Archives for March 2018

Ask the Doctor – Do You Recommend ADM for Support? Are There Other Options?

Tulips

This week, Dr. Kline, of The Center for Natural Breast Reconstruction, answers your question about breast reconstruction.

Question:  I underwent a left skin-sparing mastectomy for DCIS in 2010. I also had immediate free tram reconstruction. My entire lateral mammary and inframammary fold were removed. I have significant pain, rupturing of blood vessels on the skin and I have to wear a bra at all times. I have been told I need an ADM for support to the breast as well as tacking of mastectomy tissue to the chest wall. Is this the procedure you recommend for this or do I have other options? I need surgery ASAP.

Answer:  I’m sorry that you are experiencing these problems.

The options which you have mentioned, placement of ADM and suturing skin to the chest wall, may well be what you need, but it is impossible for me to say so definitively without first evaluating you in person. If you would like to (securely) send pictures for review this may be helpful, but, again, a final recommendation cannot be made without actually in-person assessing factors such as skin laxity (or lack thereof) and flap characteristics (consistency, shape, volume, etc). For what it’s worth, however, I have never personally encountered a patient with completely natural breast reconstruction with contour problems which required the placement of ADM to correct, but that doesn’t mean it can’t happen.

We have certainly had women travel to Charleston with complaints very similar to yours, and have successful surgery here. However, it may be worth your while to consult with other experienced surgeons in your immediate geographic area first, as the techniques we are discussing can ordinarily be competently performed by any capable plastic surgeon with significant breast reconstruction experience. If you decide to come here, however, we will be pleased to help you any way we can.

Thanks for your question, and have a great day!

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

The Center for Natural Breast Reconstruction Gives Answers to Commonly Asked Breast Reconstruction Questions

Having breast reconstruction surgery is a big decision.

It’s only natural that there may be many questions floating around your head about having this procedure. Questions like…

  • How much does the surgery cost?
  • Will my insurance pay for the surgery?
  • How long will it take me to heal and recover?

In order to get these questions answered, we highly encourage you to schedule an appointment with your doctor to get all the details.

In the meantime, however, our expert surgeons give some great insight into some of the most commonly asked questions.

Here’s what they have to say…

How Many Doctor Visits Does Reconstructive Surgery Take for Out of Town Patients?

Poinsetta

Our P.A. Audrey and N.P. Lindsey spend a lot of time on the phone with out-of-town patients (and their local healthcare providers) before we ever see them, making sure that nothing important is overlooked before you make the trip to Charleston.

At some point, our surgeons have a phone consultation with future patients, so that they will have an opportunity to directly ask any questions they wish.

We usually see out of town patients for the first time the day before surgery. On that morning, they get an MR angiogram at Imaging Specialists of Charleston and then bring the disc to our office to help us plan their flap.

We operate the next morning, and our patients usually spend 4 nights in the hospital.  You will typically follow up with your surgeon in our office 2 to 3 days after discharge.

We do our best to minimize the number of follow up visits by remotely managing post-operative care.  Travel is a significant risk factor for blood clots, which is a risk of the surgery (as it is for many other surgeries).

Keep reading…

Why Won’t Insurance Pay for Reconstruction?

Yellow Lily

Original Question: I don’t understand why the insurance company doesn’t pay for reconstruction if you’ve had a lumpectomy. With radiation, your breasts shrink a lot and you are all out of proportion.

Answer: Not getting insurance coverage is not always the case, especially with a lumpectomy.

If the surgery results in a significant defect or radiation negatively impacts the tissue, most times we can submit your case to your insurance company along with photos of the affected area, and they will indeed cover a reconstruction surgery for you.

Keep reading…

Would Reconstruction Be Successful for Me?

two white lilies

Fortunately, a history of radiation (and/or multiple failed attempts at implant reconstruction) does not at all decrease the success rate of subsequent reconstruction using only your own tissue.

