Let’s Be Clear About Reconstruction...with Dr. Jay Orringer (Part1)
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This is Let's Be Clear with Shannon Doherty. Welcome to a new episode of Let's Be Clear with Shannon Doherty. And I have on one of the loveliest, loveliest doctors I have ever encountered, Dr. Jay Orringer. He is a plastic surgeon. He is also a reconstructive plastic surgeon, which is how I know him because he...

reconstructed my breasts and then the other one to match it. Hi. Hello, Shannon. Hi, Dr. J. Great pleasure to be here with you. Good to see you. You really are one of those doctors who takes so much time with your patients. You don't overbook yourself. I just remember you drove to my house constantly to check on me. When I had the expander in and the drains, all of that,

I'll get into everything that you did for me and what you do for so many others. But can you tell us how you started down this path? Sure. So originally, Shannon, I was believing that I was heading down the path of chest surgery, thoracic surgery. And I was in my general surgery training, which was one of the prerequisites for that.

And very early in that training, I was on the oncology service and we rounded on a lovely young woman who had just had a mastectomy. And in those days, the reconstructions weren't done immediately. If done at all, they were often done as a subsequent stage following the mastectomy. As opposed to today, when we do the vast majority of our reconstructions immediately, at least start them immediately so that

The patient wakes up with some form of breast. I felt so bad for this woman when I saw how this affected her and how it would affect her. It changed my life. That day changed my life. When I rounded on that patient and I just saw what resulted from that life-saving procedure, what she would face unless her...

wholeness were able to be restored through a good quality reconstruction. And I then said that day, this is what I want to do for the rest of my life. I want to help these people. And so I completed my general surgical training. I feel that as a surgeon who operates on the breast in any capacity or any part of the body for that matter, it's helpful to be fully trained in general surgery. So I completed a wonderful training and then

Got my boards in general surgery and then completed my plastic surgical residency and training. And then following that, as if that weren't enough, I decided that I wanted to do a super specialization in microsurgery. Microsurgery is a subspecialty of plastic surgery where, and it's used by other specialties as well, where we use the operating microscope to reattach blood vessels or nerves to

And we can transplant tissue. What's remarkable about it is we can take tissue, let's say, from the tummy. A woman says, I have excess tummy tissue. I don't like this extra skin and fat. I've thought about having a tummy tuck, but instead now I need a mastectomy.

We can take that tissue and using techniques of microsurgery, reattach blood vessels so that that tissue can be shaped to create a breast that is in many instances almost indistinguishable from a real breast. So I decided I wanted to acquire that expertise. And so the microsurgery has been a very nice opportunity

adjunct to sort of complete my armamentarium in terms of what we can offer patients. In general terms, there are two ways we can reconstruct the breast. One uses some form of implant, one uses one's own tissues, and each has advantages and disadvantages. The advantages of using an implant include the fact that it is typically a shorter and simpler procedure

associated with a somewhat shorter recuperative period in most instances. And the site of the surgery is limited to the chest. Using one's own tissue, where we transfer tissue, basically we transfer an organ of fat to make a new breast, and it has its own blood supply. As opposed to situations where commonly today surgeons will liposuction fat and inject it into the chest wall and hope that that fat will live,

The reality being that much of that fat will resorb. When we reattach blood vessels that are attached to this organ of fat, it lives just like a kidney transplant. Right, because you're pumping blood into it. Into it and out of it. And so it's quite a remarkable concept. And we can take tissue from the tummy, again, the tissue that would be discarded with a tummy tuck,

We can revascularize, put it under the skin, under the nipple, under the skin of the breast. When you feel it, it feels just like a breast because the breast is an organ, largely a fatty tissue, and there's fatty tissue now placed under the skin. So it feels very much and looks very much like a natural breast. Similarly, in a very thin woman, there are some people who are quite thin and

you're in great shape, you didn't have a lot of tissue to work with and we had to use everything we could from that small tummy. There's some women who simply there isn't enough tissue on the tummy to even do a single breast. And so then those women generally will have enough tissue on the upper buttock or gluteal area where we can in essence do a buttock lift and take that tissue and

and transplant it to make the new breast. The scar that results from that simulates a butt lift on the upper buttocks. A bathing suit that's sort of high cut would cover that. And so the advantage of using one's own tissue is that unlike an implant, it doesn't require maintenance.

