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How Long Does a DIEP Flap Procedure Take? What Is the Recovery Time?

March 22, 2013 by

This week Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answer your questions about DIEP flap surgery. 

 

Q: Approximately how long does the DIEP flap surgery take on one breast?

 

A: Thanks for your question.

A unilateral DIEP typically takes from 3-6 hours, depending on whether you already have had a mastectomy, and on how complicated the microvascular anatomy of your particular flap turns out to be.

Richard M. Kline, MD

Center for Natural Breast Reconstruction

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Q: I do not personally know anyone that has had DIEP flap surgery. What should I expect within the first two to three weeks of recovery after DIEP flap surgery?

A: The first 4 days will be in the hospital, the next three weeks you will be very mobile but no driving. After one month your drains will be out and you will feel much better. Over the next 6-8 weeks you should be getting back to normal. Let me know we will be glad to let you talk to one of our patients who is in a similar situation.

See you soon.

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!

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Replacing an Implant With a Flap: Will My Muscles Recover and Function Normally?

March 15, 2013 by

The following question is answered by  Richard Kline of The Center for Natural Breast Reconstruction.

 

Q: My reconstruction consisted of chest muscle to create a pocket for a silicone implant. I have had it since 2004. They used an expander. It was the best choice for me at the time. If the implant is removed and the muscles are fixed, will they recover and function normally? For example, will I be able to do pushups and bench presses again?

 

A:  Thank your for your question. Although the muscle is replaced against the chest wall when an implant is replaced with a flap, it is impossible to duplicate the strength of the original muscle attachment.

Having said that, most patients function quite well with an implant under the muscle, and I’m hesitant to tell you you’ll see dramatic functional improvement if you convert your implant to a flap.

I hope this helps.

 

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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Does Fat Necrosis Make It More Difficult To Detect Cancerous Tumors?

March 8, 2013 by

Will a fatty necrosis make it more difficult to detect any new formations of cancer?

 The following question is answered by  Richard Kline of The Center for Natural Breast Reconstruction.

Q: I am a  7-year Stage I breast cancer survivor.   I’ve had lumpectomy and radiation, with no chemotherapy.

Three years ago, had a bilateral breast reduction. Six months later, developed nipple retraction and a mass. General surgeon (who follows me for BC) was concerned at first and biopsied it twice. The results were negative.  Mammograms have been reported as within normal limits.  

My plastic surgeon (who did the reduction) would like to have yearly MRI’s because he said eventually, this mass will start to calcify, most likely keeping me flagged for biopsies. The general surgeon disagrees and feels it’s been biopsied twice and he would not do any more unless my mammogram changed.

My concern is that this fatty necrosis will hide any new cancer that may form. It’s pretty big area approx. 7.5cmx5cm.  My new internist is not happy with this area and wants me to see another surgeon. So my question is: will this make seeing any new cancer form harder? Is my risk for more necrosis higher if I have it removed since this was the radiated breast and that is what caused the necrosis in the first place? My original surgeon suggested a mastectomy to be 100% sure that nothing would ever get missed. I will be seeing new surgeon next week and would like to have some ideas before I go. I have no problem with another lumpectomy or even a mastectomy if needed.

 

A:  I’m sorry to hear you’re having so much trouble.

It’s outside of my area of expertise to advise you whether calcifications from fat necrosis can mask a tumor recurrence, but I just called our breast imaging radiologist and asked. She said fat necrosis definitely makes imaging “more challenging,” and you may require ultrasound and/or MRI in addition to mammography in the future, should you choose to leave the mass in place.

I CAN advise you that the risk for wound healing problems (including more fat necrosis) is certainly higher in a radiated breast, so the answer to the second part of your question is yes, you could end up with additional fat necrosis after surgery.

Even a mastectomy will not reduce your risk of another cancer to zero, as some breast cells are frequently left behind, but it will reduce your risk significantly. We would be happy to put you in touch with one of our surgical oncologists who specializes in breast disease, if you would like to get more specific information about risk reduction.

Hope this helps, and feel free to call or email with any more questions.

 

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!

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Can I Have Reconstruction Surgery Even If My Radiation Treatments Damaged My Chest Area?

March 1, 2013 by

Are there natural methods of breast reconstruction surgery?
The following question is answered by Dr. Richard Kline of  The Center for Natural Breast Reconstruction.

In 2001, I had to have my implant removed because I had to a recurrence of breast cancer. After chemo, my 36 treatments of radiation did considerable damage to my chest area. I did have a latissimus flap and it was a total failure! I look like a road map to California. I had both of my implants removed in 2007 because of infection that went into my right implant.

Sometimes I think I might be okay without breasts, but not really. I wear prosthetics, but they are uncomfortable. Is there any way to get a successful reconstructive surgery with one of the natural ways of reconstruction?

 

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. Contact us and we can talk more about your specific situation.

 

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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Dealing with Juvenile Papillomatosis: Should I Have a Risk-Reduction Mastectomy?

February 22, 2013 by

 The following question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

 

 I am getting antsy with my breast health and am concerned for my future cancer risk. I have been diagnosed with juvenile papillomatosis, and have had one benign breast lump removed.

I currently have one lymph node and 5 masses (bilateral) under watch by mammogram/ultrasound every 6 months. I am really considering a prophylactic mastectomy due to my young age (39).

What are your thoughts, and would you recommend this if I were your patient? Also, do you think insurance would cover it in my case?

