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Can You Perform a Buried DIEP Flap Procedure Utlizing Expanders?

December 27, 2013 by

The following question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

Q: I have had bilateral mastectomies without radiation. Cancer was in the left breast and I have been cancer-free for over a year.

I may be interested in DIEP reconstructive surgery. However, I am having trouble finding a surgeon to perform a buried flap utilizing expanders and my current mastectomy scars.

It is bad enough to have to have a large ugly scar across my abdomen, but to have my breast look like patches with two scars each is even more horrible than having cancer! It is even more disfiguring than the mastectomy and is not doing any woman a favor by making their self confidence and self image even worse. Are buried DIEP flaps one of the procedures that you perform?

A: Thank you for your question. I am sorry you are having difficulty finding a surgeon to address your situation. Every person’s situation is unique and if I had more info I could be more specific to you. However, I think I can help clarify why you are having a difficulties finding a surgeon to address your concerns:

During a mastectomy surgery, it is the breast surgeon removing the breast who has a major impact on subsequent reconstruction options. If no reconstruction was performed at the same time, then the surgeon was obligated to remove excess breast skin in order for the mastectomy incisions to heal without complications. It is important to understand the breast shape is determined by the breast skin that surrounds the new DIEP breast. If surgery removed the skin, then it has got to be replaced in some way.

In your question you spoke of tissue expansion. This technique does not create new skin but stretches the remaining skin. It also stretches the chest muscle and the muscle does not recover. Also, it’s important to note that some people will reject the tissue expander and have problems expanding the breast scar. In my opinion the technique of expanding the skin and later rebuilding the breast with a DIEP works best when the surgeons work together and extra skin is saved by the breast surgeon. Please try not to be discouraged! We have helped many women in your type of situation regain their self-confidence and their body image after mastectomy.

Also, please understand that in order to undergo the procedure you mentioned would require another surgery when the expanders are placed and the skin and muscle stretched over six months or sometimes less. When the stretching was completed then the DIEP procedure would be done but would require another two surgeries. It is unknown whether your body would stretch well and the process could be more complicated.

Most of our patients want to have reconstruction with their own tissue and do not want to sacrifice any important muscles. Our goal is to restore our patients’ self esteem and not simply scar their bodies and put them together with “patches.” Please let me know if you would like any more specific information we may need to touch base with you by phone.

James E. Craigie, M.D.

Center for Natural Breast Reconstruction

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by submitting your questions here.

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The Best Tips to Help You Prepare for Surgery

December 20, 2013 by

Q: I’m getting ready to undergo a mastectomy, and I’m nervous. There are so many things to think about and organize right now, and I feel overwhelmed! Do you have any tips on how I can prepare for my procedure?

A: Thanks for your question! First of all, take a deep breath. You’re not alone. A lot of women ask us how they can optimize their time and resources before and after surgery. We love this in-depth article from Best Friends for Life Co., which gives you an essential checklist of items to cover and pack, as well as key terms to understand your medical status pre-surgery. They also have post-surgery steps for what to expect. From the article, here are a few essential tips:

“If you work, you will need to inform your employer that you will be on medical leave for at least 2 weeks.  You might feel up to going back earlier, but it’s best to give yourself a buffer.

Make sure you’ve discussed payments and coverage with your health insurer before your surgery. Get all pre-authorizations in writing, and make sure you are aware of any out-of-pocket costs you will have to pay. There is sometimes a difference between what you are billed for and what your insurance will pay, and you should be prepared ahead of time to avoid surprises.

Get your house in order – literally. Pay bills, do your financial chores, get the laundry done, prepare and freeze microwave meals, and have help lined up for yourself, your house and kids.  Do any necessary heavy cleaning before your surgery, because pushing a vacuum cleaning or changing sheets will not be possible for quite a while afterward

Go shopping. Make sure you have several days’ worth of groceries for your family. Stock up on crackers, broth based soups (not creamy) and jello.  These are all easy to digest the first few days at home. Get some bendable straws; it makes it easier to drink.”

Be sure the read the entire article at their website. We also LOVE their BFFLBags, which take care of a lot of little details while you’re in the hospital or surgical center.

Do you have medical questions? Submit your question to Ask the Doctor today! Be sure to browse our archives, too.

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Will My Previous Surgeries Compromise My Chances for a DIEP Procedure?

