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

Question: My Dad had a DVT 5 years ago—it was out the blue no known cause. I had a consult online with PRMA and another doctor who asked for “blood clotting” blood work to be done because of my fathers history. It came back showing the Factor V Leiden and activated protein C resistance. I personally have not had any problems with clots, DVT.

Answer: Many people can have abnormal clotting tendencies and never know it. There are different kinds of disorders and some factors can increase or decrease for different reasons. Many of the clotting abnormalities are grouped together and referred to as a condition called thrombophilia. The concern is that people who are positive for thrombophilia have an increased risk for DVT (like your father)—especially during or after surgery. A DVT is a potentially life threatening condition as you may already know. The blood clot can possibly cause a pulmonary embolism.

The other concern associated with thrombophilia and DIEP breast reconstruction is an increased risk for failure of the tiny blood vessels that we connect under the microscope to stay open after the microsurgery. Clots can form and may prevent the new breast from receiving the blood supply that keeps the new breast alive. This can happen in patients without thrombophilia. There is no consensus on the exact risk when it comes to procedures like DIEP breast reconstruction. In our practice we have had patients with factor V leiden and protein C resistance successfully have DIEP surgery with no problem. We treat all of our patients as if they potentially have thrombophilia by giving them a light blood thinner(lovenox) before and after surgery. This is the most effective way to reduce the risk of a DVT.  Also if we know a patient is positive for thrombophilia before surgery, we always have them seen by a hematologist before surgery. There are many different types of thrombophilia and some of the factors increase and decrease depending on other medical factors. This allows us to determine if the risk is relatively  high or low. If its high we may wait until it goes down. Also the treatments may change and the hematologists are the experts at keeping up to date with any changes in the treatments or tests and can look at your labs and determine your precise risk.

I personally am reviewing our practices experience with 1184 breast reconstructions with DIEP, GAP and PAP procedures. Our overall success rate is 98.5%. Of the patients who have had a flap (DIEP) failure at least one had factor V leiden thrombophilia. If someone has a thrombophilia it is most likely that they have a higher chance than normal of losing a flap (DIEP). It is important to know what the “normal” risk is for any practice that offers these procedures. In that one patient however she also had a successful flap at the same time on the opposite breast, and later went on to complete her reconstruction with a third flap procedure. Again, all our patients that we have known before surgery that they had thrombophilia have done well. We also know that some patients have had it and we never knew. So I would recommend getting the advice of an hematologist before surgery, but would not say at this time that you could not have DIEP breast reconstruction. Please send me any questions you might have.

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 breast reconstructed surgery after breast cancer, in 2002 in my left breast. Now I just notice it has gotten larger and feels uncomfortable. Should I be very concern? Am I in danger? I am willing to do without my breast if I have to. Thank you.

Answer:  Is it your reconstructed breast that has suddenly changed, or is it the opposite breast? If it is your reconstructed breast, then the possible causes may depend on the type of breast reconstruction you have had. Regardless, you should have your doctor examine you in order to look in to what is causing the change. Lots of things could cause changes that have nothing to do with the breast cancer.  However, you should have it checked right away to rule that out first.

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 breast cancer in 2011, and the surgeon who did my reconstruction did a wack job on me. I was a DDD before surgery, and I told him I wanted to go down to single D cup. When I woke up from surgery, things just didn’t look right. When I took my bandage off, he had taken so much off that I had breast the size of man’s chest. I was horrified. I had them redone later, but they are still way to small for my body frame. Can I have them redone again? Or am I stuck with this? It has affected my life so much, I’m depressed, and I hate going out. Any advice would be appreciated.

Answer: Thanks for your question. I’m sorry you have had problems with your reconstruction. The best approach to helping you depends on several factors. Did you have reconstruction using your own tissue or did you have implant reconstruction? Both approaches can be adjusted or redone to hopefully get an improvement. If you had radiation treatments, then it is likely that implants are not your best option. If you used your own tissue, it is possible to add more. It is important to remember that breast reconstruction always requires more than one step. When patients see their results after the first stage and only after one surgery, it is important to know the next step may make things much better. The most important achievement is to have the breast cancer removed.

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