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Breast Reconstruction After Lumpectomy and Radiation

November 2, 2012 by

The below questions are answered by Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

Can I have a breast reconstruction two years after the lumpectomy and radiation?

Absolutely! While reconstruction with implants after radiation (even if lumpectomy and not a whole mastectomy were performed) can often be problematic (if not impossible), the chance of getting a successful reconstruction using your own tissue is very high. In the simplest scenario, it is usually possible to use tissue from the abdomen or buttocks to simply “replace” the breast tissue lost from lumpectomy and radiation.

Alternatively, sometimes a better result can be obtained if the lumpectomy is converted to a mastectomy prior to reconstruction. Finally, if the survivor is in a high-risk group for developing another breast cancer, she may wish to consider whether bilateral mastectomy is advisable prior to reconstruction. Usually reconstructing a lumpectomy defect will require only one side of the abdomen, so if the other side is not needed for reconstruction, it will be removed for symmetry and discarded.

What tips do you share with your patients for them to achieve the very best results from breast reconstruction?

1. Have a positive attitude! Patients who are excited about their reconstruction frequently do very well and tolerate any “bumps in the road” much better.

2. Education. Try to become very familiar with your desired type of reconstruction, both through reading and discussing it with patients who have been through it already. Knowing what to expect allays fears and makes everything easier.

3. If time permits, maximize your body’s fitness through diet and exercise, to the extent that you are comfortable doing so.

—Richard M. Kline Jr., M.D.

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Lymphedema After A Mastectomy: Will Breast Reconstruction Surgery Affect This?

October 26, 2012 by

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

Lymphedema after mastectomy. What will reconstruction surgery do to my lymphedema if anything? 

The lymphedema is a difficult problem and it is directly related to having a mastectomy as well as removal of the lymph nodes under the arm.  It happens more frequently when these procedures are followed by radiation.  It is a combined effect and we do not understand why some people have it and some people don’t.  We feel that there is something with regard to someone’s anatomy that makes one person more prone to lymphedema.  There have been people who get lymphedema of the arm even after a sentinel node procedure although it is rare.  Therefore, it is important to know if reconstruction surgery of the breast can impact lymphedema.  There have been some studies to show that actually a healthy reconstruction of the breast may improve someone’s lymphedema.  It is unlikely to cure it but there have been situations when the reconstruction has helped if not minimize it.  Other things to expect while undergoing reconstruction or any surgery of the entire body may have become more swollen and therefore people who have lymphedema may see an increase in the size of the arm following breast reconstruction surgery or any other surgery for that matter.  Therefore, leading up to surgery we made sure that they have been compliant in performing their compression daily routines as well as massage helps and frequent follow-ups with their lymphedema therapist may be beneficial as well.  After surgery we have our patient seen by the lymphedema therapist to have their arm appropriately treated with massage and customized compression.

-Dr. James Craigie

The Center for Natural Breast Reconstruction.

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

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Can I Use Vitamin E on Incisions Resulting from Breast Reconstruction Surgery?

October 19, 2012 by

vitamin e on incisionsThe below question is answered by Charleston breast surgeon, Dr. James Craigie, of The Center for Natural Breast Reconstruction.

Is Vitamin E of any use on incisions? 

Scarguard or silicone sheeting may be a better alternative.  There are several things, scientific improvements, which helps the appearance of scars. Silicone is probably the most effective.  Silicone works by an unknown mechanism to help soften raised or severe scars regardless of how old they are.  The other technique proven to work is massage.  Topical massage can help the scars whether they are new or old and combined with silicone is probably the most useful combination treatment for difficult scars.  Scarguard is a product that contains silicone, comes in a liquid form is painted on like fingernail polish, and because of the silicone component it is effective for some scars.  Regarding Vitamin E, there have been some studies to hint that it may help with scar formation and some people find a benefit in taking vitamin E orally from a capsule or rubbing it into a scar.  However, it may be that massage is more effective than the Vitamin E.  In summary, the best answer is that all of these techniques can help.  They must be used at the appropriate time so it is always best to ask your surgeon for guidance as to when the best time to begin scar therapy would is.  Also, it is important to know that no technique will make scars disappear completely.  The goal with these treatments is either to minimize the severity of the scar or to improve its appearance.

-James E. Craigie, M.D.

Have questions about breast reconstruction options? Submit them here and get answers straight from our surgical team!

 

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Dr. James Craigie Answers Your Questions About Natural Breast Reconstruction

October 12, 2012 by

The below questions are answered by Dr. James Craigie of The Center for Natural Breast Reconstruction.

Do you perform a stacked combination DIEP/SGAP using both to make a breast(s)?

We do on occasion. It may be needed when one area of the body does not have enough tissue to achieve the desired result. This is an unusual situation in our practice we can usually achieve our goals with one area of the body.

