Ask the Doctor- Is it Possible to Remove my TRAM Flap?

This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I had tram flap surgery 5 years ago for one breast in Sacramento at Kaiser with the Chief of plastic surgery. I am experiencing horrible pain under my breast and around the side of the breast as well. It also feels like 1000 bees are stinging me all the time. It also feels VERY heavy and not a part of my body. I’m in constant discomfort and I HATE it. Is it possible to “just remove this tram flap altogether? I am miserable and wish I had never had the surgery!

Answer:   I’m sorry you are having so much trouble. Discomfort such as yours is very rare, especially when you are reconstructed with your own tissue, but unfortunately it can happen.

Firstly, I would advise you to discuss this with your original plastic surgeon, if at all possible.

It may well be possible to remove the TRAM flap, but there is unfortunately no guarantee that this will help the pain. Has the pain always been there, or is it new? Has the appearance of the reconstruction changed? Is there any drainage, redness, or other symptoms? Imaging studies, such a contrasted MRI, may be useful. While it is not always possible to determine the origin of pain, I think it greatly increases the chances of success if the situation is studied carefully prior to taking action.

I would be happy to discuss your situation further, if you wish.

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

Top 5 Must-Visit Seafood Restaurants in Charleston

 One of the most frequent questions we get asked at The Center for Natural Breast Reconstruction is, “What are the best Charleston seafood restaurants?”

It’s no surprise, considering we live so close to the ocean, which is filled with delicious fish, blue shell crab, clams, and oysters. Charleston is the perfect place to grab a dish filled with your favorite seafood while overlooking the very ocean it came from.

There are so many amazing restaurants in Charleston that it’s hard to narrow down which are the best. But, we thought we’d recommend a few of our favorites to help narrow down your choices.

Skip the Red Lobster, and give a few of these local places a try…

Hank’s Seafood Restaurant

Hank’s Seafood Restaurant is a very popular, award-winning restaurant that is located right in downtown Charleston.

Hank’s is open for dinner, and features all your favorite fresh seafood entrees including soft shell crab, grouper, and fresh tuna. It also has a raw bar where you can chow down on oysters, shrimp, and clams.

Hank’s is known for three of its signature dishes: the Lowcountry bouillabaisse, roast grouper with lobster risotto, and fish and shellfish ceviche.

Find out more about Hank’s here.

167 Raw

167 Raw has been voted Charleston’s best raw bar for years.

Although the restaurant is small, the delicious seafood is packed with big flavor. Right now, the most popular menu option is the lobster roll, which includes large chunks of lobster meat fresh from the sea, tossed with aioli and topped with chives.

Aside from the raw bar, guests can choose from menu items such as po boys, shrimp and fish tacos, tuna burgers, and more.

Find out more about 167 Raw here.

Bowens Island Restaurant

If you’re looking for incredibly fresh seafood, Bowens Island Restaurant is where you will want to go.

Bowens Island Restaurant is famous for its locally harvested oysters, fried shrimp, hushpuppies, and Frogmore stew.

On top of delicious food, this restaurant is situated on James Island and comes with beautiful views of the river, marshes, islands, and wildlife. It’s a wonderful place to grab a meal or a cold beer, and relax at the end of a long day.

Find out more about Bowens Island Restaurant here.

Charleston Grill

The Charleston Grill is one of Charleston’s most upscale restaurants and is a recipient of the AAA Four Diamond Award for food excellence. The restaurant’s head chef, Michelle Weaver, specializes in New South cuisine with a French influence.

As a seafood lover, you don’t want to leave this venue without tasting their creamed oyster and leeks, Charleston Grill crab cakes, or their Thai fish.

This restaurant encourages guests to abide by a semi-formal dress code—in other words no jeans, swimsuits, flip-flops, etc. For a meal this special, we recommend leaving the kids at home and enjoying a night out to this venue with your friends or significant other.

Find out more about the Charleston Grill here.

Fleet Landing

Fleet Landing is located right on the harbor and is one of Charleston’s best waterfront dining venues. Located in the historic district, it’s easy to access and is in a beautiful area.

