Breast reconstruction the whos whys and hows with dr damian marucci

Dr Marucci: Thank you very much.

Trish Hammond: Thanks for joining us, Dr. Marucci.

Dr Marucci: Thanks very much for having me.

Trish Hammond: Okay, all right. Awesome.

Dr Marucci: Yeah, awesome.

Trish Hammond: I thought I’d be formal for the podcast, but I’m…

Dr Marucci: Oh, yes. No, of course.

Trish Hammond: Okay, great.

Dr Marucci: Thank you, Ms. Hammond. Thank you. Yes.

Trish Hammond: Well, I’m really excited for today. We’re going to have a chat about breast reconstruction. Because I know that you do so many of them. I’ve actually got a bit of a list of questions here, so I hope you don’t mind or anything.

Dr Marucci: No, hit me. Straight away.

Trish Hammond: If there’s anything that you want to add, feel free to just go for it. The more, the better.

Dr Marucci: Of course. No worries.

Trish Hammond: I know you do lots of reconstructions, but how often do you do a reconstruction at the same time as removing breast implants?

Dr Marucci: Yeah. In terms of reconstruction after breast cancer, the timing, there are essentially two options. It either occurs at the same time as the mastectomy, that follows an immediate reconstruction, or it can occur after the patient has finished having all these treatments. They finish their surgery, their radiotherapy, their chemotherapy, and then they have another reconstruction. Probably nowadays, it’s been a big change over the last 10 years, and probably most of the reconstruction I do nowadays is at the time of the mastectomy. So I work very closely with the breast surgeons in the area. We go by the same patients separately. You need to get your patient directly. They’re not applicable to every patient, but certainly a very high portion of patients can have an immediate reconstruction. In terms of how it’s actually done, it’s different for different patients.

Probably the majority of patients who have an immediate reconstruction is a reconstruction with an implant. The breast surgeon comes along and removes the breast cancer and the rest of the breast tissue. Sometimes, the nipple is also removed, unfortunately. Other times, the nipple can be preserved. I will then come along and lift up the muscle on the chest wall. Sometimes I’ll use a sheet in order to hold everything in the right position, and then I’ll take a breast implant like this one here, and I’ll put this implant underneath the muscle, and I’ll close the seam at the top. It’s a drain on top and a drain underneath, close the wound, and that’s it. So this is a one and it’s done technique. It’s called direct to implant reconstruction, and it’s a single-stage procedure. There are many considerations in terms of whether someone is suitable to have an immediate reconstruction.

If someone needs, for example, radiotherapy soon after their surgery, because they have a particularly aggressive disease, it might be best not to perform a reconstruction at the time. We’d rather wait until the patient’s finished having all their other treatments, and then goes onto reconstruction, so it can deal with the irradiated tissue. Just to take a step back though, in terms of breast reconstruction overall, the thing to remember is, there are essentially only three ways to reconstruct a breast. We can either use an implant, or we can use the patient’s own tissue, or we can use a combination of the two. Again, those three different groups can be used either at the time of the mastectomy, so in an immediate reconstruction.

So say, for example, someone suitable to have the… that’s where we take fat and muscle from the tummy and move that up onto the chest walls and onto a reconstructed breast without the use of an implant. If it’s suitable to have that at the time of the mastectomy, that can be done at the same time. Other patients might not be suitable or might not want that kind of surgery, and instead we can either look to putting in an implant at the time, or even doing it with an implant at the time. So to take that back to the original question, probably over half the reconstructions I’m doing now are immediate reconstructions, and the majority of those are just directly with an implant.

Trish Hammond: Okay. So depending on how aggressive the cancer is depends on which … So it’s an individual thing?

Dr Marucci: Yeah. The key thing about breast cancer is that patients with breast cancer, our treatment is part of a team. It’s not just the breast surgeon, it’s not just the oncologist, it’s not just the radiation oncologist or the breast care nurses. It is a team, including the reconstructive surgeon. So it’s important that all members of the team have input, and it’s good, in a way. Because it means that you know that everyone brings their expertise. So the radiation oncologist will come along and say, “Look, I know you and you are really keen to just get on and do this operation, but I really would like to do radiotherapy sooner rather than later, so you need to think about that.” It’s important that the team communicates well and is harmonious, and that everyone is focused on what is in the best interest of a patient, and in treating the underlying cancer. If the team decides that it’s fine for a patient to undergo reconstruction at the time of surgery, then that’s probably the way to go.

