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

Overcoming ‘Scanxiety’: 5 Tips to Keep Your Wits for Your Next Breast Scan

Even though you won’t find the word in any dictionary — yet — scanxiety is real. Just ask any breast cancer patient. Scanxiety is the anxiety you feel when your next scan — mammography, ultrasound, PET scan or other major test — approaches. You’re nervous, restless and tense, your heart is pounding and you may have trouble sleeping or eating. You’re constantly worried about what the test will find.

These tests can determine if your cancer is in remission or if you still need additional treatment. For some, the scanxiety over these tests can start days, weeks and even months before the actual test occurs and continue while you take and wait for the results. And even those who have received good news from scans in the past still suffer from scanxiety leading up to their next one, hoping that they will hear those same results again.

There have not been many medical studies done on the impact of scanxiety, but one small study done on lung cancer patients was published in the October 2016 edition of Lung Cancer. It showed that scanxiety can mimic the symptoms of post-traumatic stress disorder (PTSD), including distressing thoughts, difficulty concentrating, anxiety, insomnia and irritability. The study showed that scanxiety can actually impair your quality of life.

Fortunately, there are steps you can take to help reduce or even eliminate the symptoms of scanxiety:

  1. Meditation: Whether you do it in a group or by yourself, meditation has been found to settle thoughts and help reduce stress and improve concentration. According to the Mayo Clinic, there are several ways that you can meditate:
  • Guided meditation: Led by a teacher, you are guided to conjure mental images that you find relaxing.
  • Mantra meditation: repeating a calming word or phrase that will be used to prevent distracting thoughts from entering your mind.
  • Mindfulness meditation: This is increased awareness and acceptance of living in the present moment. “I took a mindfulness course which I firmly believe kept me from completely going off the rails,” said one triple negative breast cancer patient in an online support group.
  1. Support Groups: Speaking of support groups, there are many in-person and online support groups that you can join to help you get through these difficult times. Your cancer center may have a supportive care department that is staffed with doctors, social workers and psychiatrists or psychologists. Here you can express your concerns about your upcoming scans. Others who may have also experienced the same symptoms can share additional coping mechanisms. Sometimes, just letting it out can help.

There are Facebook groups for breast cancer patients as well as patients with specific conditions, such as Triple Negative Breast Cancer. The best thing about online support groups is that they are available 24/7, so you can let people know what you’re going through even if it’s the middle of the night.

  1. Support System: Often scanxiety gets worse if you feel like you’re going through the tests alone. Will someone be with you when you go to the test or get the results? Having that person to hold or talk to can often reduce scanxiety.
  2. Fun Things: It might sound simple, but distracting yourself with some fun activities may help to reduce your scanxiety. A good book or a good movie, dinner with friends, or a weekend getaway can keep your mind occupied.
  3. Medication: Sometimes, patients need help keeping anxiety under control. Before taking anti-anxiety medication, such as Lorazepam, discuss these options with your physician to find the right one for you.

Most importantly, don’t ignore your scanxiety symptoms. Treating them allows you to live a better quality of life while you’re going through these very important tests.

Q&A #1: May 2019

 

 

 

 

 

 

 

 

 

 

 

Q:

I had bilateral mastectomy on May 11, 2018, as a result of inflammatory breast cancer. I did have a tumor, but I also had a complete response to chemo and clear margins at surgery, followed by six weeks of radiation. A 5mm metastasis to one lymph node and a total of two lymph nodes were removed. I do have scar tissue and some swelling on the affected side, but I control it with OT and exercise. I am 61 years old, and otherwise healthy. Am I a candidate for reconstruction and, if so, how long should I wait? I currently see my oncologist yearly and my surgeon every six months for a vascular ultrasound.

Thank you!

A:
You are absolutely a candidate for reconstruction with your own tissue, and we would be happy to help you any way we can. I feel it is rarely, if ever, necessary to wait more than six months after radiation for reconstruction, and you are well past that. Also, your history of radiation, fortunately, has no impact on our ability to reconstruct you successfully using your own tissue.
I would be happy to chat with you further by phone, or see you in consultation in our Charleston office. Please let us know what we can do to help.

Best,
Richard M. Kline, Jr., MD

Why Keeping a Breast Cancer Journal Is Good for Recovery


For many young girls, it’s a rite of passage to keep a diary filled with secrets, hopes and dreams. It feels good to have a private place to write down those things that are too difficult to share with another living soul. Looking back at it later in life, it allows you to discover details that have long since been forgotten. Unfortunately most of us stopped writing in those diaries that were locked away when we hit our teen or adult years.

