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Post Operative Care Tips From Our Team

August 24, 2012 by

Healing TimeOur team is constantly being approached with questions on the healing process and post operative care after breast reconstruction surgery. We strive to provide our patients with the information to ensure they achieve the most optimal surgical experience. For Today’s Ask The Doctor post, we are sharing with you some steps and tips we have to help our patients improve their post surgery recovery and healing time !

After Surgery

Family members will receive periodic updates during your surgery.

Following the procedure, you will be moved to a special unit in the hospital where you will be connected to monitoring equipment. There, nurses trained in post operative care of breast reconstruction will monitor you at all times.  Family members can see you during visiting hours.

You will also receive an informative sheet that discusses your specific information and post-operative care.  This likely will include information concerning drain care; it is very important to monitor flow from the drains in a 24-hour period. This guides us on when to remove them.  You will also have a kind of thermometer on your chest, which monitors the flap.  Other specifics and information will be provided in your post-operative packets.

As You Heal

Family and Friends:
Support from loved ones is very helpful. But understand that comments they may make during your recovery can cause you concern. Remember this: We will tell you honestly how you are doing and what we expect your result will be.  Please trust in our knowledge and experience when we discuss your progress with you.

Healing:
You will heal! How quickly depends on factors your genetic background, your overall health and your lifestyle (exercise, smoking, drinking, etc.). Many people believe the surgeon “heals” the patient.  No person can make another heal. Dr Craigie and Dr Kline can facilitate, but not accelerate, the healing process.  But you play the starring role, so your cooperation is key.

Swelling:
You may find swelling of your new breast and abdomen (DIEP) or buttock (GAP) to be troublesome and your clothes may not fit.  Be patient, this swelling will gradually subside and you will feel better in a few weeks.  There will be a certain amount of tightness in the area where the flap was taken from.  This will slowly relax in a few months.

Following Instructions:
Another way to improve healing is by following the instructions given by Dr. Craigie and Dr. Kline’s staff.  We believe “the difference is in the details” and strive to achieve the best possible results for you.  It is imperative that you act as a partner in this process — not a passive participant.  The instructions are designed to give you the best opportunity for healing without delay or surprise.

Click here for a complete list of post surgery healing and recovery tips and instructions.

Have questions about post operative breast reconstruction? Or questions in general? Join us on August 28th for our Post Op Pearls Webinar.

 

 

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Is This Normal? Your Post Op Breast Reconstruction Question Answered

August 17, 2012 by

Post Op Breast ReconstructionThe below question comes all the way from Australia, and is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction!

6 weeks after surgery I had a leak a long my stitches all bright yellow came out when that stopped a week after my scar further round swelled and it started leaking from there. Thats stopping now, is this normal? Will it keep happening, and I think my breast seems to be going smaller?

Hello,

It depends on the type of surgery you had. Drainage from incisions 6 weeks from surgery could be related to  incision healing. If the incision healed without problems and then the drainage occurred it could be a reaction to stitches or from a collection of fluid underneath that is working its way out. Your description might suggest liquefied fat is working its way out. If it is coming from the breast it may stop on its own or could require a procedure to remove all of it. Make you sure you check with your surgeon to make sure there is no infection. I hope this helps answer your question.

James Craigie, MD

Center For Natural Breast Reconstruction

Would you like your breast reconstruction question answered?  Register for our no-cost webinar on August 28th where there will be a live Q and A session!!

 

 

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Can Natural Breast Reconstruction Correct Pain, Cosmetic and Functional Issues Caused by Implants?

August 10, 2012 by

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

I am 44 yrs old. I had a lumpectomy/chemo/radiation for my left breast in 2003 and I  had a mastectomy on my right breast 2009. I went ahead and did a prophylactic left mastectomy as part of my reconstruction process. I had a Latissimus dorsi muscle flap on my left breast and started the process in September of 2009. Apparently, some nerve that was to be severed was not and I now have constant spasm/pain that I of course, still need to camouflage in my clothing choices. The implant is not under the flap, its just below my collar bone. Now, is it possible to reverse this type of surgery as the symptoms are painful/disabling? Can this type of surgery be revised? Is there any other option for me for function/pain/cosmetic-symmetry?

Thanks

Hello,

Sorry to hear about your problems. I obviously can’t say for sure what you need based on this limited history, but here are a few thoughts.

If you are referring to the thoracodorsal nerve that “runs” the latissimus, that can certainly be divided with additional surgery. However, I can’t say for sure that that is the source of your pain. If your implant is very high, and especially if it is hard, you may have capsular contracture, which can be very uncomfortable, especially in a radiated area. It is also possible that the spasms are in your pectoralis major muscle, which is (or should be) in front of the implant.

