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Ask The Doctor – Recovery After a Failed Implant Reconstruction

October 3, 2014 by

<alt='failed implant reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had breast cancer twice, and one of my breast implants got a bad infection. My implants had to be removed, and I’ve left them that way since. Now I’m 58 years old, and I’d like to have reconstruction. Is this possible for me at my age and after an infection?

ANSWER: Thanks for your question. While I cannot obviously make precise predictions about our ability to help you without knowing a little more, I can tell you that your situation is actually a very common one. Fortunately, a history of failed implant reconstruction has very little impact on our ability to subsequently reconstruct you with your own tissue, and we have successfully reconstructed many, many women in your situation. If you wish, one of us can give you a call to discuss your situation further, and we can go from there. Have a great day!

— Richard M. Kline, Jr., M.D.    

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

 

 

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Ask The Doctor – I am not happy with the results of my DIEP Flap surgery – Should I get an implant?

August 29, 2014 by

<alt="orange flowers"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Hi, in May 2013, I had my transfer done at the same time as my DIEP flap. In that surgery, I also had a reduction on my left breast. The doctor that did my surgery left and moved somewhere else, so I’ve seen another doctor since. My new doctor tried to fix it, but it’s still messed up. He said he really doesn’t know what to do. As far as the transfer is concerned, I’m not sure it worked. I had another procedure done that helped it at first, but my cancer came back again on my pelvis bone and the chemo has made it worse. I am no longer on chemo, but I will take Herceptin for the rest of my life. Is it possible to remove the fat and put an implant in my breast?

ANSWER: Hi, if you had radiation on the reconstructed side, an implant might not be the best option. It is possible to add an implant to a DIEP to increase the size in order to match the other breast. I personally prefer to perform fat grafting to add more volume when possible. It is harder to match a normal opposite breast with an implant breast reconstruction. Removing fat normally is not the answer to revising the shape unless the fat is not living. This is called fat necrosis and feels hard not soft like normal fat. Also, if you went with an implant on that side the results would be more natural if you had more of your own fat to cover the implant. Otherwise the new breast has no natural tissue to cover it and the end result looks less natural.

James E. Craigie MD

Center for Natural Breast Reconstruction

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

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Ask The Doctor – Are There Any Tests To See if My Implants Are Causing My Health Problems?

August 15, 2014 by

<alt="Pink Flowers in a Field"/>

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

QUESTION: I had a bilateral mastectomy back in 2000 because of numerous precancerous lumps in my breasts. I had Stage 3 melanoma 8 years prior, and they operated numerous times on me. I decided to have latissimus reconstruction surgery, and since then have had numerous problems. I’m allergic to latex, numerous adhesives, sulfa, and penicillin. I’ve been suffering from fibromyalgia, severe edema throughout my body, and itchiness within the area of my chest wall and breasts. After getting this issue checked out, I was told this was not an implant problem and was sent home. Are there any tests that can check to see if the problems relate to my implants? I had a CT scan done at Mayo Clinic, and they said I had an allergic reaction to what they thought was an antibiotic. Have you seen this before in your patients? Any help would be greatly appreciated. Thank you.

ANSWER: I’m not aware of a test to see if your implants are causing any problems. To my knowledge, there has been no firm connection established between implants and symptoms such as yours, but you should check with your rheumatologist to be sure.

Having said that, we do see many patients who have implant reconstructions along with various complaints such as discomfort, tightness, pain, etc. Although it is obviously difficult to objectively quantify, many of them seem to get significant relief from their symptoms if their implants are removed, and their breasts reconstructed with their own tissue. In all fairness, most of these patients have what would be considered unacceptable reconstructions anyway (hardness and asymmetry being common issues), so it is usually pretty easy for them to decide to have their implants removed and replaced with natural tissue. If your reconstruction is presently aesthetically acceptable to you (other symptoms notwithstanding), then the issue of what to do is significantly less clear-cut.

Best of luck, and let me know if we can be of any further assistance.

Dr. Richard M. Kline, Jr.

Center for Natural Breast Reconstruction

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

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Ask The Doctor – Can A Saline Implant Leak Long After Surgery?

August 1, 2014 by

<alt="pink blossoms"/>

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

QUESTION: Can a saline implant slowly leak approximately 16 months after surgery? Also, can a bacterial or fungal infection occur during this time? I am hearing and feeling a gurgling sound in my right breast which I believe is fluid. I am concerned because I read that an implant can leak out and cause fungal and bacteria infections.

ANSWER: Thank you for your question! A saline implant can leak at any time after surgery. The leak can be slow or sudden. Eventually, you would notice the size go down. Implants are normally filled with sterile saline that would not cause an infection. If you have an infection it most likely would not be from the fluid that was in the implant. Usually that fluid is absorbed by the body after a leak and causes no medical problems. The best way to get an accurate answer would be to report what you are experiencing to your surgeon who performed the implant surgery.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask the Doctor: What Are My Options For Post-Op Reconstruction Using Implants?

