Thank you, friends and clients, for your support and love! We hope you have a wonderful Memorial Day Weekend!
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
Happy Memorial Day Weekend!
May 24, 2013 by
Ask the Doctor Special Edition: BRCA+ and Preventive Mastectomies
May 17, 2013 by
This week, The Center for Natural Breast Reconstruction was flooded with calls and inquiries regarding the BRCA+ gene and questions regarding preventive mastectomies. Angelina Jolie’s moving op-ed in the New York Times highlighted her choice to have a double mastectomy.
For those of you who are considering this procedure, or simply want to find out more about the BRCA+ gene and whether a mastectomy is right for you, we’ve rounded up the best of our Ask the Doctor posts to help you move toward an informed decision. If you have any additional questions, please feel free to contact our office.
Should I Have a Preventive Mastecomy?
Who Can Have a Skin-Sparing and Nipple-Sparing Mastectomy and Why?
Will My Insurance Company Pay for My Mastectomy to Reduce My Risk of Breast Cancer?
What is a BRCA Test and Do I Need One?
Improving Your Self Esteem After a Mastectomy
The Latest Technology in Preventative Mastectomy Procedures
One Woman’s Journey to DO Something About Her BRCA Status
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
Can I Have an Autologous Fat Transfer After a Lumpectomy?
May 10, 2013 by
This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.
Q: I am a stage IV breast cancer patient looking for autologous fat transfer to fill in my left breast after a lumpectomy in 2008. Can you please let me know how to proceed regarding consultation and such?
A: I would be glad to have our PA call you for more information or phone consultation. I would also be glad to see you in person if you want to come for an office visit to Charleston. I frequently see patients with similar requests. In my opinion, fat injections to repair lumpectomy and radiation deformities is usually not the most effective approach. There are also concerns by experts in this specialty regarding fat injections of the breast after that breast has already developed breast cancer once.
As long as the breast tissue remains then there is a risk–although very small–for the cancer to recur. That is why you still need to monitor that breast for any suspicious changes. The fat injections could make monitoring the breast more difficult and most importantly there could possibly be (not proven definitely yet ) an increase in the risk for recurrence after fat grafting. No one knows this for sure yet, but we are always careful regarding this type of safety issue. I could be more specific and talk to you about alternatives if I had more information and especially if I saw you in person. I hope this helps! Please let us know.
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Q: I have BRCA mutation. I am 25 years old. I want to have mastectomies with reconstruction but don’t really know which would be the right way to go.
A: I am sorry you are facing such a difficult decision. Fortunately, breast reconstruction after preventive mastectomies allows for more planning before surgery and usually sets the stage for the best possible breast reconstruction result. There are several reasons for this.
One reason is more of your natural tissue can be saved. It is usually possible to keep your natural nipple and all of the normal breast skin. Other problems related to possible treatments like chemo and radiation are eliminated because the mastectomies are done to remove breast tissue and prevent breast cancer.
The techniques for breast reconstruction are generally the same following preventive mastectomy and mastectomy for cancer. Implants are used most frequently because of availability and more rapid recovery from the initial surgery. The end results with implants tend to be less natural than with your own tissue and after the process is complete there is a tendency for the results to deteriorate with implants because they are not living tissue. Your body may reject the implants or they may leak or deflate. The results with using your own tissue are generally more natural and more permanent. We specialize in breast reconstruction using your own tissue but without sacrificing your body’s important muscles. To be more specific about recommendations for you I would need more information. I will be glad to have our office contact you for this information, just let me know.
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!
The Final Touch: Nipple Tattoo and What You Can Expect
May 3, 2013 by
Our discussion boards have been abuzz recently about the nipple micro pigmentation (tattoo) procedure. Kimberly Kay, PA-C of the Center for Natural Breast Reconstruction provides this comprehensive overview and answers your questions.
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The ultimate goal of the reconstructive surgeon is not only to restore the three dimensional breast mound but also to recreate the nipple areola complex. Some women choose not to undergo nipple/areola reconstruction, it’s a personal choice.
Micro pigmentation (tattoo) is used to re-create the color of the areola and nipple and is often the final step in the breast reconstruction process. A variety of colors and color combinations are used to create a dimensional or projected look. Here is a basic idea of what to expect:
1. The entire nipple/areola is shaded with the color you choose.
2. Then the original color is darkened with a slightly darker shade and a special needle is used to create the bumpy “Montgomery Gland” look of a natural breast.
