July Q&A #2

I would like to learn more about liposuction or non-surgical liposuction around my abdomen and my thighs.
– Harmony

Hey Harmony,

Depending on your personal goals, both are great options for body contouring.

Trusculpt iD is a non-invasive option that offers fat dedication and skin tightening with minimal downtime. It’s Monopolar Radio-frequency platform tailors to patients’ individual needs and features Real-Time Temperature Control for clinically proven results, safety, and patient experience. In 15 minutes, truSculpt iD treats the entire fat layer, resulting in an average of 24% fat reduction.

Surgical liposuction is a more invasive method, with 1-2 weeks of downtime. It reshapes specific areas of the body by removing excess fat deposits and improving your body contours and proportion. Anesthesia is required for this procedure, but it is also safe and effective.

I would like to discuss this in more detail. If you’re interested please call 843-849-8418 to schedule a consultation. I am sure we can tailor a plan to meet your specific needs.

Thank you for reaching out. Hope to hear from you soon!

Dr. Lindsey Weaver, FNP-C

July Q&A #1

Q.I’m waiting to have surgery to take a cancer lump from my left breast. Then I will be taking radiation treatment. Will my breast be disfigured from this and will I be suitable to build my breast appearance with reconstruction surgery?
Judi

A.Hi Judi, Sorry you’re having to go through this. Management of a lumpectomy defect can be more complicated than reconstructing an entire breast after mastectomy. If you are sure you want to have a lumpectomy instead of mastectomy, then it may be best to have a plastic surgeon do reconstructive surgery on your breast at the same time as your general surgeon does the lumpectomy, before radiation, as the radiation will make any subsequent surgery to improve the shape of the breast much, much riskier (particularly regarding wound healing problems). If you would like to discuss your situation in more detail by phone, I would be happy to speak with you.

Richard M. Kline, Jr., MD

Coping after surgery

Surgery is a common method of treating breast cancer, but it can be overwhelming. There is so much to think about and you might be feeling scared, especially about how you will handle recovery. Here are some tips that we hope will help to make your recovery easier:

Prepare: Recovering from breast surgery really begins before you even have your surgery. It will take you a few weeks to recover, at least, so take time to brainstorm everything you do on a daily and weekly basis. What can wait to do until after you’ve recovered? What do you need help with on a daily or weekly basis? You will need assistance, but before you make any arrangements, figure out exactly what those needs are. For example, do you need someone to drive the kids to activities? Take the garbage out? Cook or clean for you? Help with laundry or taking care of your bandages?

Find support: Once you know what you need, it is time to create a support system. You might need someone to help you dress, undress and bathe until your doctors remove your drain, if you’ve had a mastectomy. Ask what your spouse can help with and see where there are gaps. Perhaps your children, a few close friends or relatives can alternate times to help you. Neighbors might offer to take your children to their activities, while your mom offers to cook and do the housework for you.

Stock up: Make sure to cook and freeze a few days or weeks worth of meals before surgery, so you have easy-to-grab foods and snacks. Eating healthy is important for your recovery too, so choose low-fat, highly nutritious options. Keep fruit, vegetables and water on hand as well.

Don’t forget that you may have an issue putting on your current clothes, so consider purchasing several shirts that are a little larger than what you currently wear and that button up in the front so they are easier to get on and off and do not rub against your incision.

Don’t overdo it: Everybody wants to get back to their regular routine after surgery, but it’s important for your recovery that you don’t overdo it. Get plenty of rest and sleep, especially in the first few weeks.

Follow post-surgery care: You will be given exercises to do after surgery, information on how to care for your skin and directions on what you can and can’t do. For example, you may not be able to shower for a week or go in a pool for several weeks. Make sure to keep your follow-up appointments too. To heal properly, be sure to follow all directions that you’ve been given.

Be observant:If you have a drain, keep an eye out for any excess blood, signs of infection or other problems. If you see something that doesn’t seem right, contact your physician right away.

