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Archives for September 2011

Handling Breast Implant Infections: What You Need to Know

September 30, 2011 by

Dr. James CraigieThe below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

What is the usual process for handling infections with breast reconstruction when tissue expanders are used?

Infections can occur following any type of surgery. The risk of getting an infection after breast reconstruction is low because the immune system can help defend the body from bacteria if they have invaded and are trying to multiply. Antibiotics can also be used, specifically to fight different types of bacteria, following certain surgical procedures. These antibiotics are sometimes given preventively.

When an infection does occur it is because the defense mechanisms have been compromised and the invading bacteria grow. Specifically with implants the bacteria may enter through a wound healing problem. They attach to the implant shell and hide from the bloodstream that normally delivers the body’s immune response, as well as antibiotics.

The management of this type of infection is difficult and almost always requires removing the implant. When the infection resolves and the area is healthy, then it is possible to restart the process. Usually it is 3 to 6 months before it is safe to try another implant. It is occasionally possible to save the implant when the infection has been caught early and treated with antibiotics and surgery to wash the implant pocket and to put a new one in. This approach usually involves antibiotics for a long time and uncertainty about recurrence of the infection weeks or months later when the powerful antibiotics have been discontinued.

It is important to realize that the antibiotics may resolve the outward signs of infection at first, but it only takes the surviving bacteria hiding on the implant to restart the infection when the antibiotics have been discontinued. With each new infection the bacteria may become more difficult to control because of resistance to the antibiotics. At this point, it is usually my advice to consider a new option for breast reconstruction that does not involve an implant. Usually the skin and fat can be transferred from the tummy, buttock or thighs. This can be done without sacrificing any of the important muscles. In my practice, 30 % of my patients have had problems with implants and we can successfully replace implant problems with healthy tissue and obtain a permanent natural result.

—Dr. James Craigie

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Lowcountry Pink for the Cure Event Starts Soon

September 28, 2011 by

pink for the cureThe Komen Lowcountry Race for the Cure® is sponsoring the Lowcountry Pink for the Cure Window Display Competition 2011 to commemorate Breast Cancer Awareness Month. The group challenges local business to get creative and decorate their storefronts with the Race for the Cure’s® signature color pink.

Windows will be judged on their use of the color pink, their creativity, and their breast cancer awareness. Winners will be announced on ABC News 4 Lowcountry Live and the radio, and the grand prize-winning business will receive a live radio broadcast from their location.

Registration has begun, and all signups are due by Wednesday, September 21, 2011 at 5 p.m. Windows must be decorated by Friday, September 30, 2011, and remain decorated through the Komen Lowcountry Race for the Cure® on October 15, 2011. Photos of the decorations are due Tuesday, October 4, 2011, and judges will be visiting participating businesses in person. Winners will be announced on Friday, October 14, 2011, and the radio broadcast from the grand prize winner’s location will take place.

Participants may decorate their windows any way they choose, but they must display the Race for the Cure® poster.

Local sponsors for the event include:

  • Roper St. Francis Cancer Care
  • Roper Radiologists
  • TBonz Restaurant Group
  • TBonz Gill & Grill
  • Liberty
  • Pearlz
  • Flying Fish
  • Liberty Tap Room & Grill
  • Kaminsky’s Baking Co.
  • Rioz Brazilian Steakhouse
  • Bi-Lo Charities
  • Sherwin Williams

For more information about the event, visit http://www.komenlowcountry.org/komen-race-for-the-cure/lpftc-competition/.

Is your business going to participate?

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5 Tips for Improving Skin’s Appearance and Health

September 26, 2011 by

skincare tipsHealthy, beautiful skin is within reach of anyone, no matter the age. A few simple tips will help your skin heal itself and glow.

Reduce sun exposure.

While a certain amount of sun exposure is a vital source of vitamin D, spending too much time in the sun can prematurely age your skin. Don’t be afraid to spend 10–15 minutes in the sun without sunblock a couple of times a week. The more skin you can expose, the less time you need to spend in the sun. Be sure to use sunscreen, cover-ups, and hats if you’re out longer.

Increase antioxidants.

While antioxidants are added to some skin products, you also want to get them from your diet. Eating plenty of vegetables and fruits of all colors gives you a full range of antioxidants, which strengthen collagen and restore elasticity to skin. Other sources of dietary antioxidants include green tea, wine, coffee, dark chocolate, and grapeseed oil.

Eat more essential fatty acids.

