Archives for November 2012

Wound Healing Post Breast Reconstruction Surgery

The below question is answered by the Charleston breast surgeon, Dr. James Craigie.

How do you determine when to use a wound vac in place of a traditional drain?

We have discussed the idea of using a wound vac in place of drains.  We have actually determined the use for combining the wound vac and drains under certain circumstances.  Some people have had radiation or have challenging wounds that result from wound healing problems combined with fluid collections caused seromas.  Sometimes drains are needed to evacuate seromas but unfortunately they are not always adequate.  Also, radiated tissues have difficulty healing and wounds developed in radiated tissue sometimes typical wound dressings may not be adequate as well.  We have used the wound vac combined with the drain in order to treat these complex wounds.  We have found that complex wounds are usually a combination of wound separation with fluid collections.  The drain actually passes through the wound vac sponge, the wound vac sponge is then covered with the steel dressing that is connected to a pump and the strong negative pressure generated is greater than the pressure of a normal drain.  This allows a deep pocket of fluid to be dressed with the drain tip and the open skin edge or wound edge to be treated with the sponge.  When the wound vac dressing is changed every 3-5 days, the drain can be backed out slowly and therefore as the wound edge heals, the fluid collection is controlled and the wound eventually heals quicker than other approaches.

-James Craigie, M.D.

Get answers to your questions about breast reconstruction and breast health straight from our surgical team! Submit your questions here today.

 

Packing Guide: What to Pack in Your Hospital Bag for Breast Reconstruction Surgery

At The Center for Natural Breast Reconstruction, we know the key to a comfortable recovery begins with what you pack for your hospital stay. When preparing for your breast reconstruction surgery, pack the right things can give you some control over the upcoming experience, and can help you prepare mentally, physically, and emotionally. Consider what things may give you comfort and peace of mind, and take those items, along with an optimistic outlook.

Here’s our checklist for things you’ll need to bring along for breast reconstruction surgery, as well as some suggestions for items that will offer you comfort during your visit:

Prepare for Hospital Check-In. Get ready for your hospital stay, and make sure you bring everything you need for check-in paperwork. This includes:

  • Your identification
  • Your insurance card
  • Your checkbook
  • Admission papers (if applicable)

 Pack Relaxed, Easy Clothing. While packing for your return trip from the hospital, keep in mind that you may have surgical drains, dressings, and tender incisions. Make comfort your top priority when you choose your clothing to wear after your surgery, and bring along:

  • Loose tops that close in front. You may not feel like lifting your arms or pulling on anything over your head.
  • Elastic-waisted pants. Not only are these are easy to get into and out of, but also easy for someone to help you slip on.
  • Slip-on shoes with a good tread. If you don’t want to bend down and tie up shoelaces, have some slip-on shoes at the ready.
  • Post-surgical bra. Ask your surgeon which will be best for you—a supportive bra, or a sports bra. Look for a front-closure bra—it may have to fit over your dressings, and having the closure in front gives you more control over getting dressed.
  • Robe, slippers and warm, clean cotton socks. There’s nothing more comfortable than a soft bathrobe—and it’s easy to slip on and off without lifting your arms. And it’s always a good idea to keep your feet warm and covered!

Bring the Comforts of Home. Since you will be staying overnight in the hospital, bag up some soothing items that help you pass the time and give you a sense of reassurance, such as:

  • Your regular medications.
  • Your toothbrush, toothpaste, and deodorant.
  • A makeup kit and some skin lotion to help lift your spirits.
  • iPod with earphones so you can listen to your favorite calming music.
  • Novels or magazines to occupy your mind while you recover.
  • A journal, needlework or other items to keep you comfortable and busy as you rest in the hospital.
  • A small comfort pillow for keeping a seatbelt from pressing on your chest during the ride home.

Do you have other questions about how to prepare for breast reconstruction surgery ? Let us know in the comments section below!

