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Ask the Doctor: Will Scar Tissue Buildup Be A Concern With The Gap Flap?

July 25, 2014 by

 

<alt="pink lotus flower"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Question: My wife had a double mastectomy 10 years ago. At that time she had latissimus surgery to fill in her breasts. Since then, we’ve had numerous surgeries, about every 2 years, due to scar tissue building up in 1 of the 2 (or both) breasts that causes tightening and even pain. Will scar tissue buildup be a concern with the Gap Flap? 2. Regarding the Gap Flap procedure, what is the rate of failure that you experience with any of the 4 surgery sites (2 buttocks, 2 breasts)? Thanks.

Answer: Hi — I’m assuming your wife has implants under the latissimus flaps, which would explain the buildup of scar tissue. GAP flaps are generally large enough to make a breast by themselves (obviously, sizes differ among different people), so implants are not needed, and internal scar buildup would be a very rare event. We last calculated our statistics in October of last year. Over 10 years, we did 217 GAPs, 49 as unilateral, 168 as simultaneous bilateral. The GAP flap survival rate was 97% overall. All of the failures were in bilateral cases, but no patient lost both flaps, yielding a simultaneous bilateral flap survival rate of 96.4%. We have done quite a few GAPs since then with no failures (most recently a simultaneous bilateral last week), so the current statistics are actually a little better than that. We don’t bury flaps, and therefore can’t miss (or ignore) a failure, so these are ironclad statistics that could survive a GAO audit. To our knowledge, only Dr. Allen (who invented breast perforator flaps and trained the rest of us), his ex-partners in New Orleans, and ourselves actually do simultaneous bilateral GAP flaps on a routine basis. I’d be happy to discuss your situation further if you wish, just call or email.

Dr. James Craigie

Center for Natural Breast Reconstruction

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 My Options for Natural Breast Reconstruction?

July 18, 2014 by

 

<alt="pink peony"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I had right breast ductal carcinoma, Stage 2. Two out of 22 lymph nodes had cells. I did a gene test, and had both chemo and radiation. The expanded radiation destroyed it. I had a mastectomy in Charleston, and now I’m ready to have my breasts fixed. I don’t want to have implants. I’d rather have a reconstruction using my own body fat and tissue. What are my options?

Answer: Hi — I’m sorry you’ve had so much trouble, and hopefully things will continue to improve for you. Your history of radiation fortunately has no bearing on our ability to do a reconstruction using only your own tissue. Many of our patients initially had failed implant reconstructions elsewhere, only to be later successfully reconstructed with their own tissue. Please feel free to come by for a consultation if you live locally, or, if you’d rather, we can arrange a phone consultation. Thanks for your inquiry, have a great day!

Dr. James Craigie

Center for Natural Breast Reconstruction

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 My Options For Post-Op Reconstruction Using Implants?

July 11, 2014 by

<alt="pink dahlia"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I’m 42 years old, and I have a surgery this month for breast reconstruction. Due to my genetic history, a plastic surgeon will be performing a double mastectomy. I want to know what my options are for post-op reconstruction? Thanks.

Answer: Hi — Thanks for the information about your planned surgery. If you have requested using your own tissue and were told that was not a good option for you, then you certainly can get a second opinion. You stated that your mastectomies were for preventive reasons, which gives you the time to consider all possibilities. Before having surgery you should feel good about your decision and be confident you know all your options. You have excellent surgeons and I know you will do well.

One advantage of using an implant is that you don’t require an incision anywhere else on your body in order to donate the tissue to make the new breasts. Using your own tissue requires a longer recovery and more healing. The donor area ends up healing with a scar. If you don’t need a tummy tuck or have “excess” tissue in your thighs or buttocks then you may not want a scar in these areas. You should also know that it is not necessary to sacrifice any of your muscles in order to use your own tissue. Finally, it is important to know that if you have implant reconstruction and it does not work out you can still use your own tissue later–even years later! Most likely it will work out and you will have an excellent result and speedy recovery. I hope this has helped. Let us know if you have more unanswered questions. If you would like a second opinion, you could set up an appointment in our office, or we could also consult over the phone if you cannot make the trip to Charleston.

Dr. James Craigie
Center for Natural Breast Reconstruction

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: Do you have a recommendation for a topical that will help scars heal or fade?

July 4, 2014 by

<img src="pink flower" alt=" " />

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: Do you have a recommendation for a topical that will help scars heal or fade?

A: Unfortunately, nothing of which we are aware does this reliably. Avoidance of sun exposure is critically important to give scars their best chance of fading, but no topical preparations routinely make scars better. If scars are heavy or raised, Mederma can help, but it should not be used on scars which are already flat.

