Restoring What Cancer Steals: Specialized Plastic Surgery For Skin and Breast
One of our most important missions at Rejuva is to help cancer patients recover the sense of wholeness that the disease ruthlessly snatches away. We know that cancer’s assault on physical appearance can be devastating, leaving people who’ve battled the disease to grapple with the disfigurement that treatment and cures inevitably leave behind.
In his 14 years in the Tampa Bay area, Dr. Bart Rademaker has become one of Florida’s most sought after Board Certified Plastic Surgeons who deals extensively with the ravages of both breast and skin cancers. Trained in reconstructive surgery for all parts of the body, he brings a profound appreciation for the human form and its underlying mechanisms. Over decades of practice he has honed his skills to give his patients the most functional and aesthetically pleasing results.
Skin Cancer Recovery
Dr. Rademaker at the forefront in the fight against Florida’s skin cancer epidemic. While he and his Rejuva team target prevention, he’s refined his surgical techniques and deployed non-surgical modalities such as Platelet Rich Plasma and stem cells to restore blood flow to key areas, soften damaged skin and speed healing.
Breast Cancer Post-Mastectomy Reconstruction
"Most women unfortunate enough to have breast cancer are completely underserved. In my practice, we completely take care of a woman through all the different sages of cancer treatment. I help her through the grueling process of surgery, recovery and reconstruction. I coach them through the mental gymnastics that’s required of them. And I help her think about her future and plan for it. Because there will be a future. My focus isn’t on the cancer, it’s on the person." — Dr. Bart Rademaker.
His unusually compassionate approach is evidenced in his careful and sensitive treatment of breast cancer patients. His insight into the disease and his mastery of different surgical options is evidenced by the sheer number of referrals from oncologists for patients considering post-mast-mastectomy reconstruction.
That singular combination of empathy and skill has helped women in the Tampa Bay region achieve the outstanding outcomes they hope for. Justly renowned for his humanism, Dr. Rademaker has made the Rejuva Center a safe haven for women who have been just diagnosed to those who’ve long since beat back cancer and are now thinking about reconstruction. Much as he understands the terror of the mortality threat the diagnosis brings, he’s also keenly sensitive to the usually unacknowledged terror of the loss of feminine identity that breast cancer carries.
"We do everything we can to answer every question a patient might have. We’re not experts in oncology or radiology or chemo. But we’ll do everything we can to make sure women get the all information they need to make informed decisions every step of the way,” said Dr. Rademaker. “Knowing there’s an experienced, non-judgmental and kind staff to hold them, allows women at any stage in her diagnosis and treatment to break down and let go of the crushing anxiety and anger. Once they do, they can start being a little bit more rational and objective. They’re better able to participate in their own health care plan."
Most important, Dr. Rademaker reinforces every breast cancer patient’s priorities:
- Know everything is going to be fine, she will be healed and cancer-free
- Encourage her commitment to stick with the treatments that will make that happen, especially excellent “curative” surgery in the first instance. This includes an expansive and clear conversation about cancer surgery options: lumpectomies (where oncologists propose that option) vs a full mastectomy. For many patients, it’s a choice they’re not aware they have. Dr. Rademakes strives to help each woman understand the ramifications of each on managing or eradicating the disfigurement surgery brings.
- Envision a return to her healthy, feminine body from the get-go.
"My goal is to coach them into being cancer-free and feeling normal with a great body image where there are breasts or not," he says.
When it comes to the concretes of breast reconstruction, there are four key approaches:
- No reconstruction whatsoever. For some women that’s the optimal choice. They’re happy and don’t want or need it. They’re might be perfectly satisfied with a prosthesis or using nothing at all.
- An immediate reconstruction at the time of the mastectomy.
- Reconstructive surgery several months after the mastectomy.
- Reconstructive surgery when the patient is confident she’s completely cancer-free, usually after a minimum of 1½ years.
The Breast Reconstruction Process
If breast reconstruction is the choice, there are specific options to consider. Dr. Rademaker takes each patient through the choices, giving as much information and a candid assessment the situation—including lifestyle and goals–to pinpoint the best solution for each woman.