8 Ways to Catch a Better Night’s Sleep

According to the National Institutes of Health, more than 40 million Americans suffer from chronic, long-term sleep disorders, and an additional 20 million report sleeping problems occasionally. Between work, family, and a wealth of other demands, many people struggle to shut out their stressful day  when it’s time to turn in. Fortunately, some factors that interfere with your sleep can be controlled.

If you’ve been daydreaming about a good night’s rest, then take a look at our checklist of things to do (or avoid!) before you hit the hay:

  1. Cut out caffeine. 6 hours before you turn in, it’s a good idea to switch to decaf. Though caffeine is well know for keeping us awake during the day, it is also linked to interrupted sleep during the night.
  2. Skip the booze. Or, at the very least, don’t drink alcohol 4 hours before bed. As the alcohol wanes from the body at night, it could pull you out of a much-needed slumber.
  3. No more exercise. Exercise stimulates us and can make it harder to fall asleep. When your blood is pumping, your heart rate is up, which puts your body in an active mode rather than a restful state. Try to do your workouts earlier in the afternoon and save the evening for more gentle practices, such as yoga or meditation.
  4. Reduce your fluids. An hour before bed, have a glass of warm milk (the tryptophan promotes relaxation), then cut off fluids. Otherwise, your bladder is likely to wake you up from an otherwise sound sleep.
  5. Turn off your computer. Painful as it may be, put your cell phone aside, too. The light from the screens reduces melatonin production—that magical sandman hormone that whisks us to dreamland. Besides, at this point, looking a work emails will only keep you wired (and stressed).
  6. Take a warm bath. After your skin warms, your core body temperature will drop, which triggers sleep.
  7. Relax. Thirty minutes before bed, read a book, listen to music, meditate, or simply get in bed and breathe deeply. These calming activities will unwind your body (and your mind) and help usher in sleepiness.
  8. Hit the lights. Once you adjust thermostat to 68 to 74 degrees—ideal sleeping temperature—turn off the lights. Darkness triggers the release of melatonin, the hormone that induces sleep. If it’s impossible to make your room completely dark, invest in an eye cover.

What helps you fall asleep?                                 

Breast Reconstruction Options To Correct Uneven Breasts

The below question is answered by the Charleston breast surgeon, Dr. James Craigie.

I had TRAM flap reconstruction in 2006 with revision and a follow up surgery in six months later. Since then some shrinkage has occurred in the reconstructive side and I have a hollow area on the upper portion. Do I have options for more normal looking breast without the hollow area?

You potentially have many options to improve your reconstruction. No one solution is perfect for all situations, but some options include repositioning the flap to a higher location, augmenting the hollow area with your own fat grafts (taken usually from abdomen, thigh, or buttocks), or using any excess skin / fat from under your armpit as an additional flap to lift and augment the TRAM (we call this a 5th intercostal artery perforator flap). Some more aggressive options would include placing a small breast implant under the TRAM flap, or adding a whole new microvascular flap from another area, although this is rarely in practice necessary.

Hope this helps. Please feel free to email or call with any additional questions.

Dr. James Craigie

The Center for Natural Breast Reconstruction

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

6 Tips for a Thinner Thanksgiving

Thanksgiving is one of the most challenging times of year when it comes to watching your weight. Temptations are everywhere—from that buttery bird, to the table glowing with homemade pecan pies and pumpkin cheesecake.

Check out these simple tips, and you’ll be ready to spare your waistline while still enjoying your family’s holiday feast.

Prepare a dish or two you can eat guilt-free.

Sure, vegetables are never the stars of Thanksgiving meals. However, if you make a lovely salad, butternut soup, mashed sweet potatoes, or creamed spinach, you can make sure you have healthy dishes to snack on throughout the evening. Besides, every table needs some color to spruce up the spread!

Don’t fast before the feast.

