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Ask The Doctor – What is the risk of keeping older saline implants in?

October 17, 2014 by

<alt="saline implants"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had my breasts removed 25 years ago and I have saline implants in. I have discovered that one the right one has capsular constriction. It has become very hard, very round, very painful, and almost swollen under my armpit. If I let this go as is, what could happen? What are the risks involved?

ANSWER:  With saline implants, nothing much else is likely to happen, but the situation is not likely to improve on its own. If you had silicone gel implants, the gel could continue spreading through your tissue indefinitely. While this is not medically dangerous (doesn’t cause cancer or lupus or anything like that), it does “mess up” a lot of breast tissue, and I would encourage you to have it removed ASAP. With saline, there’s far less concern for ongoing damage. If you would like to have implant(s) removed and replace with your own tissue, that is our specialty, we do it routinely, and we would be glad to help you. But if you just wanted reassurance and can live with the present situation, you’ll be OK. Thanks for your question!

— Richard M. Kline, Jr., M.D.    

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

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October 15: BRA Day USA

October 15, 2014 by
BRA day usa ribbon

BRA DAY USA
Closing the Loop on Breast Cancer

It’s a fact: many women eligible for breast reconstruction following cancer surgery are not being properly informed of their options.

The Breast Reconstruction Awareness Campaign–a collaborative effort between the American Society of Plastic Surgeons, The Plastic Surgery Foundation, plastic surgeons specializing in breast reconstruction, nurse navigators, corporate partners, and breast cancer support groups–hopes to change this.

Statistics show:

  • Eighty-nine percent of women want to see successful breast reconstruction surgery results before undergoing cancer treatment.
  • Less than a quarter (23 percent) of women know the wide range of breast reconstruction options available.
  • Only 22 percent of women are familiar with the quality of outcomes that can be expected.
  • Only 19 percent of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.

 

Breast cancer does not discriminate, and while every journey is unique, all breast cancer patients have the right to know their reconstruction options. Click here to meet our team and learn more about our practice, success stories, and natural reconstruction surgery.

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How to Positively Support Someone Who Has Breast Cancer

October 14, 2014 by

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Hamed Saber

On average, 1 out of 8 women will get diagnosed with breast cancer. This statistic puts the harsh reality of this disease into perspective. Because you might not know how to react to a friend who says she has breast cancer, we put together some suggestions for you should this unfortunate situation happen.

Support her decisions

Having breast cancer means making a lot of decisions, and a lot of stress. For example, she may have to decide if she will get a lumpectomy, radiation treatment, or mastectomy. All of these things require research and an investment of time and energy.

In this scenario, you have to remind yourself that unless you’re a qualified medical expert, you are not in the best position to determine someone else’s life.

Instead, you can be of greater help by simply listening. Listen to her without judgement and let her share her ideas with you. Whatever she says, let her know you’re behind her all the way.

If you notice any strong emotional undertones to her words, support those too.

Go to appointments with her

One of the worst feelings to have when going through something difficult is feeling like you’re alone. Don’t let your friend go to appointments or meetings by herself. Simply being with her means a lot. If she says she wants to go alone, you could offer to drive her to and from the location. That’s a start, and it will help.

Be specific

Questions like “how are you?” and “let me know if you need help” are not as helpful as you think for a few reasons. First, she’s getting asked those questions by mostly everyone she knows.

Secondly, she might not know the right way to answer.

For example, if you ask her “How are you?” she might say, “I’m fine, thanks.” But the reality is she doesn’t want to talk about how she’s really feeling: sad, sick, and low on energy.

Instead, ask specific questions and make specific inquiries, like:

  • Let’s grab a coffee and chat this Tuesday, okay?
  • Can I come by and make you dinner tomorrow?
  • Let’s go see a movie this weekend!

Be a positive action-taker who goes beyond asking general questions. It will mean more to her than you know.

If you follow these 3 general rules, you will be a better supporter.

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Ask The Doctor – Can the breast cancer gene develop cancer in fat tissue?

October 10, 2014 by

flower-197343_640 (1)This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Can the breast cancer gene develop cancer in the resisted fat tissue? Is it best to not have any sort of tissue whatsoever in the breast area? I also know fat from the tummy area has been used in reconstructing breasts for 10 years with no known problems as yet, as another solution.