- Implants are the fastest and easiest reconstructive choice. The patient gets good aesthetic results without much downtime.
- Fat Grafts. The breasts are reconstructed using the patient’s adipose tissue. Coupled with implants this process yields wonderful aesthetic results that look and feel natural.
- Muscle reconstruction using patient’s own muscle and skin tissue. In certain circumstances this may deliver a better result. Putting his concern for his patient’s welfare ahead of everything else, Dr. Rademaker generally refers muscle tissue reconstruction to an academic center hospital. Because the surgery is much more involved that either implants or fat grafts, there’s a greater potential for complications and longer down time. Academic hospitals are equipped to deliver the intense care that’s required for this more complex surgery and recovery. As his patient’s ultimate medical advocate, he will help find the right center and surgeon.
- Muscle and implant reconstruction. Similar to the situation above, Dr. Rademaker will refer his patients to the appropriate surgeons and hospitals.
This is a critical conversation because every woman has different ideas about what she wants and what’s possible. Dr. Rademaker discusses the upsides and downsides of each option in the context of each woman’s cancer history and what limitations various treatments may impose. He takes into consideration the impact of radiation, chemo, that actual extirpation of the cancer, lymph nodes, single or bilateral mastectomies, whether or not the mastectomy is prophylactic.
At the outset, Dr. Rademaker explains that the purpose of reconstruction is twofold: first to have an aesthetically pleasing breast and the second to create symmetric breasts. Depending on the mastectomy and the condition of the normal breast (if it is a single breast removal), he helps patients understand that achieving symmetry may require augmenting or lifting the normal breast.
"It is so crucial to each patient’s happiness at the end of the process that we’ve met their expectations and those expectations must be based in reality," said Dr. Rademaker.
Post-Mastectomy Implant Reconstruction In Brief
The Surgery: Dr. Rademaker places an expander underneath the muscle. That procedure takes about one hour. Often patients go home the same day or the next, even if the mastectomy was performed at the same time.
Every two weeks or so, Dr. Rademaker proceeds with the sequential expansion of the muscle. An in-office procedure, he places a needle through the skin into a special port in the expander and adds normal saline solution. This process may take up to several months but it gently and gradually allows the muscle and skin to ideally accommodate the permanent, usually silicone implant three months after the final expansion.
Depending on the patient, Dr. Rademaker does a surgery for symmetry on the other breast at the same or later. There are times when an adjustment of both breasts if beneficial, and sometimes making those adjustments later on, including nipple reconstruction, yield better results.
In addition to expanders and implants, patients also have the option of fat grafting at any time except at the time of the initial mastectomy.
"In our experiences we are finding that in all patients who have had radiation therapy, fat grafting with or without regenerative cells improves the quality of the skin and the final aesthetic result of the breast,” said Dr. Rademaker. “There appears to be improved blood supply and skin quality because of the regenerative potential of the adipose tissue."
Lumpectomy Plastic Surgery
As more and more women opt for lumpectomies, the dialogue about the corollary deformities is increasingly important. Most women are unaware that lumpectomies coupled with radiation-induces changes to the tissue, leave significant visible disfigurements that aren’t easily addressed. These may include contour abnormalities (divots and holes); leather-like skin around the radiation site that can also be painful.
However, fat grafting, especially with Adipose Derived Regenerative Cells (ARDC), offers an excellent opportunity to mitigate the problems. ARDC is a concentrated amount of regenerative cells that may help enhance the blood supply as well as the survival of the fat graft. The ARDC healing potential becomes especially more significant because radiation injury goes deep and cruses any blood supply that tissues, including fat, need to thrive.
Dr. Rademaker, in the vanguard of regenerative cell treatment and clinical study and a respected authority on the subject, has the only surgery practice in the Tampa, Florida area to offer ARDC.
"It is my personal mission and passion to help women who have lumpectomies to restore form and function to the breast with these new technologies," said Dr. Rademaker. "I have become expert in them because they work."