Mission Plasticos: Reshaping Lives

By Amy Carpenter-Aquino

ASPS member Karen Leong, MD, is so committed to helping breast cancer survivors in need of reconstructive surgery that she performed a volunteer surgery while 37 weeks pregnant.

Dr. Leong is lead surgeon for Reshaping Lives California (soon to be Reshaping Lives America), which serves, among other patients, low-income and uninsured women who are postmastectomy and in need of reconstructive breast surgeries.

“These women are able to have their disease treated, but once they have the cancer removed, it’s deemed a cosmetic concern for them to receive reconstruction,” Dr. Leong explains. “It’s pretty devastating for a woman to, first of all, receive a diagnosis of breast cancer; second, to go through all those treatments to be given the diagnosis of cancer-free; and then to be left with a daily constant reminder of what was taken away from them.”

The loss of one or both breasts leaves female patients feeling less feminine, less attractive to their partners and less than whole because part of themselves has been taken away, Dr. Leong notes.

“Every time a breast cancer survivor takes off her clothing or is unable to wear a certain type of clothing because of the result of her cancer treatment surgery, I think it changes the way that they view themselves and how they think others view them. It’s like they have that scarlet letter on them: ‘Yes, I’m a survivor, but now I’m deformed.’ ”

Reshaping Lives California is the domestic arm of Mission Plasticos, which since 1999 has provided more than 15,000 life-changing reconstructive surgeries to underserved populations through medical mission trips to Mexico, Guatemala, Bolivia and other countries. The shutdown of international travel due to COVID-19 halted trips to foreign countries and prompted Mission Plasticos to shift its focus and resources to Reshaping Lives California.

“I’ve always been interested in medical missions internationally, but I also thought that there was a domestic, local need that was not being met,” says Dr. Leong, whose practice is based in Newport Beach, Calif. “There are so many people here with similar reconstruction needs but who are lacking the resources, connections and financial funding necessary. We can’t have a strong international component without an equally strong local component.”

A national initiative

Mission Plasticos Executive Director Susan Williamson says they started the Reshaping Lives California program in 2016 after discovering that a primary need in the United States was breast reconstruction surgery for women who had undergone mastectomies.

“Fifty-thousand U.S. women live below the poverty line and have breast cancer, and 30,000 of those women are uninsured and can’t afford reconstructive surgery,” Susan notes.

Each year, Reshaping Lives California’s volunteer plastic surgeons screen patients and perform surgical procedures supporting breast reconstruction, including placement of tissue expanders and implants, nipple reconstruction and performing a lift on a patient’s original breast to match the reconstructed breast, if only one side was affected. About one-third of the patients who receive a consultation from a Reshaping Lives California volunteer plastic surgeon are deemed eligible for a reconstructive procedure, Susan says.

“The reasons they may not be eligible could be morbid obesity, being a heavy smoker or having had heavy radiation treatment during their care after their mastectomy,” she says. If a patient’s breast cancer was treated in a country that still uses cobalt radiation, for example, the tissue damage would make performing reconstruction too challenging and risky.

“However, many of our patients have gone ahead and had several procedures with us to complete their recovery journey,” Susan adds.

Beginning in October, Reshaping Lives California will support even more patients along their recovery journey with the launch of a national expansion and a new coalition dedicated to breast reconstruction called Reshaping Lives America, Susan says. The expansion is being funded in part by a fouryear partnership between Mission Plasticos (The PSF Charitable Care Grant recipient), and Sientra, which donated $1 million for hiring additional staff and will provide all the tissue expanders and implants needed for reconstructive surgeries. Sientra CEO Ronald Menezes will serve as the chairman and trustee of the Reshaping Lives America Corporate Council.

“Women who are dealing with breast cancer are in one of the toughest fights of their lives,” Menezes says. “Sientra’s partnership with Mission Plasticos allows us to help women during this challenging time and highlights our mission of bringing transformative treatments and technologies to patients and surgeons.”

Susan says she was inspired to approach the company about the expansion and partnership after attending the 2019 ASPS annual meeting.

“We liked the fact that they only sell to board-certified plastic surgeons,” she says. “Many of Reshaping Lives California’s patients are prone to scar tissue because they are years out from their mastectomy, and their bodies are sensitive to rejecting the implant.”

Moreover, as Dr. Leong points out, delayed reconstruction cases can take several procedures.

