Q&A: Ask the Doctor

Q: I was wondering if I would be able to schedule a phone consult?

I was recently diagnosed BRCA1 positive in April 2019. I have been working with a breast surgeon and plastic surgeon in the Midwest and I am interested in a double mastectomy with immediate DIEP reconstruction. After the initial consult with our local plastic surgeon, he thought this would be possible. In addition to that he wanted to do a mastopexy in preparation for nipple sparing mastectomy and DIEP.

We did complete the mastopexy almost four weeks ago. At my last appointment, our plastic surgeon told us that he is not comfortable doing the immediate DIEP reconstruction after the mastectomy. This is due to limited resources and being the only microsurgeon capable of doing this near my hometown. He typically will complete these in two steps. We are interested in looking into a second opinion, as we would like to try and complete both surgeries in one step if possible. We are also wondering what a schedule or timeline to get in for this type of procedure would be. In the consult I would also like to discuss my journey so far, including screening results, and my past recommendations.

A: Sorry you are having to go through this, but congratulations on having a great plastic surgeon. I’ve never met him, but I know he’s good because 1) he suggested / did the preliminary mastopexy, and 2) he is obviously putting your welfare first by referring you for bilateral DIEP. We would be honored and delighted to help you through the next stage of your journey. I will be happy to discuss the details with you by phone as soon as it can be arranged.

–Richard M. Kline, Jr., MD

Survivor EMPOWERED – Meet Local Breast Cancer Advocate Shana Brown

We’ve been thrilled to help Shana with goody bags for her October Celebration events for the past several years.    We’ve asked Shana to share her “In Her Words” story about how she was inspired to start and continue to host these successful fundraising events.  Be sure to mark your calendar for ZUMBATHON October 12, 2019!

Shana’s Story

I am a daughter. I am a mother. I am a wife. I am a Christian, a pharmacist, cousin, niece, aunt, godmother and friend. I am 42 years old ….and I am also a 10 year Triple Negative BC Survivor.

Never in a million years did I think that I would hear the words “You have breast cancer “. What initially began with swelling and pain under my left arm turned into an appointment scheduled at Hollings by my primary physician.

I still was not overly concerned. My 30 minute appointment turned into an all day appointment. I had an ultrasound and mammogram and was scheduled for a Biopsy of the lump found in my left breast and swollen lymph nodes under my arm. Before I even received the results, I knew that it was going to be breast cancer. I just had a feeling.

I was 32 years old with a 4 year old and 7 year old. I knew what BC was, but I had no idea about the multiple subtypes.  Since it was BC Awareness month, there were many specials on television. I was watching one that was about TNBC and the African American community. They spoke about the high mortality rate, high recurrence rate and the higher incidences in minority women.

 

When I got the results of my tumor, I prayed that it wasn’t TNBC. Hearing that it was TNBC felt like a death sentence. I then remembered the special taking about clinical trials. I realized that I needed to do all that I could to beat this!

I signed up for a clinical trial and randomized to the study medication. I received the standard of care plus the study medication. I also received 10 additional doses of the study medication after surgery and radiation.

I was diagnosed with Stage 2 TNBC. I had neoadjuvant chemotherapy, a total axillary dissection, a lumpectomy and Radiation.

“Hope and Fear can not dwell in the same place. Invite one to stay” Maya Angelou

My faith and family gave me the strength to press on. I never questioned God, never thought “why me?” My focus was on my children, family and becoming cancer free. I always believed that the final outcome of my treatment would be NED (no evidence of disease), and it was!

My commitment now is to educate and encourage! Along with my church (Folly Road Church of Christ), I have a yearly BC Awareness Event, Knowing Your Girls. It began as a Tickled Pink Reception and  has grown into so much more! We have had Painting for a Cure, Dancing for a Cure and this year a Zumbathon. We have many people in the community that help to make our programs a success, including The Center for Natural Breast Reconstruction and our partnership this year with MUSC Hollings Cancer Center.

 

For me there is Life before Breast Cancer and Life After Breast Cancer. ~ Shana

“Each place along the way is somewhere you had to be in order to be here. “

 

 

 

 

Previvors: Family History and Breast Cancer Risk

Abby recently found out that she has a family history of breast cancer — she has a cousin and a grandmother who have both been diagnosed at different stages. Abby is 37 years old and doesn’t have breast cancer, but the idea that she might have a higher risk of getting the disease because of her family history concerns her. She has decisions that she has to make about her health and what she needs to do to reduce her risks. Abby is known as a Previvor.