While waiting for the turkey to cook, it’s tradition to save our appetites for the main event. Yet, fasting throughout the day is an easy way to overeat once you sit down for the feast. Have a light snack before the finale so you won’t overindulge at dinnertime.

Decide how many drinks you can have.

If you decide to indulge in the festive beverages, be sure to decide how many you’ll have over the course of the evening and stick to it. Remember, every glass of wine, every bottle of beer, and each shot rack up the extra calories, so plan accordingly.

Follow the 30-minute rule.

Take half of the amount you really want to eat, enjoy it, and then wait 30 minutes before you eat anything more. It takes that long for your stomach to signal to your brain that it’s full. In that 30 minutes, you’re likely to get involved doing something else and won’t miss eating more.

Eat two or three bites of anything you wish.

If you can’t resist Aunt Millie’s Mississippi mud pie, have a small slice and eat just a couple of bites. You’ll get the taste you want without too many extra calories. The same applies to high-calorie drinks—take that raspberry margarita, enjoy three sips, and then give it to someone else.

If you overindulge, make up for it the next day.

Don’t skip meals, but if you overindulge one day, eat less the next couple of days, and be sure to make selections that are low in fat and full of nutrients. Also, make sure you drink plenty of water!

 We Hope Everyone Has A Happy Thanksgiving Holiday!

5 Delicious Ways to Get More Pumpkin in Your Life

That’s right, pumpkin. It’s not just a Halloween symbol or the star ingredient of your Thanksgiving pie. In fact, this magical gourd is any health nut’s dream. This often-underappreciated veggie is exceptionally low in calories and loaded with potassium, beta-carotene, and Vitamin A. Studies show that pumpkin prevents cancer and heart disease and protects eye health—which means your diet deserves a little more pumpkin.

Here are our five favorite ways to enjoy pumpkin and rack up the health benefits:

  • Roast whole pumpkins and use it in a variety of vegetable dishes. The roasted flesh makes a perfect base for a creamy, low-fat  fall-infused soup.
  • If you’re looking for a sweeter way to relish your freshly roasted pumpkins, you can blend the pumpkin flesh and add it in your smoothies. Another option is to puree the flesh with apple juice, brown sugar, maple syrup, cinnamon, and nutmeg, then boil the mixture to make fresh homemade pumpkin butter.
  • One of our favorite tricks for using canned pumpkin is to buy a box of cake mix, and instead of adding any milk or eggs, simply add one whole can of pureed pumpkin, stir with the mix, and bake! Not only is this a breezy way to make a sweet treat on the fly, but you also save good deal of calories and saturated fat by using pumpkin. Try it with a chocolate cake mix—the result is somewhere between a muffin and a cupcake. In a word, it’s heavenly.
  • Pumpkin pie may be more popular this time of year, but cheesecake made with a cup or two of canned pumpkin is the perfect combination of creamy, sweet and savory. Bake it all in a crust made of crushed ginger snaps and you’ll never want to eat your cheesecake any other way.
  • Perhaps best known for their role in prostate health, pumpkin seeds are nutritional powerhouses. Just scoop them out of the pumpkin, wash them thoroughly, season with sea salt, and bake in the oven at 375 for 10 to 15 minutes. These toasted seeds make a healthy snack  for only 187 calories per a one-quarter cup serving.

What are your favorite ways to enjoy pumpkin?

Could I Be A Candidate for DIEP Reconstruction After Implants?

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

I had a bilateral mastectomy and had 850cc silicone implants placed after tissue expansion. I am not happy at all with the result as I had radiation on the right side and that breast is considerably smaller than the left. I am also not happy with the shape and look of the breasts with silicone implants. I currently wear prosthetics in my bra to achieve symmetry and a normal shape. Even with the bra and the prosthetics I am not happy with the result. I am currently a D/DD and would like to maintain that size. Given this situation, could I be a candidate for a DIEP or Stacked DIEP breast reconstruction?

