Good morning everyone, I am Christine with BRAVE, and I am really excited to introduce our guests today. About a week ago we had Jen Reynolds on as a patient survivor and also the founder of the Pink Warrior Advocates in San Antonio. With us today is her doctor, her plastic surgeon, Board Certified Plastic Surgeon Dr. Peter Ledoux. Thank you both for taking the time to be on. I think I will start, Dr. Ledoux, I know you are part of PRMA, one of the largest plastic surgery practices in the United States. Maybe you could just tell us a little bit about your background, I think you were one of the first to start PRMA, is that correct?

That’s right, Thank you Christine. My partner, Dr. Pisano and I started the practice in 1994, if you can believe it! With the intent and the mission to help women get through breast cancer. We finished our training in Houston at MD Anderson and we learned the latest techniques there on how to reconstruct the breast and help patients get through cancer. So when we finished our training we wanted to come out and do breast reconstruction to help women get through breast cancer, that was our primary goal.

And you said that was 1994, right?

Yes, we just had our 25^th anniversary, last may!

Wow! The breast cancer act came out 4 years later, so you were ahead of your time! That is wonderful!

Yes, we have been able to help lots of women, and really we like to just help women get through breast cancer so they can go on with the rest of their lives, and have it just be a memory.

That is wonderful! Getting to the other side of it, Dr. Ledoux, and I think that is sort of what BRAVE is about. BRAVE came about from my work, I worked in the industry many years, and found that a lot of women couldn’t find, they didn’t even know about the Breast Cancer Act, that says you should at least have the option of breast reconstruction. So what we try to do is enable women when they get diagnosed, to find a board certified plastic surgeon, to find out what their restoration options are. By no means are we forcing reconstruction, obviously if a woman doesn’t want it, she wants only her mastectomy, or prosthetic or whatever that is for that person. That is our job. I would love to maybe talk about your relationship with Jen. Jen started this non-profit we can actually send the link out Jen, because I know you have a silent auction going on. But Jen, can you tell us about when you were diagnosed and how you found PRMA and Dr. Ledoux?

So, it is actually a really long story that I am going to give you the cliff notes version on. But, when I was finally diagnosed it was November of 2013, I was next door over at the women’s center. The OBGYN next door to PRMA and when the doctor had diagnosed me, he actually said you have cancer. I said, “is it breast cancer, or is it skin cancer” and he said “No, it is breast cancer.” In his next sentence he had said there is a great plastic next door, and I am like… Woah wait a minute. I just got diagnosed with breast cancer, and now we are talking about reconstruction and you know the reconstruction that is next door. I felt like I didn’t even know what was happening. It was kind of like a whirlwind from there, and I got in touch with Dr. Rosenthal who they referred me to as my general surgeon, and he then referred me over to Dr. Amy Lang, who then, when the process kept going through, she had said “I am going to send you over to PRMA, I want you to see Dr. Ledoux, he is the best and I would only recommend him, and I really think he would be great for you.” So obviously I hadn’t really met with him until I got into the phase of reconstruction. I did my phase of chemotherapy first, and then I did my double mastectomy, which prior to my mastectomy I did meet Dr. Ledoux at that point and I can tell you that when I met him and his staff, immediately I knew that I was in the right hands, and that I was exactly where I wanted to be, I didn’t have to get a second opinion, and I am not steering people away from getting a second opinion, I think that is, you know, you do what feels right for you. But for me, what felt right for me, was exactly where I was with Dr. Rosenthal and Dr. Ledoux so that is kind of how I fell into their arms, and throughout the entire process from mastectomy to having my expanders placed to filling my expanders, to finally, I think it was about 3 months from my mastectomy to my final reconstruction, it was a seamless process. I feel incredibly grateful for how I guess I could say “easy” it was, given the situation that I was in, with breast cancer, and with reconstruction, and accepting the loss of my breast and going through that whole process. Between Dr. Rosenthal and PRMA and Dr. Ledoux, I have zero complaints.

That is an amazing story, because unfortunately we help women that don’t always have this story. I never talk about the surgeons out of ethics but we had a woman in Florida, most recently, that had been seeing several surgeons that probably were not qualified to do her surgery, and she ended up at the Cleveland Clinic and you know it was a very bad outcome, where she had open wounds and implants seeping out, and open wounds. Fortunately, she, after many surgeries ended up in very good care of a plastic surgeon at the Cleveland Clinic. But there are people out there that probably shouldn’t be doing what Dr. Ledoux does on a daily basis. Training at MD Anderson obviously is one of the best places to train.