There is a lot of discussion about a maximum BMI what about a minimum?

BMI is a guide line that helps the surgeon determine who is at a higher risk for complications. It is not a strict guideline and the final decision is left to the surgeons judgment among other things. Safety is our first priority and studies have definitely linked high BMI to an increased rate of complications without a doubt. Unfortunately  BMI is not a perfect calculation and different doctors may use the information differently. A low BMI is not linked to complications if someone is otherwise fit for surgery. Someone with very little body fat will have a low BMI and possibly not enough tissue to make a very large breast. This does not mean they cannot have a good result. It  may mean they require and combined or stacked flap approach. We have seen many patients who have been told they “don’t have enough tissue” but after consultation can reassure them they can get a very proportional result.

Dr. James Craigie

The Center for Natural Breast Reconstruction

Do you have a question about breast implants or natural breast reconstruction? Submit them here for an answer straight for our surgical team!

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Out of State Patients Considering Breast Reconstruction in Charleston

October 5, 2012 by

Out of Sate PatientsThe below question is answered by breast surgeon, Dr. Richard M. Kline Jr., M.D.  of The Center for Natural Breast Reconstruction.

Is it reasonable to consider DIEP surgery in Charleston, S.C. when I live in Savannah, Georgia? How long after DIEP surgery before I can travel home to Savannah, GA.? Furthermore, during post- op course how often would I have to travel back to Charleston?

Hello,

We’ve had patients come from as far as California and Washington state, so I think it’s very reasonable to consider coming from Savannah. We need to see you the day before surgery, the hospital stay is typically 4 days, and ideally you’d stay in town 2-3 more days. If you have a local plastic surgeon who is supportive of you traveling for surgery and can help with some of the aftercare, that would be very useful. I’d be happy to discuss things with you in more detail by phone, or our nurse Chris or PA Kim can talk to you, if you wish.

Have a great day!

Richard Kline

Center for Natural Breast Reconstruction

American Cancer Society Hope Lodge Carol Grotnes Belk Campus—Charleston

We have had several of our out of town patients recover at the ACS Hope Lodge downtown.

What does the Hope Lodge facility offer guests?

Image Above Taken From: www.cancer.org

  • Guest rooms with private baths
  • Telephones and televisions with cable and DVD players in each room
  • Large kitchens furnished with appliances, dishes, utensils and individual shelf space for each suite
  • Guest computers with Internet access for laptops
  • Free transportation to guests provided through the hospitals
  • Common areas with games, books and magazines
  • Educational materials for guests in a Cancer Resource Center
  • Encouragement from staff, volunteers and other guests
  • A healing garden with a patio and large screened in porch
  • A handicap elevator from the parking lot, as well as an elevator inside the Hope Lodge

For more information on the Charleston ACS Hope Lodge and to see if you qualify as a guest visit their website today!

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

 

 

 

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Capsular Contracture From Breast Implants

September 28, 2012 by

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

I have had two failed breast reconstructions using an implant. First was placed too high up, and the second one anchored down with abdominal advancement flap. After 5 months the implant began to disappear. MRI proved it was not ruptured. Doctors were not worried  and I was told to stop worrying about it, so I continued on with my life. I then developed chest pain, muscle/ligament/joint/back pain and breathlessness when climbing hills or stairs. Eventually after 2 and a half years, I referred back to PS who told me I had a chest wall concavity due to the implant being forced inwardly under pressure from the scar tissue and muscle. The implant size was 770cc. Will this concavity “spring” back into place or will I have it for the rest of my life? Also what effects might this have on my body if my frame is being pushed out of alignment?

Hello,

Thanks for your question. I’m sorry you have had these problems. We see people whose chest wall and ribs become indented due to implants quite frequently. The problem develops because body reacts to the implant by making scar. We call this capsular contracture and in some people it can exert tremendous force due to constant pressure. The process will persist as long as you have an implant. We have not performed scientific studies to prove the ribs return to normal but we have treated hundreds of patients with this type of problem by removing the implants and replacing them with their own tissue with out taking their muscles. This has solved their problems related to implants permanently. I hope this answers your question, let me know

James Craigie, MD
Center for Natural Breast Reconstruction

Get answers to your questions about breast reconstruction straight from our surgical team! Submit your questions here today.

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Complications From Vascularized Lymph Node Transfer

September 21, 2012 by

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

I am recovering from a DIEP flap reconstruction and lymph node transfer. I had breast cancer when I was very young and have had lymphedema for 25 years. I was so happy to hear that there was a surgery that possibly could correct the swelling in my arm that I jumped on it with out really researching. I am two weeks into my recovery and I have noticed swelling in my leg and groin. The groin I think is normal for a surgery site. However, the swelling in my leg Im afraid is the onset of lymphedema. I would appreciate any information you could share with me on this .

