Search Results for: implant

This week, Richard M. Kline Jr. M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I seeking information on reconstruction after radiation. The side that received radiation is very tight and now about 3 inches higher than the non-radiated implant. I have had two stem-cell surgeries and it is suggested to have another. Before going back to surgery for another stem-cell/fat transfer I want to know is there any other options that might help me. Can the radiation side be fixed? Can the non radiation implant be replace to match the radiation side?

Answer: Your problem is very common, unfortunately. Typically, with implant-based breast reconstruction, the radiated side will be harder, higher, less mobile, and often smaller than the non-radiated side.

Fat grafting around the implant is a reasonable and relatively innocuous way to address the problem, but is, at best, only variably successful. It is thought that stem cells within the fat may rejuvenate the radiated tissue in some fashion, and from my experience it seems this may in fact sometimes occur. Other times, however, fat grafting doesn’t seem to have much effect.

The most sure-fire way to address the problem is to remove the implant, and then reconstruct the breast with your own tissue, usually either with a DIEP flap (from the abdomen) or a GAP flap (from the buttocks). We have successfully reconstructed hundreds of patients with failed implant reconstructions by using their own tissue. Neither a history of radiation, or previous failed attempts at reconstruction with implants have any effect on the success of using your own tissue (98-99%).

There are some other recent developments which MAY (notice I said “MAY”) improve the success rate of implants in a radiated field. For the last 2-3 years, we have been performing our implant-based reconstructions by completely wrapping tissue expanders with acellular dermal matrix (Alloderm – processed cadaver skin graft) and placing them in FRONT of the muscle. Please note that if this is done in a patient who needs radiation, it is done BEFORE they receive the radiation.

Most of our patients who receive radiation are planning on having natural tissue reconstruction, and receive tissue expanders only as a temporary measure, as we do not ever want to subject a flap (natural tissue reconstruction) to radiation. However, we have noticed that some patients’ breasts with these Alloderm-wrapped implants remain surprisingly soft after radiation. Theoretically, the implant in a radiated breast could be removed, and an Alloderm-wrapped tissue expander or implant could then be placed (in front of the muscle if possible). I haven’t actually tried this (again, most of our patients in this situation just convert to natural tissue reconstruction), but theoretically it might provide some improvement over your present situation. On the other hand, it could result in a big mess if things didn’t work out well. However, even this would not impact your ability to subsequently have natural tissue reconstruction, if you decided to go that route.

Hope this helps a little bit. I would be happy to chat with you on the phone about your situation in more detail, if you wish.

Have a great weekend!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: What can be done for a 2004 radiated breast with implant. As common, it has encapsulated to a high degree and is painful, misshaped and raised, looking very unnatural. Thank you

Answer:  Without question, the course of action most likely to work is to remove the implant and proceed with reconstruction using your own tissue. If you still have breast tissue remaining, it can be removed by a breast surgeon at the same time that your healthy tissue is transferred.

The most common source for the new tissue (the “flap”) is the abdomen, which is usually harvested as a DIEP flap. If the abdomen is not available or not adequate, then the buttocks (“sGAP flap”) can often be used. Our success rates over the last 13 years are 99.07% using the DIEP flap, and 95.7% using the sGAP flap. The initial surgery requires on average 4 nights in the hospital, but subsequent stages are much easier.

If you can’t or don’t want to use your own tissue, there are a couple of other options which may offer some hope, although the chances of success are nowhere near as good as using your own tissue. One is a course of hyperbaric oxygen, which has been shown to bring new blood vessels to the radiated tissue.

Another potential option, which must be regarded as experimental at this point, would be to completely cover the implant with acellular dermal matrix, or “ADM” (Alloderm being the most commonly used variety). This material has some efficacy in preventing contracture, but the effect would be less pronounced in radiated tissue.

Hope this helps. I would be happy to discuss your situation further with you, if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I had a Dbl. Mastectomy 6 months ago. The expanders were placed & then removed 2 months later, (necrosis) I’ve lost confidence in the original plastic surgeon & went for 2 consults with new Dr’s. One wants to do above the muscle (as did the original Doctor.).

The other says that it needs to be under the muscle. In my research, I’ve found the pros & cons to both, but I’ve also read that in above the muscle technique there has to be enough breast tissue. So my question is that since I had mastectomy could I have enough tissue for above the muscle? Is there a better choice? One Dr suggested that above the muscle is the lazy way to do it.. is that the case?

Thank you.

Answer:  Thank you for your question. I’m sorry to hear you have had problems with your breast reconstruction. There is no one procedure or technique that is best for every patient or for every plastic surgeon. If you had necrosis after your mastectomy then any technique used for breast reconstruction could be very difficult. Breast reconstruction with implants is always difficult when there is necrosis and putting the expander under the muscle may not help in any way.

