Ask the Doctor – DIEP Flap

Q:  I am weeks out from a unilateral DIEP flap procedure on my right side. Regarding the tightness and cramping in the abdominal area, is there any type of stretching or massage that can be done to speed healing and/or alleviate discomfort? Also, when can I begin to use moisturizers for scar reduction, and what type would you recommend?

A:  Good afternoon, thank you for reaching out to us. Those are great questions! Who was the plastic surgeon who did your DIEP procedure? It might be best to reach out to your surgeon about these questions since every practice has different recommendations. We tell our patients to leave the abdominal incision alone – to let it heal on its own – so we often discourage patients from doing any serious stretching or massage until a few months after surgery. It is OK to try standing up a little straighter each day, but you never want to force it. The tightness and discomfort will resolve on its own over time with little intervention. As far as the scars go, a lot depends on whether your surgeon feels you would benefit from having the abdomen redone at a later stage to remove scar tissue, lower the incision or remove extra skin for an aesthetically pleasing result. If you have the incision reopened, there is no reason to worry about the scars now. If you do not intend to revise the abdominal incision, then we recommend waiting closer to at least 2-3 months post-op before using any scar products.

I hope this was helpful. Please let us know if we can answer additional questions for you and we wish you the best in your recovery. Have a great day!

Audrey Rowen, PA-C, East Cooper Plastic Surgery, The Center for Natural Breast Reconstruction, Phone: (843) 849-8418, Fax: (843) 849-8419, 1300 Hospital Drive, Suite 120, Mount Pleasant, S.C. 29464.

The Many Choices in Breast Reconstruction Surgery

One aspect of a breast cancer diagnosis that requires careful consideration is choosing your reconstruction plan. Decisions about breast reconstruction can be emotional and confusing. Fortunately, you have several options from which to choose, but it’s important to know all the facts about each before you make a final decision that’s right for your body and your desired outcome.

If you choose to undergo breast reconstruction, you have the option to either have your breasts made from implants – saline or silicone – or from natural tissue flaps, which means they are made using your own skin, fat and muscle. There are pros and cons to each of these procedures.

Tissue Flap Reconstruction

Most women want to match the look and feel of their natural breasts, and there is a greater chance of successfully creating natural looking breasts by using tissue flap reconstruction. Using flaps to reconstruct your breasts will actually make them look and feel more natural compared to using silicone or saline implants. This is especially important as you age and your natural breast changes shape.

There are several types of flap procedures:

DIEP Flap: The most commonly used, DIEP flap procedure provides breast reconstruction and a tummy tuck all in one. That’s because this procedure uses your abdominal skin and tissue, but not your abdominal muscles.

PAP Flap: This flap procedure utilizes the tissues of your upper thigh to reconstruct the breast following your mastectomy.

GAP Flap: The tissue is taken from your buttock area, while the skin, fat and tiny blood vessels are removed through an incision that is hidden under your panty line.

SIEA Flap: This flap procedure is an option for the minority of women whose abdominal blood supply comes from the Superficial Inferior Epigastric Artery, which runs just below the surface of the skin.

Keep in mind that flap reconstructive surgery is a longer, more invasive procedure than having breast implant surgery. The good news is that flap reconstruction surgery hides the scars well from where your donor tissue was taken. It is also a procedure that does not need to be repeated in your lifetime, whereas silicone or saline implants may need to be replaced down the road.

Implant Reconstruction

When it comes to implant reconstructive surgery, you can choose to have the surgery at the same time as your mastectomy or at a later time. You can also choose saline or silicone implants. Saline are filled with a salt water solution. Saline implants start out deflated and are filled during surgery to the desired size. Silicone implants are pre-filled with a silicone gel.

Implant reconstructive surgery is less invasive than any of the flap surgical procedures, however they don’t provide as natural of a look as tissue flap reconstruction options.

There are other factors to consider when choosing a reconstruction option, including your current health status and whether or not you still need additional cancer treatment, such as radiation. Radiation can cause additional problems such as scarring that can cause delays in your surgery.

Discuss all of these options and their pros and cons with your surgeon to decide what’s right for you.

To learn more about natural breast reconstruction and find out if it might be the right choice for you, contact The Center for Natural Breast Reconstruction at NaturalBreastReconstruction.com or toll-free at 866-374-2627.

