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

Question:  I had a double mastectomy May 24, 2016. My treatment was 5 rounds of chemo and I have completed 9 of 30 radiation treatments. My radiation oncologist had told me that reconstruction can’t be done until 1 year post radiation. I was to start reconstruction at the time of mastectomy but due to 1 positive node that was not done. That was devastating to wake up to that news. I wanted to know if that is true since I have read that a lot of women get expanders and then have radiation. I want reconstructed as soon as it is possible. Any information would be appreciated.

Answer:  I’m sorry things have thus far not worked out ideally, but there is still an excellent chance you can have a satisfactory reconstruction.

Expanders are often put in at the time of mastectomy, whether or not radiation is anticipated, with the goal being to complete expansion before the initiation of radiation. After you are radiated, expansion becomes much more difficult, so much so that many surgeons (including us) will not even attempt it.

The good news is, radiation does not in any way impact our ability to do reconstruction with your own tissue (typically with DIEP flaps, sometimes with sGAP or other flaps). While most surgeons wait for 6 months after the completion of radiation to do flap reconstruction, it can sometime be done successfully as early as one month, depending on how healing is progressing.

I would be happy to call and discuss your situation in more detail if you wish, and thank you very much for your question.

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

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

Question:  I am having mastectomy in January; I would like to know about the TUG procedure – if it can be performed following a mastectomy or does it have to be done at the time. I should not be receiving chemo or radiation. My surgery is in Houston ( MD Anderson ). I live in the Nashville area.

Answer: We do not recommend the TUG flap under most circumstances. A significant incidence of lower extremity lymphedema has been reported following its use, and it is often not large enough to provide a satisfactory breast mound by itself. In addition, the donor site is prone to wound healing problems, and the donor site scars can be difficult to conceal.

Our first choice for autogenous breast reconstruction is the DIEP flap from the abdomen, which is a tried-and-true technique. If this donor site is not available, we recommend the SGAP donor site from the upper buttock. The sGAP can produce arguably the best breast reconstruction of any donor site, but is difficult to perform, which usually means the patient needs to travel to get the necessary surgical expertise.

The PAP (profunda artery perforator) flap, which comes from the “banana roll” of the posterior thigh, is our choice if neither the DIEP nor sGAP are available or adequate. It provides about as much volume as the TUG, but has far less risk of lymphedema, and a dramatically better donor site scar.

Any of these flaps can be done at the time of mastectomy or later, with the caveat that you never want to let a flap get radiated, as it can “shrivel up” dramatically. There are advantages to doing the flap at the same time, and advantages to waiting, but probably most of the time it is better to do it at the same time, if possible.

For completeness’ sake, it bears mentioning that if you are not receiving radiation, you may be able to get a satisfactory reconstruction with implants. However, even the best implant reconstruction does not approach the “naturalness’ of a reconstruction using your own tissue.

Thanks for your question, and good luck!

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

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

Question: I had a double mastectomy 5/2/16. The plastic surgeon placed expanders on both sides with the intention of doing reconstruction surgery in 6 months. I was diagnosed with pre-cancer stage 0 dcis in situ but genetic testing showed I was positive for the BRCA2 gene which led to the double mastectomy. The left expander had to be removed due to thin tissue that wouldn’t knit together and I had a wound vac in place for 10 days. I was thinking of getting natural reconstruction but since I have the right expander was told that it would have to be removed along with the dog ears skin on both sides. I am 64 and don’t know what to do.

Answer: I’m sorry you have had so much trouble so far.

You have already had trouble with implant (expander) – based reconstruction, and that could make it more likely that you will have trouble in the future with additional attempts at implant reconstruction. Fortunately, however, previous failed attempts at implant reconstruction almost never reduce the chances of having successful reconstruction with your own tissue (assuming that you are otherwise a good candidate for that).

Because you have had a somewhat complicated course thus far, apparently with some tissue loss, I would appreciate the opportunity to evaluate you in person, if possible, before giving you any more specific advice. We will give you our honest opinion about what we believe your best options are, whether using more implants or your own tissue, and then even of you just decide to have your expander removed, you may feel better about your decision. If you wish, we can have our P.A. Kim or nurse Chris call you to discuss your situation further.

Thanks for your question.

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

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

Question: I had breast reduction surgery a few months ago and have developed fat necrosis. I keep reading it may resolve, I’m scared it won’t! My right breast has a 4″ X 1.5″ area of it. Is that considered a large area? I’ve read that only small areas have a chance of resolving on their own. I keep massaging the area and applying heat. Is the icy hot patch a good option for heat?

Answer: Fat necrosis usually resolves on its own, but it is true that large areas may persist indefinitely. If the area is not painful, it probably does no harm, other than potentially complicating mammograms and breast exams. If it concerns you, however, you may wish to consider having it removed. There are no firm guidelines, but large areas persisting more than 6-12 months are less likely to go away on their own.

Thanks for your question.

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