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?

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.



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!


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!



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.


Richard M. Kline, Jr., MD