Q&A: Ask the Doctor

Ask the Doctor: QA’s
Q: I have a history of benign proliferative breast disease with associated atypical ductal
hyperplasia. I have had two needle biopsies and three surgical biopsies in my left breast. I took
Tamoxifen for five years and currently am taking Evista. Last year I completed the Myriad My
Risk Test resulting in a 37.9% remaining lifetime breast cancer risk. My monitoring plan since
2006 has been alternating diagnostic mammogram and breast MRI.
My most recent MRI located an enhancing nodule in my right breast. My oncologist has referred
me to a local surgeon to begin the process for prophylactic double mastectomy. I am interested
in natural breast reconstruction. I would like to schedule an appointment to discuss my options
with your plastic surgeons. I also will need to set up an appointment with the surgeon you use
for the actual mastectomy. I am not sure which appointment should be first.
A: Hi Stacy,
Thank you for contacting us. I am sorry you are having to make very difficult decisions in order
to prevent getting breast cancer. I commend you for being very vigilant with screening. As you
are aware screening alone won’t prevent breast cancer unless you act on the results of the tests
that indicate your risk is high.
Many women would consider preventive mastectomy in your situation. For many women
knowing that they can have immediate natural breast reconstruction for a permanent natural
result makes the decision a little easier to make. If you feel like you have any amount of extra
fatty tissue anywhere on your body then chances are you can use your own natural tissue. I’ll be
glad to answer any other specific questions just let me know.
James Craigie MD

Benefits of Autologous Reconstruction vs. Implant Reconstruction

When considering breast reconstruction, a woman is faced with a few options — she can

choose autologous reconstruction — which is the use of her own skin and tissue to

create a breast mound, implants, or go flat.

Recently, the recall of certain breast implants has made the news, as the FDA reported

their connection to 573 rare cases of anaplastic large cell lymphoma and 33 patient

deaths. As a result, the FDA asked Allergan to recall its BIOCELL textured breast

implants and tissue expanders and they obliged.

We are sure that this news is upsetting and leaves questions in the mind of patients

who wonder about implants and their safety, as well as the choice they should make for

their own breast reconstruction procedure.

At The Center for Natural Breast Reconstruction, we educate our patients on the

differences between all types of procedures and their risks, but our emphasis has

always been on autologous reconstruction. Here’s a little about each autologous

procedure that we do:

DIEP flap: This is the most popular type of perforator flap reconstruction due to its high

success rate and its ability to reconstruct the breast without the patient having to

sacrifice much needed abdominal muscles. In addition to reconstructing the breast, the

contour of the abdomen is often improved – much like a tummy tuck.

GAP flap: Similar to the DIEP, tissue is taken from the buttock area instead of the

stomach.

PAP flap: The Profunda Artery Perforator Flap (PAP) utilizes the tissue of the upper

thigh just below the buttock to reconstruct the breast following mastectomy.

So now that you know the difference between each procedure, why should you choose

autologous reconstruction over implants?

● Autologous reconstruction lasts a lifetime: Breast reconstruction using tissue

from someplace else on your body will last a lifetime. There is nothing synthetic

that can break or cause illness or other major issues. On the other hand,

implants will normally have to be replaced between 10 and 20 years.

● Breasts made by autologous reconstruction feels more natural: When your

breasts are reconstructed, you want them to feel just like your old breasts.

Implants do not always feel real, but since the tissue on your belly, buttocks, and

upper thighs is very similar to your breast tissue, it makes for a good, more

natural substitute.

Deciding what kind of procedure is best for you is a big decision. The best thing to do is

to gather all of your facts, talk with your doctor and your surgeon and weigh all of the

pros and cons before deciding on what’s right for you.

Woman to Woman

 

When you’re going through something big in your life, there isn’t anything more comforting than talking to someone who has been through it before.

For women who are having breast reconstruction surgery, a doctor is certainly available to answer many of your questions, but it’s also helpful to hear from another patient who has had the same surgery. What should you expect? How should you prepare at home? How will you feel when you wake up after surgery? What clothes are best to wear? When will you feel like yourself?

Meet Shirley. She’s a patient at The Center for Natural Breast Reconstruction who had a double mastectomy, followed by DIEP breast reconstruction surgery. She wanted to have a ‘girl-to-girl talk’ with other patients, so she wrote a 31-page booklet filled with raw, honest tips and advice that could help others. “No offense to the medical team that put together a technically comprehensive document, but boy did they leave out a lot of information that would have been helpful!” she wrote. “The kinds of things that, really, only a patient would know.”

Here is just a sampling of her tips and advice:

It’s a process, not a procedure:After the initial surgery, Shirley reminds patients that they will have one or two more minor procedures for final “sculpting.” “It’s important that you look at your reconstruction as a process, not one procedure and it’s done,” she writes. “Some healing is required between steps, and so there will be months between each step.”

Be vigilant at following instructions: Shirley made sure she followed her doctor’s instructions completely. That means that she ate a high-protein diet, made sure to exercise and took her vitamins. “I wanted to do whatever necessary to make sure everything went smoothly,” she writes. “Getting in shape prior to surgery will set you on a path to stay in shape, which will preserve your new body! Now that I have a flat tummy and perky “girls,” I’m more motivated than ever to stay fit.”