 

Dr. James Craigie

Center for Natural Breast Reconstruction

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: Questions About Reconstruction Surgery Years After A Mastectomy

June 27, 2014 by

<img src="image.gif" alt=A pink rose" />This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I have been cancer free for 4 years, and have been very undecided about reconstruction. My surgery removed the underside of my right breast. I am very lumpy and the scar is very hard. Would I need to have a reduction in the other side or can the surgery site be repaired? I am “usually” a D in size currently. Also, is this surgery considered a “tummy tuck” type operation?

A:  You have several potential options, depending on your present physical situation, and your wishes.

I’m assuming you are radiated (please correct me if I’m wrong). With this in mind, an implant to increase the size of the right breast is not likely to work. Increasing the size of the right breast with a DIEP flap (I assume this is what you meant by “tummy tuck”) is potentially a large operation for a lumpectomy defect, but sometimes it is actually the best option.

If you don’t mind being smaller than you were, reducing the size of the left breast may well be your best (and simplest) option to get better symmetry. That’s probably all I should try to say without knowing more details about your particular situation. We’d be happy to have our nurse Chris or PA Kim call you to discuss your situation further, if you wish. Thanks for your question, and have a great day!

Q: I had bilateral mastectomy in 2011, but didn’t have insurance. Now that I do have insurance, can I get reconstructive surgery? And how do I go about it?

A:  Thanks for your question. There is no time limit to when you can have reconstruction surgery. Your next step would be to start researching what kind of procedure would achieve your goals. If you’d like a permanent reconstructive procedure, the ones we offer might be what you are looking for. We use excess tissue of your abdomen, buttock or upper thigh and transfer that along with it’s blood supply to build a new warm natural breast.

Richard M. Kline, Jr., MD
The Center for Natural Breast Reconstruction

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Ask the Doctor: Is there any surgery for a Tram flap patient with a belly bulge, no hernia?

June 20, 2014 by

<img src="image.gif" alt="Pink Flowers" />This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q. Is there any surgery for a Tram flap patient with a belly bulge, no hernia? Breast reconstruction was great and there were no complications. I have heard that mesh can be used, does this flatten the belly, or would I be at risk for complications such as a hernia?

A. Hi Karen, Thank you for your question. If your tummy bulge is due to the TRAM flap procedure then it is possible that repair of the bulge using mesh could help flatten your tummy or repair the bulge. We normally check for a possible hernia by ordering a CT Scan of the tummy wall before planning this type of procedure. The findings help us determine what is the best approach and if we need to use permanent mesh or some other type. If there is no hernia then repairing the bulge should not risk creating a hernia. Depending on the situation, it is possible that the bulge could come back. Prior to this type of repair you should make sure you do all you can to avoid being overweight, as your weight can impact the success of the repair. I hope this answered your question.

Dr. James Craigie

Center for Natural Breast Reconstruction

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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I Have Had Breast Cancer Three Times–Am I Still A Candidate for Reconstruction?

June 13, 2014 by

Spring-flowers-pink-pretty-1-jpgThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I have had breast cancer three times. A lumpectomy (right) in 2001, a mastectomy (right) 2003, and mastectomy (left) 2008. I’ve only received radiation in my right breast. Am I still a good candidate for the reconstruction?

A: Thank you for your question, I’m sorry you have had to go through breast cancer   three times. Depending on your overall health and any other types of surgery you could  be able to have breast reconstruction. As you may know already it is not extremely rare for women to have breast cancer in one breast and later have it in the other side. It is definitely less likely than having it on one side only. It is also not unusual for women to undergo bilateral breast reconstruction. To determine if you should undergo surgery we would need to have a bit more info about your overall health. My office can contact you if you like.

Dr. James Craigie

Center for Natural Breast Reconstruction

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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After Multiple Grafting Procedures, What Are My Options to Finish My Reconstruction?

May 30, 2014 by

1401377_roseThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a RB mastectomy in 2008. Since January 2013 I have had 6 micro-fat grafting procedures with my current surgeon. After the fifth procedure, some of my radiated skin failed. The sixth procedure was Apr 4, 2014 and he sewed up the open wound, did a reverse abdominoplasty fat transfer to create a breast fold, and transferred some fat. I am not confident that my skin will stretch sufficiently to finish this process satisfactorily with additional fat transfer and want another opinion, and to evaluate other procedures, before I proceed.

My belly fat is still intact but would be the next place to go. Several patients I’ve corresponded with online have been in a similar position and recommended Dr. Richard Kline. Any advice?

A: Thank you for your question and I am sorry you are having problems. You mentioned that your tummy fat was intact. Does that mean no lipo in that area? If so using the tummy skin and fat may be a good option. Other options include fat from the buttock or thigh. We will have Chris from our office contact you for some additional information and photos. We can then set up a consult via Skype or phone with myself or Dr. Kline. Thank you again for your question.

Q: I would like to set up a consultation about the possibility of replacing my implants from breast reconstruction after a bilateral mastectomy with my own tissue. I’m not happy with the results of my reconstruction.