We have successfully reconstructed hundreds of women who have had bad experiences in the past.

It is important to realize that natural tissue reconstruction is not just an operation, but a process. The first operation, the microsurgical transfer of the flaps, is by far the largest. It usually takes 6-8 hours, requires a 4-day hospital stay, and a total stay in Charleston of about a week. Recovery takes approximately 6-8 weeks.

After you have healed fully from the first surgery (usually 6 months if you have been radiated), 1-2 additional surgeries are required to achieve optimum results. These are much less involved, ordinarily requiring only one night in the hospital, and you can usually go back home as soon as you are discharged.

While the process can be lengthy, once you are done, you are REALLY done. Most women reconstructed with their own tissue come to regard their reconstructed breasts as their own, and are finally able to put the issue of breast cancer behind them.

Keep reading…

Do you have breast reconstruction questions? Send us your questions here!

Ask the Doctor – Can My Latissimus Flap Reconstruction Surgery Be Reversed?

This week, Dr. Kline, of The Center for Natural Breast Reconstruction, answers your question about breast reconstruction.

Question: I had that flap reconstruction 4 years after my mastectomy. That was 8 years ago. I’m in constant pain from the pulling in my chest. I hate that I can no longer paddle my canoe or swim.

I’m also having continued back problems that require the use of a chiropractor.

Can this procedure be reversed? I did not have any radiation or chemotherapy.

Answer: What type of flap did you have? It would be very unusual for a free tissue transfer (such as DIEP) to cause pulling, but not so unusual for pedicled flaps like a latissimus (or even a TRAM).

If you did have a latissimus, it could quite possibly be revised to improve your symptoms.

If you had a DIEP, it would require a little more investigation. Please let me know, and I’ll try to give you a more precise answer. I’d also be happy to chat with you by phone, if you wish.

Inquirer’s Response:

I believe it was a latissimus.

They used a portion of muscle from the side of my back, just a few inches lower than the armpit. The breast has also shifted slightly so that it isn’t centered in the chest anymore and is closer to the armpit.

In addition to the pulling pain in the chest, I’m having severe pain in the upper back, shoulders, and neck. I’ve also had recurring numbness and tingling in the hand and sharp pain shooting down my arm.

The chiropractor says that the realignment of the muscle will mean a forever battle of trying to keep the spine aligned and not pinching the nerve.  

Having the latissimus procedure is a huge regret for me. I wish I’d just had an implant.

The other breast just had a lumpectomy, rather than a full mastectomy. I have a small implant on that side that has never caused me any issues.

I want to know if the latissimus can be reversed and have an implant put in.

Answer from Dr. Kline:

I’m sorry you’re having so much trouble. That actually isn’t the norm for latissimus flaps, but it certainly can happen, as you know.

The latissimus can be transferred with or without dividing its motor nerve (thoracodorsal), and with or without dividing its attachment to the humerus (arm bone).

If the breast is shifting away from the center, that’s an indication that it may still be attached to the arm bone. If you have spasms, or intermittent pulling pain, it could be because the nerve isn’t divided, and the muscle is still functioning.

This doesn’t bother most people, but it definitely bothers some.

Sharp pain shooting down your arm (especially the inside of the upper arm) could indicate compression of the intercostobrachial cutaneous nerve, which lies in that area.

Offhand, I can’t think of an obvious anatomical explanation for your hand numbness and tingling, however.

Three muscles, the pectoralis major, the teres major, and the latissimus dorsi all attach to your upper arm bone at about the same place, and all pull the arm towards your body, but they each pull from a slightly different angle.

The latissimus is now rearranged to pull from the same angle as the pectoralis major. Usually, this does not cause a problem, but that’s not to say it never does.

It’s not really practical to actually “reverse” a latissimus flap, in the sense of putting it exactly back where it was. The flap can certainly be removed, however, and it is not at all unreasonable to think that that might help your symptoms.

