Dr. Tracy Cordray is a plastic surgeon specializing in breast surgery, microsurgery, as well as other plastic surgery procedures. She graduated with honors from the College of Charleston in South Carolina then went on to earn her MD at the Medical University of South Carolina. She worked as a Resident in General Surgery also at the Medical University of South Carolina and moved to Los Angeles upon its completion in 2002. She has pursued several specialized Fellowships in Breast Oncologic (Cancer) Surgery, microsurgery, and Plastic and Reconstructive Surgery in LA in addition to her training in surgical oncology at the world-renowned John Wayne Cancer Institute in Santa Monica, California.
WT: What is the difference between surgery and microsurgery?
Microsurgery is surgery under the microscope. When suturing small blood vessels or nerves, a surgeon must use a powerful microscope in order to magnify these small structures, vastly improving visualization.
WT: What are the top three things a woman can do to prevent breast cancer:
Breast cancer is a multifactorial disease, and there are no guaranteed preventive measures at the present time.
However, there are three steps every woman should take to lower her risk:
1. Women should discuss their risk of breast cancer with their doctor before undergoing hormone-replacement-therapy [HRT]. Studies have shown increased risk of hormone-sensitive breast cancers in women treated with HRT.
2. Maintain a healthy weight, as there is an increased risk of breast cancer with obesity. A healthy diet and regular exercise are important in preventing many different kinds of cancer.
3. Perform monthly self-breast exams; get annual clinical breast exams and annual mammograms starting at the age of 40. These assessments cannot PREVENT breast cancer, but they can certainly aid in early detection and higher cure rates.
WT: Have you ever detected a cancerous growth while performing a plastic surgery procedure?
Yes. Whenever a suspicious breast mass is encountered during a plastic surgery procedure (such as a Reduction Mammoplasty), a frozen section specimen should be sent to the pathologist to confirm the diagnosis of malignancy. IF the frozen section reveals cancer, the operation should be aborted so as not to disturb margins surrounding the tumor.
WT: What is the one question you wish every plastic surgery patient would ask?
I think that every plastic surgery patient should ask me, “Why should I choose you over any another plastic surgeon?†My answer would be two-fold:
1. I have more training than the average plastic surgeon. I hold TWO Board Certifications—I am Board Certified in General Surgery as well as Plastic and Reconstructive Surgery.
2. I am available to my patients 24 hours a day, 7 days a week. My patients are given my cell phone number, so they can contact me personally anytime.
WT: What is the one question you wish every breast cancer patient would ask?
I think that every breast cancer patient should ask me, “What makes you more qualified than another surgeon to do my breast reconstruction?â€
My answer would be as follows: I was a breast cancer surgeon before I became a Plastic & Reconstructive Surgeon. I understand the concept of margins, the indications for chemotherapy and indications for radiation therapy, and all of these factors impact a plastic surgeon’s decision-making process in reconstruction. Due to my extensive training in breast oncology and plastic surgery, I am more qualified to perform breast reconstructive surgeries.
WT: What is (are) the best and worst change(s) that you’ve seen in the treatment of breast cancer and reconstructive surgery from when you began your training (or practice) and today?
The best change in the treatment of breast cancer: The sentinel node biopsy is a technique which has evolved over the past 10 years. It provides valuable information regarding the spread of breast cancer beyond the breast tissue WITHOUT all of the risks associated with complete axillary node dissections [e.g., lymphedema (swelling of the arm).]
The best change in breast reconstruction surgery is the ability to provide the best reconstruction possible while limiting the functional and aesthetic defect at the “donor site†(abdomen or back.) This principle is no more apparent than in our current approach to autogenous breast reconstruction.
There really are no “worst changes,†as the practice of science and medicine only improves with time. Scientific advances occur daily. There is really no “backward†component.
WT: Is the DIEP reconstructive surgery new? What is the name of “the latest†reconstructive technique? What criteria determine which technique is used to reconstruct a breast? Are any of these techniques applicable to augmentation as well as reconstruction?
1. The DIEP flap was introduced into training programs in 1999-2000. But, it is more recently being performed by private-practice Plastic Surgeons, such as me.
2. “The latest†reconstructive technique would be either the DIEP flap or SIEA flap, which are both autologous tissue reconstructions. The SIEA flap has minimal donor site dissection, and thus, the least loss of function.
3. Many criteria determine which technique is best to reconstruct a breast. Some criteria are as follows: Previous abdominal surgery (abdominal scars), amount of abdominal subcutaneous fat, body-mass-index, and whether or not there is a need for radiation therapy.
4. Neither the DIEP or SIEA flaps are applicable in breast augmentation. However, the most innovative technique in augmentation today is fat –grafting to the breast. This technique involves transferring fat from either the abdomen or thighs to the breast. Fat-grafting to the breast is not yet a widely-accepted technique in breast augmentation but is certainly on the horizon.
WT: What surgery do you like to perform most and why?
I most enjoy performing breast reconstruction surgery, in all forms. I have a unique approach to breast cancer patients since I was a breast cancer surgeon first, before becoming a plastic surgeon. I have special (additional) training in microsurgery as well, which allows me to do the more challenging DIEP and SIEA flaps. All of my additional training allows me many more options for the patient than the average plastic surgeon. I enjoy the challenge!
More information on the surgeries Dr. Cordray has discussed above.
The DIEP (Deep Inferior Epigastric Perforator) flap is state-of-the-art surgery designed for a breast that has been removed due to cancer or other disease. Dr. Cordray routinely performs this surgery and her extensive training and experience in this procedure allow her to achieve consistent and superior aesthetic results.
Similar to the DIEP flap, the SIEA flap utilizes tissue from the abdomen to recreate the natural look and feel of a woman’s own breast tissue. While the blood vessels used in this flap are slightly different than that of a DIEP flap, the final result is similar to that achieved with a DIEP flap.
The latissimus muscle flap utilizes tissue from the upper torso and back to reconstruct the breast. A small breast implant is often required underneath this flap to provide adequate breast volume.
Tissue Expander->Implant Reconstruction–Similar to cosmetic breast implants, this type of breast reconstruction is commonly used by community Plastic Surgeons when a patient’s own tissue is not available.
Dr. Cordray is a very experienced breast surgeon, having done fellowship training in BOTH oncology (cancer) surgery AND plastic and reconstructive surgery. She did her plastic surgery training at UCLA, which performs the largest volume of perforator flaps for breast reconstruction in the country. She is very dedicated to her patients, is always available to them, and treats them with the utmost kindness and respect.
For more information on Dr. Cordray: www.drcordray.com