The menu offers items for both surf and turf lovers. However, if you’re a seafood lover, you don’t want to pass on giving their famous shrimp pot pie, herb crusted baked cod, or Charleston shrimp and grits a try.

This location is relatively causal (men are required to wear sleeved shirts) and is a great place for families and friends to gather and enjoy a delicious seafood dinner together. Reservations are strongly recommended, so be sure to save yourself a seat before you head out for dinner.

Find out more about Fleet Landing here.

Do you have a favorite Charleston seafood restaurant?

Let us know in the comments below!

Ask the Doctor- I Am Thin, Mid-Sixties, and Active. Which is Better for Me — Saline or Silicone Implants?

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

Question: I’ve had a mastectomy on right side and am ready for breast reconstruction and enhancement on the left side. I am small framed,thin and a very active mid 60 year old. I am having trouble deciding on saline or silicone implants. My expander feels very hard and I don’t want that for implant.

Answer:   Thanks for your question. It is important for you to know that permanent implants (saline and silicone) are softer than the expander. Expanders are designed with metal ports and thicker shells so they can stand up to the expanding process. Silicone implants are definitely softer than saline filled and are generally preferred for breast reconstruction. My recommendation is that you ask your plastic surgeon to show you each type and let you feel for yourself prior to your surgery.

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

Summer Safety Tips for Kids and Adults

Between swimming, vacations, and being able to spend time enjoying outdoor activities, the summer months are fun for everyone! We certainly hope that you take some time this year to get out and enjoy them with your friends and family.

That being said, the summer months also come with certain risks–sunburns, dehydration, or suffering from an injury while enjoying an outdoor activity.

At The Center for Natural Breast Reconstruction, we want your family to stay safe, healthy, and happy. For that reason, we encourage you to check out some of our summer safety tips.

Water Safety

Family time at the pool, beach, lake, or water park should be fun.

Unfortunately, while water activities are a lot of fun, they can also be dangerous. Here are a few ways to ensure you and your loved ones stay safe around water.

Take swimming lessons—Swimming doesn’t come naturally to everyone and it’s certainly a skill that little ones should learn before diving headfirst into a pool, lake, or ocean. Community pools and places like the YMCA often offer swimming lessons. Join a class and brush up on your skills. And if you have kids, this is a great opportunity for them to learn water safety and how to swim.

Wear life jackets–Even the strongest swimmers should wear a life jacket when enjoying water activities such as boating, jet skiing, or tubing. Accidents can happen anytime. And, if for some reason, you ended up injured or exhausted and became unable to swim, a lifejacket would save your life.

Life jackets for small children are also a must…even if you’re just hanging out around the pool deck or dock at the lake. Drowning can occur in a blink of an eye. Protect your little one with a life jacket.

Don’t swim alone—Always enjoy water sports or a dip in the pool, lake, or ocean with a buddy. It’s important to have someone around in case you suddenly need help in the water.

Sun Safety

While the hot sun may feel good on our skin, it unfortunately has the potential to damage skin and even cause cancer.

Here are a few things you can do to keep your skin safe

Apply sunscreen—Anytime you go outside for an extended period of time, be sure to lather up with some sunscreen. If you’re sweaty or have been submersed in water, apply sunscreen more frequently as it can easily wash off—yes, even the waterproof sunscreens!

Wear a hat–Wearing a hat is an easy way to keep your face, scalp, and neck from burning. The skin on your face is particularly delicate, so it’s important to keep it safe and out of direct sunlight.

Limit your time outside—It’s important to take breaks during the day to get out of the sun. Keep watch of how much time you’re spending outside, and be sure to come in for cooldown breaks throughout the day.

Play Safety

There’s nothing better than a day of bike riding, hiking, or playing in the yard. But there are precautions you should take, even in the safety of your own neighborhood to ensure your kids stay safe while at play.

Wear helmets/safety gear—Every year people fall off bikes, scooters, skateboards, rollerblades, etc., and end up with broken bones, head injuries, and bumps and bruises. To prevent serious injuries, always hear helmets and other safety gear like knee pads.

Stay hydrated—An intense game of basketball or tag in the hot summer sun is enough to dehydrate you. Make sure you and your kids drink a glass of water every hour or so to stay hydrated and healthy.

