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Scarring After Breast Reconstruction Surgery

June 15, 2012 by

The below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

Is there anything you do to diminish the scars resulting from all of the reconstruction processes?

Generally speaking the quality of the scar is not affected by the surgeon’s technique, and is unfortunately completely dependent upon the patient’s biochemistry.  Having said that, there are some scar patterns, which are more favorable than others, in terms of allowing patients to wear different styles and types of garments without displaying scars.  In a best case scenario, every patient would have a nipple sparing mastectomy where scars readily conceal beneath most swimsuits, although this is unfortunately not possible.  The next best scenario is to have skin sparing mastectomies with a nipple reconstruction, which can still result in a scar pattern which can be readily hidden under most swim wear and in most types of clothing.

More Information on Scarless Mastectomy/Hidden Scar Mastectomy Procedures

Advances in microsurgery and breast surgery allow us to perform mastectomy with hidden scars as in a breast lift or augmentation, without leaving scars on the breast skin. Patients who are candidates for this surgery preserve their breast skin – including the nipple and areola.

This technique begins with an incision under the arm, under the breast fold, around the nipple or down the bottom of the breast below the bra line. Reconstruction involves using a one of the perforator flap techniques (DIEP, SIEA or GAP), with the relocated tissue filling in and shaping the breast.

Share this post with your followers on Twitter. And if you have a question for our breast surgeons, please submit them here!

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Back to Bras: Adjusting to Bras After Reconstructive Surgery

June 8, 2012 by

post surgery braThe below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

How soon can I wear a regular bra after the first stage surgery?

Well, I am not sure I know what a regular bra is.  Sport bras are very similar to the bras which we use in the hospital and we often recommend the people transition to sport bras.  I think most patients could wear almost anything they wanted, even an underwire, somewhere from 1-2 months after surgery, although this may not be as comfortable as some other options.

If you do need to have a special bra after your incision lines have healed, we are happy to provide a prescription. We’ve had lots of our patients rave about Nordstrom’s for post mastectomy bras. Not only do the kind folks there provide a professional fitting for mastectomy patients, but they also handle the insurance paperwork for you too!

Here are more helpful hints for post surgery clothing:

If you are having a DIEP breast reconstruction, abdominal swelling limits clothing choices. Wear loose-fitting garments to the hospital. Women should avoid fitted, zippered pants and skirts because they probably won’t zip when it’s time to leave. Even clothing with snug elastic waistbands may be uncomfortable. A loose chemise or drop waist dress or jumper is a good choice.

Slacks or skirts with elastic in the back and a smooth band in the front may be slightly more comfortable than those with a totally elastic waistband.

Consider clothing that doesn’t wrinkle easily. Resting and naps are necessary while recuperating.

Cotton underwear breathes and is absorbent and comfortable next to the skin. Cotton’s fiber ends help the fabric stand away from the sensitive incision area rather than hug it, as some textured, synthetic fabrics do. If you don’t already have cotton briefs, buy a pair a size larger than your normal size. A little extra room adds comfort during recuperation. For waistline incisions, bikini cut styles may be better, while full cut panties and shorts might be preferred for incisions in the lower abdomen and buttocks.

Loose-fitting nightgowns and nightshirts are comfortable, especially when made from absorbent, breathable cotton or cotton-blends. If you prefer pajamas, select those with drawstrings. Elastic waists may be less comfortable for some people depending on swelling, tenderness, and location of incision. Sweatpants or crew pants are a comfortable change from bed wear, especially those with drawstrings, which allow some flexibility at the waistline.

Flat soled shoes that slip on your feet rather than tie are great to have, too, as you may be limited in your ability to bend over and tie your shoes.

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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Will An SGAP Procedure Help With My Lymphedema?

June 1, 2012 by

sgapThe following submission below is answered by Dr. Richard M. Kline Jr., MD, of The Center for Natural Breast Reconstruction.

Will a SGAP help with lymphedema?

There is some indication that patients with lymphedema may benefit from having an autogenous reconstruction, and this is one reason why we have elected in our practice not to perform vascularized lymph node transfer at the same time as breast reconstruction.

About Our Procedures

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.

View an animation of our procedures here.

Share this post with your followers on Twitter and Facebook. And if you have a question for our breast surgeons, submit them here!

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What’s Next if My First Attempt at DIEP Flap Breast Reconstruction Fails?

May 25, 2012 by

The below question was answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr., MD of The Center for Natural Breast Reconstruction:

If the first DIEP flap breast reconstruction fails what are my options?

This is a rare scenario, but in our practice we generally recommend waiting 3 months for the body to recover, then using another area of tissue, most commonly the buttock to perform the reconstruction.  The failure of the first reconstructive attempt does not seem to adversely affect the success rate of the second reconstructive attempt. We have in the past sometimes attempted to perform the salvage reconstruction at an earlier date, but we have come to feel that the patients do better overall if they are allowed a period of healing before proceeding with the next surgery.