Trish Hammond: Okay. All right. It’s a decision that’s made as part of the team, and-

Dr Marucci: Exactly. Exactly.

Trish Hammond: I actually have a friend who just recently had it done, and she had it in a two set process because it was very aggressive.

Dr Marucci: Yes. Well, the thing about it is that in terms of even just using an implant, a lot of times … Because skin often has to be removed in addition to removing the breast tissue. If you remove a lot of skin from the breast, you can’t simply just put an implant straight back in, because there’s not enough room. You can’t close the skin over the top. So what we do in that situation is in two stages of reconstruction using implant. At the third stage, we’re putting this. This is called a tissue expander. It’s basically an implant, and from this special part here … the thing about this port is you’ve got this magnet finder that can show you where the port is. So for example, say this is underneath the skin. If that’s underneath the skin, this will point to where that port is.

You can put a needle into the port and put fluid into the expander, and then slowly, over a period of weeks … You see the patient every one to two weeks. Over a period of … It depends on how much fluid you put in. You will slowly feel the expander, and it stretches the overlying skin and creates new skin, in a sense. And then once you get to the volume you want, then you can remove the expander and put in an implant. That’s a two-stage, implant-based breast reconstruction. In terms of going just directly to the implant, we just put the implant in. That’s something that has only really gotten a new lease of life in the last probably two or three years, due to improved technology that we have around holding the implant in position using something called… which is a sheet that you can suture to hold the implant in position, or part of the implant.

That’s only been gaining traction in the last, probably, four or five years. Before that, almost all implant-based reconstruction was with the first step of the expander, and then the second stage where the implant went in. So if you look in the literature, there are a lot of surgeons from all around the world, but particularly in the United States, who have great experience, and have fantastic results, and all they do are two stage reconstructions. Whereas, I do my best whenever I can, is to go for a one stage reconstruction.

Trish Hammond: Okay. And with the expander, what do you actually fill it with?

Dr Marucci: Saline, just salty water. At the time of surgery, we’ll put a little bit of fluid in there. We’ll put as much as we can to start things off, but not so much that it puts tension on the wound. Then after everything’s settled down, I’d only wait about two to three weeks, and then I’ll see the patient here in my office, and I just put a needle straight through the skin into the expander. And normally the skin’s pretty numb, because the patient’s had a mastectomy. And then you can slowly start to fill it. I put in as much as I can every time I see the patient, and I’m limited by when the patient tells me, “Oh, that’s starting to feel a little bit tight.” Then I stop, I keep track of how much fluid I’ve put in. Because at the end of it, the patient will look down and say, “Oh, I’m actually happy with this volume.” And I’ll say, “Okay. We’re at 400 mils.” I’ll actually over expand a little bit, but then I know we’ll need a 400 mil implant when I come to exchange the expander for the implant. That second procedure does involve a second general anaesthetic, it also does involve a drain, which is a bit of a hassle. But it’s a pretty straightforward kind of thing.

Trish Hammond: And what can the timeframe be like from-

Dr Marucci: Between the two?

Trish Hammond: Yes.

Dr Marucci: That’s probably the most common question I get, and the answer is, it depends. Say I put in 100 mils at the time and we need to get to 400 mils, and then I see you, I put in 25 mils, and you say, “Oh, that’s feeling a bit tight.” And then a week later, I do 25 mils and you say, “That’s feeling a big tight.” You can see it’s going to take me a couple of months before we’re anywhere near the volume. There are some patients where to get to 400 mils, I put 100 mils on the day, I put 100 mils in two weeks, 100 mils in three weeks, 100 mils at four weeks. And that’s it.

Trish Hammond: Oh, okay.

Dr Marucci: As I day, I do like to overfill by at least 10%, and I like to let everything settle for at least two weeks.

Trish Hammond: Okay.

Dr Marucci: But the thing about it is, that with the expander, you can still get practically everything you want to do. You can do exercise, you can travel, all that kind of stuff. So there’s no huge rush from that point of view. It’s not like they’re looking at a matter of [inaudible 00:10:19] client when I set a period of time that something bad happens. It’s not even just saying that you can go for as long as you want. The expander, when it feels with fluid, doesn’t feel as nice or as natural, or look as nice as an implant does. It feels quite firm and solid. One of my patients had two expanders in and she gave her son a hug, and her son said, “Oh, my god, mum. They feel like door stoppers.” And they do feel pretty rock-hard.