ANSWER:  There are two ways to transfer the fat – as a single large “flap” with its own blood supply, which has been done in one form or another since the 1980’s (most recently the DIEP), or as fat “grafts”, which means taking the small particles harvested during liposuction and injecting them into the breast area through a needle. “Flaps” are time-tested, and no ill effects have been observed. “Grafts” may well be just as safe when used in breast tissue, but don’t have the benefit of having been used for decades yet, so we’re not absolutely sure. For many years it was taboo to inject fat grafts into

For many years it was taboo to inject fat grafts into breasts, because people were afraid the fat would adversely affect the radiologists’ ability to interpret mammograms. A few years ago, a consensus was reached that there really wasn’t much impact on reading mammograms, so people began cautiously injecting fat into breasts for various reasons (reconstruction as well as cosmetic augmentation).

Since we began using fat grafts more, we have learned that it does some interesting things. Fat is potentially a rich source of stem cells, which can transform into different cell types under certain conditions. As one example, we have observed that fat grafts sometimes seem to produce remarkable beneficial changes in previously radiated skin, and this is thought to possibly be due to stem cell effects. On the other hand, there is at least one study purporting to show an increased risk of local recurrence when fat grafts are used to reconstruct partial breast defects after lumpectomy.

The study is controversial, but it has raised concerns among many surgeons about injecting fat into breast tissue in general. No one is quite sure what is potentially going on with stem cells in fat grafts, and no one is quite sure how they may affect residual malignant or pre-malignant cells in breast tissue. The potential ramifications are enormous, because while DIEP and other flaps are large, complicated procedures, fat grafting is extraordinarily easy, and a there is a lot of interest in it for that reason alone.

I haven’t read a good explanation of why fat transferred with its own blood supply (flaps) should behave differently than fat particles which induce a blood supply to grow into them (grafts), but that doesn’t mean there isn’t a difference. To complicate it further, when a flap is transferred (or even when a breast reduction is done), small particles of fat are de-vascularized initially but ultimately survive as grafts, yet no problems have been observed to date.

I realize now that you were probably just asking about flaps (maybe DIEP – of which we have done many hundreds). However, we do periodically get inquiries about fat grafting into breast tissue, and people sometimes want to know why we are so “behind the times” when I tell them we don’t do it.you were probably just asking about flaps (maybe DIEP – of which we have done many hundreds). However, we do periodically get inquiries about fat grafting into breast tissue, and people sometimes want to know why we are so “behind the times” when I tell them we don’t do it.

Hope this helps.

— Richard M. Kline, Jr., M.D.    

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

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10 Important Breast Cancer Facts

October 7, 2014 by

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Because October is Breast Cancer Awareness Month, we want to highlight the significance of this serious illness. Below you’ll find a list of 10 facts about breast cancer.

This post pairs well with our 10 Breast Cancer Fundraising Ideas post. If you want to raise money for awareness, the ideas we shared in that post will help get you started.

Now let’s go over these very important facts:

1. About 1 in 8 women born today in the United States will get breast cancer at some point. The bright side of this is women can survive breast cancer if it’s found and treated early. How? With a mammogram — the best screening test to detect signs of breast cancer.

2. Breast cancer is the most commonly diagnosed cancer in women. Each year it is estimated that over 220,000 women in the United States will be diagnosed with breast cancer.

3. Breast cancer is the second leading cause of death among women. It is estimated that over 40,000 women will die from breast cancer every year.

4. Men get breast cancer, too. Although breast cancer in men is rare, an estimated 2,150 men will be diagnosed with breast cancer and approximately 410 will die each year.

5. Breast cancer rates vary by ethnicity. Rates are highest in non-Hispanic white women, followed by African American women. They’re lowest among Asian/Pacific Islander women.

6. Genetics have a role in breast cancer. Breast cancer risk is approximately doubled among women who have one first-degree relative (mother, sister, or daughter) with the disease. On the other hand,more than 85 percent of women with breast cancer have no family history.

7. Breast cancer risk increases as you get older. Even though breast cancer can develop at any age, you’re at greater risk the older you get. For women 20 years of age, the rate is 1 in 1,760. At 30, it significantly jumps to 1 in 229. At 50, it’s 1 in 29.

8. It’s the most feared disease by women. Yet, breast cancer is not as harmful as heart disease, which kills 4 to 6 times the amount of woman than breast cancer.

9. The majority of breast lumps women discover are not cancer. But you should still visit your doctor anyway, even though 80% are benign.

10. There is so much HOPE! There are currently more than 2.5 million breast cancer survivors in the United States alone — and this number continues to climb each year.

It’s important to understand the facts about breast cancer, and learn how you can support loved ones and friends who are suffering from this illness, or have been affected by it. To learn more about breast cancer, you can download a PDF about the last 2013-2014 breast cancer facts from cancer.org.

To learn more about our mission, our practice, and our team, start here and meet our doctors.

