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Natural Breast Reconstruction on Slender Females

December 21, 2012 By Leave a Comment

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

I had a 4.6 cm lobular carcinoma treated with neoadjuvant chemo (ac+t). Five treatments to go scheduled to end on 1/17/12. Tumor had been reduced to 2.7cm thus far. Scheduled for bi-lat mast in early Feb. I am slim, 5’4″ and 112 lbs now. Normally about 120 lbs. surgeon here in nj is recommending expander and fills followed by radiation and several months later, an exchange. He says I may have enough abdominal fat for a tram flap for one breast. Could I come to you six months after radiation for a diep flap or some other procedure if I just have mast and do nothing else for six months following rads? Thank you

Hi,

Sorry to hear about your situation, but we would absolutely be happy to see you. If you have decided for sure you want to be reconstructed with your own tissue, I would strongly recommend that you stick to your guns and not have expanders placed, for the following reason. The expanders will create a “divet’ in your bony chest wall, which will not go away, and some of your flap volume will be required to fill the “divet,” and thus not be visible in the breast mound. If you were more “fuller-figured” this would not be an issue, but it is a huge issue for slender patients. We have encountered very few patients who cannot be reconstructed due to inadequate donor sites, although it’s not too uncommon for slim patients to not end up quite as large as they’d wished. If you’d like to send photos of front and back we could give you a preliminary assessment of your donor sites, although of course the absolute assessment is best done in person.

Good luck, and please feel free to call or email with any other questions.

Richard Kline
Center for Natural Breast Reconstruction

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DIEP Flap Procedure: Is this covered by my insurance?

December 14, 2012 By Leave a Comment

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

I had a double mastectomy last month and am considering the DIEP procedure. My insurance is Aetna PPO and I wanted to know if this is covered. Also, I keep reading about stage 11 follow up to do lipo on the upper abdomen so it is flat like the bottom half ( after surgery) . Is that part of the reconstruction and is it covered by insurance? Thanks

Hi,

I’m almost sure we are in-network for you, but our office will let you know for sure.

We use liposuction to help correct some donor site deformities, such as bulging of the upper abdomen, or fullness of the “muffintop” areas. Often, that fat can be used as graft to enlarge the DIEP flaps, or improve little areas of asymmetry. If we place fat in the breast, we add a code for fat grafting for the insurance company, but we never bill anyone for liposuction per se.

Hope this helps, and thanks for your question.

Richard Kline
Center for Natural Breast Reconstruction

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Implant Procedure Without Expanders?

December 7, 2012 By Leave a Comment

breast implantsThe below question is answered by the Charleston breast surgeons at The Center for Natural Breast Reconstruction.

Is it possible to have a simple implant procedure without expanders if you have a lot of skin tissue left?

Yes, absolutely, if you are willing to have Alloderm (acellular dermis) used to help support the implant.  We specialize microsurgical reconstruction using your own tissue so we don’t actually do this procedure in our practice but there are plastic surgeons in every metropolitan area who do.  If you are in or near the Charleston area we can give you names of surgeons who are especially good at this procedure.    We know many out of our area too if you’d like to identify where you are located we can see if we know anyone to suggest you consult.

–The Center for Natural Breast Reconstruction Team

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Breast Reconstruction Options To Correct Uneven Breasts

November 23, 2012 By Leave a Comment

The below question is answered by the Charleston breast surgeon, Dr. James Craigie.

I had TRAM flap reconstruction in 2006 with revision and a follow up surgery in six months later. Since then some shrinkage has occurred in the reconstructive side and I have a hollow area on the upper portion. Do I have options for more normal looking breast without the hollow area?

You potentially have many options to improve your reconstruction. No one solution is perfect for all situations, but some options include repositioning the flap to a higher location, augmenting the hollow area with your own fat grafts (taken usually from abdomen, thigh, or buttocks), or using any excess skin / fat from under your armpit as an additional flap to lift and augment the TRAM (we call this a 5th intercostal artery perforator flap). Some more aggressive options would include placing a small breast implant under the TRAM flap, or adding a whole new microvascular flap from another area, although this is rarely in practice necessary.

Hope this helps. Please feel free to email or call with any additional questions.

Dr. James Craigie

The Center for Natural Breast Reconstruction

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Could I Be A Candidate for DIEP Reconstruction After Implants?

November 16, 2012 By Leave a Comment

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

I had a bilateral mastectomy and had 850cc silicone implants placed after tissue expansion. I am not happy at all with the result as I had radiation on the right side and that breast is considerably smaller than the left. I am also not happy with the shape and look of the breasts with silicone implants. I currently wear prosthetics in my bra to achieve symmetry and a normal shape. Even with the bra and the prosthetics I am not happy with the result. I am currently a D/DD and would like to maintain that size. Given this situation, could I be a candidate for a DIEP or Stacked DIEP breast reconstruction?

Thank you for your question. I’m sorry you are having some concerns about the shape and evenness of your breast reconstruction. Because you had radiation on the right side it is almost certain that the two sides will be different to some degree regardless of the type of reconstruction. Unfortunately, when this occurs with implant techniques it is usually more noticeable and nearly impossible to fix long-term as long as the implants are in place. The reason for this is the implants will be treated as foreign material by your body and the right side will always react more severely due to previous radiation even if radiation was done before the mastectomy. Also, the process of scar formation continues as long as the implants are in place, making the firmness, shape change, and stiffness more noticeable to you as time goes by. These are the reasons that women who have implant reconstruction have multiple procedures to revise results as time passes.

Fortunately when someone has had problems of this nature with implants we can frequently solve them by removing the implants and replacing them with their own fatty tissue (DIEP, stacked DIEP). We can do this without taking tummy or back muscles. Immediately the fatty tissue takes on a more natural shape compared to implants. Thirty percent of my patients have had failed implants before we start over and use their own tissue. My opinion and answer to your question is that you could have a DIEP to replace your implants and I can usually predict that many of the implant problems are much improved immediately after the surgery. I cannot predict what size you would be without seeing you but the size depends on how much extra tummy tissue you have as well as any previous surgery.

I hope I have answered your questions.

—James Craigie MD

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What Is the Recovery Period for a DIEP Procedure?

November 9, 2012 By 1 Comment

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

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Breast Reconstruction After Lumpectomy and Radiation

November 2, 2012 By Leave a Comment

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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Dr. James Craigie Answers Your Questions About Natural Breast Reconstruction

October 12, 2012 By 2 Comments

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

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Capsular Contracture From Breast Implants

September 28, 2012 By Leave a Comment

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

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Can I Expect Tissue Problems After Radiation Therapy?

September 7, 2012 By 1 Comment

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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