If you have adequate donor tissue in your abdomen or buttocks, it may well be possible to “discard” your entire L reconstructed breast, and replace it with a breast made entirely of your own tissue. We have done this many times in similar scenarios, and most patients seem to be significantly happier afterwards. However, I must stress that operating for symptoms of discomfort is not guaranteed to work, and involves other risks.

If you’d like to send photos of potential donor areas, or have our nurse or PA call you for more info, we’ll be happy try and give you more specific advice.

Richard Kline

Center for Natural Breast Reconstruction

Best of luck to you, and please feel free to ask any more questions you may have.

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What are the Symptoms of Capsular Contracture from an Implant?

August 3, 2012 by

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

What are the symptoms of capsular contracture from an implant?

Capsular contracture is commonly described using the four-grade Baker Scale.

  • Grade I — the breast is normally soft and appears natural in size and shape
  • Grade II — the breast is a little firm, but appears normal.
  • Grade III — the breast is firm and appears abnormal
  • Grade IV — the breast is hard, painful to the touch, and appears abnormal

The symptoms can be varying from mild to severe.  Mild capsular contracture may only be detectable by your surgeon.  If the process worsens and becomes severe it may lead to changes in the breast that a person easily could tell themselves.  In other words, the shape may change, the breast may become different in shape, and clothes may begin to fit differently.  The breast may become hard and the skin and tissue over the implant can change in appearance and color.  The most severe problem related to capsular contracture would be pain and discomfort that may eventually limit the range of motion and movement of the shoulder and upper body.  Some patients relate symptoms that they describe as an “iron bra” across the chest when the scar is so thick and tight.  The chest feels like it is wrapped in something as wrapped in an “iron bra” all the way around.  Sometimes the process can worsen and actually press in, move the muscles away from the breast area, and change the shape of the ribs.  This would be the most severe form of capsular contracture and at that point we would recommend removing the implant and replacing the reconstruction with a muscle-sparing procedure.

Did you find this post helpful? We’d love to hear from you in our comments section.

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What are the Next Steps if Capsular Contracture Occurs from a Breast Implant?

July 27, 2012 by

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

What are the next steps if capsular contracture occurs from a breast implant?

The next step would depend on how severe the capsular contracture is.  All implants will develop a capsule and this may slowly lead to changes in the shape or in the most severe cases painful scarring and hardness.  When symptoms develop it may be necessary to surgically intervene.  The next step would depend on whether the patient has had radiation and the available options for reconstruction.  The first step and the least involved regarding surgery would be capsulotomy or release of the scar. Sometimes the healing process, whether there was an infection or a bruise around the breast, could have increased the risk for capsular contracture. Other times it may simply be the body’s reaction to an implant.  If after capsulotomy or capsulectomy the contracture has not resolved, the next step would be to consider moving additional healthy tissue to cover the implant or to remove the implant and replace it with your own tissue.  30% of our patients who choose to undergo autologeous reconstruction have had prior implant reconstruction and their bodies have developed severe capsular contracture.  If someone has had radiation, the capsular contracture will be more severe and most likely once problems develop the problems will continue.  Therefore, when multiple capsular contracture procedures have been necessary; our recommendation would be to consider removing the implant and replacing it with your own tissue using a muscle-sparing procedure.  Your own tissue would not develop capsular contracture and it is the most successful way to solve problems resulting from implant reconstruction.

Would you like your breast reconstruction question answered? Just ask us!

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Increase Breast Size Through DIEP Flap Natural Breast Reconstruction Surgery?

July 20, 2012 by

The below question was answered by Charleston breast surgeon, Dr. James E. Craigie  of The Center for Natural Breast Reconstruction:

Can I increase the previous size of my breast during a DIEP breast reconstruction?

Breast reconstruction requires detailed planning before surgery.  One of the most important considerations is the desire of the patient to either be the same as she was before mastectomy or to change some aspect of the breast.  When there is adequate donor tissue (in the case of a DIEP excess tummy tissue) we may have the opportunity to increase the patient’s bra cup size given adequate planning and adequate donor tissue.  The desire of the outcome is always to be proportional and if someone has more tissue on the tummy we can usually achieve this.  In ideal circumstances, we plan to make the reconstructed breast approximately 20% larger at the first stage than the end goal after the reconstruction process is complete.   During the first stage of surgery, the tissue from the tummy is transferred and the primary goal is to have adequate blood supply and healthy nourished tissue.  The shaping of the breast is secondary to the functioning of the blood vessels during this stage. At the second stage of surgery, in order to create a more natural shape, some tissue may need to be removed or any tissue that did not survive the initial transfer (fat necrosis) removed.

