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

Question:  My doctor wants to do a DIEP FLAP but my insurance doesn’t advise it. I want my breast to look normal so could you help me? 

Answer: Your insurance company should not be in the business of recommending or not recommending medical care, although they may agree to pay or refuse to pay for certain procedures. By law, if you have had breast cancer, they must generally cover the cost of the reconstruction of your choice, whether it’s DIEP, implants, or whatever.

A lot of factors go into determining how natural your breast reconstruction can look, with perhaps the most important factor being the type of mastectomy performed. Generally speaking, nipple-sparing mastectomies have the potential to look the very best, followed by skin-sparing mastectomies.

Even non-skin-sparing mastectomies can sometimes be reconstructed with a very natural appearance, however, it just depends on a lot of things such as whether you are radiated, the quality of your scars, overall symmetry, etc.

If you would like to give us more specifics on your situation we would be happy to help you all we can, and thank you 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 stage 1 of my Diep done in NY. I would like to have stage 2 completed closer to home as I live just outside of Charlotte. We have our insurance policy with Bc/Bs.

I had some minor healing issues but now I am doing well. I am not happy with how my breasts and body look post Diep. My original surgery was December 1 2015. Thank you.

Answer: I’m sorry you are not happy with your breasts / body now, but things often don’t look too great after stage I, so don’t despair.

I liken stage I to throwing one or two lumps of clay on the chest and waiting for them to “stick”, then at stage II we actually come back and make something pretty out of them.

We would be delighted to help you in any way we can. Our nurse Chris or P.A. Kim will call you soon to get 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 have an expander and I notice there are soft spots on the front of my breast. Does this mean there is something wrong?

Answer: The best thing to do would be to ask your surgeon about the spots on your breast.

The soft spots that you described don’t sound worrisome but unless we did your surgery and are familiar with your situation then we have no way to knowing if anything is wrong.

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 nipple sparing surgery. I also had latissimus dorsi for my right breast with an attempt to pull fat from my stomach to fill in (there was very little). Now under my right arm is a roll of what appears to be fat and it feels like I have a ball under my arm. Also, my right breast is so small and very tight.

The lipo attempt has left me with HUGE hard lumps and rolls that are very uncomfortable. It hurts to wear a bra or anything that has a band around me cause of the lumps and bumps. Prior to this my stomach was FLAT and actually nice.

Now it is HIDEOUS! Since this was all due to having bc. I am looking for a brilliant Dr. who can smooth out my stomach and give me a breast that is actually there and doesn’t feel like like a baseball!!

Answer: Thanks for your question.

I’m sorry you have had so much trouble with our reconstruction. Sometimes people have problems under the arm such as you describe after a latissimus flap, and there are techniques which can improve this.

What was done for your left breast?

If you wish, we can have our nurse Chris or PA Kim call you to discuss your situation in more detail, just let us know

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 an overwhelming history of breast cancer in my family (2aunts and grandmother ovarian cancer). My mother was diagnosed at age 50 before menopause and had to have chemo and radiation. I have BCBS of SC health insurance and it looks like the genetic testing is covered under medical necessity.

If I test positive I wanted to explore my options and know my coverage. Have you seen insurance cover a mastectomy and reconstruction under BCBS of SC for someone who has not been diagnosed but tests positive? Thanks for your help.

Answer: Thank you for your question. Yes we have had many patients who had negative genetic testing who have had preventive mastectomies and immediate breast reconstruction.

You should discuss your risks and history with a breast surgeon. They will let you know what the insurance company requires. If you are approved for a preventive mastectomy then reconstruction will be covered as well.

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 lumpectomy on my right breast 16 years ago. I also had chemo and radiation. I never had reconstruction but was willing to live with it. But over the years I think the radiation has made my breast smaller and both breasts droop now.

Are there any surgeries being performed using stomach fat and how complicated for a 66 year old would this be? I am very healthy and exercise and workout a lot.

Answer: We routinely do reconstructive surgery on patients your age and older with good results (we did a bilateral DIEP reconstruction on a 74 year old lady a few weeks ago). Your overall medical condition is much more important than your chronological age.

You are correct to think that using your own tissue is usually preferable if you have had radiation, as the success rate in this situation is much higher using your own tissue than trying to use implants. The surgery is big, but we do it routinely, and it may well be your best option.

We would be happy to have our nurse Chris or P.A. Kim call you to discuss your situation further, and I will be happy to speak with you, if you wish. Thanks for your inquiry!

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 a bilateral mastectomy in December, I am in the process of having my expanders filled. I am looking for a ‘C’ cup size when finished but I can’t equate this to the amount of ‘cc’ that need to be injected. Right now I am at about 420 cc and my doctor tells me that we are just about done.

When I look at my breast it doesn’t appear to be very large. Would you be able to tell me how many cc would be needed to achieve the size I want? Thank you.

Answer: Thank you for your question. I’m sorry to say that there is no correlation between cc’s and bra size. The best place to start is to ask your surgeon how much your mastectomies each weighed.

Grams of breast compared to cc’s of saline and then extrapolate to your bra size you were before your mastectomy. It will not be exact but will give you a ballpark figure.

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