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Flap Procedure Using Tissue or Muscle–What is My Best Option?

October 4, 2013 by

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

Q:  had a double mastectomy in July 2012. I have one successful implant (right) and the left had to be removed due to infection. I need a flap procedure and want to know which one you usually recommend? I have had a lot of bad ratings for the stomach procedure. 

A: Thank you for the question, and I am sorry you have had problems with your implant.

When implants don’t work out,  usually using your own tissue can be an option to complete the process without using an implant. We specialize in using your own tissue but without sacrificing your muscle. Giving up the tummy muscle can be a problem and may have been part of the reason you have had less than favorable reviews on that subject. We prefer to use the body area that has sufficient tissue to rebuild the breast and take no muscle to do that. We can use the tummy, buttock or thigh tissue. I would be glad to give you more specific recommendations if I had more info. Let me know if you would like my office to contact you for more specifics.

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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Can I Have Reconstruction After Recurrence of Cancer? Should I Go to My Local Surgeon or Elsewhere?

September 27, 2013 by

This week, Dr. Richard Kline and Dr. James Craigie of The Center for Natural Breast Reconstruction answer your questions.

Q: I have been diagnosed with a second primary breast cancer in the right breast. 13 years ago it was IDC now DCIS. What are my reconstruction options? 

A: I’m sorry you are having to deal with a recurrence. Glad to hear it is DCIS. I imagine you had radiation before and could have mastectomy with immediate reconstruction. If you like I will have my office contact you for a few more details.  I would be glad to set up a phone consult so you could get my opinion right away.

Dr. James Craigie

 

Q: I was referred by a coworker who was a patient. I’ve had a bilateral mastectomy, expanders and two sets of implants (taken out due to capsular contracture). My plastic surgeon said my body just isn’t taking to the implants and suggests I try DIEP flap reconstruction. My plastic surgeon does them, but my coworker said she recommends more experience. At this point I am torn. She suggested I contact you. I live in Florida and I am very comfortable with my surgeon, but understand the more you do, the better you are. I’ve also had a gastric bypass 10 years ago and I am scheduled for a hysterectomy (via DaVinci robot) Oct 2nd.

A: Thanks for your inquiry, and sorry for the trouble you’ve had.

Having said that, more surgeon experience, having two microsurgeons involved, and using a hospital with a dedicated flap team does potentially provide benefits, probably most so in terms of shorter operating times and increased flap survival rates. We have presently done about 1030 DIEP and GAP flaps, with a 98.4% survival rate, and we would be happy to see you at any time.

However, I would suggest that you consider discussing your concerns with your plastic surgeon, and if he still feels confident he can do it, I think I would give him the benefit of the doubt. Even if you ultimately decide to have your surgery elsewhere, it would be very helpful to have him on board with your decision.

Dr. Richard M. Kline, Jr.

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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Can You Obtain Perfect Symmetry in Breast Reconstruction?

September 20, 2013 by

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

Q: I looked at your gallery  and I’m concerned about what I see as a mismatch in the photo examples. Is this not something you try to achieve?

A: Thank you for your wonderful question!

By “mismatch,” I’m assuming you mean the two breasts do not look the same when reconstruction is completed.

Firstly, we have many patients with very symmetrical breasts following reconstruction, and we could easily put only their pictures on our website, if we wished.

Thus far,  we have chosen to put less-perfect results on our website as well, believing it serves our potential patient population better, for the following several reasons.

In the real world, many patients will not be able to achieve a highly symmetrical result due to prior conditions, or will choose to not go through the multiple surgeries that will be required to get them as close to perfect symmetry as possible. If all patients came to us before their cancer was removed, we would coordinate their surgery with one of our highly experienced breast surgeons, they would nearly all receive nipple-sparing or at least skin-sparing mastectomies, and they would then have the greatest potential for good symmetry in the end.

In actuality, we see many patients from out of town who have already had non-skin-sparing mastectomies (often when nipple-sparing or skin-sparing mastectomies would have treated the cancer just as effectively). In this scenario, they have little potential to have their scar pattern converted to a more favorable one, and commonly need a lot of extra flap skin left in place in the breast. Occasionally a temporary tissue expander can be used to reduce the size of the skin paddle, but this does not always work, especially in radiated patients. If they chose to have a contralateral prophylactic mastectomy, they could then of course choose to have the same type of mastectomy on the other side (which would help symmetry), but many patients understandably do not want to do any more damage to their healthy breast than they have to.

