Cosmetic and Plastic Surgery are terms often used interchangeably but there are differences. At St. Vincent, our surgeons are comprehensively trained, practicing both in the art of aesthetic surgery and complex reconstructive procedures, such as:
Most health insurance programs provide coverage of medically necessary plastic surgery procedures and breast or limb reconstruction. For more information contact a St. Vincent Financial Consultant.
St. Vincent Cancer Care provides educational programs and support group activities that address breast reconstruction. To learn more, contact St. Vincent Cancer Care, 317-338-3551, ask about activities and support.
St. Vincent leads the state in breast care and breast reconstruction services and offers breast cancer patients many options. Your St. Vincent Cancer Care team includes a plastic surgeon who specializes in breast reconstruction. We encourage every patient to ask about the plastic surgery breast reconstruction consult early in the diagnosis-treatment period. All breast reconstruction after being diagnosed with breast cancer diagnosis is covered by Medicare, Medicaid and most health insurance plans.
"As a surgeon, I specialize in micro-surgical procedures that are complex and involve the delicate dissection of tiny blood vessels from donor tissue and fine suturing techniques. As a problem solver, I tailor my breast reconstruction procedures for the individual needs of our patients. Today we have so many more options to give our patients, especially breast cancer survivors."Robert M. Paul, MD, St. Vincent Medical Group, Plastic Surgeon and Breast Reconstruction Surgeon
The plastic surgeon will explain the different types of breast reconstruction. Many factors are considered including the stage and size of the breast cancer tumor; if the skin, nipple or chest wall is involved; whether radiation therapy is needed after surgery; and other risk factors such as diabetes and smoking history. We believe every woman has the right to the option of immediate reconstruction. This topic can be very emotional, and in our experience, taking a holistic approach that balances the physical, mental and spiritual needs of each woman makes a difference in the long run. At St. Vincent educating all involved is a very important first step. Breast reconstruction is life-changing for many women and their families, in a positive way, but it's not for everyone.
Oncoplastic surgery may be appropriate for some patients having a lumpectomy at the time of a breast-conserving surgery. These plastic surgery techniques are used to reshape and restore a more natural contour to the breast. Fat grafting (a lipofilling procedure) may also be beneficial to “fill” in the resection defects.
If breast reconstruction is recommended, the timing of reconstruction varies --immediate, or delayed reconstruction – based on the needs of each patient. In all cases, St. Vincent breast reconstruction surgery is a highly coordinated with the Breast Surgeon and the Cancer Care team members. All recommendations are personalized for your individualized cancer treatment plan. Some of these reconstruction options may also apply to women having prophylactic mastectomies as a result of high-risk, hereditary breast cancer
Immediate reconstruction is a coordinated surgery that happens as part of the original surgery to remove the cancerous tumor from the breast. It may be accomplished in one stage with the placement of an implant or flap; or it may be staged and an inflatable tissue expander may be put in to the preserve the skin for later procedures. Things that influence this decision include potential for radiation therapy, patient outcome desires and other medical problems. Our goal is to have every breast cancer patient evaluated for the possibility of one of these immediate reconstructive options.
Delayed reconstruction happens after the cancer treatment plan is completed. There may be several steps in the surgical process depending on the type of reconstruction desired by the patient and the steps needed to accomplish those goals. We recognize that treatment and life circumstances can and do affect the timing and ability to undergo reconstruction.
Our plastic surgeons are well-trained in oncoplastic techniques and microvascular surgery. This may include, pre-pectoral breast implant placement (so no chest muscle is impacted), fat grafting, and accessing the flap tissue from the abdomen.
Breast implants are the most common type of reconstruction and may be placed above or below the chest muscles. Timing of implant placement can also vary. Most often, the implants are placed in a staged fashion after a period of tissue stretching with inflatable expanders, however, under the conditions, they may be placed directly at the time of mastectomy.