December 13, 2013 by

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

Q:  I am BRCA 1 positive and researching prophylactic mastectomy with immediate reconstruction. As far as I can find out, DIEP is not available in TN. I am planning to have a bilateral salpingo oophorectomy at some point in the near future and have had 2 previous C-sections. Does that exclude me from being a DIEP candidate?

A: Thanks for your question. Most likely your previous  surgeries have not compromised your chances for DIEP breast reconstruction. In fact, I see patients frequently who have been told they can not have a DIEP, and in fact it works quite well. I would be glad to get more info and could be more specific. Let me know.

 Q: I’m considering implant-based breast reconstruction. My surgeon mentioned a “risk of capsular contracture.” What exactly is that?

A: Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.

The occurrence of capsular contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule tightens and squeezes the breast implant; as such, it is a medical complication that can be very painful and discomforting, and might distort the aesthetics of the breast implant and the breast.

Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.

Moreover, because capsular contracture is a consequence of the immune system defending the patient’s bodily integrity and health, it might reoccur, even after the requisite corrective surgery for the initial incidence.

The degree of an incidence of capsular contracture is graded using the four-grade Baker scale:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

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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What is a BRCA Test and Do I Need One?

December 6, 2013 by

What is a BRCA Test and Why Do I Need One

According to the American Association for Clinical Chemistry, “In the general population, the lifetime risk of developing breast cancer is approximately 12% and the lifetime risk of developing ovarian cancer is about 1.4%. The risks increase with age.”

So how can you tell if you are at risk for breast cancer? One way is through a BRCA test.

What is a BRCA test?

There are a variety of BRCA-1 and BRCA-2 mutations present in individuals around the world, and a BRCA-1 and BRCA-2 test is used to detect various mutations in the genes. Some of these mutations are seen in individuals who have a high risk of developing breast and ovarian cancer. If you have a relative who has been diagnosed with breast or ovarian cancer, you would be a good candidate to receive a BRCA test to determine if you carry the same gene mutation. However, a BRCA test is not recommended for the general public. It is only recommended for individuals who have a close relative(s) that has been diagnosed with breast or ovarian cancer, especially before the age of 50.

It’s important to note that there are options for individuals who receive a positive result on their BRCA test and there are ways to help prevent the onset of breast or ovarian cancer. Just because someone receives a positive result on their BRCA test, doesn’t mean they will definitely develop breast or ovarian cancer. The positive result means that they are at higher risk of developing these cancers.

It’s also important to note that if an individual receives a negative result from the BRCA test, this doesn’t completely rule out the development of breast or ovarian cancer in the individual for the future. This is because the BRCA test can only detect if a person has a hereditary breast cancer or ovarian gene mutation.

If you have more questions about breast cancer and testing for breast cancer, don’t hesitate to contact us.

 

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After Breast Reconstruction, Do I Still Need an Annual Mammogram?

November 22, 2013 by

diep and mammogramThe following question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

Q: After having breast reconstruction using the DIEP method, do I need to have an annual mammogram?  If so, can the pressure from the procedure cause any damage to the tissue or blood vessels used in the reconstruction?

A: First of all, following mastectomy and reconstruction with your own tissues, a mammogram is routinely not needed on a regular screening basis.  Screening mammograms are only helpful for normal breast tissue; therefore, in our patients we do not recommend that they have regular screening mammograms.

From time to time, people will be seen in follow up for examination and have areas of the breast feel firm or hard and sometimes the oncologist or other physicians will order mammograms to investigate a specific finding.  This would normally be performed after the first and second stages of the reconstruction process were completed and therefore should pose no risk of injury to the blood vessels that were connected to the breast.

Thank you for your question!

James E. Craigie, M.D.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by submitting your questions here.

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Post-Operative Care: What to Expect and Helpful Tips

November 8, 2013 by

Post-Op Care and TipsOur team often receives questions on the healing process and post operative care after breast reconstruction surgery. We strive to provide our patients with the information to ensure they achieve the most optimal surgical experience. For today’s Ask The Doctor post, we are sharing with you some tried-and-true steps and tips we have to help our patients improve their post surgery recovery and healing time.

After Surgery

Family members will receive periodic updates during your surgery.

