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Is There a Time Limit on my Breast Reconstruction Options?

May 9, 2014 by

1418214_blue_flowerThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a right mastectomy in May 1995 with 12 nodes removed at age 42. Then I received chemo for 3 months. Can I still have a reconstruction done at this point? How long is the recovery time? I work as a nurse on a cruise ship and am often 3-4 months away from home with varying times home (anywhere from 10 days to 3 months).

A: Thank you for your question. There is no time limit for breast reconstruction after having a mastectomy. The recovery depends in general on what type of reconstruction you had. If you did not have radiation you may have the option of implant reconstruction or reconstruction with your own tissue. Recovery from using your own tissue in general in longer and for our patients 8 weeks after stage one is typical. With more info I could be more specific. Let us know we could contact you for more details.

Q: I had a flap with reconstruction about 17 years ago. The right side is smaller than the left, and I would like to get them back to the same size, as well as get my nipple finished on the reconstruction. Is this still possible?

A: You can always have your reconstruction completed. There is no time limit in general. In order to proceed, we need to know what type of breast reconstruction you received 17 years ago (for instance, implant or using your own tissue). If you contact our office with more details, but we’re happy to discuss your options.  Thanks for 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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Will Reconstruction Improve the Shape and Size After My Lumpectomy?

May 2, 2014 by

1426157_white_rose_1This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy and radiation in 2004. The defect in my breast is increasingly more noticeable (clothed) than in the past. Now, I’m interested in reconstruction to improve shape & size of my breast. Do you have any advice?

A: Lumpectomy defects can be challenging, for several reasons. Firstly, the tissue is radiated, which of course makes ANYTHING less likely to work. Secondly, there is no really satisfactory way to reliably replace the volume that was lost, precisely where you want it. Sometimes a small implant can be helpful, but not always. If the defect is large enough,  a microvascular flap of the type we do can be used, but often this seems like overkill for the size of the defect. Free fat grafting (sucking fat from elsewhere and injecting it into the breast) might be as close to an ideal solution as possible, and some surgeons do it currently, but it has not been established with certainty that this does not increase the chance of cancer recurrence, so we are holding off on that procedure until more evidence is in.

In many lumpectomy / radiation breasts the entire breast envelope, including the skin, has shrunken significantly. This often presents the option of re-arranging (with surgery) the remaining breast tissue to improve the shape, then subsequently lifting or reducing the other side to match as closely as possible.

Hope this helps. If you’d like to send pictures, I can possibly give you more specific suggestions. If you’d to speak with our nurse Chris or PA Kim to give them more information, they’d be happy to give you a call.

Dr. Richard Kline

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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Mastectomies and Expanders: Your Questions Answered

April 25, 2014 by

Ask the DoctorThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: Both my mother and my aunt have been diagnosed with breast cancer. If I were to get a mastectomy, would it be covered by insurance in the state of Pennsylvania?

A: The situation with “high risk” patients and prophylactic mastectomy seems to be evolving. If you are tested and found to have the BRCA gene, most or all insurers seem to be covering mastectomy and reconstruction. Even if you do not have the BRCA gene, but have a strong family history such that your medical oncologist recommends mastectomy, your insurer may well cover it. There may be other laws specific to this in the state of Pennsylvania of which I am not aware, but possibly Gail, our office manager and insurance specialist, can help you more.

Q: I had breast cancer in my right breast, and received a double mastectomy in November. They placed expanders in both. I didn’t have any trouble on the left side. However, six surgeries later, I opted to have my right-side expander removed. It feels better. However, I am now scared to undergo reconstruction due to this past trouble with my right expander. I still have the expander in my left breast. Any advice for me? Is it common to have trouble with expanders?

A: Sorry you are having trouble.

Unfortunately, trouble with expanders is pretty common. It’s more likely if you were radiated on the “problem” side, but it also happens with some regularity even if you aren’t radiated.

Fortunately, previous trouble with expander or implant-based reconstruction does not adversely affect your ability to have natural breast reconstruction using your own tissue. Many of our patients come with stories very similar to your own, some already having had over 10 surgeries, and almost all have subsequently achieved satisfactory, natural-feeling reconstructions without the use of implants.

I think there is an excellent chance that we can help you. If you wish, we can have our nurse Chris or P.A. Kim call you to discuss the specifics of your situation in more detail.

Dr. Richard Kline

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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Tram Reconstruction and Recurring Cancer in Breasts–How Should I Proceed?