Implants can be a great option for a lot of women, especially if radiation hasn't taken place. Implants can be a good option, but it must be understood that they require maintenance. Implants are likely to need to be replaced multiple times in the course of a young patient's life. Don't really know exactly what the life expectancy of an implant is, and it will vary from the setting and from the individual.

But it's commonly said that an implant may last 10 or 15 years if we're lucky. They then will often have to be replaced either because of wear and tear where the implant cracks. In other words, it can leak. The newer implants are more cohesive. We can talk about that, the cohesivity or the gummy bear implants. But still, if it cracks, there's some element of leakage, although it tends to be more contained with the newer implants.

So when they crack or leak, we tend to replace them. If they encapsulate or form tight scar tissue around them... Which is when they get very hard. And uncomfortable often. Encapsulation is the formation of tight or thick scar tissue around the implant. It's the body's response to the implant. It's tissue. It's not part of the implant. It's the patient's own tissues. When that gets hard...

then that scar tissue will have to be released or removed in many instances. And so the implant has to be replaced, another operation. The problem is that once encapsulation forms, an individual is prone to have it occur again. There's just no guarantee that it won't come back. As implants age, oftentimes the tissues overlying them thin and implant imperfections such as implant edge and implant rippling becomes more apparent.

And so for cosmetic reasons, particularly if we have a better quality implant that's been developed since the implant was first placed, for cosmetic reasons, we may want to replace the implant. So rupture, encapsulation of scar tissue, and cosmetic modifications, those are all reasons that an implant might be maintained. Use of your own tissue is associated with a permanent reconstruction.

It will droop a bit over time, just like a normal breast, but it's not going to encapsulate and it's not going to rupture because it's your own tissue. Now, if you have a young individual who's in wonderful shape and putting a scar on the tummy is not going to be an acceptable option, we have to really consider whether we should do that.

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So to join Lenovo Pro, visit Lenovo.com. That's Lenovo.com. And unlock new AI experiences with Lenovo's ThinkPad X1 Carbon, powered by Intel Core Ultra processors.

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you need to go or check out an affordable and reliable corolla with a trim for every lifestyle from the hip sedan to the sporty hatchback there's a corolla built just for you check out more national sales event deals when you visit buyatoyota.com toyota let's go places like you said everybody's different there are people that have had the same implants for 20-25 years

And that when that scar tissue started forming, their doctor, and yes, you know, it doesn't necessarily feel good, but pushes and breaks that scar tissue and go in over and over and over again until that scar tissue forms way outside of the implant.

So it is possible. And I know that you've done implants where it's possible. And so there's the positive side of the implants and you get exactly the size that you want and everything else. And there's minimal scarring, like you said, it's contained to like the chest area. And with flap surgery, the positives are everything that you mentioned, but there are some negatives and those negatives are the scars. Right. Because, um,

You know, if you're taking from the belly, you have a scar from hip bone to hip bone. And sure, you know, you can drop it a little bit lower. Hopefully you can, you know, keep stretching that skin and go back in and get that scar, you know, redone to drop even lower. But it's only going to go so low. Yeah, there's no question, Shannon, that the heavier individual or the more weight fluctuation she's had or the more pregnancies she may have had,

the lower you can place that scar. It is a scar of a tummy tuck. You have to decide, you know, if someone is thin, the scar is going to be higher by definition because you just can't get it quite as low if there isn't the laxity of the skin. And that trade-off has to be weighed. You know, there are women who simply...

would benefit aesthetically in some regards from getting rid of the excess skin and fat of the tummy, but the scar simply isn't worth it to them. So we always discuss that. I spend typically an hour, sometimes an hour and a half with patients, as you know. There are a lot of options that are available. And it's a great honor and privilege to work for the people that I take care of.

And it's really important that they know the options that we discuss, that they have an opportunity to ask questions and get their questions answered. So those are the things we talk about. Yes, you have this extra tissue on your tummy. Would you tolerate a scar? And that really has to be an individual decision. A couple of things that you mentioned that are relevant.

The concept of the closed capsulotomy, I just want to mention, we no longer accept the squeezing of an implant to treat a capsule.

As a generally well thought of technique. I'm talking about something that was done, you know, literally back in the 90s. I'm sure it's still being done somewhere. I'm sure there are doctors still doing it. So I'm just telling the wonderful people that may be enjoying this and benefiting.