In addition to perforator flap breast reconstruction, we also do implant reconstruction, but we shifted to placing the implant exclusively in front of the muscle about three years ago.

This can result in some visible rippling, but it has multiple benefits, including lack of animation deformity when the muscle is contracted, less chance of the implant coming out of position, less damage to the pectoralis muscle, and less discomfort.

Successful placement in front of the muscle is made possible by completely or nearly completely wrapping the implant in acellular dermal matrix (preserved skin, such as “Alloderm”), which heals to the tissue around it, and provides support.

While it may often be a very prudent decision to travel to see surgeons with extensive experience for complex procedures such as perforator flaps (DIEP, sGAP, PAP, etc.), simply removing the latissimus and placing an implant (or a tissue expander initially, which can be safer) requires no unusual skill, so I would recommend that you first consult your previous plastic surgeon, or another in your geographic area.

I would still be happy to speak with you about your situation, however, if you wish.

Have a great weekend, and thanks for your inquiry.

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

 

 

3 Healthy Slow Cooker Recipes That Make Cooking Dinner a Breeze

Crock pot Chicken

It seems that no matter who you are, what you do, where you work, etc., you’re always running out of time. And, when you’re strapped for time, this can make simple things– like cooking a meal–a real challenge.

If you’re tired of constantly reheating leftover pizza or cooking easy mac on your stovetop, you’re not alone.

We at The Center for Natural Breast Reconstruction desire to come home to hot, nutritious, home-cooked meals after a day at work. And, we’ve found a solution that will let us prepare meals ahead of time in order to achieve that goal.

The solution: Using a slow cooker to cook premade dinners while we work.

If you’re someone who works long hours, is always on the run, or who simply doesn’t want to have to think about cooking dinner every night, we hope you’ll give some of our favorite slower cooker recipes a try.

Enjoy…

Honey Dijon Chicken Recipe

Honey Dijon Chicken

The following recipe creates a family-sized portion of tender, juicy honey Dijon chicken.

We recommend that you cook up a side of rice or a vegetable, or grab some dinner rolls to turn this chicken dish into a complete meal.

Ingredients:

  • 2 lb. chicken breasts (4-6 depending on size)
  • 1/2 cup honey
  • 1/2 cup Dijon mustard
  • 1 tsp. paprika
  • 1/2 tsp. onion powder
  • 1/2 cup chicken broth
  • dash red pepper flakes
  • 1 gallon-sized freezer bag

Directions:

  1. Throw all ingredients into a freezer bag.
  2. Freeze for up to 3 months.
  3. When ready to use, thaw bag of ingredients overnight. Then, place in crockpot and cook for 8 hours on low.

Recipe Source: http://www.plainchicken.com/2014/08/freezer-meal-honey-dijon-chicken.html#dxRXwFhdo1ysjF8r.99

Honey Soy Pork Tenderloin Recipe

Honey Soy Pork Tenderloin

This mouthwatering honey soy pork recipe will feed up to 6 people.

If you’re cooking for 3 or less people, we recommend cutting the tenderloin in half and using the marinade ingredients to create two freezer bags’ worth of this meal.  

Ingredients:

  • ¼ cup olive oil
  • 1 cup chicken stock or broth
  • ¼ cup soy sauce
  • ½ cup honey
  • 3 tbs. Montreal Steak Seasoning
  • 2 cloves minced garlic or ½ teaspoon garlic powder
  • pinch ground ginger
  • pinch red pepper flakes (optional for heat)
  • 1 (2½ – 3 pound) pork tenderloin

Directions:

  1. Mix all ingredients together and throw everything into a freezer bag.
  2. Freeze meal. You can freeze this meal for up to 3 months.
  3. When you’re ready to use the freezer meal, spray your slow cooker insert with nonstick cooking spray.
  4. Set slow cooker for 6 hours on low setting.