Following the procedure, you will be moved to a special unit in the hospital where you will be connected to monitoring equipment. There, nurses trained in post operative care of breast reconstruction will monitor you at all times.  Family members can see you during visiting hours.

You will also receive an informative sheet that discusses your specific information and post-operative care.  This likely will include information concerning drain care; it is very important to monitor flow from the drains in a 24-hour period. This guides us on when to remove them.  You will also have a kind of thermometer on your chest, which monitors the flap.  Other specifics and information will be provided in your post-operative packets.

As You Heal

Family and Friends:
Support from loved ones is very helpful. But understand that comments they may make during your recovery can cause you concern. Remember this: We will tell you honestly how you are doing and what we expect your result will be.  Please trust in our knowledge and experience when we discuss your progress with you.

Healing:
You will heal! How quickly depends on factors your genetic background, your overall health and your lifestyle (exercise, smoking, drinking, etc.). Many people believe the surgeon “heals” the patient.  No person can make another heal. Dr Craigie and Dr Kline can facilitate, but not accelerate, the healing process.  But you play the starring role, so your cooperation is key.

Swelling:
You may find swelling of your new breast and abdomen (DIEP) or buttock (GAP) to be troublesome and your clothes may not fit.  Be patient, this swelling will gradually subside and you will feel better in a few weeks.  There will be a certain amount of tightness in the area where the flap was taken from.  This will slowly relax in a few months.

Following Instructions:
Another way to improve healing is by following the instructions given by Dr. Craigie and Dr. Kline’s staff.  We believe “the difference is in the details” and strive to achieve the best possible results for you.  It is imperative that you act as a partner in this process — not a passive participant.  The instructions are designed to give you the best opportunity for healing without delay or surprise.

Click here for a complete list of post surgery healing and recovery tips and instructions.

Have questions about post operative breast reconstruction? Or questions in general? Contact us today!

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Will I Have Any Breast Sensation After a DIEP Procedure? Will My Insurance Cover My Post-Op Stay?

November 1, 2013 by

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

Q:  I was recently diagnosed with LCIS and then in a second and third look was re-diagnosed with ALH. I am leaning toward undergoing a  double mastectomy and reconstruction.

As a 45 year-old single mother of three, I would like to know a few things regarding your procedure.

1) Is there any nipple stimulation with the stomach flap DIEP procedure?

2) Is the week-long stay in Charleston covered by insurance in addition to inpatient charges?

3) How early can you get an appointment scheduled? My insurance rolls January 31, 2014 and my deductible has been met after my lumpectomy.

A: I am sorry you are having to make these difficult decisions. Regarding your questions:

1) Breast sensation after mastectomy is never normal. The more of your breast and nipple skin that is saved, the better the sensation after surgery. Also, the DIEP tissue has nerve tissue in it and if all goes well with the surgery, sensation can return faster. Again: it is not expected to be 100% normal. Implants have no nerve tissue and scarring can impair nerve healing.

2) There is at least one place that some patients qualify for that is free. Otherwise, lodging is not covered at all by insurance. We do have a list of places that give medical discounts.

3) If you would like an appointment, I will be glad to have my office contact you.

Thank you!

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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What Technique Do You Use For Nipple Reconstruction?

October 25, 2013 by

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

Q:  Can you tell me how successful you have been in doing nipple reconstruction and what technique you use? I had one done from tissue gathered from my own breast, then had fat transferred but it is still flat. Now that I am losing the other breast (2nd mastectomy) I would like to have a protruded nipple even if just a bit on each breast. 

A: I use the “skate flap” technique, although many similar techniques using local tissue exist. There are, in my experience, two potential problems which may cause nipple reconstruction to be unsuccessful.

1) Sometimes, a portion of the flap just dies. This is, to a large extent, unpreventable and unpredictable, as these flaps are too tiny to be based on any known blood vessel. Additionally, the need to put the nipple in the proper location precludes altering its design to potentially improve blood flow.

2) We have learned that it is essential to protect the flap from the pressure of clothing until it is fully healed (at least one month). There are special domed “Tupperware” protectors made just for this purpose.

It helps to make the nipple larger than desired at first. That leaves a little leeway if things go awry, and it only takes a few minutes to reduce a nipple in the office if it ends up being too large.

Hope this helps, good luck.

