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Archives for December 2018

Ask the Doctor: Flap Surgeries

December 10, 2018 by

natural breast reconstructionQuestion: 

I had a bilateral mastectomy last December after chemotherapy for stage 3 breast cancer in my right breast and lymph node removal. Expanders were inserted, and I had radiation treatment that ended in the spring. 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 third plastic surgeon and I have concerns about going forward with this doctor 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) he specializes in at his practice. I have never considered going out-of-state for medical treatment, and my work schedule is a concern.

I just want to know your thoughts about my situation and if I should go forward with my current doctor. I have found your website to be a great source of information and encouragement. God bless you for all your doing to help!

Answer: 

Thanks for reaching out to us.

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 does have 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, is occasionally absent or very small. The preoperative MRI angiogram will determine this; and
  3. If you have a donor site complication, such as dehiscence (ruptured wound along a surgical incision), it can be difficult to manage due to the location and motion in the 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 around 1350 flaps) is 99.0 percent.

The SGAP, our next choice, is an extremely good flap, although the dissection is difficult, which is why it is not routinely performed in most places. This flap can be quite large, occasionally in excess of 1000 grams in certain individuals. We have completed 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. Allen, and we would not have the results that we do without it.

At The Center for Natural Breast Reconstruction, we never do flaps without two equally competent microsurgeons present.

Thank you again for your inquiry. Please contact us if you need anything, and we would be happy to speak with you by phone, or see you in-person for a consultation at any time.

Richard M. Kline, Jr., MD, 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.

Filed Under: Ask the Doctor

Seeing Friends and Family for the First Time Since Surgery

December 10, 2018 by

breast surgery visitorsThere is nothing like a support system to help you get through cancer diagnosis and
treatment. After you have surgery, your family members and friends will probably want
to stop by and visit. They may also want to cook for you, clean your home or just keep
you company as you recuperate.
While seeing friends and family can be a positive part of your recuperation, it can also
be overwhelming. You might not feel up to having company or you might feel self-
conscious about how you look. Here are some tips on how you should handle seeing
friends and family for the first time since surgery:
1. Talk About it Ahead of Time
If friends and family know when you are having surgery and want updates, use that time
to tell them what you expect about having visitors. For example, you—or the person
updating everyone for you—can say, “Mary is out of surgery and recuperating. If you’d
like to stop by and visit, please text or call us ahead of time so Mary can pick a time
when she’ll be up to enjoying your visit.”
2. Limit Time
Once you know when someone is going to stop by, it’s okay to limit how long they
spend with you. Visits can be fun, but they can be tiring. Let your friend or family
member know how much time you have to spend with them before you have to lay
down, change a dressing, etc. This is especially important for those who just drop by
without calling ahead of time. Feel free to say something like, “Thanks so much for
stopping by to see me. We can chat for a bit and then I’m going to lay down for a nap.”
3. Keep the Sick Away
You just had surgery and should be doing what you can to avoid getting sick. Let your
guests know that if they are germy or feeling under the weather in any capacity, they
should change their visit to another time. If they show up sick, it’s okay to tell them
you’re not feeling up to their visit and plan it for another time. For example, you can say,
“I’m excited to see you now that surgery is over, but it sounds like you’re getting a cold.
Can we reschedule your visit until you’re feeling better so I don’t catch it?”
4. Say No When You Need To
It’s okay to say no if you’re not up to having visitors on any particular day or only want
certain family members or friends to visit. This is your surgery recuperation and,
honestly, you have the right to handle it however you want. Simply say, “Thank you so
much for caring enough to visit, but I’m really not feeling up to guests right now. Can we
get together at another time?”
5. Don’t Let Feeling Self-conscious Get in the Way of Enjoying Visitors
Some women are self-conscious about having visitors, especially after surgery. While it
is normal to feel this way for a little while, think about who is visiting you and whether
they are worried more about how you look or how you feel. In most cases, your friend or
relative is there to see you and do what they can to help. They probably don’t care
about how you look, so it’s best to remind yourself why they are really there.
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.

Filed Under: Breast Cancer Awareness, Health and Wellness

Ask the Doctor: Phase 2 & 3 DIEP Procedure

December 10, 2018 by

diep flapQuestion: Hello! I’m currently seeking a surgeon for phase 2 DIEP. My plastic surgeon
here did a great job for phase 1, but doesn’t seem interested in correcting what I think is
a problem for phase 2. My breast size is currently a DD and I do not like the size. They
are heavy and my back hurts by the end of the day. I’m seeking a C cup. Also, my
abdomen is hard and bloated from underneath the breasts to just below my bellybutton.
This hardness makes it difficult to breathe. Is this something you have seen, and
something you could fix?

Answer: For one reason or another, we routinely work with patients who have had
phase 1 DIEP elsewhere, but end up coming to us for the “finishing” work. Of course,
we are delighted to help, no matter who has operated on you, and no matter what
condition you are in. Breast size certainly can be reduced; symmetry often can be
improved; and the donor site usually can be optimized. It is important to remember that
to obtain the optimal result, several procedures are commonly necessary. Typically,
each subsequent procedure decreases in length and complexity as the process
progresses. An average stage 2 scenario would include open revisions of the breast
mounds and donor site, and stage 3 would involve free-fat grafting to further refine the
shape of the breast mounds and lower body. While the initial flap transfer is obviously
the “big procedure,” we believe that the subsequent procedures are absolutely essential
to getting the results most patients to feel confident and pain-free.

Filed Under: Ask the Doctor

Opening up the Conversation on Family Cancer History

December 10, 2018 by

natural breast reconstructionAt the doctor’s office, you are given pages upon pages of paperwork to fill out about
insurance information, medications and past illnesses and surgeries. When you get to
the family history page it can be a bit overwhelming or you might even draw a complete
blank. Did your Aunt Mabel have breast cancer? You vaguely remember your father
telling you something about your second cousin’s diagnosis, but you can’t remember,
and now some family members aren’t talking, so the facts are elusive.
It’s important to open up the conversation on family medical history with your family
regardless of how difficult it may be. Why? Whether Aunt Mabel or your second cousin
had breast cancer is important to determining your own risk and your children’s risks.
With this information, you can make decisions about your own health, breast cancer
prevention and potential treatment, if you are diagnosed.

Unfortunately, starting a conversation with family about medical history, and especially
one about cancer, can often be difficult. While some family members may open up,
others may consider this private information, or they might get upset talking about
cancer. Others might not even know their own history.
So how do you find out what you need to know?
1. Make a List
Your medical history should include information from at least three generations of family
members — grandparents, parents, uncles, aunts, siblings, cousins, children, nieces,
nephews and grandchildren. Make a list of who you need to approach.
2. Explain What You’re Doing
Contact each family member – whether in writing, by email or by phone – and explain
that you are trying to obtain family medical history. If they are still reluctant to talk about
everything, try to ask specific questions about breast cancer. Some information is better
than none.
3. Ask Pertinent Questions
You should have a list of questions that you need answered. A complete family medical
history includes the age of the relative and any diagnosis or, if you are asking about a
deceased relative, the age and cause of death.
4. Keep it Confidential
Assure your relatives that the information you are compiling will be kept confidential —
and then keep it confidential.
5. Use Additional Resources
If your relatives are deceased or difficult to talk to, there may be other resources you
can use, such as public records – marriage licenses or death certificates.

Once you have all the information compiled, make sure you give a copy to your doctors
and update it regularly. They are bound by law to keep the information confidential.
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.

Filed Under: Breast Cancer Awareness, Health and Wellness