Additionally, many patients are left with permanent changes in their skin from radiation, which can cause permanent color mismatches, as well as excessive tightness in the skin. This can make it very hard to match a radiated side to a non-radiated side, more so in some patients than others. The more times we can operate in this situation, the closer we get, but sometimes ideal symmetry remains elusive.

We want ladies who have already had aggressive mastectomies, who are left with significant radiation damage, or who don’t want to go through many, many surgeries in pursuit of ideal symmetry to know that there is still help for them, without implying to them that they will get a result that is probably not realistic. All busy reconstructive practices have these patients, but not all choose to put them on their websites. It may not be a good marketing decision for us, but we feel it is the most honest way to deal with our prospective patients.

We’d enjoy any feedback you’d care to give us on this topic, as we argue about it a good bit amongst ourselves.

 

Dr. Richard M. Kline, Jr.

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 Should I Do If An Abnormal Lymph Node Has Been Detected?

September 13, 2013 by

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

Q: My sister had breast cancer. She completed DIEP flap surgery and a lymph node transfer. A knot has now appeared under her arm. She had a sonogram completed and found an abnormal node. I am really concerned that my sister’s lymph node has died or the cancer has returned. Your insight would be greatly appreciated!

A: We have not run in to that scenario (yet), but I can offer some thoughts. When we transfer lymph nodes we move only a very small amount of tissue (typically 15-20 grams), and even if it dies, it’s unlikely it would be noticed. If more tissue is transferred (as in, a lot of fat with the lymph nodes), and it dies, it could well produce a “knot” as you describe. This would typically become evident a few weeks after surgery, or possibly a little longer. If your oncologist or surgeon is concerned, a PET scan would probably differentiate dead tissue from active cancer in this area.

 

Q: How long after breast reconstruction do I need to wait to drive a car?

A: After flap surgery we usually recommend waiting at least a month, but everyone is different. If you’re having implant reconstruction, you may well be able to drive much sooner.

 

Dr. Richard M. Kline, Jr.

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 My Best Reconstructive Surgery Option After Lumpectomy and Radiation?

September 6, 2013 by

Sometimes, the answers we need are found in unexpected places. Our team is happy to share our information…wherever we go!

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

Q: I had a lumpectomy on my right breast in 2007. My oncologist has given me the green light to plan reconstructive surgery. I’m hoping to have some sort of reconstructive surgery to balance both breasts. I’m 69 years old. The odd part of this request is that a close friend of mine sat next to Dr. Kline on a flight from Louisville to Charleston!

A: It was a pleasure talking with your friend on the plane, she seemed extremely nice, and immediately mentioned you when she learned what I do for a living.

There are potentially several reconstructive routes one can go after lumpectomy with radiation, depending on your present situation and your goals. As you probably know, your chances of successfully tolerating a breast implant in the radiated breast, while not zero, are much diminished due to the radiation.

If it’s OK with you, I’d like to have our nurse Chris or P.A. Kim call you, and get a few more details about your situation. After that, we can chat by phone, and I’ll give you my honest opinion about which potential interventions might be best for you.

Dr. Richard M. Kline, Jr.

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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Chronic Pain After DIEP Flap Surgery–Can You Help?

August 30, 2013 by

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

Q: After a double mastectomy in April 2010, my left expander was replaced in June 2010 due to leakage and became infected.

I was hospitalized and given vancomycin and oral antibiotics for almost 3 weeks. Infection spread to right breast and both expanders were removed the same month.

I had DIEP flap surgery in December 2010, but I have had severe pain and shocking sensations in chest, ribs and stomach. My surgeon says he does not know what is causing this pain. Is it the result of nerve damage? And is there any way to fix this?

A: So sorry to hear about your experience! Out of 1,011 flaps to date, we have very few patients with chronic pain, but unfortunately it does sometimes occur. We usually examine the areas in question with a CT and/or MRI, but usually this does not show any abnormalities other than normal post-surgical changes.

In this scenario, we then refer the patients to our pain therapists, who almost always are able to provide significant relief. Please let us know if we can provide additional information.

Dr. Richard M. Kline, Jr.

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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I Have Poland’s Syndrome–Am I Candidate for Reconstruction?

August 23, 2013 by

Natural Breast Reconstruction options

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

Q: I am a 56 year-old woman who has Poland’s Sydrome. I have no right breast tissue. Are any of your procedures appropriate for my condition? What is the cost? Because my condition is congenital, I will not be covered by insurance. 