If you’re getting the good fats you need every day, your skin will glow and your hair will shine. The best way to get these fatty acids is to eat real food, such as avocados, fish, and nuts. Some women keep their skin supple and moist by applying coconut oil or olive oil directly to the skin. Beware: a little bit goes a long way!

Read labels and reduce the number of products you use.

Beauty products are full of chemicals, petroleum, and preservatives. Many women are switching to gentler, more natural beauty products, such as goats’ milk soap. Read your labels, and consider switching to products with fewer ingredients.

Many of us are using the same products we used when we were young adults, and we may not need them anymore. For example, toner formulated for younger skin can be drying, while cleansers may be harsh. Don’t kill your skin—cleanse it gently and rethink the products you use, including all of your makeup. Do you really need them? Could you use a moisturizing cleanser and skip a separate moisturizer?

Try mineral makeup.

In addition to using the same skin care products we used 20+ years ago, we also tend to use the same type of makeup we did as youngsters. Mineral makeup covers as well as any other foundation—even if you have acne or rosacea—and it’s better for your skin because it’s not made from petroleum and doesn’t clog your pores. Mineral makeup has fewer chemicals, is easy to use, and makes your skin glow. It’s you, just better.

When buying mineral makeup, beware of the ingredient bismuth oxychloride, as it can cause irritation or itching.

What do you do to keep your skin healthy and beautiful?

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Mastectomy and Uneven Breast Size: What Are Your Options?

September 23, 2011 by

The question below is answered by Charleston breast surgeon Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

Because of failed implant / expander surgery (3rd degree burn damage) from radiation, I underwent a second reconstruction procedure with DIEP flaps earlier this year and a revision three months later. I have not yet had my nipples created. There is still about a cup size difference in my breasts as well as a hollow part of the cancerous breast at the top. Is this still able to be fixed as part of reconstruction procedure or do I have to live with this? Currently, I wear a prosthetic to try and even them out but it doesn’t take care of the hollow area.

Sorry to hear about your problem. If I understand you correctly, you had a mastectomy for cancer on one side and a prophylactic mastectomy on the other side, then had radiation to the cancerous side, followed by bilateral DIEP flaps.

A size mismatch in that scenario is fairly common, even when the initial flaps weigh the same, for a number of potential reasons. The cancer surgeons are sometimes more aggressive with their mastectomies on the cancerous side, and the radiation sometimes seems to cause loss of additional tissue volume. Additionally, localized fat necrosis can occur within one or both of the flaps, which would decrease their size.

As you might expect, there is no perfect one-size-fits-all solution for this. The easiest solution might be to lift the flap on the cancer side to fill the hollow part, and then reduce the other side to match.  Autologous fat injections to the areas of tissue deficiency are sometimes surprisingly effective and long-lasting, even in the face of radiation, but there is no way to tell if the fat will survive without just going ahead and trying it.

We have significant experience using the excess skin and fat, which many people have beneath their armpit to augment the upper / outer areas of the breast mound, using this tissue as a flap based on the 5th intercostal artery. This technique often carries the added benefit of lifting and rounding the breast mound. While we are not fans of using implants in the face of radiation, the presence of a healthy flap sometimes means a small implant to make up the size difference will be better tolerated. As a last resort, another perforator flap from another donor site could be added to the first flap, but we have rarely found this to be necessary.

I would advise you against having your nipple reconstructions until you are satisfied with the state of the breast mounds, because significant later work on the breast mounds may change the nipple position or orientation.

-Richard M. Kline, Jr. M.D.

Would you like your breast reconstruction question answered? Just ask us!

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Celebrating National Hereditary Breast and Ovarian Cancer Week

September 21, 2011 by
Image to the left taken from the FacingOurRisk.org website.

In the United States, at least one million people carry genes, such as the BRCA or breast cancer gene, that put them at risk for cancer. In 2010, a Congressional resolution created National Hereditary Breast and Ovarian Cancer (HBOC) Week.

From September 25–October 2, 2011, HBOC Week raises awareness of hereditary cancer and recognizes those affected, including those with a family history of cancer, ovarian and breast cancer survivors, and previvors, those with a high risk of cancer who have not yet developed it.

Previvor Day is Wednesday, September 28, 2011, and a free teleconference with inspirational speaker and previvor Merit Gest will be held at noon EST. This event will focus on empowering previvors to understand the complex choices they face and make decisions about their health. To register, visit http://meritgest.com/national-previvor-day-september-28-2011.html.