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Ask The Doctor – Recovery After a Failed Implant Reconstruction

October 3, 2014 by

<alt='failed implant reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had breast cancer twice, and one of my breast implants got a bad infection. My implants had to be removed, and I’ve left them that way since. Now I’m 58 years old, and I’d like to have reconstruction. Is this possible for me at my age and after an infection?

ANSWER: Thanks for your question. While I cannot obviously make precise predictions about our ability to help you without knowing a little more, I can tell you that your situation is actually a very common one. Fortunately, a history of failed implant reconstruction has very little impact on our ability to subsequently reconstruct you with your own tissue, and we have successfully reconstructed many, many women in your situation. If you wish, one of us can give you a call to discuss your situation further, and we can go from there. Have a great day!

— Richard M. Kline, Jr., M.D.    

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

 

 

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Mammograms 101: What You Need to Know

September 30, 2014 by

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According to The United States Preventive Services Task Force, women aged 50 to 74 should get a mammogram every 2 years. As for women younger than age 50, they should talk to a doctor about when to start and how often to have a mammogram.

If you haven’t talked to your doctor about getting a mammogram, you should. When you get a mammogram, you’ll receive a low-dose x-ray that looks for irregularities in your breasts. Unlike a breast exam, an x-ray will uncover changes in breast tissue that cannot be felt or seen. All women have breast changes as they age. But without a mammogram, you don’t know if the differences in size, shape, and feeling is a natural occurrence or a result of something more serious.

 

How to Detect Breast Cancer ASAP

The best way to detect breast cancer is to get a mammogram and breast exam from a doctor. The earlier you take preventative measures, the better your chances of catching possible cancer and treating it. The faster your cancer is detected, the better your chances are of eliminating it.

 

What’s It Like to Have a Mammogram?

Mammograms are not an arduous process. Your doctor will place your breasts in a special x-ray machine. The machine will flatten your breast to get a clearer look at the tissue. The pressure may cause some discomfort, but any pinching that happens will only take place momentarily. Considering the alternative, a few seconds of minor soreness is worth it.

 

What Your Doctor Looks For

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Picture courtesy of the National Cancer Institute

If your mammogram is clear, then your doctor will let you know and you can breathe a sigh of relief. If you’re wondering what your doctor is looking for, here are some things she’ll look for:

  • Lumping of tissue. If you see a “building up” of tissue, this could be a sign that something’s irregular. If the lump has a clear edge, chances are it’s benign (at a very early stage). If the lump can’t be distinguished clearly, then it could be cancer.
  • White spots. There are two types of white spots you may see on your x-ray — one is normal and the other may be a sign of cancer.

 

How to Prepare for a Mammogram

Here are few things you can do to make your mammogram go smoothly:

  • Avoid unnatural products before your mammogram. The chemicals in deodorants and other hygienic products may disrupt the x-ray process. It’s best to not use any sort of make up, lotions, etc. when you proceed with your mammogram.
  • Schedule accordingly. The best time to make an appointment for a mammogram is one week after your menstrual cycle because this is when your breasts are the least tender.
  • Male or female. It’s okay to ask for a male or female doctor to conduct your exam if that’s what makes you most comfortable.
  • Don’t drink coffee. Also, skip the energy drinks or any other type of stimulant. Why? Because the caffeine my increase breast tenderness, which will make the x-ray process more painful.

 

Where to Get More Information

Contact the following organizations for more information about breast cancer and mammograms.

American Cancer Society

Phone: 800-227-2345 (TDD: 866-228-4327)

Breast Health Access for Women With Disabilities

Phone: 510-204-4866 (TDD: 510-204-4574)

Centers for Medicare and Medicaid Services, HHS

Phone: 800-633-4227 (TDD: 877-486-2048)

National Breast and Cervical Cancer Early Detection Program

Phone: 800-232-4636 (TDD: 888-232-6348)

National Cancer Institute, NIH, HHS

Phone: 800-422-6237

Susan G. Komen for the Cure

Phone: 877-465-6636

 

Photo Credit: kristiewells

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Ask the Doctor: Lymphedema and Lymph Node Transfer

September 26, 2014 by

<alt="3 pink roses"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I’ve had breast cancer and developed lymphedema after my mastectomy.  I recently heard about Lymph Node Transfer surgery.  Does it work?  I’m scheduled for a DIEP breast reconstruction, can it be done at the same time?

ANSWER: Lymphedema is a very difficult problem that results when a patient has had breast cancer and has to undergo surgical removal of the lymph nodes under the arm as part of their surgical treatment for breast cancer. There are other causes of lymphedema but our specific interest has been in patients who have had breast cancer.