If that's suggested, avoid that option. So in other words, listen to the doctor and not the Shannon, you guys. No, no. I don't think you're advocating for it. You're saying that it's done. That it is done, yeah. That can rupture an implant. So yes, while you might break the capsule, the scar tissue, you may also break the implant shell. Of course. Shannon, in terms of more specifically,

What technique is appropriate for what? I think it's worthwhile mentioning the effects of radiation and reconstructions. I think that's a very important point. One must realize that while potentially life-saving, life-prolonging, radiation is a double-edged sword in that it permanently damages the tissue of the chest wall. That's permanent. Someone lives to be 100, microscopically, you'll see the changes happening.

of radiation in the tissues. As a result, when you place an implant beneath radiated tissues or you radiate an implant after implant placement, the radiation incites a more vigorous cap-thor response, a thicker or tighter capsule formation, the scar tissue around the implant. That's what radiation does. It incites a vigorous reaction. And so it's a very, very common phenomenon

happening that if you radiate the chest wall that has an implant, the patient will, within a fairly short period of time, say, wow, this feels really tight. This feels tight and uncomfortable. That's not every patient, but it's very common. And it's common enough that I tell patients an implant beneath your radiated tissues may not be

a comfortable long-term option. I think in many instances, it's not. It might be an acceptable option in the short term, but I think that over time, the radiation induces increasing capsule formation, tightness, perhaps discomfort. And so it's particularly in the radiated patient or the patient that has failed an implant, who just hasn't done well with implants, even in the absence of radiation,

Use of your own tissue in that setting really is often a blessing because it brings blood supply to those radiated tissues. We hook up those blood vessels to transfer that tissue from that tissue that is under the skin, the tissue we transfer, new blood vessels grow into the surrounding chest wall tissues. It grows from the flap into the bony area, into the muscle, into the overlying skin and fat.

it brings new blood supply to the radiated chest wall and improves the quality of the radiated chest wall. So in the setting of someone who has had an unfortunate thinning of tissues from multiple implant operations, because each time you remove that capsule, the tissues overlying the implant become thinner. And so someone who has had, let's say, multiple capsulectomies or removal of implants,

They may be referred to me. They may come into my office and say, look how you can almost see my implant through the skin. That's a very, very difficult problem that I think is generally best treated with the addition of healthy tissue. But how often do you actually see that? It's pretty common. Really? It's pretty common.

Not everyone does well with implants. And, you know, again, it's hard to accept the concept that they have to be maintained. But I think in the last 10 or 15 years, we've really come to accept that it's not often a one and done operation where you put an implant in. It's pretty common that they'll have to at some point be replaced.

And there are some people who simply just don't do well with them. The body just doesn't seem to tolerate them. Right. Rejects it. Still identifies it as a foreign object. And they get recurrent encapsulation. You get recurrent encapsulation over and over and over. There are certain things we can try. And sometimes it's beneficial. Yeah.

There's a material, what's called a cellular dermal matrix. It's a skin-derived product, and it's a hammock that you can put in under the skin to support the breast. Many surgeons use it as a means of potentially diminishing recurrent encapsulation. In addition to supporting the implant, it might decrease inflammation.

encapsulation, either the first time implant patient or may prevent recurrent encapsulation. Studies are ongoing, but there are a number of studies that suggest that that might be a benefit. But despite trying everything we know, still there are patients who simply don't accept their implants well.

And it's in that patient besides the radiated patient or use of ones on tissues may be especially beneficial. So with my surgery, I had the surgery, only one breast was removed, which is always, it's so funny when you make these decisions and you think you're making the right decision and then

later, a couple of years later, you're like, ah, I should have had both. And it's probably why this podcast is so important to me so that I can share my experiences, the ones that I think were mistakes that still, the outcome was still good. Just maybe I would have done things differently. So one of those was both breasts, goodbye, see you later. And because then you

For my particular reconstruction, I could have gone a lot smaller. I could have, you know, there's those things. So let's tune the audience in for a second too. I had surgery. I only had one breast removed. And then what you did, which was remarkable, is you actually were in there with

again, one of the best surgeons, Dr. G, I remember you did the final stitch. It was very important to you that you did the final stitch because you liked the way that your stitches are. So you were literally there during that entire surgery. And there's not a lot of plastic surgeons for reconstruction that would actually be there for a surgery that they don't even get paid for. They don't have to be a part of.