A: I have seen many patients with Poland’s syndrome who we were able to help. As you know, there are many different problems–mild to severe–that can occur. All of our patients who have had reconstruction of their breast due to congenital (Poland’s) problems have been covered by insurance. So don’t give up on getting coverage. I will be glad to give you more information about your situation if you like. My office will be happy to contact you, too. Just let us know.

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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Experiencing Cosmetic Problems After Breast Reconstruction?

August 16, 2013 by

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

Q: I recently had breast surgery. I think my nipples are positioned too high up, and one breast is harder than the other. What can I do? 

A: Usually asymmetries in this situation can at least be improved, although it is often best let a few months (at least) pass first for the tissues to heal. If one breast is hard, it could mean that you have a significant fat necrosis under the skin, although there could be other reasons. I would strongly urge you to see your surgeon and share your concerns with him or her.

Q: In December 2011 I had a bilateral mastectomy with immediate tissue expanders, followed by silicone implant and nipple tattoo. My problem is that I have developed the “double bubble” look, rippling and contractors bilaterally.

I am 63 and realize that my age does reflect my outcome, however, I just need to know if I am alone or if you have patients that experience this? All of the pics I have seen have really great results and none of them look like me!

I am facing another surgery now to remove these implants and replace them with a different shape. I forgot to mention the cleft/ledge above each implant. They tried fat grafting but it was minorly successful. I need advice and have searched the internet with no success. Can you help?

A: Your situation is far from unique, especially if you don’t have much thickness of soft tissue cover over the implants. Rippling, implant malposition (double-bubble), and contracture are unfortunately fairly common problems even after cosmetic breast augmentation, and can be yet more common after reconstruction.

Our practice is limited to fully autologous breast reconstruction using perforator flaps (DIEP, sGAP, PAP). The surgery to replace the implants with your own tissue is long (6-8 hrs), and carries risks not associated with implant reconstruction alone, so it is not for everyone. Having said that, we have successfully removed implants and replaced them with flaps hundreds of times, and it can work very well indeed (especially if you have a good flap donor area).

There are some additional options your surgeons might consider, if you don’t want to pursue complete implant removal and replacement with your own tissue. These include the addition of latissimus flaps to the implant reconstruction, or potentially the addition of acellular dermal matrix (Alloderm, etc.) to cover the implants. We don’t perform these procedures, but they are commonly available in almost all areas, and can bring extra “cover” over the implants.

 

 

 Dr. Richard M. Kline, Jr

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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I Found Lumps After Reconstruction Surgery–Could I Possibly Have Breast Cancer Again?

August 9, 2013 by

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

Q: I had breast reconstruction surgery 5 years ago.

Upon my 5-year check up, three lumps were found on my left breast. I had an ultrasound, then an MRI. I just received a call from my general physician informing me that I need a biopsy done due to fat necrosis on my left breast. Meanwhile, I have found many more lumps on both breasts. I’m waiting for my plastic surgeon to return from vacation to schedule a biopsy. I’m extremely nervous. Could I possibly have breast cancer again? Why do they need to do a biopsy? 

A: Although I don’t know what type of mastectomy or reconstruction you had, at least microscopic amounts of breast tissue are left after any mastectomy, so it’s still theoretically possible to develop  cancer. This is very unlikely in most cases, however. If you just had lumpectomy with radiation, it’s much more common. Fat necrosis after reconstruction with your own tissue is pretty common, but it’s unusual to have it show up after five years. If you had radiation after your reconstruction, however, that could help explain the late changes you note.

 Dr. Richard M. Kline, Jr

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 Doctors: Listen In, Again!

August 7, 2013 by

Yesterday’s live call was amazing—did you miss it?

Here’s a shot of Dr. James Craigie in action, as he listened and answered questions.

If you missed the call, don’t worry!

Here’s a link to the replay:

==> http://InstantTeleseminar.com/?eventID=43480677

Drs. Craigie and Kline answered your questions on a wide range of topics related to natural breast reconstruction, including:

    • Recovery issues–how long do certain procedures take
    • Aesthetic concerns—scar tissue, nipple sparing, etc.
    • More about preventive mastectomies…
  • And much more you’ll want to hear!

We are here for you. Feel free to scroll back through our comprehensive Ask the Doctor archive here on the blog, too, for more information! Or contact us anytime.

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