastic surgeon in your community to do an implant reconstruction. It's fairly doesn't require the fellowship training. It's a it's sort of bread and butter classic surgery.

Speaker 2: 21:56

The nice thing about a deep flap is that, although there is a recovery period to it, the critical part where we're really monitoring the flap is really for the first 24 hours or so. The vast majority of the problems that you have and they're exceedingly rare, less than 1% of the time with like a free flap or like a deep flap occur in the first few hours after surgery. By the time the patient goes home, and usually we send patients home on the second day after surgery, not really worried about it. I usually have patients stick around for about a week or so just to manage their drains and try and get those out before they depart home. After they arrive at home I'm not worried about the flap anymore, I'm not worried about viability.

Speaker 2: 22:40

So the only really issues that you can run into between sort of seven and 28 days is maybe there's a little bit of a superficial infection, maybe develop a little bit of a fluid collection called a seroma. Those are issues that happen with every single procedure we do, whether it's a breast reconstruction, a tummy tuck, a breast reduction, facial plastic surgery. So all of these issues can really be managed by any plastic surgeon. It sort of gets back into the bread and butter. And similarly we have friends and colleagues throughout the country and even when we don't usually get on the phone with the patients sort of the plastic surgeon that they may have seen originally and if they're not familiar with the procedure that we've done, bring them up to speed and then managing whatever issue you know minor issue there is is really not a big deal.

Speaker 2: 23:35

And so you know I have. Right now I'm actively taking care of patients in Ohio and New Mexico and Florida. Either they're doing totally fine or they've gone back to follow up with their plastic surgeon there and just are more comfortable having a physician, you know, see them, and they're also flying back to me to have periodic follow up as well. So I think that the critical time after, say, a deep flap is really the first few days, and once patients head back home there's really no specialized care that's really required.

Speaker 1: 24:08

That was my experience. So I mean, I stayed in the hospital and then I was there for a whole week because of course, I was waiting for pathology too, and then when I went back there, I got a couple drains removed and then made it back home. I got enough advice on how to travel. That that was really helpful. And also having a caregiver with you, of course, is really important. And when I got home, I actually did get a little wound they called it a wound in my incision and so they called in an antibiotic and then I had to get some gel and I just put the gel on and took the antibiotic and it was gone, and that was the only thing that ever even happened with me.

Speaker 2: 24:43

So yeah, Right, that's sort of like the simple run of the mill things that can happen and most of the issues resolve on their own and can be managed just by conversation. Sometimes it might require a visit to a local plastic surgeon but that's exceedingly rare.

Speaker 1: 24:59

I'm putting together a website for my nonprofit and categorizing a bunch of resources so that people can click on it, like what to bring to the hospital, how to travel, anything that I can to put under whatever category so people can have it at their fingertips for free and just learn from it.

Speaker 2: 25:18

I just feel like it would really shorten the learning curve for a lot of people 100%, especially those who may be traveling from a place where there isn't a major breast reconstruction center. There might not be support groups locally, and so they're scrambling. They're online, they're trying to get information from you know, facebook groups and any resource where it's the patient sort of giving tips and pearls of what made the first week, two weeks, month, three months easier. What did you find helpful? What wasn't helpful? Like, for example, we have a local pharmacy that rents. It's almost like a lazy boy chair that's mechanical and will help you stand up, and so we refer patients to them and it's inexpensive to rent one of these chairs and most of our patients will rent it, which just helps them get up and move around. Some of them even sleep in it. They find it very comfortable in it. They find it very comfortable. So little pieces of information like that that just make it so much more pleasant and easy, rather than experimenting and having everyone learn the hard way every single time.

Speaker 1: 26:21

Right, and I was literally just working on a list, one of my breasties sent me the list of things that is really good to bring to the hospital and, if you're traveling, keeping at the Airbnb or hotel or whatever, and one of those items on there was to rent in the area one of those lazy boy type chairs. Yeah, okay, so let's talk insurance. I know this is really fun, but it's so important. That's another resource that I have two of my friends working on to put together how to navigate and understand insurance, but patients have a challenging time actually navigating their options, especially when it comes to insurance. I know that, not you know, some facilities accept certain insurance and some don't. What are your thoughts about that, and how can patients advocate for themselves to get the care from the surgeon they most want to go to?