3. Finally, a little darker shade is used to give the nipple a projected look.
It sounds like a pretty straightforward procedure, right? Given that the shades you can choose from are numerous, the process itself takes may require some needle changes & stroke techniques to be precise; we like for you to plan to spend at least an hour or two with us on your tattoo procedure day.
Be aware, the process is not always painless, so it’s beneficial that the procedure be done in a medical office setting if you think you may require a clinician to administer a local anesthetic prior to the procedure. The addition of the local anesthetic Lidocaine with Epinephrine has the benefit of reducing bleeding at the tattoo site thus keeping more of the pigment from leaving the tissue. And the procedure is not without risk. You should be provided with an informed consent document prior to undertaking this procedure that outlines contraindications and possible complications (i.e. – allergic reaction, contact dermatitis, etc).
Our nurses and PA’s at The Center for Natural Breast Reconstruction receive specialized training through the PMT/Permark Training School Midwest in the Art of Nipple Areola Micro pigmentation. Their instructor, Kathy Jones, is the Director of the Permark Training School and a board certified plastic surgical nurse with close to 20 years experience in the plastic surgery field. Since, 1994 she has taught micro pigmentation to hundreds of practitioners in the United States and abroad and is a popular micro pigmentation lecturer.
The tattooing procedure is billed to your insurance company as a part of the reconstruction process since it is performed in our medical facility under the direction of our surgeons. Touch up procedures may be required as some tattoos tend to fade with time, more so on scarred tissue. If you have additional questions you’d like answered about the “nipple tattoo” process….please send them in.
Be sure to check out our gallery for more photos!
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
What Form Of Reconstruction Do You Prefer? What Type of Implants Are Best?
May 3, 2013 by
This week, Dr. Richard M. Kline, Jr. and Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.
Q: What form of reconstruction do you prefer and which requires the least amount of procedures?
A: Our practice specializes in breast reconstruction using your own tissue and without sacrificing important muscles and without implants. Our preferred approach is to give women the option that works best for them! This takes into consideration each person’s situation and body type.
We prefer to transfer skin and fatty tissue from the “donor” area a person happens to have extra tissue. Each person’s body has its own form and shape therefore we prefer to make our recommendations based on where each person’s body has extra tissue to work with. Implant breast reconstruction is usually a shorter recovery because there is no donor site that has to heal. The results with implants are not as natural as using your own tissue and people with implant reconstructions generally have more procedures as time goes by because of changes due to the implants etc..
All types of breast reconstruction may involve multiple steps, usually 2 stages. Sometimes minor adjustments may follow depending on many different variables. I hope this answers your question.
James Craigie, MD
The Center for Natural Breast Reconstruction
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Q: Can implants be used for reconstruction for breast cancer patients? If yes, is there a preference among medical practitioners as to whether the implant should be saline or silicone?
A: Implants not only CAN be used, they ARE used the great majority of the time (as opposed to reconstruction with the patient’s own tissue). Natural breast reconstruction with the patient’s own tissue is a longer, more involved procedure than implant reconstruction, with more serious risks, and is not the best choice for everyone.
Patients who have been radiated as part of their breast cancer treatment tolerate implants poorly as a rule, and for them, natural breast reconstruction may be their only hope for restoring symmetry. On the other hand, many patients who could be reconstructed with implants simply prefer to use their own tissue. Breasts reconstructed with your own tissue are warmer, softer, move more naturally, and are generally much closer to the “real thing” than implants. We have made a conscious decision to limit our practice to this type of reconstruction so that we can optimally serve the women who want or need it. However, implants seem to work quite well for the majority of breast cancer patients.
Richard M. Kline, Jr., MD
The Center for Natural Breast Reconstruction
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
Is It Normal to Experience Pain Years After a TRAM Flap Surgery?
April 26, 2013 by
This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your questions.
Q: I had tram flap surgery 6 years ago for one breast in Atlanta at Emory with a good plastic surgeon. I am experiencing horrible pain under my breast and around my upper rib cage where it has been mostly numb for all these years. It feels like 1000 bees are stinging me all the time. It also feels like something has pulled loose. There’s a bruised feeling as well. I wonder if the nerves are just now growing back which is causing the pain? My breast is very heavy. Is it possible to “re-do” this breast to relieve the constant pain? Or is this “normal” after six years? I am miserable.
A: I’m sorry you’re having so much trouble.
