Dr. Mark Barlow MD, Plastic Surgeon in Houston, Clear Lake, Texas

The diagnosis of breast cancer is one difficult pill to swallow. With it comes an onslaught of information to digest and decisions to make. We know, because we've been there! That is why we have made it our mission to make sure that you, as our patient know, without a doubt, that you are not alone. Each member of our team is whole-heartedly devoted to guiding you through this journey. In fact, our mission statement evolved from our relationships with our breast reconstruction patients. "We want every patient to feel as though they are our only patient and that we are your only doctor." We pride ourselves with working with, what we hope does not come across as glib; "the dream team for your nightmare" (general surgeons, oncologist, radiologist, and pathologist) and we participate in every aspect of your care.

Offering you more options

When we first opened our practice in the Clear Lake Area, no other plastic surgeon offered patients the option of beginning the reconstruction process at the time of surgical excision. One reason for this may be because it requires a tremendous amount of interaction between a plastic surgeon, their patient, and surgical oncologist or general surgeon. It is so important that you like your doctor and their staff. It is even more important that you trust your doctor and their staff to help you with every detail. This is not a date, but a marriage. Lately, with the economy's effect on cosmetic procedure bookings, we have seen more plastic surgeons begin to offer this as an option. We've been here physically, spiritually, emotionally, and financially for the patients no one was eager to help, and we will remain here, even after the economy resurges.

While every patient is unique and treatment plan specifically designed, we will provide a general guideline for how things usually progress for someone who chooses reconstruction at the time of surgical excision or mastectomy. This is a very clinical description of what will be a life-changing journey for you and for us.

1. We meet!

Normally, patients are referred to us by either a general surgeon or a radiologist to discuss the many options for reconstructive surgery. Our medical patient coordinator would schedule that appointment. While our schedule is usually booked six months in advance, we strategically keep openings in our schedule for our patients who have been diagnosed with cancer. In fact, it is not unheard of that one of our general surgeon colleagues to call our office and ask if they can send a patient directly to our office, even if just to make the initial contact and get an appointment.

2. We plan

Dr. Barlow takes great care to understand your pathology, proposed treatment plans, and especially your concerns. Our goal is to provide for you the best information so that you can make the best decision for you. Sometimes, just having another physician explain things again, helps. We also have a network of patients who have offered their phone numbers to you. They have been where you are and want to help you through their experiences. Mostly, they want you to know what you should look for when choosing a plastic surgeon.

3. We take action

Once a clear plan is created we begin working as your advocate. We coordinate surgical schedules between your general surgeon and Dr. Barlow. We coordinate with your insurance company doing our best to help you navigate through what can be a complicated process. We coordinate with the hospital for your pre-operative screening, O.R. scheduling, and admitting process.

4. We keep you in the know

Our goal is to stay on top of everything for you. We want to be your "go to" staff. We plan all of your post-operative follow-up appointments one year out. We provide all of this information in a folder for your reference. We program Dr. Barlow's cell phone number into you and your caregiver's cell phones.

• Prior to surgery. Although you are welcome to visit any time, we arrange for a pre-op visit here at our office. We work with your general surgeon so that you can pre-op with them, Dr. Barlow, and the hospital admitting staff and pre-operative workup. During your appointment with us, we will give you your prescriptions, instructions, and heart-felt support.
• The morning of surgery, both Dr. Barlow and your general surgeon will meet you in out patient surgery (even though you will spend a night or two). They will be available to answer any additional questions, reiterate the plan that has been created with you and make surgical markings on your breast.
• During surgery, your family members will be given updates on your progress.
• When your general surgeon has completed surgical excision, they will find your family and give them an update. Dr. Barlow will find your family when he has completed the reconstruction portion of your surgery.

5. We leave you in good hands

We have worked extremely hard to create a special relationship with the hospital staff. Your comfort and well-being is of the utmost importance to us. However, if at any time, you have a question or concern, simply call Dr. Barlow directly. Dr. Barlow will see you the next morning, but don't be surprised if our staff pops in to say hello and check up on you too!

6. We keep a good thing going

Once you and Dr. Barlow agree that you are comfortable and prepared to be discharged from the hospital, Dr. Barlow and our medical patient coordinator stays in communication with you. No question or concern is too little for us. We are at your service. We will see you at all of your follow-up appointments. It is not uncommon to call a doctors office to schedule a follow up appointment only to hear a frustrated scheduler say "I'm trying to see where I can squeeze you in!" Be clear, there is no one more important to us than our post-operative patients, we work our schedule around YOU! That is why all of your post-operative appointments are created for you BEFORE you even have your surgery.