The Breast Reconstruction Surgeons at St. Vincent have a coordinated surgical program with the St. Vincent Breast Care Surgeons. The DIEP flap micro-surgery procedure may be done at the same time as the mastectomy if no radiation therapy is needed as part of the treatment plan or staged for a later time. The DIEP procedure does not involve tissue expanders, unlike come breast implant procedures. The DIEP flap itself is comprised of skin and fat tissue (not muscle) that is taken from a horizontal incision in the lower abdomen (near the bikini line) and used to form a breast after mastectomy. The DIEP procedure is a more complicated surgery and lasts longer than other breast reconstruction surgeries because tiny blood vessels must be dissected in the tissue flap and then reattached with great precision. The result is a reconstructed breast that has a more natural look and feel. Since muscle is not removed, as in a TRAM flap, there is a lower risk of developing hernias, bulges or weakness at the abdominal site. After a one-sided DIEP procedure, the plastic surgeon may also apply symmetry techniques so both the breasts are similar such as lifts or reductions in the unaffected breast. Women who are very fit and trim with a low BMI or who are morbidly obese are generally not candidates for this procedure.
Regional muscle flap generally refers to the muscle and skin tissue that is taken from an area near the breast, in order to form a breast mound. The latissimus flap is made of the skin and muscle of the back below the shoulder blades and is rotated under the arm to the breast. In a TRAM flap reconstruction the muscle is taken from the abdomen. These patients may have decreased muscle strength in that area of the body which may decrease body function and could result in a post-operative hernia or bulge. These procedures are still used regularly in breast reconstruction and are the most common flap procedures performed nationwide but are falling out of favor due to the superiority of the DIEP flap.
Fat grafting after reconstruction is common place and is often used to help contour the breast or fill in areas that require additional volumes. The patient’s own fat is gently liposuctioned from the abdomen, flanks, thighs and buttocks and injected back in to the breasts. This allows for fine-tuning of contour and addition of volume to other types of reconstruction. Another method of breast reconstruction, in which fat grafting is used as the sole method of reconstruction is the SIEF procedure. In this procedure, the breast mound is recreated from the patient’s own fat that is injected in to the breast flaps. As more fat is injected and the breast increases over time, the tissue expander that was placed at the initial mastectomy surgery is gradually deflated. The SIEF procedure is outpatient and requires multiple operations (4-7) to create a larger breast mound. There is no long-term SIEF data currently available; however, plastic surgery case studies have reported promising results.
St. Vincent Breast and Plastic Surgeons make every effort to salvage the nipple and areola at the time of the original surgery if it is unaffected by the tumor. There are multiple nipple and areola reconstruction options that are available to patients who have lost these structures during the breast surgery process.
At St. Vincent Carmel Women’s Center, we have a reconstructive tattoo specialist with more than ten years of experience in post-operative, realistic nipple and areola tattooing. In coordinator with the plastic surgeon, this specialist can either replicate a 3D nipple and areola to match your existing areola or create two completely new nipples and areola to your size, shape and color preferences. To learn more, go here.
Cosmetic procedures focus on enhancing appearance through surgical and medical techniques and can be performed on all areas of the head, neck and body. Cosmetic surgery is often considered elective and not typically covered by health insurance payers.
For Spa Services by a licensed aesthetician, see SKINnovations.
VeinSolutions is now part of St. Vincent Medical Group. Their board-certified vascular physicians have created an innovative approach to vein care. They use the latest technologies in the diagnosis and treatment of varicose veins, spider veins, and vascular birthmarks and treat both cosmetic and therapeutic vein conditions.
Now locations in Carmel and Fishers!
Plastic surgery is a surgical specialty that focuses on the reconstruction of conditions related to facial and body defects due to birth disorders, burns, breast and other cancers, or a severe traumatic injury. Using advanced training and surgical techniques, the plastic surgeon seeks to restore both form and function.
