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Ask The Doctor-What is the best next step after losing an implant on the radiated side?

May 1, 2015 by

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

Question: I had both breasts removed with stage 4 cancer. The left breast with the silicone wouldn’t stay closed, so the plastic surgeon did a tram flap with muscle from my abdomen. So now one breast has silicon and the other has muscle from my adomen. I didn’t get nipples on my breast. Is there anything else I can do to improve this mess.

Answer: Thank you for your question. After losing an implant on the radiated side, the best next step is to reconstruct that breast with natural tissue. Which you did. As you are aware complications with implants increase when radiation is needed. Since you already have an implant on the other side. it will tend to be different from the tram side. Options include adjusting the shape of both breasts vs. replacing the other implant with natural tissue from another area of your body. We recommend doing this without using any of your muscles, only skin and fat either from the thigh area or buttock area. If you are happy with the implant breast reconstruction and don’t want to start over and go through another extensive reconstruction using natural tissue then it may be possible to adjust the TRAM reconstruction in a way that helps. You can always have nipple reconstruction if you desire, and that can be done as a minor procedure alone or possibly combined with revision of the reconstruction. I could give you more specific information about your options if you would like to give me a few more specific details. Thanks again for the question, let me know if I you would like more information.

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

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Ask The Doctor-Do you accept Advicare Medicaid?

April 24, 2015 by

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

Question: Do you accept Advicare Medicaid?

Answer: Thanks for reaching out to us.  We only recently heard of Advicare and have not been approached to contract with them.  I’ve tried calling them and haven’t received a response to my inquiry yet.  I’ve also asked them if they can tell us who is currently within their network that might perform the types of breast reconstruction surgeries that we do and can’t seem to get them to give me a list, they just tell me to have the member call in to inquire.   I am hoping to get a call back from one of their representatives very soon in the hope that I might be able to give some good alternatives to ladies who’ve contacted us.  I will be certain to keep on my list to contact as soon as I know something more. Thanks again!

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

 

 

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Ask The Doctor-Can I have reconstruction surgery with a low immune system and infection?

April 17, 2015 by

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

Question: I have had three surgeries already: 2 to remove cancer and 1 reconstruction. I can’t have the last one because of infection in left breast where the cancer was, plus I keep getting sick because my immune system is low. Is this common if I just had radiation in the infected area?

Answer: I’m sorry you are having problems. If you are having an infection after radiation it would definitely be best to hold off on your reconstruction until your immune system has recovered and the infection is gone. Radiation treatments definitely increase the chance of getting an infection. If you have an implant in place already it may need to be removed to resolve any infection. Once that has occurred you can still proceed with breast reconstruction at a later time when you have recovered.

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

*Before we post to the blog, we double check to ensure we respond to each person who submits a question personally so that you receive the information you need first.

 

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Ask The Doctor-What can be done about infected implants?

April 10, 2015 by

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

Question: I had implants, and they got infected. I had six operations I’m in New York right now, but I’m on my way to South Carolina. I would like to come in so I could see what can be done. Thank you.

Answer: I’m sorry your having problems with your implants. We have helped many women who have lost implants due to infection. Let us know when your in town, and I’ll be glad to see you.

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

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Ask The Doctor-Does lipomodelling make breasts more natural looking?

April 3, 2015 by

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

Question: Do doctors do lipomodelling of the affected breast to make it more natural looking? Implant does not help. Thanks.

Answer: Thanks for your question. We perform fat grafting as part of the breast reconstruction process. If you had breast reconstruction with an implant and the results are not natural, fat grafting can help. There are some situations that require removing the implant in order to get a more natural result. Let me know if you need more info.

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

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Ask The Doctor-Will my pectoral muscles will return to normal after I have my implants removed?

March 27, 2015 by

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

Question: I had a mastectomy with reconstruction using saline implants. I am considering having the implants removed, and am wondering if my pectoral muscles will return to normal.

Answer: Thank you for your question. If you are planning to have your implants removed, then are you planning to have any further reconstruction? Frequently, tissue expanders and breast implants used for breast reconstruction are placed under the chest muscle. If you are having problems with your chest muscles because of the breast implants, it is likely that some of the  problems would improve or possibly go away completely if you have the implants removed. On the other hand, it is very unlikely that your muscles will ever go completely back to normal after they have been lifted up and or divided to cover an implant. In my practice we keep the implants above the muscle. When this is possible the muscle is not disrupted at all. When we have a patient who has had problems with their implants, we can usually help them by removing the implant and capsule and reattaching the muscle. We then perform the breast reconstruction with the new breast on top of the muscle. If you  choose to have breast reconstruction after problems with implants, then replacing them with your own fatty tissue can be a great option. Let me know if you need more information. Thanks again for your question!