You do that. You're remarkable. And then you, you did expanders because we knew that I was getting chemo and we knew that I was getting radiation and I

We wanted all of that to happen right away. So you did expanders, which can you explain exactly what an expander does and how many times I went back to see you and you sort of blew them up or deflated? It's like a balloon where my breast was. I'm happy to discuss that. An expander, Shannon, as you know, is a temporary adjustable volume implant.

It has a port within it where with a magnet, we can pass a magnet over the skin, identify the center of that port, or we can put a small needle in safely, actually into the implant, into the expander.

add salt water, sterile salt water, and adjust the size. As the boss, you'll tell me, Jay, I want to be a little larger, I want to be a little smaller, but we have the capacity to do that. I kept just saying, I want Kate Moss boobs. By the way, Shannon, I don't disagree with anything that you did. From your reconstructive perspective, I think your thinking was very reasonable.

Each patient has to really do it with their oncologist, with their medical oncologist, their oncologic surgeon, geneticist, really has to do a risk assessment. It's very important as it pertains to the other breast. If they're G negative and they have no family history and lack of variety of potential risk factors, leaving the other breast

It is not unreasonable. That breast has a nipple that has sensation, a natural feel, a natural shape. It's not unreasonable. I think that it is also reasonable sometimes to remove both breasts, especially if

If there's a very strong family history, if someone has a BRCA gene or other genes, there are genes called CHECK2, PALB2, a variety of other genes, it may place someone at significantly increased risk for cancer on not just the involved breast, but the other breast. So it's not unreasonable at times to do that. But you really have to weigh that decision.

I encourage patients not to act reactively where they say, well, doggone it, I got a cancer in this breast, I'm taking them both off. The issue at that time is the cancer in that breast that we have to deal with. It's very reasonable to think about the other breasts in future risk. But before you just reactively say, let's take them both off, I really strongly encourage patients to do an analysis of their actual risk.

It's important to understand that just because we elect to have a breast removed prophylactically, the good Lord doesn't necessarily smile upon us and say, we're not going to have any issues with that breast. There won't be pain in that breast. There won't be healing issues. There won't be any situations that arise that we don't want. That breast has the same risk of having pain issues or any other issues.

as the cancer breast. Right. So you need to have a good reason for taking it off. That doesn't mean that there aren't good reasons. And for some people, the reason to do it is peace of mind. And I understand that. Right. Because for some people, it becomes preventative. And even if in their heads or in reality, like

Like you said, there's a lot of people with different hereditary stuff, different genes that short, then you need a double, both gone. But also mentally, if it makes you feel more secure in your future so that you're not walking around simply scared and worried and obsessing,

then people do it for those reasons too, which is 100% valid. Absolutely. I mean, there are certain findings on the pathology, Shannon, in addition that aren't cancer, but there are findings, something, for example, called atypical lobular hyperplasia, for example, which is a number of long words, meaning not cancer. Yeah.

But it's a sign, a marker that in the course of life, that individual is at an increased risk for developing a cancer in that breast or the other breast, that breast or the other breast. So there are certain findings that can be found that aren't cancer. But besides a positive gene testing, one can have findings in their breast pathology that would suggest we might consider removing the other breast.

So in your situation, you are going to have radiation. I think that with the desire to have a patient wake up with a breast, and I think that's really important. In my way of thinking, having a patient wake up and look down and say to me, it looks pretty good right away. I mean, that really makes me happy. That's my goal.

And whether we do it by putting your tissue up there or a tissue expander or go directly to an implant, that's my goal, that someone wake up or leave the hospital at least saying, I look okay. I can see where this is going to look pretty good. Yeah, because having cancer is traumatizing enough. Absolutely. There are some of us, me specifically, that the idea of waking up with no breasts at all and just this sort of horizontal scar, that was really...

I thought for me, it would mentally be even more damaging. Absolutely. And there's probably a large percentage of women out there who feel that way. So in your situation, we were able to preserve the tissues, nipple, skin, by using that expander. And even though we knew that the radiation acts almost like a shrink wrap on the tissues, it would tighten that.

The fact that the expander was in there to hold the mold, so to speak, to hold the position of the soft tissues. I then knew that after initial healing from the radiation, usually you wait at least six months. You wait a little longer, which was even better. But at least six months typically after the final radiation treatment when the tissues are a bit more normalized. I knew then that we could take out that expander, take out the capsule,

put in your own tissue to bring new blood supply and a breast that would much better match the opposite lifted breast than an implant. I will tell you that your own tissue will virtually always match an opposite breast of normal tissue than an implant. There is no implant that looks exactly or feels exactly like one's own tissues.