Thank you for your question. I’m sorry you are having some concerns about the shape and evenness of your breast reconstruction. Because you had radiation on the right side it is almost certain that the two sides will be different to some degree regardless of the type of reconstruction. Unfortunately, when this occurs with implant techniques it is usually more noticeable and nearly impossible to fix long-term as long as the implants are in place. The reason for this is the implants will be treated as foreign material by your body and the right side will always react more severely due to previous radiation even if radiation was done before the mastectomy. Also, the process of scar formation continues as long as the implants are in place, making the firmness, shape change, and stiffness more noticeable to you as time goes by. These are the reasons that women who have implant reconstruction have multiple procedures to revise results as time passes.

Fortunately when someone has had problems of this nature with implants we can frequently solve them by removing the implants and replacing them with their own fatty tissue (DIEP, stacked DIEP). We can do this without taking tummy or back muscles. Immediately the fatty tissue takes on a more natural shape compared to implants. Thirty percent of my patients have had failed implants before we start over and use their own tissue. My opinion and answer to your question is that you could have a DIEP to replace your implants and I can usually predict that many of the implant problems are much improved immediately after the surgery. I cannot predict what size you would be without seeing you but the size depends on how much extra tummy tissue you have as well as any previous surgery.

I hope I have answered your questions.

—James Craigie MD

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

The Best Home Décor Shops in Charleston

At The Center for Natural Breast Reconstruction, we’re always surprised by how a little decorating around the office breathes new life and energy into the space.

For those visiting Charleston, plan a little time to stroll through these fantastic galleries and shops, and let your imagination wander as you envision the transformation of your most-loved rooms. When you’re ready to revamp your interiors, these boutiques will help bring your ideas to fruition with elegant home décor:

Candelabra: Are your interiors in need of a contemporary flourish? Then you’ve come to the right place! Candelabra in Mount Pleasant offers an array of home décor and light fixtures to take any room from ordinary to fashionable. Take a look at their teal mirrors, sculptures, wall art, throw pillows, designer bookends, and beaded chandeliers, and you won’t want to leave empty-handed!

  • Elizabeth Stuart Designs:  For the connoisseur of fine home furnishings, this emporium is indeed a wonderland. Glowing with luxurious furniture, lighting, frames, candles, and paintings, you could easily spend an evening simply taking in the beauty of this store. ESD even offers work local artists, such as the Charleston painter Teil Duncan.
  • GDC Home Interiors: The original Gregorie, Douglas & Co. was founded in historic Charleston, South Carolina in 1781, and has offered gorgeous textiles, furniture, lighting, rugs, and garden décor ever since. Though all of their merchandise is exceptional, we recommend their hand-knotted carpets and the Algonquin Table Lamp!

    Image Above Taken From: www.shopcandelabra.com

  • Michael Mitchell Gallery: Just walking through the doors of this gallery is sure to leave you breathless—and inspired! Featuring original work from painters, sculptors, and glass artists, you can take home a one-of-a-kind piece to liven up your home. If you need an artist’s eye to truly capture the beauty of your spaces, gallery owner Michael Mitchell is also a seasoned interior designer.

Which of these boutiques have you visited in Charleston? We’d love to hear about the treasure you brought home!

Your Favorite Football Appetizers Slimmed Down

With football season in full swing, there’s no shortage of game day appetizers to tempt even the most diligent dieters. Fortunately, you don’t have to forego your favorite snacks to spare your waistline.

Check out these easy recipes that save you calories, but still retain their entire flavor:

Baked Wings:

Ingredients

3/4 cup all-purpose flour

1/2 teaspoon cayenne pepper

1/2 teaspoon garlic powder

1/2 teaspoon salt

20 chicken wings

1/2 cup melted butter

1/2 cup hot pepper sauce

Directions

Line a baking sheet with aluminum foil, and lightly grease with cooking spray. Place the flour, cayenne pepper, garlic powder, and salt into a resealable plastic bag, and shake to mix. Add the chicken wings, seal, and toss until well coated with the flour mixture. Place the wings onto the prepared baking sheet, and place into the refrigerator. Refrigerate at least 1 hour.