Speaker 2: 27:12

Yeah, so I think that the institutions, the hospitals that we operate, they accept most insurance, so it's usually not the hospital that's the issue. Usually it's the physician may accept some plans, not all plans, and so the insurance. You need an entire education just on insurance to understand it and it's very confusing. And patients don't understand deductibles and coinsurance and how they're calculated, and we actually have an entire authorization department. There's a number of people that work in it for our practice and they will walk patients through everything and some of them have been doing it for over 25 years and are really experts in advocating for patients for breast reconstruction. Good.

Speaker 1: 27:54

I like that.

Speaker 2: 27:55

Yeah, and it's sort of you need that handholding to get you through it. If you're in a situation where you know there's a doctor that you found and you're comfortable, and maybe they don't accept your insurance, it doesn't mean that that's where the conversation stops, you know, especially if you're traveling from a location that doesn't have a surgeon in the area to actually perform your procedure. You have some rights. There's the Women's Health and Cancer Rights Act that basically states that not only does the mastectomy but the reconstruction needs to be covered as well, including all stages. And if, for example, you had a reconstruction on one breast, the symmetry procedure on the other breast would be reconstructed.

Speaker 2: 28:40

So options for breast reconstruction that needs to be offered for the patient, and it's the patient's decision on which option they choose. And so if there isn't a microsurgeon in your immediate area and you have to travel and maybe it's a plan that they don't accept there, there isn't a microsurgeon in your immediate area and you have to travel, and maybe it's a plan that they don't accept, there still can be a conversation. That's not where you should give up. The surgeon's office will hopefully advocate for you the way ours does, and then you can also advocate for yourself. There can always be a discussion and it happens to us all the time. There are plans that aren't even offered in our local New York area, where a patient is coming from the Midwest to the West Coast, and you know, we simply contact the insurance company, explain the situation and are able to get coverage.

Speaker 1: 29:23

There's one part in the document that I was just talking about that we want to be able to help walk people through how to appeal a denial by using the verbiage that's used in the denial letter, Because I know a long time ago I watched a documentary about insurance companies and how a lot of the employees are trained to deny first, deny, deny, deny first. And I had that happen firsthand when I developed a really rare anemia during my chemo. We didn't know it was a rare anemia, we thought it was just an iron deficiency, but it turned out to be a completely different type of anemia. But I got a letter in the mail that I was denied the blood transfusion that I had to have because it wasn't in a hospital stay, because it wasn't life threatening, when actually it was. So we had to appeal it and got it back. So that was my first time ever having to deal with that. But some people just give up.

Speaker 2: 30:22

They're like I was denied and I always want to say no you can always appeal and we definitely have our share of problems with insurance companies and denials. And sometimes you scratch your head and you're like I can't believe this is. I'm actually reading this and they're actually denying it. And sometimes the denial is actually illegal. It's literally breaking the law. But sometimes you just have a person on the other side that doesn't have any experience. You know you would love to get a medical director who reviews it, who's a former plastic surgeon and understands exactly the verbiage and what's happening, but sometimes it's not. Sometimes it's a retired nephrologist who doesn't really. You know, they're sort of doing their best If you have a conversation with them.

Speaker 2: 31:08

There's something that doctors can do, called a peer to peer. Yes, depending on the type of denial, sometimes it has to be a written appeal, in which case we will write a letter. It's basically explaining, you know, why we think there was an error made and and try and get it overturned. And sometimes you can do a peer to peer. So I will actually get on the phone with the medical director and sort of walk them. They'll tell me why it was denied and I'll clarify why I think that's incorrect. And there are many times where they're like, okay, didn't realize what exactly you were doing, and so they'll overturn it. And so it's another hoop to jump through, it's another hurdle. It can be certainly disappointing when you get that letter and like, oh my God, now what am I going to do? But don't give up so easily. Good, great advice. That's the moral of the story.

