The MEDQOR Podcast Network

40 Episodes
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By: Medqor

The MEDQOR Podcast Network provides insights, reporting and analysis on MedTech Innovation across all of healthcare. We’re supported by ten leading brands in healthcare, whose chief editors will join us on a recurring basis to talk with key leaders in their industries about what’s happening now. MEDQOR provides healthcare business intelligence to help MedTech and Pharma professionals connect and stay abreast of the advancing technologies to drive improved patient outcomes. We help healthcare innovators engage their market to bring new technology into hospitals, clinics and offices to improve and streamline patient care. Thanks for listening as we discuss tech...

Direct 3D-Printed Aligners Redefine Treatment Possibilities A Deep Dive with Dr Ki Beom Kim
#125
08/17/2023

Innovation is rampant in orthodontics—to the point that we’re seeing innovation within innovation. Take 3D printing, for example. The 3D printer alone—just the printer itself—has been revolutionary. It has allowed the orthodontic practice to take control and fabricate aligners in-office, on their own schedule. But it wasn’t the 3D printer alone that facilitated this. Along the way, additional innovations were needed—chief among them the thermoforming plastic material. And now, these materials are further evolving with a new material that allows for direct 3D-printed aligners. Orthodontic Products Chief Editor Alison Werner spoke to Ki Beom Kim, DD...


Pathophysiology of Idiopathic Hypersomnia
#124
08/17/2023

While the pathophysiology of idiopathic hypersomnia is unknown, emerging science suggests that nighttime sleep dysfunction may contribute to daytime sleepiness in patients with idiopathic hypersomnia. A systematic review and meta-analysis that included 10 studies found that, on average, several sleep architecture hallmarks were different in patients with idiopathic hypersomnia relative to controls.

Total sleep time and percent of REM sleep were increased in patients with idiopathic hypersomnia compared with controls.Sleep-onset latency and percent of slow-wave sleep were decreased in patients with idiopathic hypersomnia compared with controls.Sleep efficiency and REM latency were similar between patients with IH and...


The Big Challenges Facing Clinical Labs
#123
08/15/2023

In this episode of Clinical Lab Chat, Chris Wolski, CLP’s director of Business Intelligence, David West, CEO of Proscia, and Lou Welebob, vice president and general manager of pathology at Agilent, take a deep dive into the big challenges facing clinical labs today, including workforce shortages, scaling lab operations, and reimbursement, along with some of their solutions, including increased automation, agnostic platforms, and more coherent reimbursement coordination with regulatory agencies.


Burden of Idiopathic Hypersomnia
#122
08/10/2023

People with idiopathic hypersomnia face a significant disease burden. Idiopathic hypersomnia is associated with challenges that impact daily living activities, such as limitations at school, work, interpersonal relationships, and social activities. Various impairments include 

Impacts on attention and cognition, which can be characterized as “brain fog”The burden of memory problems and a feeling of the mind going blank or making a mistake in a habitual activity

Public health and safety are also impacted, as more severe causes of sleepiness can be cause for accidents. Management strategies may not address the underlying sleep dysfunction associated, resulting in subop...


How Should we Tackle the STI Epidemic
#121
08/09/2023

In the latest episode of Clinical Lab Chat, CLP’s director of business intelligence, Chris Wolski, has a wide-ranging discussion with Jeff Andrews, MD, FRCSC, vice president of Medical Affairs for BD, about BD’s recent STI health survey and what the findings mean for women’s health and their access to care. They also discuss the poor state of medical health education in the U.S., solutions that can help healthcare providers more efficiently test women for sexually transmitted infections, and how laboratorians can help improve testing rates.


Mouth Taping During Sleep
#120
08/04/2023

This episode also provides valuable advice for sleep techs dealing with patients wanting to use mouth tape during in-lab sleep studies. DeNike underlines the importance of ensuring patients have a healthy nasal passageway and clarifies the role of mouth tape as a supportive accessory, not a standalone treatment. This episode is sure to provide you with a deeper understanding of mouth taping during sleep, armed with expert advice and valuable insights, whether you're a sleep professional or someone simply interested in optimizing your sleep health. In this episode, we answer the questions:What exactly is mouth taping during sleep?How...