Therefore, when planning the first stage procedure, we try to end up with slightly more than desired.  That gives us the ability to shape the breast and we can always make it slightly smaller at the second procedure; which is a much easier adjustment than making it larger.  So, it is possible to increase the current breast size with the DIEP, but it would depend on the size of the breast prior to the mastectomy and  how much donor tissue is available for reconstruction.

Are you thinking of having reconstructive surgery and have questions or just want more information? Then click here to ask our team, we’d love to hear from you!

 

 

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The Advantages of ICAP Flap Breast Reconstruction and When to Use This Procedure

July 13, 2012 by

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

When would we use the ICAP flap for breast reconstruction and what are the advantages of this procedure?

The TCAP flap is a procedure for reconstructing the breast or partial breast reconstruction and is another of the muscle-sparing flaps. The ICAP does not require microsurgery or reattachment of the blood vessels, but usually the amount of tissue available is small.  In our experience it is most frequently used to perform partial breast reconstruction of mainly the outer side of the breast or to add volume to a previously reconstructed breast or when the resulting size is not as quite as large as desired from the original planned procedure.  An advantage of the ICAP flap is that it removes tissue from the side of the body that is usually in excess and sometimes bothersome following a mastectomy.  It is just above the bra line and the scar, and although it extends to the back, can almost always be covered in a bathing suit or a support type bra.  Again, the ICAP’s best use is in adding additional tissue to an already reconstructed breast or providing small amounts of tissue for partial breast reconstruction.  It typically does not involve microsurgery to reconnect the blood vessels and the blood vessel that nourishes the tissue is conveniently located on the side of the body near the breast just above the bra line.

For more answers to your breast reconstruction questions, visit our Ask the Doctor section of this blog or submit your questions here.

 

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TDAP Flap Breast Reconstruction Surgery: When and Why to Choose This Option

July 6, 2012 by

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

When would we use the TDAP flap for breast reconstruction and what are the advantages of this procedure?

The TDAP flap or thoracodorsal artery perforator flap is a procedure for reconstructing the breast or partial breast reconstruction and is another of the muscle-sparing flaps.  The procedure allows for the fatty tissue from the side and back to be mobilized and then transferred to the breast without disconnecting its blood supply and performing re‑anastomosis of the small blood vessels.  The tissue that is used is in the area above the latissimus dorsi muscle, which is the largest muscle in the body; however, the procedure does not involve transferring the muscle or destroying the muscle.  The advantages of this procedure are that the tissue can be used for breast reconstruction without performing the microsurgery and without damaging or removing the muscle.  The disadvantages of the procedure are that there is a limited amount of tissue available to use for breast reconstruction and because the blood vessel remains attached and is not divided, there is a limit to the shaping and positioning of the new tissue.  It is most frequently used for reconstruction of a part of a breast, mainly the outside, but in some circumstances can be used for reconstructing the entire breast.  However, this is usually a smaller reconstruction and the amount of skin available is typically limited as well.  The TDAP can be used for transferring fat to the breast at the time of mastectomy or can be used later after mastectomy and the body has healed.

Procedures: Transforming Healthy, Living Tissue
Microsurgery has come a long way since its invention by vascular surgeons in the 1960s. The term refers to any surgery involving a surgical microscope. And it has found one of its best applications in breast reconstruction. Through microsurgery, our skilled surgeons are able to harvest healthy tissue from one part of a womans body and reattach it to the breast area. Through the careful process of attaching blood vessels, microsurgery allows patients to have natural looking breasts made from their own, living tissue. Another benefit is the minimized impact and injury to muscles, allowing patients to enjoy a faster, fuller recovery.

Did you find this post helpful? We’d love to hear from you in our comments section.

 

 

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Am I A Candidate for Natural Breast Reconstruction?

June 29, 2012 by

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

I was diagnosed with breast cancer in 1999 at age 24 (infaltrating ductal, triple negative). I had a lumpectomy with a lymph node dissection, chemotherapy and radiation. I found out I was positive for the BRCA1 mutation in 2008 and had a myomectomy (c section cut) and subsequent full hysterectomy (via davinci) in 2010, since pathology found the mass to be Endometrial Stromal Sarcoma.

I am now considering a mastectomy to decrease my chances of reoccurrence. Would you recommend a prophylactic mastectomy? If so, what type of reconstruction can I have? I prefer natural reconstruction rather than implants, but do not know if I am eligible since I’ve had two abdominal surgeries and do not have a lot of extra tissue anywhere else.