HBOC Week falls in the week transitioning from Ovarian Cancer Awareness Month to Breast Cancer Awareness Month. During HBOC Week, Passing the Torch Ceremonies across the country pass a ceremonial flame from an ovarian cancer survivor to a breast cancer survivor to commemorate the transition.

The group FORCE (Facing Our Risk of Cancer Empowered) is a community dedicated to fighting hereditary breast and ovarian cancer, and it has chapters throughout the U.S. Events during HBOC Week are scheduled by local FORCE groups and can be found at http://www.facingourrisk.org/events/HBOCWeekEvents.php. This year, chapters will be sponsoring walk / runs, film screenings, conferences, discussions, and charity events.

FORCE’s website offers the latest information and research on HBOC, and features webinars, books, and movies, as well as support to hereditary cancer victims and their families. FORCE holds an annual conference and HBOC forum during the summer, and focuses on cancer advocacy, education, and peer support. Visitors to the site will find inspiring artwork and blogs, a tribute wall, and the latest news about HBOC.

For more information, or to find out how you can help, visit http://www.facingourrisk.org.

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How to Keep Your Tresses Healthy and Radiant

September 19, 2011 by

healthy hair tipsHaving a healthy head of hair is easier than you might think. It all starts with your diet and ends with what you put on your hair. Following are a few tips to create the healthy hair you’ve always wanted.

Your hair is what you eat.

One of the easiest ways for doctors to see if their patients eat a healthy diet is to look at their hair. What you eat dictates how healthy your hair is from the inside out.

When it comes to nourishing your hair, get your nutrients from food, and use supplements such as multivitamins only as an insurance policy. Other concoctions that promise thicker, fuller hair don’t give your body anything you can’t give yourself through good food choices.

Eat a balanced diet of the following foods to nourish your hair:

  • Salmon, flaxseed, nuts, and seeds for omega-3 fatty acids.
  • Meat, dairy, and poultry for high-quality protein.
  • Fruits and vegetables, especially dark green and carrots, for vitamins A and C.
  • Nuts, seeds, eggs, and beans for trace minerals such as biotin and zinc.

If you eat a poor diet, your hair will suffer because it’s not getting the nutrients it needs.

Use a gentle shampoo and conditioner.

As it cleanses, shampoo strips the natural oils that make your hair shiny and healthy, so you put conditioner on it to bring back the shine and promote softness. Many shampoos have harsh detergents called sulfates, and two of the most common are sodium laureth sulfate (SLES) and sodium lauryl sulfate (SLS). These ingredients create the suds we’re used to, but they also cause  your hair to lose moisture and can fade color.

Sulfate-free hair cleansing can take many forms: sulfate-free shampoos, cleansing conditioners, and natural hair soaps. Any of these choices are much gentler to your hair, and you’ll be amazed at how much softer and healthier your hair looks and feels.

Try hair treatments.

Especially if you blow dry, curl, or straighten your hair, regular hair treatments can dramatically improve the look and feel of your hair. Your hairdresser can recommend treatments, and stores carry a large variety, ranging from hot oil vials to deep conditioning packs.

You don’t need to wash every day.

Women who switch from washing their hair every day to every other day report that their hair is stronger, silkier, and healthier than those who wash every day. It’s simply not necessary for most women to wash their hair daily. Often, women who believed their hair was oily find that after a short adjustment period, they are able to wash less frequently, and some use dry shampoo in between washings.

What do you do to keep your hair healthy?

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10 Questions to Ask Your Breast Surgeon

September 16, 2011 by

breast surgeryUndergoing any type of surgery is stressful. But the best way to reduce your fears, stresses, and concerns is to do your research and be prepared both before and after surgery. It’s important to understand possible complications during and after surgery, as well as details on the actual procedure.

For patients who are considering breast reconstruction surgery, it’s important to talk with your doctor about your concerns. Some of the most important questions to ask include . . .

1.     Why are you recommending this procedure?

2.     What are the risks? How do they compare with the benefits?

3.     How do I prepare for surgery?

4.     What type of anesthesia will I have?

5.     What happens during and right after surgery?

6.     Who do I talk to about breast reconstruction?

7.     How long will I be in the hospital?

8.     Are there possible complications?

9.     When can I go back to work and resume normal activities?

10.  What are the risks of lymphedema?

Did you find this post helpful? We’d love to hear from you in our comments section.

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Breast Cancer Survivor Shares Reconstruction Success Story

September 14, 2011 by

according to shirleyWe are so happy to share with you another In Her Words post, this time with Shirley Trainor-Thomas, a breast cancer survivor, Hodgkin’s lymphoma survivor, and reconstruction success story!