For women who find themselves on the emotional journey that is breast cancer, it might be time to start journaling again. Studies have shown there are mental and health benefits to journaling. After all, journaling has been shown to improve your mental health, reduce stress and make you feel better physically. It’s also just a great way to document your recovery.

Although not many studies exist on the effects of journaling, WebMD.com suggests that writing can improve sleep, help fight feelings of fatigue, and provide an outlet for positivity.
Before starting a journal, here are five ideas to guide you:

1. Rule #1: No Rules

The only rule to keeping a breast cancer journal is that there are no rules. Treat yourself to a new notebook or pretty journal or download one of the many journaling apps that are available. Write for a few minutes or several times a day. You can draw, write your thoughts in poetry or take pictures and write captions about what you see. Anything goes.

2. Start Anywhere

It doesn’t matter where you are in your breast cancer journey, you can start a journal today. You can work backward on the path you’ve already walked and write down as much as you can remember or write going forward only.

3. Be Prepared for the Emotions

One breast cancer patient had big aspirations of writing in a journal throughout her journey. Unfortunately, writing about her tests and treatment brought out too many emotions and she put the journaling aside. Journaling can be emotional, but it can be therapeutic too. If it gets to be too much, stop for the time being, but make a date to pick it back up again and perhaps write in smaller chunks or skip a few days in between. Find what works best for you.

4. Make a Caring Bridge Journal

There are online websites that allow you to journal and share it with family and friends who want to keep up with your journey but who may not be able to see you. “Anne-Marie” started a CaringBridge account to share her journey. She wasn’t posting every day, but often enough that when she goes back now and re-reads the entries, she remembers details about things that she started to forget.

5. Use Your Phone

Maybe you prefer to use your phone to journal, which is probably with you all the time. If so, try a journaling app, such as Dabble.me, Day One, or Five Minute Journal. Some charge a fee for the download but can provide prompts to remind you to write.
Whatever you do, and however you do it, make sure it works for you. That’s really the ultimate test of any effort to deal with your breast cancer journey.

Ask the Doctor: Q&A

 

Q:

What is the success rate for someone with:
• a bilateral mastectomy with immediate reconstruction in 2011;
• encapsulation in 2016 with several fat graft attempts;
• failed implant on radiated left breast site, removed in December 2016; and
• removed right implant in February 2017?
I am now am searching DIEP options.

Thanks,

C

A:

Hi C,
I am sincerely sorry you have had so much trouble. Fortunately, none of your prior problems affect the success rate of DIEP flaps in our practice.
We recently tabulated and presented our 15-year flap experience. After 1,362 DIEP flaps, the overall survival rate was 99 percent. Neither radiation nor previous failed implant reconstructions affects the flap survival rate. Many, many, many patients with a history of radiation and multiple implant failures have gone on to have successful DIEP flap reconstructions.
I would be happy to meet with you and review your options, or chat with you by phone, just let us know how we can help.

Sincerely,

Richard M Kline Jr MD

Ask the Doctor: Q&A

Q:

I had a mastectomy in 2008 with implant reconstruction. I had the implants exchanged during additional procedures to help improve the look of the breast. I am very unhappy with how I look as it is very unnatural. I am not opposed to a procedure with another implant if done correctly. Is this something you do? Otherwise I may need to consider alternatives as I feel so uncomfortable in my own skin.

Thanks,

V

A: Hi V,
Thanks for your inquiry.
We frequently revise implant reconstructions to improve patient satisfaction. For several years, we have done essentially all of our implant-based reconstructions in front of the pectoralis muscle, which confers a number of significant benefits in terms of comfort, appearance and naturalness (compared to behind-the-muscle). I also have converted a number of patients with older behind-the-muscle reconstructions to modern in-front-of-the-muscle reconstructions, and they all feel the result is much nicer.
If implant reconstruction still proved unacceptable to you, using your own tissue is another powerful option. We have completed more than 1,800 natural tissue reconstructions – many in women who previously had unsatisfactory implant reconstruction – with great success.
I would be happy to see you in consultation, or discuss your situation in more detail by phone, if you wish. Please let us know what works for you.
Best,

Richard M. Kline, Jr., MD