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Archives for March 2011

Who’s on Your Team?

March 30, 2011 by

breast surgeonsGO TEAM! Lots of phrases are used to describe a team concept. Some people call it “Multidisciplinary Breast Team, “Breast Cancer Team Conference,” “Breast Health Team,” “Cancer Clinic Team,” or, the one I like the LEAST, “Tumor Board” (ick!).

These teams are the groups of doctors, P.A.s, nurses, and therapists—basically everyone who would be involved in treating a patient with a breast cancer diagnosis—who meet to coordinate the best care for you. Yes, YOU and your unique self! They talk about your individual case, bounce ideas and treatment plans off of one another, and come to a consensus about what treatment would be best at beating your type of breast cancer. All of the members of this team may not necessarily be the providers treating you, which is a good thing for a wide perspective of opinions, but may include breast radiologist, general surgeon, breast surgeon, surgical oncologist, plastic surgeon, pathologist, medical oncologist, oncology nurse, radiation oncologist, social worker, financial aid counselor, and an oncology psychiatrist.

If you are in a community that does not have a team or you would like to be presented to a team prior to beginning treatment, just ask that one be found for you. Most hospitals have one and some exist that are composed of a group of providers in the community with a particular interest in breast cancer and breast health.

What is A Breast Cancer Navigator?

A breast cancer navigator is a term that hopefully most of us don’t know and won’t learn in our lives. But simply stated, this person, usually an oncology nurse, is there to help you from the time of your breast cancer diagnosis through the treatment maze to the end of your breast cancer journey. Consider her the person who reads the map while you are trying to drive the car, or perhaps if we keep in line with navigator, she sits on the stern of the boat and tells you when and how to row.

We like to think of her as more of a concierge at a really cool classy hotel (no tips required!!). She’s right there at check-in if you need her. But when you want to leave the hotel, she’s the go-to girl. She’s informative and has all the great information on the BEST places to go in town. Sometimes, she might even give you a little side information on the places that people have given her rave reviews about.

The Center for Natural Breast Reconstruction now has a new breast cancer navigator on board at our favorite “hotel,” the new East Cooper Regional Medical Center. We’re confident that once gets the hang of the lowcountry, she’ll be the best concierge in town! You’ll be able to call her for the best rates during your stay, ask her about what kind of post-op care you might need, and what types of support services are available during your time in Charleston. She’ll always be available to our clients.

Filed Under: All Things Charleston, Health and Wellness Tagged With: , , , , , ,

What Does It Mean to Eat Healthier?

March 28, 2011 by

healthy eatingWhat does healthy eating mean to you, personally?

Eating healthier means different things to all of us. For one person, it might mean cutting out animal products and eating strictly organic vegan food. For another, it might mean eating out no more than a couple times a week and learning to cook.

Transforming your eating habits is a process, and you can’t expect to be perfect overnight. Eating healthier means striving to avoid unhealthy food most of the time. Only you can decide what it means to decrease unhealthy food and add healthy food. Your doctor or nutritionist can help, but you must live with your new eating habits, so your plan must be realistic.

We’ve seen people stop eating certain foods cold turkey, and while it works for some, for others it’s a recipe for disaster. When you deprive yourself of foods you love, you may reach a point where you have an overwhelming craving for that food, and then you’re likely to binge, or eat a large amount at one sitting.

We recommend that instead of cutting out favorite foods completely, allow small portions occasionally, or find an acceptable substitute. One example is moving from eating large amounts of milk chocolate daily to small amounts of dark chocolate a few times a week. Another example is limiting yourself to one soda a day.

When you’re ready to change your diet for the better, you can start with these tips:

  • Think about how you eat now. Look at how often you eat processed food, such as frozen pizza, versus food in its natural state, such as fruit. Generally, the less often you eat processed food, the better.
  • Keep a food diary for two weeks. You’ll see where you can improve, and you’ll have a good idea of exactly what you’re eating.
  • Visit www.healthfinder.gov, www.healthypeople.gov, and www.mypyramid.gov for more information on healthy eating and ways to change your eating habits.
  • Decide what you can and cannot live with when it comes to healthy eating, and start with small steps such as reducing sugar intake. Once you’re comfortable with that, add another small change to your diet.