Avoid heat stroke—Heat exhaustion can be very serious. Before you end up getting sick or passing out, make sure you take rest breaks in the shade, cool off inside, and drink plenty of water.

Do you have any summer safety tips? Share them in the comments below!

Ask the Doctor – Can a Radiated Breast Be Fixed and Can the Non Radiated Implant be Replaced To Match the Radiated Side?


This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I seeking information on reconstruction after radiation. The side that received radiation is very tight and now about 3 inches higher than the non-radiated implant. I have had two stem-cell surgeries and it is suggested to have another. Before going back to surgery for another stem-cell/fat transfer I want to know is there any other options that might help me. Can the radiation side be fixed? Can the non radiation implant be replace to match the radiation side?

Answer: Your problem is very common, unfortunately. Typically, with implant-based breast reconstruction, the radiated side will be harder, higher, less mobile, and often smaller than the non-radiated side.

Fat grafting around the implant is a reasonable and relatively innocuous way to address the problem, but is, at best, only variably successful. It is thought that stem cells within the fat may rejuvenate the radiated tissue in some fashion, and from my experience it seems this may in fact sometimes occur. Other times, however, fat grafting doesn’t seem to have much effect.

The most sure-fire way to address the problem is to remove the implant, and then reconstruct the breast with your own tissue, usually either with a DIEP flap (from the abdomen) or a GAP flap (from the buttocks). We have successfully reconstructed hundreds of patients with failed implant reconstructions by using their own tissue. Neither a history of radiation, or previous failed attempts at reconstruction with implants have any effect on the success of using your own tissue (98-99%).

There are some other recent developments which MAY (notice I said “MAY”) improve the success rate of implants in a radiated field. For the last 2-3 years, we have been performing our implant-based reconstructions by completely wrapping tissue expanders with acellular dermal matrix (Alloderm – processed cadaver skin graft) and placing them in FRONT of the muscle. Please note that if this is done in a patient who needs radiation, it is done BEFORE they receive the radiation.

Most of our patients who receive radiation are planning on having natural tissue reconstruction, and receive tissue expanders only as a temporary measure, as we do not ever want to subject a flap (natural tissue reconstruction) to radiation. However, we have noticed that some patients’ breasts with these Alloderm-wrapped implants remain surprisingly soft after radiation. Theoretically, the implant in a radiated breast could be removed, and an Alloderm-wrapped tissue expander or implant could then be placed (in front of the muscle if possible). I haven’t actually tried this (again, most of our patients in this situation just convert to natural tissue reconstruction), but theoretically it might provide some improvement over your present situation. On the other hand, it could result in a big mess if things didn’t work out well. However, even this would not impact your ability to subsequently have natural tissue reconstruction, if you decided to go that route.

Hope this helps a little bit. I would be happy to chat with you on the phone about your situation in more detail, if you wish.

Have a great weekend!

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

June Charleston Activities You Don’t Want to Miss


Between the beaches and historic sites, world-class restaurants and shopping galore, Charleston has a lot to offer. With so much constantly going on in this city, it’s easy to miss some of the best Charleston activities when they pop up on the calendar.
For that reason, we decided to share some of our favorite Charleston events that happen in the month of June. Regardless of whether you live here full-time, or are planning to visit, we hope you’ll add some of these suggestions to your itinerary if you’ll be around in the month of June.

Carolina Lady Anglers Fishing for the Cure Tournament – May 31 through June 4

The Carolina Lady Anglers raise funds for breast cancer every year with a Fishing for the Cure Tournament. This year, we are honored to be a Species Sponsor for the event.

