Ask the Doctor-Are Your Doctors Experienced with Tuberous Breast Deformities and Repair Without Breast Implants?

This week, Richard M. Kline, Jr., MD  of The Center for Natural Breast Reconstruction answers your question.

Question: Are any of your doctors experienced with tuberous breast deformities and repair without breast implants?

Answer: We don’t have specific experience with tuberous breast deformities, but I am nonetheless optimistic that we can address your concerns. The cornerstone for tuberous breast deformity reconstruction is reduction of the nipple areolar complex.

This is straightforward, and the remaining part of the equation, enlargement of the breast mound, is also well defined. If you do not want to use implants, but also want to be larger, you may have to accept some additional scars associated with transfer of natural tissue.

Otherwise, there are no particular problems. I would be happy to 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!

Breast Reconstruction Surgery: 16 Pre-Op Q&As from Our Physician Assistant

Breast reconstruction surgery can be scary. And we know that you’re bound to have questions about what to expect when it comes to the surgery itself and the healing process afterwards.

Thankfully, we have a handful of reconstruction surgery experts at The Center for Natural Breast Reconstruction. We’re thrilled that one of our very own Physician Assistant, Audrey Rowen, PA-C, takes special care to personally answer reconstruction surgery questions asked by our patients. We were particularly impressed by this group of them and wanted to share with you!

If you’re about to have breast reconstruction surgery, or are considering the option, please keep reading! We think you’ll find comfort in the answers below.

1. Where will the scars on my breasts be and will I be able to wear low-cut tops like I did before?

We try to use previous implant scars if we can, but sometimes we need to do things a little differently in order to access the blood vessels behind your breasts.

The incisions we make are generally below the nipple line and should be covered by most clothing. The shape and overall appearance of the breasts after stage 1 is not the final result so things won’t look as you are hoping until after the second stage. But, every person is different, and we will be better able to answer this question at your pre-op marking appointment and after your first surgery has been completed.

2. How long will I be in the surgical bra?

We typically keep our patients in the surgical bra for a minimum of 6-8 weeks and during any strenuous activity after that. After most healing is complete, we can switch you to a front-closing sports bra or other similar bra that provides support without being too tight. Most women wind up wearing a surgical bra through the first 2 stages and may be able to go without a surgical bra after that.

3. I think you said you could make me a C cup. I’d like you to make me as big as you can with what I have to work with.

We will do our best to give you the biggest flaps we can at the first stage. After that we can do fat grafting to increase the size of your breast. 

4. Does more fat in my tummy area make bigger, better breasts?

It can. This doesn’t mean we want you to go out and try to gain a bunch of weight before surgery because you can’t target where you want to store fat. In fact, sometimes the fat goes around your intestines or below your abdominal muscles, and we can’t get to that fat. Women who have larger tummies often have larger flaps, but we can always use liposuction to gather fat from other areas (buttocks, thighs, inner knees, waist area) at subsequent stages to add volume to the breast mounds later.

5. I understand they will not be pretty at first, but will they be lumpy or smooth, or what should I expect about how they are going to look in the beginning?

Every patient is different so the outcomes are not always standard. At the first stage, you will have what we call a “window” where the donor site flap skin is visible on your new breast. This does not mean it is an opening, but rather imagine that a piece of your skin is donor skin while the rest of your breast has your original breast skin.

This is not always permanent as we can sometimes completely close the breast skin on top of the flap, but in some patients who could not have skin-sparing mastectomies, they may always have that section of tummy skin showing.

Things stay pretty swollen for up to 2-3 months so there may be hard or squishy areas that may change throughout your recovery. We try to create a semi-smooth transition from your breast/chest skin to your donor site flap, but our main priority at stage one is to get the blood vessels attached and keep them working.

Things may look a little deformed, asymmetrical, or strange after the first stage, but we fix these issues at stage 2. You are also likely going to have what we call “dog ears” on either side of your abdominal incision from pulling the skin together. This will also be fixed at stage 2.

6. I think you said I wouldn’t need to have mammograms anymore. Is that correct?

Usually, you will not need any mammograms after having a mastectomy with reconstruction. Your oncologist often makes the definitive decision if you are at any increased risk of recurrence or need any routine monitoring. We still highly recommend doing monthly self-breast exams to monitor for any changes. If it does, please notify us or your oncologist/breast surgeon if you find anything of concern.

7. I would like to see some before and after pictures of the different stages and final result. How can I accomplish this? Can you send some to me?