Preheat oven to 400 degrees. Whisk together the melted butter and hot sauce in a small bowl. Dip the wings into the butter mixture, and place back on the baking sheet. Bake in the preheated oven until the chicken is no longer pink in the center, and crispy on the outside, about 45 minutes. Turn the wings over halfway during cooking so they cook evenly. Makes 20 wings. (Recipe courtesy of Allrecipes.com.)

Spinach and Artichoke Dip:

Ingredients

1 (8 ounce) container reduced-fat sour cream
1 cup fat-free mayonnaise
1/2 cup chopped canned artichoke heart
1/2 cup frozen spinach, thawed, squeezed and dried
3 scallions, diced
1 teaspoon garlic powder
1 tablespoon sun-dried tomato, finely chopped
1 tablespoon asiago cheese, shredded

Directions

Preheat oven to 350 degrees. Combine ingredients in an oven-safe casserole dish, sprinkling cheese on top. Bake until heated through and cheese is bubbling; serve with veggies [] and baked tortilla chips. Serve and enjoy! (Recipe from .)

Guacamole:

Ingredients

1 large zucchini, cut into 1/2-inch cubes

1 large ripe avocado, cubed

1/4 cup coarsely chopped fresh cilantro

1/4 cup finely chopped onion

2 cloves garlic, minced

2 tablespoons lime juice

1/2 teaspoon hot sauce, such as Tabasco, or more to taste

1/4 teaspoon salt

Directions

Place zucchini in a microwave-safe dish, cover with a damp paper towel and microwave on High until tender, 4 to 5 minutes. Drain in a sieve, pressing lightly on the zucchini to extract any liquid. Transfer the zucchini to a large bowl; add avocado, cilantro, onion, garlic, lime juice, hot sauce and salt and coarsely mash until combined. (Recipe from Eatingwell.com.)

Nachos:

Ingredients

1 pound lean ground beef, I used 96%

1 cup onions, chopped

1 tablespoons garlic, minced

1 (1 oz) package taco seasonings mix

⅔ cup water

7 ounces reduced-fat tortilla chips, (about 100 chips)

1 (15 oz) can black beans, rinsed and drained

1 (4 oz) can Ortega fire roasted diced green chiles, see shopping tip

1¼ cups salsa, I like Pace Chunky Salsa, medium hot

1½ cups (6 ounces) reduced-fat cheddar cheese, shredded

6 tablespoons fat-free sour cream

Tabasco Sauce, optional

Directions

Preheat oven to 350 degrees. In a large pan or skillet, cook ground beef with onions and garlic until meat is browned. Stir often. Pour cooked meat into a colander in the sink and drain off all excess fat. Add meat mixture back to pan. Add taco seasoning, water and mix well. Bring to a boil, turn heat down to simmer and cook for 5 minutes.

Place the tortilla chips evenly on a large oven proof serving plate or baking sheet coated with a little cooking spray. Top the chips with ground beef mixture. Sprinkle beans evenly over the meat. Next, spoon over beans the fire-roasted chilies and then salsa. Sprinkle the cheese all over the top.

At this point, you can place in the fridge until you’re ready to serve it. When ready to serve, bake in preheated 350 degrees oven for 15 – 20 minutes until the cheese is melted and the nachos are hot. Dollop with sour cream and add a bit more salsa. If you really like food spicy, sprinkle a bit of Tabasco sauce over the top! Makes 12 servings. (Recipe from Skinnykitchen.com.)

Do you have a favorite slimmed down recipe to share? Tell us about it in the comments section!

What Is the Recovery Period for a DIEP Procedure?

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

Do you have breast reconstruction questions you want answered? Submit them here and get personal answers, straight from our doctors!!