What is the difference between having breast reconstruction with a physician in a large academic hospital and physician at a private practice?
I am exploring all options. I had a NSM in May 2023 with immediate reconstruction w/TEs.. Both TE’s failed. The 1st several wks after surgery and the 2nd a month after rads 10/3/23. I was referred to a surgeon who can do a Diep but not until Feb ’25
Physicians at academic medical centers are training residents and fellows who will perform part of your surgery under supervision of the attending physician. All fully trained plastic surgeons were trainees at one time.
Most private practice physicians will do your entire surgery themselves with the aide of an assistant.
Nowadays most DIEP flaps are being performed in academic medical centers.
As you are less than 30 miles from Boston, you should be able to find surgeons there who perform DIEP flaps.
Plastic surgeons who are skilled in breast reconstruction are in many different type of practices such as academic, group practice and solo private practice. In all of these settings you can get an excellent care and outcome. In all three of these settings your surgeon may utilize residents, fellows and PA's to be part of your care team. For example I am in solo private practice and do a significant amount of breast reconstruction. Residents and PA's are part of my team to help take care of my patients.
It is of utmost importance to research your surgeon to make sure that the surgeon is a board eligible or board certified plastic surgeon who's practice involves breast reconstruction.
Irrespective of what kind of setting the surgery is done in, important factors that lead to failure of Tissue expanders include, any exposure to nicotine, higher BMI, uncontrolled diabetes and history of external beam radiation.
Best wishes
Do your research both can get you great results. If you are having a DIEP make sure you go to someone who does a lot of flaps and not someone that does 1-2 a month. The service level is sometimes much different as you may get more one on one care with your surgeon in a private setting vs an academic setting. In my practice we do 2-4 patients a week and it’s my brother and I and an NP. Most cases take us between 6-8 hrs. Some places it takes 10-14 hr on a regular bases. You have to feel comfortable with your surgeon and look at before and after pictures. Some may do the DIEPs and be great at them but aesthetically not care. I work to have my patients build their confidence back to preop levels or even better which comes with lots of work in the second stage with reshaping the breast and body.