Normally the breast is above the chest muscle. When breast reconstruction with implants is performed with the expander or implant below the muscle then there is always distortion or unnatural movement of the breast when the chest muscles contract. For many patients this is a significant problem. The problem is avoidable when the implant is in a more natural position. We call this approach prepectoral breast reconstruction. If someone has a mastectomy they should have no breast tissue to cover an implant/expander. That is one of the downsides to breast reconstruction with implants. It is a problem regardless of whether the implant is above or below the chest muscle.

The best breast reconstruction results with implants are when the implant is not below the muscle, but in the normal pre pectoral position. I strongly disagree with the “lazy” excuse. Breast reconstruction with expanders /implants in front of the muscle is much more work for the plastic surgeon compared to below the chest muscle. It also requires specialized expertise and judgement.

You should also be aware that if you have already had problems with your implant breast reconstruction then your best option for a permanent natural result may not be implants at all. Your own fatty tissue may be your best option. Please let me know if you would like more information about natural muscle sparing breast reconstruction without expander/implants. I hope that I answered your question. Please let me know!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I had my breast done once when 25 with silicone implants, once when I was 55 with saline. Now I need a breast lift. My only question is can the same implants stay there and just lift everything? Is that ridiculous. I want to leave the old implants and just lift the breast and move the nipple up some. I think it will be less expensive not to add a new implant.

Answer: It might be possible to leave the implants in place, but it would depend on your particular anatomy, and how much of a lift you needed. Even if you do try to use the same implants, it will be necessary to have “extras” in the operating room in case one is damaged during the surgery and must be replaced.

 Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  Three years ago I had a double mastectomy after being diagnosed with breast cancer. Can I have my silicone implants removed? And what is the recovery time?

Answer: You can always choose to have your implants removed. If no further reconstruction is done, recovery time ranges from a few days to two weeks, possibly longer, depending on your individual situation.

If you have the implants removed and then have reconstruction with your own tissue, recovery is a lot longer, usually about two months.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  I had bilateral mastectomies with reconstruction in 2007. I recently had my implants replaced due to a capsular contracture on the left side. I now have 495CC contour implants. I love the right side but not much the left. Is there anything that can be done to help?

Answer: There is possibly something that can be done to improve your situation, but it is difficult to say for sure without knowing a little more about what is going on. Some possible things which could make your reconstruction unacceptable include recurrent contracture, inadequate soft tissue cover, or the implant shifting from the proper position.

Additionally, if you are radiated on that side, it can be very difficult to get an acceptable result. We would be happy to call and discuss your situation further, if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I currently have breast implants that were done about 9 years ago following a double mastectomy. I want to have the implants removed and redone with my own tissue. I do not know if my insurance will cover this procedure and I need to have a bloodless surgery. My current plastic surgeon recommended that I get someone who specializes in this type of surgery since there aren’t any in our area that do it often enough for him to recommend.

My surgeon also suspected that one of the implants has ruptured and I didn’t know if I should go ahead and have my MRI done here or if I should wait to have it done as part of the surgery that you would perform. I just wanted to avoid duplicating necessary lab and xray work.

Answer:  Hi, thank you for your question. It is our mission to help women restore their bodies after mastectomy. We named our practice the Center for Natural Breast Reconstruction because we specialize in using your own natural tissue. We replace problem implants frequently with fatty tissue (DIEP, sGAP, fat grafting etc…). What do you mean by bloodless surgery? It is very rare for our patients to require blood replacement.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: Have there been any improvements in the shape of silicone implants in the last 13 years? I had my reconstruction done then and have never been able to find a bra that fits. They are too round with no “apex’, or point to fill in the front of my bra.

Answer: Thank you for your question. Yes there have been improvements made regarding breast implants over the last decade. The silicone inside is more “cohesive” which in general means the implants hold their shape better and are probably less likely to leak over time. Also the implant companies are frequently coming up with different options or sizes for patients.

If you are not satisfied with the results of your breast reconstruction I recommend you follow-up with your surgeon to discuss what bothers you and if any of the newer implants would help.

If it is not possible for you to see the surgeon who performed your surgery let me know and with more information I could give you my opinion.Thanks again.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had a double mastectomy and final saline implants on February 26 2016. Dr has to redo because breasts aren’t symmetrical. I have felt lousy since surgery.

After reading a forum of women experiencing side effects with implants rash fatigue, pain in shoulders arms and back.

I was wondering if I can still have natural breast reconstruction after having implants. Please let me know at your earliest convenience. Thank you

Answer: We have done natural reconstruction on hundreds of women who started with implants, so don’t despair.The easiest way to proceed would be for us to call you and discuss your situation in more detail, if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!