Archives for November 2018

Ask the Doctor – Bilateral Mastectomy

bilateral mastectomy

Q: I had a bilateral mastectomy on 12/11/2017 after chemotherapy for stage 3 breast cancer in my right breast with 10 lymph nodes removed. Expanders were inserted, and I had radiation treatment. I am now ready to get rid of these expanders and have reconstructive surgery. I am confident I want an autologous tissue surgery. I am on my 3rd plastic surgeon. I have concerns about going forward with my current surgeon since he has not shown me any pictures and does not talk about a “team” approach. I was interested in the PAP flap surgery since I have large hips and thighs, but he has only talked about doing the DIEP flap surgery or implants. He has other plastic surgeries (not breast reconstruction) that he specializes in his practice. I have never considered going out-of-state for medical treatment, and my work schedule is a concern. I want to know your thoughts about my situation and if I should go forward with my current surgeon. I have found your website to be a great source of information and encouragement. God bless you for all your doing to help!

A: The PAP is our 3rd line flap (after DIEP and SGAP). It is ideal in some situations, and yours may well be one of them, but it has a few potential downsides: 1) In MOST people, the flaps are fairly small, typically 200-300 grams (but you may be an exception); 2) The profunda artery perforator, while usually present, can be absent or very small. The preoperative MRI angiogram will determine this, however; and 3) If you have a donor site complication such as dehiscence, it’s difficult to manage due to the location and motion in area. One good thing about the PAP in contrast to the TUG (which we do not use) is that it involves few if any lymph nodes, and thus the risk of lower extremity lymphedema is minimal. We usually recommend the DIEP if you have a good donor site, but many people do not. Our DIEP success rate (after ~ 1350 flaps) is 99.0 percent. The SGAP—our next choice—is a good flap, although the dissection is difficult, which is why it is not performed in most places. This flap can be large, occasionally over 1000 grams in certain individuals. We have done about 270 of these flaps, most simultaneous bilateral, with a success rate of 94.8 percent. We firmly believe in the team approach, which was taught to us by Dr. Robert Allen— who was the pioneer of the DIEP, SIEA, and GAP flaps—and we would not have the amazing results we do without it. We never do flaps without two competent microsurgeons present. Thank you very much again for your inquiry. Please contact us if you need anything, and I would be happy to speak with you by phone, or see you in consultation.

Richard M. Kline, Jr., MD, East Cooper Plastic Surgery, The Center for Natural Breast Reconstruction, 843-849-8418, Fax: (843) 849-8419, 1300 Hospital Drive, Suite 120, Mount Pleasant, SC 29464.

I Tested BRCA Positive, Now What? 7 Things You Should Know

brca positive

If you have a family history of breast cancer and want to know if you’re at risk of getting it, too, a genetic test might provide the answers. A simple BRCA blood test can determine if there are changes in your genes, known as BRCA1 and BRCA2, which show you are at a higher risk of getting breast cancer. But what happens if your test results come back positive?

  1. A Positive Test Does Not Mean You Have Cancer: First, understand that a positive BRCA test result does not mean you already have breast cancer. Not everyone who is “BRCA positive” will get breast cancer down the road. There are many other factors that determine your ultimate breast cancer risk, including alcohol consumption, body weight, breast density, physical activity levels, age, and reproductive history, and this test result is just one. It is normal to worry about any positive test result, so the best thing to do is to inform yourself about what a positive BRCA test result means and what the next steps are if you test positive.
  2. A Positive Test Indicates You May Be at Risk: Statistics show a BRCA1 or BRCA2 gene mutation diagnosis means you have a 45 to 65 percent chance of getting with breast cancer by the time you turn 70. Remember, this doesn’t mean you will get cancer. It means you have a higher chance than someone else.
  3. A Positive Test May Alter Your Treatment: If you already have breast cancer, knowing you have a BRCA mutation may change your course of treatment as many breast cancers in women that are BRCA positive result in more aggressive tumors. Armed with this information, you should talk to your doctor about your current cancer treatment plan and determine what, if any, changes, should be made.
  4. You May Need Further Screening: If you have not been diagnosed, a BRCA positive test result should prompt you to create a screening plan with your doctor. You will probably have more breast screenings including mammograms, ultrasounds, and MRIs, starting at a younger age.
  5. Better Overall Health Improves Your Odds: Whether your test was positive or negative, taking steps to improve your health will reduce your risk of cancer. Eating right, not smoking, and avoiding the sun and other things that cause cancer help to improve your odds.
  6. You May Opt for Preventative Surgery: Depending on the genetic test results, your own health history and your current health, some women who are BRCA positive have undergone a preventative double mastectomy, which is the surgical removal of both breasts. It’s important to note that this reduces, but does not eliminate, your risk of developing breast cancer.
  7. You Need to Alert Your Family: Getting a positive BRCA test result naturally leads to concern about the breast cancer risk for children and other family members. Notify them of your positive results and talk to the genetic counselor about getting other family members tested.