April 18, 2014 by

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

Ask the DoctorQ: I had a mastectomy on my left breast with the tram–which partially failed–then Latisimis Dorsi surgery. I now have breast cancer in my right breast. What is the likelihood of decent symmetry and matching both breast shapes during this procedure?

A: I’m sorry to hear about your new diagnosis. In our practice, we have treated quite a few people referred to us with similar situations. We do not perform tram reconstruction but instead use the skin and fat of the lower tummy without taking the tummy muscle. If we have a patient that later develops a second breast cancer we would use skin and fat from either the upper buttock or the back of the upper thigh below the buttock. This can create a very good match for the tummy fat or a tram reconstruction. I would be glad to give you a more detailed answer with more specific information about your situation, let me know. I do think you most likely have good options without needing to give up any other important muscles. For more specific answers I will need to have my staff contact you for more details about your medical history.

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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Is It Possible to Have My Current Implants Enlarged?

April 18, 2014 by

IFThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a breast augmentation surgery last year in August. I did NOT get a bad surgery, but I can tell the doctor didn’t listen to my wishes about size. Is it possible to have the implants I have now enlarged? Or would I have to have the surgery all over again with new implants? Thanks for your time!

A: If you have saline implants, it may be possible to enlarge them by putting more saline in, but it will void your implant warranty. Also, the more saline that is put in an implant, the firmer it gets, which is not how most people want breasts to feel.
If you have silicone gel implants, they cannot be enlarged, and new ones must be purchased to go larger.
Keep in mind that the larger you go with implants, the less natural your breasts will look. We talk to our augmentation patients extensively before surgery to try and determine what they want in their final result, but we also try to educate them about the relationship between size and naturalness.

Good luck, and thanks for your question!

Q: Hi! I had a breast reduction procedure when I was fourteen. I am 23 years old, and when my nipples get cold, I get a sharp pain in them and it hurts. What does this mean, and should I be concerned?

A: We don’t actually treat breast problems, we just reconstruct breasts that are damage or missing, so I’m not the best person to answer your question.The best person to consult with would be a general surgeon specializing in breast surgery. I’m not sure they’ll be able to help, but it’s worth a try.

Dr. Richard Kline

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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What Should I Do About My Post-Surgery Scar Neuromas?

April 11, 2014 by

1416012_gerber_daisy_isolatedThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I have scar neuromas as a result of breast reduction surgery. I have been told it is not recommended to have a surgery to excise the neuromas by my pain specialist and breast surgeon. Would it make a big difference if a surgeon who specialized in peripheral nerve surgery did this type of surgery? Thanks for your help.

A: The problems with operating for pain in this situation are potentially several-fold. Firstly, it’s hard to know with certainty that a neuroma is the culprit, although a well-defined area of touch-tenderness is certainly suggestive. Secondly, the neuromas are often too small to be readily seen, so it’s hard to know if you’ve actually gotten it out. Finally, you could end up with another neuroma from the “hopefully corrective” surgery as easily as you got the first one.

I would definitely try for a few months with injections, etc. with your pain specialist. However, if that fails and your symptoms are bad enough, I don’t think it would be unreasonable to try excising the area one time, and seeing what happened.

 

Dr. Richard Kline

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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What Are My Options for Nipple Reconstruction?

April 4, 2014 by

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

Q: I’m four months post-reconstruction and am looking at nipple possibilities. Do you also create 3-D nipples, or refer your patients to a specific tattoo artist? Do you have a preferred prosthetic nipple source?

A: Thanks for your question. We perform nipple reconstruction first, using skin from the new breast. When that heals, our nurse or physician assistant do the tattoo. You can do either both or none of the above. I know there are resources for prosthetic nipples but I have no knowledge of what company provides them. I think 3-D refers to the tattoo technique performed without the nipple reconstruction. The color technique creates the apparent nipple. Therefore if you do not want to have a procedure to make the nipple, you could have the tattoo alone with 3-D coloring. Unfortunately, I’m not sure who does that particular tattoo technique.

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’m Not Happy With My Implants — Is Flap Surgery Possible?

March 28, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a double mastectomy last August with immediate expander reconstruction. My expanders were replaced in January with silicone implants and needless to say I’m not thrilled with them. They are hard, cold and I now have ripples across them. My surgeon is going to remove more excess skin in hopes to alleviate the “wrinkling” effect, but I’m honestly not sure if I even want to have this done. I originally wanted to have a tissue transfer (abdominal) but was advised to try the implant route first.