But other than that, there’s no problem with having the expanders inside you. Until you get to the volume you want, and then you can just exchange the expander for an implant. I’ve had two patients who both have cruises a couple of months away, and both raised cane to try to get the whole thing done before they went on the cruise, and neither of them did. They just went on their cruise with their expander, and when they came back, we finished the expansion and we put in an implant. You can still do everything you want to do with an expander, it’s just that it doesn’t look as good or feel as good as if it is an implant.

Trish Hammond: Yeah. So probably the most important takeaway from that is, don’t rush it, because it’ll just naturally be at the right time for you.

Dr Marucci: Yeah. There is no rush, and the key thing is, you don’t want to have any more discomfort and pain during the expansion process than what you have to.

Trish Hammond: Yeah. Okay. Is there any special preparation for the breast reconstruction that the patient can actually do? I know there are tissue expanders, but what else might a breast reconstruction patient need to consider during the weeks or months leading up to … Or during the process, even?

Dr Marucci: Yeah. Well look, obviously for patients that are having an immediate reconstruction, that means they’ve got a diagnosis of cancer. Many of them have only just been diagnosed with a cancer and they’re in a terrible situation from a psychological point of view, from a family point of view. I think it’s very important to make sure that you’re comfortable with all the information you’ve been given by all the members of the treatment team. I always encourage patients to come along with their partner, with their family, and come and see me as many times as they need to before the surgery, to make sure that all their questions are answered. It’s a time, you can understand, great concern, great fear, great worry. So it’s important that patients understand what their options are, because there are options, and…

And it’s also important that they understand the journey which they’re about to go through. In terms of patients who are having an elective reconstruction … So say, for example, they’ve had a mastectomy a year or two before, and now they’ve decided they’re going to go through a reconstruction, the most important thing is to be as healthy as you can. And the most important thing in terms of being healthy is not smoking. Smoking is the worst thing you can do in terms of any form of reconstructive surgery in general, and breast reconstruction in particular. I see patients who, even having an immediate reconstruction and they may be an active smoker, and the big message that I just need to give out says, “One last cigarette and that’s it. Give me as many weeks as you can before the surgery.”

And the reason why smoking is so important to be ceased, is because it affects the blood flow to the skin, and when we’re doing our surgery, especially if we’re putting an implant in, there might be a bit of tension on the skin. So you want the skin to have good blood supply, otherwise the skin inches to die back. That’s called mastectomy flap necrosis. If that happens, we may need to go back and take out the dead skin. And if we take out the dead skin, we might not be able to close the dead skin over the implant. So then we have to take the implant out and maybe put an expander in, or take the implant out and leave the implant out. In terms of patients who are smoking, every complication you can think of, whether it’s going to have problems, bleeding or infection, increase in patients who smoke.

And certainly, being healthy is very important. In terms of delayed reconstruction, and now I’m getting along to other forms of breast reconstruction. Whenever we can, whenever I can, I like to use the patient’s own tissue to reconstruct a breast. The most common tissue we use is skin, fat, and muscle from the lower abdomen. And so essentially, you give the patient a tummy tuck, but instead of throwing that tummy tuck tissue away, you use that tummy tuck tissue to reconstruct their breast. You remove the tummy tuck tissue with an artery, which takes blood to the tissue, and a vein that takes blood away from the tissue. You find an artery and a vein up here on the chest wall, you join the artery to the artery and the vein to the vein, and you reestablish the circulation of that tissue, up on the chest wall.

Trish Hammond: Okay.

Dr Marucci: That is called a free flap. A flap just means tissue which is isolated on blood supply. A free flap actually is free, it’s out of the body, and then you put it back where you want it to be. Where that tissue came from, which is the lower part of the tummy, you just close that as you would a normal tummy tuck. So it’s a scar from side to side with a new hole for the belly button. But as you can imagine, if someone has had a mastectomy or even a double mastectomy, a bilateral mastectomy, and you are able to then reconstruct both breasts using the skin and fat of their lower abdomen, and give them a tummy tuck at the same time, the results are incredibly dramatic. And it complete changes their body shape, and I’m going to say for most of them, it really changes their outlook.

As you can imagine, it’s incredibly confronting to someone to have one mastectomy, let along two mastectomies. And to be able to perform a reconstruction where we can replace what has been removed in treating the cancer, is something that patients find and surgeons find very rewarding. That procedure, being a trans flap or a DF flap, which is where you leave the muscle behind, or a muscle bearing… they’re all pretty similar. You’re just taking the tummy tuck tissue. But that kind of operation, it’s a longer operation. It’s a safe operation, surgery we do all the time. But particularly risky complications. I do want patients to be as healthy as they can. Patients say to me, “Oh, no. If I lose weight, then you won’t have enough.” That’s not true. There’s always more than enough.