Recipe Source: https://addapinch.com/honey-soy-pork-tenderloin-recipe/

Chicken Soup Recipe

Chicken Soup Recipe

You simply can’t go wrong with having hearty, warm, and delicious chicken soup freezer meals on hand for the days you’re chilly or not feeling well.

Grab a loaf of fresh bread on the day you plan to cook your soup, and you’ll have a hearty, wholesome meal that took little to no time and energy to prepare!  

Ingredients:

  • 1 1/2 lbs. boneless skinless chicken breasts
  • 2 cups carrots, peeled and chopped
  • 1 medium yellow onion, diced
  • 3 stalks celery, chopped
  • 3-4 cloves garlic, minced
  • 3 tbs. extra virgin olive oil
  • 1/2 tsp. dried thyme
  • 1 bay leaf
  • 6 cups chicken broth
  • 1 cup water
  • Salt and freshly ground black pepper, to taste
  • 2 cups uncooked wide egg noodles
  • 3 tbs. chopped fresh parsley

Directions:

  1. Throw all ingredients, except egg noodles, into a bag.
  2. Store in freezer for up to 3 months.
  3. When you’re ready to cook, dump ingredients, except egg noodles, into your crock pot and cook for 7 hours on low.  
  4. 10 minutes before you’re ready to eat, add in your egg noodles.

Recipe Source: https://www.familyfreshmeals.com/2014/10/best-crockpot-chicken-noodle-soup.html

What is your favorite slow cooker recipe? Let us know in the comments below!

 

Ask the Doctor: I am Ready for My Second Mastectomy. What are my Options and Can I do a Lymph Node Transfer at the Same Time?

purple crocus

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I am looking at reconstruction options after a right mastectomy in September, ready for other side mastectomy and reconstruction in June. I’m interested in lymph node replacement also.

Answer: We would be more than happy to help you any way we can. We work with several breast oncology surgeons, and routinely do immediate reconstruction with DIEP flaps, GAP flaps, or pre-pectoral implants (usually just local patients for implants, though, as they actually require more postop visits than flaps).

We usually don’t recommend doing lymph node transfer at the same time as flap reconstruction, because 1) doing the nodes at the same time entails compromises in the flap placement, the node placement, or both, and 2) placing a healthy unradiated flap will sometimes improve lymphedema by itself. We do, however, routinely incorporate lymph node transfer in second-stage flap surgeries, and that has worked nicely from a technical standpoint.

I would be happy to chat with you more about your options, or see you any time you would like to make an appointment.

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

3 Ways to Support a Friend with a New Breast Cancer Diagnosis

In the past, we’ve talked about how you can help someone who is in the midst of battling breast cancer.

It’s amazing how simple things like cooking a meal or sending a card can really make a difference in the life of someone who is undergoing treatment.

In this article, however, we thought it would be nice to give some advice on how to be a friend when someone is newly diagnosed with breast cancer.

After all, while a battle with breast cancer is certainly challenging, the initial shock of being diagnosed is downright difficult.

Many times, we are quick to jump in and say, “Everything’s going to be fine” out of the kindness of our hearts. But, that’s not necessarily true or helpful.

Keep reading to discover 3 powerful ways you can help someone who is coping with a new cancer diagnosis.

Be a Good Listener

Humans are verbal creatures, so sometimes it’s our natural instinct to start blurting things out like “You’ll beat this,” “You’re tougher than cancer,” or “Everything will be fine.”

But, in the midst of a new diagnosis, these words are very cliché and unhelpful.

No one knows what the future holds, and your friend has just started the battle of a lifetime. Now is the time to sit quietly and listen.

Take in what your friend has to say and only chime in when appropriate.

Don’t push for details on what type of cancer she’s been diagnosed with or how bad the diagnosis is. Your friend or family member will reveal that information if she wants to in her own time.

It’s possible that your loved one won’t want to talk about her diagnosis at all. Perhaps, she needs some time to get her mind off the matter and focus on other things.

Let your friend or family member direct the conversation.