Shirley was a patient of ours at The Center for Natural Breast Reconstruction and we are delighted to share her story with you.

See below for the interview (*Don’t forget to download a copy of According to Shirley, a short story / information booklet written by Shirley about her breast reconstruction experience):

When you were diagnosed with breast cancer in your left breast, you chose to have a double mastectomy. What influenced this decision? In other words, what factors did you consider when deciding whether or not to have a double mastectomy?

“It’s not good, princess.” Those were the exact words Dr. Bob Flowers used when he called to tell me the results of my biopsy. I promptly informed him that it was not the right answer! And after I caught my breath, I asked what we were going to do about it. He said he would get me to a surgeon that very day. True to his word, my husband and I were in Dr. Stan Wilson’s office that afternoon and we started discussing options. I was a bit of a difficult case because many years ago I had Hodgkin’s lymphoma and radiation to my entire torso—which is what likely caused my breast cancer. There was a lot of discussion among physicians and tests that were taken to make sure we had all of the information we needed to make the best decision.

The waiting to get answers and opinions that would lead to a plan was excruciating. All I could think about was breast cancer and I spent endless hours on the Internet trying to learn everything I could about my diagnosis and choices. My husband and I were in a fog.

Long story short, it appeared that chemo and mastectomy was my option. But, Dr. Wilson wasn’t totally convinced chemo was the really indicated and sent my tissue to have the Oncotype test.   As we waited on those results, we were moving forward with the chemo option. On a Thursday evening, I was preparing for surgery to take place the next morning to have a port put in—and at 8:00 pm, Dr. Wilson called with the Oncotype results—they were great. We opted to not have chemo.

Because other cells in my breasts were described as “busy” by the pathologist, I knew there was a chance of cancer striking my other breast. Given the painful waiting and emotional impact we went through, my husband and I said that we need to eliminate the chance of having to go through this again. Playing into that decision was that I was aware of the DIEP reconstruction option. I’m lucky, not everyone knows about that option and most people have to do a lot of research to find it or the right surgeon. I knew right out of the gate that the only person I would allow to do this procedure was Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

2. What type of reconstruction surgery did you have and how do you feel about the results? Would you make the same decision again if you could go back?

I had DIEP. The great thing for me is that I went into surgery with bosoms and came out with bosoms—and a flat tummy. Bi-lateral mastectomy and reconstruction were done in one surgery.

Recovery was frustrating. As Dr. Kline kept telling me, “It’s a process.” No matter what he told me, I was convinced I would be back to normal in just a few weeks. Okay, so it took longer.  I got tired easily and couldn’t stand up straight for a while because of the stomach incision. But, my job requires travel and I was able to get on an airplane six weeks after surgery and get back to work.

My energy level took some time to return—it’s a big surgery. But, if faced with the same decision today, knowing what I know, I absolutely would do it again.

My bosoms are perfect.

Unfortunately, I didn’t have enough tummy fat to make them bigger than they were (my one chance—had I known, I would have eaten a lot more over the years!). Even my oncologist has marveled at how real they look and feel. But I would only allow Dr. Kline and Dr. Craigie to do it. I’ve read some horror stories online about women who went to surgeons who either weren’t trained properly or didn’t have the skill level needed for microsurgery. I actually communicate with women around the country to share my experience and to alert them that they really need to investigate their surgeon’s success record.

3. You decided to write a short story / information booklet about your breast reconstruction experience titled According to Shirley. Why did you choose to write this book and what do you hope readers will get from reading it?

I love Dr. Kline and his entire staff. But, when planning for surgery they gave me a booklet of what to do and expect. After going through the experience, I let them know they left A LOT of information out! It was written by medical professionals who never actually experienced the procedure. When I told them that the information was technically good, but needed to include more practical information, they said fine—write one. So I did. It’s really meant to give women a better idea of what to expect throughout the process and to keep positive about the experience.

4. What advice would you give to women who have undergone a mastectomy or double mastectomy and are unsure about natural breast reconstruction?

Research, research , research. Unfortunately, not all plastic surgeons will present options that they are not capable of providing, such as DIEP. Talk to several surgeons and get a feel for the success rate of the surgeon. Talk to their patients. It’s a major procedure. Women need to know how many procedures the surgeon has done and what his or her success rates are.

Have you downloaded your copy of According to Shirley? If not, click here.

