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Test Those Breasts ™️
This podcast by Jamie Vaughn is a deep-dive discussion on a myriad of breast cancer topics, such as early detection, the initial shock of diagnosis, testing/scans, treatment, loss of hair, caregiving, surgery, emotional support, and advocacy.
These episodes will include breast cancer survivors, thrivers, caregivers, surgeons, oncologists, therapists, and other specialists who can speak to many different topics.
Disclaimer: I am not a doctor and not all information in this podcast comes from qualified health care providers, therefore does 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.
Test Those Breasts ™️
Episode 47: Dr. Andrew Gassman: The Breast Advocate Approach to Personalized Reconstruction & Recovery
Unlock the door to a transformative journey with Dr. Andrew Gassman of PRMA in San Antonio, Texas, a beacon of expertise in the field of plastic surgery and breast reconstruction. This episode is a heartfelt narrative that intertwines medical mastery with the emotional landscapes of those navigating their breast reconstruction options. We navigate the complexities of autologous surgeries, like the DIEP flap, and explore the empowering potential of the Breast Advocate app. Dr. Gassman's cross-country odyssey of knowledge and his dedication at PRMA reveal the remarkable impact of patient education and personalized care that reaches individuals far beyond the San Antonio borders.
Prepare to be enlightened by the intricate dance of a multi-disciplinary team approach, where shared decision-making is at the heart of PRMA's philosophy. Our conversation reveals the nuances of pre to post-operative care and the innovation behind the dual surgeon operating room technique, all aimed at enhancing patient outcomes and recovery experiences. As we discuss the challenges and triumphs of accessing tissue reconstruction surgery, a personal anecdote serves to inspire and reassure those contemplating the journey for life-altering care. Join us for an episode that promises to reshape your understanding of the breast reconstruction landscape and the passionate professionals who navigate it.
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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 .
Welcome to season two of Test those Breasts podcast. I am your host, jamie Vaughan. 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, 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. Hello friends, welcome back to this episode of Test those Breasts. I am your host, jamie Vaughan, and today I am honored to have yet another amazing surgeon on my show Dr Andrew Gassman.
Speaker 1:Dr Andrew Gassman is a board certified plastic surgeon and breast reconstruction surgeon at PRMA in San Antonio. He also did his fellowship in breast reconstructive microsurgery. Today I am super excited. As you all know, I love to seek out amazing plastic and microsurgeons around our country and even the world, because, most of you know, I didn't even know autologous surgeries even existed and all of you know that I had the deep flap surgery. I just kind of got on this mission to find as many really well liked have good reviews and everything for their plastic and microsurgery. I found, well, actually, dr Crisoppolo, as you all know, I have interviewed him a couple of times and he led me to Dr Andrew Gassman. I just want to welcome you, dr Gassman, to our show today. Thank you for being here. How are you?
Speaker 2:Very good, it's a pleasure.
Speaker 1:Absolutely Well. I just want to let you know that we girls out there talk to each other about breast reconstruction and the type of breast reconstruction we have gone through, and I just didn't ever know that I even had an option other than implants and I just personally did not want to have implants and I was super scared. I mean, obviously I was really scared to even have a mastectomy and you know that my body was going to change and I was going down that implant road because that's all we have in my area that I live in. And it wasn't until about three friends reached out to me to let me know that they had knew somebody who'd gone to New Orleans, actually, to be exact, to have this type of surgery where they take your own tissue, and I thought, wow, that sounds intriguing. So that's how I got onto the road of researching and made that decision.
Speaker 1:But it was really really kind of like at the last minute after my chemotherapy it was time to have my surgery, so I had to make some quick decisions and since then I have learned that Dr Corsopolo has this app called the breast advocate app. That had I known about that app, I would have used it, but even further than that. I want to know where all of the other surgeons are that can do these types of surgery, so that you know like you're in San Antonio, so anyone who is in that area will know where you are. And so I just want to talk to you a little bit, kind of get to know you. I want to know who you are. Who is Dr Andrew Gassman, like in your normal life?