Make Yourself Available

Processing a cancer diagnosis is mentally draining.

And, as treatments begin, a battle with cancer becomes physically draining as well.

This is why making yourself available to a friend who has been newly diagnosed is so valuable.

A friend or family member might need you to sit and talk with her as she processes her diagnosis.

Or she might just need you to watch her kids, walk her dog, etc., so she can get in a nap when she is feeling drained and exhausted.

Making yourself available to jump in and help whenever and wherever help is needed is one of the best gifts you can give someone.

It’s possible that your loved one will be afraid or embarrassed to ask for help. For this reason, be sure to extend the invitation to help so she doesn’t have to ask for it.

If your loved one declines the help, make it a point to let her know that you’ll always be there for her as time goes on in case she needs an extra hand later.

Be a True Friend

Being a true friend means being honest, open, giving, and readily available when needed.

It also means not gossiping about your friend’s recent diagnosis or sharing things that shouldn’t be shared.

We understand that it can be hard to not discuss your friend’s personal matters with others who are close to you. After all, it’s likely that you’ll need time to process a friend or family member’s cancer diagnosis, too.

But, it’s important to remember that your loved one who has been diagnosed is sharing difficult and often deeply personal information with you–information that she might not want shared publicly.

Always ask permission before you share information.

For example, you might be a part of a religious group that wants to pray for the friend or family member who has been diagnosed.

This is a lovely thing to do. But, before you tell your entire prayer circle about your loved one’s diagnosis, make sure it’s ok to share.

Your loved one who is battling cancer needs someone who she can confide in and depend on.

Be a true friend.

How have you supported a friend or family member who was diagnosed with cancer? Let us know in the comments below!

Ask the Doctor: Do You Take Medicare Replacement Plans for Breast Reconstruction?

This week, Gail Lanter, CPC Practice Manager, of The Center for Natural Breast Reconstruction answers your question.

Question: The worst part of my battle was with a Medicare Advantage Plan HMO. I’ve switched to a different plan and am thrilled with the way my breast cancer situation has turned out. We are not objects for the medical community. Most women would never initiate what I have had to go through. I am so thankful that I have gone the route I did.

Answer:  Thanks for reaching out. Sounds like things are going well for you, that’s great to hear!

We understand completely the problems many patients are having with Medicare Advantage (Replacement) plans, both the PPO and HMO’s. They are difficult and sometimes impossible to deal with from both the patient and provider perspective. We have decided that our practice will not accept new patients with a Medicare Replacement plan going forward for microsurgical free flap breast reconstruction procedures – only Traditional Medicare.

Maybe one day we’ll reconsider – but not until some significant improvement in both the provider service and claims processing areas within those payers takes place. It’s awful the way two of the top 10 largest insurers in the United States who offer Medicare Replacement Plans treat patients and their providers and it should be stopped.

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

5 Ways to Celebrate International Women’s Day This Year

Women are amazing.

From working full-time jobs and raising families to caring for those in need and having to deal with awful things like breast cancer, women are powerhouses.

We don’t let life get us down, and even in the midst of a struggle, we keep our heads held high.

For that reason, it’s no surprise that International Women’s Day, which falls on March 8, was established in order to celebrate women from all walks of life.

It doesn’t matter if you’ve won a Nobel Peace Prize, or if you’re simply the peacekeeper in your home.

You (and all of your lady friends) deserve to be recognized and honored.

During the week of March 8, we invite you to celebrate International Women’s Day with us.

Not sure how to celebrate? Check out some of the fun suggestions below!

Bake an International Women’s Day Cake and Host a Party

No celebration is complete without a cake!

This year, bake your favorite cake, decorate it, and then host a party for all your favorite gal pals. There’s nothing better than being surrounded by cake and good company.

If you’re worried about making enough dessert for everyone, ask your friends or family members to all contribute a small cake or dessert of their choosing. Doing this ensures you’ll have enough food and that everyone at your party will be able to enjoy their preferred dessert.

