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Family History: Should I Consider A Preventive Mastectomy?

August 2, 2013 by

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

Q: I was diagnosed with stage 3 breast cancer about 3 years ago. I underwent all the usual treatments since then; however my oncologist has moved to another state, leaving me without one! I have not been able to get the reconstruction process completed.The last time I spoke with my oncologist, I was informed that it couldn’t be done. Do you think you can help?

A: Thanks for your inquiry!

Without knowing more details I can’t answer your question with certainty, but only rarely do we encounter a patient who can’t be reconstructed by any means. If you would like, we can have our nurse or PA call you to get more details.

 Dr. Richard M. Kline, Jr.

 

Q: My doctor recently told me that based on my family history–mom with a bilateral mastectomy, aunt (on mom’s side) with bilateral mastectomy, and another aunt (on mom’s side) with partial mastectomy–and combined with my PTEN mutation, thyroid issue, and other auto immune illnesses, that my chances of getting breast cancer in the next three years is 1 in 3. Should I seriously consider getting a preventive mastectomy?

A: A preventive mastectomy is the most effective way women can reduce their risk for breast cancer.

Close screenings with exams and x-rays or MRI, will only help with early detection and do not lower the chances of getting breast cancer. Women who are at high risk for breast cancer because of many different factors, family history or known genetic mutations do have preventive mastectomies to lower their chances. Before considering this big step you should review your risks with someone familiar with preventive mastectomies or a specialists in genetics.

It sounds like you have a doctor helping you through this decision. When it comes to proceeding further you should look for a team with a surgeon specializing in the breast removal and one specializing in rebuilding the breast at the same time as the mastectomy. Preventive mastectomies can preserve the breast skin and nipple, and are very different from most other types of mastectomy. Also the reconstructive procedures are specific for preventive mastectomies and have the chance to be the most natural results.

Our practice specializes in this type of breast reconstruction and we work with specialists who regularly perform nipple-sparing mastectomy. If you want more information we can contact you with a few more questions. Regarding my recommendation about when or if to do it I would say it is a very individualized decision to make, and the process is major surgery. You should know about all the risks and know what to expect regarding possible results.

We would be glad to review the details with you if you like. If so just let us know and I will have our PA or RN give you a call to discuss the details. I hope this helps.

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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Do You Provide the BRAVA and AFT Procedure?

July 26, 2013 by

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

Q: I am a breast cancer patient who has recently finished chemotherapy. I am looking now into reconstruction, but I was wondering if you performed the BRAVA+AFT procedure?

A: We are actively looking into BRAVA and AFT, but not doing it yet. I would suggest you contact Dr. Khouri, he’s certainly the expert at this point. If you should need GAPs, PAPs, or DIEPs, we would be happy to help you.

 

Q: I recently finished 8 weeks of chemotherapy. I did not have radiation. I still have Herceptin until next May. I understand you do not currently offer BRAVA, but I’m interested in a fat transfer. Do you use expanders or something? I really want to have something done sooner than later but am willing to wait if it’s necessary. Could you explain to me the procedures you recommend?

A: I would not recommend fat transfer alone as a breast reconstruction technique without BRAVA. Even with BRAVA, it will probably take several sessions to get to the size you want, and there is still no guarantee that it will ultimately be successful, as fat survival is not strictly predictable.

We primarily offer microsurgical breast reconstruction (DIEP, sGAP, PAP), we do it on an almost daily basis, and our flap survival rate over the last 10 years (98.4 %) is realistically probably as high as anyone’s. However, we realize that this is not for everyone. If you have not had radiation, implants may well be a good option for you, and there is likely no need for you to travel a long distance for this, as most communities of any size have plastic surgeons skilled in this area.

Any type of reconstruction can usually be done in between Herceptin treatments, although we ultimately defer to your oncologist’s advice on this.  If you live near us and want an opinion, we’ll be happy to see you in consultation at any time.

Hope this helps!

Dr. Richard M. 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: Smoking, Risks During Reconstruction, Researching Your Options

July 19, 2013 by

Ask the Doctor July 18This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I need to have breast reconstruction due to breast cancer occurring twice since 1999. I’m scared because I can’t quit smoking. The surgeon will not perform the procedure unless I quit. Are there any surgeons who will perform reconstruction even though I am a smoker?