To learn more about natural breast reconstruction and find out if it might be the right choice for you, contact The Center for Natural Breast Reconstruction at NaturalBreastReconstruction.com or toll-free at 866-374-2627.

Ask the Doctor – DIEP Flap

diep flap

Q:  I am weeks out from a unilateral DIEP flap procedure on my right side. Regarding the tightness and cramping in the abdominal area, is there any type of stretching or massage that can be done to speed healing and/or alleviate discomfort? Also, when can I begin to use moisturizers for scar reduction, and what type would you recommend?

A:  Good afternoon, thank you for reaching out to us. Those are great questions! Who was the plastic surgeon who did your DIEP procedure? It might be best to reach out to your surgeon about these questions since every practice has different recommendations. We tell our patients to leave the abdominal incision alone – to let it heal on its own – so we often discourage patients from doing any serious stretching or massage until a few months after surgery. It is OK to try standing up a little straighter each day, but you never want to force it. The tightness and discomfort will resolve on its own over time with little intervention. As far as the scars go, a lot depends on whether your surgeon feels you would benefit from having the abdomen redone at a later stage to remove scar tissue, lower the incision or remove extra skin for an aesthetically pleasing result. If you have the incision reopened, there is no reason to worry about the scars now. If you do not intend to revise the abdominal incision, then we recommend waiting closer to at least 2-3 months post-op before using any scar products.

I hope this was helpful. Please let us know if we can answer additional questions for you and we wish you the best in your recovery. Have a great day!

Audrey Rowen, PA-C, East Cooper Plastic Surgery, The Center for Natural Breast Reconstruction, Phone: (843) 849-8418, Fax: (843) 849-8419, 1300 Hospital Drive, Suite 120, Mount Pleasant, S.C. 29464.

The Many Choices in Breast Reconstruction Surgery

natural breast reconstruction

One aspect of a breast cancer diagnosis that requires careful consideration is choosing your reconstruction plan. Decisions about breast reconstruction can be emotional and confusing. Fortunately, you have several options from which to choose, but it’s important to know all the facts about each before you make a final decision that’s right for your body and your desired outcome.

If you choose to undergo breast reconstruction, you have the option to either have your breasts made from implants – saline or silicone – or from natural tissue flaps, which means they are made using your own skin, fat and muscle. There are pros and cons to each of these procedures.

Tissue Flap Reconstruction

Most women want to match the look and feel of their natural breasts, and there is a greater chance of successfully creating natural looking breasts by using tissue flap reconstruction. Using flaps to reconstruct your breasts will actually make them look and feel more natural compared to using silicone or saline implants. This is especially important as you age and your natural breast changes shape.

There are several types of flap procedures:

DIEP Flap: The most commonly used, DIEP flap procedure provides breast reconstruction and a tummy tuck all in one. That’s because this procedure uses your abdominal skin and tissue, but not your abdominal muscles.

PAP Flap: This flap procedure utilizes the tissues of your upper thigh to reconstruct the breast following your mastectomy.

GAP Flap: The tissue is taken from your buttock area, while the skin, fat and tiny blood vessels are removed through an incision that is hidden under your panty line.

SIEA Flap: This flap procedure is an option for the minority of women whose abdominal blood supply comes from the Superficial Inferior Epigastric Artery, which runs just below the surface of the skin.

Keep in mind that flap reconstructive surgery is a longer, more invasive procedure than having breast implant surgery. The good news is that flap reconstruction surgery hides the scars well from where your donor tissue was taken. It is also a procedure that does not need to be repeated in your lifetime, whereas silicone or saline implants may need to be replaced down the road.

Implant Reconstruction

When it comes to implant reconstructive surgery, you can choose to have the surgery at the same time as your mastectomy or at a later time. You can also choose saline or silicone implants. Saline are filled with a salt water solution. Saline implants start out deflated and are filled during surgery to the desired size. Silicone implants are pre-filled with a silicone gel.

Implant reconstructive surgery is less invasive than any of the flap surgical procedures, however they don’t provide as natural of a look as tissue flap reconstruction options.

There are other factors to consider when choosing a reconstruction option, including your current health status and whether or not you still need additional cancer treatment, such as radiation. Radiation can cause additional problems such as scarring that can cause delays in your surgery.

Discuss all of these options and their pros and cons with your surgeon to decide what’s right for you.

To learn more about natural breast reconstruction and find out if it might be the right choice for you, contact The Center for Natural Breast Reconstruction at NaturalBreastReconstruction.com or toll-free at 866-374-2627.