The Pros and Cons of Primary Reconstruction Following Mastectomy

When a woman is diagnosed with breast cancer, she faces many decisions about her health and her treatment. If treatment includes a mastectomy – the surgical removal of one or both breasts to either treat breast cancer or reduce her risk of getting it – one of those decisions will be whether to follow it up with reconstructive surgery.

Reconstructive surgery is rebuilding the shape and the look of the breast. This can be done at the same time as the mastectomy, or at a later time. Whether or not to have reconstruction immediately following mastectomy (also known as primary reconstruction), is a big decision that depends on a variety of factors:

  1. Body Image

Many breast cancer patients choose reconstruction for both cosmetic and personal reasons. Reconstruction can make the chest look more balanced and enable women to feel more comfortable and confident in their clothing. Some women feel more confident looking at breasts they can call their own rather than the lack of a breast due to a mastectomy without reconstruction. Some women also feel that having breasts that look and feel like their own enhances their sexual relationship with their partner. After going through diagnosis, treatment, and mastectomy, breast reconstruction can help improve a woman’s confidence and help her feel like her normal self again.

With primary reconstruction, an additional procedure to correct any defects or improve symmetry is often necessary. Remember to communicate with your surgeon, and if your breasts don’t look and feel exactly the way you envisioned, your surgeon will be happy to work with you to help you achieve the results you desire and deserve.

  1. Avoiding Additional Surgery

Natural breast reconstruction uses tissue harvested from other parts of the body, such as the stomach, thighs or buttocks, and uses it to reconstruct the breasts (also known as autologous or flap reconstruction). Having primary reconstruction, breast reconstruction done at the same time as the mastectomy, eliminates the patient’s need for an additional major surgery and allows a woman to come out of surgery with a breast present.

However, after undergoing a mastectomy, many women opt out of reconstruction – either delayed or immediate – because they do not desire to undergo another operation or simply do not want implants. Women should know that choosing to not undergo reconstruction is always an option as well.

Reconstructive surgery that is done using the patient’s own tissue – such as the DIEP (deep inferior epigastric perforator) flap and the GAP (gluteal artery perforator) flap – typically involves a longer recovery than with implant reconstruction, and scars on both the breasts and donor site are to be expected. Be sure to consider your schedule for the two months or so following your reconstruction, as recovery following DIEP/GAP procedures is typically 6-8 weeks. If your schedule requires that you are able to resume normal activities quickly, take this into consideration before proceeding with mastectomy with primary reconstruction using the DIEP/GAP flap. 

  1. Eligibility

In addition, not all mastectomy patients are eligible for reconstructive surgery due to age, prognosis, medical history, etc.

To make the best decision for you about mastectomy and reconstruction, be sure to create a personalized plan with your doctor to ensure that the outcome you desire aligns with the best choices for your overall health. It’s also a good idea to speak with other patients who have undergone the same surgery to better understand the experience from another’s perspective.

Remember – your doctor may recommend that you do both procedures immediately (primary reconstruction), wait until later for reconstruction (secondary reconstruction), or do part of it at the time of the mastectomy and part of it after you complete chemotherapy/radiation. Do your research, weigh all your options, and then make the right decision for you.

To learn more about natural breast reconstruction and find out if it might be the right choice for you, contact The Center for Natural Breast Reconstruction at NaturalBreastReconstruction.com or toll-free at 866-374-2627.

Q&A: Ask the Doctor

Q: How is natural breast reconstruction done and what is the cost? Also, how long is the recovery period? 

A: Thanks for your question, my name is Audrey and I am one of the Physician’s Assistants with the Center for Natural Breast Reconstruction. I will try to give you some basic information and please email or call if you have more.

There are three common options for natural reconstruction—DIEP, PAP and GAP:

  • DIEP stands for Deep Inferior Epigastric Perforator, and the tissue comes from your abdomen, like a tummy tuck. We never take muscle—only the fat and skin—and then we close up the abdomen similar to the closure for a tummy tuck. The tissue is detached from your body and then placed in the breast pockets. The blood supply to this flap is traced out and dissected, and then the tissue is transplanted into the breast skin envelope. To keep the flap viable, microsurgery is performed to restore its blood supply by attaching its blood vessels to recipient blood vessels in the chest. This flap requires specialized operating room equipment and postoperative personnel. Some skin on the flap is kept as a skin paddle to allow us to monitor the flap’s color, temperature and vessel signals. That skin paddle may be removed at a subsequent stage of surgery in certain patient situations. DIEP is the most commonly performed free flap reconstruction and has the highest success rate.
  • PAP stands for Profunda Artery Perforator. The procedure is the same as above, but it uses tissue from the thighs instead of the abdomen. Often, it is taken from the back and/or inner thighs, and we typically take a small amount from each thigh to make either one or two breasts. The recovery takes a little more time since you would have two donor sites instead of one—but it is very achievable. The risks are the same as with DIEP as is the procedure of connecting the blood vessels through microsurgery.
  • GAP stands for Gluteal Artery Perforator, and the donor site is the buttocks. Depending on whether you need one breast or two, we take only fat and skin from each side of the buttocks to make into breast mounds using the same process as the DIEP. This also has the same risk, can have more than one donor site, and requires repositioning during surgery since we are working on each side of your body.

For each of these procedures, the surgery time is anywhere from 5 to 10 hours with an average of about 7 to 8—it depends primarily on whether you need mastectomies; whether you have had previous reconstruction procedures; and on your personal anatomy in terms of how difficult it is to find and connect your blood vessels. We keep patients in the hospital for three-four nights. Out-of-town patients are asked to stay in the Charleston area for a full week following surgery so we can check in on them, and hopefully remove breast drains, which prevent blood and lymphatic fluid from building up under the skin, before you head home. We provide a list of hotels that offer medical rates to help you control lodging costs. Patients have one drain per breast and then one drain at each donor site. Breast drains are removed within 6-7 days post-op and the donor site drains are in for 2-4 weeks, depending on the site. We require a special MRI called an MRA (magnetic resonance angiography) of the donor area before surgery to look for where your blood vessels are located. We request this be done at Imaging Specialists of Charleston as they have the right equipment and outstanding radiologists who use a specialized protocol to read the MRA and know exactly what to report to our surgeons.

If only a cancer-side mastectomy was completed, the other breast may also require augmentation, lifting, reduction or some combination thereof to establish symmetry.

Breast reconstruction is a staged process with a minimum of two surgeries, with each subsequent surgery getting smaller, and requiring less recovery time. The first stage requires three-four nights in the hospital, and subsequent surgeries typically require a one-night hospital stay. Second stages can be a minimum of three months after the previous surgery (often six months after if you have had radiation), or can be spread out further as needed to fit in with your schedule. The recovery is about six-eight weeks, and requires you to keep your arms close to your sides, no heavy lifting and no high-impact activities. You will, however, be up and walking around and able to do most basic activities with some restrictions. Driving is not allowed for at least the first few weeks. Some patients can go back to work after six to eight weeks—maybe sooner—depending on the job they have.

As follow-up appointments go, within a week to 10 days after the first surgery, you are typically cleared to head home and need not see us again until right before your next surgery stage. If you have a local breast surgeon or plastic surgeon close to home, we recommend following up with them, and we do frequent telephone/email/patient portal outreach to check in. We are always happy to see you in the office if you wish to make the trip.
Our office also does expander/implant reconstruction, but it is harder for patients out-of-state because of the number and frequency of follow-up appointments needed in the first few weeks to months after surgery. If you are interested in hearing more about this option, please let me know.

I hope this information helps to answer your questions and give you a better idea of your natural breast reconstruction options. We are happy to continue answering questions via email or phone calls, and we would love to set up a consult for you to come meet us in the office at a time convenient for you. We often like to gather more health information before you make the trip to make sure that one of these options could work for you. That information includes:

  • Breast cancer details (which breast, when were you diagnosed, what type of cancer is it, do you need radiation?)
  • Mastectomy/reconstruction details (have you had lumpectomy, mastectomy, was it skin/nipple-sparing, did you have any reconstruction done already?)
  • Abdominal surgeries (have you had any major surgeries with large scars across your belly, do you have enough tissue to use?)
  • Medical history (any history of clotting disorders, DVT/PE blood clots, problems with anesthesia, diabetes, obesity, etc?)

Once you have a breast cancer diagnosis, insurance is supposed to cover the cost of breast reconstruction. We have no control over your personal deductibles or out-of-pocket maximums—everything is billed as reconstruction through your insurance. Using your own tissue for reconstruction is not a simple or low-cost procedure; however insurance typically makes it affordable. We are in-network with most major insurers and can usually negotiate a one-time contract with those we are not.