Speaker 1: 31:56

It just can be stressful.

Speaker 2: 31:57

You're going through cancer, you have to get rid of your boobs and then you have to then this right and sometimes it all takes care of itself in the final hours, like days and even hours, like I've even taken patients to the operating room without having an authorization yet, just because I'm not going to cancel their surgery tomorrow. They have a diagnosis of cancer and there's some ridiculous denial that I know is going to get appealed, and we just sort of move forward, take care of the patient and then figure it all on the back end. So that's not an ideal situation, but it happens.

Speaker 1: 32:34

Yeah, no, but I mean just the mere fact that you would do that, that speaks volumes. Actually, just the mere fact that you would do that Deep flap. We almost lost access to that and I didn't find out about that until after my first surgery. I just kind of went in, did my surgery and then after I came out I was like what? We almost lost access and we were it was still going on because I had mine in 2022. How were you involved with the advocacy for that?

Speaker 2: 33:03

There was some work by the ASPS and some microsurgeons as well, headed up by Dr Potter in Texas, and so we were supporting those efforts as well. What the insurance companies were trying to do was remove what's called an S-code. So there's a specific code for deep flaps. There's another code, which is a CPT code, which really originated from tram flaps, so it's a breast reconstruction free flap code, but it's sort of all comers. It can include, you know, like a tramp, a full muscle tram flap which is an easier operation and takes less skill than doing a perforator flap like a deep flap. And so the S-code was a way to basically identify that a more difficult procedure was performed, and so the reimbursement for that S-code was greater than the CPT code.

Speaker 2: 33:57

And so there was an attempt to sort of remove the S-code and just have one code like a catch-all code for all microsurgical free flaps, whether it's a full muscle tram flap or a deep flap or a pap flap. And so that could dramatically change surgeons' ability to offer the surgeries, especially in private practice, because offering a deep flap it might actually be a money-losing sort of procedure for the surgeon. So to give up the majority of your day to do a surgery that doesn't even cover the cost of your staff the PA who's who's helping you would make it hard for a surgeon to continue to do a high volume of deep flap and offer that to many patients. And so it luckily the final decision was sort of postponed, but it's you know, we're not out of the woods completely.

Speaker 1: 34:47

No, and that's why I like to bring awareness through these podcasts for women to pay attention. Pay attention to what's happening with women's health, pay attention to what's happening with, like, your breast health and all of that stuff and what's going on with, you know, insurance companies. And I'm just so glad that I found out about that, because I did get involved and that's how I connected with Dr Potter and I'll put her episode link in our show notes so that people can kind of refer back to that, because I know that she worked her tail off on that.

Speaker 1: 35:16

And I know, quite a few people did.

Speaker 2: 35:18

I commend her. She really sort of took it on and was a real grassroots effort and put a lot of work into raising awareness and postponing the final decision.

Speaker 1: 35:27

Yeah, and it's interesting because some of those people that were making the decisions probably they didn't know the difference between a trans flap and a deep flap. I mean, it's like compromising the muscle, not compromising the muscle. Yeah.

Speaker 2: 35:38

Well, all you need to do is talk to a few patients that have had well-performed deep flaps, where not only the muscle was preserved but the nerves to the muscle is preserved, so you have a completely functional abdominal wall. You can sit up normally, you can do crunches, and then speak to a few people who have had bilateral tram flaps, where they don't have any rectus muscle, no six pack muscle, and so when you watch them get out of bed it's more like a log roll where they're using their oblique muscles on the side to try and compensate, cannot do sit-ups, cannot do. They really lose a lot of their core function and it's a totally different sort of way of life and your function afterwards is really quite different.

Speaker 1: 36:20

And you can't get that back.

Speaker 2: 36:22

There's no way to train and get it back, there's no way to compensate for the loss of those muscles.

Speaker 1: 36:27

Yeah, I went to yoga today and did quite well with my abs. I got some strong core muscles. So I have a couple more questions before we go. Breast cancer has proven to be an incredibly emotional journey for so many women. In your experience, how have surgeries such as feet flap changed the trajectory of their lives, like these patients' lives, I mean, do you hear back from a lot of them and what does that look like?