This fun, family-friendly tournament is a great way to help an important cause while making many memories along the way. If you’re in the area, we encourage you to grab a fishing rod and sign up!
Each team that participates must select a captain to attend the Captain’s meeting on May 31, at 6:00 p.m. at Charleston Maritime Center. The fish weigh-in is on June 4, from 4 to 6 p.m. at the same location.
For registrations costs, prize details, and other info, please visit the Carolina Lady Anglers website.
Spoleto Festival USA – Runs through June 11
If you love art, music, and theater, the Spoleto Festival is an event you’ll want to put on your calendar.
Technically this festival started at the end of May, but it’s still in full swing. Live events for this festival will continue on through June 11, so be sure to find a day to enjoy the festival with your family.
Between art galleries, dance shows, theater performances, and more, there’s bound to be something at this festival for every member of your family—kids included!
Check out the Spoleto Festival calendar here.
Blues & BBQ Harbor Cruise – June 8, 15, 22, or 29
If you love ocean views and Lowcountry blues, you definitely need to get yourself signed up for a Blues & BBQ Harbor Cruise.
This dinner cruise is a wonderful way to experience Charleston while listening to the musical stylings of well-known blues pianist Shrimp City Slim and his band.
On this 2-hour cruise, you’ll enjoy a full all-you-can-eat BBQ buffet with access to a cash bar. Yum!
Find out more about tickets and pricing here. 
Sunset at Fort Sumter – June 9, 16, 23, and 30
Charleston is rich in history. So, if you’re here for a visit or live in town, we highly recommend spending an evening taking a step back in time with a Sunset at Fort Sumter tour.
On this tour, you will interact with period-dressed Civil War historians and learn about the Civil War. Once at the fort, enjoy the rich history provided by the National Park Service Rangers and spectacular views of the city, harbor, and Atlantic Ocean from the top of the fort.
This tour also includes a return cruise where you will relax and take in the spectacular views of the harbor and the marine life while dining on southern BBQ cuisine. Beer, wine, and cocktails are available for purchase at the fort and during the cruise.
Advance reservations are recommended. Call 843-722-BOAT to purchase tickets.
Moonlight Mixers – June 16
Moonlight Mixers is a family-friendly event that’s fun for both adults and children. All ages are invited to celebrate the arrival of summertime weather with some shag dancing on the Folly Beach Pier.
During this event, DJ Jim Bowers will keep your feet moving with the hottest oldies and beach music. This even runs from 7:00 p.m. – 11:00 p.m.
Admission is $8 per person when tickets are purchased in advanced online. On-site tickets cost $10 per person.
Purchase your ticket now!


Charleston Carifest – June 22, 23, 24, and 25

Charleston Carifest is a Caribbean Carnival celebration in honor of Caribbean American Heritage Month.
This festival is four days long and is full of food, fun, music, and costumes. When you attend this event, you will instantly be submerged in education and culture.
Join in on the festivities and embrace Unity in Diversity.
Visit the website for more information.

Do you have a favorite Charleston event you attend in June?

Comment below and let us know what it is!

Ask the Doctor – What Would Deem Breast Reconstruction Medically Necessary and How Much Does It Cost?

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

Question: Hi. I was wondering if you could answer a couple of questions. My first question is what would deem breast reconstruction medically necessary? My second question is how much would breast reconstruction and nipple reconstruction cost? I am a size B and have collapsed breasts. I used to be a double D. My nipples are also partially inverted.

Answer:  Breast reconstruction is generally regarded as being medically necessary if the breast is removed for cancer, or to prevent cancer in certain high-risk individuals. It sounds like what you are asking about would be considered cosmetic breast surgery. The most common cosmetic breast surgeries are breast augmentation (with saline or silicone filled implants), breast reduction, or breast lifting. What you describe as “collapsed breasts” could potentially be improved with a breast lift, breast augmentation, or a combination of the two.

Inverted nipples are caused by shortened ducts leading to the nipples. They are fixed by making a small incision adjacent to the nipple and dividing the ducts.

Gail in our office can give you prices for these procedures.

Thanks for your question.

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

3 Delicious Picnic Recipes for a Great Memorial Day Picnic

Every Memorial Day, we celebrate the courageous men and women who have died serving our country. If you’re a retired or active member of any of our armed forces, we thank you for your service!

On this special holiday, many people get their friends and families together and host a delicious picnic or BBQ. And while traditional burgers, potato salad, and watermelon slices are always good picnic staples, we thought you might like a few new ideas for your picnic menu this year.

If you’re hosting—or attending—a Memorial Day picnic, we recommend adding the following recipes to your menu to mix things up. We hope you love them!