Differential Diagnosis of Idiopathic Hypersomnia
#119
08/03/2023

The differential diagnosis of idiopathic hypersomnia is challenging for several reasons. Its hallmark symptom, excessive daytime sleepiness, is a common symptom of many disorders, and ts ancillary symptoms also overlap with other disorders. A lack of validated biomarkers adds to the challenge. Assessing for key symptoms and medical history is a first step to help identify patients presenting with excessive daytime sleepiness who may have idiopathic hypersomnia. From there, there are several symptoms that can differentiate the diagnosis of idiopathic hypersomnia from other disorders such as sleep apnea or narcolepsy. These include:
Sleep inertia: sleep inertia is common in...


The Hidden Risks of Obstructive Sleep Apnea
#118
08/01/2023

Sleep specialist Indira Gurubhagavatula, MD, MPH, is our guest and chair of the Count on Sleep Tool Development and Surveillance Workgroup for The Obstructive Sleep Apnea: Indicator Report, which provides an in-depth analysis of the symptoms, risk factors, prevalence, and burden of obstructive sleep apnea and serves as a resource for both the public and the health care communities on the importance of diagnosis and long-term treatment. Gurubhagavatula and Sleep Review editor Sree Roy discuss the hidden risks of obstructive sleep apnea—the mortality and morbidity that makes obstructive sleep apnea (OSA, for short) particularly insidious. We discuss obstructive sleep ap...


Diagnosis of Idiopathic Hypersomnia
#117
07/27/2023

The International Classification of Sleep Disorders, 3rd ed, lists the criteria needed for a diagnosis idiopathic hypersomnia.

For a diagnosis of idiopathic hypersomnia, the following must be met:
o excessive daytime sleepiness daily for at least 3 months
o cataplexy is not present
o multiple sleep latency test (MSLT) shows 90%)
o Long, unrefreshing naps (>1 hour)

This episode is produced by Sleep Review. It is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information.

In episode 2, listen as Sleep Review’s Sree Roy an...


Medical Device Cybersecurity - How It’s Impacting Health Systems and the BMETs Serving Them
#116
07/27/2023

Join 24x7 chief editor Keri Forsythe-Stephens as she sits down with cybersecurity expert Scott Trevino to delve into the pressing issue of medical device cybersecurity. As senior vice president for cybersecurity at comprehensive clinical asset management service provider TRIMEDX, Trevino shares how he stays at the forefront of cybersecurity trends, with a keen focus on medical devices. Moreover, he reveals his pivotal role in developing cutting-edge cybersecurity solutions for TRIMEDX's clients, aiming to fortify their defense against evolving cyber threats.

The podcast provides a comprehensive analysis of the current state of healthcare cybersecurity. Trevino points out that the...


Symptoms of Idiopathic Hypersomnia
#115
07/20/2023

Excessive daytime sleepiness is an essential feature of idiopathic hypersomnia, but other key symptoms and aspects of the medical history are crucial when evaluating patients who present with excessive daytime sleepiness. Patients with idiopathic hypersomnia commonly report the following symptoms in addition to excessive daytime sleepiness: severe and prolonged sleep inertia, long and unrefreshing naps, prolonged sleep time, and cognitive dysfunction.

Knowing the key symptoms and utilizing sleep testing can increase a healthcare professional’s confidence in his/her diagnosis of idiopathic hypersomnia.
The Idiopathic Hypersomnia Severity Scale is a 14-item questionnaire that is a clinical to...


The End of the COVID Public Health Emergency & the Orthodontic Practice
#114
06/09/2023

Infection prevention expert Jackie Dorst, RDH, BS, is back on the Orthodontic Products podcast to talk to host Alison Werner about the end of the COVID-19 public health emergency and what is means for the orthodontic practice.

The COVID-19 public health emergency, issued on January 31, 2020, by the U.S. government put in place temporary measures to increase the federal government’s ability to detect and contain the virus. On May 11, 2023, the U.S. Department of Health and Human Services allowed the public health emergency to expire. This will bring an end to a number of programs, including those th...


An Interview with AAO President Dr. Myron Guymon
#113
05/31/2023

In this podcast, American Association of Orthodontists (AAO) President Myron Guymon, DDS, MS, joins host Alison Werner for the Orthodontic Products podcast on the Medqor Podcast Network. Guymon, who just started his 1-year term as AAO president, shares his priorities for his term and talks about the ongoing work of the AAO.

