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Ask The Doctor- If you choose natural breast reconstruction as opposed to implants is there sensation in the breast?

February 20, 2015 by

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

Question: If you choose natural breast reconstruction as opposed to implants is there sensation in the breast? Is there sensation with nipple sparing? What is the rate of success with natural reconstruction? Thank you.

Answer: As a general rule, there is no erogenous sensation after any type of breast reconstruction, although in isolated circumstances some people do seem to get that back, or something like it. Most of the skin is usually completely numb initially, but may regain some feeling after months, or even years. Even after nipple-sparing mastectomy, there is usually no sensation. While it is theoretically possible for the nerves to grow back, it is rare to get normal feeling back, even after a prolonged period. The flap survival rate after natural breast reconstruction is approximately 98%. Completion of reconstruction usually requires 2 or 3 surgeries in all, but they tend to get sequentially shorter and less involved. Once you have competed natural breast reconstruction, however, your breasts will usually continue to improve on their own for many years. This is in sharp contrast to implant-based reconstruction, where the quality of the reconstruction often tends to deteriorate over time. Thank you for your question.

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

(**Note to our readers: We really do personally reply to all questions sent through our website within 24 to 48 hours directly to the e-mail provided by the sender. We want you to receive your answer quickly, so please assure that you are entering your information correctly so that you receive the personal answer to your question and do not have to wait for it to be published as an Ask The Doctor Q & A.) 

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Ask The Doctor-Are the lymph nodes disturbed during DIEP flap reconstruction?

February 20, 2015 by

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

Question: After a DIEP flap reconstruction, the top part of my tummy above the incision protrudes over the scar-especially in the evening. Is this a lymph issue or edema? Are the lymph glands disturbed in the abdomen with this kind of surgery?

Answer: Thanks for your question. During a typical DIEP procedure the lymph nodes that serve the tummy area are not removed and the lymphatic fluid can move in the normal direction. It is possible to have lymphedema of the tummy area after a DIEP but it certainly is not very common. It would be more likely if someone had multiple tummy surgeries and scars before the DIEP procedure. In my patients I see that their tummy wall and tummy incision may be swollen for 3-4 months after the surgery. If someone has healing problems, infections or a seroma (pocket of fluid underneath the incision), then swelling can be more prolonged. If someone has persistent swelling and none of the above issues for 6 months then I would consider having a therapist who has experience treating lymphedema see them for possible lymphatic massage treatments. Let me know if you need more information, thanks again.

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

(**Note to our readers: We really do personally reply to all questions sent through our website within 24 to 48 hours directly to the e-mail provided by the sender. We want you to receive your answer quickly, so please assure that you are entering your information correctly so that you receive the personal answer to your question and do not have to wait for it to be published as an Ask The Doctor Q & A.) 

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Ask The Doctor-What can be done with unsatisfactory reconstructive surgery results.

February 13, 2015 by

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

Question: I am 3 yrs s/p bilat mast, chemo and L radiation for stage 2 lobular cancer. I received good reconstructive surgery, but I am unhappy with the cold temperature of my breasts and especially with the hardness/immobility of the L breast which had radiation. Can anything be done? Thank you!

Answer: Thanks for your question. When breast reconstruction with implants doesn’t work out, or if the breast feels cold or hard, an option may be replacing the implant with your own fatty tissue. The end result with your own tissue is more natural and permanent. The downside to this approach is it requires starting over, and you need to use  your own fatty tissue. That means an incision that has to heal and a longer recovery time. We frequently take that approach for patients with implant problems. If you would like more info, please let me know.

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 do 3T MRI of both the abdomen and the chest before a DIEP flap?

February 6, 2015 by

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

orange flowerQuestion: Hello, I was wondering if you do a 3T MRI of both the abdomen and the chest before a DIEP flap? I would rather not have more radiation, because I had mantle radiation when I had Hodgkin’s 20 years ago and developed breast cancer as a result. Also have you heard of an APEX flap? Thank you for your time.

Answer: Thanks for your great question! We perform preoperative MR Angiograms with an open 3T MRI protocol on all possible patients we have who are undergoing breast reconstruction with a DIEP procedure. We do the same for any of the multiple muscle sparing natural tissue reconstruction procedures we regularly perform. We do not perform MR angiogram of the chest. That would not provide us with any useful preoperative planning information. There are quite a few people who cannot have a MRI. People who have metal knee replacements or breast expanders with metal parts are examples of reasons some of our patients cannot have an MRI. In our practice we have found CT angiograms are not as useful and avoid them if we can because of the increased radiation. As you may be aware, your history of previous mantle radiation may also increase your chances for problems with implant breast reconstruction. I agree that a DIEP may be a very good option for you. I hope I answered your question. If you would like more information please let me know.

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 my inward nipple fixable?

January 30, 2015 by

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

Question: 12 years ago, my cancer left me with a inward nipple, and a surgeon is telling me nothing can be done. I find that in today’s medical world that can’t be true. There must be someone who can fix it or make me one. Just wondering. Thank you!