If you want to provide your insurance information, we’re happy to investigate your benefits for you and assure your insurance will cover any procedure you choose. Our office manager, Gail, could give you detailed information about the costs and once we have more information from you.

Please call us or email any questions you have with information/details from above. We look forward to speaking with you soon. Thanks and have a great day!

Audrey Rowen, PA-C
East Cooper Plastic Surgery
The Center for Natural Breast Reconstruction,
Phone: (843) 849-8418
Fax: (843) 849-8419

1300 Hospital Drive, Suite 120
Mount Pleasant, SC 29464

New Technology Can Help Restore Sensation After Mastectomy

According to the most recent statistics from American Cancer Society, 1 in 8 women will develop breast cancer during her lifetime. For many of these women, a mastectomy – which is the removal of most or all of the breast tissue – will be one of their primary, life-saving methods of treatment. A mastectomy, however, comes with various side effects, including loss of sensation to the breasts.

Tingling, numbness and loss of sensation to the breast area, and under the arm from the removal of lymph nodes, is one of the most unwanted side effects. This happens because the procedure severs nerves that provide sensation to the breasts, and the numbness often remains even after breast reconstruction is complete.

Regenerating Nerve Tissue
One Florida-based company dedicated to peripheral nerve repair is changing this life-altering outcome. AxoGen has taken steps to address this numbness, once thought to be a permanent side effect, with a new technology called ReSensation. They use allograft nerve tissue, or donated human peripheral nerve tissue, to regenerate feeling to the breasts.

The Way It Works
ReSensation sounds complex, but it isn’t. The breast surgeon takes donated nerve tissue and attaches it to a patient’s remaining nerve tissue in the affected area. Over time, that donated nerve becomes part of the patient’s body and helps to regenerate nerve-endings in that area. 

“With this new surgical method, we are not only able to provide patients with a more natural-looking breast, but the possibility that the breast will feel more natural to them as well,” says James E. Craigie, M.D., with The Center for Natural Breast Reconstruction. “ReSensation is an exciting development in care that we hope will help bring our patients that much closer to feeling like themselves during and after treatment.” 

Patients interested in ReSensation face few limitations, and the procedure is performed during breast reconstruction. Breast implants pose one limitation in that they are artificial and do not contain nerves, therefore this procedure does not pertain to patients undergoing breast reconstruction via implants. ReSensation is best used for patient’s who choose to reconstruct the breasts using their own tissue.

Once the ReSensation procedure and breast reconstruction is complete, patients can feel confident that they took all steps possible to hopefully restore their breast sensation and therefore achieve an even more natural result. 

What Should You Do Next?
If you are a breast cancer or mastectomy patient, the next step should be to talk to your breast and plastic surgeon about reconstruction options. If you haven’t had a mastectomy yet, your breast surgeon can tell you what you should expect with surgery and recovery from the mastectomy. Your plastic surgeon can also determine if the ReSensation technology is right for you. Keep in mind that the answer is different for everyone. Your current medical conditions and breast cancer treatment plan help determine the final decision.

“We’re excited to offer this cutting-edge procedure to our patients and are committed to offering the women the best care possible,” continued Dr. Craigie. “It is our goal to make sure every patient understands her options for reconstruction and provide access to pioneering surgical treatments that could help improve her quality of life.” 

Is ReSensation right for you? Visit NaturalBreastReconstruction.com to learn more, or call toll-free at (866) 374-2627.

Q&A – Ask the Doctor

Q:  
I have an implant from reconstruction 7 years ago. I do not have breast symmetry as the other breast was a TRAM flap reconstruction. I would, however, like to have symmetry – how can this be achieved?

A:
Great question! You have several options to improve breast symmetry. We could simply “fat graft” the TRAM flap reconstruction to improve the size and enhance the shape of the breast mound. In fat grafting, fatty tissue is removed from other parts of your body – usually your thighs, belly and buttocks – by liposuction. The tissue is then processed into liquid and injected into the breast area to recreate/enhance the breast. This technique is especially helpful when trying to improve the symmetry between an implant reconstruction and autologous reconstruction.

If your implant is currently under the muscle, this can be revised. The implant can be re-placed in front of the muscle with a full ADM (Acellular Dermal Matrix, specially preserved cadaver skin – AlloDerm® is most commonly used brand) wrap. This allows much better control of implant position, and often helps create better projection and shape. The main complication is that you can sometimes see more rippling of the skin than you typically do with an under-the-muscle implant, but not necessarily. It is also possible that simply revising your current implant reconstruction could produce improvement, but we have less control with that method. 