Lymphedema can be a very debilitating process; it remains a terrible problem worldwide, for all types of reasons. There is still much to be learned about why some people develop lymphedema and others do not. It appears that lymphedema is directly related to several factors in our breast cancer patients. It is directly related to having the lymph nodes removed from under the arm and seems to develop from the scarring that occurs under the arm following mastectomy and / or axillary dissection.

Undergoing radiation of the arm or axilla increases this risk. However, there are many people who undergo removal of the lymph nodes and radiation that do not develop lymphedema. There are also people who have mastectomy, have lymph nodes removed followed by radiation, and don’t develop lymphedema until many years after their surgery. That is the main reason that patients are warned to pay particular attention to their arm if they have had removal of any lymph nodes.

It is also possible that someone could get lymphedema even after simply having a sentinel node removed. A sentinel node procedure (lymphadenectomy) is a way to examine the lymph node without having to remove more than one or two. The whole idea of examining only the sentinel node is to lower the risk for lymphedema, but even with the sentinel node procedure, there is still a chance of developing lymphedema. Our practice became interested in options to help breast cancer patients with lymphedema as we see many who are suffering from the symptoms of this process while undergoing breast reconstruction.

Our practice specializes in microsurgical free flap breast reconstruction utilizing skin, underlying tissue, and microscopic blood vessels that transport life-giving blood to the reconstructed breast. This procedure is commonly referred to as the DIEP if using the abdomen or a GAP if using the buttock tissue. The muscles of the abdominal wall are left intact as it is the removal of the muscles of the abdominal wall that can lead to problems in the donor area, like hernias and bulging, as well as a more involved extended recovery. The lower tummy wall is the most common area that we transfer and it’s also an area where lymph nodes are present. Therefore, over the first decade this surgery was being done, we would encounter lymph nodes in the area of the blood vessels, as well as fatty tissue.

It became obvious that we could transfer lymph nodes on the blood vessels as we refine our technique for microsurgery. Due to the lack of effective treatment for lymphedema, for years surgeons doing perforator flaps have taken on this challenge and are trying to come up with ideas and techniques to treat it. We began doing an extensive amount of research, spanning the globe, looking for information on procedures that may help these patients. In 2005, we formed a group known as the Group for the Advancement of Breast Reconstruction, known as GABRs, and we included members throughout the world who had had a unique experience with our type of breast reconstruction.

We encountered one individual who had 15-years of experience with what is now known as “vascularized lymph node transfer” for the treatment of lymphedema. Initially, Dr. Robert Allen had attempted lymph node transfer during breast reconstruction and the biggest concern was how to transfer lymph nodes from one area of the body to treat lymphedema but not to create lymphedema in the donor area. In 2006, the GABRs met in Beijing, China and invited Corrine Becker, a surgeon from France who had a long history of experience with vascularized lymph node transfer.

She presented her work and through communication and travel to Paris to work with her, members of the GABRs group began to gain experience and learn more of her technique. The biggest hurdle that we were able to overcome was learning how to select the lymph nodes that could be removed as the donor lymph nodes and use those for breast reconstruction without causing lymphedema of the leg. We spent an extensive amount of time discussing her techniques and reviewing her results, as well as her publications.

We then made arrangements for her to travel to South Carolina and actually performed surgery on our own patients with her as an assistant surgeon. Since that time we have been very encouraged by the results with vascularized lymph node transfer as an effective treatment for reduction of the symptoms of lymphedema. We feel very excited but yet are very cautious about all results. It is important that patients realize that this procedure is still evolving and that there are risks involved, but to date we have had very good results and no serious complications.

Improvement of symptoms with vascularized lymph node transfer can occur immediately; however, they also may take up to 2 years to be appreciated. In most of our patients, the indicators of success are different. For the majority, the goal was to improve the edema, lessen the need to wear compression garments on a regular basis, and to eliminate the risk for frequent infections, which are the typical problems that those affected by lymphedema experience.

In order to lower the risk for complications and to closely study our results in conjunction with other colleagues who perform this procedure, we prefer to perform vascularized lymph node transfer as an isolated procedure. It can be done at the time of breast reconstruction; however, there is a chance that some people with mild lymphedema who undergo breast reconstruction may have improvement without lymph node transfer. Therefore, in order to closely study our results, we perform the breast reconstruction first followed by vascularized lymph node transfer as the second step. When the results are complete, we can determine whether it was the reconstruction or the transferred lymph nodes that gave the end result. It is important again to reemphasize that the main risk for of the surgery is that the transfer may not work. It is possible that if the transfer did not work resulting in more scar, the lymphedema could worsen.