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How to Address Stubborn and Chronic Back Pain

September 12, 2011 by

back painBack pain is not merely inconvenient; it can incapacitate you and make everyday living painful and difficult. Statistics show that 70–80% of us experience severe or prolonged back pain at some point in our lives.

In addition to pain relief creams and stretching exercises to do at home, your doctor can prescribe heat treatments, braces, and medications. If you have stubborn or chronic pain and are open to complementary or alternative therapy, you can manage back issues whether your pain is in the neck or upper, middle, or lower back.

Always keep your doctor informed about any complementary therapies you decide to try, and make sure that any professionals you work with are appropriately licensed in their fields. A simple Google search will tell you all you need to know about certification and licensure.

Yoga and Tai Chi

The slow, gentle movements in yoga and tai chi stretch your back muscles and increase blood flow, helping to reduce pain. No matter which part of your back hurts, your instructor will know at least one pose to alleviate pain—and you’ll feel relief in minutes. Yoga and tai chi require little to no equipment, so you can do them anywhere you have a little room.

Physical Therapy

A physical therapist will not only show you exercises to reduce back pain, but he or she will also show you how to move to keep pain at bay. You’ll discover how to get up from a chair, walk, bend over, and pick up items correctly. He or she will also discuss how good posture will help your back.

When you work with a physical therapist, you’ll have exercises to do at home as well as appointments for therapy in an office or hospital. Physical therapists use a range of equipment and tools, such as stationary bicycles and heated pools.

Massage Therapy

A good massage therapist will soothe your back pain while working on the muscles that are causing you to hurt. When you meet your massage therapist, describe exactly where the pain is and how sharp it is so he or she will know which muscles to massage. Often, therapists work with essential oils and salves to further decrease pain and relax muscles.

Chiropractic

Spinal manipulation is an excellent tool for realigning the body and reducing back pain, whether it is acute or chronic. As with physical therapy, your chiropractor may use a variety of tools to help you in the office and send you home with a list of exercises. Many people use chiropractors on a short-term basis, while others visit regularly even after the pain is gone.

Acupuncture

An ancient Chinese therapy, acupuncture involves very thin needles inserted in specific areas of the body to balance the flow of energy and reduce pain. Back problems, as well as knee and elbow pain, are commonly treated with acupuncture, though not everyone will respond to the therapy.

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Breast Reconstruction Surgeons Answer Your Questions About Reconstructive Surgery

September 9, 2011 by

reconstruction optionsThe question below is answered by Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

What is the difference between breast reconstruction and augmentation?

Breast augmentation is when you increase the size of a normal healthy breast, almost always with saline or silicone gel implants.

Breast reconstruction is restoring the form of a breast that has been damaged, partially removed, or completely removed. Breast reconstruction is almost always done after treatment for breast cancer, although there are some birth defects that can result in the need for breast reconstruction. Breast reconstruction can be performed with implants (the same ones used for breast augmentation), or with the body’s own excess tissue (usually from the abdomen or buttocks), thus avoiding the need to place foreign objects in the body.

What are the pros and cons of a DIEP versus a TRAM flap reconstruction?

The primary advantage of DIEP flaps over TRAM flaps is a far greater potential for preservation of rectus abdominus muscle function, since no muscle is removed with a DIEP, yet one or both rectus muscles is obligatorily completely sacrificed with every TRAM flap. Additionally, since the muscle does not need to be tunneled under the skin to reach the breast area with a DIEP, the shape of the inferior region of the breast can be better defined.

The primary advantage of the TRAM flap over the DIEP flap is that it can be done by one surgeon who does not have the skills or equipment (microscope and special instrumentation) to perform a DIEP flap. While TRAM flaps can sometimes be performed more quickly than DIEP flaps, this is not always the case, and is very dependent upon the skills and experience of the surgeon. In our practice, DIEP flaps are always performed with two fully-trained perforator flap surgeons present, which we believe contributes greatly to the success and timely completion of the surgeries.

Why don’t more plastic surgeons offer the DIEP procedure?

When the DIEP flap was originally presented by Dr. Robert Allen in the 1990s, it was frequently criticized as being too difficult for many surgeons to learn to perform easily. While many more surgeons now offer the DIEP flap, it is still more technically demanding for the surgeon than many other procedures, and can be quite difficult to learn without spending significant time with another surgeon who has considerable experience with the operation.

Do you have a question for the breast surgeons of The Center for Natural Breast Reconstruction? If so, we’d love to hear from you. Click here to ask us!

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