Hello,

Sorry you are having problems.

As your surgeon probably explained to you prior to surgery, vascularized lymph node transfer is experimental surgery, and no one really knows how often it works, if at all, and what the complication rates are.

As your surgeon also probably explained, lower extremity lymphedema is a potential risk of the node harvest. We strictly limit our node dissection to the area lateral to the superficial inferior epigastric vein and superior to the inguinal ligament, and have thus far had no problems with lower extremity lymphedema developing after the procedure. You may wish to consult with your surgeon about having bioimpedance analysis of your affected lower extremity performed to determine whether early lymphedema is actually present. If it is, then prompt institution of treatment may be advisable.

Richard Kline

Center for Natural Breast Reconstruction

Get answers to your questions about breast reconstruction straight from our surgical team! Submit your questions here today.

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Ask The Doctor: Guest, Dr. Lisa Baron Answers Your Question on Breast Health

September 14, 2012 by

Today we are pleased to present Dr Lisa Baron, of The Charleston Breast Center as a guest author on this editon of, Ask The Doctor.  See below as Dr. Baron answers a question submitted to our site.

I really need advice.  I recently relocated to Charleston, SC & just saw a new oncologist.  When I lived in CT, my breast surgeon would do an annual digital mammogram & breast ultrasound since I have dense breasts.  I’m pretty sure that my former surgeon had said that there are new guidelines that state that if breasts are dense, a breast ultrasound should be done also.  My new oncologist in SC is only planning on doing an annual digital mammogram. Has anyone heard of these new guidelines stating that a breast ultrasound should be done in addition to a mammogram if breasts are dense?  I also have very cystic breasts with a density of 50-75%.

I think the confusion regarding additional testing with mammography for dense breast tissue centers around the fact that South Carolina and Connecticut handle breast cancer screening differently.  Recently the state of Connecticut enacted laws requiring insurance companies to provide screening ultrasound and/or MRI for those women who have dense breast tissue.  In Connecticut these additional screening tests are to be included in the patient’s screening test benefits and not subjected to any co-pays or out of pocket payments.  In addition, in Connecticut the patient is required to be informed of her breast tissue density and the additional screening tests  available to her (ultrasound, MRI).  However,  the state of South Carolina does not mandate the insurance companies to follow these protocols (or the patient to be informed about her breast density), therefore, you will likely be responsible for any co-pays and deductibles.  You should check with you current insurance carrier to determine how these additional tests will be covered.

 Hope this helps,

 Lisa

Have questions about breast reconstruction options? Submit them here and get answers straight from our surgical team!

 

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Can I Expect Tissue Problems After Radiation Therapy?

September 7, 2012 by

Tissue ProblemsThe below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

What type of tissue problems should I expect after having radiation therapy post mastectomy and chemo? I have implants now, but will be having them removed and have a DIEP procedure. Thank you.

Hello,

If your implants will be removed then you should not expect problems with capsular contracture following radiation. Mainly these problems are related to your body’s rejection of the implant . The radiation will permanently affect the skin and others parts of your body that are treated with radiation. However when you recover from the radiation short term affects (usually 3-6months) you should be able to safely have a DIEP. Using your own tissue will give you the most natural permanent result without a high risk for problems due to radiation. When we know someone will need radiation following mastectomy this is our preferred method.

I hope this helps let me know if you have additional questions.

James Craigie, MD

Center For Natural Breast Reconstruction

Get answers to your questions about breast reconstruction straight from our surgical team! Submit your questions here today.

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Your Questions About Breast Reconstruction Answered

August 31, 2012 by


The below questions are answered by the surgical team at The Center for Natural Breast Reconstruction:

Q: A double mastectomy left me with butcher marks on my chest. The plastic surgeon who was part of the team that performed the mastectomy now proposed to do implants. The existing (very bad) scars will not be in the breast fold but will “cut” the bottom half of the new breasts in two. Could one get rid of these scars when doing a DIEP procedure?

A: We can’t actually “get rid” of scars, but often they can be improved, &/or moved to a less objectionable position. If you wish to send pictures, I could possible give you little more specific information.

Have a great day!

Richard Kline

Center for Natural Breast Reconstruction

Q: I’m having the tram flap done, can you tell me how long after the surgery that it doesn’t work?

A: Hi

It would depend on what type of TRAM procedure you have. If you have microsurgery the first three days are the most important and usually after that the blood supply to the new breast is ok. If no microsurgery is involved it may take longer to know for sure.

James Craigie, MD

Center for Natural Breast Reconstruction

Have questions about breast reconstruction? Submit them here and get answers straight from our surgical team. We’d love to hear from you!


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