At St. Vincent Medical Group, our plastic surgeons are all board-certified by the American Society of Plastic Surgeons, recognized for their abilities in plastic, reconstruction and cosmetic surgery.
St. Vincent is one of the busiest centers in the state of Indiana for breast reconstructive and secondary revisional procedures due to breast cancer. We emphasize coordinated care at the time of your diagnosis. In many cases, breast reconstruction begins on the same day as the breast cancer surgery. Every woman and man faced with a cancer diagnosis should understand their options for breast reconstruction. For breast cancer survivors with breast defects, newer plastic surgery techniques are improving function and appearance, especially tissue and breast implants that have been affected by radiation therapy. To learn more, go to Breast Reconstruction Surgery.
St. Vincent Plastic surgeons are trained in skin repair and wound healing and support the trauma team and wound healing specialists as needed in the care of more localized and smaller burns. More extensive burns warrant transfer to verified burn centers to receive the treatment they need.
The St. Vincent Pediatric Craniofacial Center at Peyton Manning Children’s Hospital treats all types of craniofacial conditions including cleft lip and cleft palate. Pediatric-trained plastic surgeons are an integral part of this comprehensive program. To learn more, click here.
St. Vincent plastic surgeons experienced in complex lower limb flap reconstruction use specialized techniques to repair skin and muscle tissue damaged because of:
This plastic surgeon works closely with the trauma surgeons, cardiovascular surgeons, orthopedic surgeons, podiatrists, and wound healing specialists. In many cases, Post-Acute Care Services for acute inpatient rehabilitation, skilled nursing, or home health care are needed to attain therapeutic goals.
Board-certified plastic surgeons are trained to do hand surgery procedures. Some of our providers specialize in hand and wrist surgery.
Following the treatment for cancers of the pelvis and genitals, St. Vincent plastic surgeons with pelvic floor reconstruction experience are able to assist our gynecologic and colorectal surgeons in reconstructing the pelvic floor defects created from their cancer treatment. For more information about gynecologic cancer care, go to Gynecologic Cancers.
Plastic surgeons have treatments to improve scarring from previous surgical procedures or injuries.
Carmel, IN 46032
Keep your skin as healthy as possible with medically-supervised esthetic treatments. All skin care services are provided by a licensed esthetician, a skin specialist who uses skin cleansing and rejuvenation products and techniques to improve the softness, youthfulness and health of the facial skin. We treat men, women and children with all types of facial skin concerns including some medical skin conditions such as acne, rosacea, and secondary chemotherapy burns. A physician’s referral is welcomed but not necessary. We will communicate with your primary care physician or the dermatologist, bariatric surgeon, and women’s health specialists who referred you to our office.
We also offer skin care products in our office in addition to a full spectrum of skin care treatments: Derma-planing and skin rejuvenation, facials, skin exfoliation, wrinkle fillers and smoothers, skin tightening, vein therapy, massage and the removal of unwanted hair. See all treatments, products and pricing below.
Our skin care services are also available to children and teenagers with acne and skin concerns. For women who are pregnant, facials are available, and after consider having a facial mommy make-over.
Take years off your face with this simple, non-surgical treatment. Botox Cosmetic treatment can temporarily smooth moderate to severe frown lines and lasts up to four months.
Spend less time fussing with shaving and waxing. Offered for both men and women, laser hair removal is the solution to permanently remove hair from all parts of the body. Using the Cutera CoolGlide technology, skin is left cool to the touch.
Advanced intense pulsated light (IPL) technology treats sun spots, tiny veins, rosacea, acne and diffuses redness. The Cutera LimeLight’s non-invasive approach to skin rejuvenation targets areas with pulsated light that goes deeper than traditional IPL, with better results seen after one to three treatments.
Treat wrinkles, large pores, skin texture, acne, rosacea, scars and redness with this non-invasive laser treatment. Laser Genesis offers advanced technology that has been scientifically proven to produce new collagen, resulting in the restoration in the skin’s youthful glow. Treatments are typically described as relaxing and therapeutic.