So Dr. Ledoux, you have this partnership with the breast surgeon. Are there times when you go into the surgery with the surgeon and and plan it out, or is it usually done this way where the patients finishes and then comes to you after?

Ideally, Christine, it is better to do reconstruction at the same time as the mastectomy. You can preserve more skin, and now with nipple sparing techniques, it just looks a lot better if we do it together. We do most of our patients that way, now. I think the problem Christine, and one of my dreams, has always been to have a center of excellence for breast reconstruction in every large city so people could have access. But I think that point that you mentioned, about reimbursement, is not great for breast reconstruction so it drives plastic surgeons into other areas. We just felt called to do it, and it has paid off because there is nothing more satisfying than helping someone through a difficult spot in their life.

You know, Dr. Ledoux, I would love to talk to you more about this because I think if we as BRAVE and working with all of you, we have about 200 surgeons that work with us now. I know that the surgeons want to stay in breast reconstruction, we did surveys with surgeons, and I have a survey that we are about to publish, where about 300 surgeons said they really want to stay in this. Some of them, what they are doing is cash pay breast augmentation to make enough money to pay for the losses. I don’t think patients really realize that. They think if a doctor is a doctor and they are making all this money, but a lot of surgeons lose money in breast reconstruction, and they are trying to offset it by doing cash pay. That is a real tragedy.

Yes, there has been some progress in that arena, but I think you know with your help, and Jen’s and other organizations, I think we can make more progress.

This COVID thing has obviously hurt a lot of surgeons, a lot of them have not been able to work, and that is when BRAVE started doing these videos, because we found that a lot of you were stuck at home, like ourselves, doing zoom calls with your children! During COVID we have found an opportunity to talk to surgeons about these elective procedures and how they really try to focus on the awareness on breast reconstruction, so Jen next steps for you, I know you have started this non-profit, what can we do to help you, Jen?

I mean I guess, you know, with everything that is going on, everything is just kind of weird. We have been trying to get creative in our fundraising efforts, and I will talk about that in a second. But ultimately where I have gone is, with my non-profit, with Pink Warrior Advocates, if something were to happen and we couldn’t provide the level of financial assistance and grants that we provide, you know that to me is what sets us apart. We are such a small organization when you think about it in terms of other large organizations, we are small but we give back a lot of money a month. We were doing $10,000 a month in financial aid, among everything else that we do with our mastectomy kits and our chemo kits. We have taken that back a little bit just because we don’t know what is going to happen so we want to be able to extend those financial grants for a longer period of time vs. giving a larger amount and then being out of money in 6 months. So we have taken it back to $5,000 a month which is still a very large amount for such a small organization to give back. With that being said, I have already, I have had to come to this place of acceptance with where we are at and just re-doing things and figuring out how we can do things differently. I am at peace with knowing that if we were to lose our incoming funds we are always going to be able to provide that emotional support that we provide. That emotional support that we provide, the largest part of that, well there is two, but it ultimately comes back down to the emotional effect that the surgery that we have has on us from a physical standpoint and, you know, when you go through a double mastectomy or a single mastectomy, or any type of surgery where you are essentially amputating a body part. You know we are women, its not that we want to be given this attention for our breast, but we want to look in the mirror and feel confident, and we want to look in the mirror and feel good about ourselves and not see stars everywhere. We have already gone through chemotherapy, we have already had to look at ourselves in the mirror with no hair with no eyelashes, no eyebrows, and then we have this period of time where we may have to look at ourselves without our breast, that is a really really tough time to strip yourself from everything that makes you feel like a woman. So if we are brought back to a point where we can only provide that emotional support, I think at the end of any day, that is something that is so much more important than the financial assistance, and being able to lift these women up and letting them know that we have been there, and we get it, we know how you feel and we are going to be there for you through this process. Just letting them know that 100% you are not alone, we have been there, we get it, your hair is going to grow back, it may take some time, my biggest advice to women, the very first thing I say to them when they are going into a double mastectomy I say two things, one is “This is temporary, what you are looking at in the mirror right now, right after your surgery, is temporary. Focus on what the end result is going to be at that time, not what you are looking at right now. Focus on that.” And two, my biggest, biggest thing is that when you get your double mastectomy, when you get the surgery, that is the end to the cancer, it is leaving your body! That is the cancer leaving your body, is that surgery, and that is the biggest, the most positive message I can give you. This is it the cancer is going away, and we are moving forward! You are going to get there, and you will look beautiful, and you will feel beautiful! Just going back to Dr. Ledoux really quick, I can’t be more happy with physically how I look, and we didn’t do nipple sparing, but we did spare my areola, because I do have BRCA2, so we were able to save my areola, and I do have a little scar that goes across the center but I know that has kind of changed over time since I have had my surgery, but I don’t even see those scars, personally. You know I feel great about my reconstruction, I don’t look in the mirror and feel insecure about it. I really do have Dr. Ledoux, and I don’t want to not mention his staff too, because they are a part of it for sure! The front end, the admin side, the nurses, all of them. So I could just praise them all day for giving me my life back after cancer.

