Ask the Doctor- Can you you improve my issues and tell me the cost?

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

Question: Due to strong family history of breast cancer, I had a bi-lateral subcutaneous mastectomy. I had this surgery shortly after my husband died suddenly from a MI. I was in my early thirties with two young children to raise. I had such a poor result and complications from that procedure, I am now interested in using abdominal fat for both breasts. Until this year, I had no fat @ 123lbs.

I now have abdominal fat, @ 137lbs. The poor result of the surgery destroyed my self-confidence as a woman. I am 68 yrs. old in great health but, because of the way I look, I have never accepted an invitation for a “date,” in all those years. My chest is tight, painful, with random indentions that were cuts made into the muscle in an effort to give me some relief.

I got no relief, just exacerbated the look, the shape of both breasts. Does this sound like an issue you could improve? Also, could you give me just a ballpark cost, a guesstimate, the range of lowest to highest cost? Thank you.

Answer:  Good questions. I’m going to copy our doctors and physician assistant to answer the clinical questions for you. There are other options for you to consider and they can ask some questions to be able to help you decide what might work out best for you. The whole team is in surgery right now but I am sure they will reply as soon as they have a chance to catch up on their e-mail.

In the meantime, here are some basic ideas of cost. This would be for a “self pay” patient. We do accept most insurances so ultimately your financial responsibility would be based on the contract between you and your insurance company. This is a very rough estimate based on some research into the same question for a patient early last year. We’d have to update for you if you choose to proceed but it’s a good starting point.

The fee for a DIEP flap for a private pay patient is $10,000.00 per side. Rib cartilage resection to access vein $1604.78. Mesh placement to repair abdomen $1032.00. Second side/procedures are discounted by 50%.

Anesthesia is per hour at $500 for the first hour and then $300 each hour after. These procedures typically take 4 to 5 hours for one side.
Pre-operative imaging $3015.44 (MRA pelvis/abdomen)

East Cooper Hospital $ 25,000.00 – covers operating room and 4 day inpatient stay.

Hope this information is useful, please feel free to send any additional questions you may have, we’re always happy to help!

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

Ask the Doctor- Can you help with a radical?

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

Question: Had a radical on one side and a more common one on the other due to cancer. Can you help?

Answer:  If you have some extra skin and fat on your abdomen, buttocks, or thighs, then there may be a good chance we can use that to reconstruct you. It can be very difficult or even impossible to reconstruct a radical mastectomy defect with an implant, but if we are able to use your own tissue it could potentially be very straightforward, depending on the particulars of your situation.

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

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

Ask the Doctor- What exercises will help my pain?

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

Question: I had tissue expander insertion 3 weeks ago, drain removed today, filling started last week (60 ml) and again today. I’m having a significant amount of pain in my armpit, drain site and back of shoulder above scapula. Knowing I can’t raise arm above my shoulder, what exercises would help?

Answer: Not sure any exercises would help. It is fairly common to have pain in armpit and drain site, not so much so above scapula. My first recommendation is to discuss your concerns with your treating surgeon. We are happy to give you all the support we can, but at this point your treating surgeon should be your first resource. We are, however, here if you have further questions.

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

Ask the Doctor- Can I use extra skin to save reconstruction?

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

Question: I had my surgery in 2012 , double reconstruction. I had Bariatric surgery in 9/2006. I have continued to lose weight. Now under 130 lbs, my breast are sort dwindling away. Is there a way to take all of the extra skin I have on my arms and thighs to save my reconstruction?

Answer:  There is probably some way to use at least some of the tissue you describe, but we may have to get a little creative. One potential option would be to harvest fat from the involved areas to graft into the breasts, then excise the extra skin. It also may be possible to transfer the thigh tissue as another flap, but that would obviously be much more involved. If you would like to come for a visit, we can evaluate you and carefully consider the options.

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

Ask the Doctor- Would I be eligible for reconstruction?

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

Question: I will be having a prophylactic mastectomy for PALB2 mutation. I am interested in DIEP natural breast reconstruction but I have had mesh umbilical hernia repair. Would I be eligible for this surgery? Are there any tests that would be needed to find out if my vessels are any good in my abdomen?

Answer:  Thank you for your question. Yes and yes. It is still very possible you could have a DIEP. It depends on several other factors. The specific test I would order for my patients in similar scenarios is an MRI angiogram. The test is very specialized and very helpful. 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!

