This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I am having mastectomy in January; I would like to know about the TUG procedure – if it can be performed following a mastectomy or does it have to be done at the time. I should not be receiving chemo or radiation. My surgery is in Houston ( MD Anderson ). I live in the Nashville area.

Answer: We do not recommend the TUG flap under most circumstances. A significant incidence of lower extremity lymphedema has been reported following its use, and it is often not large enough to provide a satisfactory breast mound by itself. In addition, the donor site is prone to wound healing problems, and the donor site scars can be difficult to conceal.

Our first choice for autogenous breast reconstruction is the DIEP flap from the abdomen, which is a tried-and-true technique. If this donor site is not available, we recommend the SGAP donor site from the upper buttock. The sGAP can produce arguably the best breast reconstruction of any donor site, but is difficult to perform, which usually means the patient needs to travel to get the necessary surgical expertise.

The PAP (profunda artery perforator) flap, which comes from the “banana roll” of the posterior thigh, is our choice if neither the DIEP nor sGAP are available or adequate. It provides about as much volume as the TUG, but has far less risk of lymphedema, and a dramatically better donor site scar.

Any of these flaps can be done at the time of mastectomy or later, with the caveat that you never want to let a flap get radiated, as it can “shrivel up” dramatically. There are advantages to doing the flap at the same time, and advantages to waiting, but probably most of the time it is better to do it at the same time, if possible.

For completeness’ sake, it bears mentioning that if you are not receiving radiation, you may be able to get a satisfactory reconstruction with implants. However, even the best implant reconstruction does not approach the “naturalness’ of a reconstruction using your own tissue.

Thanks for your question, and good luck!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had a double mastectomy 5/2/16. The plastic surgeon placed expanders on both sides with the intention of doing reconstruction surgery in 6 months. I was diagnosed with pre-cancer stage 0 dcis in situ but genetic testing showed I was positive for the BRCA2 gene which led to the double mastectomy. The left expander had to be removed due to thin tissue that wouldn’t knit together and I had a wound vac in place for 10 days. I was thinking of getting natural reconstruction but since I have the right expander was told that it would have to be removed along with the dog ears skin on both sides. I am 64 and don’t know what to do.

Answer: I’m sorry you have had so much trouble so far.

You have already had trouble with implant (expander) – based reconstruction, and that could make it more likely that you will have trouble in the future with additional attempts at implant reconstruction. Fortunately, however, previous failed attempts at implant reconstruction almost never reduce the chances of having successful reconstruction with your own tissue (assuming that you are otherwise a good candidate for that).

Because you have had a somewhat complicated course thus far, apparently with some tissue loss, I would appreciate the opportunity to evaluate you in person, if possible, before giving you any more specific advice. We will give you our honest opinion about what we believe your best options are, whether using more implants or your own tissue, and then even of you just decide to have your expander removed, you may feel better about your decision. If you wish, we can have our P.A. Kim or nurse Chris call you to discuss your situation further.

Thanks for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had breast reduction surgery a few months ago and have developed fat necrosis. I keep reading it may resolve, I’m scared it won’t! My right breast has a 4″ X 1.5″ area of it. Is that considered a large area? I’ve read that only small areas have a chance of resolving on their own. I keep massaging the area and applying heat. Is the icy hot patch a good option for heat?

Answer: Fat necrosis usually resolves on its own, but it is true that large areas may persist indefinitely. If the area is not painful, it probably does no harm, other than potentially complicating mammograms and breast exams. If it concerns you, however, you may wish to consider having it removed. There are no firm guidelines, but large areas persisting more than 6-12 months are less likely to go away on their own.

Thanks for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had a prophylactic double mastectomy 9 years ago. I am BRCA 1 positive and have lost several family members to both breast and ovarian cancer. I would like to have my silicone implants removed and have the DIEP surgery. However, I don’t know if my insurance will cover this procedure and how being out of state will affect the payment of it if it is covered.

Also, I am one of Jehovah’s Witnesses and I wanted to verify the surgical team is okay with performing bloodless surgery. Maybe this surgery is designed to be bloodless but I wanted to make sure everyone is comfortable with working on Witness patients.

Answer: Thank you for your question. Yes we frequently help women who have problems with their implant breast reconstruction. If you feel like you have extra tummy tissue there is a very good chance that removing the implants repairing the chest muscle and rebuilding the breasts with the DIEP procedure would be our recommendation.

I am very familiar with the Jehovah witness faith regarding surgery and blood products. I have quite a few patients and would be glad to discuss this with you. Let me know if you have more questions or if you would like to arrange a time to discuss your situation.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: After having surgery, radiation treatment left my breast very small so I want to know if I may be a candidate for a procedure to rebuild my self-esteem. I had a complete mastectomy after the radiation on the right breast.