Speaker 2:Oh yeah, thank you for having me on and it's great to kind of catch up. These are important topics and I think that the patients we take care of are very similar circumstances to what you went through. They were given a very limited set of options and they didn't even know what was available, and then, basically through word of mouth and friends and families and thankfully even the internet, but people are able to communicate and get these options out. And these podcasts that you do are super important as far as disseminating critical information, and it's really, really great because that helps us deliver care to people from all over the country. It's a real privilege what we get to do by case example, like this week I've had a patient from Maryland, a patient from Illinois and a patient from Alaska, so literally you just see to see taking care of people from all sorts of locations where they were told that they weren't a candidate or they were told that they only had a certain set of options, and now we can provide them A little bit about me. I have basically been all over. That's kind of the easiest way to kind of put it all together.
Speaker 2:I grew up on the East Coast, I grew up in New Jersey and then I lived there until I went off to college in Massachusetts and I lived in North Carolina and I did some research time there and then I went to Chicago and in Chicago I did medical school and general surgery and some research time there as well.
Speaker 2:And then after that I moved out to LA and I did my plastic surgery training at UCLA. When completing that I went to UT Southwestern in Dallas to do microsurgery. And then I went down a path doing academics where I was teaching. I had a lab studying FAP and adipose or tissue engineering related to that and really kind of got to understand how to use that in a relatively novel fashion and taught how to do complex reconstruction deep flaps to many, many plastic surgeons. And after I was an associate professor I met the guys at a conference here and got recruited effectively and came down. He was been one of the best decisions I've ever made and it has really opened doors in terms of access because as a group we're very well plugged in to people throughout the country and it's really the outreach is really really exceptional in terms of the number of people that whose lives we get to impact and it's and that's great yeah yeah, and I've heard a lot.
Speaker 1:I've actually talked to quite a few women who have gone to PRMA and they speak very highly of your facility, and so that's what I was gonna ask you is what even brought you to PRMA? But they recruited you so obviously you had something to show for it. Well, for plastic surgery and microsurgery, specifically breast surgery, is there anything in particular that brought you to being interested in just specifically dealing with breast surgery?
Speaker 2:Breast surgery. It's an excellent part of plastic surgery Like I got into plastic surgery as a whole because within medicine it's the part of medicine that allows me to kind of use my mind's eye and my history and art and design to apply that to help people. And within plastic surgery, breast reconstruction kind of picks up the highlight reel, if you will, in terms of all the best aspects of our specialty, where there's very, very technically demanding operations that really kind of help push the limit of what you're able to do and there's very important surgeries that involve aesthetic refinement to deliver a result. And the difference in surgeon out there between someone who's good and someone who's very, very good really comes down to those people that are really willing to do all the technical and all the aesthetic components in one. That just speaks to me.
Speaker 1:Right, right, we women also talk about wanting to go to a facility with surgeons who are very empathetic. They listen to them. Dr Crisopolo and I have talked about shared decision making and the team aspect of the surgery and the holistic care, and so it's so important to and men and women for that matter. I speak to women just because that's who I speak to a lot and we are really, really into making sure that we get that holistic care. Can you speak to how PRMA and the team there handles the holistic care? Like? What does that look like? How long are patients in the hospital and how are they taken care of that way?
Speaker 2:Yeah, I can give you a little bit in terms of the journey during the operations, but I think, specifically for what we do and I think what we do is unique is that we really evaluate each moment that we are spending with the patient we have. It's amazing we actually have meetings about how we improve each sort of touch point moment we spend with the patient and we make sure that our patients are really cared for in each step. So, for examples, from the moment that someone calls their information and how they're dealt with it, that moment is sort of critical information that we cherish and that is then delivered to the care team and it's usually a combination of a doctor and a nurse that's gonna be with that patient through their course and sometimes the patients get to select it and sometimes they don't know who they want and they get paired up based on some of the interview questions that we ask and what kind of surgeon they're looking for. From there there's phasons, that kind of help answer questions prior to the first consultation and then during that consultation, we have a lot of time built in for any and all questions and I tell all my patients when I go into a room I don't look at the clock. We just talk. That conversation takes as long as it takes After that consultation often any and all questions that come up.
Speaker 2:Our nurses are fantastic as far as kind of answering questions, helping prepare liaisons come in again and help get people into our protocols and how we really deliver excellent care. Then we prepare them for the surgery. When someone comes in for the surgery, we have a dedicated group of anesthesiologists that just do our cases. We have a dedicated group of nurses. We have in the OR and on the floor units that are just ours in beautiful facilities that are brand new. It allows us to kind of help keep that person protected and give them a sense of confidence through the whole process. Then during the post-operative period the nurses sort of come back into the mix again, or clinic nurses. They really help during that initial phase with all the uncomfortable parts, you know brain and binders and all that stuff that nobody loves. At that point that's when the surgeon and the patient really meet up again and start to make plans for additional stages if they're necessary.
