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

Question: Hi, I have widespread DCIS in one breast. I am very interested in reconstruction using my own tissue. I had a lumpectomy but all of the DCIS was not removed. Not all margins were clear. I live in Columbia and if I’m a candidate, I would love to know recovery time as I work full time.

I just have so many questions as I was not expecting to hear I needed a mastectomy. I’m 52 and am probably a B cup at best. I’m not looking to go bigger, etc. I just want to do the best thing to feel normal. I also am considering double mastectomy.

Judy K. told me all about you and has given me so much information on reconstruction. I would love to see if I’m a candidate. I do have a clotting disorder called the prothrombin gene mutation so am usually on Lovenox for a few days after any surgery.

Answer:  We would be more than happy to see you and discuss your options.

Reconstruction is not just one operation, but a process, with the first stage (flap transfer) being by far the largest. The first stage usually requires 4 days in the hospital, and another 2-3 days in town. There isn’t any “magic point” when you are fully healed, but we usually say 6-8 weeks is necessary for recovery. Any subsequent stages typically require only one night in the hospital (at most), and you can leave town the next day.

We ordinarily keep patients on Lovenox for at least a full week after surgery. If you have a clotting disorder, we may extend that, based upon your hematologist’s recommendations.

If you would like to see an experienced breast oncologic surgeon also at the time of your visit, we can easily arrange that.

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 mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had.

The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast. I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere.

As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much!

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best. Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue.

If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles. The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

Question:  Thank you very much for taking the time to answer my email!

I appreciate the options you are giving me without sacrificing the muscles of my body. I wasn’t so thrilled about that kind of surgery. As I read your website, I understand that you do that surgery. Do you see good long-term results with DIEP or sGAP?

Answer: Yes. When using your own fatty tissue the long-term results are typically the most natural of all the options. When the process is successfully completed the fatty tissue is living tissue that never deteriorates. In other words the results should be permanent. Implant techniques tend to deteriorate over time due to the fact that the implant is not living tissue. Implants can leak, move out of position or need to be removed secondary to infections.

Also the body can reject them because they are a foreign body. Long term results from techniques that remove or sacrifice important muscles can have long term problems associated with removing the muscle. Furthermore the breast is not made of muscle so muscle should not be needed to make a new natural breast after mastectomy. Every situation is different and perfect results are not guaranteed with any approach. No one technique is best for every individual.

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: Hi! I had a mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had. The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast.

I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere. As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much! 

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best.

Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue. If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles.

The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

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 am trying to find a surgeon that can repair an already breast reconstructed breast that was done 5 years ago.

Answer:  Thank you for your question. The answer is yes, I frequently revise breast reconstruction that was performed elsewhere. Whether your previous surgeon is no longer available or if you would like a second opinion I would be glad to help.

My practice specializes in breast reconstruction of all types and we frequently see patients who have failed a previous attempt at breast reconstruction. If it would be convenient for you to come for a consultation let me know and someone from my office will contact you for more details. If not convenient for you to come for a consult we could talk over the phone. Let me know if I can help.

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: Hi, I am 19 years old and 13 months ago I had a benign lump removed from my right breast. Since then, my right breast has increased in size significantly but my left one has not. My left breast is a full size smaller than my right breast and I’m very self-conscious about it.

I want to get a procedure done that will even them out. I’m just having a hard time finding the right doctor to do it, and I’m unsure how much the insurance will cover. If you could help me with the insurance policies and what your surgeons could do for me, I would greatly appreciate it. Thank you so much.

Answer:  Thanks for your question!

It is difficult to sort out exactly what is going on and what would need to be done based on your brief description, but we would be more than happy to see you in the office and evaluate your situation (medical and insurance).

While your insurance company may not be obligated to cover any treatment without the diagnosis of breast cancer, that does not automatically mean that they won’t.

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 have breast cancer Stage 1 grade2 in my right breast. The surgeons here want to use my latissimus dorsi muscle for reconstruction. This is unacceptable to me because I am very active and snow ski and garden etc.

I think this method runs too much of a risk to my future ability to do things I like to do. I had lipo on my lower abdomen years ago. I do have more than enough fat on my upper abdomen. Can that be used? I am not comfortable with what I have been told so far.

Answer: Thank you for your excellent question! I’m sorry you are having to go through breast reconstruction and breast cancer treatment. You make a very good point and I agree that you should not need to sacrifice your bodies important muscles in order to restore your body after having mastectomy.

In some circumstances it may be necessary but you should know that there are options that use your own natural fatty tissue without sacrificing your important muscles. You should also anticipate that you can continue to be active as before surgery. In our practice we frequently help patients who have had tummy lipo or other surgeries that make the tummy fat inadequate.

We can also use fatty tissue from the buttock or thigh area without sacrificing muscles or using silicone breast implants. 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 don’t understand why insurance company doesn’t pay for reconstruction if you’ve had lumpectomy. With radiation your breasts shrink a lot and you are all out of proportion. I finally did get them to pay for prosthesis and bra.

Answer: That’s not always the case with lumpectomy. If the surgery results in a significant defect or radiation negatively impacts the tissue, most times we can submit your case to your insurance company along with photos of the affected area and they will indeed cover a reconstruction surgery for you.

We’re happy to chat with you about your specific situation and see what we can do to help you through that process.

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 wanted to know if you accept patients that are considering implant removal and reconstruction (with no history of mastectomy). If so, I’d like an idea of costs involved. Thank you!

Answer: Thank you for your question. Yes we do surgery to reconstruct and re shape the breasts after implants are removed. The cost is determined by what procedure is necessary to help restore the breast shape.

If your implants were put in for cosmetic reasons then the surgery to restore the breasts is usually cosmetic as well. If you would like to come for a consultation I could give you more specific details regarding the fees.

Alternatively if you can not come for a consult I could get more information from you about your situation. A call from.my staff for more details may be needed. Just let me know if either option is good for you.

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 and wanted to do the natural breast procedure but the surgeon wouldn’t even discuss it. Then he totally botched the reconstruction. I look deformed. I still avoid the mirror. A redo was set but was canceled day of surgery because b/p and bipod star were elevated. I want it redone. I would like to have the natural breasts. I have plenty of abdominal tissue. I am diabetic.

Answer: I’m sorry you have had so much trouble with your reconstruction.

Fortunately, previous attempts at implant reconstruction rarely impact our ability to successfully perform a reconstruction with your own tissue. Diabetes increases your risk of some complications, most notably wound healing problems and infections, but it rarely keeps us from doing the reconstruction at all.

If you wish, we can have one of our staff call you to discuss your situation further.

Thanks for your question, and look forward to meeting with you.

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 tram flap done back in 2012. Didn’t like the results so I didn’t go back to get it finished. I was to receive a breast reduction on my left breast because I was heavy. My left breast is still larger than my right. Can it be re-fixed to how I want so that I can be happy with my body?

Answer: Thanks for your question. Yes you can still have a procedure to adjust your other breast. There is a good chance that adjusting your “heavy” breast will improve the match or symmetry between the two and improve your overall result.

It is also possible that your TRAM breast could be adjusted so that the result is better. If you never went back to have it revised then there is a good chance that improvements could be made. If you would like more information then let me know I can have someone from my office contact you for more information.

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