According to FORCE, Facing Our Risk of Cancer Empowered, a Previvor is an individual like Abby who may have a predisposition to cancer but who hasn’t actually had the disease. This includes people who carry a hereditary mutation, a family history of cancer, or some other predisposing factor.

In 2010, Congress passed the first-ever National Hereditary Breast and Ovarian Cancer (HBOC) Week and National Previvor Day to help raise awareness about hereditary cancer.

How do you know if you have a hereditary or higher risk for developing breast cancer?

 

Uncover your family history

 

To find out if you have a hereditary risk of being diagnosed with breast cancer  – start by taking a full health history of your own family. If any of your family members have battled breast cancer, find out how old they were when they were diagnosed, the type of breast cancer and the stage. And find out what age they were if they unfortunately succumbed to the disease. This family history should be as complete as possible and go back for as far as you can.

 

Your risk of getting breast cancer may increase if you have a first degree family member — mother, father, sister, or daughter — or multiple family members on either your mother’s or father’s side of the family who have had breast cancer.

According to the Centers for Disease Control, hereditary cancer syndromes are caused by mutations (changes) in certain genes passed from parents to children. In a hereditary cancer syndrome, certain patterns of cancer may be seen within families.

 

Genetic testing

 

The most publicly recognized breast cancer susceptibility genes are BRCA1 and BRCA2 but there are others. If you have a personal or family history of breast cancer, you can undergo BRCA genetic testing. A negative BRCA test result means that you do not have a detectable mutation in BRCA1 or BRCA2.  Some families have a BRCA mutation that is missed by this test, or another gene (s) that might explain the cancer in the family.  If you test negative for a BRCA mutation previously found in another family member, then you may have a true negative result.  A variant result means there is a variation in your genetic code, but it is unclear if it is the cause of the cancer in your family.  If you undergo genetic testing it is strongly recommended that you seek genetic counseling to understand the results and what the options are for your health.

 

Calculate your risk 

 

Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer. 

Q&A: Ask the Doctor

Ask the Doctor: Q&A
Q: Three years ago, I had a double mastectomy and am now cancer-free. Unfortunately, my
plastic surgeon did a terrible job with the reconstruction. The left side implant is way off to the
outer side and looks larger than the right. The right side is way too far to the outside. There is
zero cleavage. Is there any way to re-position the implants to the more natural position of the
breast? I do not expect perfect but don’t like looking like a botched job. Please let me know if
your team can help. Thank you.
A: Congratulations on becoming cancer-free. At the Center for Natural Breast Reconstruction it
is part of our mission to help women move on with their lives after breast cancer. We focus our
efforts on helping women get their bodies back together with permanent “natural results.”
I’m sorry you are disappointed with your reconstruction results. If you have had radiation
previously, then it may be more difficult to have your breasts match with implant reconstruction.
If you have not had radiation then perhaps your implants could be revised or adjusted for an
improved appearance.
It is possible that using your own fatty tissue would be a more permanent option without
implants. Sometimes it is hard to start over with another approach but it may be necessary if
you desire a more natural and permanent result. If you would like more information about
natural breast reconstruction with your own tissue let me know.
We are here to help!
James Craigie MD

Q&A: Ask the Doctor

Ask the Doctor: QA’s
Q: I have a history of benign proliferative breast disease with associated atypical ductal
hyperplasia. I have had two needle biopsies and three surgical biopsies in my left breast. I took
Tamoxifen for five years and currently am taking Evista. Last year I completed the Myriad My
Risk Test resulting in a 37.9% remaining lifetime breast cancer risk. My monitoring plan since
2006 has been alternating diagnostic mammogram and breast MRI.
My most recent MRI located an enhancing nodule in my right breast. My oncologist has referred
me to a local surgeon to begin the process for prophylactic double mastectomy. I am interested
in natural breast reconstruction. I would like to schedule an appointment to discuss my options
with your plastic surgeons. I also will need to set up an appointment with the surgeon you use
for the actual mastectomy. I am not sure which appointment should be first.
A: Hi Stacy,
Thank you for contacting us. I am sorry you are having to make very difficult decisions in order
to prevent getting breast cancer. I commend you for being very vigilant with screening. As you
are aware screening alone won’t prevent breast cancer unless you act on the results of the tests
that indicate your risk is high.
Many women would consider preventive mastectomy in your situation. For many women
knowing that they can have immediate natural breast reconstruction for a permanent natural
result makes the decision a little easier to make. If you feel like you have any amount of extra
fatty tissue anywhere on your body then chances are you can use your own natural tissue. I’ll be
glad to answer any other specific questions just let me know.
James Craigie MD