It is certainly possible that something could have “pulled loose,” although, as you might suspect, it would be a little unusual after all this time. Also, while there is no theoretical time limit on how long sensory nerves can take to grow back, it would also be unusual to have that process stretch out this long.
Probably the best idea is to go back and see your original plastic surgeon. She or he may wish to obtain a CT scan, MRI, or some other type of imaging study, depending on your physical findings. If nothing unusual is detected, she may possibly send you to a pain therapist for treatment.
Richard M. Kline, Jr., MD
The Center for Natural Breast Reconstruction
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
I’m Having a Strange Skin Sensation Post-LD Flap Reconstruction. Will This Pass?
April 19, 2013 by
This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your miscellaneous questions.
Is it possible to have a nipple transfer (from someone who has not had breast cancer)? If so will they ‘work’?
Theoretically possible if that someone is your identical twin, but probably not practical even then, as it is easier and generally more successful to reconstruct a nipple from ordinary skin.
I am 4 weeks post-mastectomy and LD Flap reconstruction. I have the sensation that my skin is stuck to my ribs on my back. Will this pass?
In all probablility, yes. Symptoms of tightness and discomfort can persist for months, and occasionally seromas (fluid collections) can persist for over a year, but most people eventually recover completely.
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
DIEP Flap: Post-Procedure Questions
April 12, 2013 by
This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your questions.
Q: After having a DIEP flap breast reconstruction, is it okay to sleep on my side instead of my back?
A: Eventually. We generally like people to sleep on their back for at least two months to avoid any chance of crushing the flap. After that, we transition to side sleeping if all is going well.
Q: Right after having a DIEP flap breast reconstruction, is there a risk of having circulation problems? What should I be watching for?
A: I’m assuming you mean circulation problems in the new flap. Yes, there is a risk, and that is the primary reason we keep you in the hospital for at least 4 days for careful observation. If a problem with circulation does develop after surgery, the success rate of fixing it is usually pretty good if the problem is caught early. The risk of having a problem decreases as time elapsed since surgery increases. In almost 100 flaps, we have had 2 flaps develop problems 3 days after surgery, 1 flap developed problems 4 days after surgery, and one developed problems 5 days after surgery. We have had a few problems with bleeding or wound healing later than that, but no problems which put a flap in jeopardy. Nonetheless, it could happen.
Q: I had a DIEP flap breast reconstruction two weeks ago. What is the possibility of the flap failing? What should I be watching for?
A: Our overall flap failure rate is about 1.6%. Once you get beyond a certain point, however, the chance of the flap failing gets much less than that. (see above answer)
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
Can a Mammogram Hurt My TRAM Flap?
April 5, 2013 by
This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your questions.
Q: I have an 18-year TRAM (Transverse Rectus Abdominis Myocutaneous) flap. Recently I have found a perpendicular ridge about an inch from my sternum. It feels like a lump. I have had an ultrasound and now they want to do an MRI and an mammogram. They found nothing on the ultrasound. My concern is the mammogram. Could this cut off blood supply to my TRAM flap? I would like to ask my original doctor but he is strictly doing plastics. Thank you for your help!
A: While it’s not impossible, a mammogram is highly unlikely to hurt your TRAM flap, especially after this length of time. Certainly it is important to find out what the lump is, anyway.
Good luck, let us know if we can be of any help.
Richard M. Kline, Jr., MD
Center for Natural Breast Reconstruction
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
I’m Having Trouble Healing After My DIEP Flap Surgery. Is This Normal?
March 29, 2013 by
This week, we continue with Dr. James Craigie of The Center for Natural Breast Reconstruction answering your questions about DIEP flap surgery.
Q: I had the DIEP flap surgery for both breasts in February this year. The incision in my stomach area has split and I am being told that this happens to 50% of patients. Is this true? I am told to use wet to dry dressing twice a day. I just don’t know if this is accurate because at the same time I’m told to exercise more? Can you please advise? Thank you for your time.
A: I am sorry you are having problems healing. It is not uncommon after a DIEP procedure to have some healing problems. These range from minor (usually little treatment needed) to more involved (may require a longer time to heal, special wound care or surgery). Because the tummy is pulled together, sometimes tight, an opening in the incision is pulled open even more by tension.
One of the benefits of the DIEP is that your muscles are spared and no artificial mesh over your tummy wall is needed. Therefore infection is usually not a serious problem. Healing may take a while. Take special care but it should not permanently affect the end result. I hope this answers your question and you have a speedy recovery.
James E Craigie, MD
Center for Natural Breast Reconstruction
Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!