So if someone makes the decision based upon analysis of their risk factors, their own worries, their concerns, that they're going to keep the opposite breast, then again, in many instances, it's entirely reasonable. I feel that your own tissue in that setting will typically match much better than an implant. Okay. Let's talk a little bit about scarring. Let's talk about...

incisional approaches. And I think that's really important. You really touched upon something that was so important. I've spent many years of my practice analyzing incisional approaches. What is socially acceptable? What is most cosmetically pleasing? And how can we use the scars that are associated with cosmetic surgery? For example, a scar that's in the fold, which is commonly done for a breast augmentation.

or the common breast lift incision. There's a scar that may go around the nipple or it may go under the nipple and down like an inverted T or an anchor that we think of as a lift scar. Lift scars are something that are somewhat socially known and socially accepted. If someone has a droopy breast,

I'll often try to simulate the scar of a breast lift to do the mastectomy. And oftentimes we can lift the nipple that we keep by using certain nuanced techniques. I think we can get the nipple into a more youthful position, save the nipple in many instances, and do the whole procedure, the mastectomy and the reconstruction through incisions that in many ways mimic traditional known cosmetic approaches.

And that's always my approach. In the now fairly rare situation where we have to remove the nipple, sometimes I will do that again using the breast lift incision and make the nipple on the top of that inverted T-shaped scar, that breast lift scar. We'll make the nipple on the top of that so that it looks like the patient had a lift or a reduction.

If the nipple has to be removed in a transverse fashion because we can't use the breast lift scar because she doesn't have droopy skin of the breast, the scar can be limited in its inner extent, keeping the scar whenever possible off the aesthetically important decollete area, the center area of the chest. So I think it's very important that we as surgeons, cosmetic surgeons,

discuss with our patients a variety of incisional approaches and arrive at the one that, while being oncologically sound, is most cosmetically pleasing. I think that's very important. I mean, it for sure is because, again, I don't think...

Women really want a lot of scars. And when we put on a bikini or when we find someone worthy of seeing us nude, we don't want them to focus on scars all over the body. And so it is important to think of those scars and where they are hidden. In my case, you did the expanders.

I was able to heal from radiation. And then you did in the breast that was still left that didn't, I just, you know, didn't get chopped off by Dr. G. It, you know, we, didn't you do a little bit of a reduction and a lift so that would match. So guys, I, I, I obviously had the flap surgery. So he took,

fat and tissue from my stomach and created a breast out of that. Didn't you also take a blood vessel from there? Absolutely. Yeah. In order to pump the blood like we talked about earlier. That's right. So we used the techniques of microsurgery where we identified an artery and vein going to that. And you didn't have a lot of fat. We had to really kind of work hard

to find the sufficient volume. Fortunately, you know, you had just enough. I also wanted small, so that's good. Yeah, that was helpful too. We identified an artery and vein that went to that fat. We took that up off the tummy. Normally, that tissue on a tummy tuck would just be discarded. But because we had that artery and vein going to that tissue, we could plug that artery and vein into an artery and vein on the chest wall and we would have

as you mentioned earlier, flow into that tissue and flow out of it just like a normal organ. So the tissue didn't die. Yeah, it's remarkable. The skin didn't die, nothing. It's remarkable. Having done this now for so many years, I still am excited by the amazing nature of that technology. It's really something amazing.

Another thing is, as we were talking about incisional approaches, one thing that I want people to be aware of, I want women to be aware of, I want colleagues to be aware of, is that if a woman has had previous surgery around her nipple or around her areola, that doesn't necessarily preclude the saving of a nipple at the time of the mastectomy. Unlike 20 years ago,

The concept of preserving the nipple at the time of mastectomy is now quite often done. If the tumor is a prophylactic setting or the tumor is sufficiently remote from the nipple, we often...

save the nipple, which is really, really an aesthetic benefit. By the way, can I interrupt you? I feel like this is going to become a drinking game with this episode where every single time you say nipple, somebody's going to take a drink. That was part of breast surgery. What can I tell you? I know, right? I'm like, that's- It's an integral, important part of the breast. It is. It is an important part of the breast. And so- Well, you saved mine. Yes. There are times when

If there are certain techniques, there's something called a nipple delay, the E-L-A-Y procedure, delay procedure, where 10 to 14 days before the mastectomy, we divide some of the underlying blood supply to the nipple so that that which remains gets hardier. Okay, that's just the concept. And so patients who have had prior radiation or prior surgery around the nipple, they're

can still often keep their nipple. It's really very valuable. So I just mentioned that so that if people are told that their nipples have to come off because they've had a previous breast lift or a previous breast reduction, that may not necessarily be true. And so just be aware of that. Right. Maybe go see another doctor. Get a second opinion. Get some other opinions in that regard.

