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Ask The Doctor- What Can Be Done for Inflammation of Scar Tissue?

December 19, 2014 by

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

Question: I have chronic inflammation of scar tissue after having breast cancer surgery and reconstructed surgery. I have been in pain now for over a year. What if anything can been done to for this?

Answer: Thank you for your question. We cannot specifically give you medical advice by email because we would need more information.  You should make sure your surgeons (plastic surgeon and breast) and oncologists know you are having problems right away if you have not already.  They will be familiar with your history and can make sure you have been checked thoroughly.

We specialize in breast reconstruction and frequently help patients having problems with their reconstruction. The effects of radiation and scaring can lead to problems and pain. We help patients with implant problems by replacing their implants with their own fatty tissue. If you would like more information I would need to have my office contact you regarding your specific situation.

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 had a double mastectomy in 2008 and now wish I had implants…is it too late?

December 12, 2014 by

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

Question: I had a double mastectomy in 2008 and now wish I had had implants…is it too late?

Answer: Yes, you can have breast reconstruction 8 years after your mastectomies. I have patients who have waited 22 years. Also its up to you and your plastic surgeon which technique is best for you. That includes implants. Thank you for you 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-I’m having implant difficulties. Can you help?

December 5, 2014 by

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

Question: I was diagnosed with triple negative breast cancer in my left breast in December of 2010. I had a lumpectomy in January 2011 followed by chemotherapy, a bilateral mastectomy and radiation. I have implants now. The right implant has dropped and the left is hard and contracted. I need help. My 36d has been replaced by 38b and the cups are too big. Please help.

Answer: I’m sorry you’re having problems with your breast reconstruction. Our practice specializes in breast reconstruction using your own tissue and preserving your body’s muscles.  Approximately 30% of our patients have already had implants and we remove them and complete their reconstruction without implants. You may already know that after radiation the chance for complications with implants increases. We have helped many women having similar problems to what you described. I would be glad to give you more specific information about your situation but I would need more information from you. I could talk to you over the phone or you could come for a consult depending on what is most convenient and where you live. Let me know.

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

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Ask The Doctor-What are the Reconstruction Options for an Overweight Person Who Had Radiation

November 28, 2014 by

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

Question: What are reconstruction options for me as an overweight person who had radiation?

Answer: Thanks for your question. Knowing only that you are overweight and have had radiation, I can only speak in generalities, but it may be of some interest to you.

 

Radiated patients are far less likely to tolerate implants than non-radiated patients, so that may mean that you could be better served by natural breast reconstruction with your own tissue. While it can be extraordinarily difficult (sometimes impossible, actually) to achieve a satisfactory delayed reconstruction with implants in a radiated patient, radiation commonly has almost no impact on our ability to reconstruct you with your own tissue, since we are bringing fresh non-radiated tissue to the area.

 

Additionally, implants are only commonly manufactured up to a volume of 800 cc. While this may seem like a lot (and actually is a lot, when used for cosmetic augmentation), it often falls far short of the volume requirements needed by a large patient for a complete reconstruction. Fortunately, there is no firm limit on how large a natural tissue flap can be transferred, except for how much tissue is available. We have in the past transferred flaps in the (1500 – 2000) cc range with success.

Of course, extra weight (also depending to some extent on how it is distributed) can bring additional risks. Extra weight brings an increased risk of blood clots (which can be fatal), and an increased risk of wound healing problems. As a very rough guideline, and, again, with the knowledge that how the fat is distributed makes some difference, we start to get concerned when the BMI exceeds 30 and approaches 35. This doesn’t necessarily mean that surgery can’t be done, just that all of an individual’s specific risk factors and options must be scrutinized very closely before making specific recommendations.

 

I hope this has been of some help. Please feel free to call or email if you would like more information.

 

 

 

 

 

 

 

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Ask The Doctor-Is it Possible to Perform Breast Reconstruction 28 Years after Mastectomy

November 21, 2014 by

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

Question: Is it possible to provide a reconstructive breast to a 28+ years left radiate then mastectomy-cancer x 2 in that breast?

Answer: Thanks for your question. Yes it is possible to perform breast reconstruction 28 years after mastectomy, radiation and other treatments. There are no definite time limitations. Personally I recently had a patient who waited 22 years before having reconstruction.  Some, but not all, important factors we may consider when we evaluate someone for breast reconstruction are: overall health (other medical conditions), weight, no tobacco smoking and successful surgery to remove the cancer. I hope that I answered your question.

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

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Ask The Doctor-Can I Get Trans (TRAM) Flap Surgery if I Am Overweight?

November 14, 2014 by

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

Question: I’ve been told I cannot get Trans Flap surgery because I am overweight. In fact, the practice said there was nothing they could do for me. Is that so for you also?