Finally, it may be possible to have the implant replaced with your own tissue. You might consider using another area of the body, such as the buttock or thigh, to replace the implant completely. One option would be the SGAP (Superior Gluteal Artery Perforator). Breast reconstruction with the GAP flap involves moving a segment of skin and fat from the buttock to recreate a breast mound shape after the removal of the breast tissue (i.e., mastectomy defect). This involves the disconnection of the tissues from the gluteal muscles and surrounding gluteal tissue. (We DO NOT take the muscle.) The tissue is then transplanted into the breast skin envelope. To keep the flap alive, its blood supply must be restored by microsurgery, a procedure that attaches its blood vessels to recipient blood vessels in the chest. 

I hope this information helps. Please let me know if you have any further questions. 
 
Lindsey Weaver, FNP-C
East Cooper Plastic Surgery

The Center for Natural Breast Reconstruction

Phone: (843) 849-8418

Fax: (843) 849-8419

In Her Words – CP

natural breast reconstruction
I had a bilateral mastectomy with Superior Gluteal Artery Perforator (SGAP) reconstruction done two and a half years ago. It was all done at the same time. Dr. Kline was my primary and his partner, Dr. Craigie, assisted. They did all the stages [of my reconstruction] and I am very happy with the results. Dr. Kline is an absolute perfectionist as anyone can attest. I had previously had radiation treatment but you would never know it.
FYI, when they do the nipple reconstruction, they will ask you what you want, so in that regard a picture would be helpful for color, amount of projection and so on. Their office staff is incredible – friendly and very helpful. The care is phenomenal. I would be happy to share my experiences and answer any questions; just ask one of the office staff and they will pass your number to me to call at your convenience.
– C.P., Mt. Pleasant, S.C

Flap Procedures for Natural Breast Reconstruction: Understanding Your Options

gap flapWhen a woman is diagnosed with breast cancer, she will be faced with many decisions including “Do I want breast reconstruction?” and if so, “What kind of reconstruction is best for me?” With numerous options available, it is important to evaluate each choice and decide which is best for each woman individually.

Breast reconstruction using the patient’s own tissue, also known as autologous tissue reconstruction, is becoming more and more popular for many reasons. Here, we’ll discuss two options in more detail – the deep inferior epigastric (DIEP) flap and the (gluteal artery perforator) GAP flap.

What is the DIEP Flap?

The DIEP flap procedure reconstructs the breasts using tissue from the patient’s abdomen. The tissue consists of mostly skin and fat and never includes the muscle.

What Is the GAP Flap?

The GAP flap reconstructs the breasts using tissue from the patient’s buttocks. The tissue consists of mostly skin and fat as well and never includes the muscle.

What Are the Benefits of Each One?

Women who are considering natural reconstruction often choose one of these two flap procedures according to what benefits her individual needs. The DIEP flap is popular with many patients because of its potential to provide “tummy tuck” results – a flatter appearance to the lower belly. Meanwhile, patients who elect the GAP flap might prefer the benefit of removing tissue from the buttock area instead. In either case, muscles are spared, reducing recovery time. It is important to note that both procedures can be used for unilateral cases (only one breast needing reconstruction) or bilateral cases (both breasts needing reconstruction).

What Results Should a Patient Expect?

With both the DIEP and GAP flap procedures, the result is a breast reconstructed from the patient’s own bodily tissue. For this reason, patients are often more satisfied with a natural reconstruction than with implant reconstruction. However, the recovery time can be longer than with implant reconstruction and scars on both the breast and donor site are to be expected.

How Should a Patient Choose One Procedure or the Other?

A patient should first decide if natural reconstruction surgery is a viable option for her. Some women are not ideal candidates due to vascular (blood vessel) issues, as healthy blood vessels are necessary for the flap procedure to succeed. Once the patient decides on natural reconstruction, choosing reconstruction via the DIEP or GAP procedure depends on the health of the “donor site” from where the tissue is removed.

No woman should have to choose the best procedure for her alone – it should be an ongoing discussion with her medical professionals. At the Center for Natural Breast Reconstruction, these and other issues are addressed in person within a compassionate and professional environment.

Want to know more? Call toll-free at (866) 374-2627 or visit NaturalBreastReconstruction.com.

