Archives for March 2019

Ask the Doctor: Q&A

Q:

I am interested in DIEP and live in N.C., but before I go any further, I have questions. I’m a healthy, 43-year-old female; married with children; I work, and I’m a non-smoker. I was recently diagnosed with multi-centric DCIS in my right breast. MRI enhancing revealed a left breast lesion, and a biopsy will be scheduled soon. Genetic testing came back negative. A local plastic surgery consult indicated sufficient abdominal tissue to create a breast mound. My first question — who are the breast surgeons that your office works with? Would they do a sentinel node biopsy as my surgeon has recommended? Second, could the mastectomy and DIEP occur during a single surgery? Third, do you coordinate care with my current breast surgeon? I anticipate that if the lesion on the left is also DCIS, I would opt for a lumpectomy and radiation on that side since the area is small, and do it locally with my current breast surgeon. Finally, how would I start the process of moving forward with a consult with your office for DIEP?

A:

Hi, Kay,

Thank you for your question, I am sorry you have to go through surgery. It seems you have already gotten a lot of good information about your possible treatment and reconstruction. Our practice has specialized in breast reconstruction using natural fatty tissue and procedures such as the DIEP flap since 2002. My partner and I have performed nearly 2000 breast reconstructions using natural tissue with an overall success rate of 99%. We work with several breast surgeons who we collaborate with on every patient. We are also accustomed to patients having to travel to us from out of state and have had patients come from 48 of the 50 states. We understand the difficulties associated with what you are going through and our mission is to help people in your situation. You have some excellent questions so I will answer them in list format. 

1. Who are the breast surgeons that your office works with?

We work with multiple breast surgeons who we are familiar with and collaborate with to offer our patients the options that are best for each individual situation.  Drs. Megan Baker, Jennifer Fiorinni, and Jennifer Beatty are excellent breast surgeons who we work with. Would they do a sentinel node biopsy as my surgeon has recommended I have done? Yes, they would and frequently do prior to mastectomy to determine if radiation is needed after mastectomy.

2. Could the mastectomy and DIEP Flap occur during a single surgery?

Yes, absolutely! We feel this is very important to get the best result and to minimize the number of surgeries needed.

3.  Do you coordinate care with my current breast surgeon? I anticipate that if the lesion on the left is also DCIS that I would opt for lumpectomy and radiation on that side since it is a small area and would do that locally with my current breast surgeon.

Yes, we coordinate with our patient’s home breast surgeons. For what treatment is best we also rely on the opinion of the breast surgeon here. In your situation it may be best to consider possibly having both breasts removed and then reconstructing both at the same time with the same technique. That approach allows us to achieve better symmetry between the breasts. Sometimes after a lumpectomy and radiation, the breast can develop an abnormal shape that is not desirable and difficult — if not impossible — to match with the opposite breast. The problems might not surface until after radiation and are then nearly impossible to repair. When we use the DIEP flap, it is often available for each breast and therefore makes for a great match. We can discuss this more if you like.

4. How would I start the process of moving forward with a consult with your office for DIEP?

Just let me know if you would like to see me for a consult in person or make an appointment to talk over the phone. Most of the time, we can plan and answer questions before an actual visit in person. My staff can contact you to schedule an appointment and gather additional information.

I hope that I have answered your questions, let me know if you have other questions.

Thank you,

James Craigie, MD

CNBR

Finding the Right Surgeon

5 Key Attributes to Look for in a Plastic Surgeon

 

You’ve been diagnosed with breast cancer and had a mastectomy. Now you’ve made the important decision to have reconstructive surgery to rebuild your breast. Your next important decision is to make sure you have the right plastic surgeon to do the job.

Finding the right surgeon isn’t always easy. But you need to put the same time and effort into it that you would put into hiring a real estate agent to find you a home or finding the right school for your children. After all this is your health we’re talking about and you deserve the best.

So what should you look for when choosing a surgeon?

1. Make Sure the Plastic Surgeon Specializes in Your Procedure

Some plastic surgeons specialize in implants, while others do tissue flap procedures, such as TRAM or the newer microsurgical procedure, the DIEP flap. Perhaps you already had a reconstruction procedure and need it revised. You need someone who has extensive experience with revision surgery.  Ask how many procedures the surgeon has performed and the success rate for the specific procedure you are considering.

2. Make Sure They are Board Certified and Well Trained.

Plastic surgeons are certified by the American Board of Plastic Surgery (ABPS)  which means that they have completed residency training specifically in Plastic and Reconstructive Surgery at an accredited institution.  They have passed comprehensive written and oral examinations covering all plastic surgery procedures. You can visit the ABPS website to find out if your plastic surgeon is an up-to-date certified member.  Fellowship training in a specialized field such as Breast Microsurgery is desirable if you are considering muscle sparing autologeous reconstruction procedures such as DIEP, GAP, PAP etc.

3. Make Sure the Surgeon’s Record is Clean

There are licensing boards for each state where you can check a surgeon’s background for any malpractice judgments or disciplinary actions. Visit the Federation of State Medical Boards’ website for more information.

