Archives for June 2017

This week, Richard M. Kline, Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I had a breast augmentation 12 years ago at the age of 21. I am now 33 and after having my son I went up another 1-2 cups sizes. I’m not sure what my options are but I would like the implants removed completely if possible. Do your surgeons only work with cancer patients? The reason I ask is while I’m not a cancer patient I do have health issues including severe osteoporosis and an undiagnosed connective tissue disorder. I really need a doctor that is knowledgeable about the effects of implants over time and how this could be possibly affecting me now or in the future. Thank you.

Answer:  Yes, we do a lot of cosmetic breast surgery, some on its own, and some as an adjunct to breast reconstruction.
There is no demonstrated statistical relationship between breast implants and systemic health issues, but this does not mean it cannot ever be an issue in a given patient (although it may be impossible to prove). If you want the implants out, there is no reason that they cannot come out. Of course, you MAY find the cosmetic appearance of the breasts less favorable without the implants, but some of your concerns could potentially be addressed with additional breast surgery, such as lifting. Sometimes procedures such as lifting the breasts can be performed at the same time the implants are removed, but other times it is safer to let the breasts heal for a few months, then return to do the additional surgery.

I would be happy to see you to discuss further, if you wish, and thanks for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: Why do expanders have to be used when breast are removed and the pocket is empty and ready to be filled with an implant?

Answer:  It is not always necessarily to place expanders at the time of mastectomies, but in many situations it is a safer choice than immediately putting in an implant. Even if the breast surgeon leaves the nipples and removes no skin at all, the skin is not always healthy, as the blood flow is invariably at least somewhat compromised after mastectomy. Placing an implant very poorly perfused skin would put additional pressure on the skin from within, and quite possibly cause skin to die that otherwise would have lived. With an expander, we have the option of placing no fill at all at the initial surgery, thus minimizing additional pressure on the skin. In actual practice, sometimes the skin’s blood supply is so poor we don’t even put in an expander right away, but rather return to the operating room several weeks or months later to begin reconstruction.

Having said the above, I do agree it is nice if the final implant can be placed under healthy skin flaps immediately. However, it should only be done under ideal circumstances.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I had tram flap surgery 5 years ago for one breast in Sacramento at Kaiser with the Chief of plastic surgery. I am experiencing horrible pain under my breast and around the side of the breast as well. It also feels like 1000 bees are stinging me all the time. It also feels VERY heavy and not a part of my body. I’m in constant discomfort and I HATE it. Is it possible to “just remove this tram flap altogether? I am miserable and wish I had never had the surgery!

Answer:   I’m sorry you are having so much trouble. Discomfort such as yours is very rare, especially when you are reconstructed with your own tissue, but unfortunately it can happen.

Firstly, I would advise you to discuss this with your original plastic surgeon, if at all possible.

It may well be possible to remove the TRAM flap, but there is unfortunately no guarantee that this will help the pain. Has the pain always been there, or is it new? Has the appearance of the reconstruction changed? Is there any drainage, redness, or other symptoms? Imaging studies, such a contrasted MRI, may be useful. While it is not always possible to determine the origin of pain, I think it greatly increases the chances of success if the situation is studied carefully prior to taking action.

I would be happy to discuss your situation further, if you wish.

 Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I’ve had a mastectomy on right side and am ready for breast reconstruction and enhancement on the left side. I am small framed,thin and a very active mid 60 year old. I am having trouble deciding on saline or silicone implants. My expander feels very hard and I don’t want that for implant.

Answer:   Thanks for your question. It is important for you to know that permanent implants (saline and silicone) are softer than the expander. Expanders are designed with metal ports and thicker shells so they can stand up to the expanding process. Silicone implants are definitely softer than saline filled and are generally preferred for breast reconstruction. My recommendation is that you ask your plastic surgeon to show you each type and let you feel for yourself prior to your surgery.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I seeking information on reconstruction after radiation. The side that received radiation is very tight and now about 3 inches higher than the non-radiated implant. I have had two stem-cell surgeries and it is suggested to have another. Before going back to surgery for another stem-cell/fat transfer I want to know is there any other options that might help me. Can the radiation side be fixed? Can the non radiation implant be replace to match the radiation side?

Answer: Your problem is very common, unfortunately. Typically, with implant-based breast reconstruction, the radiated side will be harder, higher, less mobile, and often smaller than the non-radiated side.

Fat grafting around the implant is a reasonable and relatively innocuous way to address the problem, but is, at best, only variably successful. It is thought that stem cells within the fat may rejuvenate the radiated tissue in some fashion, and from my experience it seems this may in fact sometimes occur. Other times, however, fat grafting doesn’t seem to have much effect.

The most sure-fire way to address the problem is to remove the implant, and then reconstruct the breast with your own tissue, usually either with a DIEP flap (from the abdomen) or a GAP flap (from the buttocks). We have successfully reconstructed hundreds of patients with failed implant reconstructions by using their own tissue. Neither a history of radiation, or previous failed attempts at reconstruction with implants have any effect on the success of using your own tissue (98-99%).

There are some other recent developments which MAY (notice I said “MAY”) improve the success rate of implants in a radiated field. For the last 2-3 years, we have been performing our implant-based reconstructions by completely wrapping tissue expanders with acellular dermal matrix (Alloderm – processed cadaver skin graft) and placing them in FRONT of the muscle. Please note that if this is done in a patient who needs radiation, it is done BEFORE they receive the radiation.

Most of our patients who receive radiation are planning on having natural tissue reconstruction, and receive tissue expanders only as a temporary measure, as we do not ever want to subject a flap (natural tissue reconstruction) to radiation. However, we have noticed that some patients’ breasts with these Alloderm-wrapped implants remain surprisingly soft after radiation. Theoretically, the implant in a radiated breast could be removed, and an Alloderm-wrapped tissue expander or implant could then be placed (in front of the muscle if possible). I haven’t actually tried this (again, most of our patients in this situation just convert to natural tissue reconstruction), but theoretically it might provide some improvement over your present situation. On the other hand, it could result in a big mess if things didn’t work out well. However, even this would not impact your ability to subsequently have natural tissue reconstruction, if you decided to go that route.

Hope this helps a little bit. I would be happy to chat with you on the phone about your situation in more detail, if you wish.

Have a great weekend!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!