We have some pictures on our website that show you the before and after photos. We do not have any designated photos of the in-between stages to show you, unfortunately. Dr. Kline may have a few extra pictures to show you at your pre-op marking appointment if you wish.

Click here to view our image gallery. 

8. Will you be lifting my left breast to make it match the right one that doesn’t sag because of the radiation?

We always take radiated breasts into consideration when making the flaps. We sometimes make a radiated breast flap a little larger to account for this, or we lift the non-radiated breast more. Most of this tweaking is done at stage 2 or 3, and there is no hard-and-fast guarantee of how the radiated tissue will do. But, we try our best to give you a symmetrical result.

9. How is the fat grafting accomplished? With needles or what?

Fat grafting is done just like traditional liposuction, but instead of throwing away the fat, it gets strained of any debris, blood vessels, etc., and gets injected back into your body, just below the skin, wherever it is needed.

We only make a small incision through which we insert a cannula that gets shifted around under your skin to collect the fat cells. We make a few incisions in the donor sites that are discussed with you before your surgery and those incisions are closed with a few stitches and a little Dermabond glue on top. The strained fat is then inserted with a special bendable needle that can be shaped to follow around a breast mound or however we need it to go to inject the fat.

10. After the fat grafting, will that fat continue to replenish itself? Like if I gain weight, will my breasts get bigger?

After liposuction, fat accumulation tends to appear in areas other than sites that you have had the fat grafting from. This doesn’t mean you will never get fat in those areas again, but it often finds its way to a few different places. Your breasts will be your own tissue and fat, so if you did gain weight, you could possibly gain weight in your breasts and the same goes for losing weight. 

11. Will my C-section ledge be gone?

We try to take other abdominal scars into consideration when finding the best placement of your new “abdominoplasty” scar. By removing the tissue located on your abdomen, there is a good chance your C-section ledge will resolve, but we cannot guarantee this. It’s another one of those things that depends on the patient, and we will have a better answer for you when we do your pre-op marking.

12. When can I drive?

We don’t want you driving as long as you have drains in (breast or abdominal), which is typically 2-3 weeks. Also, if you are taking any prescription pain medication (Percocet, Dilaudid, Valium), we don’t want you driving until you have switched to taking over-the-counter medications.

We also want to ensure that you feel you can be a defensive driver and not worry that if you had to swerve out of the way, you’d hurt something. Most women sit in the back seat away from the airbag for about 2 weeks and often place a pillow between their chest and the seatbelt to help cushion the pressure from the belt itself.

13. When can I have sex?

We don’t recommend any strenuous activity for several weeks following surgery. I would plan to wait at least 2 weeks and then see what may be tolerated. You don’t want to be using your abdominal muscles for up to 6-8 weeks so you have to be mindful of your limitations. As things heal and you progress in your recovery, you may increase activity as tolerated.

14. Can you also remove the lump of scar tissue from the four drains that were put in my rib area by the other doctors? It makes my bra roll up, and it’s uncomfortable.

Depending on the exact location, we may be able to remove it at the first stage, but it is more likely that we will look into that at second stage as the process of harvesting and grafting the blood vessels is very time-consuming and is the main priority at that time.

15. When will I know if my nipples have to be removed?

This is really a question for your breast surgeon. If you are able to have a nipple sparing mastectomy, we cannot guarantee that your nipples will live as they can sometimes scab over and become necrotic. But, there is also a good chance they will survive. In the event that one or both of your nipples needed to be removed or did not survive, we have multiple options for nipple reconstruction.

16. Can I go ahead and get my flu shot before I have my surgery?

As I am answering this, I don’t believe it is currently flu season, and we would rather not introduce anything into your body this close to surgery. I would wait until 1-2 months after surgery.

Do you have a question about breast reconstruction or post-surgery that you’d like answered from our surgical team? Ask the doctor now 

Ask the Doctor – How Many Trips are Required to Have Reconstruction with Your Doctors

This week, Richard M. Kline, Jr., MD  of The Center for Natural Breast Reconstruction answers your question.

Question: I’ve had implants since a 2004 mastectomy following breast cancer diagnosis. I’m healthy, but feel that my implants have shifted and I’m considering a redo. I live in Colorado, and wonder how the system works for out of town patients. How many trips are required to have reconstruction with your docs?

Answer: By “considering a redo,” I’m assuming you mean replacing your implants with your own natural tissue.