Guymon, who is a graduate of Baylor Dental College (now known as Texas A&M School of Dentistry) and went on to open his practice in northern Utah, started in leadership at the component level with the Utah Association of Orthodontists before moving on to leadership...


Skin Deep: Dr James Beckman & Theraderm Clinical Skin Care
#112
05/18/2023

In this podcast, Plastic Surgery Practice Co-Chief Editors Alison Werner and Keri Stephens interview James Beckman, MD, founder and CEO of Therapon Skin Health. They talk about the company’s Theraderm Clinical Skin Care line, its proprietary peptides, and how Theraderm grew out of Beckman’s works to develop a product to improve the skin of burn victims with skin-grafted hands. They also talk to him about where skin care is headed.

Beckman, who spent 20 years in private practice as a plastic and reconstructive surgeon and has a degree in biochemistry, shares his journey to creating a commercial prod...


How DentalMonitoring Grows the Orthodontic Practice Without an Additional Salary
#111
05/17/2023

In this podcast, sponsored by DentalMonitoring, Orthodontic Products Chief Editor Alison Werner is joined by Blake Davis, DDS, an orthodontist in private practice at Kirkland Redmond Orthodontics in Washington to talk about remote monitoring, the role it plays in practice growth, and how it fits into the digital workflow of today’s orthodontic practice.

When Davis started his private practice 6 years ago, he was limited on space; the only spaces available were under 1,200 feet. But within this space, Davis built out four chairs and relied on technology and a digital workflow to make that small space as useful an...


The Present and the Future of At-Home Testing
#110
05/15/2023

In this episode of Clinical Lab Chat, Chris Wolski and his guest, medical lead at Hurdle, Alex Owens, MD, MPH, discuss the reasons for the rise of at-home testing during COVID, how at-home test improves healthcare access, and the win-win-win it brings to clinical laboratories.


Unlocking the Secrets of Rhinoplasty
#109
05/11/2023

Join PSP co-chief editor Keri Stephens as she sits down with Alexander Zuriarrain, MD, FACS, a board-certified plastic surgeon and owner of Miami-based Zuri Plastic Surgery, to delve into all things rhinoplasty.

The conversation kicks off with the impact of the so-called “Zoom Boom” on the popularity of rhinoplasty. As people spend more time on video calls, they find themselves scrutinizing their own appearances, leading to a surge in interest for nasal corrections. Zuriarrain explains how the advent of remote work has contributed to this phenomenon, with individuals seeking rhinoplasty to address nasal deformities and enhance their facial feat...


How ‘Ollie the Biomed’ Is Reaching HTM’s Next Generation
#108
05/11/2023

In this episode of the 24x7 podcast on the MEDQOR Podcast Network, 24x7 chief editor Keri Forsythe-Stephens welcomes good friend of the podcast Chace Torres (aka: “The Bearded Biomed”) to discuss the launch of his new book, “Ollie the Biomed.” Torres shares that the book was inspired by the impending arrival of his firstborn son and his desire to create awareness and interest in the biomed field at an early age. He believes that building awareness among children is crucial and compares it to how kids learn about other professions through cartoons and books.

Torres describes the process of writi...


A Boutique Practice Offering an At-Home Concierge and Retainers for Life
#107
05/11/2023

In this podcast episode, host Alison Werner is joined by Deborah Solomon, DDS, an orthodontist in private practice in Beverly Hills and Los Angeles to talk about her boutique practice, which includes an at-home concierge service, and why she recently implemented a Retainers for Life program into her practice.

To get started, Solomon talks about how she spent the first part of her career as an active-duty general dentist with the U.S. Air Force and then worked for a corporate practice after finishing her orthodontics residency. It wasn’t until the pandemic hit, when she had time on...


How to Treat Insomnia in Primary Care
#106
05/05/2023

Join Sleep Review’s Sree Roy in conversation with sleep expert Russell P. Rosenberg, PhD, and primary care physician Paul Doghramji, MD, FAAFP about managing insomnia in primary care. They share insights from an expert consensus group and answer the questions:
What are the challenges that prevent insomnia from being diagnosed in the primary care setting?Can you provide practical advice on how to fit in insomnia screening and diagnosis into primary care settings?In what circumstances should primary care physicians refer patients to sleep specialists?What are best practices for CBT-I in primary care settings?Why is trazodone so...