 Answer:It is true that a person’s weight can be an important factor in the chances for serious complications during breast reconstruction. Specifically for a TRAM flap procedure the risks can potentially be life threatening! One of the most serious complications that can happen with any surgery is a blood clot in the leg veins that can become a blood clot to the lungs. This is called a pulmonary embolus. It is  true that the risk for this type of blood clot is increased in people who are seriously overweight. It does not mean that a patient has to be their ideal weight but at a certain weight the risk goes up. In order to completely answer your question I would need to know how much you weigh and how tall you are. Also your overall health and any other medical problems like diabetes or high blood pressure. If you were also a smoker that has a major impact on the risks. We look at each patient’s body mass index to determine if we should have the patient lose weight before surgery. We also like to evaluate each individual and the overall situation not just the weight alone. The body mass index is a general guide and we work with each patient to determine individual goals for their weight in order to make sure the risks are as low as possible. I hope I answered your question, let me know if you need more information.

Thanks for your question!

-James E. Craigie, MD

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

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Ask The Doctor – Will My Medical Insurance Policy Cover My Procedure?

November 7, 2014 by

<alt="medical insurance coverage"/>This week , Gail Lanter, CPC, Practice Manager of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I have Buckeye Medical Insurance and I wanted to know if it will cover reconstruction of my right breast after having a lumpectomy and radiation treatment. It left my right breast disfigured, so I need to have this surgery. Thanks!

ANSWER:  I’m happy to try to answer your question for you. Buckeye Medical Insurance looks like it offers a few different types of policies so without knowing which you have I can give you some general information. There are some payers who will not consider reconstruction of lumpectomy defects unless medical necessity has clearly been established. However, the majority of reputable insurers will allow for a reconstruction procedure if a medically necessary lumpectomy results in a significant deformity – as often happens with radiation treatment. Your surgeon’s office should be able to submit all of your documentation, including photos, demonstrating the problem you are having and ask that Buckeye pre-authorize the procedures necessary to reconstruct the area so you have a definitive answer prior to undertaking surgery.

There are many possibilities as far as what procedure to use according to what specific problem you are experiencing. It could be as simple as a scar revision procedure with fat grafting or as complex as the muscle sparing procedures in which we specialize according to how severe the defect. You would definitely want to consult with your plastic surgeon to get a plan as your next step.

Hope that information is useful, and please let us know what else we can do for you. We’re always happy to help!

— Gail Lanter, CPC, Practice Manager 

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

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Ask The Doctor – I Have an Implant But Want Natural Reconstruction

October 31, 2014 by

<alt="natural breast reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had reconstructive surgery on my right breast in 2008. I have a silicone implant, but it feels like a hard lump on my chest. I’m 62 and healthy. I don’t know if my insurance will cover it if I decided to have the natural reconstruction.

ANSWER: Usually your insurance will cover conversion of an unsatisfactory implant reconstruction to a reconstruction using your own tissue with no problem, but we always check first to be sure. If you wish, we can give you a call to discuss your situation in more detail. Many, many people are or have been in your situation, and we are usually able to help.

— Richard M. Kline, Jr., M.D.    

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

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Ask The Doctor – My reconstructed breasts are not well proportioned, can you help?

October 24, 2014 by

<alt=breast reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had a DIEP done at the same time of my mastectomy a few years back. My incisions opened up around both breasts one week after surgery. After about 3 months of my doctor telling me to put Vaseline on them and keep the areas covered, they became very infected. I then got a second opinion.

The next doctor had me on the operating table the next day and probably did a dozen surgeries on me over the next year to get me healed because I was so infected from being open for so long. I’m scared about this, and I’m very self-conscious about my breasts. One of my breasts was set lower on my chest than the other, making wearing bras difficult. The same breast that is positioned lower on my chest is also larger. It is impossible to wear bathing suits comfortably, too. I have to watch how tops are cut on me because they will show that my breasts are uneven. Is there anything your doctors can do to help with this?

ANSWER:  I’m terribly sorry about all the trouble you’ve had – it sounds like a real nightmare. I can’t, of course, guarantee you that we can make you good as new, but I strongly suspect that we can help, as we’ve seen plenty of other patients with similar stories. Probably the best place to start would be to have one of us call you to discuss your situation further, if that’s OK. It would be very helpful if we had some pictures to look at at the time of the conversation, but that’s not essential at this stage. I also suspect you will ultimately benefit from having an MRI at some point, as this is the best way to look for dead fat or other potential problems. Hang in there, no need to lose hope at this point.

— Richard M. Kline, Jr., M.D.    

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

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Ask The Doctor – What is the risk of keeping older saline implants in?

October 17, 2014 by

<alt="saline implants"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had my breasts removed 25 years ago and I have saline implants in. I have discovered that one the right one has capsular constriction. It has become very hard, very round, very painful, and almost swollen under my armpit. If I let this go as is, what could happen? What are the risks involved?

ANSWER:  With saline implants, nothing much else is likely to happen, but the situation is not likely to improve on its own. If you had silicone gel implants, the gel could continue spreading through your tissue indefinitely. While this is not medically dangerous (doesn’t cause cancer or lupus or anything like that), it does “mess up” a lot of breast tissue, and I would encourage you to have it removed ASAP. With saline, there’s far less concern for ongoing damage. If you would like to have implant(s) removed and replace with your own tissue, that is our specialty, we do it routinely, and we would be glad to help you. But if you just wanted reassurance and can live with the present situation, you’ll be OK. Thanks for your question!

— Richard M. Kline, Jr., M.D.    

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

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