Trish Hammond: Always some fat to get from somewhere.

Dr Marucci: Yes. And so the key thing is, approaching this kind of surgery, to get as healthy as you can.

Trish Hammond: All right. Do you do any grants in that process? Is that-

Dr Marucci: Yeah. In terms of granting, I think most surgeons who do breast reconstruction, there’s small amounts of that grafting. After you’ve done the main reconstruction, whether it’s with an implant or some sort of slab, we might use small amounts of [inaudible 00:17:25], which is where you harvest some fat elsewhere, either from the buttocks or the thighs or the lower abdomen, you prepare the fat in some way. I normally just filter it until I get purified fat. Then you inject that fat onto the chest wall. There are actually certain places around the world where they’re actually trying to do the whole reconstruction just using fat grafting. That is something that hasn’t been widely embraced in Australia, mainly because there are some, at least theoretical concerns about possible promotion of cancer.

Fat grafting contains growth factors in the large, and in the laboratory, it’s being shown that the kind of growth factors you can get with fat grafting can actually promote the growth of cancer cells in general. So for that reason, in Australia as a group, everyone’s held back a little bit in terms of doing massive fat grafting. Just to make sure that there isn’t going to be any sort of issues with patients developing further cancer down the trail. Or even developing things like cysts or lumps as a result of the fat grafting, which would be extremely distressing, and would need to be differentiated from the cancer. But certainly, yes, fat grafting is something that is used to a small degree as an adjunct. But to say, you do your reconstruction, there’s a little area which is flatter or one side’s a little bit smaller than the other, we might use relatively small amounts of fat grafting just to improve symmetry and the overall shape.

Trish Hammond: Yeah. And I think as a nation, we are pretty conservative with supplements. It’s better to err on the side of caution when it’s not-

Dr Marucci: It is.

Trish Hammond: I’d feel comfortable if it was me. I would want them to be more conservative.

Dr Marucci: No, without a doubt. I keep my eye on what’s in the literature pretty carefully, and certainly there is a big group in Miami who have been using fat grafting for breast reconstruction for quite a few years. They’ve had all their patients have MRIs. They haven’t reported any increased incidents of breast cancer at this stage, so that’s certainly something that may become more common in Australia in future years. But at the moment, it’s something that we’re still holding back a little bit.

Trish Hammond: All right. And if the patient has only lost one breast and only needs reconstruction on one side, how often do you also need to adjust the other breast in order for them to be balanced? Or do you just try to get the reconstructed breast to be more like the existing one?

Dr Marucci: It all depends. The questions which I ask patients who are coming for a reconstruction is, “Are you happy with the shape and size of the other breast?” Because the whole idea is symmetry. But the other thing to say, Trish, is that different patients have different aesthetics demands, cosmetic demands. So there are some patients who say, “Look, it doesn’t have to look exactly the same as the other breast, just as long as the volume’s the same so I don’t have to put something inside my bra. So when I’m wearing a bra and I’m going out, I’m at the beach, I don’t have to worry about the chicken filler,” the implants that patients put in their bra to make their symmetrical. Some patients have a very low aesthetic demand, so all they might want is just something with volume, which is generally like the other side.

Whereas other patients have a very high aesthetic demand, where they want it to look as close as they can, when they’re naked, from one side to the other. So that’s talking about nipple reconstruction, nipple tattooing, trying to get the shape and size as good as we can. The first thing is, reconstruction surgery, ascertain what the final goal is of the patient, and then have a look at them and have a frank discussion about, what are the things I can get them. Just so that their expectations marry with what my surgical ability is. In terms of the other breast, if a patient has a breast which is very useful and there’s no drooping or ptosis or whatever, then that might make it easy. Then we can just say, “Look, you’ve got a great looking breast on the other side. We’ll just try and match that.”

If the other breast is very broad and large, and very dropping, then we might say, “Look, why don’t we go to do a breast lift or a breast reduction on the other side, and then try to match that on the reconstructed side.” As a general rule … And then there are some patients who say, “Look, I’ve actually always wanted to be larger than what I was before,” so we’ll put an implant on one side, and then we can do an implant-based reconstruction on the other. As a general rule, what I explain to patients is that it’s easier to match a breast reconstruction with an implant, with the other side if it also has an implant. If the other side doesn’t have an implant, then often you’ll get better symmetry, because their own natural tissue is using the patient’s own natural tissue.