4. Make Sure You are Comfortable

Once you find a plastic surgeon that specializes in your chosen breast reconstruction procedure, make sure to meet and ask a variety of questions. For example, how many procedures have you performed? What is your success rate? What is your background? What will the surgery entail and what is recovery going to be like?

Even if you have done your research and know the answers, see if you are comfortable with how the doctor communicates with you during this meeting. Does the surgeon answer your questions thoroughly and address your concerns?  If the answers are off-putting or you feel uncomfortable in any way, that surgeon may not be the one for you.

5. Make Sure They Take Your Insurance

It might sound like an obvious thing to ask, but some surgeons will require that you pay out-of-network fees. You don’t want to be surprised with a big bill at the end of the procedure, so make sure that your plastic surgery procedure and the surgeon’s fees are covered at in-network rates by your insurance plan. Work with the surgeon and their staff to make sure everything is covered and you know all of the out-of-pocket costs prior to the procedure.

The Center for Natural Breast Reconstruction believes in good health for everyone. If you or someone you know is in need of breast reconstruction, contact them at NaturalBreastReconstruction.com or toll-free at 866- 374-2627.

Ask the Doctor: Q&A

Q: I had a lumpectomy and radiation for breast cancer. I would like to know if I can get reconstruction surgery.

Sincerely,

Ms. Jones

A: Ms. Jones,
Thank you for your question. You can absolutely get reconstruction after lumpectomy and radiation. Some of your options depend on the extent of deformity/radiation damage and asymmetry between breasts, and whether you want to proceed with a complete mastectomy.
If you are looking to just improve the appearance of your radiated breast, different things that can be done to adjust that breast to achieve a better cosmetic result and symmetry. Often modifying the non-cancer breast with a reduction and/or lift can create better symmetry.

With true breast reconstruction, you need a complete mastectomy for an implant or your own tissue to replace the breast mound. Implants are often not recommended for and do not work the best in a radiated breast, but it is not impossible. Having had a lumpectomy with radiation has no effect on your ability to have the breast reconstructed with your own tissue by using your abdomen, buttocks or thighs as the most likely donor sites.

We work with multiple excellent breast surgeons in our area who could do the mastectomy immediately followed by reconstruction in the same surgery. Depending on your overall risk and preference, you could also have the non-cancer breast removed and reconstructed, but we leave that decision up to you and your oncology team.

Our reconstruction procedures are most commonly a staged process that involves at least two surgeries to achieve something close to a satisfying result. We would be happy to meet you in the office for a consult with one of our surgeons, Dr. James Craigie or Dr. Richard Kline, to discuss your best options and give you more information on the different procedures. If you live out of town, we can often offer a phone consult first to help you better understand the process before you make a long trip here. We also can set up a meeting for you with a local breast surgeon on the same day as your consult with us if you are interested. Please let us know how we can best help you, and we look forward to hearing from you.
Sincerely,

Audrey Rowen, PA-C

Autologous vs. Implant

Benefits of Autologous Breast Reconstruction vs. Implants

 

If you had a mastectomy as part of your breast cancer treatment, you may be considering reconstruction to get back the look and feel of your natural breast. The two reconstruction options that patients normally choose between are autologous breast reconstruction and implant reconstruction.

Autologous breast reconstruction involves using your own tissue to recreate your breasts and can be done either when you have your mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). Autologous breast reconstruction typically involves multiple stages; however, implant reconstruction often requires several stages as well.

With autologous reconstruction, a plastic surgeon uses the tissue from another place on your body (called a donor site) — typically from your abdomen, buttocks, or thighs – to recreate natural looking (and feeling) breasts. Using microsurgery, the surgeons attach vessels from the donor site to vessels in your chest to provide adequate blood flow to your new breasts.

Many patients who undergo autologous reconstruction, after having implants placed previously, state that their new breasts look and feel more like their old breasts compared to when they had implants.

Women who need radiation therapy before or after their mastectomy may also want to consider autologous breast reconstruction instead of implants because of the higher rate of failure associated with placing an implant under radiated skin and tissue. However, it is important to note that radiation must occur before undergoing autologous breast reconstruction.

Whether you decide to have autologous breast reconstruction or implant reconstruction depends on several factors, including your age, health status, location of the tumor, previous surgeries, and the availability of extra tissue in your body. There are pros and cons of each procedure, so it’s important to talk to your doctor about which one is best for you.

Implant reconstruction carries its own unique set of risks. Risks include inflammatory reaction, leaks, and mechanical implant failures.  There is also a chance that excessive scar tissue can form around the implants (capsular contracture) and cause pain and malposition necessitating removal or revision of the reconstructed breast. Due to these possibilities, implants may have to be surgically replaced or exchanged at a later time.

The Center for Natural Breast Reconstruction believes in good health for everyone. If you or someone you know is in need of breast reconstruction, contact them at NaturalBreastReconstruction.com or toll-free at 866- 374-2627.