You could also ask people to contribute things like drinks, plates, or plastic silverware.

Volunteer at a Women’s Shelter

Serving women is one of the best ways to celebrate women. After all, many women are nurturers by nature and are great at loving on others and building them up.

The best way to serve…volunteer at a women’s shelter.

From homeless women’s shelters to domestic violence and abuse centers, there’s no shortage of places that could use a helping hand.

The best part…you don’t have to have a special talent or gift in order to volunteer.

Whether you’re serving a meal, helping with laundry, providing entertainment, or just spending time with someone who could use a friend to talk to, your presence will be greatly appreciated.

Gather up your girlfriends and make a day of it while giving back to the women who need your help.

Tip: Be sure to call around to your local shelters and women’s centers to see what they need help with. Some places might need volunteers, while others might need physical donations like blankets, soap, or food.

Enjoy a Chick Flick Movie Night Starring Your Favorite Female Leads

A long time ago, women’s movie roles were often limited to wives and love interests.

However, in the past few decades, women have really started to make headway in the film industry, taking the lead and starring as strong, independent, and intelligent characters.

For this reason, we think it would be fun to have your girlfriends and female family members over for a chick flick movie night that features female actresses.

Here are a few movie suggestions that feature female leads…

  • Thelma & Louise
  • The Wizard of Oz
  • Legally Blonde
  • The Help
  • The Heat
  • Miss Congeniality

Enjoy a Spa Day with Your Girlfriends

Every lady deserves a day of pampering. And what better way to be pampered than with a mani/pedi, massage, or new haircut?

In honor of International Women’s Day, get your best girlfriends together and make a day of it at the spa.

Splurge on the gel nails or foot massage–you deserve it!

Tip: Make your spa day even more extravagant by enjoying brunch before your appointment or lunch and drinks after your spa day.

Give Your Kids a History Lesson on Amazing Women

Harriet Tubman courageously led hundreds of enslaved people to freedom along the route of the Underground Railroad.

Marie Curie was the first woman to win a Nobel Prize for research on radioactivity.

Amelia Earhart was a fearless female pilot.

These are just three examples of amazing women role models that we should be teaching our children about.

In honor of International Women’s Day, we encourage you to talk with your kids about the brave, intelligent, and powerful women who have helped shape our country.

It’s so important that kids (especially young girls) understand that women can do anything that men can do.

How do you celebrate the women in your life? Let us know in the comments below!

Ask the Doctor – I Was Recently Diagnosed With Cancer. When Is The Optimal Time for Natural Reconstruction If Radiation Treatment Is Planned?

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

Question: I am a newly diagnosed cancer patient in Atlanta.  I am scheduled for a left side mastectomy a week from today.  Mammography and MRI found pretty extensive DCIS on the left side of the left breast extending to and abutting the chest wall.  I am likely to require radiation treatment because of the proximity to the chest wall.  My plan is to have a tissue expander put in at the time of surgery.  I cannot get myself comfortable with the idea of an implant although my plastic surgeon here has said I am too thin for a natural reconstruction procedure.  I am interested in revisiting this and/or maybe getting a second opinion after the mastectomy.  My question is when the optimal time for a natural reconstruction would be when radiation treatment is planned?  Should it be done at the same time as the mastectomy ideally or after radiation treatment?  Thank you.

Answer:  Hi and thanks for your question. Sounds to me like you are on track for doing things the right way. If you need radiation we would not want you to have natural tissue reconstruction until after your radiation treatment. Possibly 3 months after radiation is complete. In the meantime having the expander placed immediately after the mastectomy (same procedure). Then you can remove the expander later at the time of your natural tissue reconstruction. I would be glad to give you my opinion I frequently see patients who other doctors say they don’t have enough tissue. Frequently we can get a nice result with natural tissue. Let me know if you have other questions or would like to talk over the phone.

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