I know that I don’t have a lot of abdominal fat and would probably end up with very small breasts if I went this route instead. I don’t mind the smallness but am concerned on the dangers of having a tissue transfer and wonder if this would be a better, more natural breast for me. I’m not getting the feeling that my surgeon is comfortable with this type of surgery and would like more information on your facility. I feel like I have so many questions that no one can seem to answer. Is there someone that I can reach out to?

A: We would be very happy to discuss your situation with you. It is very rare for someone not to have enough stomach or buttock tissue, especially with subsequent fat grafting, to provide an acceptable breast size. Flap surgery can be a little intimidating, but our success rate over the last ten years is 98.4%. We have helped many women who have started out with implant reconstruction, only to decide that it was not the right choice for them.
Our nurse Chris or P.A. Kim can call to discuss your situation further, if you wish.

Thank you for your question.

Dr. Richard M. Kline

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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Help! Is This Long-Term Pain After Breast Reconstruction Normal?

March 21, 2014 by

DIEP flapThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions when considering reconstruction or pain after reconstruction.

Q: I had flap surgery in October 2010. Since then, I have experienced pain to the touch in that area, all day, almost every day. Is this normal? 

A: I’m sorry you are having pain in your reconstructed breast. If you have not had your surgeon examine you, that should be your first step to get to the cause of the pain. After breast reconstruction is completed, the new breast should not be painful.  Some people who have implant reconstruction can have pain related to capsular contracture or implant rejection.

If I had more details about your situation, I could possibly give you more information. I would strongly recommend that you make sure your surgeon and or oncologist thoroughly look in to the cause of the pain. I would also not wait a long time to do this. Let me know if you would like to give me more info.

 

Q: I’m considering breast reconstruction. How long will it take for breast to look normal? What are the differences in the different types of procedures?

A: Thank you for your question. All types of breast reconstruction require time to complete and almost always more than one surgery. Depending on the circumstances, some patients may require chemotherapy and/or radiation. If this is the case, treatments can delay the completion of the process. I tell my patients to allow 3-6 months after any procedure for the results to settle and swelling to resolve.

There are generally two types of reconstruction: implant reconstruction and reconstruction using your own tissue. Implants are generally less natural and for some patients, the results are less permanent. Using your own tissue can be grouped into procedures that sacrifice muscles in the body and those that preserve muscle and use only skin and fat. The latter muscle-sparing procedures are our specialty and require expertise in a specific type of microsurgery.                

I hope this helps! Let me know if you need more info.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Breast Reconstruction Surgery: What Can I Expect In Terms of Nerve Recovery?

March 14, 2014 by

breast reconstruction

This week, the Charleston breast surgeons with The Center for Natural Breast Reconstruction answers your questions.

Q: How long does it take for nerves to recover and for full skin sensation to return after reconstructive surgery?

A: During any surgery, numerous sensory nerves, generally too small to have names, are invariably cut. Depending on the extent of the surgery, this can result in numbness of the skin or other areas. This is not typically regarded as a complication, but rather an essentially inescapable result of making an incision in the body. Most of the little divided nerves literally “wither away,” and other sensory nerves eventually grow in to take their place, restoring sensation once again. This process can take anywhere from a few months to 1 – 2 years. There is no limit on how late sensation can be regained, but the longer, beyond 1 – 2 years numbness, lasts, the less likely it is that sensation will spontaneously return. Occasionally, numbness can persist indefinitely, although this is uncommon.

In addition to numbness, other symptoms such as discomfort, hypersensitivity, or chronic pain can also result as a consequence of nerve damage following any surgery. Thankfully, these complications are much rarer then numbness. While it can be very difficult to ascertain exactly what mechanism is causing discomfort, some possibilities include traction or tethering of nerves by scar tissue, or formation of a “neuroma,” which is a painful little ball of tissue at the end of a regenerating nerve.

Nerves irritated by adjacent scarring may be helped by massage, injection of local anesthetics, or simply the passage of time. Neuromas, which are thankfully extremely rare following breast surgery, usually result in pain when pressure is applied to a very specific location, and can be much harder to treat. Surprisingly, additional surgery is often not effective in treating these rare cases of chronic pain, and referral to a Pain Therapist for injectable nerve blocks may be the most effective option.

Dr. Richard M. Kline and 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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