As Aligner Treatment Evolves, What Sets ClearCorrect Aligners Apart
#105
04/21/2023

In this episode, sponsored by ClearCorrect, Orthodontic Products Chief Editor Alison Werner talks to Mark Lowe, DDS, an orthodontist in private practice in Fresno, Calif. A frequent lecturer on aligner therapy, he joins the podcast to talk about aligner treatment, why he’s opted to use ClearCorrect aligners in his practice, and the features the brand brings to the table.

In practice since 1991, Lowe is an early adopter of clear aligners, and has watched the treatment modality evolve over the last 25 years. Digital technology has been a key driver of the evolution in aligner treatment, he says, even mo...


An Orthodontist’s Deep Dive Into the Damon Ultima System
#104
04/20/2023

In this episode, sponsored by Ormco, Orthodontic Products Chief Editor Alison Werner takes a deep dive into the company’s Damon Ultima System, with Michael Bicknell, DDS, MS, an orthodontist in private practice in Illinois. Bicknell, who was part of the team of clinicians who validated the system before its roll out in 2021, has since transitioned his practice into a full-Ultima practice, giving him a keen understanding of the bracket system’s mechanics and how it can impact treatment.

As a frequent lecturer, Bicknell talks about the evolution of brackets and how the biggest challenge has always been an i...


Mindful Movement with Karen Danchalski, PT, DPT
#103
03/29/2023

In this podcast, Melanie Hamilton-Basich, chief editor of Rehab Management and Physical Therapy Products, talks with Karen Danchalski, PT, DPT, who has been practicing physical therapy for 25 years and has a special interest in mindful movement. They discuss how incorporating qigong and other types of mindful movement practice into physical therapy can benefit both patients and therapists.

For more information about mindful movement and physical therapy, read Karen Danchalski’s series of articles on the subject:

The Case for Mindful Movement in PT
The Benefits of Mindful Movement in Physical Therapy
Qigong for the Ph...


The 2022 Orthodontic Practice Performance Survey: A Deep Dive
#102
03/29/2023

Orthodontic Products and Levin Group teamed up again for the 2nd Annual Orthodontic Practice Performance Survey to find out how practices faired in 2022. In this podcast, Orthodontic Products Chief Editor Alison Werner is joined by Roger P. Levin, DDS, founder and CEO of the practice management consulting firm, Levin Group, to take a deep dive into the results. Levin shares strategies to help listeners navigate the impact of increased overhead costs and economic uncertainty in the year ahead.


Lyme Disease: Is a Better Diagnostic Test Around the Corner?
#101
03/28/2023

In this episode of Clinical Lab Chat, Chris Wolski meets the Texas A&M team behind what could be an effective, highly sensitive test for Lyme disease. Artem Rogovskky, PhD, ACVM, and Dmitry Kurouski, PhD, outline why Lyme disease is a diagnostic challenge and their work on developing a Lyme disease test using Raman spectroscopy.


The Hidden Dangers of Medical Tourism
#100
03/27/2023

Medical tourism has been on the rise in recent years as people seek cheaper cosmetic surgery options in foreign countries. However, this trend has been associated with a range of risks and complications, as discussed by Alexander Zuriarrain, MD, FACS, a board-certified plastic surgeon and owner of Miami-based Zuri Plastic Surgery, in this podcast with PSP co-chief editor Keri Stephens.

According to Zuriarrain, patients seeking affordable cosmetic surgeries often consider traveling to the Dominican Republic, Venezuela, Colombia, or Mexico, where the costs are significantly lower than in the United States. However, there are a number of concerns associated...


What Doctors Get Wrong About Sleep and Mental Health with Barry Krakow
#99
03/27/2023

A large proportion of mental health professionals misunderstand the nature of sleep problems in mental health patients, according to sleep specialist Barry Krakow, MD, who has worked in the field of sleep research and clinical sleep medicine for more than 30 years. Such professionals view sleep issues as a symptom of mental health disorders, rather than as a distinct disorder that needs to be addressed.

Healthcare professionals fail to understand that treating sleep problems can help to alleviate mental health issues.

The sleep medicine community itself also struggles with how to serve the mental health community. Many...


