I turned to Dr. Pisano and PRMA after a failed breast reconstruction with another surgeon. They specialize in the DIEP flap reconstructions like the one I had, and I have no doubt that PRMA generally delivers good results with the DIEP flap. But they’re a DIEP assembly line, and I wouldn’t recommend going there for anything else. It’s a volume practice that doesn’t have the time to deal with more complicated cases. Dr. Pisano recommended a back flap for me. He warned me that it might not result in any cosmetic improvement depending on the amount of damage from the previous surgeries, but it would at the least replace damaged tissue with healthy tissue so that the next surgery could be successful. That turned out to be the case. I was disappointed after the first surgery but hopeful that the next one would work. The second surgery wit Dr. Pisano was a complete flop. We did a reduction on the healthy breast and fat graphs on the reconstructed breast. After the surgery, I was still a D cup on one side and a B cup on the other. I assume Dr. Pisano knew that the results weren’t good because right after the surgery he told my husband that we might be able to try the fat graphs again and be more creative about where to take the fat or we could talk about an implant. But a few days later, his nurse told me that he «didn’t recall» that conversation, that my insurance wouldn’t cover anything else, and that I would have to pay Dr. Pisano’s higher cosmetic rates if I wanted a better outcome. I felt like I’d been kicked in the head. When I asked his nurse why the fat graphs didn’t work, she told me that I was«a trim little thing.» Who knew that would be such a surprise to my surgeon? At that point, I had lost all faith in Dr. Pisano so I went to another surgeon. He told me that my insurance would cover as many revisions as necessary to achieve symmetry, but the reimbursement was low so some surgeons wouldn’t accept it. I don’t know why PRMA doesn’t just explain that to patients. It’s hard to imagine that people who work all day with cancer patients could be so cruel and heartless. As for Dr. Pisano, I’m sure he has more successes that failures, but I can’t recommend a surgeon who has so little personal integrity. I remember during my first appointment, he was talking about all that I had been through and he reached up and touched the cross he wore around his neck. I was touched by the move, but in hindsight it would have been more appropriate if he had been wearing a dollar sign.