Answer: The procedure to repair a retracted nipple depends on the reason the nipple is retracted. If you have had lumpectomy and radiation and the retraction developed after scar developed, then a procedure to reconstruct the breast may be the best approach. Do you happen to have a breast implant? Other causes are less involved to fix.

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 surgery help my scar tissue?

January 23, 2015 by

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

Question: I have scar tissue in my right breast from a horse bite that occurred when I was about 11 years old. I am now 43. Each year it has caused doctors to require repeated mammograms , ultrasounds, and non MRI’s. Now they are recommending I have a biopsy or have the scar tissue removed. I was wondering about having it removed by a plastic surgeon to decrease scaring. Do you think that is possible?

Answer: Sorry you are having problems with your scar. Did you have surgery after your horse bite accident? Did the injury lead to your breasts being uneven? I think you have a very good question and its possible that a plastic surgeon could help. Because of the nature of the injury it is possible that the scar could be removed and the breast reshaped in the process to allow healing to occur in a more favorable way and create a more favorable scar. I would need more information to give you more specific answers. I would be glad to see you in consult or if that’s not convenient, have my office contact you for more specific details and possible photos. Let me know. Thank you 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-Should I have a preventative mastectomy?

January 16, 2015 by

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

Question: I am 60. I have had a core bio in right breast, and my maternal aunt had breast cancer. My left breast is became two sizes bigger than right, and I have fibefib. Cystic diseases. Last year my mamo showed no cancer, but I am about a 36 c in right breast and 38c in left. It’s painful. Should I be proactive and have both removed since already in right? I have had a core bio for two lumps showed benign. Thanks

Answer: Thanks for your question. Women who are at an increased risk for breast cancer and/or who have difficult breasts to screen for breast cancer do sometimes consider preventive mastectomies. Certainly not every woman in your situation would do that. In order for you to make a decision you should discuss your specific situation with a breast surgical oncologist. They could give you more specifics about your risks. Other considerations are quality of life issues. Having to undergo frequent biopsies or repeat imaging are all reasons some of our patients tell us they have preventive mastectomies. Finally, the options for breast reconstruction available to you can make a difference to you in your decision. We can give you more specifics about those options if you like. We have all our patients discuss their risks with one of the breast oncologist and geneticists we work with. Let me know if I can help in any way.

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 the DIEP flap procedure an option for me?

January 9, 2015 by

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

Question:I had a bilateral mastectomy with expanders in October of 2013, followed by chemo and radiation. It is now time for my exchange surgery, but I really want the DIEP flap procedure. My plastic surgeon is hesitant to do the surgery. Is a flap procedure even an option at this point?

Answer: Thanks for your question. Yes it is possible and we frequently do replace expanders or implants with DIEP flaps. In other words the extra skin and fatty tissue from the tummy area. Some people may not have extra tissue to use from their tummy or may have had previous surgery (tummy tuck). In that situation we can usually find extra fatty tissue from another area without removing any of your important muscles. If your surgeon does not think you should do that, ask why. There may be a good reason. You can always get a second opinion if you like. Let me know if you would like more information. 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-I am 52 years old and thinking about a bilateral DIEP flap surgery.

January 2, 2015 by

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

Question: I am 52 years old and thinking about a bilateral DIEP flap.

Answer: Thank you for your question. Have you already had a bilateral mastectomy? Do you have a specific question regarding the surgery? If you are thinking about a bilateral DIEP you have been considering options for breast reconstruction. This surgery can be done at the time of mastectomy or it can be done any time after. Also it can be appropriate for patients who have had breast cancer or who are at high risk for breast cancer. We would be glad to contact you for more specific information if you like.  

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-I have just undergone a nipple sparring bilateral mastectomy, and I’m concerned about the outcome. What are my options?

December 26, 2014 by

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

Question: I am a 49 year old woman, and I have just undergone a nipple sparring bilateral mastectomy with a lat flap & expanders put in. My surgery was on 10/30, so I am at 3 weeks and am having necrosis issues on one nipple and in another area near an incision. I am extremely concerned about the outcome of my results and would love to hear your opinions as to what my options might be? We were actually scheduled for a trip to Charleston in Nov for 5 days that I regretfully had to postpone due to my recent breast cancer diagnosis. Any advice you could give me would be GREATLY appreciated!

Answer: Thank you for your question. I’m sorry your having some healing problems.   I know it can be stressful. It can also seem a lot worse than it really is. It is hard to picture the end result when you are going through the healing phase. When my patients have mastectomy skin healing problems we are very conservative and let the healing progess slowly and manage the wounds carefully. Many times the end result is much better than anticipated. I would be glad to see you when your in town to give you my opinion. Just let us know. We can try to make it convenient, it sounds like you could use a nice vacation. My office can contact you to make arrangements if you like.

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

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