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

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Ask The Doctor-Is it possible to do a flap reconstruction after first surgeon tried expander on radiated breast on a smoker?

March 20, 2015 by

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

Question: Is it possible to do a flap reconstruction after first surgeon tried expander on radiated breast on a smoker who had quit 7 weeks before surgery? 4 weeks later I still have open wounds almost the size of a quarter.

Answer: Thanks for your excellent question.

Fortunately, previous breast surgery, no matter how extensive, rarely impacts our ability to do a flap reconstruction using your own tissue. In fact,  a healthy, non-radiated flap is often beneficial in improving the quality of the radiated tissue around it.

As you seem to already be aware, nicotine is an absolute “no-no” when having surgery, and also when trying to heal a chronic wound. Nicotine causes the microscopic blood vessels in your tissue to clamp down, just like shutting off a valve, which deprives the healing tissues of oxygen. Usually, however, nicotine levels are unmeasurable after a full month of exposure cessation.

We have treated several chronic wounds in patients with failed implant reconstructions, and we have always felt that it was best to get the wound healed before proceeding with flap reconstruction. Achieving healing in these situations is often not straightforward,  but we have thus far eventually been successful. Sometimes retained foreign material (such as Alloderm) can play a role in keeping the wound open, and sometimes there is just not enough skin left in the radiated area. Rarely, deep infection of the bone or cartilage can be an issue, although this is unusual.

If you wish, we can set up a phone consultation to discuss your specific circumstances in more detail.

Best of luck, and thanks again for your question.

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

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Ask The Doctor-Will you give me your second opinion on insurance coverage?

March 13, 2015 by

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

Question: Do you accept BCBS insurance from Ga? I had a double mastectomy a year ago and breast implant reconstruction. I’ve had to have both taken out their weeks apart due to one being infected and one implant exposed. I would like a second opinion on where to go from here.

Answer: I’d have to see your card and check your plan to be completely certain, but we do participate within the Blue Cross Blue Shield Blue Card Nationwide Network.  Does your card have a little suitcase on the bottom corner that looks like the one below?

BlueCross Blue Shield insurance card example

 

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

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Ask The Doctor-What can be done about hard breasts?

March 6, 2015 by

8404745471_aa5de5fd5f_mThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I have had a natural breast reconstruction. I have several places in both breasts that are hard. I also have a hole in the right breast that needs tissue. Will the hard places soften as time goes by? I am considering having tissue taken from my groins to fill the cavity. I also have to have the tummy tuck closed. Please advise. Part of me is thinking to have all the tissue removed. The hard areas feel like armor. Thanks. What do you recommend?

Answer: Thanks for your question, I’m sorry you’re having difficulties. How long ago did you have breast reconstruction? Have you had a second stage yet? If you had reconstruction with your own fatty tissue, sometimes some of the fat may not survive and can cause hard lumps. The lumps will soften with time but usually not completely go away  unless they are small. We usually remove any hard lumps at the second stage procedure about 3 months following the first surgery. If most of the fat is hard then sometimes we might need to add more fat to the breast to give it shape, or start over with tissue from another area. The thigh area is another possible area to get fat if needed depending on your situation. We avoid taking the groin muscles when we use the thigh fat to rebuild the breast. Let me know how long ago you had your surgery. Time may improve your situation and hopefully you won’t feel like you need to go back to having no breasts.

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

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Ask The Doctor-What could be causing the cramps in my breast?

February 27, 2015 by

5987018633_ca7f1c6f97_mThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I am 70 years old, and 5 years ago had a bilateral with reconstruction. Since then, I have had severe cramps in both breasts and they can even tie a knot in my stomach I can feel knot up when I cough. These are not like stomach pains, they are very painful, hard cramps like one experiences in the calf of their legs….I asked my Plastic Surgeon about them, and he just said he had never heard of cramps in breasts. I can cause my breasts to cramp by simply turning over on. My side, raising my arm or reaching around for something…I’m a tough ole broad, but these cramps make me nauseous they hurt so bad…have you any experience with this? Thank you so much for your time.

Answer: Thanks for your question. I’m sorry you’re having a difficult time. Painful cramping suggests muscles are having spasms. Normally the breast does not have muscle but the chest muscle is underneath the breasts and can have spasms for different reasons. The explanation could possibly be related to the type of breast reconstruction. If you have implant reconstruction the implants are often placed under the muscles. If the body rejects the implants or develops scaring that tightens around the implant the distortion can cause muscle spasm. If you had reconstruction using one of your body muscles to rebuild the breast,  that too could possibly be related to the cramping pain. If the muscles from the tummy wall were used to rebuild your breast or breasts that might explain the “knot in your stomach”. I would need more information to let you know what I would recommend. What type of breast reconstruction did you have? Do you have implants and did you have radiation to the breast? Thanks again.

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

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