Crisp Cucumber Salad

If you’re attending a picnic feast, chances are someone is already bringing your standard potato or green leaf salad. In an effort to not double up on the same menu item, we recommend giving this recipe for a crisp cucumber salad a try.

Not only is this a unique salad option, but it’s a cool and refreshing menu option for a hot day.


  • 2 cucumbers, thinly sliced
  • 4 scallions, thinly sliced
  • 1/2 small red bell pepper, chopped
  • 1/4 cup sour cream
  • 3 tablespoons white vinegar
  • 3 tablespoons sugar
  • 1 1/4 teaspoons salt
  • 1/4 teaspoon black pepper


1. In a medium bowl, combine cucumbers, scallions, and red pepper.

2. In a small bowl, combine remaining ingredients; pour over cucumber mixture.

3. Cover and chill at least 2 hours before tossing and serving.

Recipe Source:

Shrimp Burgers

A burger is a classic summertime picnic staple. Yet, as tasty as they are, you’re bound to get bored of the traditional ground beef burger—especially if you cook out a lot or are attending more than one picnic over the weekend.

This year, impress your seafood-loving friends with a new twist on a classic menu item and make them a shrimp burger.


  • 1 pound peeled and deveined medium shrimp
  • 1/3 cup panko breadcrumbs
  • 1 tablespoon lemon juice
  • 1/2 teaspoon kosher salt
  • 1/4 teaspoon garlic powder
  • 1/4 teaspoon freshly ground black pepper
  • 2 scallions, white and green parts, thinly sliced
  • 1 large egg, lightly beaten
  • 1/4 cup canola oil

Old Bay Mayo Ingredients:

  • 1/2 cup mayonnaise
  • 1 tablespoon Old Bay seasoning


1. Coarsely chop half of the shrimp.

2. Put the remaining shrimp in a food processor and pulse until smooth. Then, combine both shrimp in a large bowl with the breadcrumbs, lemon juice, salt, garlic powder, pepper, scallions, and egg, and mix.

3. Refrigerate for 10 minutes, and then form into 4 patties. Refrigerate 10 more minutes.

4. Heat the oil in a large cast-iron skillet over medium-high heat. Cook the burgers, about 3 minutes per side.

5. Make the mayo by combining the mayonnaise and Old Bay to taste in a small bowl.

Recipe Source:

Lime Margarita Bars

No picnic is complete without a tasty dessert.

These lime margarita bars are sweet, tangy, and salty and will be sure to please any palate. And don’t worry, despite the name, there is absolutely no alcohol in this dessert so they are 100% kid friendly!


  • 1 1/2 cups finely crushed pretzels
  • 1/4 cup sugar
  • 3/4 cup (1-1/2 sticks) butter, melted
  • 2 (14-ounce) cans sweetened condensed milk
  • 3 eggs, lightly beaten
  • 1/2 cup fresh lime juice
  • 4 teaspoons grated lime peel


1. Preheat oven to 350 degrees F. Coat a 9 x 13-inch baking dish with cooking spray.

2. In a medium bowl, combine pretzels, sugar, and butter. Press firmly into bottom of prepared baking dish.

3. Bake 8 to 10 minutes, or until crust is firm; remove from oven and cool slightly, leaving oven on.

4. Meanwhile, in a large bowl, combine remaining ingredients. Pour into cooled crust.

5. Bake 25 to 30 additional minutes, or until center is firm. Cool completely on a wire rack. Cut into bars and serve, or refrigerate until ready to serve.

Recipe source:

What’s your favorite picnic recipe? Share it in the comments below!

Ask the Doctor – What Can Be Done To Fix a Previous Radiated Breast with Implant?

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

Question: What can be done for a 2004 radiated breast with implant. As common, it has encapsulated to a high degree and is painful, misshaped and raised, looking very unnatural. Thank you

Answer:  Without question, the course of action most likely to work is to remove the implant and proceed with reconstruction using your own tissue. If you still have breast tissue remaining, it can be removed by a breast surgeon at the same time that your healthy tissue is transferred.

