OUR TEAM

OUR STORY - A practice dedicated to breast reconstruction

 

Dr. Theresa Wang and Dr. P. H. Samuel Shih met as general surgery interns at the University of Pennsylvania in 2006. Their common interest in breast reconstruction and their desire to provide the latest and most demanding microsurgical procedures to women with breast cancer lead to their collaboration in Atlanta breast reconstruction. 

 

Dr. Wang and Dr. Shih offer pioneering and revolutionary breast reconstruction techniques such as microsurgical free flap reconstruction - DIEP, SIEA, Stacked DIEP, DIEP-DCIA extension, TUG, PAP, SGAP, and IGAP reconstruction. They work closely as a team to provide women with the best, individualized, reconstructive options that meets both their needs and expectations.

 

Our patients are seen in the same location by both surgeons, allowing for individualized care with simultaneous input from both surgeons. Our staff shares the same care and compassion toward each patient with the highest level of support and attention. They will act as a liaison and advocate for insurance companies, scheduling appointments, and for coordinating care with hospitals and other surgeons.

 

Dr. Wang and Dr. Shih have the largest DIEP/SIEA practice in the region. They perform over two hundred DIEP/SIEA flaps a year in hospitals across Atlanta. Their success rate is amongst the best in the nation. Not only do they specialize in immediate breast reconstruction and nipple sparing reconstruction, they are routinely consulted for complex reconstructions such as delayed reconstruction following radiation and failed implant based reconstruction.

 

 We will work diligently for you and your breast surgeon to provide the best care for you. 

Dr. Theresa Wang

Dr. Wang is one of the few fellowship trained plastic surgeons specializing in microsurgical breast reconstruction in the state of Georgia. 

 

Dr. Wang attended Yale University and received her medical degree from the Johns Hopkins School of Medicine. She completed her plastic surgery training at the University of Pennsylvania, a program with one of the highest volumes of DIEP/SIEA breast reconstructions in the world. This included work at the prestigious Hospital of University of Pennsylvania and the Children’s Hospital of Philadelphia. 

 

This was followed by additional fellowship in cancer reconstruction and microsurgery at the internationally renowned Memorial Sloan-Kettering Cancer Center in New York City. During her fellowship in New York she received extensive training in breast reconstruction focusing on both implant and autologous methods. 

 

Well published in plastic surgery journals and textbooks, Dr. Wang has presented her work in every significant plastic surgery society meeting. Dr. Wang is Board Certified by the American Board of Plastic Surgery.

Dr. Sam Shih

Dr. Sam Shih founded Plastic & Reconstructive Surgery of Atlanta with the vision of providing the best reconstructive surgery to patients facing cancer or following traumatic injury.

 

Born in Hong Kong and educated in Europe, Dr. Shih came to the United States for his surgical training and completed his internship and general surgery residency at prestigious Ivy League institutions - University of Pennsylvania and Dartmouth College. In addition, Dr. Shih completed a two year research fellowship in advanced minimally invasive surgery and obtained a Masters in Public Health at Johns Hopkins Hospital.

 

Dr. Shih completed three additional years of training in plastic and reconstructive surgery at Emory University, often regarded as one of the top plastic surgery programs in the country and pioneering facility of autologous breast reconstruction and oncoplastic surgery. He received extensive training in breast reconstruction focusing on both implant and autologous methods and conducts the most effective of the latest techniques based on the patients needs. 

 

He has given talks on reconstructive surgery both nationally and internationally, and is well published in journals and text books. Dr. Shih is Board Cerified by the American Board of Plastic Surgery.

A PRACTICE DEDICATED TO BREAST RECONSTRUCTION

DIEP . SIEA . Stacked DIEP . PAP . DIEP-DCIA . TUG . S-GAP

 

 

ATL DIEP

 

Dr. Theresa Wang and Dr. Samuel Shih are amongst only a handful of surgeons in Georgia that routinely utilize the DIEP and SIEA flaps in breast reconstruction. These techniques utilize the patients’ own abdominal skin and fat to recreate the breasts while sparing the abdominal muscles.