What is DIEP Flap Reconstruction?

Perforator  flaps and natural breast reconstruction represent the state-of-the-art in breast reconstruction. The DIEP flap is the most frequently used type of  perforator surgery for breast reconstruction because of the tummy tuck benefit  that can be part of the process. Doctors  borrow skin and tissue from your abdomen, and use it to create a soft, warm,  living breast.

It starts  with an incision along the bikini line similar to a tummy tuck incision.  Surgeons remove the necessary skin, soft tissue, and tiny feeding blood  vessels. The blood vessels are matched to supplying vessels at the mastectomy  site and reattached under a microscope. Tissue is then transformed into a new  breast mound.

Our refined technique provides all the necessary  tissue to build a breast, without removing the abdominal muscles. In addition  to reconstructing the breast, the contour of the abdomen is often improved –  much like a tummy tuck.

Have questions for our team? Send them on over, we’d love to hear from you!

 

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Exploring the Recovery Process after DIEP Breast Reconstruction

May 18, 2012 by

The below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What is the recovery process like for DIEP flap breast reconstruction?

Generally speaking, patients can sit in a chair the day after surgery, they are walking by 2 days after surgery, and they leave the hospital on the fourth day after surgery.   We ask you to sleep on your back for a minimum of a month, sometimes longer (depending on the size of the flaps), and to avoid vigorous physical activity for at least 6-8 weeks.  Most people seem to feel like they are well on their way to recovery within 2 months, although obviously healing goes on for a significantly longer.  However, everyone is different, and some patients recover more rapidly, other seems to take a little more time.  We feel that the optimal approach is to let you speak to other patients who have been through the process, so that they may share their experiences directly with you.

Below are some additional tips for optimal post surgical experience.

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 for surgical team at The Center for Natural Breast Reconstruction? Send them on over, we’d love to hear from you!

 

 

 

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The Benefits of DIEP Flap Breast Reconstruction Over Other Reconstructive Options

May 11, 2012 by

diep reconstructionThe below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What are the benefits of the DIEP flap breast reconstruction over other options?

I am going to break this question into two parts.

The first part is what are the benefits of the DIEP flap over reconstructive options using implants?  Let us start with the benefits of implants.  The primary benefit of implant is that the operations are shorter, they are potentially safer, and you do not need to operate on another part of the body. Additionally, implants are readily available, and if you do not have enough extra body tissue somewhere to make a breast, implants may be the preferred choice for this reason.  The advantage of the DIEP flap over implants is that it produces a much more natural feeling, warmer, and trouble free breast (after the reconstruction process is completed).  There is data to suggest that women tend to accept the reconstructed breast as their own more readily if it is made using their own tissue, in comparison to women who have a reconstructed breast using implants.  Additionally, many women feel that they have too much extra tissue in their abdominal area, and they may actually view removing this tissue to make a breast as an added bonus.

The second part of this answer is going to be why is the DIEP flap better than other reconstructive options using the patients own tissue, with the most commonly performed in our practice being the GAP or gluteal artery perforator flap, which is taking the buttock.  The primarily advantage of the DIEP over the GAP is that it is faster, and no position changes are needed during surgery to harvest the flap.  If the patient has adequate abdominal tissue to meet her reconstructive needs, we generally recommend using this as our first line option.  Having said that, however, the buttock serves very well to make breast, although the process is a little more tedious and lengthy.

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

 

 


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At What Point During Your Journey Is It Time To See Our Surgical Team?

May 4, 2012 by

time to see a doctorThe below question is answered by Richard M. Kline Jr., M.D., of The Center for Natural Breast Reconstruction.

At what point in the process should a breast cancer patient see a breast reconstruction surgeon?

Opinions on this vary, but I think the prevailing opinion is the sooner the better.  Ideally, the patient would see the reconstructive surgeon even before plans were finalized for treating her cancer.  This is because many times several options are available to the patient, and she may not fully understand the implications of the various options available to her unless she understands what reconstructive options are available in each setting.

A Little Bit About Our Surgical Team :

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the RIGHT Questions to Ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions.

Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • How many board certified physicians will be assisting with the first stage of the procedure? Will there be physicians in training (residents) involved with my surgery
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

Do you have a question about breast implants or natural breast reconstruction? Ask our surgical team by clicking HERE.

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Potential Issues to Watch for After DIEP Flap Breast Reconstruction

April 27, 2012 by

The below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What potential issues should I be watching for right after having DIEP flap breast reconstruction?

I am going to split the answer for this into two parts.  First, what you should watch for while you are in the hospital (at which time you will, of course, have lots of help watching for things). Second, what should you watch for when you go home?