Our P.A. Audrey and N.P. Lindsey spend a lot of time on the phone with out-of-town patients (and their local health care providers) before we ever see them, making sure that nothing important is overlooked before you make the trip. I recommend that at some point you and I also have a phone consultation, so that you will have an opportunity to directly ask me any questions you wish. We usually see you for the first time the day before surgery. On that morning, you get an MRI angiogram at Imaging Specialists of Charleston, then bring the disc to our office to help us plan your flap. We operate the next morning, and you usually spend 4 nights in the hospital. We recommend that you stay in town another 5 nights, if possible, although this is not absolutely required.

We actually discourage you coming back for follow-up visits, as travel is a significant risk factor for blood clots, which is a risk of the surgery (as it is for many other surgeries). If you have a local health care provider who can help with drain management (plastic surgeon, breast surgeon, primary care, etc.) that is helpful, but certainly not essential.  We stay in close contact with you via telephone and secure messaging to manage your post operative period.  You’ll send updates and photos on a routine basis and discuss your progress with our clinical staff.

Most of the time it will take at least 2-3 surgeries to complete the reconstructive process. If you are not radiated, these can be done as closely as 3 months apart (although they can be delayed as long as you wish). None of the subsequent surgeries are anywhere near as big as the initial surgery, and usually you can get by with just two nights in Charleston.

Hope this is helpful, and I hope I get the opportunity to meet you.

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

Ask the Doctor- I’m Looking For a Plastic Surgeon that Specializes in Microvascular Breast Reconstruction. Are You in my Insurance Network and Do I Have to Make a Huge Down Payment Before Surgery?

This week, Gail Lanter, CPC of The Center for Natural Breast Reconstruction answers your question.

Question: I am looking for a p.s. who specializes in microvas. breast recon. I had dcis in 2014 lumpectomy with 6 weeks rads followed by bilat mast. 2016 with immed. recon with expanders then implants in March. Then I got a serious infection in the left (rad) breast, had implant removed and refused to do have lat flap done.

I am thin and one ps said I might be able to do a bodylift type or one where they take from my backside and use an implant on both sides. I do not want the implant I have now. It is subpec and is painful. Can someone help? I have anthem bc/bs and you are out of network.

I do not have 8500 to have this done at another location. My insurance is agreeable to a pay if the it is in network. I can’t afford much out of pocket. We are low middle class, but don’t qualify for help.

Answer:  Hi and thanks for your inquiry. Glad you found us – you’ve definitely found a team that specializes in microvascular breast reconstruction. Regarding your insurance, does your card have a little suitcase on the lower corner of your card? If so, we’re actually in network for you utilizing the Blue Card program through our contract with BCBS of S.C.

I’m happy to check into that and assure that is the case if you would like. I’d only need a copy of the front and back of your card and some basic demographic information like – Name of insured on card and birthday if different from yours, your birthday, and address. I can run eligibility in a matter of minutes once I’ve received the information.

Also, I am sure that one of our physicians will be sending an answer to the remainder of your question very soon.

I look forward to your reply, we’d love to help you!

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

Ask the Doctor- I am Unhappy with my Previous Bilateral Mastectomy with Reconstruction Using Implants. Are you Able to Fix it?

This week, Richard M. Kline, Jr., MD of The Center for Natural Breast Reconstruction answers your question.

Question: I’m not happy with the results of my bilateral mastectomy with reconstruction using implants. Reaching out to see if it can be fixed.

Answer:  It is very likely that we could help you with your unsatisfactory reconstruction, either by using your own tissue, or by revising your implant reconstruction. I will be happy to discuss your situation in more detail by phone, 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-My Sister Had a Mastectomy 4 Months Ago and Is Almost Done with Chemo. Is it Too Late for Reconstruction?

This week, Richard M. Kline, Jr., MD of The Center for Natural Breast Reconstruction answers your question.

Question: I have a sister whom had a mastectomy 4 months ago. She has 2 more chemo treatments left. She is now sorry she did not have reconstruction, and wants to know if it can be done-after the chemo and no flap was made.

Answer:   We routinely do flap surgery breast reconstruction long after mastectomies and other treatment, sometimes many years later, with great success. I would be happy to see your sister in consultation, or speak with her by phone, whenever she feels she is ready. We can discuss her situation in more detail, and review all of her options, at that time.

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

Ask the Doctor-I Had DIEP Surgery that Failed and Have No Left Breast. What are my Options Now for Reconstruction?

This week, Richard M. Kline, Jr., MD and James Craigie, MD of The Center for Natural Breast Reconstruction answers your question.

Question: I had left implant removed due to contracture. ( double mastectomy and left radiation) Just had DIEP surgery that failed so now have no left breast. I am thin , especially now with little belly removed. What are my options for reconstruction now?

