EVOLV Medical Aesthetics

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Category: Breast Reconstruction


Even though it was over 30 years ago, I will never forget her face.

She was a young mother and school teacher with 2 small children and I was a first year plastic surgery resident.  She had a mastectomy for breast cancer and was left with a large and painful tight scar.  The implant that had been placed by my instructor under the scar was hard, unnatural and uncomfortable…..at that time in the mid 1980’s there just were not many options or choices. She looked at me and I did not know what to say to comfort her.  That was the day I decided to seek post graduate training in breast reconstruction and that young mother, with the eyes I cannot forget, changed my life forever.

This year an estimated 230,000 women in the U.S. will be diagnosed with breast cancer but less than 25% of those women will be aware of their reconstructive options before treatment.  The breast cancer experience touches not only those women but also their spouses, their children, their families and their lives for years.  The breast cancer experience involves much more than just removing a tumor or having a mastectomy, it is a journey that can involve medical and other post-operative treatments as well as impact a women’s personal life and self-confidence and relationships at every level.  In short it will someday effect all of us and someone we love.

The really exciting news is that the breast cancer experience is changing significantly for the better for a variety of reasons:

Education and Patient Awareness – public awareness and educational efforts by a number of professional     organizations have resulted in women being more informed and aware of their options.  The American Cancer Society, the American Society of Plastic Surgery, the Susan G. Komen Foundation, The Victory Center and many others are doing an incredible job of communicating useful information to patients and their families.  The best informed patients make the best choices!

Identifying Risks and Cancer Prevention – the most effective way to fight cancer is prevention.  New research on nutrition and life style as well as genetic testing to quantify risk factors have actually made a substantial difference in breast cancer incidence.  Advances in genetic mapping have made great progress and resulted in improved options and treatment outcomes for patients at risk.  Prophylactic mastectomy or removing the breast tissue to prevent cancer in high risk individuals, as popularized by actress Angelina Jolie, can reduce cancer risk by 90-95% in appropriate patients and result in excellent aesthetic outcomes.  We encourage everyone to learn more about these exciting advances in order to protect themselves and their families.

– Early Detection – After prevention, the next most effective way to impact breast cancer is early diagnosis.  Improved patient education and self-exam, consistent doctor’s visits, advances in imaging techniques such as mammography, ultrasound, MRI and other scans have resulted in earlier detection of breast cancer and breast ‘pre-cancers’ which will improve the overall patient experience and outcomes as well as reduce breast cancer morbidity.

– Improved Surgical and Reconstructive Techniques – Significant advances in biomaterials for breast implants and implantable materials (acellular dermal matrix) to help shape breast reconstruction procedures, have resulted in much more natural breast shapes as well as improved safety and less recovery.  Earlier detection and research on tumor biology have resulted in less invasive resection procedures (lumpectomy and mastectomy) and options such as sparing the breast skin and nipple in appropriate patients.  Placement of implants above the chest wall muscle (pre-pectoral reconstruction) and advances in tissue flap surgery reduce recovery time and have improved results for patients dramatically.  Our very own Dr. Peter Koltz, an associate with Dr. Barone at evolv Plastic Surgery, completed advanced training in tissue flap surgery for breast reconstruction last year and has been offering these options for patients in the Toledo area.

Post Treatment Quality of Life Improvementthe consequences of breast cancer treatment do not stop after the procedures have ended.  Many patients taking  estrogen blocking medication or other targeted chemotherapy or radiation deal with side effects such as bone and heart health, hair loss, premature skin aging, tissue dryness and laxity, post-menopausal vaginal dryness and urinary incontinence.  This often results in femininity and intimacy challenges, sexual difficulties and overall loss of self-confidence and intimacy.  New advances in clinically proven topicals, non-estrogen growth factors and other therapies can reduce symptoms and help restore confidence and vitality.  Regenerative treatments with platelet rich plasma (PRP) and other stem cell growth factors as well as collagen stimulating noninvasive technologies have given many patients much improvement in these issues and a better quality of life.

October is Breast Cancer Awareness month and October 17th is Breast Cancer Awareness Day (or ‘BRA Day’).  Please support these worthwhile programs and help bring more awareness, education and encouragement for the many women, men and their families that are dealing with this life changing issue.  We invite you to join myself, Dr. Peter Koltz and the evolv staff at Rosie’s on Wednesday, October 17th to support BRA DAY and spread the word on the improving awareness and quality of life for breast cancer patients and families.  