So that’s part of the way I approach it overall. If someone has a very natural breast with a natural sag on the other side, even if it’s not so bad that they need a lift or whatever, generally I find I get much better symmetry by using their own tissue, by using a DM flap, a trans flap, or some other flap using their own tissue. But the end result of this conversation is, the goal is symmetry, and it’s just important to work out from the patient what level of symmetry they’re after.

Trish Hammond: Yeah, okay. In the case of, oh, what’s her title? The most gorgeous woman in the world-

Dr Marucci: Angelina.

Trish Hammond: Angelina Jolie.

Dr Marucci: Yeah, she had a bilateral.

Trish Hammond: Yeah. She had tissue removed from both breasts, and replaced with implants.

Dr Marucci: Exactly, yes. The idea is symmetry. In fact, I have many patients who come to see me with the breast cancer on one side, and they come to see me to have one side replaced. But then during our consultation, I’ll show them before and after photos and actually say, “You know what? I don’t want to have a mammogram every year for the rest of my life, because I know I’ll just be nervous leading up to the mammogram and then waiting for the next mammogram, drumming my fingers, thinking, ‘Oh my goodness. My next mammogram is 10 months away. Is it going to be okay?’” And many patients actually opt for a bilateral mastectomy and a simultaneous reconstruction, because then I can be more confident that I’m giving them a symmetrical result. When they’re not removing the other one for a cancer reason, they’re removing the other one prophylactically, so it can never develop the cancer. But it also means that I can be more confident in giving them a symmetrical result.

Trish Hammond: Okay. And in that case where you’re doing both at once, is that something that you do, or do you need the breast … Because I know it’s a team. But is that something that you can, do, or-

Dr Marucci: No. The breast surgeons I work with do the mastectomy side of things, and I do the reconstruction side of things.

Trish Hammond: Okay, got it.

Dr Marucci: But obviously, we work very closely together, and you’ve got to make sure you’ve got a close relationship with your breast surgeons. There are times when they will say to me, “Look, I know you’re thinking of doing a transfer to this patient here, but I think she’s got a very high change of needing radiotherapy. You might want to hold off on a tran, just in case the tran gets shrivelled by the radiotherapy, and you’re better off doing it after the radiotherapy,” for example. So we’ll often have a bit of a conference call before our cases just to make sure that we’re agreed on what their plan is and what my plan is. Sometimes, the patients will insist on a nipple-sparing mastectomy, for example, where their nipple is preserved. And the breast surgeons I work with might have me, for example, help them design the incisions they’re going to use just to make sure that I can comfortably complete my surgery with the access that I need for whatever I’m doing.

Trish Hammond: Okay. That leads to the next question. Obviously with a breast reconstruction, a nipple may also need to be created. How does that work? And would the patient ever have sensation in that nipple at all?

Dr Marucci: No. Unfortunately with most reconstruction, they remain numb. They remain insensate. In terms of reconstructing nipples. Like I said, sometimes they spare the nipple, which is great, that gives you a really good cosmetic result. If you actually spare the nipple. But breast cancers are normally ductal cancers where they start in the ducts or where the ducts empty on to the nipple, so in many cases, the nipple needs to be removed just to make sure the cancer’s gone. And remember, that is the most important thing here, to ensure the cancer is handled appropriately. But if the breast surgeons are confident that the cancer can be treated and preserve the nipple, they will try and preserve the nipple. If the nipple needs to be removed, which does need to happen quite often, then there are ways of reconstructing a nipple. The most basic way to actually get a [inaudible 00:26:35] nipple, they make little adhesive nipples which you can-

Trish Hammond: Oh, I’ve seen them. They look amazing.

Dr Marucci: Yeah, they do look amazing, but they’re a bit of a hassle. You’ve got to tape them on and take them off, and they’re not there all the time. But many patients of mine transition through that stage when they’re deciding whether they’re going to go for a nipple reconstruction or not. And I try using it and they think, “Oh, I do like having a nipple. I don’t like having one that I have to take on and off, so yes, I’ll have surgery in order to reconstruct the nipple.” Okay. A stick-on nipple is one option. The next option is a tattoo. You can just get a simple tattoo. They call it a 3D tattoo, because they can sort of give the appearance of a shadow of the actual areola, the prominent part of the nipple itself. But just in general we’ll do the areola, which is the circular area and not the nipple itself, which is the part in the middle.