 

Thank you for your question. Do you have any family members who have had breast or ovarian cancer? Even if the answer is no, some people would consider a risk reduction mastectomy and immediate reconstruction. Multiple papillomas may increase your chance for breast cancer. Frequent screening with exams, ultrasounds mammograms will not prevent cancer. The idea of screening is to find something early.

If you are undergoing high risk surveillance (it seems that you are with all those repeat exams) then you should at least have the conversation with a breast surgeon who has experience with that type of surgery.  

My expertise is in breast reconstruction and one area that we specialize in is breast reconstruction immediately at the time that someone has preventive mastectomy to reduce their chances of developing breast cancer. We work with an expert breast surgeon who performs the mastectomy but preserves the breast skin and nipple. Mastectomy for preventive reasons is very different from mastectomy when cancer has already developed. The reconstruction is different in that we can usually get the best possible result under those circumstances.

I hope I have answered your question please let me 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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Should I Have a Preventive Mastectomy?

February 15, 2013 by

Should I Have a Preventive Mastectomy?The following question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

 

I have no history of breast or ovarian cancer in my family, but my  mother and my sister do have a history of benign masses.  I’ve been told that I will need to frequently monitor any masses  I have or develop… likely for life. 

Every month, I can feel my breast tissue changing and becoming more fibrous (lumpy-bumpy), which makes me very uncomfortable.  I’ve watched a few friends with no cancer risk battle breast cancer recently, and I’m just not willing to allow myself to get to that point if possible. For peace of mind, and reduced cancer risk, I’d be much more comfortable undergoing a major surgery.  

Is this a logical solution given this circumstance, or am I overreacting?

 

Hello,

I have had numerous patients in similar situations decide to have preventive mastectomies and immediate reconstruction. It is a very personal decision to make and I do not feel you are overreacting to at least consider the option. Risk reduction mastectomy is the most effective way one can actively reduce the risk of breast cancer.

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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Best of Ask the Doctor

February 8, 2013 by

charleston breast surgeonsAt The Center for Natural Breast Reconstruction, our mission is to help women everywhere make smart, informed decisions about breast reconstruction and overall healthcare.

Over the years, our surgeons, Dr. James Craigie and Dr. Richard M. Kline, Jr., have answered a wealth of questions about breast reconstructive surgery—from the different kinds of procedures to post-op healing tips.

If you’re searching for a thorough introduction to breast reconstructive surgery, here’s a sample of the invaluable advice our surgeons gave the past year:

Your Questions about Natural Breast Reconstruction and Implants Answered

Scarring After Breast Reconstruction Surgery

Tackling the Challenges of Breast Reconstruction After Lumpectomy and Radiation

The Benefits of DIEP Flap Breast Reconstruction Over Other Reconstructive Options

Is This Normal? Your Post Op Breast Reconstruction Question Answered 

Tips for Improving Recovery and Healing Time

If you are seeking advice about breast cancer, breast reconstruction, or healthcare options, please send your questions our way! We will address all of your questions with detailed and valuable insight straight from our surgeons.

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Natural Breast Reconstruction: What Are My Options If I Have Scarring?

February 1, 2013 by

The below question is answered by Dr. Richard M. Kline of The Center for Natural Breast Reconstruction.

I lost my implants in 07 due to an infection from my lymphedema. I had both removed and didn’t have reconstruction since the prior surgery was a failure. I have scaring from radiation in 2001. I’d like to think about reconstruction again BUT afraid of failure due to the scaring. Do I have options? Really would rather not have implants, I’ve both types, didn’t like either but would accept silicon over saline.

Hello,

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. If you’d like more info, we could have our nurse Chris call you. If you wanted to send pictures, that would also be very helpful.

Thanks for your inquiry.

Richard Kline
Center for Natural Breast Reconstruction

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

 

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Can Breast Cancer Return After Breast Reconstruction Surgery?

January 25, 2013 by

The below question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

Is it possible for cancer to come back in a new reconstructed breast?

Hello,

Breast cancer can reoccur in the breast after mastectomy. This can happen with or without reconstruction.  If the reconstruction is done with your own skin and fatty tissue, then the new breast has no real breast tissue and can not develop breast cancer. If breast cancer remains after mastectomy it could possibly grow into the new breast. This is rare but not impossible.

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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DIEP Flap Reconstruction Surgery After Capsular Contracture

January 18, 2013 by

The below question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

Does anybody have any idea what the difference is “surgically” when DIEP surgery involves removing an implant that has developed a capsular contracture? That is what my situation is. I’m wondering if the skin that has been stretched over the implant will be removed, or become part of the new flap?

Thirty percent of our patients have previous implant surgery that has failed. During the reconstruction we remove the implant, implant capsule and any Alloderm that may have been used.   We also must return the chest muscle to its natural position because the implant always goes under the muscle. Unfortunately the muscle may be permanently changed from implant surgery. The stretched skin over the implant is allowed to recover and usually not removed.  If the skin initially needed to be stretched by the implant/expander then that indicates breast skin has been removed during the mastectomies. Usually skin from the DIEP will be needed depending on previous radiation and size of the DIEP breast. If the remaining breast skin is thin, tight, too scarred or damaged by radiation we may need to remove more of it at another surgical stage.

-James Craigie

Center for Natural Breast Reconstruction

Have questions for our surgeons? Submit your questions today and get answers straight from our surgical team! No matter where you are in your reconstruction process, we are here to help!

 

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