Maybe you've noticed that when it comes to business, the people who succeed tend to be the people who seek out partners with skills or knowledge that they don't have. And that's what Lenovo's free online membership program, Lenovo Pro, can do for small businesses. They have the resources and expertise to help you make big tech decisions. As a small business owner, you understand more than anyone that any decision can make or break your business. That's where Lenovo Pro can help.

especially if you're not a tech expert yourself. They can keep up with the latest tech trends like AI and help you save money on the smartest tech solutions for your business. And by joining Lenovo Pro, you can enjoy a long-term partnership focused on helping your business take advantage of every tech opportunity in the future. So you can add Lenovo's team to yours and then lean on them for all your tech questions.

So to join Lenovo Pro, visit Lenovo.com. That's Lenovo.com. And unlock new AI experiences with Lenovo's ThinkPad X1 Carbon, powered by Intel Core Ultra processors.

♪♪♪

Hey, it's Lunchbox from the Bobby Bone Show, and I'm here to tell you the national sales event is on at your local Toyota dealer, making now the perfect time to get a great deal on a dependable new car like a legendary Camry built for performance and available with all-wheel drive. You can count on your new Camry to get you anywhere you want.

you need to go or check out an affordable and reliable corolla with a trim for every lifestyle from the hip sedan to the sporty hatchback there's a corolla built just for you check out more national sales event deals when you visit buyatoyota.com toyota let's go places i mean i think that that's what i sort of encourage on the podcast and on my instagram is it's

The white coat does not always know everything. Absolutely. And it's really important to go get a second opinion, even a third opinion. I mean, you weren't, you weren't, I met with, I think four different plastic surgeons, just like I met with multiple oncologists. I don't think Dr. G was,

was my only meeting for, you know, I just always thought I need to meet different people, see what different people say, and also find the person that I connect the most with. Absolutely. I couldn't agree more with that. And I think that unlike many areas of medicine, medicine is an art, but sick surgery really is an art. And

What you said about connecting, yeah, that's true. I mean, the surgeon should be able to show you examples of his or her work. Some examples, you know, I mean, just to get a sense of, do you like their aesthetic? Do you like what they see as beautiful? You know, there's some people, for example, who surgeons and fine surgeons who like placing very large implants. Right.

It's the same thing with people who do facelifts. I mean, I know you do facelifts, but there's this doctor that several women I personally know have gone to and they all look the same.

Because that's his aesthetic. So, you know, the mouth is always, you know, a little bit wider. It's a very specific. Sure. Eyebrows are always. And I see them and I'm like, uh-huh. Okay. That's who your surgeon is. So you may not feel that that was.

That's not your aesthetic. I think that's important to know. They look beautiful. Sure. But that beauty may not be optimal beauty for you. Correct. And so that's what I think has to be determined. And I think that in plastic surgery, I think that if someone can't show you their results, that's of concern. That to me, I think of...

As if you were to work with an artist and you said, I'm going to commission you to make a beautiful painting. You'd have to see their work to some extent. For sure. Are they impressionist? Are they modern? Of course. You want to know. Now, with that said, surgeon may show you pictures and should show you pictures and get you some sense, give you some sense of what he or she does.

That obviously doesn't say that you're going to get that same result. Each patient is different. The body is different. The situation is different. But at least you have the opportunity to get a sense of the artistry of that individual. I really think that's what you're doing. You're getting a sense of the artistry of the individual. Do you like the individual? Is it someone you can get along with? That's also somebody you want to find a surgeon who...

adjust to your desires, right? Because one of the plastic surgeons I met with for reconstruction was a big boob guy. He

put big implants in and I'm 5'4 and 104 pounds. I can't like big, huge knockers is not my personal aesthetic. Other people, it looks great on do whatever pleases you. I'm all for it. But for me,

And it didn't really matter how much I just kept on showing him a picture of Kate Moss being like, do you see how small her boobs are? Like this is perfection to me. He, it, it just wasn't resonating with him. And whereas with you, you know, maybe that's not even your personal style either, but you looked at me and you said, beautiful breasts. Let's try to get as close as possible. Just beautiful.