Thankfully, to date, we have not experienced this complication. Other complications are damage to the blood vessels under the arm or the nerves under the arm. Therefore, our preference is to have an oncologic surgeon, who performs axillary dissection, release the scar under arm.  At the same surgical setting, after the scar is released, we perform the transfer by removing very specialized lymph nodes from the outer and lower abdominal wall or outer upper leg. We preserve the lymph nodes of the inside leg. These are the ones that drain the lower extremity and therefore, we feel that the risk for lymphedema of the donor area is reduced.

At this point, we have received some very exciting results along with some mixed results and continue to follow our patients very closely. We have had no patients with any serious complications and no patients at this point with lymphedema of the donor site. We are hopeful that the future holds vascularized lymph node transfer as an effective option for people with lymphedema following breast cancer surgery.

We plan to continue to devote and focus our energies on a surgical solution while simultaneously not exposing people to excess risk of additional problems. Once again, we do have to admit that the surgery, although giving some promising results, is  still evolving at this point and we choose to proceed with caution in the best interest of our patients.

— James Craigie, M.D.

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

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Back to School: How to Keep Your Kids Focused

September 23, 2014 by

<alt="School Desks"/>In an age of instant gratification, it’s never been more difficult to get people to focus. Many adults have a hard time staying on track without distraction from phone notifications, email alerts, and people competing for our attention. Imagine how difficult it is for children and young adults in school to stay focused.

Youths today love their gadgets because these small devices give them an escape from their environment and access to a bigger world. There’s nothing particularly wrong with this concept. If you were growing up in the 21st century, you’d love your smartphone and Internet just as much, too.

As adults, we can provide guidance and teach our youth lessons about self-control. We can also pass along what we know about responsibility, so our children can stay focused in and out of the classroom.

Here are a few ways you can make a difference in someone’s life and help them focus, achieve, and learn.

 

Nurture Their Interests

 

Even the most timid child opens up when you find out what they’re interested in. Everyone has a natural gravitation toward a certain subject, topic, or hobby. Once you find out what that is, you can “unlock” a young person’s motivation.

Finding out what someone is interested in is simply a matter of paying attention. People naturally crave attention. Think about all the status updates you see on social media about the most mundane things. It seems silly, but that’s a perfect example of how we all want people to listen to us.

When you nurture the interest of a child, you can watch them develop the thing they like doing most. As I’m sure you know, it’s much easier to stay focused when you’re doing something you enjoy.

 

Regularly Schedule Family Time

 

There’s nothing more important than having a safe place to talk, share, and be yourself. Your home and your family is the best support you can provide for your child. Scheduling regular family time each evening keeps a consistent environment in place that nurtures you and your family, both physically and mentally.

For example, you could make 6-8 p.m. strictly family time. This means turning off the smartphones, TV, and any other distracting devices. Make it a time for a non-rushed dinner, conversation, and a family activity.

 

Keep Them Active

 

Kids get in trouble when they don’t have anything to do. A way to free a child from boredom is to keep them active in groups, sports, or activities. Not only will this keep them from getting in trouble, but they’ll also live healthier lives, develop social skills, and learn the importance of teamwork.

In a nation where obesity rates get worse each year, it’s important to keep your child physically engaged with at least one thing each day. Aim for 30-60 minutes of physical activity every day. It’s much easier to stay fit and healthy as you age if you learn the fundamentals of exercising as a child. Plus, when your child stays active, they can focus better on their schoolwork.

These are just a few ways you can promote focus and attention for your child. Do you have any of your own you’d like to share? Let us know in the comments!

Photo Credit: Night Owl City

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Why Microsurgical Breast Reconstruction?

September 19, 2014 by

<alt="pink flower"/>The access to GAP and DIEP procedures is not widespread, only a handful of surgeons have invested the time to learn this intensely specialized microsurgical procedure, and have access to another equally qualified micro-surgeon to provide the required surgical assistance.

To give you an idea of how few of these surgical teams exist, in late 2007 we were one of only three practices in the country that offered simultaneous bilateral GAP reconstruction.  As a result, we see patients from all over the United States seeking this highly successful option, with 30 to 40% of our patients referred to us as a result of repeatedly failed implant reconstructions.

In a critical analysis of 142 GAP procedures published by six physicians at LSU, the GAP procedure is reported as “not easy to learn; however, it does provide a reliable flap and an excellent aesthetic reconstruction.”  The report further states “overall flap survival was 98%”and perhaps most importantly “patient satisfaction with the reconstructed breast and donor site has been excellent.”

A little bit about us:

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the right questions to ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions. Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • How many board certified physicians will be assisting with the first stage of the procedure? Will there be physicians in training (residents) involved with my surgery
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

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

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