Answer:  I’m sorry you are having such difficulty getting a satisfactory reconstruction. As you know, given your history of radiation and prior problems, you are unlikely to ever get a successful reconstruction of the left breast with an implant.

When the DIEP is not available, the next option is often the sGAP flap (from the buttocks). This is far less widely available than the DIEP flap, but we have performed about 300, with a 95.7% success rate (our DIEP success rate is a little higher, at 99.08%). Other options include the PAP flap, from the posterior upper thigh, the anterolateral thigh flap, and the latissimus flap. The latissimus is rarely large enough to use by itself, and is usually combined with an implant; unfortunately, in a radiated tissue bed, the implant still often does not work well, even with a latissimus covering it.

Sometimes we can do two smaller flaps at the same time to reconstruct one breast. This is more difficult with a previous flap failure, as the recipient vessels are a little harder to reach, but we have done it successfully in some cases.

Over the last few years we have gained extensive experience augmenting the size of natural tissue flaps with fat grafting. This basically means we first do a natural tissue flap, then come back a few months later and do liposuction (yes, it can be a problem getting fat in some people), then inject the fat with specially designed needles into the flap. On some occasions, we have essentially doubled the size of flaps, although our ability to do this obviously varies with different patients’ body types. We have successfully made small “C” breast mounds even with latissimus alone + fat grafting, however.

I would be happy to chat with you by phone, or see you in person and discuss your options further, if you wish.

Thanks for your question!

Answer #2:  I’m sorry to hear you have had a difficult time. I’m sure you still have options. If I had additional information about the size of your natural breast and your body weight I could perhaps be more specific. In our practice we use your own fatty tissue without muscle sacrifice. If the DIEP did not work out then possibly thigh, or buttock fat or a combination of the two would be an option.


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

Ask the Doctor – Does Insurance Cover Breast Reconstruction for Poland’s Syndrome?

This week, Gail Lanter, CPC of The Center for Natural Breast Reconstruction answers your question.

Question: I was wondering what insurance would cover breast reconstructive surgery that’s due to having Poland Sydrome? My case I where I was born with out having my right breast muscle and a smaller areola.

Answer:  I would be happy to check into your specific insurance company medical policy if you want to share that information. I’ll just need basic demographic information (I’ve attached a form you can use to provide what I’ll need) and a copy of the front and back of your insurance card. I’m not sure from the phrasing of your question if you currently have coverage or if you are researching to find out which insurance would offer coverage, could you clarify? I can help either case.


The good news is that we’ve been able to get breast reconstruction for Poland’s syndrome covered for past patients and certainly know how to navigate the process to make that happen for you. Feel free to give me a call or send info via e-mail. I’m always happy to help – and I do love a challenge !!) Have a great day and I look forward to your reply.


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

Ask the Doctor – I’m still in pain and swollen after my implant reconstruction 4 months ago. Can you help?

This week, Richard M. Kline, Jr., MD of The Center for Natural Breast Reconstruction answers your question.

Question: Hello, I hope you can help me with my dilemma, I did my full mastectomy and put the breast implant on Feb 2 2017, since then my body did not heal, still in pain, hardness and tightness in my breast but the other problem my stomach got big it looks like I’m 5mnth pregnant, the surgeon and specialist told me it’s because of the pain medicine but I know my body it’s just not the medicine something else, this problem is preventing me from doing the things I do in life, don’t want to go out anymore because of what I look like, please help me.

Answer:  I’m sorry you are having such a rough time. Sadly, it is not unusual for women to feel like the implants “don’t belong”, and describe unpleasant symptoms such as yours, although many women seem to tolerate them well. I’m not sure what to make of your stomach issues – pain medicine can certainly constipate you, but whether that explains your problem, I can’t know.

I would suggest that you first address these issues with your local plastic surgeon, as he/she is in the best position to help you. If that doesn’t work, I would be more than happy to see you in our office in Charleston, where hopefully I could make some more definitive recommendations.

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

Ask the Doctor-Do You Remove Breast Implants?

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

Question: Do you do breast implant removal?

Answer:  Thank you for your question regarding implant removal. Yes we do frequently remove breast implants. There are many different situations when it might be necessary. In general there are two categories of scenarios. Cosmetic reasons (implants originally placed to enhance the normal breast) and reconstruction ( rebuilding the breast after it has been removed for cancer treatment and or prevention) reasons. If you would like to let me know more about the specific details of your question I could give you more specific information. Thanks again.

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