Remember, this is a marathon, not a sprint. Make minor changes gradually, and you’ll still enjoy eating while you work toward your goals. Use your doctor and nutritionist for help and guidance.

What steps to improve your diet are you considering? If you’ve already taken steps to change your eating, please share in our comments section.

Filed Under: Health and Wellness Tagged With: , , , , , , , , ,

What Are My Options If I Develop Lymphedema?

March 25, 2011 by

I’ve had breast cancer and developed lymphedema after my mastectomy.  I recently heard about Lymph Node Transfer surgery.  Does it work?  I’m scheduled for a DIEP breast reconstruction, can it be done at the same time?

Question answered by Dr. James Craigie:

Lymphedema is a very difficult problem that results when a patient has had breast cancer and has to undergo surgical removal of the lymph nodes under the arm as part of their surgical treatment for breast cancer. There are other causes of lymphedema but our specific interest has been in patients who have had breast cancer.

Lymphedema can be a very debilitating process; it remains a terrible problem worldwide, for all types of reasons. There is still much to be learned about why some people develop lymphedema and others do not. It appears that lymphedema is directly related to several factors in our breast cancer patients. It is directly related to having the lymph nodes removed from under the arm and seems to develop from the scarring that occurs under the arm following mastectomy and / or axillary dissection.

Undergoing radiation of the arm or axilla increases this risk. However, there are many people who undergo removal of the lymph nodes and radiation that do not develop lymphedema. There are also people who have mastectomy, have lymph nodes removed followed by radiation, and don’t develop lymphedema until many years after their surgery. That is the main reason that patients are warned to pay particular attention to their arm if they have had removal of any lymph nodes.

It is also possible that someone could get lymphedema even after simply having a sentinel node removed. A sentinel node procedure (lymphadenectomy) is a way to examine the lymph node without having to remove more than one or two. The whole idea of examining only the sentinel node is to lower the risk for lymphedema, but even with the sentinel node procedure, there is still a chance of developing lymphedema. Our practice became interested in options to help breast cancer patients with lymphedema as we see many who are suffering from the symptoms of this process while undergoing breast reconstruction.

Our practice specializes in microsurgical free flap breast reconstruction utilizing skin, underlying tissue, and microscopic blood vessels that transport life-giving blood to the reconstructed breast. This procedure is commonly referred to as the DIEP if using the abdomen or a GAP if using the buttock tissue. The muscles of the abdominal wall are left intact as it is the removal of the muscles of the abdominal wall that can lead to problems in the donor area, like hernias and bulging, as well as a more involved extended recovery. The lower tummy wall is the most common area that we transfer and it’s also an area where lymph nodes are present. Therefore, over the first decade this surgery was being done, we would encounter lymph nodes in the area of the blood vessels, as well as fatty tissue.

It became obvious that we could transfer lymph nodes on the blood vessels as we refine our technique for microsurgery. Due to the lack of effective treatment for lymphedema, for years surgeons doing perforator flaps have taken on this challenge and are trying to come up with ideas and techniques to treat it. We began doing an extensive amount of research, spanning the globe, looking for information on procedures that may help these patients. In 2005, we formed a group known as the Group for the Advancement of Breast Reconstruction, known as GABRs, and we included members throughout the world who had had a unique experience with our type of breast reconstruction.

We encountered one individual who had 15-years of experience with what is now known as “vascularized lymph node transfer” for the treatment of lymphedema. Initially, Dr. Robert Allen had attempted lymph node transfer during breast reconstruction and the biggest concern was how to transfer lymph nodes from one area of the body to treat lymphedema but not to create lymphedema in the donor area. In 2006, the GABRs met in Beijing, China and invited Corrine Becker, a surgeon from France who had a long history of experience with vascularized lymph node transfer.