When you are in the hospital, we primarily look for changes in the vascular status of the flap.  There are monitors attached to the flap which will within seconds pick up any change in the blood flow to the flap.  If on further evaluation by the nurses, it shows that there is a problem, we will take you back to surgery immediately and attempt to correct the problem.  Fortunately, incidents such as these are rare, but if they do occur.  We have learned that the most important factor is to get to the operating room quickly, in which case we can almost always fix whatever might be wrong.

Thankfully, it is unbelievably rare to have a problem with the blood flow to the flap after going home, although it is not impossible.  Your primary concern should be to follow the specific directions which we have given in terms of positioning and brassiere support.  Most patients still have temperature monitoring strips attach to the flap, and this can serve as useful reassurance to let you know that your flap is fine.  Infections are extremely rare after DIEP flap surgery, but they can occur either at the reconstruction site or at the abdominal donor site.  Wound healing problems are not as rare as infections but may occur.  If you are not radiated, the most likely place to have a wound healing problem is your abdomen.  If you are radiated, it is very common to have a little bit of a wound healing problem where the healthy flap tissue meets the radiated breast skin.  Essentially all wound healing problems can be managed very effectively, so it is not something you need to worry about.

Share this post with friends and family on twitter or facebook. Do you have a question for our surgical team? Submit them here!


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Ask The Expert Series Spotlights The Center for Natural Breast Reconstruction

April 20, 2012 by

We’re thrilled to share some exciting news with you, today! Our very own Dr. Richard Kline and Dr. James Craigie, Charleston breast surgeons, were recently on ABC News 4 Ask the Experts Series. During this interview the doctors answer questions on air about natural breast reconstruction submitted by viewers .

See below for the interview:

 

For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit our website today for more information.

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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Our Recommendations for Post Surgical Clothing After Breast Reconstructive Surgery

April 13, 2012 by

post operativeThe below question is answered by the team at the The Center for Natural Breast Reconstruction.

I am having a SGAP breast reconstruction in a few weeks. Do I need to buy post op surgical bras? If so, which kind and can I get a prescription for insurance purposes? Also, I heard people use various bras / camisoles with pockets for drains. Have you heard of those or think they are helpful? Do you think button down shirts are something I need to get? Anything else?

No need to buy any special bra, vest, or camisole in advance. Our hospital, East Cooper Regional Medical Center, provides a soft cotton vest with drain pockets as well as a surgical bra that acts as a post operative surgical dressing. Let them know if you feel like you need an extra for when you leave the hospital and they are great about sharing another with you.

Absolutely, I would make sure I had button down shirts and loose clothing that you can easily get in and out of. You’ll have some limitation of lifting your arms above your head so button down shirts are easiest to get on and off without lifting your arms. Some women choose to wear loose sundresses; others track suit pants or cotton shorts. Whatever you are comfortable in is fine, but keep in mind we won’t want you wearing anything right away that could potentially put any pressure on your suture lines.

Here are more helpful hints:

If you are having a DIEP breast reconstruction, abdominal swelling limits clothing choices. Wear loose-fitting garments to the hospital. Women should avoid fitted, zippered pants and skirts because they probably won’t zip when it’s time to leave. Even clothing with snug elastic waistbands may be uncomfortable. A loose chemise or drop waist dress or jumper is a good choice.

Slacks or skirts with elastic in the back and a smooth band in the front may be slightly more comfortable than those with a totally elastic waistband.

Consider clothing that doesn’t wrinkle easily. Resting and naps are necessary while recuperating.

Cotton underwear breathes and is absorbent and comfortable next to the skin. Cotton’s fiber ends help the fabric stand away from the sensitive incision area rather than hug it, as some textured, synthetic fabrics do. If you don’t already have cotton briefs, buy a pair a size larger than your normal size. A little extra room adds comfort during recuperation. For waistline incisions, bikini cut styles may be better, while full cut panties and shorts might be preferred for incisions in the lower abdomen and buttocks.

Loose-fitting nightgowns and nightshirts are comfortable, especially when made from absorbent, breathable cotton or cotton-blends. If you prefer pajamas, select those with drawstrings. Elastic waists may be less comfortable for some people depending on swelling, tenderness, and location of incision. Sweatpants or crew pants are a comfortable change from bed wear, especially those with drawstrings, which allow some flexibility at the waistline.

Flat soled shoes that slip on your feet rather than tie are great to have, too, as you may be limited in your ability to bend over and tie your shoes.

If you do need to have a special bra after your incision lines have healed, we are happy to provide a prescription. We’ve had lots of our patients rave about Nordstrom’s for post mastectomy bras. Not only do the kind folks there provide a professional fitting for mastectomy patients, but they also handle the insurance paperwork for you too!

Thank you,

The team at The Center for Natural Breast 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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