“We have to put a balloon in there and stretch out the skin to try to recreate the semblance of a breast,” she says. “We have to add fat. We have to do symmetry procedures if it’s only on one side.”

Susan emphasizes that because Reshaping Lives works with board-certified plastic surgeons, their patients receive the same treatment as any other patient.

“The patients are not treated differently,” she says. “They’re not going to the giant low-income clinic where they’re made to feel marginalized. The plastic surgery office staff do not know that they’re Reshaping Lives patients. The only difference is the plastic surgeon interacts with us when it comes to billing. And there is no bill.”

With the national expansion, Susan says the goal is to connect thousands of women who cannot afford breast reconstruction with volunteer plastic surgeons.

“We’re asking surgeons to commit to one surgery a year, and we’re hoping they’ll commit to more,” she says, adding that surgeons, anesthesiologists and nurses reach out regularly to Mission Plasticos looking for volunteer opportunities. “I think that is fantastic. And this is a way for them to give back in a very meaningful way with a structure around it.”

Dr. Leong says that volunteering her time is the best part of her job as a plastic surgeon.

“In Orange County, Calif., practitioners mostly serve cosmetic surgery patients, so this is a completely different population, where there’s nothing in it for us other than being able to give them back what they’ve lost,” Dr. Leong says. “I think it brings us back to our roots, back to the reasons why we went into medicine or why we were drawn into reconstruction – to just purely serve the need without any other driving forces for ourselves.”

Dr. Leong shares the story of her “perfect patient,” Kareen Sandoval, and the impact that reconstruction surgery had on Kareen’s quality of life.

“She was so excited by the time she received her implants that she says, ‘Look at my cleavage!’ ” Dr. Leong recalls. “She just has this amazingly positive attitude, and she’s been so grateful every step of the way. That’s the thing I find about all of these patients. Even before you touch them, they say, ‘Thank you, thank you, thank you,’ because you’re offering them an option that would be otherwise closed to them.”

Kareen is the patient Dr. Leong operated on right before her due date.

“She remembers feeling my baby kick against her side before she fell asleep,” Dr. Leong says. “And she held my 9-monthold baby before we took her back for her second and final stage of reconstruction. She says having a baby in her arms helped calm her nerves and take her mind off the upcoming surgery.” At a Mission Plasticos gala event where she was invited to share her journey, Kareen showed Dr. Leong a video she’d taken with a girlfriend who had supported her at every surgical visit. “They went into the pool, and she was twirling in her bathing suit with her cleavage, and she was just glowing,” Dr. Leong says.

After Kareen’s heartfelt gala speech, which she delivered in English even though her comfort was in Spanish, Dr. Leong says there was not a dry eye in the place. Kareen only had good things to say about the process – even with the unavoidable delays and unexpected rescheduling of procedures.

Dr. Leong notes she was grateful for the faith and patience that Kareen and all the Reshaping Lives patients place in their surgeons.

“They don’t give up on us,” she says. “And we don’t give up on them.”

Reshaping Lives California has a robust patient outreach system centered on local churches, clinics, and community centers, and advertisements in publications that serve low-income populations and on social media. Referrals come from Susan G. Komen and local healthcare agencies.

However, the unmet need is still great, and Dr. Leong is passionate about spreading awareness to more low-income and uninsured women in need of postmastectomy breast reconstruction.

“I know we’re only reaching a small percentage out there, and we want women to know that we are here, we will review every case personally, and we don’t turn people away. I don’t want them to say, ‘I wouldn’t be a good candidate.’ Just apply.”

Dr. Leong says she was “beyond thrilled” about the potential to reach more women in need through Reshaping Lives America.

“I believe that giving back begins with serving within our communities, and a big part of our mission is to help complete the journey of care for women in poverty in the U.S. in need of post-mastectomy breast reconstruction,” Dr. Leong says. “Sixty percent of women living in poverty with breast cancer are not given the opportunity or option to receive the final step, a step I believe is critical for them to regain their sense of femininity and self. These women are breast cancer survivors, but they deserve to continue their lives without a daily reminder of all they lost to be called survivors. These numbers are significant, and this partnership with Sientra gives us the ability to make a difference.

“I’m calling out to all my fellow breast reconstruction colleagues to please join us,” she continues. “If we each pledge to help one woman in need of breast reconstruction, we are taking a step towards eliminating this gap in our healthcare system and providing a much-needed service to our home communities.”