The Benefits of Spark Clear Aligners to a Growing Orthodontic Practice
#98
03/23/2023

Join Orthodontic Products’ Chief Editor Alison Werner as she talks with Alyssa Emory-Carter, DDS, MS. In this podcast episode, sponsored by Ormco, Emory-Carter, who is in private practice in Texas, shares her experience as a solo practitioner, building a three-office practice, and how she is using Ormco’s Spark Clear Aligners in her practice and the benefits she has found, from achieving better outcomes and to more efficient systems.

Only 6 years out of her residency, Emory-Carter is early in her career. But in that short time, she has taken ownership of three orthodontic offices, starting with the one owne...


Secrets from 24x7’s Salary Survey
#97
03/23/2023

In this podcast, 24x7’s chief editor Keri Stephens sits down with Chace Torres, aka “The Bearded Biomed,” to discuss the results of 24x7’s 2022 compensation and job satisfaction survey. Notably, the survey saw an increase in engagement, with female respondents doubling from the previous year.

Stephens and Torres discuss the factors that may have contributed to this increase, including outreach from educational parties and social media engagement from industry professionals. The pair also highlight the value of continuing education, which 35% of survey respondents said they were pursuing, and how it is vital for healthcare technology management professionals to grow...


Advanced MedAesthetic Partners: Supporting Plastic Surgeons’ Business Needs
#96
03/20/2023

Plastic surgeons today face a unique set of challenges, from changing patient demographics to increased competition in the marketplace. In this podcast episode, Plastic Surgery Practice Editors Keri Stephens and Alison Werner talk to Nicole Chiaramonte, CEO of Advanced MedAesthetic Partners (AMP). Chiaramonte joins them to discuss how AMP can help plastic surgeons overcome these challenges and grow their practices. What’s more, she explains why AMP is an alternative to the private equity consolidation model sweeping the industry.

AMP works as a management service organization, coming in, as Chiaramonte describes it, as a consulting firm of sorts to...


Navigating the Cloud: Key Considerations for Radiology Practices
#95
03/15/2023

Keeping up with the latest advancements in technology is crucial to staying competitive in today’s fast-paced healthcare landscape. But did you know that moving to the cloud could be the key to unlocking your full potential?

We’re excited to share this podcast featuring two experts in radiology technology: Sonia Gupta, MD, Chief Medical Officer, and Eric Lacy, Senior Product Manager, both from Change Healthcare. In this video, you’ll discover how cloud computing can help you transform your practice for the better.

Our experts will cover:
The many benefits of cloud computing for radiol...


Busting Common Sleep Myths with Jade Wu
#94
03/10/2023

For #sleepawarenessweek (March 12-18, 2023), Sleep Review is joined by sleep psychologist Jade Wu, PhD, DBSM. She is the author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. She is also a Mattress Firm Sleep Advisor. Sleep Review’s Sree Roy and Dr. Wu discuss common #sleep myths including:

-What is the most damaging sleep myth you have heard?
-What is one sleep myth that you previously believed, but was disproven over your career?
-Have you seen other sleep physicians perpetuate certain sleep myths?
-Do those who move around in their sleep ge...


Maximizing Patient Care and Practice Growth With ClearCorrect Aligners
#93
03/09/2023

As an orthodontist, you are always looking for ways to improve your practice and provide the best possible care for your patients—and clear aligners can meet both those needs simultaneously. Join Orthodontic Products Chief Editor Alison Werner as she talks to Daniel Berant, DMD, a dual certified orthodontist and periodontist in private practice in New York City, about the many benefits of clear aligners, how they impact the practice, and why he has chosen ClearCorrect aligners for his patients.

First, Berant shares his experience working in a multi-specialty practice, Smile Design Manhattan, founded by Lee Gause, DDS, a...


Skin Deep: ELEVAI Labs Post-Procedure Aftercare Products
#92
03/09/2023

Join Plastic Surgery Practice Co-Chief Editors Alison Werner and Keri Stephens as they talk to ELEVAI Labs Founder and CEO Jordan Plews, PhD, to talk about the company's ELEVAI E-series post-procedure aftercare products featuring a proprietary exosome technology. ELEVAI Labs is a biotechnology company developing regenerative skincare applications. The company is focused on physician-dispensed products that can work to support patient skin health following a range of procedures, from microneedling to laser resurfacing.