Yes the breast cancer experience is changing for the better and helping improve the quality of life for many.  Advances in clinical research, cancer biology, genetic testing, surgical and reconstructive option have transformed the breast cancer experience in such positive way.  The quality and safety of new reconstruction choices and postoperative treatment options can restore a patient’s self-confidence and lifestyle. As plastic surgeons we now may often hear a post reconstructive patient say, “Doctor, I sometimes forget I had a mastectomy!”

And I am forever grateful to that young mother and cancer survivor that inspired me with her courage so many years ago.

The Organic Approach

Whether you just received a breast cancer diagnosis or have been living cancer free from your diagnosis for years, every survivor remembers their first consult. Not only the many doctor’s consults but also with family and friends. Everyone tries to piece together all the information they are being told.  Much has changed in breast reconstruction, especially in Toledo over the past year that we want all of our patients and friends to be aware of. We like to think we take a very “organic” approach to breast reconstruction and customize the approach to every patient’s goals and personal situation. Our focus is to give you as natural of a breast as possible while causing as little disruption to your body and your life as possible. 

There are 5 new advances in breast reconstruction that we want to bring to your attention. We would welcome a discussion with anyone who may have questions about these points, which we will only touch on in this newsletter.

1. Autologous Breast Reconstruction
2. New and Improved Implants
3. Breast Sensation Following Reconstruction
4. Save the Pecs!
5. Yellow Gold!

1. Autologous Breast Reconstruction
The prefix “Auto” means “self”. Therefore, reconstruction of your breast with “self”. We think this approach personifies the “organic” breast reconstruction. While traditionally (as well as today) many breast reconstructions are performed with tissue expanders and implants, there are several operative procedures that allow the surgeon to use your own tissues (wherever you have excess, but most commonly the abdomen) to reconstruct your breast. This can take place at the time of your breast removal or even years later, even after you may have already had implants. Through the use of microvascular reconstructive surgery, tissue can be removed from one part of your body and transplanted to your breast with a quicker recovery and with less disruption of where your tissue was removed than autologous operations (TRAM) of the past.

2. New and Improved Implants
If you elect to undergo an implant-based approach to your breast reconstruction, today’s implants have drastically improved. The “organic” approach to implant-based reconstruction is based around the concept that you want your implant to be more “natural breast like” in feel and shape than the implants of the past. Additionally, today’s implants are safer than they have ever been. When the correct implant is chosen for your body there is no doubt that today’s implant breast reconstructions can come closer than ever to your “organic” breast.

3. Breast Sensation Following Reconstruction
So, you have had your breast removed…it frequently is not discussed that you will not feel your reconstructed breast again. This is important to discuss and realize going into your reconstruction. While currently it is not possible to restore sensation if you opt for an implant-based reconstruction, there have been some exciting developments with autologous (auto=self) reconstruction. At the time of transfer of your tissue from one part of your body to your breast, the nerves to your breast can be connected to your tissue that supplies sensation or feel to your abdomen to allow you to regain some sensation to your breast again. We feel like this is an exciting development worth talking about as the “organic” breast is sensate, or able to be felt!

4. Save the Pecs! 
Of Course, we all want to preserve as much of the total breast as possible but cancer removal may not allow.  However, it may be possible to save your “Pec” muscle or pectoralis major muscle at the time of your breast reconstruction. Traditionally in implant-based breast reconstruction, the chest muscle, the pectoralis major, is lifted from the chest wall and the implant is placed beneath. This is not “organic” but was previously thought to give the safest, most reliable reconstruction. However, with advances in implants and other biologic material now at our disposal, we have been able to produce implant reconstruction above the muscle, where the breast “organically” resides. This allows for less pain, a more natural look, and quicker recovery to your normal activities.

4. Yellow Gold!
Yellow Gold! While jewelry was previously a girl’s best friend, we are here to report that the new yellow gold is your own “organic” supply- FAT! With the advent of new liposuction techniques, developments in processing the fat, and injection techniques, it is now possible to deliver a much more natural looking and feeling breast reconstruction. No matter if you choose implant or autologous reconstruction, most people benefit from a touch of liposuction from one part of your body with transfer to the breast. This can happen at any point in your reconstructive journey in order to produce the most “organic” breast reconstruction.

We sincerely hope everyone is enjoying this beautiful (and HOT!) time of year and look forward to welcoming you all to the office in the near future. We greatly value our relationship with each and every one of you.

National Cancer Survivors Day – Mary’s Story


In honor of National Cancer Survivors Day 2015, we have a very heartwarming story for each of you. We are so blessed to have such amazing patients that we can share such a personal journey with. Mary is such a joy each time she visits us and we each smile a little brighter afterwards! This is her amazing story of how she beat cancer, it didn’t beat her! Thank you for letting us share your story and we love you and are so proud of you!