So it can have a tattoo of the areola, which gives a shadow effect, gives you the idea that the patient has a nipple. In terms of surgery, what we can do, we can actually fold skin on itself in order to create the prominence of a nipple. We made need to do a skin graft, or we can just sew the skin back together around it. And then we let that settle down, and then that nipple that we created can then have a tattoo a couple of months down the track, about six months down the track. And that gives you the absolute best result. Because you actually have the prominence of a nipple, the shape of a nipple, and the colour of an areola. And that really is the gold standard. In terms of when patients come to me, because sometimes they do, they come to me and they say, “Look, I just want to have the best. What is considered to be the best reconstruction?”

In terms of what would be considered our gold standard, it would be using the patient’s own tissue with a nipple reconstruction that is being tattooed. And that would be a gold standard reconstruction. But not everyone wants to have that degree of surgery. Many patients get an excellent result with an implant. Even with an implant, the vast majority of patients, you can still construct a nipple. Some patients who, say, had radiotherapy after they’ve had an implant, and all the tissues are a bit thin, it might not be safe to try to raise some skin on top of the implant, in case it gets infected or exposed, for example. But other than that situation, the overwhelming majority of patients are suitable for nipple reconstruction.

Trish Hammond: Okay. I’ve actually seen some of the most amazing nipple tattoos. What they can do to that is amazing.

Dr Marucci: Yes, it really is.

Trish Hammond: So I’ve got one question. You said breast reconstruction, obviously, it’s got the potential to be a more emotional genre than other plastic surgery because of the reasons behind it. Do you find that these patients and their journeys are more emotional than other types of plastic surgeries?

Dr Marucci: Yeah. No, without a doubt. You’re dealing with a number of issues, not just dealing with cancer, and the thought of ill health, but the thought of mortality, the thought of death one day. Also, you’re dealing with family. The majority of patients tend to be between the ages of 40 and 70. The majority are wives and mothers, and so their family are who they tend to be the main carer for. So there’s not only concerns for their own health, but, “What’s my family going to do while I’m having chemotherapy and radiotherapy and my husband [inaudible 00:30:03], and all this stuff?” So there’s those very practical fears that patients have, just outside the fear of, “My goodness, I’ve got cancer,” which is a leading killer. “And I’ve got to go through surgery,” and often, chemotherapy and radiotherapy. SO that does add an element of emotion. In terms of one’s self identity, your identity as a woman is extremely important, and to lose a breast or two breasts is devastating. If you think about a male who had to be castrated, it’s the same thing. It’s a potentially devastating surgical procedure from that point of view. And that is why reconstruction is actually very important for these patients. That’s why reconstructive surgery is paid for by the health funds. It’s covered by medical to have it done at the public hospital, because it’s recognised as being an important part of the treatment for that reason. And so there are … Yeah, as you quite rightly say, it’s probably unique amongst reconstructive plastic surgery procedures you perform. It’s one where you get to know the patient’s story well, and you really have to get to know the patient’s story well in order to understand where they’re coming from. And you work with the patients in order to work out a plan of what’s going to be best for them, at what time, in what way. And all of those issues. But the final thing I’ll say is that it’s actually been probably the most rewarding part of my practise, even though it’s not the easiest part of my practise, by any means. It’s a very rewarding thing to hopefully be of use and helpful in that particular time.

Trish Hammond: Yeah. That’s so good. I know that you’re really passionate about it, and I love that you’re so empathetic about it, as well. I really appreciate your time today.

Dr Marucci: No worries.

Trish Hammond: That’s been so helpful for people, as well. Ladies … Some of you ladies. Actually no, I do know men that had breast cancer.

Dr Marucci: Yes. That’s a 1 to 2%, but obviously they don’t need reconstruction.

Trish Hammond: Yeah. If you’re in Sydney, Dr. Damian Marucci, he practises at Kogarah, and he’s able to help you. Thank you so much, Dr. Marucci. Thank you so much for taking the time out today.

Dr Marucci: No worries.

Trish Hammond: All right. Thank you. Bye.

Dr Marucci: Yeah, thanks.

Trish

*This transcript is taken from an interview with Dr. Marucci and Trish Hammond, founder of Plastic Surgery Hub. We have very gratefully reposted her work to inform and educate our customers. You can find more of Trish’s wonderful articles at: www.plasticsurgeryhub.com.au

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn’t mind a little bit of ‘help’ from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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