Speaker 2: 36:52

Yeah, I think patients and multiple studies have shown this People have used what's called the RESQ, which is a validated survey that looks at multiple different modules. So there was like a sexual well-being, many different aspects of the patient's life and natural tissue autologous reconstructions like deep flaps score very highly with satisfaction across almost every category, and so I think patients are overwhelmingly happy. Patients will say that, especially patients that had implants and then switched to deep flaps. The common things that they'll say is the implant never felt quite like me.

Speaker 2: 37:30

The deep flap feels like me and there's just sort of a tremendous sense of self, like I feel normal.

Speaker 2: 37:38

It feels like me, it's warm, it's soft, it moves like a natural breast, and so I think that has a tremendous impact on someone's well-being and just sort of emotional state where there isn't certain activities during the day that reminds them that they've had a breast reconstruction or breast cancer or you know whatever it may be.

Speaker 2: 37:59

The goal is really to sort of move on, get to a place of sort of comfort and just feeling good about oneself without the constant reminders that something happened. Don't get me wrong. I'm sure when any woman who has a deep flap gets undressed and they see the abdominal scar. That's a little bit of a reminder but sometimes that's a silver lining as well if they were happy that their abdominal contour changed. So I think overall patients are very happy and it's one of the reasons why I love doing the procedure. I know that a couple of weeks later after a deep flap, that patient is good for life, that whatever I did for them, if it's soft and healthy, then it'll remain soft and healthy and they're going to be comfortable and sort of put all of this behind them and move on.

Speaker 1: 38:46

I will say that for sure. It is hard to wrap your mind around. Will I ever feel good about my body again? What is this going to look like a year down the road? Two years down the road? I will say that, hearing people ask those questions now who have just been diagnosed or just going into surgery and wondering the same thing, I can attest that that is exactly why I didn't want to have implants. I wanted to have something natural and I do feel good about my body. Somebody asked me the other day are you happy and are you happy with your body? It was actually a sex therapist that I interviewed and she deals with people with cancer and helping couples get that connection again and all of that. And I said you know I am. I do feel good about myself and even though I do see the scars, I still feel good about myself. I don't feel bad looking in the mirror. Let's put it that way.

Speaker 2: 39:39

Yeah, and that's exactly what any surgeon wants their patient to feel. You know you sort of asked me in the beginning why plastic surgery? How did I get to this route? What really attracted to me, especially breast reconstruction? You know it had the technical aspect to it, but, unlike other specialties, where you make someone better but they may still have ongoing issues or other challenges breast reconstruction is a highly successful operation that has a very high patient satisfaction, and so it's a beautiful thing to do all day, every day, because you're going to have happy patients 99% of the time and even if there's some hiccups along the way, there's always options. There's always ways to make things better.

Speaker 1: 40:25

Well, you can tell that you really are passionate about doing what you do. How many of these deep flaps do you do every week?

Speaker 2: 40:31

It varies, Sometimes it's two sometimes it's four.

Speaker 1: 40:40

Okay, I always tell people ask your doctor, ask surgeons, do they do this all the time? Are they a microsurgeon? Because that's really important.

Speaker 2: 40:44

Right, it's a longer procedure, but, as with anything, the more you do it, the more efficient and comfortable you get at it. So you definitely don't. Pas, who are experts in helping us as well. Some of them have been doing it for 17 years plus, and so the staff and the support that goes into this. You know it's now a well-oiled machine, but it took years to get there and so and there's other practices you've interviewed many of them that are the same way that, because the volume is so high, it's smooth, it's usually seamless and, like with any surgery, little things come up.

Speaker 2: 41:33

But when you do hundreds of them a year, the little things are normal and they're put in the rear view mirror very quickly, they're taken care of and usually the patient doesn't even realize anything happened, Whereas when you're not doing them, very often little things in a long procedure can build up. And now I hear patients who you know found me online and they're like oh, someone in their Facebook group said that this is a 12 hour or 14 hour, 18 hour operation and that should not be there.