Q&A: Ask the Doctor

Q: Hi, I was wondering if I would be able to schedule a phone consultation. I was recently diagnosed BRCA1 positive. I’ve been working with a breast surgeon and plastic surgeon and am interested in a double mastectomy with immediate DIEP reconstruction. After the initial consult with our local plastic surgeon, he thought this would be possible. In addition to that he wanted to do a mastopexy in preparation for nipple sparing mastectomy and DIEP. We did complete the mastopexy almost 4 weeks ago. At my last appointment, our plastic surgeon told us that he is not comfortable doing the immediate DIEP reconstruction after the mastectomy due to limited resources and being the only microsurgeon capable of doing this in my area of the Midwest. We are interested in looking into second opinion, as we would like to try and complete both surgeries in one step if possible. We are also wondering what a schedule or timeline to get in for this type of procedure would be. In the consult I would also like to discuss my journey so far, including screening results, and my past recommendations. Thank you!

A: Hi Laura, sorry you are having to go through this, but congratulations on having a great plastic surgeon. I’ve never met him, but I know he’s good because 1) he suggested /did the preliminary mastopexy, and 2) he is obviously putting your welfare first by referring you for bilateral DIEP.

We would be honored and delighted to help you through the next stage of your journey. I will be happy to discuss the details with you by phone as soon as it can be arranged.

Richard M. Kline, Jr., MD

Cool for Summer: Tips to Feel Confident in Your Summer Wardrobe After a Mastectomy

Baby, it’s hot outside! You want to feel cool and confident in your summer wardrobe, but you’ve been through a lot lately — your breast cancer diagnosis, surgery and now breast reconstruction. You might be feeling a little unsure about stepping out. Here are some tips to help you feel more confident in how you’re dressing post-reconstruction so you can enjoy the summer sun.

Don’t sacrifice your own sense of style and comfort.

You’ve gone through many physical and emotional changes since your diagnosis and having a sense of control is important to feeling more confident. So wear what makes you feel good. Do not think you need a new style or a new wardrobe to bring back your sense of self.

For example, you know that favorite summer t-shirt or sundress that you’ve worn for years because it brings back great memories? If putting either of them on makes you feel good, wear it. When you feel good, you will automatically smile and feel better about yourself.

Dress up another asset.

Feeling insecure? That’s fine. Accentuate a different part of your body for now. Got great legs? Draw attention to them. Or consider getting your hair done to invite conversation about that instead.

Wear the right bra.

It’s already a hot summer, so the last thing you need is to feel sticky and sweaty in your bra. What you wear underneath your clothes is just as important as what you wear on top of your clothes. You should wear a post-reconstruction bra that is soft and provides breathability. Fabrics like cotton make bras more comfortable on sensitive skin and any scar tissue that is still healing. Your current bras might not fit or may be uncomfortable as you heal. Use a company that specializes in post-mastectomy bras, such as Masthead Elizabeth Pink Surgical Bra. They will fit better after reconstruction which, in turn, will provide a much-needed confidence boost.

Find the right swimsuit.

If you have been given the all-clear from your doctor to go into the water, then make sure you’re prepared with a properly-fitted swimsuit. After reconstruction your breasts may not be the same size, so you may need to purchase one with a better fit. If you’re concerned about swimsuits that show scars, don’t be. Many companies offer post-surgical swimsuits that come with a higher neckline and more underarm coverage, so your scars should barely be noticeable.

Keep a positive attitude.

What you see as a breast cancer patient may differ from what others see. Your scars may not be as visible as you think and the change in the look of your new breasts may

not be as extreme as you think they are. It’s important to maintain a positive attitude throughout your entire journey. Then, it won’t matter if you wear a potato sack if you feel good about yourself. You’ll rock any look. Be comfortable and cool and the confidence will show.

Ask the Doctor: Q&A

woman sitting looking out in the distance in front of a lake

Q: I see post bariatric surgery plastic surgery referenced on your site. I didn’t realize you also offered these procedures. Which doctor cares for this? Thank you for any information you can provide.

Thanks,

M

A: Hello, M.