~hugs to you from the entire Frank Barone MD and evolv Medical Aesthetics staff ~

maryMary’s Story

I never wanted cancer. I didn’t want the free boob job or all the attention. I didn’t want to see the expressions on my son’s faces or the sickness or the pain. I didn’t choose cancer, but cancer chose me. In turn I chose Doctor Barone.

In January 2012, three major life events happened: I moved from North Carolina to Ohio, my mother in law passed away and I found a lump in my right breast. They always tell you to listen to your body and I just knew this was not good. Two weeks later I had it biopsied and it was cancer. Here I was, away from my friends and family, home alone and the cancer chose me. My doctor was sweet, with my husband out of town he offered to have his family take me out to dinner so I wasn’t alone. Although I was thankful I didn’t feel like eating. I am the matriarch of my family. How was I going to tell my husband Doug and what would I tell my two boys. Although, grown men, they will always be my babies. I didn’t know my prognosis but how could I tell any of them that I could be dying.

I never worried about losing my breast or breasts for that matter. I cared about kicking cancer’s butt and evicting it from its home in my body. I knew one thing for certain, I did not want to die and I was not losing this battle. I began my journey with that decision. I continued it with millions of doctor’s appointments. I had a mastectomy and then, I again, listened to my body and got a second opinion on my reconstructive surgery. See, I was in a depression, I had five months of chemotherapy, a poison they drip into your body to kill the cancer. But chemo, it also makes you feel like the living dead. I began to cover up mirrors, I didn’t want to see myself. I lost self-respect because I felt my beauty was gone. Half of my womanhood was gone, I was a shell of who I was. I tried to laugh through it, I called myself the “unaboober” and would tell my sons and husbands I was fine. But the truth was, I was sick all of the time. I could not work, I could not shop, and I didn’t even want to get out of bed. Now, if you know me at all you know not shopping is like the sun not shining, I was losing who I was.

Then the journey took a turn when I met Dr. Barone and his staff. My body told me to look for a new doctor and instead I found much more. Through these warriors, I began to feel whole again, pretty again, and I felt like me again. Dr. Barone and his nurse Susie and all the other wonderful staff gave me my confidence back. They made me feel good about my looks. My new boob, my new improved cancer free boob, is incredible. My husband laid by me and held me and supported me through all of this. He told me I was beautiful when I covered mirrors and felt less than but even this great man loves the new me and thinks every woman should look like me!

There is not a day that goes by that he does not tell me how pretty I am and thanks me for taking care of myself. In this aspect, he means for me wanting to be my best me, a woman who respects herself and her body. This is not vanity this is a commitment to being happy and healthy so that we can have as many years together as possible. Dr. Barone gave me hope back into my life when I did not feel l had much left. This great doctor and his staff made me whole again. I did not choose cancer. Actually I hate cancer. But I beat cancer, cancer did not beat me. Every day I deal with the side effects of chemo, but I would take it one hundred times over to be able to hug my husband and spend time with my wonderful boys in the new and improved me.

Love to all,

Permanent Makeup and the Oncology Patient

Restoring Confidence and Feeling Your Best

By Lindsay Cole, Aesthetician, Permanent Makeup Artist and Makeup Artist

Lindsay work photo 3Are you familiar with permanent makeup? Also known as permanent tattooing or cosmetic tattooing, this type of procedure can bolster confidence by not only making you look great, but feel great too! Depending upon the individual, this procedure is done for a variety of reasons and on different areas of the body; the most common areas the procedures are performed are, eyebrows, eyeliner, and lip liner. Another popular procedure is nipple/areola restoration. Having aesthetic areola re-pigmentation after finishing the breast reconstruction journey can be liberating for many women. But did you know that in order to ease the loss of eyebrows and eyelashes, permanent tattooing can also be done before or after chemotherapy or radiation? Through medical aesthetics and oncology aesthetics we have bridged the rift between cancer and beauty. Our patients are treated as a whole, so with that in mind, our goal is to ease the psychological effects of having cancer, hair loss being one of the most gut wrenching for some individuals. Wanting to look your best is healthy. When a woman looks good, she feels better about herself and radiates confidence, no matter her age or circumstance. By using permanent makeup tattoo techniques, we can help you regain a new sense of confidence by very carefully and skillfully enhancing your features to recreate the appearance of brows with our 3D brow effect, eyeliner, lash enhancing, areola restoration, camouflaging the effects of hair loss, and even blending in scars or skin discoloration; even if you are a current brave fighter or brave survivor of cancer.