A: Surely there are some physicians who will do reconstruction while you’re smoking, but we are not among them. This policy is only because we have personal experience dealing with the many months of wound healing problems (and tears) that commonly follow this type of surgery performed on smokers.

Smoking  isn’t just bad, it’s absolutely terrible. If you want all of your wounds to fall apart, leaving you miserable for months, there may be no better way to accomplish it than to smoke during your reconstruction. The good news is, if you stop for one month before and 3 months after your surgery (with absolutely no cheating), you can often have successful surgery.

 

Q: I am, after total mastectomy performed 12 months ago, scheduled for reconstruction. My age is 59 and I do not have any emotional concerns about being without a breast. However, I would like to stop wearing epiteze, and would like to not worry that it will show in summer. My concern is whether the long-lasting and repeated reconstruction (several operations, including making the healthy breast smaller) represents too big of a risk to my health. After anesthesia last year, I experienced problems with forgetting and lack of focus for about 3 months. Also, what about the operation and healing stress to the overall body? I would hate to start a new health problem because of reconstruction. What is the general risk apart from risks mentioned here?

A: The risks you are worried about are probably not so much from the surgery, but more from the anesthesia. I would suggest you discuss your concerns with your primary care provider. We can advise you about risks such as bleeding, blood clots, infection, etc., but these do not usually result in the problems you describe.

 

Q: Am I putting my health at risk in order to research the best reconstruction method before surgery?

A: No, I think you are looking out for your health by doing careful research in advance. Please let us know if we can help you

 

Dr. Richard M. 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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DIEP Flap Procedures: Can You Restore My Original Breast Size? Do You Remove Muscle?

July 12, 2013 by

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

Q: I am having a double mastectomy on August 1st. I want to have a DIEP flap reconstruction, but will have to settle on being half the size I am now because there isn’t an abundance of fatty tissue in my tummy. I am a full C cup now and will probably be a B cup following the reconstruction. Can additional fat be harvested from my buttocks at the time of my initial surgery to make me look like I do now or do I have to wait until Stage 2?

A: There are a few potential ways to look at your situation.

First, it is possible to do DIEPs and GAPs simultaneously (4 separate flaps). We don’t do this, because we have concerns about our ability to monitor the buried flap, but we do know have references to associates who can and we are happy to provide you with this information.

Second, it is possible to inject fat into the DIEP flap, and potentially the mastectomy skin flaps as well (if they are thick enough), as well as in the pectoralis muscle at the time of the DIEP flap. All that together will buy you some extra size, but it’s hard to predict how much.

Finally, you could do fat injections after healing in a subsequent stage(s). I would call this the “tried-and-true” technique, little to lose, much to potentially gain. We are investigating BRAVA as an adjunct to this, but not quite ready to use it yet.

 

Q: What happens if I am getting a DIEP flap done and some muscle has to be removed from my abdominal area?

A: A true DIEP flap never results in the removal of muscle, by definition. Some flap surgeons apparently tell patients they may need to remove a little bit of muscle, and we’re not sure why they say that, because we’ve never found it necessary in many hundreds of flaps.

However, with rare exceptions, the rectus muscle does have to be “disassembled” (and put back together again, of course) to remove the blood vessels, and this can occasionally result in partial loss of muscle function. We work extremely hard in designing each DIEP flap to maximize the blood supply to the flap, while minimizing the potential for loss of muscle function.

We obtain an MR angiogram pre-operation. This  requires an unusually strong 3T MRI for best images, which gives us an excellent “road map” of your individual perforator anatomy. We also frequently use the SPY intraoperative laser fluorescent angiogram to help determine exactly which perforating vessels supply the flap best. Thanks to these technologies, in addition to using the best surgical technique we can, it has been many years since we have encountered any significant functional abdominal wall problems in any of our patients.

Hope this helps!

Dr. Richard M. 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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Can Small Implants Be Used with Flap Surgery for Added Volume?

July 5, 2013 by

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

Q: Can small implants be used with flap surgery for added volume?

A: The short answer is “yes, sometimes.”