Hi and Thank you for your question. I’m sorry you have been faced with these difficult decisions. Removing as much breast tissue as possible is the most effective thing you can do to reduce your chances of getting breast cancer. I  refer to this type of mastectomy as “risk reduction” because it does not make the chances 0 but is as close as one can get. Your previous tummy surgeries have probably not affected your ability to have natural breast reconstruction, as we have had many people who have had the same types of surgery before using the extra tummy. Even the people who have had surgeries that compromise the tummy we can almost always come up with an option for natural breast reconstruction. Many of our patients have been told they do not have enough extra to use but when we see them we can usually give them a very nice result without implants. I hope this answers your question.

Sincerely,

James Craigie, MD

Center for Natural Breast Reconstruction

 

Would you like your breast reconstruction question answered? Just ask us!

 

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What Changes Can I Expect After an SGAP Procedure?

June 22, 2012 by

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

What changes will I notice, if any, from an SGAP procedure after the first stage?

That is an extremely variable thing, some patients scarcely notice a difference in their buttocks after harvest of an SGAP from one side, while other patients noticed a significant difference.  In almost all situations, the buttock shape will not be optimized however after the first stage, whether it is a unilateral or bilateral SGAP.  The second stage of the SGAP, which can occur as early as three months after the first stage, typically involves a fairly extensive revision of the GAP flap donor site.  Our present feeling is that the GAP flap scar is ideally placed as high as possible, so that it may fit within most bathing suits, but still fit comfortably under shorts.

Learn More About Our Surgical Team

The Center for Natural Breast Reconstruction was created by two surgeons, Dr. James Craigie and Dr. Richard Kline. Through their work at East Cooper Plastic Surgery, they saw patients benefit from breakthroughs in microsurgery and breast reconstruction. Their combined skills helped women achieve the very best results possible.

The result: a center devoted completely to helping women gain the breast shape and fullness they seek, without the loss of muscle or use of artificial implants.

Dr. Richard M. Kline Jr., MD

Home: James Island

Education: M.D., Medical University of South Carolina; B.S., Furman University

Residencies: The Cleveland Clinic, Louisiana State University Medical Center

Specialties: Perforator flap breast reconstruction

Certification: American Board of Plastic Surgery

Personal: Married with two children

Dr. Kline trained in microsurgery with Dr. Robert Allen, who was pioneering the DIEP, SIEA, and GAP flaps at LSU while Dr. Kline was a plastic surgery resident. “We knew that he (Dr. Allen) was on to something very exciting,” remembers Dr. Kline, “but I doubt anyone back then foresaw just how sought-after those procedures would become.”

After completing his training, Dr. Kline spent several years in full-time academic surgical practice, first at LSU in New Orleans, then at the Medical University of South Carolina, during which time he performed the first successful DIEP flap in the southeastern United States. He entered private practice in 2000, and the practice rapidly became a regional referral center for complex microsurgical reconstruction. The practice has since evolved to focus almost exclusively on microsurgical breast reconstruction. “Our passion” says Dr. Kline “is restoring women’s body image after mastectomy using only their own natural tissue. We and our entire staff feel very privileged to be able to use our skills to help so many people in this way.”

A Charleston native, Dr. Kline lives near his childhood home and his parents. His wife, Elizabeth, is a thoracic surgeon, and the two met in the operating room. They have two children, daughter Bellamy and son Mahlon.

Dr. James E. Criagie

Home: James Island

Education: M.D. Medical University of South Carolina: B.S. Erskine College

Residencies: Medical University of South Carolina; Fellowship. Louisiana State University Medical Center

Specialties: Muscle sparing Breast reconstruction with the patient’s own fatty tissue

Certifications: American Board of Plastic Surgery

Personal: Married with two children

Some of Dr. James Craigie’s earliest memories are of afternoons spent at hospitals with his father, a general surgeon. “I liked to go with him on call and see the things that he did,” Dr. Craigie says. Today, Dr. Craigie is an accomplished surgeon himself, conducting 70-100 breast reconstruction surgeries each year, along with all types of body contouring and cosmetic breast surgery that is part of the process of breast reconstruction. “As plastic surgeon’s we use techniques that are often cosmetic in nature but included as part of the reconstructive process. My main goal is to help people,” he says.

His constant aim is to bring state-of-the-art techniques and the best possible results. Before joining our practice, Dr. Craigie opened a general plastic surgery practice in North Carolina and completed advanced training in micro-vascular breast reconstruction in New Orleans. He is one of a limited number of doctors who perform the specialized surgery, considered the “gold standard” in breast reconstruction techniques. “To do this complicated surgery, you have to have extensive training and a strong commitment.” Dr. Craigie says. “We saw a real need for this procedure, that many women could be helped.”

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.

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