Because I opted to only have one removed, it was, you're still working with a real one. There's got to be symmetry because that's what I would want. So ultimately, did I get tiny A's? No. Am I happier that I didn't? Yes. Like I'm pretty happy with your work, sir. Thank you. It's important to determine if the surgeon hears you.

I mean, I'm sure that surgeon who made the large breast, he or she might have been a fine surgeon. But if he didn't hear what you were saying, you know, that's more of an issue. I think that the plastic surgeon after a mastectomy reconstruction tends to follow you the most. You know, certainly among the surgeons, the general surgeon does his job, her job.

Then the plastic surgeon really has to help you with the healing process and follow scars and make certain that you maintain a good path. So I think it's important to like your doctor. Well, you visited me over the weekend at my house. You would drive all the way out to Malibu and you would check the drain, see how much was draining. Yeah.

before we could actually take the drains out. You wanted to make sure the skin was staying alive, that there was no issues there. And you were really, really very, very, very hands-on. And I know that some people who have heard conversations between myself and my doctors are

have made a comment of, well, you know, you're Shannon Doherty, so you're getting special treatment, or maybe it's your insurance. And I'm just going to tell you guys that I know that Dr. J does this for every single one of his patients. It doesn't matter if they're famous or not. You do this for every single one. And-

to just chalk off sort of my experience as, well, you're famous, so you get extra is incredibly unfair. It's not a fair to me because I don't really care what people say. It's unfair to my doctors because I know for a fact you are this meticulous and hold your, every single one of your patients, you literally hold our hands through all of this. And, and,

Even after I was totally cleared by you, everything was fine. You know, we went to the Greek theater together with my mom and your wife, Jolynn. Like, you know, and then we went to the Italian place together. It's a relationship. You build relationships with your patients and you constantly check in with them. Even years and years and years and years later. Like when was, when were we together?

probably done with everything, like 2017, I think. I think that's, I think it's about right. We still check it. And there's a true, you, you just, you care. And it goes back to that story you told in the beginning. It does. Of seeing that young woman and wanting to help her and what that did to you mentally of that. You want people to at least have as good of an experience as

through something like this that they possibly can't. Thank you, Shannon. I appreciate your kind words. Yeah, I think, you know, I often tell my staff that we should be like family for as long as we're needed. You know, and I had a young patient recently who I had, wonderful young woman, who I had

reconstructed her breasts who had a bad congenital problem she was born with very very asymmetric breasts and she she had a she had her reconstruction completed was thrilled thankfully thrilled and she said so

So am I going to see you guys anymore? And I joked with her. I said, no, no, we're done. And she started crying. You know what I mean? It was like, and I said, of course you're going to see us. You'll see us for as long as you need us. And we're going to continue to make sure your scars heal well, that everything is great, you know, in the coming months and years. I said, you're never done with us. You know, we're always here for you. But it made me feel great because, you know, I tell my staff, look,

As long as they need us, as long as they want us as part of their extended family, as people who are really meaningful in their lives, that's a blessing. And when they're happy and we no longer hear from them, that also means we've done a good job because they no longer need us. And so it's a very wonderful thing.

opportunity to help people. Every day in my life, I feel immensely grateful and honored to do what I do. It's really a privilege. And yes, Shannon, I mean, you're very important. You're a very wonderful person. I have so many patients who are also wonderful people who I deeply care about. And that's just the way it should be. Medicine is

It's very different, I think, than anything else in society, their job, so to speak. I think it's very different. I grew up in a family of doctors, and my dad instilled in me the concept that what we do really is a privilege and an honor. I've never not felt that. That's always been my feeling from day one.

And once I saw that patient and directed my life's professional path where I wanted it, it's really been just such a privilege and great honor to hear from people that I made a positive difference. You know, Shannon, we don't always succeed. We're not perfect. We certainly are not perfect. But

Boy, when we do succeed, it's the greatest feeling in the whole world. Right? Yeah. I know. I'm sure. I'm sure that feels amazing. There's a lot more, you guys, with Dr. Jay Oranger. So stay tuned for part two.

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