Facial telangiectasia and unsightly blood vessels caused by sun damage, smoking, heredity, hormones or other factors can affect both men and women. The Cutera CoolGlide removes veins from all parts of the body, including the face and legs. Laser treatments of both facial and leg veins can provide a safe, effective method of treatments and requires no painful injections.
The latest in skin fitness. Skin is tightened with this non-surgical procedure using a safe infrared light that heats the dermis deep beneath your skin’s surface. Titan can be used on any area of the body and on any skin type or age.
Remove skin’s dull surface with a customized chemical peel. Perfect for acne, rosacea, fine lines, wrinkles and achieving that all-over healthy glow. The intensity of the peels varies, but all achieve one result—smoother, softer skin texture.
Remove unwanted hair with this temporary form of hair removal. Hair is removed directly from the root, allowing the results to last for 3–8 weeks.
Being able to save your nipples during a mastectomy procedure is possible but is based on several factors. First and foremost, the nipple is a part of the breast tissue and there must be adequate distance between the cancer cells and the nipple to allow for the cancer to be removed and the nipple to be preserved. Sometimes this is obvious to the physician and at other times it may be close, and the determination cannot be made until the final pathology report informs the surgeon about the negative margins.
If the breast surgeon can completely resect the cancer and save the nipple, then aesthetics become the deciding factor. Depending on your nipple position on your breast, it may not be in an ideal position after the surgery resulting in a suboptimal cosmetic result. Plastic surgeons are generally unable to move the nipple during a mastectomy procedure as they would during a breast lift procedure and therefore the nipples would be removed and reconstructed in the correct position at a later time.
If you are having a prophylactic procedure, there are options to stage your procedures by lifting or reducing the breast first to achieve the desired aesthetic appearance and then undergoing your mastectomy at a later time once you have recovered from the first procedure.
Choosing to have a double or both-sided mastectomy is an option for surgery. This decision should come after an in-depth discussion with your surgeon as for most patients there is not a statistical outcome advantage to remove the other breast if it is unaffected by cancer or if you are not a high-risk patient such as a genetic carrier of a breast cancer gene. However, you may elect to have this procedure performed at the time of your mastectomy. The mastectomy along with the breast reconstruction is covered by insurance. People often chose this option to achieve better symmetry as the same procedures are being performed on both breasts.
All patients should be evaluated for breast reconstruction prior to their breast surgery. There are many options available to patients having either partial resections or mastectomies that may not be available after radiation therapy.
For partial resections or lumpectomies, plastic surgeons can employ rearrangement techniques to prevent shape changes or divots left from the resection. We can also perform breast lifts and reductions at this time, whereas these procedures often cannot be performed after completing radiation therapy because of increased risk of healing and surgical complications.
For mastectomy patients, every patient should have immediate reconstruction at the time of the breast surgery. While there are situations that can occur during the surgery and the reconstruction may temporarily be delayed, these are rare, and the reconstruction should still be performed prior to proceeding to radiation treatment. Most surgeons will place tissue expanders, but implants can also be placed. Both devices will tolerate the radiation well but there is a small risk of post-operative complications, such as wound healing. By undergoing immediate reconstruction, you keep all your options open for your final reconstruction after you complete radiation because your natural breast skin was preserved.
For the patient who previously had radiation therapy and is now facing a mastectomy for a recurrence, all reconstruction options are available to you as well. There is an increased risk for post-operative complications but your surgeon should discuss these with you and help you decide which reconstruction method is best for you.
2001 West 86th Street
Indianapolis, Indiana 46260
13500 North Meridian Street
Carmel, Indiana 46032
13861 Olio Road
Noblesville, Indiana 46037
2001 West 86th Street
Indianapolis, Indiana 46260
8050 Township Line Road
Indianapolis, Indiana 46260