Dr. Steven Struck is a well known San Francisco Bay area plastic surgeon. He performed Asteame’s co-founder Andrea Hammer’s breast and nipple reconstruction after she was diagnosed with breast cancer in March, 2004. Dr. Struck has been in private pracitice for the past 10 years and trained at Stanford University in Plastic Surgery for 5 years before then.

 Good evening Dr. Struck.  Thank you so much for taking time out of your incredibly busy schedule to do this interview.  Our goal with talking to you is multifold:  One, we’d like you to describe the nuts and bolts of the reconstruction process, specifically focusing on the roles of expanders and implants, since that is your specialty; Two, we want you to provide women with important information that they often don’t hear or don’t fully understand as they begin to decide  what’s best for them regarding the reconstruction process; And three, we’d like your insights on some difficult questions, especially regarding topics that are often avoided.

BREAST MOUND RECONSTRUCTION

 Okay. Let’s jump right into things. So after a woman has a mastectomy, what are the different surgical options for reconstruction?

There are two main pathways that you can take. One is to use an implant - where usually we use an expander, or temporary implant followed by the placement of a permanent implant, and then nipple reconstruction afterwards. The second is to do some type of flap. All of the flap procedures have the same premise: that is to use the woman’s own tissue to reconstruct the breast mound, instead of using an implant, followed by a nipple reconstruction. The TRAM flap is one, which is where we use the abdominal skin and fat to reconstruct the breast.. But there are numerous types of flaps that we can do now, some of the more advanced ones we don’t even take the muscle anymore – we leave the muscle there and just take the skin and the fat, which is nice because it leaves the abdominal muscles in tact. Lat flaps may not be as popular as they used to be - that’s one where we use the back muscle and move that around to reconstruct with the mound with. There are surgeons who use the skin and fat out of the middle thigh area by the groin to reconstruct with. So the main two options are the implants and the flaps.

And, which of the two procedures do you specialize in?

I primarily do implants, and then I have a friend in San Francisco at the Bunke Clinic who I send the flaps to – the TRAM flaps.

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