Ask the Doctor- Can you provide relief for my discomfort?

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

Question: Due to a family history of breast cancer I had a bi-lateral subcutaneous mastectomy with saline implants, all in one surgery. The result was not good. My chest muscles did not stretch/relax, the implants did not drop. Not only are they misshaped they are painful, in that my chest feels tight. My surgeon went into my arm pits and cut the muscles in several places to relieve some of the restriction. There was no relief.

I have indentions in my breasts from that procedure. Using my arms, lifting, vacuuming, etc. is sure to produce more discomfort. I have gained some weight, and wonder if I could use my own fat, including implants to relieve this discomfort and regain some measure of self confidence. In thinking back, I have missed so many things because of the discomfort as well as feeling like a freak, I have absolutely been depressed.

I was widowed in my 30’s,and had this surgery shortly after my husband suddenly died from a MI. I had two young children to take care of and had this surgery as a prevention. My result was so poor…I have never accepted a date. Your opinion will be appreciated. Thank you.

Answer:  Thank you for your question. I’m sorry you are having problems with your breast reconstruction. Specifically regarding your question there are possible options that could help. It is possible that using your own fat and moving your implant from below the chest muscle to above the chest muscle could help improve your result.

One drawback to implants over time is that your body can develop more scar as time goes by. This scar can make the new breasts hard and cause tightness. Some people will not do well with implants because they make more scar than normal. In that case it may be better to rebuild both breasts without implants.  This procedure is more complex but includes removing the implants repairing the chest muscle and rebuilding the new breast with fatty tissue from another part of the body that has extra fat.

I cannot tell you what option is best for you without more specifics about your medical history and previous surgeries. If you would like more information let me know my staff would need to contact you for the details.

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

Ask the Doctor- Is it possible to have expanders then radiation?

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

Question:  I had a double mastectomy May 24, 2016. My treatment was 5 rounds of chemo and I have completed 9 of 30 radiation treatments. My radiation oncologist had told me that reconstruction can’t be done until 1 year post radiation. I was to start reconstruction at the time of mastectomy but due to 1 positive node that was not done. That was devastating to wake up to that news. I wanted to know if that is true since I have read that a lot of women get expanders and then have radiation. I want reconstructed as soon as it is possible. Any information would be appreciated.

Answer:  I’m sorry things have thus far not worked out ideally, but there is still an excellent chance you can have a satisfactory reconstruction.

Expanders are often put in at the time of mastectomy, whether or not radiation is anticipated, with the goal being to complete expansion before the initiation of radiation. After you are radiated, expansion becomes much more difficult, so much so that many surgeons (including us) will not even attempt it.

The good news is, radiation does not in any way impact our ability to do reconstruction with your own tissue (typically with DIEP flaps, sometimes with sGAP or other flaps). While most surgeons wait for 6 months after the completion of radiation to do flap reconstruction, it can sometime be done successfully as early as one month, depending on how healing is progressing.

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

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

Ask the Doctor- Can you tell me more about the TUG procedure?

 

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.

AnswerWe 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!

Ask the Doctor-Are prosthetics right for me?

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.

AnswerI’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!

Ask the Doctor- What are my reconstruction options using only my tissue?

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

Question: I am 39 years old and seeking options regarding a double mastectomy with reconstruction using only my own tissue. I was treated for an aggressive breast cancer in my left breast 3 years ago; went through neoadjuvant chemo, then lumpectomy followed by radiation. Due to my lifetime high risk status, I feel a double mastectomy is necessary using my own tissue for reconstruction.

AnswerThank you for your question, I am glad to hear that you have completed your breast cancer treatment 3 years ago and are doing well. It is very likely that using your own natural tissue is going to be a very good option for you.

Since you have already had radiation on one side the option of removing the remaining breast tissue and having a preventive mastectomy on the other side is the most effective option to minimize your chance of getting breast cancer again.

Although i imagine it is already very low. Have you had any previous surgery on your tummy? Do you feel that you have extra fatty tissue there or any other area of your body? If so then you can probably achieve a proportional natural tissue result without having to sacrifice your important muscles.

If you like I could arrange for a convenient time to answer any other questions by phone. Let me know and ill have one of my staff contact you to make arrangements.

Thanks again.

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