Benefits of Autologous Reconstruction vs. Implant Reconstruction

When considering breast reconstruction, a woman is faced with a few options — she can

choose autologous reconstruction — which is the use of her own skin and tissue to

create a breast mound, implants, or go flat.

Recently, the recall of certain breast implants has made the news, as the FDA reported

their connection to 573 rare cases of anaplastic large cell lymphoma and 33 patient

deaths. As a result, the FDA asked Allergan to recall its BIOCELL textured breast

implants and tissue expanders and they obliged.

We are sure that this news is upsetting and leaves questions in the mind of patients

who wonder about implants and their safety, as well as the choice they should make for

their own breast reconstruction procedure.

At The Center for Natural Breast Reconstruction, we educate our patients on the

differences between all types of procedures and their risks, but our emphasis has

always been on autologous reconstruction. Here’s a little about each autologous

procedure that we do:

DIEP flap: This is the most popular type of perforator flap reconstruction due to its high

success rate and its ability to reconstruct the breast without the patient having to

sacrifice much needed abdominal muscles. In addition to reconstructing the breast, the

contour of the abdomen is often improved – much like a tummy tuck.

GAP flap: Similar to the DIEP, tissue is taken from the buttock area instead of the

stomach.

PAP flap: The Profunda Artery Perforator Flap (PAP) utilizes the tissue of the upper

thigh just below the buttock to reconstruct the breast following mastectomy.

So now that you know the difference between each procedure, why should you choose

autologous reconstruction over implants?

● Autologous reconstruction lasts a lifetime: Breast reconstruction using tissue

from someplace else on your body will last a lifetime. There is nothing synthetic

that can break or cause illness or other major issues. On the other hand,

implants will normally have to be replaced between 10 and 20 years.

● Breasts made by autologous reconstruction feels more natural: When your

breasts are reconstructed, you want them to feel just like your old breasts.

Implants do not always feel real, but since the tissue on your belly, buttocks, and

upper thighs is very similar to your breast tissue, it makes for a good, more

natural substitute.

Deciding what kind of procedure is best for you is a big decision. The best thing to do is

to gather all of your facts, talk with your doctor and your surgeon and weigh all of the

pros and cons before deciding on what’s right for you.

In Her Words – CP

natural breast reconstruction
I had a bilateral mastectomy with Superior Gluteal Artery Perforator (SGAP) reconstruction done two and a half years ago. It was all done at the same time. Dr. Kline was my primary and his partner, Dr. Craigie, assisted. They did all the stages [of my reconstruction] and I am very happy with the results. Dr. Kline is an absolute perfectionist as anyone can attest. I had previously had radiation treatment but you would never know it.
FYI, when they do the nipple reconstruction, they will ask you what you want, so in that regard a picture would be helpful for color, amount of projection and so on. Their office staff is incredible – friendly and very helpful. The care is phenomenal. I would be happy to share my experiences and answer any questions; just ask one of the office staff and they will pass your number to me to call at your convenience.
– C.P., Mt. Pleasant, S.C

In Her Words

I had my Stage 1 DIEP in Charleston with Drs. Kline and Craigie on May 25, 2018. On a scale of 1-10, I would rate my experience a 12! Before I go into more detail about my Charleston experience though, let me go back in time a little bit. I had my first unilateral mastectomy in 1998 (right side) with a reduction on the left side and immediate expanders.

A while later, I had the exchange for the permanent implants. This was all done in Atlanta, Georgia. The process was painful and inconvenient, took more than a year and was a complete flop. My right breast was half the size of the left, terribly scarred and deformed. The left breast was oddly shaped and had a very bad, fat scar underneath, and was hard.