Go shopping before your surgery: It’s not just about retail therapy that will make you feel better. Shirley is advising patients to find specific clothing that will help with recuperation. “I would recommend that you get a very good idea of where your incision line will run and try to find some clothing that will be comfortable and not hit right on it for when you get home,” she writes. “And have large shirts at hand so that your drains will fit under. They need to button up the front, too, because it will be uncomfortable to raise your arms at first.”

Arrange help: “Another thing about showers — you have to dry off with a towel. So, here I was with limited arm movement juggling four drains and trying to dry all of my pieces and parts,” she writes. “I wasn’t supposed to be alone for showers the first couple of days. Dizziness and lightheadedness are common. My husband stayed with me and even helped me towel off, dress me and blow dry my hair. Naps usually followed showers.” If you don’t have a spouse, a trusted family member or friend should be available to help you.

Paint your toes:“Everyone will see your feet,” she writes. “I got so many comments on how pretty my toes looked. For some reason, that was comforting to me.”

Shirley also provides a day-to-day synopsis of her recovery, including her challenges such as sitting up after surgery and her accomplishments. Her booklet is helpful and inspiring to other patients who also may be struggling with finding the “light at the end of the tunnel.”

From one woman to another, Shirley gets you there.

The Center for Natural Breast Reconstruction would love to send Shirley’s book to anyone who like to receive it! Requests can be made via email, Facebook message, website chat, or phone at 843-849-8418. 

New Breast, Now What: Managing Expectations Following Reconstruction

Let’s face it — no matter what you’re going through your experiences are going to differ from someone else. Others who have had breast cancer, a mastectomy and reconstruction can tell you all about it but your journey will be different than your best friend’s, your neighbor’s or the woman sitting next you in chemo.

However, you are still going to have some expectations of how things may — or may not — happen following your reconstruction. The question is: How do you manage them?

You expect that reconstruction should be easy.

Ann* said that she educated herself immensely throughout her journey, but she was not fully prepared for the magnitude of her reconstruction surgery. She knew it would be a big deal and it would take a few months to recover, but for her, it took multiple surgeries

and her recovery took a lot longer than that. Your body has been through so much and it’s going to take time to heal. Don’t get dejected. Everyone heals at a different pace, but if you’re concerned about how fast your recuperation is going, talk to your doctor.

You expect everything done in one procedure.

Most breast reconstructions require more than one surgery, and, if desired, a nipple tattoo will be added months later to complete the process.

You expect to look the same after reconstruction.

You’re missing your breast and want the new one to look the same. While doctors do what they can to recreate your natural-looking breast, the new one will be a little different. It may end up slightly smaller or higher or rounder or feel different. Expect that there will be changes. It might take time to get used to these changes, but it’s easier to do it if you expect them going in.

You expect that your breast will feel the same.

When Susan had her reconstruction, she expected that the new breast would feel the same as it did before. Instead, it had no feeling at all and made her self-conscious, especially when she was intimate with her spouse. Of course, losing sensation can happen, but fortunately, The Center for Natural Breast Reconstruction offers ReSensation™, where donated nerve tissue attaches to a patient’s remaining new tissue in the affected area. Over time, nerve-endings regenerate and feeling returns.

You expect adjustment to be easy.

Jill said there are many things she misses about not having her natural breast. She didn’t expect to feel so down after a procedure that is supposed to help. To help her cope, Jill reminds herself of her goal to stay healthy for herself and her family, including her beautiful grandchildren and she said that she is grateful for everyday she can do that. Over time, she has learned to accept her new breast and enjoy her life.

You expect limited options.

Your doctors should work with you throughout the process. All breast reconstruction options should be discussed to help you to make a smart, informed decision.

Q&A: Ask the Doctor

Q: I have a history of benign proliferative breast disease with associated atypical ductal hyperplasia. I have had two needle biopsies and three surgical biopsies in my left breast. I took Tamoxifen for five years and currently am taking Evista. Last year I completed the Myriad My Risk Test resulting in a 37.9% remaining lifetime breast cancer risk. My monitoring plan since 2006 has been alternating diagnostic mammogram and breast MRI. My most recent MRI located an enhancing nodule in my right breast. My oncologist has referred me to a local surgeon to begin the process for prophylactic double mastectomy. I am interested in natural breast reconstruction. I would like to schedule an appointment to discuss my options with your plastic surgeons. I also will need to set up an appointment with the surgeon you use for the actual mastectomy. I am not sure which appointment should be first.

A: Hi Stacy, thank you for contacting us. I am sorry you are having to make very difficult decisions in order to prevent getting breast cancer. I commend you for being very vigilant with screening. As you are aware screening alone won’t prevent breast cancer unless you act on the results of the tests that indicate your risk is high. Many women would consider preventive mastectomy in your situation. For many women knowing that

they can have immediate natural breast reconstruction for a permanent natural result makes the decision a little easier to make. If you feel like you have any amount of extra fatty tissue anywhere on your body then chances are you can use your own natural tissue. I’ll be glad to answer any other specific questions just let me know.

Dr. Craigie

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.