Speaker 1:Yeah, well, it sounds like you really try to get to know the patient. It just makes the patient feel so much more comfortable with knowing who you are and that you care about the decisions that they are making and making the right decisions and things like that. Dr Seed mentioned that PRMA is very adamant about working as a team, like having two surgeons. Can you speak to that and how that has played a role in what you do?
Speaker 2:We are very heavy in philosophy and emphasis and our own mental, personal and, frankly, financial and into team approach. What that means is that we have an excellent relationship amongst the surgeons, amongst our PAs and amongst our anesthetic colleagues and as well as our nurses, in terms of how we're going to all work together. We have very clear, defined roles. When we're paired together, who does what and how we best help to deliver the best care to the patient? We each independently, can do these surgeries.
Speaker 2:I was at the university. I was by myself teaching young doctors how to do this and how to stop and educate and process. That's not the question. The question is really how do you deliver the best possible care? And your own biases are put aside. If there's some other concern, then I and being human may be biased. That's one thing that we don't do. If we do not compromise and we're very critical with each other to say this isn't your best work, you need to do better or you seem to be not doing what we do. Well, let me help you. And so that sort of redundancy is something that's critical for what we do. Getting done rapidly is only one metric that seems to help. It's really the quality that gets delivered. That means a lot more to us. We are much invested in the team approach because I think our patients deserve that. They're going through enough for us to cut corners and to try and eke out as much as we can here and there. It's the patient's worth it.
Speaker 1:Right, yeah, and I mean, going through breast cancer is just a horrendous journey in itself, and so the point of surgery. It's so comforting to know that there are people out there like you who take that into consideration and knowing that we need to somehow rebuild this person's life and make it so that they are able to feel good about themselves again. And we all know that. You know we lose sensation in our breasts. Dr C and I were talking about that restoration of sensation. How do you play into that? What is your experience with helping out with that and providing as much sensation as possible back to the woman?
Speaker 2:Sensation is actually a big thing that we really focus in on, and both the good and the bad. Honestly. Specifically, the best thing that you can do is prevent loss of sensation, and that really comes down to how the mastectomy is performed, whether it's one of our surgeons or one of our trusted partners oncologic surgery partners that we trust to do these surgeries and do them well. Preventing injury to the nerves or avoiding them when it's oncologically safe is really important, and we emphasize that it's not uncommon that we'll look around and say like you're doing that, okay, what can we preserve safely? So preventative is really the best thing that we can do in preserving the nerves that you have.
Speaker 2:But if there is an oncologic reason or, correctly, a technical reason that would mean that the nerve has to be cut, then we have to think about the best way to restore it, and that would either be something that we can do at the time of the original operation and that would be a nerve repair if we see it. If possible, we also bring nerves with the tissue that we move, and sometimes that's not possible. Where people have had major abdominal surgeries, they've had substantial scar tissue throughout their abdominal region. That may actually prevent nerves. But otherwise we generally find the sensory nerves of the abdominal wall that would have been thrown away for other abdominal operations and we bring them with and wherever possible we make those connections. If there is a compromise to the sensation of the breast after the mastectomy, yeah, that is our patient's best chance of kind of having that sensation throughout the process.
Speaker 1:Yeah.
Speaker 2:The other element too is a lot of times having multiple, multiple stage operations where there's this initial phase, a temporary implant or expander and then other tissue. That can be a concern as well, and it's another reason why we try to minimize the total number of operations and do immediate tissue-based reconstruction. That's just our gestalt and it seems to be successful. Now kind of getting into the downside for sensation you know, post-mastectomy pain is a real thing. That is Dr C's passion as well, and so he and I'll let him I'm sure you want to speak to him again about that, but giving him a plug, if you will. Yeah, in terms of he's also very passionate about this is how do you approach when sensation when it hasn't gone yet? That's a new area of expertise for him that he's really trying to give patients access to who are sort of on I don't want to say on the back end of their journey, but have kind of gone through all these surgical inventions and now dealing with long-term effects.