That is what we live to do, is to get women through it, and I think Jen is right, I think the emotional support is key, and having her and her team and helping other people through it since they have been through it is so important. So thank you Jen for all you do!

This interview is obviously no planned questions, it is just naturally has come out, but Dr. Ledoux, if a woman was just diagnosed with breast cancer, what would be your advice to her?

Well if she could get plugged in to a good breast “team” like Jen mentioned with an oncologist, a general surgeon or an oncological surgeon, and a good plastic surgeon and coordinate care from the beginning and do reconstruction immediately, studies have shown over and over that women do better to have their reconstruction right away, they wake up with a breast, they feel more positive, and it just goes better for them. So that would be my thing, and that is why I would love to have a center of excellence for breast cancer in every city in the country. So people could have access to that.

You are inspiring me, Dr. Ledoux. Something else for me to do in my spare time, I think that is so important and BRAVE would obviously like to get there. But what I would love to do is, Jen, there is a comment section and I am going to put your website in there and also I want to mention, if women have interest, PRMA is here in San Antonio, and women fly in from everywhere. I know the Breast Advocate app that Dr. Chrysopoulo mentions is a great resource, and then Jen what is the website for your non-profit. It is pinkwarrioradvocates.org so we were pink warrior angles hill country, and we just changed over to advocates because we truly do feel like everybody who is involved, our supporters our sponsors, our volunteers, our board members, our warriors, our survivors, are all advocates for each other. So we felt like that word encompassed everybody, so that actually just happened this past Saturday. We are super excited about that, and we do want to let everybody know that our financial aid that we provide is throughout the San Antonio, Austin and surrounding areas, and we do offer mastectomy kits and chemo care kits so if anyone needs assistance, please let us know! We also have our mastectomy bras through AnaOno, we offer those as well for women who have undergone radiation, they have special radiation bras and special bras for women who are maybe flat chested on one side. We donate those out as well, that comes at no cost to the patient, those are all funded through our efforts. So if y’all go to our website, I will also post the link below in the comments, we have an ongoing silent auction, we have had to redo some things with everything going on. So we keep adding items, as we get them since we had to put off our Gala. So check that out, we have some great raffles going on.

You should go to ASPS, the American Society of Plastic Surgery, they do grants for these types of things. If you are helping patients the American Society of Plastic Surgery may want to help you, Jen.

Before we get off, because I know we are wrapping this up, I really just want to say, I tell Dr. Ledoux thank you every time I see him, and he has always been so amazing. I know that all of the patients that we send have great things to say but I truly don’t know that I have the words to tell you how grateful I am for everything that you have done for me, and for giving me my life back and supporting the organization. I mean there really are no words for that, and I don’t think that doctors get enough credit for what they do for us as patients. So on behalf of so many breast cancer patients, I hope you really do know how much we appreciate you and everything that you do for us emotionally, physically, all that.

I appreciate that Jen, and I really feel like we are called to do that! So that means a lot, thank you!

It is so honorable that you have stayed in it, Dr. Ledoux, as we have said before, many cannot weather the storm. So we appreciate you on behalf of BRAVE, thank you so much!

Author: Dr. Peter Ledoux and Courtney Floyd