The consequences of my low self-esteem led to intimacy problems with my husband, which resulted in divorce. Several attempts by different plastic surgeons only made the appearance of my breasts worse. The emotional consequences became compounded. In short, I felt like a freak. Dating was a concept I couldn’t even fathom – I was so self-conscious about my looks.

One day, 13 years after my first botched surgery, I saw a program on TV that discussed new procedures for reconstruction surgery after mastectomy. I immediately went online to research the DIEP procedure and decided to look into the facilities in Charleston. I was certain that Charleston was the right fit for me. Drs. Kline and Craigie are artists, and their highly trained staff made each and every step of the procedure flawless. Their attention to detail made me feel secure before, during and after. I’m about four months out from Stage 1 now. In those short months, my life has been transformed.

I haven’t had my stage 2 yet – that comes next month – but already I’m walking around with my head up and my shoulders back! My breasts look great. They are soft and warm, and it’s great to have those implants out. I would also like to add, if you are a single woman contemplating a location for reconstructive surgery, I highly recommend Charleston. The entire staff has a special sensitivity for those of us flying solo now.

–B.L., Thomasville, GA

Life after Mastectomy: Prosthetic Nipples

Being diagnosed with breast cancer and facing a cancer battle can be a long, draining, and scary experience.

While women who beat cancer find themselves overjoyed and grateful, there’s still a part of having breast cancer that tends to linger—especially if they’ve had to go through a mastectomy.

While we know women feel incredibly grateful that they’ve won their battle with cancer and feel they can begin life again, it’s also very common for them to long to feel like their old selves again.

At The Center for Natural Breast Reconstruction, we want all women to feel confident, radiant, and beautiful after a mastectomy, which is why we were so excited to find out about a new non-surgical solution to breast reconstruction—prosthetic nipples.

We love the product so much, we even carry demos in our office for women to try.

So, how exactly did this product come to be and how does it work?

I’m going to let breast cancer survivor and inventor Randi Johnson tell you in her own words.

Here’s her story…

After the shock of my IDC breast cancer diagnosis in 2007, I was hoping for the least invasive corrective surgery. The lump was too large for a lumpectomy, so a unilateral mastectomy was the choice I made. I had a new full-time job and didn’t want to take 6 weeks off for breast reconstruction.

The mastectomy was not very painful and I had a good recovery, but reality hit as bandages came off and I saw “my new normal” in the mirror. I’m not an especially vain person, but it was hard to feel “pretty” for my husband, even though I knew he loved me beyond the disfigurement.

I found myself wearing my prosthetic mastectomy bra to bed at night.

We happened to hear about Dr. Khouri in Miami, FL  who was doing a less invasive type of breast reconstruction surgery. There were no incisions, it was outpatient, and had a lower risk of complications. I only had to miss 3 days of work for each step (4 fat grafting sessions, for me).

Adding to the appeal, was the fact that they would take fat from tummy, thighs and anywhere else I didn’t want it and make a new breast out of it.

What’s not to love about that!

I was amazed to find that Dr. Khouri was in network for my insurance plan. There were still travel expenses etc., but somehow it all worked out.

It felt like I was growing a new breast and hardly had time to think about not having a nipple on that side, but when Dr. Khouri made an impression of my natural nipple and made up a silicone “rough draft” of a nipple for my recon side (for purpose of photos), my husband asked if he could tinker with the idea.

Dr. Khouri was very impressed with the prototype we brought back to show him a few months later. He invited us to display our Naturally Impressive nipple prosthetics as a vendor at a couple of his fat grafting conferences.

We received a great reception as well as some helpful ideas from the international breast surgeon attending.

I was part of an “MD Rounds” event at one of those Fat Graft Conferences and it was exciting to have MDs ask in disbelief (right after they heard my history). “Did you have a mastectomy?” We have heard countless similar stories from our clients about their Naturally Impressive nipples “fooling” others because they look so natural.

Now it’s become my new body image. If I have it off for a day or two, the asymmetrical image in the mirror doesn’t feel like it’s me.

We’ve been serving women through Naturally Impressive, LLC, since January 2010. As a “Mom and Pop” shop, we keep operating costs low and we also get to know many of our clients quite well. It’s an incredible joy! We love it!