Speaker 1:Yeah, and he's very reflective. I've noticed that about him in the two interviews that I've done with him very reflective and I feel like that surgeons need to be, because not only are you learning how to reconstruct breasts for women, you're also learning about what's going on in their minds and their world. So it all just sort of goes together and understanding things that you might think might have been be a bias view or whatever, like you were talking about before, what they're thinking and being able to reflect on. You know, we really need to be thinking about this because women go through this, this and this and maybe this isn't the right thing for this woman, but it could be for this woman. So I really appreciate knowing that there are surgeons out there who are very reflective and sort of change the way they do things accordingly.
Speaker 1:And we did speak about the restoration and the pain that comes with mastectomy. Definitely I can attest to that. I was told by one surgeon that there's no way that people are going to get the sensation back, and then the other surgeon was like, yeah, that's not true. So I'm learning more and more that it actually is true, that it is possible. Does it happen the same way for all patients? Probably not, but it's nice to know that there are surgeons who can try. And, as Dr Crisopoulos said, he doesn't know anyone who would turn that down Like do you want to try to preserve or help restore?
Speaker 1:And I guess I will say that after my surgery I do have some sensation in some areas and some I don't, but I've kind of gotten used to it. So I just think it's very fascinating that it is possible to work on that. So one of the things that I like to ask surgeons is this idea of access for women. So we're in a lot of private Facebook groups and we hear a lot of stories coming from women that definitely need all the help they can get as far as education and understanding their options. Women have been told that they are not candidates for deep flap surgery the kind of surgery that I had and they're just absolutely devastated. And we women who have been through this are now like you need to get a second opinion. So what's your take on all of that?
Speaker 2:There's several reasons why I think somebody might be told that they don't qualify for tissue reconstruction, and one is essentially a practice pattern that occurs in that person's area. So there may not be people that are trained to do these surgeries or have the facility or have the infrastructure to make it happen. Because it is a major undertaking in terms of what it takes to kind of make this surgery happen, or I should say, make it happen is a major, major undertaking, and this is process and culture and lots of things that, where you have many, many people all invested in a quality outcome, that's a hard thing to come by. So access to the technical aspects and access to care is, I think, an important element. There are sometimes financial limitations related to insurance coverages and that sort of thing, and I guess last year we had a big scare in terms of this operation not being covered or at least it's coverage rate, I should say, being reduced to the point that it can't keep the lights on in most facilities. So that, fortunately, was obviously realized for its faults and put away.
Speaker 2:Then there's also some health concern. That's a real question that everybody and I think an appropriate discussion with a doctor needs to be had to make sure that somebody is healthy enough to undergo an operation one and two, that they're a suitable candidate for that kind of surgery because of certain medical conditions, but kind of unpacking all those things. Most patients don't fall into that last category. Most patients can tolerate this surgery, I think quite well, and at least a lot of the patients that we see are healthy enough for major surgery. They have no major contraindication to the surgery. Those patients usually their main limitations that they haven't been offered the surgery near where they live because there isn't somebody who can provide it. There isn't somebody that has that sort of built in culture of providers of all things so that that patient gets a safe and quality reconstruction. Most things don't exist in, I would say, a substantial portion of the country.
Speaker 1:Let me ask you a question, because when I was going to get my mastectomy and reconstruction here where I live, I went to my surgeon and said hey, I have these a few friends who've reached out to me to tell me about someone that they knew who had this type of surgery. What do you know about that? And she said I don't know a lot about that, but her biggest concern was there's no local care. So Later on I found out that there is actually local care. I mean, the hospital that I went to is a world-renowned hospital and people come there from all over the world. Of course I called them right away and said well, what about local care? They said we have a lot of connections and if something happens then we take care of it from here. How do you deal with that when people say I don't know if I want to travel all the way there. What if something happens when I get back home? How does that work? I mean, how do we make people feel more comfortable about traveling to get surgery with you?
Speaker 2:So often we get the question what happens after a patient leaves San Antonio and goes home and how do we handle that? There are always the possibility of complications. There can be complications early and then late, but fortunately, going to a high-volume center, we've worked out many of the kinks and we have a very responsive staff both on call and during week, with the nurses, where we have a number of protocols in place to kind of handle minor issues. There are sometimes where we come into very unusual circumstances with very rare conditions, immunologic problems that people can't even imagine leading into their surgery, and we have a very good system in place in terms of having our staff reach out to local providers and actually begin conversations with them and individuals' primary care physicians and even though we're technically in another state, we act as a consultant for you on your behalf if needed, but fortunately that's exceedingly near and with how our protocol's in place and our requirements for how long somebody is in town, we've basically ruled out the majority of issues that can happen within that timeframe.