Currently, 90% of our activity is microvascular breast reconstruction. I did a lot of post-bariatric surgery some years ago, which is where the pictures came from. We stopped actively promoting this service (despite leaving the pictures up) because: 1) Unfortunately, insurance doesn’t usually pay for it, and 2) Most patients can’t afford to pay for it themselves. The surgeries are fairly large and serious, and as a rule, complications can be serious and patients usually need to stay in the hospital at least one night. If you can find a surgeon close to you with an express interest in performing this surgery, that would probably be your best bet. If you can’t find one and you determine we are your closest reasonable option, I would be happy to see you to discuss your options.

Thanks for your great question!

Sincerely,

Richard M. Kline, Jr., MD

Cool For Summer

Healthy lifestyle concept, clean food good health dietary in heart dish with sporty gym aerobic body exercise workout training class equipment, weight scale and sports shoes in fitness center

Making healthy changes at any point in your life can help you reduce your risk of a recurrence or new cancer, prevent additional health issues and keep your body strong as it recovers from treatment and surgery.

Consider these important 6 healthy living choices:

  1. Drop Excess Weight
    Those love handles might sound cute, but carrying around excess pounds can increase your risks for a variety of health issues, including heart disease and high blood pressure, high cholesterol, and Type 2 diabetes.

According to the Centers for Disease Control, the good news is that even a modest weight loss, such as 5 to 10 percent of your total body weight, can produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.

Losing weight prior to your breast reconstruction might also help to prevent surgical complications. One study published in the Journal of Reconstructive Microsurgery found that obese women were 2.29 times more likely to experience surgical complications.

Dropping pounds should be done gradually at a rate of 1 to 2 pounds per week.

  1. Eat Healthier
    If you skip breakfast, love sweets, douse your popcorn in a salt and butter, enjoy a double cheeseburger every day for lunch, and haven’t had a veggie pass your lips in years, you might want to consider a diet overhaul. Eating a healthy, balanced diet can prevent heart disease, diabetes, and certain cancers, keep your bones and muscles strong and help keep your weight down.

Start eating healthier by making small changes. According to the U.S. Department of Health & Human Services, you should incorporate at least six of these eight goals into your diet:

  • Make half your plate fruits and vegetables.
  • Make half your grains whole grains.
  • Switch to fat-free or low-fat milk.
  • Choose a variety of lean protein foods.
  • Compare sodium in foods.
  • Drink water instead of sugary drinks.
  • Eat some seafood.
  1. Get Moving
    Cancer treatment can tire out your body, but it’s important to get off that couch and get moving! It doesn’t matter how you do it either — whether it’s dancing to Usher’s latest tunes, walking a treadmill, hiking, or joining a weekly Zumba class, find something you enjoy and do it. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. Add moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) at least 2 days per week.

Exercise helps to lower your risk of heart disease, stroke, type 2 diabetes, high blood pressure, dementia and Alzheimer’s and several types of cancer. It also helps with depression and anxiety.

  1. Stop Smoking
    According to the American Cancer Society, about half of all Americans who keep smoking will die because of the habit. Each year more than 480,000 people in the United States die from illnesses related to tobacco use. This means each year smoking causes about 1 out of 5 deaths in the US More importantly, research shows that smokers have higher rates of wound complications after surgery, including healing after plastic surgery and breast reconstruction.

It’s hard to do, but quitting smoking can improve your health almost immediately. Quitting lowers your blood pressure and heart rate almost immediately and your risk of a heart attack declines within 24 hours.

  1. See Your Doctor
    You’re already seeing your doctor to treat your breast cancer, but have you had a general physical or other annual tests such as a colonoscopy or bloodwork? Staying on top of your health will help reduce the risks of getting sick and prevent other illnesses.

Ask the Doctor: Q&A

Woman walking on beach

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

Sun Safety Tips

 

Close up on woman applying sun cream on her arm with a spray at the beach on a warm, sunny day. Sunscreen protection, skin cancer concept

The warmer, sunnier weather is calling you to the great outdoors, but breast cancer survivors need to take extra special precautions to care for their skin. Why? Both chemotherapy and radiation treatments can make the skin more sensitive to the sun up to two years after treatment is over.