7. Things progress

• Week One (Post-operative): Your first post-operative appointment is within the week of your hospital discharge. At this appointment your bandages will be changed and you will transition into a post-surgical garment. Depending on the amount of output, there is a chance that your drains could be removed during this week. We support you in your recovery (pain management, bowel regularity, energy level just to list a few of many) concerns.
• Week Two (Post-operative): We continue to monitor your healing. Drains could be removed at this appointment. This is a painless process. Don't worry, we will walk you through all of this ahead of time, and put it in a binder for you to absorb at your own pace
• Week Three (Post-operative): If drains have not been removed, they come out during this appointment. Given that your healing has progressed, weekly expansion of your tissue expander begins. We will describe this process to you in great detail BEFORE your surgery is even scheduled!
• Week Four (Post-operative): We continue expansion and support your healing process. Our patients tell us that they feel as though we are their home away from home and that although this entire ordeal has been a major inconvenience in their lives; they look forward to seeing us. THAT is why we love our jobs!
• Week Five through Week Twelve: Expansion continues as we support you in your treatment and healing process. Remember that Dr. Barlow participates on the tumor board and stays in close communication with your oncologist and pathologist. He is always available to explain things and answer any of your questions or concerns.
• Week 13 - Week 16: Holding Pattern and Preparation of Phase II. By now your tissue expansion is complete and we allow your skin to stretch, adjust, and prepare for the removal of your expander and replacement of a silicone implant. During this time, you will begin the preoperative process. Just as we did with your initial surgery, we will walk you through every aspect of this phase II.
• Week 17: Phase II begins: Just as before, you will meet Dr. Barlow at outpatient surgery. Our medical patient coordinator will work on your behalf to clear your insurance approval, schedule the O.R., order your implants, assist you in purchasing a soft cup (no underwire) bra (the cotton sports bra that opens in the front), prescriptions, preoperative appointment with the hospital, etc. Dr. Barlow will make surgical markings and prepare you for surgery. This procedure of removing the tissue expander and placing an implant usually takes about 1 hour per side. It is at this time that a lift or reduction of an unaffected side would be performed to create symmetry. If this is the case for you, Dr. Barlow will tell you how long he expects your surgery to take. Most patients go home the same day but come to our office the next day for a post-operative appointment. Once again, you will be transition from bandages to gauze and soft cup bra, allowing the implants to begin to settle and the breast to take its shape.
• Week 18: At this appointment we monitor and support your healing progress.
• Week 19: Post-operative appointment: Continue to monitor and support your healing progress.
• Week 21: Post-operative appointment: Continue to monitor and support your healing progress.
• Week 25: Post-operative appointment: Continue to monitor and support your healing progress.
• Week 29 or 30: Nipple Construction: This is an In Office Procedure (IOP). We schedule these every Wednesday in our procedure room at our office. This is done under a local anesthetic and tolerated well. Dr. Barlow will explain how he creates your new nipples (if you have not had a nipple sparing procedure).
• Week 30: Post-operative appointment: Continue to monitor and support your healing progress.
• Week 32: Suture removal two weeks out from nipple construction.
• Week 34: Continue to monitor and support healing progress, including scar management.
• Week 38: Continue to monitor and support your healing progress, assess for tattooing, select pigment options and size.
• Week 42: First pigment (tattoo) embedding session. Dr. Barlow personally performs this procedure in our procedure room. Many of our colleagues think it is just crazy for Dr. Barlow to spend his time doing this for our patients. Most plastic surgeons send their patients to medical estheticians. We just haven't found anyone who we believe is as good as Dr. Barlow.
• Week 46: Assess for a second pigmentation. If a second pigmentation (tattooing) is necessary we will schedule that and follow up in one month to access healing.

8. Eleven to twelve months

In case you haven't guessed, by now you are our family. We like to schedule a quick appointment for you at our office on the day that you receive your last chemotherapy treatment. Given that we are next door to M.D. Anderson's Bay Area Campus, we hope that you will pop in to see us whenever you can. We love to visit with you and grab a hug! At this point, we feel we've been through so much together that we get a little separation anxiety! Mostly we are so happy for you. We continue to see you every year, monitor your progress, and catch up on your life!

That was a general description of the best-case scenario. However, this is cancer, and one thing is certain, things are not always predictable and healing is not always optimal in the immune-compromised patient. A few things to consider when choosing your plastic surgeon are:

• Can I communicate my concerns easily or will my doctor get defensive?
• Will the staff provide the proper support and keep up with any changes that may arise in treatment plans.
• Do I feel these people care? Are they good listeners and do they look for ways to make things easier for me? Are they burnt out, and impatient?
• Do I have easy access to my doctor for scheduled appointments, impromptu appointments (fever, red breast, or wound healing issue), and by phone.

This was a detailed description of just ONE of many options we make available for our patients. One thing we hear over and over, "Dr. Barlow, my breast look prettier than they did before my mastectomy, what can you do for the rest of me?" We always giggle.

During our patient's healing process they sometimes feel it is difficult to keep their friends, and family, up to date on all the details of their treatment. Or, sometimes, they are just tired of rehashing the events over and over again. For our patients that are interested, we would like to recommend they utilize a site such as CaringBridge. The website offers users the ability to create their own personal blog page, where they may write whatever they want; from daily updates on how you are feeling, to just the basic plans for treatment. You can then invite whomever you think would be interested in receiving your updates. Whenever you update your blog, CaringBridge automatically emails everyone on the email list that you provided letting all know that you have updated your blog. The best part about CaringBridge is that it is a free, non-profit, website dedicated to helping you connect with friends and family, and to share information, gain support, or, to just get it all off of your chest! If you have any questions on how to utilize the site, please do not hesitate to contact our office, and we will assist you in any way that we can.