Permanent makeup is increasingly being endorsed by oncologists as a way of helping patients feel more positive about the traumatic experience of chemotherapy. Over the last several years, there has been a surge of cosmetic eyebrow tattooing in patients undergoing chemotherapy and radiation, or that are about to embark on that journey. Pre-chemotherapy tattooing can capture the appearance of the patient’s natural brows in order to recreate them if chemotherapy causes hair loss.

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Permanent Eyebrow tattooing can alleviate the distress of chemotherapy by preserving the appearance of eyebrows. Patients can be treated one month before chemo drugs are administered, when their original facial hair is in place, so visible eyebrow and eyelash line can be enhanced with pigments. Some people are not bothered by their eyebrow loss, while others find it quite cumbersome. Some barely notice, while others feel their eyebrow loss gives them “the look” of being a cancer patient. For women who have lost their hair because of chemotherapy, permanent eyebrows and even eyeliner can restore self-esteem and also eliminate the need to reapply eyebrows and eyeliner every day.

Everyone responds differently to eyebrow loss during chemotherapy. It’s important that you honor yourself by coping with this side effect in the way that is best suited for you, and you alone. Don’t feel pressured to draw on eyebrows or eyeliner, because if it doesn’t bother you, go without it. Eyebrows in particular, frame the face, enhance your eyes, and may help you feel more like “you”, so if the loss or thinning of your eyebrows is distressing to you, never let anyone discredit the importance of your features and how you want to look.

Other candidates for permanent cosmetic tattooing are women who have arthritis, stroke, Parkinson’s disease, multiple sclerosis, or other conditions that cause tremors, putting on makeup can be a difficult task. Permanent makeup helps eliminate their frustration. Women with vision problems, who are blind, or who have cataracts may also be good candidates. Cosmetic tattooing also helps women who have allergies or hypersensitivity to makeup. Female athletes and other physically active women are turning to permanent cosmetics, as are business women, entertainers, models, and housewives.

Another good candidate to receive permanent tattooing are those with Alopecia (an autoimmune disease in which hair is lost from some or all areas of the body, usually from the scalp). It can be a devastating disorder and affects many men and women throughout the world. Permanent cosmetic tattooing is a remarkable solution to restore the appearance of their hair by masterfully camouflaging the effects of hair loss by blending specifically colored pigments, best suited to the individual, right into their scalp. It is confidence boosting and many clients become very emotional when they see how much their appearance is improved after the treatment

If permanent tattooing is a route you don’t want to go down, I would highly recommend consulting with an aesthetician and/or makeup artist to give you a brow lesson and teach you corrective makeup techniques to enhance your features and help camouflage the unwanted, and temporary changes in your appearance resulting from chemotherapy and radiation. It can be frustrating if you have little or no experience with makeup, let alone drawing on your eyebrows or eyeliner. When you first begin losing your eyebrows, you may want to just pencil them in. Until you lose all of your eyebrows, this can sometimes nicely disguise the loss. All you need is an eyebrow pencil or eye shadow that matches your eyebrow color. Having the help of an expert beats standing in front of the mirror for hours trying to get it just right. If permanent tattooing is a route you are seriously considering, schedule a consultation with a trusted permanent tattoo specialist and discuss your options, ask questions, and explore if you’re a good candidate.

Here at evolv Medical Aesthetics, myself and Rachel McCarthy are the permanent cosmetic tattoo artists, we are also licensed aestheticians and makeup artists. We completed our permanent tattoo training at the world renowned Beau Institute in New Jersey, under the close supervision of Rose Marie Beauchemin, pioneer in the permanent cosmetic tattooing industry and president of the Beau Institute.  The pigments we use are manufactured in the United States, using the highest quality colorants available in the industry, resulting in excellent color retention and superior results. Each shade has been designed and tested by permanent cosmetic professionals, who collectively have more than 40 years of color knowledge and experience. Pigments are different from “ink”. Ink has a tendency to migrate and create a blurred feathered affect in the skin over time. The pigments we use are made from iron oxides, which have been used in the skin for hundreds of years, making them the safest pigments. Iron oxide pigments are also MRI safe. The color pigments chosen for you will compliment your individual skin tone and are deposited into the dermis by using very careful and skilled techniques that are performed by your trained and certified permanent tattoo artist.

We would love to help you in any way with your permanent tattoo questions or needs, and urge you to contact our office to schedule your consultation or speak with a provider.