 

DIEP FLAP

 

The DIEP flap is the latest modification of the traditional pedicled TRAM procedure. The TRAM was pioneered by Dr. Carl Hartrampf in 1981 and actually originated in Atlanta, Georgia. Since then, there have been several modifications such as free TRAM and muscle sparing TRAM. These modifications have resulted in a flap with a more robust blood supply and less abdominal wall morbidity.

 

The DIEP flap is a free flap where the abdominal muscles are preserved. Only the skin and fat is utilized in the breast reconstruction thus causing even less abdominal wall morbidity.

 

The skin and fat is removed from the abdomen via a tummy tuck incision while keeping the blood supply attached via the Deep Inferior Epigastric Vessels. The skin/fat flap is then transplanted to the chest where it is connected to blood vessels using a microscope. The skin and fat is then molded into the shape of a breast.

 

STACKED DIEP

 

The Stacked DIEP Flap is where both sides of the abdomen (two DIEP flaps) are used to reconstruct one breast. It is an option for unilateral breast reconstruction in woman who do not have sufficient fatty tissue for a single DIEP flap breast reconstruction.

 

This technique provides the opportunity for woman, who usually are not candidates for abdominally based breast reconstruction, to receive DIEP flap reconstruction.

 

Dr. Theresa Wang and Dr. Samuel Shih are amongst the most experienced in Georgia in Stacked DIEP Flap breast reconstruction. This allows women with insufficient fatty tissue, who need reconstruction of only one breast, the option of DIEP flap reconstruction. 

 

SIEA FLAP

 

The SIEA flap does not violate the abdominal fascia or muscle at all. It is essentially a tummy tuck, with preservation of the blood supply to the abdominal skin and fat. The blood supply, Superficial Inferior Epigastric Artery, does not run through the abdominal musculature like the DIEP flap and therefore no violation of the abdominal fascia and muscle is needed at all. While this would make this the ideal flap, the SIEA is frequently too small to provide robust bloody supply to the flap. Given the potential benefits, the SIEA and SIEV is dissected out and examined in every patient undergoing abdominally based free flap reconstruction of the breasts. The SIEA flap will be offered to our patients based on our intra-operative findings.

 

EXTENSION FLAPS – DIEP-DCIA

 

There are women who require a little more fatty tissue, that cannot be provided by DIEP flaps alone, to achieve their desired size.  These women may have the option of a DIEP flap with DCIA extension. This is where the DIEP flap is extended to another zone supplied by the Deep Circumflex Iliac Artery. This adds an additional microvascular connection thus allowing for more blood flow to the larger flap.

 

 

Abdominally based free flap breast reconstruction is dependent on the availability of skin and fat from the abdomen.  Some woman are not candidates given their prior surgical history such previous abdominoplasty “tummy tuck” or major abdominal surgery. Others, simply do not have enough fatty tissue to reconstruct the breast.

There are other donor sites that can be considered for some patients:

 

 

BRCA Reconstruction

 

What do we know about heredity and breast cancer?

 

Each year, approximately 200,000 women in the United States are diagnosed with breast cancer, and one in nine American women will develop breast cancer in her lifetime. However, hereditary breast cancer — caused by a mutant gene passed from parents to their children — is rare. Estimates of the incidence of hereditary breast cancer range from between 5 to 10 percent to as many as 27 percent of all breast cancers.

 

In 1994, the first gene associated with breast cancer — BRCA1 (for BReast CAncer1) was identified on chromosome 17. A year later, a second gene associated with breast cancer — BRCA2 — was discovered on chromosome 13. When individuals carry a mutated form of either BRCA1 or BRCA2, they have an increased risk of developing breast or ovarian cancer at some point in their lives. Children of parents with a BRCA1 or BRCA2 mutation have a 50 percent chance of inheriting the gene mutation.  If a patient carries BRCA gene, they can have a lifetime risk of 50-70% of developing breast cancer.

 

BRCA Reconstruction

 

In the event you are diagnosed with a BRCA1 or BRCA2 mutation and have been referred for prophylactic, or risk-reducing  mastectomies, you have several options in breast reconstruction:

-DIEP flap reconstruction

-Direct to implant reconstruction

-Implant-based reconstruction with tissue expanders

 

© 2014 ATL DIEP

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