The most common source for the new tissue (the “flap”) is the abdomen, which is usually harvested as a DIEP flap. If the abdomen is not available or not adequate, then the buttocks (“sGAP flap”) can often be used. Our success rates over the last 13 years are 99.07% using the DIEP flap, and 95.7% using the sGAP flap. The initial surgery requires on average 4 nights in the hospital, but subsequent stages are much easier.

If you can’t or don’t want to use your own tissue, there are a couple of other options which may offer some hope, although the chances of success are nowhere near as good as using your own tissue. One is a course of hyperbaric oxygen, which has been shown to bring new blood vessels to the radiated tissue.

Another potential option, which must be regarded as experimental at this point, would be to completely cover the implant with acellular dermal matrix, or “ADM” (Alloderm being the most commonly used variety). This material has some efficacy in preventing contracture, but the effect would be less pronounced in radiated tissue.

Hope this helps. I would be happy to discuss your situation further with you, if you wish.

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

5 Fun Ways to Keep Cool This Summer

What’s not to love about summer? Bright sunshine, weekend trips to the beach, and indulging in cool treats like ice cream make this season by far one of the best.

The only downside…extreme heat.

We’ll take hot weather over cooler temperatures any day. But, after weeks of scorching heat, we’re ready for a cooldown.

Good thing there are a lot ways to keep cool when the temperatures are just too hot. If you find yourself stuck inside due to the heat this year, give our following favorite activities a try.

Go for a Swim

Swimming is a classic summertime activity.

Living in Charleston, we are lucky to have access to beautiful beaches that are perfect for swimming. If you live in Charleston, or plan on visiting, we recommend you go for a dip at the following beaches…

  • Folly Beach
  • Isle of Palms
  • Sullivan’s Island

If you don’t live near a beach, grab a summer membership to a local pool or gym that has a pool. Places like the YMCA are typically very affordable and even offer swim classes for kids and adults that want to fine-tune their swimming skills.

Whether you’re at the beach or pool, don’t forget to pack lots of sunscreen to keep your skin protected! It’s possible to get sunburn even when you’re in the water swimming, so be careful and always apply sunscreen!

Create a Cool Body Mist

Regardless of how hot it is outside, chores like mowing the lawn, gardening, and walking the dog still have to get done.

If you’re about to head outdoors for a few hours in the heat, we recommend bringing a cooling body mist spray with you. The following recipe is safe and chemical-free, and will help keep your body temperature cool.

Peppermint Body Mist Spray


  • 2 cups water
  • 2 peppermint tea bags


1. Boil 2 cups of water.

2. Steep 2 peppermint tea bags in the boiling water for 10 minutes.

3. Pour peppermint tea into a spray bottle and set in fridge. Do NOT add any sweetener or sugar.

4. Let peppermint tea sit in fridge for at least 1 hour.

5. Mist on body while you are outside to keep you feeling fresh and cool.

Go to a Movie

Movie theaters are notorious for cranking up the AC. That makes them the perfect place to cool down and get out of the hot sun.

Get your friends or family together, and make time to finally go to that movie you’ve been dying to see.

Treat your family to popcorn for dinner. (It’s ok to have some fun and have a treat for dinner every one in a while!) Not only will the kids love it, but you’ll be able to avoid turning your oven on to cook dinner when you get home so you can keep your house cool.

Set Up a Sprinkler

Call us old-fashioned, but there’s nothing better than running through a sprinkler on a hot summer day. And yes, adults, this activity is for you too!

If you don’t have a sprinkler, take a trip to your local garden center or home store. You can pick up a decent sprinkler for under $20 that can be used all summer long.

When you get home, simply change into a swimsuit, attach a garden hose to the sprinkler, and enjoy!

Indulge in an Icy Treat

Last, but certainly not least, is our very favorite way to stay cool—indulging in a tasty, ice-cold, refreshing treat.

If you’re an ice cream lover, head down to your local ice cream parlor. Love slushies? Take a trip to your nearest gas station. Or if you’re more of a smoothie connoisseur, grab your favorite fruits, juices, and yogurt, and whip up a refreshing smoothie.


What’s your favorite way to cool down in the summer? Let us know in the comments below!