Ask the Doctor: Q&A

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Q: I am an eight-year breast cancer survivor. I had a great breast doctor but my plastic surgeon botched my right breast. No implants – it was a latissimus dorsi reconstruction. My right breast is flat as can be, and I do suffer from scar tissue pain. I can be doing the simplest of things that should not cause pain, but the pain is excruciating. My current breast doctor tells me I will have to live with it. I’m so glad I didn’t have a procedure on my left breast. Do you ever come across patients with painful scar tissue? Would reconstruction repair the tissue? I’d love to hear your thoughts. Thank you for taking the time to read my note. It’s surgeons such as yourselves who give people hope!

GOD BLESS

 

A: Greetings!

I’m sorry you are having trouble with your reconstruction, both appearance and comfort-wise.

The latissimus flap is not commonly large enough to be able to provide an acceptable breast mound by itself. Traditionally, a breast implant is placed under the flap to provide increased bulk and projection. We also have found that sequentially grafting a patient’s own fat into the latissimus and surrounding tissue can sometimes provide an adequate breast mound, thus avoiding potential complications associated with breast implants.

Pain after breast reconstruction is fortunately less common after using your own tissue than after using implants, but it still can occur. It often can be difficult to determine what is causing the pain, but many times measures can be taken after careful assessment to improve the situation.

I would be happy to chat with you by phone in more detail about your situation, if you wish. Please let us know what we can do to help.

Sincerely,

Richard M. Kline, Jr., MD

Comments

  1. Renee Machat says:

    Hello, I am a 44 year old woman who recently moved to Atlanta. My mother is a two time breast cancer survivor; first incidence at 42 years old, and second at 65 years old. She tested negative for the BRCA 1 and 2 genes. I have been told that I have dense breast tissue and Because of my family history, that I should get MRI between mammograms. I believe my lifetime risk has been calculated somewhere around 25%. . I cannot imagine going through life getting tested every 6 months and going through the emotional turmoil of waiting for the results. I am also a huge hypochondriac and terrified of having MRIs unless it is absolutely necessary. I currently have large silicon implants that I’ve had for over a decade. I got my original implants at the age of 22 to correct tubular breast deformity. Following the implant surgeries I have zero feeling in my nipples. Because of all of this, I have decided that I would be most comfortable having a preventative nipple sparing mastectomy with reconstruction. Do I sound like a good candidate for this procedure? I am interested in moving forward with it this year and am looking for the right surgeon/surgeons who can perform the mastectomy and reconstruction preferably during the same surgery.

    • Thank you for your question Renee,

      I’m sorry to hear that your mother has had to deal with breast cancer twice and that you are having to make difficult decisions for yourself. I do understand your concern and recognize that a preventive nipple and nerve preserving mastectomy is the most effective way for you to avoid getting breast cancer yourself. I have had many patients explain to me that frequent MRIs and other close monitoring and imaging is a major quality of life issue. Frequent monitoring is not preventive but only helps to find breast cancer after it has developed not before. It is no surprise that some women do choose to be more proactive and have bilateral preventive mastectomies. Our practiced has helped many patients in situations similar to you. We specialize in breast reconstruction using natural tissue. For 17 years our practice has been focused on helping patients restore their bodies after preventive mastectomies and after breast cancer. In addition to using natural fatty tissue we also use implants in some circumstances. You should know that your breast reconstruction results with implants would not be like your current implants as having the mastectomy changes everything. The benefits of having preventive mastectomies and breast reconstruction is that almost always the results are the best possible. Without cancer present the breast skin, nipples and sensory nerves can always be preserved and there is no need for radiation or chemotherapy. After reviewing your question I see no reason why you would not be an excellent candidate for preventive nipple and nerve preserving mastectomies with immediate reconstruction. The reconstruction should always be started during the same surgery as the mastectomies. I would be delighted to discuss your situation in detail. Just let me know, we could talk over the phone if convenient. Of course I would be glad to see you in consult if you like. I know Atlanta is a drive but we have many patients from that area who have traveled to Charleston to have that very surgery. Thanks again for your question.
      Dr. James Craigie

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