Speaker 1: 42:01

Do you do these on your own or do you have a team that works on it on each surgery?

Speaker 2: 42:06

It's a mix that works on it, on each surgery. It's a mix. Sometimes it will be two surgeons and sometimes it's just a surgeon with one or two PAs.

Speaker 1: 42:13

Okay, all right, cool. Well, to wrap up, you've given us so much advice anyway. Is there any? And maybe you've thought about this? What is one big piece of advice you would give when it comes to awareness about breast surgery options?

Speaker 2: 42:27

So, I think, do your homework and don't settle. If you go for a consultation and you're not 100% comfortable, go for a second consultation, as we discussed before, if you hear two surgeons say the same thing to you, you have a comfort level that, okay, I'm on the right path. If you have two surgeons to say vastly different things to you, then you might want to get a third opinion, just sort of as a tiebreaker, so to say. But keep investigating, keep researching until you get to a comfort level with your decision and with your medical team.

Speaker 2: 43:02

In this day and age, just as we're doing now, having a Zoom visit, having a telemed visit, is a great way to start, even if you're out of town. That's usually how I meet all of my out-of-town patients initially, and so it's also a great way for the patient to see my face, see my approach, get a flavor for my personality, to see if, okay, is this worth getting in a car or on a plane to come and see this doctor, or do I want to look for someone else? And so you know, I think that, because of technology and the information that's out there, patients should be their own advocate, should keep doing consultations until they have a comfort level and then move forward with a procedure that they're happy with.

Speaker 1: 43:42

I like it, and I like that you meet with them online too, because that's always nice. I've had people say well, I really want to go to such and such, but I have to go there to do a consult and that makes it a lot easier.

Speaker 2: 43:55

Yeah, I always see patients in person before I operate on them. Right, the initial consultation can be a chat online and can really help to. Even the physical exam is really the final deciding factor for what's the best option for you, but you can get a pretty good flavor for what you're dealing with just by having a conversation.

Speaker 1: 44:16

Yeah, that's awesome. Well, I have your contact information that I'll have on the show notes. You're on Instagram. You have a link tree and then also I have a link on there to book a consult with you, and then I have your website on there for nybracom and breastreconstructionorg. Those are the ones I have in the show notes. I just want to thank you for taking your time and shedding some light on this. I don't know if anybody's ever said that to you Once or twice. I thought I would just get it in there. I don't know if anybody's ever said that to you Once or twice. I thought I would just get it in there. I like it. Yeah, I'm so excited that now I know someone in New York and I have another option for people out there that I can include on my website and they can listen to this podcast and reach out to you. So, dr Light, thank you so much. Is there anything you'd like to leave us with before we disconnect?

Speaker 2: 45:11

No, I just wanted to thank you for having me. I really enjoyed speaking with you and thank you for doing what you do. Organizations like yours are a resource for patients to do all of the research that they need prior so that they have a better understanding of what their options are. So the more that we talk about it and the more resources that are out there means that there are patients that are actually getting the information that they need and, hopefully, having the surgery that they want and that they're comfortable with.

Speaker 1: 45:41

Yeah, Love it. That is my whole. Goal is to really help shorten the learning curve and I know it's working because people do reach out to me people I don't even know and say hey, I ran across your podcast, Isn't?

Speaker 2: 45:52

that amazing.

Speaker 1: 45:53

Because of your podcast, I know what I'm going to do for my surgery and so I know it's working Well. Thank you very much for that and I just wish you all the best and I hope you have a wonderful summer out there and to my audience. Thank you once again for joining me on this episode of Test those Breasts. We will see you next time. Bye for now, friends. Thank you so much for listening to this episode of Test those Breasts. I hope you got some great much needed information that will help you with your journey. As always, I am open to guests to add value to my show, and I'm also open to being a guest on other podcasts where I can add value, so please reach out if you'd like to collaborate. My contact information is in the show notes and, as a reminder, rating, reviewing and sharing this podcast will truly help build a bigger audience all over the world. I thank you for your efforts. I look forward to sharing my next episode of Test those Breasts.