A: I’m sorry you are having problems with your implants. I will be glad to have my office contact you and schedule a consultation. They will need to get some information about your situation etc. We do frequently treat women who have had implant problems. Approximately 1/3 of our patients have come to us because of implant problems. We specialize in replacing your implants with your own tissue and preserving your muscles.

Dr. James Craigie

Center for Natural Breast Reconstruction

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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Bring On the Blues!

May 23, 2014 by

“Are you contracted with my insurance company?”

That’s always one of the first questions asked by our prospective patients. If your Blue Cross Blue Shield plan is a member of the “Blue Card” network then the answer is “YES” and you can rest assured there will be no surprises and you will get the best benefit available to you through our practice, our chosen hospital, and any ancillary services. We never utilize providers outside of the network for our Blue Cross Blue Shield patients.

100 million members — 1-in-3 Americans – rely on Blue Cross Blue Shield companies for access to safe, quality, and affordable healthcare. Operating and offering healthcare coverage in all 50 states, the District of Columbia and Puerto Rico, the 37 Blue Cross and Blue Shield companies cover 100 million Americans.  Nationwide, more than 96% of hospitals and 92% of professional providers contract with Blue Cross and Blue Shield companies — more than any other insurer.

The Blues® currently serve 85% of Fortune 100 companies and 76% of Fortune 500 companies.  Moreover, the Blues have enrolled more than half of all U.S. federal workers, retirees and their families, making the Federal Employee Program the largest single health plan group in the world.

bluesHow can you tell if your plan is part of the “Blue Card” network?

– Alpha Prefix – Three characters in the first position of the identification number.

– Suitcase Iconee characters in the first 

Here is how the program works:

  • We submit our claim to Blue Cross Blue Shield of South Carolina (BCBSSC)
  • BCBSSC electronically forwards the claim to the patients home plan
  • Patients home plan verifies eligibility, applies benefits, and returns claim to BCBSSC
  • BCBSSC applies pricing according to our contract and sends remittance and payment to us

If you are still uncertain or if your card looks a little different than the sample here, just give us a call and we’ll be happy to check it out for you. We have insurance experts on staff that can answer these kinds of questions quickly and efficiently. Our office is contracted with most major insurers including United Healthcare, Cigna, Medicare, Aetna, Humana, Coventry and many, many more. We’ve never met an insurance company we couldn’t work something out with.

Have a FANTASTIC DAY!

Gail Lanter, CPC

Center for Natural Breast Reconstruction

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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Pinching Pain Around the Flap Area–Is This Normal?

May 16, 2014 by

DaisyThis week, Dr. James Craigie and office manager Gail Lanter of The Center for Natural Breast Reconstruction answers your questions.

Q: Hello! I am a breast cancer survivor. In 1995, I was diagnosed and had my mastectomy and reconstruction all at one time. It was a 13-hour surgery.

Lately, I have been experiencing some pain like a pinching around the flap area. Is this normal? Perhaps scar tissue? Also, what can cause this? Most mammogram techs will not do both breasts during mammograms; they say there is no need. But this makes me a little scared. What if the pain is cancer coming back in that area? Also, could weight gain contribute to this discomfort? I appreciate your insight. 

A: It is not unusual for aches and pains to develop in the area you had surgery. If you have had weight gain then changes in the breast shape could cause pulling on the scars from your surgery. A lot would depend on the type of reconstruction you had. You should definitely have either your surgeon or cancer doctor examine you to determine if they notice anything suspicious. If so they may need to perform some type of test to get more information. They might consider an MRI or ultrasound. Our practice is dedicated to breast reconstruction and we are not experts at screening for breast cancer or  the treatment of breast cancer.

I would definitely recommend you follow up with  one of your doctors if your discomfort persists. I do not routinely have patients undergo screening mammograms of their reconstructed breasts. I hope this helps and that everything works out okay.

Dr. James Craigie

 

Q: I have the gene mutation, BRCA 1. I am from Ashkenazi Jewish descent. Many family members have been diagnosed before the age of 40. I have a scheduled prophylactic mastectomy with DIEP flap surgery scheduled for the end of May. I received a call this morning that Humana will not cover prophylactic surgeries. I know there’s got to be a way and that’s why I’m writing you. They’re telling me that my physicians can file an exemption or determination letter. Is this the best way to go about this? Do you have any advice for me on what I need to or ask my doctors?

A: I am sorry that you are having trouble getting information about the coverage of a prophylactic mastectomy.  That can make a difficult situation even harder to deal with!  Without having all of the info about your particular Humana plan, I can offer you general information that may help.  You can access here Humana’s most recent clinical policy regarding coverage of prophylactic mastectomy.  It clearly says that a patient is eligible if she has a personal history of the BRCA 1 mutation so I am unsure why you are receiving conflicting information.  Did you receive the call from a representative employed by Humana?  If so, I would certainly initiate another conversation with them and identify this clinical policy.

Gail Lanter

Practice Manager, Center for Natural Breast Reconstruction

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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