Plews, who has a background in biochemical engineering, shares how his work in stem cell research related to regenerative medicine brought him to aesthetics. He...


Sodium Intake and Other Modifiable Cardiovascular Risk Factors
#91
03/07/2023

While the US Department of Health and Human Services recommends a sodium intake of less than 2,300 mg/day, about 9 of 10 American adults exceed that limit. Increased sodium intake is believed to have a direct effect on a variety of negative cardiovascular outcomes such as coronary heart disease, left ventricular hypertrophy, and stroke. Recognizing the impact of dietary sodium on diseases like hypertension and CVD, the FDA recently released voluntary guidance for industry on the target mean and upper concentrations for sodium in commercially processed, packaged, and prepared foods. The guidance was intended to provide a measurable voluntary goal to help...


Dr Kami Hoss Shares Insights on Oral Health and Orthodontics
#90
03/03/2023

As an orthodontist, you're committed to helping your patients achieve healthy, beautiful smiles. But did you know that orthodontic treatment can also have a significant impact on their overall oral health? In this podcast, Orthodontic Products Chief Editor Alison Werner talks to Kami Hoss, DDS, MS, author of the book, If Your Mouth Could Talk: An In-Depth Guide to Oral Health and Its Impact on Your Entire Life, who shares his insights into the connection between oral health and orthodontics, and how you can help your patients achieve optimal outcomes.

The link between orthodontics and oral health is...


Buccal Fat Removal: TikTok’s Latest Darling
#89
03/02/2023

Join Plastic Surgery Practice Co-Chief Editor Keri Stephens as she talks to Michael Tantillo, MD, MBA, a board-certified plastic surgeon and founder of Clareo Centers in Massachusetts, about the popular trend of buccal fat removal. The conversation covers what the procedure is, how it works, and its benefits and risks.

Tantillo explains that buccal fat removal has been around for decades but has gained significant popularity recently, particularly among Gen Z patients who are more open-minded to aesthetic procedures. He notes that the procedure is safe when performed by a properly trained surgeon and has minimal risks and...


Incorporating Sofwave into Your Plastic Surgery Practice
#88
02/23/2023

Join Plastic Surgery Practice Co-Chief Editors Alison Werner and Keri Stephens as they talk to Los Angeles-based, board-certified plastic surgeon and inventor Gregory Mueller, MD, FACS, about a trending device in aesthetic medicine. A public speaker who educates surgeons about the minimally evasive MyEllevate procedure that he developed, Mueller discusses another technology in this podcast: the Sofwave energy-based device, which he uses in his practice. In December, the U.S. FDA cleared Sofwave to treat the appearance of cellulite, complementing its previous clearances to lift the eyebrow lax submental tissue as well as neck tissue. Here, Mueller reveals how Sofwave...


Reducing Risk of Cardiovascular Comorbidities in People with Narcolepsy
#87
02/22/2023

The prevalence of certain comorbidities is higher in people with narcolepsy compared with matched controls—both at diagnosis and at prolonged follow up.

Comorbidities that are more prevalent in patients with narcolepsy include psychiatric and sleep conditions, as well as cardiovascular and cardiometabolic conditions.

Hypocretin (orexin) dysfunction in patients with narcolepsy may partially explain the increased risk of certain comorbidities in these patients.

An increased prevalence of cardiovascular and cardiometabolic conditions, such as hypertension, obesity, diabetes, and hypercholesterolemia have been reported in people with narcolepsy compared with matched controls. One interview study of 320 patients wi...


Deconstructing Breast Reconstruction Myths
#86
02/16/2023

Join Plastic Surgery Practice Co-Chief Editor Keri Stephens as she talks to Anna Steve, MD, FRCSC, (or “Dr. Anna,” as her patients call her) about all things breast reconstruction. A breast specialist at the New York City-based Neinstein Plastic Surgery, Dr. Anna endorses an “elegant” approach to breast surgery—although she’s quick to point out that the reconstruction process can present unique challenges. In this podcast, Dr. Anna reveals why breast reconstruction is rarely a one-and-done procedure and why referring to post-mastectomy reconstruction as a “free boob job” is deeply erroneous. She also divulges what excites her most in breast reconstru...