Answer: Yes there is definitely a chance that you could have your breasts reconstructed. After radiation I would usually recommend options that use your body’s own natural tissues because after radiation implant options are higher risk for problems. If you still have your left breast but it has developed shape problems because of surgery and radiation then there are options that can help. It may be best to rebuild both breasts at the same time to achieve better symmetry.

After radiation we usually wait a period of time (approx. 3 months) before performing reconstruction. Any time after that is usually ok. For more specific information I would require more of the details of your situation, medical history and prior surgery history. Thanks for your question. I hope this helps. Let me know if you would like more information.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had implants put in 33 years ago, got breast cancer, had a lumpectomy, radiation, and got rock hard implants as a result. I just recently decided to have the implants removed and a great deal of scar tissue. They put in expanders that caused me to get an infection. I had to almost beg them to believe me as the pain was horrific. I had a 2nd doctor remove the expanders. I now have a very deformed left breast and a severely drooping right breast. I contacted the doctor who put my implants in years ago. He is no longer in the area, but told me about this procedure.

I guess my question is if this procedure would be successful for me? I do not like the way I look, and it is painful as well. I am a teacher, and would need to know the time frame this would entail. It has been a horrible summer with this ordeal. I almost wish I left the rock-hard implants in. Please let me know what you think. I am very much interested in hearing your thoughts. 

Answer: Thank you very much for your question. I’m sorry you have had so much difficulty. Your situation is unfortunately quite common, but the good news is that natural breast reconstruction with you own tissue can often help dramatically. Fortunately, a history of radiation (&/or multiple failed attempts at implant reconstruction) does not at all decrease the success rate of subsequent reconstruction using only your own tissue. We have successfully reconstructed hundreds of women in your situation.

Our first choice for a donor area, if you have some extra tummy tissue, is the DIEP flap. If you do not have adequate tummy tissue, the buttocks (sGAP flap) is also often an excellent donor area.

It is important to realize that natural tissue reconstruction is not just an operation, but a process. The first operation, the microsurgical transfer of the flaps, is by far the largest. It usually takes 6-8 hours, requires a 4 day hospital stay, and a total stay in Charleston of about a week. Recovery takes approximately 6-8 weeks.

After you have healed fully from the first surgery (usually 6 months if you have been radiated), 1-2 additional surgeries are required to achieve optimum results. These are much less involved, ordinarily requiring only one night in the hospital, and you can usually go back home as soon as you are discharged.

While the process can be lengthy, once you are done, you are REALLY done. Most women reconstructed with their own tissue come to regard their reconstructed breasts as their own, and are finally able to put the issue of breast cancer behind them.

I would be happy to call and discuss your situation in more detail, if you wish, and thanks again for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I had bilateral mastectomies with reconstruction in 2007. I recently had my implants replaced due to a capsular contracture on the left side. I now have 495CC contour implants. I love the right side but not much the left. Is there anything that can be done to help?

Answer: There is possibly something that can be done to improve your situation, but it is difficult to say for sure without knowing a little more about what is going on. Some possible things which could make your reconstruction unacceptable include recurrent contracture, inadequate soft tissue cover, or the implant shifting from the proper position.

Additionally, if you are radiated on that side, it can be very difficult to get an acceptable result. We would be happy to call and discuss your situation further, if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  What is the approximate cost and time for this procedure?

Answer: Thanks for your question. I’m sorry I can’t be too specific because there are quite a few variables to consider. Breast reconstruction is covered by insurance and the total cost depends on hospital and doctor charges.

When someone pays out of pocket we get quotes from the hospital based on what surgery is being done. The same thing is true regarding the surgery time. The average for one breast approximately 3-5 hours. The hospital stay is 4 days.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I currently have breast implants that were done about 9 years ago following a double mastectomy. I want to have the implants removed and redone with my own tissue. I do not know if my insurance will cover this procedure and I need to have a bloodless surgery. My current plastic surgeon recommended that I get someone who specializes in this type of surgery since there aren’t any in our area that do it often enough for him to recommend.

My surgeon also suspected that one of the implants has ruptured and I didn’t know if I should go ahead and have my MRI done here or if I should wait to have it done as part of the surgery that you would perform. I just wanted to avoid duplicating necessary lab and xray work.

Answer:  Hi, thank you for your question. It is our mission to help women restore their bodies after mastectomy. We named our practice the Center for Natural Breast Reconstruction because we specialize in using your own natural tissue. We replace problem implants frequently with fatty tissue (DIEP, sGAP, fat grafting etc…). What do you mean by bloodless surgery? It is very rare for our patients to require blood replacement.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!