We have had good success augmenting flaps with reasonable-sized implants in non-radiated patients. In radiated patients, it’s still sometimes possible, but it’s very dependent on how much of the breast mound is covered with flap skin versus radiated breast skin, and what the quality (the technical term is “compliance”) of the radiated breast skin is. Every case is different.

Our nurse or PA can provide you with more information upon request. 

Hope this helps!

Dr. Richard M. 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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Can Upper Stomach Fat Be Used For Breast Reconstruction?

June 28, 2013 by

Ask the Doctor

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

Q: Can upper stomach fat (fat around the rib cage) be used for breast reconstruction if liposuction was performed on the stomach area below the belly button? What if my liposuction was done more than ten years ago?

A: Liposuction is only a relative contraindication for DIEP flaps, as the necessary blood vessels may well still be present. An MR angiogram is often very useful in determining if adequate perforating vessels are available.

Additionally, it is often possible to use fat from anywhere on the body to reconstruct breasts with the aid of the BRAVA system. The use of the BRAVA with fat grafting is not yet FDA-approved, but it looks very promising for women who either have no good flap donor sites, or don’t want large incisions.

Hope this helps!

Dr. Richard M. 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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Removing Expanders and Getting Implants: How Severe is This Surgery?

June 21, 2013 by

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

Q:  I am interested in having tissue expanders removed and putting in permanent implants. How severe is this surgery?

A. Thank you for your question!

We don’t do implant surgery very often, but removing the expander and placing the permanent implants is, generally speaking, pretty straightforward.

 The second stage of expander implant reconstruction involves the removal of the tissue expander, followed by placement of the implant, and creation of the final breast shape. This is an outpatient procedure, performed by opening the mastectomy scar (no new incisions are made) and removing the expander. Before placing the final implant, changes that need to be made to the implant pocket are addressed. These can include repositioning the implant on the chest wall, improving the inframammary fold, using Alloderm or  Strattice to address areas of thin skin, and revising or removing the capsule as needed. The final implant is then placed in the pocket, and the incision is closed. Drains are usually not needed. Placement of the implant will result in a softer, more natural breast as compared to the tissue expander.  According to which of the above procedures are to be performed, you can expect to spend 2 to 4 hours in the operating room.

Feel free to forward any other questions you may have…..We’re always happy to help!

Richard M. Kline, MD

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 Experts: Dr. James Craigie

June 14, 2013 by

Dr. Craigie  of the Center for Natural Breast Reconstruction was recently featured on Channel 4, representing East Cooper Medical Center. Check out his video here!


Ask the Experts: Dr. James Craigie

 

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

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Should I Have Routine Mammograms After My Breast Reconstruction?

June 7, 2013 by

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

Q:  After my breast reconstruction, I continue to have pain in my  right breast after each mammogram. Last mammogram was two months ago. The pain wasn’t really sharp, but it did hurt where they made my reconstruction incisions. Is this normal? 

A:  I’m sorry you’re having difficulties. If you have had a mastectomy and reconstruction, then usually routine screening mammograms are not necessary. I would suggest asking your cancer doctor if you would be able to avoid screening mammograms altogether. Also: check with the doctor who ordered  your mammogram, as he or she may have had a specific reason for ordering it other than routine screening. You still have to do self-exams, of course, and  be checked for changes.

James Craigie, MD

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 PAP Flap Reconstruction? Am I Suitable Candidate for It?

May 31, 2013 by

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

Q:  I just heard about a PAP flap breast reconstruction?  Is it new?  How do I know if I am a suitable candidate for it?

A: The “PAP” (profunda artery perforator) is another type of muscle sparing technique to reconstruct the breast utilizing extra skin and fat taken from the back of the thigh. Dr Allen called this the “banana roll” flap. The concept is the same as the DIEP, sGAP, SIEA and others sometimes referred to as perforator flaps. There are situations when someone has extra tissue in this area but unlike the TUG flap it does not remove any important leg muscles.  Since lymphedema has been associated with the TUG flap in some published papers, the PAP breast reconstruction procedure is performed carefully and specifically to not disrupt the delicate lymph channels and nodes that if removed or damaged might lead to an increased risk for lymphedema.

James E. Craigie, MD

Read more about the “PAP” reconstruction technique here: Breast_Reconstruction_with_the_Profunda_Artery

 

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

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