Before you head to the park or to the beach, It’s important for breast cancer patients to follow these tips to stay safe in the sun:

  1. Wait Just a Bit

If you just finished radiation therapy, give your skin a little time to heal before enjoying the sun. It is typically recommended that radiation patients wait a few weeks before venturing out. When exposed to the sun, radiation therapy can cause something called ‘radiation recall’, where the treated area will “remember” that it was exposed to radiation and become red, inflamed, and tender again.

  1. Use Sunscreen

According to the American Cancer Society, sunscreen for breast cancer survivors should have a sun protection factor (SPF) of 30 or higher. The SPF number is the level of protection that the sunscreen provides against UVB rays. Keep in mind that no sunscreen completely protects you, so you should combine other safety tips to increase your chance of protection.

Not sure what you should use? Every breast cancer patient is different, so talk to your oncologist and your radiation oncologist to see what they want you to use. If you have already had a negative reaction to the sun or are sensitive to certain sunscreen ingredients, they may have a different product recommendation.

  1. Cover Up

The area of your breasts that received radiation therapy should be protected from the sun at all times with clothing and sunblock, especially if the area is already red or ‘burned’ because of treatments. It’s also important to keep your surgical scars covered.

  1. Sit in the Shade

Unless your doctor specifically tells you to not go out in the sun at all, you should limit your sun exposure during the times that the ultraviolet or UV rays are the strongest. This is between 10 a.m. and 4 p.m. It’s best to enjoy the early morning or later evening sun.

  1. Protect Your Scalp

Chemotherapy causes hair loss, so if your hair is thinning or if you are completely bald, make sure you wear a hat or apply sunscreen to your scalp – and don’t forget your ears too!

  1. Don’t Get Overheated

Some chemotherapy medications can cause your body to become overheated in the sun, so consider wearing a wide brim hat or a hat that is made from natural fabrics so your scalp can ‘breathe.’

Don’t use tanning beds: They employ the same dangerous ultraviolet rays that the sun emits.

You can certainly enjoy the warm summer outdoors without baking in the sun. Remember, you just finished treatment and need to take it easy and keep your body healthy.

Q&A #2: May 2019

Q:
I had a bilateral mastectomy in October 2016. I finished radiation on the right side in January 2017, and underwent bilateral latissimus flap reconstruction in August 2017. I had capsular contracture (when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant) on the right side and the implant changed out in March 2018. Once again, I have capsular contracture on the same side. What do I do? They are absolutely not even close to symmetrical. I am only 46. I am kind of thinking that I should just forget reconstruction even though I don’t really want to go flat.

A:
Without knowing all of the details about your situation, I think there is a reasonable chance you have some good options left. Here are a few potential ones:
1. We have reconstructed more than 1,800 breasts with natural tissue alone (no implants) using the abdomen or buttocks. If you have any tissue in those areas, that is our most frequently used option.
2. We have, on several occasions, reconstructed breasts with latissimus flaps alone, with added free-fat grafts, which can sometimes double (or more) the size of the latissimus flap, and make implants unnecessary.
3. For the last 4 1/2 years, we have done all of our implant reconstructions exclusively in front of the muscle, using a full Alloderm (specially preserved donor skin) wrap. This has completely changed our outlook on implant breast reconstruction, and has on occasion produced surprisingly good results – even in radiated breasts. I have converted several “implant-behind-the-muscle” patients (some who already had latissimus flaps) to in-front-of-the-muscle, and they all feel that it is a significant improvement. Free-fat grafting can also be added to implant-based reconstruction to improve shape, size and overall naturalness.
There is absolutely nothing wrong with going flat if you are sure that is what you want to do, but it might be premature for you to decide to do that only because you don’t think you have any other options. I would be delighted to discuss your situation in more detail by phone, if you wish, or see you in person for a consultation.
Thanks for your question! We look forward to hearing from you.

Best,
Dr. Richard M Kline JR MD