No matter what option women choose regarding nipples, Naturally Impressive can be a way to “feel normal” again. For some, this is a great short-term option while waiting for tissue to settle before making a permanent choice. For others, it’s a wonderful non-surgical long-term solution.

If you or someone you care about is longing to feel normal again in the nipple department, check out our website to see the realism, variety and affordability of choices we offer.

Click here to visit the Naturally Impressive website.

You can also call Naturally Impressive, LLC, at 715-829-4488 if you have any questions.

Do you have a favorite post-mastectomy product that makes you feel confident and beautiful?

Share it with us in the comments below!

In Her Words: Moving Forward in a Post-Surgical World

 Everywhere you look, it seems there are blogs, posters, and articles that talk about how to stay positive while battling breast cancer. This is not a bad thing. It’s important for women to be encouraged and think good thoughts as they are dealing with such a serious illness.

However, when our only focus becomes positive reaffirmations and fuzzy pink boas, we forget to talk about another side of having cancer—a side that needs to be discussed.

We forget to talk about the ugly, dark, painful, uncomfortable, and scary side of having cancer.

We know, this isn’t a conversation that anyone enjoys having.

But it’s important.

Why? Because understanding the “uglier” sides of battling cancer is a part of what helps women move forward after their courageous battle.

Betsi Green, a breast cancer survivor and a patient at The Center for Natural Breast Reconstruction, wants to help women who are in the same situation as she was by sharing her story.

She hopes her story will help breast cancer survivors find peace and comfort as they make the transition into a post-surgical world—despite the challenges and discomforts that come with recovery.

Here’s Betsi’s story in her own words…

“Cancer is ugly.  Cancer is raw.  Cancer is painful.  Cancer is more than simply losing your hair.” – Betsi Green

On the first of November, Dr. Paul Baron did a right skin sparing modified radical mastectomy with lymphatic mapping and sentinel node biopsy. In short that means Dr. Baron removed my right breast and a handful of lymph nodes.

In the operating room, Dr. James Craigie inserted an expander where my breast had been. The expander, as its name suggests, is used to expand the skin and keep the tissue viable for the reconstruction surgery.

During surgery, the expander is filled with air.  Shortly after surgery, in a follow up appointment, the expander is filled with a saline solution.  This is done in the surgeon’s office.  The syringe is inserted in the center of the expander.

Let’s talk about the expander.  It wasn’t painful. It was uncomfortable. It was very uncomfortable.

It was difficult to bend over.  I felt like I had a brick on my chest.  It was difficult to have water from the shower hit my tender skin. It was difficult to have material touching my skin.

Did I say it was uncomfortable?

The skin felt very thin and pulled, which I expected, just didn’t expect it to be as tight as it felt.  Sleeping with the expander kept me to my left side or on my back.

It wasn’t until the first week of December, I noticed something was wrong.  The bottom half of my expander had turned red.

Anytime you have a foreign object in your body, you want to keep a close eye on how it looks and/or feels.  This bright red color told me something, and it was not good.

I did not feel any different.  I had no pain.  The uncomfortableness of the expander remained. These days, I really didn’t care what my chest looked like.  However, in this case, looks mattered and I “kept an eye” on it.  I was hoping it would simply go away on its own.

It turned out my expander was infected.

I share this with you for one particular reason:  SPEAK UP!  If you are uncomfortable, go see your team. If you think something is wrong…it probably is!  There are things they can do to help the comfort level.

Don’t be shy.  You are (or should be) in control of your cancer journey as much as possible. The doctors and their staff are not mind readers.  Let them know if you need an “adjustment”.

Ask them how they can help you be more comfortable.

The cancer dance is an ongoing experience.  My dance has been ongoing since June 2016.  It will continue thru the 2017 calendar year.  One appointment, one diagnosis, one doctor, one surgery, one chemotherapy treatment, and one CT scan does not complete the experience.

There are a lot of ugly things that can happen as you recover from your battle with breast cancer. But if you know about them, and speak up, you will be able to get the help you need.

You can make a huge difference in how your own personal cancer treatments affect you.

Be confident and as comfortable as possible as you move forward thru your own individual journey. And by all means…keep moving forward.

-Betsi Green

Check out Betsi’s blog and read more about her journey here.

Do you have any words of wisdom on recovering from breast cancer? Share them below!