She presented her work and through communication and travel to Paris to work with her, members of the GABRs group began to gain experience and learn more of her technique. The biggest hurdle that we were able to overcome was learning how to select the lymph nodes that could be removed as the donor lymph nodes and use those for breast reconstruction without causing lymphedema of the leg. We spent an extensive amount of time discussing her techniques and reviewing her results, as well as her publications.

We then made arrangements for her to travel to South Carolina and actually performed surgery on our own patients with her as an assistant surgeon. Since that time we have been very encouraged by the results with vascularized lymph node transfer as an effective treatment for reduction of the symptoms of lymphedema. We feel very excited but yet are very cautious about all results. It is important that patients realize that this procedure is still evolving and that there are risks involved, but to date we have had very good results and no serious complications.

Improvement of symptoms with vascularized lymph node transfer can occur immediately; however, they also may take up to 2 years to be appreciated. In most of our patients, the indicators of success are different. For the majority, the goal was to improve the edema, lessen the need to wear compression garments on a regular basis, and to eliminate the risk for frequent infections, which are the typical problems that those affected by lymphedema experience.

In order to lower the risk for complications and to closely study our results in conjunction with other colleagues who perform this procedure, we prefer to perform vascularized lymph node transfer as an isolated procedure. It can be done at the time of breast reconstruction; however, there is a chance that some people with mild lymphedema who undergo breast reconstruction may have improvement without lymph node transfer. Therefore, in order to closely study our results, we perform the breast reconstruction first followed by vascularized lymph node transfer as the second step. When the results are complete, we can determine whether it was the reconstruction or the transferred lymph nodes that gave the end result. It is important again to reemphasize that the main risk for of the surgery is that the transfer may not work. It is possible that if the transfer did not work resulting in more scar, the lymphedema could worsen.

Thankfully, to date, we have not experienced this complication. Other complications are damage to the blood vessels under the arm or the nerves under the arm. Therefore, our preference is to have an oncologic surgeon, who performs axillary dissection, release the scar under arm.  At the same surgical setting, after the scar is released, we perform the transfer by removing very specialized lymph nodes from the outer and lower abdominal wall or outer upper leg. We preserve the lymph nodes of the inside leg. These are the ones that drain the lower extremity and therefore, we feel that the risk for lymphedema of the donor area is reduced.

At this point, we have received some very exciting results along with some mixed results and continue to follow our patients very closely. We have had no patients with any serious complications and no patients at this point with lymphedema of the donor site. We are hopeful that the future holds vascularized lymph node transfer as an effective option for people with lymphedema following breast cancer surgery.

We plan to continue to devote and focus our energies on a surgical solution while simultaneously not exposing people to excess risk of additional problems. Once again, we do have to admit that the surgery, although giving some promising results, is  still evolving at this point and we choose to proceed with caution in the best interest of our patients.

—James Craigie, M.D.

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Filed Under: Ask the Doctor Tagged With: , , , , , , , ,

Why Microsurgical Breast Reconstruction?

March 22, 2011 by

The access to GAP and DIEP procedures is not widespread, only a handful of surgeons have invested the time to learn this intensely specialized microsurgical procedure, and have access to another equally qualified micro-surgeon to provide the required surgical assistance.

To give you an idea of how few of these surgical teams exist, in late 2007 we were one of only three practices in the country that offered simultaneous bilateral GAP reconstruction.  As a result, we see patients from all over the United States seeking this highly successful option, with 30 to 40% of our patients referred to us as a result of repeatedly failed implant reconstructions.

In a critical analysis of 142 GAP procedures published by six physicians at LSU, the GAP procedure is reported as “not easy to learn; however, it does provide a reliable flap and an excellent aesthetic reconstruction.”  The report further states “overall flap survival was 98%”and perhaps most importantly “patient satisfaction with the reconstructed breast and donor site has been excellent.”

A little bit about us:

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the right questions to ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions. Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • How many board certified physicians will be assisting with the first stage of the procedure? Will there be physicians in training (residents) involved with my surgery
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?
Filed Under: Ask the Doctor