Speaker 1:Okay, and it's really cool because I would imagine that in the first phase of the surgery you probably have the patient hang out in San Antonio for about a week. Is that about right? And then they can come to the post-op.
Speaker 2:Not a hard minimum.
Speaker 2:There are some patients that stay with friends, family for extended duration, but that is by no means necessary. Typically after the surgery people are in the hospital about two days or so and then they have a post-op visit on day seven and I've had some patients that are comfortable and they basically go directly to the airport from there and I would recommend building an uncomfortable travel schedule but ultimately with a pretty smooth recovery. That's pretty standard. And then for the phase two, and usually for us it's only two surgeries required for the process. During phase two, I tell my out-of-state folks to treat it like a long weekend where we typically schedule those revision procedures, albeit outpatient, on either a Thursday or Friday so that we can have them stay for a day or two just to ensure that there's no issue, and if there is we can take care of it immediately, which fortunately is very untapping, and then they can travel and fly back to wherever they're from and not worry about having any sort of anesthetic or any other sort of secondary risk or complication for the lung care.
Speaker 1:I had a pretty good experience coming back. The only thing that I had was at some point I developed an open wound and I called the hospital and they got me a prescription and I had to put this gel over it for like seven days and then it was healed up, no problem. I actually did very well, and I have had friends who have had infections where they were instructed if they had a fever, go to the hospital and then they took care of the infection from there. So I just feel so much more confident about being able to go to a hospital outside of my area, and so I want people to around the country to understand that that, yes, in fact it is something that happens all the time. People come to your hospital and to other hospitals and are very well taken care of, and I want them to go into that with confidence. So thank you for explaining that. I wanna just wrap this up by asking you what makes you different, dr Gassman, from other surgeons? What sets you apart?
Speaker 2:My, I guess, angle and approach with performing deep flap reconstruction is to really use my mind's eye and aesthetic to help really push the overall aesthetic result from my patients, something that I've developed here we've branded and called High Definition. Deep and Lending Principles from High Definition liposuction, domino-plasticity techniques, body contouring techniques things I've learned all throughout my career and even time working in the lab A greater understanding of how adipose and her fat tissue behaves these are all techniques that I lend to my patients in how I approach the deep flap and setting it up in stage one for an excellent result in stage two. And so my hope is that you know, during this rebuilding process, that my patients end up with a result that's even better than they even thought was possible and, after going through a pretty horrific journey, they feel even better than where they were the day prior to their diagnosis.
Speaker 1:That's awesome. I love it. That's exactly how I felt, and I really just want everyone else to feel that same way, so thank you. To wrap it up here, I see that you have a couple of things on your biography that help you fill your cup after surgeries and on the weekends, when you get to have some time with your family, you do some things that I very much enjoy, and that's camping and hiking and spending time with your family and getting creative in the kitchen. Is there anything else that you like to do that really helps you kind of wrap your mind around the awesome things that you do for other people?
Speaker 2:Probably the one thing that gives me a lot of satisfaction and to me it's my own way of reflecting and internalizing is I do a lot of gardening, and for me it's like a quiet form of meditation. It's something that I did with my mother years ago and was part of my healing journey after she passed away, and it's something that, to me, is a sign of regrowth and renewal. It's just something that means a lot to me as a whole.
Speaker 1:I love that I lost my mother too, about four and a half years ago, and it's been quite a journey since then and I know how hard that is to lose our moms, and so, yeah, I really appreciate your time today and I know that you have a lot going on at the hospital and we got cut off a little bit a little while ago and had to rejoin. Yeah, patients come first. They do absolutely 100%.
Speaker 1:And I just appreciate your taking that role, and I just appreciate your taking that time out, though, to talk with me and help our audience understand where you are and when I come there to visit in March. I hope that you are at PRMA, so I can meet you, too, in person, that would be great.
Speaker 1:Yeah, well, listen. Thank you so much, and I just want to tell my audience thank you very much for joining us again on this episode of Test those Breasts and we will see you next time on the next episode. 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. Thank you so much for your time earlier today.