Q: I have just been diagnosed with breast cancer of the right breast. The surgeon suggest bilateral mastectomy due to family history. Should I meet with a plastic surgeon before the surgery or get a 2nd opinion?

A: Whether or not you ultimately decide to have reconstruction (at the time of mastectomy, or later), you should at least speak with a plastic surgeon beforehand so that you know all of your potential options. Ideally, your breast surgeon already works with one or more plastic surgeons, and can help direct you to one.

 

Dr. Richard Kline

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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Ask the Doctor: Medicare, Scarless Reconstruction, and Options for Smaller Body Types

October 18, 2013 by

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

Q:  I was diagnosed with breast cancer in December 2010 and had a bilateral mastectomy/ stage 3 with 25 malignant lymph nodes removed. My treatment was chemotherapy followed by radiation. The last radiation treatment was September 2011. I have been researching about the DIEP procedure and am very interested in having this done. I am 66 years old. Do you accept Medicare out of state? The facility in San Antonio does not.

A: We will accept Medicare if you are otherwise (medically) a good candidate for the DIEP procedure. We can have our nurse Chris or P.A. Kim call you to get more information, if you like.

 

Q: Can you have scarless breast reconstruction surgery following a double mastectomy for triple negative breast cancer?

A: There’s really no such thing as “scarless” breast reconstruction, although it is often possible to conceal the scars quite effectively. We’d be happy to have our nurse Chris or PA Kim call you to discuss the details of your situation further, if you wish.

 

Q: What can you do for someone who is thin (5’4″, 116 pounds), has had a unilateral, nipple sparing mastectomy with radiation? Desired cup size would be AA or A only.

A: Most patients, even very thin ones, can still be reconstructed using only their own tissue, particularly if they only need one breast reconstructed, and don’t need it to be very large. If you have any excess abdominal skin / fat at all, it is frequently possible to use both sides of the abdomen to reconstruct one breast (stacked DIEP). Sometimes other donor sites are better ( buttocks or posterior thigh), and most patients have some extra fat spread over their bodies that can be added as free fat grafts at a subsequent procedure after the initial flap. It may be easier to tell which donor site(s) is best during an actual examination, but we can usually get a reasonable idea from photos.

Dr. Richard Kline

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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After Radiation, Mastectomy and Reconstruction, I’m Having Extreme Back Pain…Solutions?

October 11, 2013 by

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

Q:  About 6 years ago, I had a bilateral mastectomy with reconstruction. The plastic surgeon took one muscle from each side of my back to reconstruct each breast. Now I am experiencing extreme back pain on the right side. This is the side where the tumor was. This was a second occurrence.

In 1993, I had a lumpectomy with chemo and radiation to this right breast/side. The extreme pain feels like it is muscular in nature on the right side. Is this normal and something I just have to live with, or might there be some other treatment for muscle pain? Should I have it checked out for a possible disc problem causing the radiating pain in my back? Should I check out physical therapy or is it too late for this therapy? I am at a loss and hate enduring this constant pain.

A: Thank you for your question, I am sorry you are experiencing pain.

When the pain first developed and exactly where it is located could help determine what the cause is and how to treat it. If it is your back in the area where your back muscle was removed it could possibly be related to your spine discs or from your body compensating for not having the muscle. If you have an implant and the discomfort is in the breast area it is possible that scarring around the implant is the cause.  Most importantly you should let your plastic surgeon,  breast surgeon and oncologist know so they determine the cause and treatment.

Your oncologist should determine if you need any special scans or tests with regard to your breast cancer history and your plastic surgeon can determine if it has to do with the reconstruction and if there is a fix.

 

Q: I had nipple reconstruction a month ago. After a summer with not having to wear a bra, I’m now having remorse that I didn’t go for 3-D tattoos. Two questions:

Can one have the reconstructed nipples removed?

Is there a way to flatten the nipples over time?

I understand that some nipples flatten naturally but others don’t. I wish I had thought all this through the way I did for every other decision I made during the breast cancer journey. Is there any thing else you would suggest for someone with buyer’s remorse regarding nipple reconstruction? 

A: Thank you for your question.

I suggest you ask your surgeon as it may depend on how the reconstruction was done. Otherwise I would also expect over time the nipple will flatten. It takes about 9 months. It can always be made smaller easily in the office with only numbing medicine.

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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