Considering Nipple Tattoos? 4 Things Patients Should Know

nipple tattoo

When a woman is diagnosed with breast cancer and begins the journey of considering which reconstruction option is best for her, the hope for a natural looking and feeling breast is normally at the top of her list. A mastectomy may involve removing all of the breast tissue, including the nipples. Thankfully there are now many ways to restore the natural appearance of the breasts following mastectomy and reconstruction. If the original nipples must be removed, many patients with breast cancer opt to have their nipples reconstructed using their own tissue and, as part of the reconstruction, decide to get nipple tattoos.
Curious about how a nipple tattoo works and whether it might be a good option for you? Here are five important things to know.
1. A Nipple Tattoo is the Final Stage of Breast Reconstruction
Nipple tattoos are a beautiful solution to create natural-looking nipples, and most women are candidates for the tattoos. Tattooing is usually done 3-4 months after a woman’s final in-hospital surgery. This is normally when the skin has healed enough from any reconstruction surgeries. If surgical scars aren’t completely healed and mature when the tattoo is created, there is risk of the tattoo becoming distorted over time.
2. The Nipple Tattoo Is Customized to Look Real
The inks used for nipple tattooing are mixed to create the most realistic appearance possible for each patient. The tattoo artist strives to create a shade that resembles the patient’s original nipple and complements her natural skin tone. This is one of the reasons it is important to have a tattoo artist perform the procedure – there is an art to making each nipple unique to each patient.
nipple tattoo3. The Best Tattoos are Done By a Tattoo Artist
Some patients have the option to have their tattoos done within a medical setting by a medical professional; however, there is a fine art to nipple tattooing. This makes finding a tattoo artist who specializes in nipple tattooing key to achieving the best, most realistic results.
Tattoo artist Shannon Purvis Barron, owner of Indigo Rose Tattoo in Columbia, S.C., has been giving breast-cancer survivors tattoos for years, and provides her services once a month in the offices of The Center for Natural Breast Reconstruction.
A lifelong artist, she shifted her focus in college from oil and canvas to ink and skin. She’s seen up close the toll breast cancer can take on women’s bodies and spirits, and believes feeling confident in their bodies is an integral part in the recovery process.
Barron, who will be in The Center for Natural Breast Reconstruction office on September 27, 2018, says she can’t even count the number of scars she has covered with flowers, tree branches and feathers, or botched nipple tattoos she has fixed.
4. The Nipple Will Look Real, Thanks to 3-D Techniques
The 3-D nipple tattoo is a work of art that looks like an authentic nipple. Shading, shadows and other artistic skills make the tattoos look just like real nipples, and helps patients feel confident in their breasts once again.
Women who are interested in learning more about nipple tattoos within a medical environment can contact The Center for Natural Breast Reconstruction at 1-866-374-2627 or online at NaturalBreastReconstruction.com. Call the office to request an appointment for nipple tattooing with Shannon Purvis Barron for our next available date, September 27, 2018.

Ask the Doctor

breast implants

Posted Question:

I had breast reconstruction with under-muscle implant in 2003. The implant was replaced in 2017 but the result has left me very uneven.

I feel that my prior surgeon didn’t take into account the proper shape and size of the breast to match the other breast. He simply measured across the breast, so I have an implant that lays beyond the center of the chest wall and is too flat. It doesn’t fill my bra cup so I have to wear a prosthesis. I trusted him and didn’t look for information about under muscle prosthesis.

Many women have asked my advice about implant procedures. I am extremely unhappy with this result but, at 68 years old, I will have to live with it for the rest of my life. I hate my result and want to be able to help others get more information in order to make sure their doctor is using proper forms/prostheses.

What can be done for a better result? Did I just make a mistake by not seeing multiple surgeons? He was my original surgeon and I was fine with the first implant. It became constricted so we did the replacement. Had I known I would have had this result, I would have just started wearing a prosthesis and skipped the misery of another surgery.

– Pat

 

Hi Pat,

I’m sorry to hear you are disappointed with your newest implant. I’m not sure I understand what was different from the previous implant. If the first was constricted and the second one was to replace the first after releasing the contracture, can you tell me what was done differently? If you liked the first one, I’m sure there is a chance to correct your problem. I think you should find out if the two implants are the same size and type. If the same surgeon did both surgeries, then he/she should have that information. If they don’t match, perhaps you need to replace the new implant with one that is a closer match to your first one.

Thanks for your question let me know if you have more information. 

-Dr. Craigie