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

Question: Long story short, I had a bilateral mastectomy with a tram flap reconstruction. For prophylactic measures 20+ years ago. 3 years ago I was diagnosed with stage 3 breast cancer Er/Pr large lymph node involvement. Chemo and radiation. Lumpectomy performed that left one breast very irregular and small—the other is very large. What type of procedure can be done to make both smaller and normal and can it be done? Thanks for your time

Answer: Thanks for your question. It might be possible to improve your symmetry by reducing the side that did not receive radiation combined with adding fat to the smaller radiated side. Adding fat  is called fat grafting and involves suctioning small amounts from one area and injecting the fat back into the breast. Ask your plastic surgeon if that is an option for you.

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

Question: I had a bilateral mastectomy in February 2013. Since that time, I went through expansion and implant procedures. Because my skin was thin, they ended up having to remove everything on the left side. Even after adding donor skin, it did not work. After researching, it seems that I would be a candidate for a DIEP flap procedure. My plastic surgeon is recommending the TRAM flap, but I am worried about taking muscle from my back. Can you please advise?

Answer: I’m sorry to hear that you had some problems with your breast reconstruction. I’m wondering if you had radiation? Thank you for asking about the DIEP procedure. Unlike the TRAM procedure, the DIEP should not involve removing your muscles. The TRAM removes all or part of the tummy wall muscle known as the rectus abdominis muscle. The TRAM also uses the fatty tissue attached to the tummy muscle to rebuild the breast. The DIEP uses the lower tummy fat also but does not remove any muscle. It  also does not remove the back muscle. The back muscle is called the latissimus dorsi muscle and can be  used to help with implant problems.  In general, I would recommend the DIEP procedure for breast reconstruction because it should not sacrifice or remove the tummy wall (rectus abdominis )muscle. I would need more information about your situation to be more specific. Please let me know if you would like more information. 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 have had several surgeries the last few months and none of them have gone well. The first was last December. After 12 1/2 hours of surgery, I had two breasts. Five days later, my left breast had to come off which left me with a gaping hole and a wound vac attached to me for 4 weeks. After the wound healed, a breast expander was inserted. The following week the expander moved down to the middle of my back. I’m a teacher, so I waited until summer to have it removed. Yesterday, I had more surgery to make my breasts both look normal. It’s not looking too great. My left breast just hangs and there’s a lot of extra skin under both my arms. I’m writing, because I’m afraid this is as good as I’m going to get. I’m hoping that it can be fixed. Would you consider taking me on as a patient? I’ve had six surgeries after my double mastectomies. I’m not sure how much more I can take.

Answer: I’m sorry to hear that you have had such a difficult time. I know that you just had surgery and that as you recover your results may improve. However, you have been through quite a few surgeries and probably know what to expect. I don’t know where you live or if you could come for a consult. If you can, I would be glad to give you my opinion. We have taken care of many women who have had challenging problems like yours related to their breast reconstruction.  If you are unable to come for a consult we could get more information from you and my staff could tell you how to send photographs. After viewing the photos, I could give you more specific information about how we have helped other women who have been in your situation.  Just let me know how you would like to proceed. 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: In late July 2012, I had a lumpectomy for St 1 invasive ductal carcinoma and a few lymph nodes. I now have my original DD with very dense tissue, and a large C that I actually like because of the location of the tumor-it gave me a bit of a lift. Honestly, I would love to have the bigger breast reduced, as if it also had a tumor removed from the same area, so they match better. Have you ever done that? Thank you for your time.

Answer: Thank you for your question. Yes, you have a good point, and I have done that before on multiple occasions. It is much better to reduce your non cancer breast than to attempt to alter the breast that has been treated with radiation. It is very fortunate that the lumpectomy and radiation left your breast in a desirable shape and size. If you would like more information, 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: Hi doc, I want to undergo breast reconstruction. Would you please inform me on how I should proceed?

Answer: Thank you for your question. If you have had or are planning to have mastectomy surgery, then chances are that you can have breast reconstruction. There are different approaches and procedures. The best option for you depends on the specifics of your situation, such as previous surgery, medical history, and expectations. If you would like to know more, we would need to get some information about your situation. Just let us know we can contact you for the details.

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’ve already had transflap and gluteal flap surgeries. Both failed. What’s different about your methods? Would I be a candidate?

Answer: I’m sorry to hear that you have had problems with your reconstruction. I can’t tell you how our approaches are different than what you have already tried without knowing all the details. I will say that our specialty is using your own fatty tissue without ever sacrificing your important muscles. Our overall success rate for these procedures, in over 1,500 breast reconstructions, is 98.5%.

We do not do the tram procedure, but we prefer the DIEP procedure that uses your tummy fatty tissue without sacrificing the tummy muscle. We also use fatty tissue from the buttock and that approach is called the sGAP procedure.

For patients who have more fatty tissue in their thighs, we can perform the same type of reconstruction using the thigh tissue. If you have not had radiation, there are techniques that require implants and fat injections that could be an option. In that situation, small amounts of fat are taken from multiple areas using techniques similar to liposuction. The fat can then be combined, prepared, and then injected around an implant or alone to perform breast reconstruction. This approach requires multiple procedures with repeat injections of small amounts of fat and when used with an implant is best when no radiation is needed.

I would be interested to know more about your situation. Did you require one breast or two reconstructed? Did you need radiation? What were the circumstances that led to the previous surgeries failing? Were the blood vessels of your chest used to connect to the new breast tissue? Using the buttock tissue is not performed many places and is not always available. I would be interested to know where you had that procedure done. Please 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: Should I have DIEP, after I had radation? I had it in 2013, and now I have non-invasive in same breast. My doctors are wanting to do this.

Answer: Thanks for the question. If you have already had radiation and are going to have a mastectomy, then DIEP breast reconstruction might be your best option. You do not want to have the DIEP breast treated with radiation. Make sure you ask your doctors if you may need radiation again after your mastectomy. Implants after radiation, in general, have higher complication rates and less favorable results.

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