July 11, 2014 by

<alt="pink dahlia"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I’m 42 years old, and I have a surgery this month for breast reconstruction. Due to my genetic history, a plastic surgeon will be performing a double mastectomy. I want to know what my options are for post-op reconstruction? Thanks.

Answer: Hi — Thanks for the information about your planned surgery. If you have requested using your own tissue and were told that was not a good option for you, then you certainly can get a second opinion. You stated that your mastectomies were for preventive reasons, which gives you the time to consider all possibilities. Before having surgery you should feel good about your decision and be confident you know all your options. You have excellent surgeons and I know you will do well.

One advantage of using an implant is that you don’t require an incision anywhere else on your body in order to donate the tissue to make the new breasts. Using your own tissue requires a longer recovery and more healing. The donor area ends up healing with a scar. If you don’t need a tummy tuck or have “excess” tissue in your thighs or buttocks then you may not want a scar in these areas. You should also know that it is not necessary to sacrifice any of your muscles in order to use your own tissue. Finally, it is important to know that if you have implant reconstruction and it does not work out you can still use your own tissue later–even years later! Most likely it will work out and you will have an excellent result and speedy recovery. I hope this has helped. Let us know if you have more unanswered questions. If you would like a second opinion, you could set up an appointment in our office, or we could also consult over the phone if you cannot make the trip to Charleston.

Dr. James Craigie
Center for Natural Breast Reconstruction

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

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Is It Possible to Have My Current Implants Enlarged?

April 18, 2014 by

IFThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a breast augmentation surgery last year in August. I did NOT get a bad surgery, but I can tell the doctor didn’t listen to my wishes about size. Is it possible to have the implants I have now enlarged? Or would I have to have the surgery all over again with new implants? Thanks for your time!

A: If you have saline implants, it may be possible to enlarge them by putting more saline in, but it will void your implant warranty. Also, the more saline that is put in an implant, the firmer it gets, which is not how most people want breasts to feel.
If you have silicone gel implants, they cannot be enlarged, and new ones must be purchased to go larger.
Keep in mind that the larger you go with implants, the less natural your breasts will look. We talk to our augmentation patients extensively before surgery to try and determine what they want in their final result, but we also try to educate them about the relationship between size and naturalness.

Good luck, and thanks for your question!

Q: Hi! I had a breast reduction procedure when I was fourteen. I am 23 years old, and when my nipples get cold, I get a sharp pain in them and it hurts. What does this mean, and should I be concerned?

A: We don’t actually treat breast problems, we just reconstruct breasts that are damage or missing, so I’m not the best person to answer your question.The best person to consult with would be a general surgeon specializing in breast surgery. I’m not sure they’ll be able to help, but it’s worth a try.

Dr. Richard Kline

Center for Natural Breast Reconstruction

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

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I’m Not Happy With My Implants — Is Flap Surgery Possible?

March 28, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a double mastectomy last August with immediate expander reconstruction. My expanders were replaced in January with silicone implants and needless to say I’m not thrilled with them. They are hard, cold and I now have ripples across them. My surgeon is going to remove more excess skin in hopes to alleviate the “wrinkling” effect, but I’m honestly not sure if I even want to have this done. I originally wanted to have a tissue transfer (abdominal) but was advised to try the implant route first.

I know that I don’t have a lot of abdominal fat and would probably end up with very small breasts if I went this route instead. I don’t mind the smallness but am concerned on the dangers of having a tissue transfer and wonder if this would be a better, more natural breast for me. I’m not getting the feeling that my surgeon is comfortable with this type of surgery and would like more information on your facility. I feel like I have so many questions that no one can seem to answer. Is there someone that I can reach out to?

A: We would be very happy to discuss your situation with you. It is very rare for someone not to have enough stomach or buttock tissue, especially with subsequent fat grafting, to provide an acceptable breast size. Flap surgery can be a little intimidating, but our success rate over the last ten years is 98.4%. We have helped many women who have started out with implant reconstruction, only to decide that it was not the right choice for them.
Our nurse Chris or P.A. Kim can call to discuss your situation further, if you wish.

Thank you for your question.

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

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

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Should I Get Permanent Sutures to Help My Implant After Lumpectomy?

January 17, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy followed by chemo and radiation treatment. The tumor was on the inner edge of my left breast — basically skin and bone. My plastic surgeon (whom I respect and appreciate) used an implant and Neulasta. He formed a sling and sewed in to my sternum and ribs. I’ve had this procedure done twice. Each time the sutures were absorbed, the skin lifted and resulted in symmastia. I am wondering if non-dissolvable stitches along with sewing the neulasta to the area behind my breast which wasn’t super blasted  — forming a sort of “sail” would be an option. I would be interested in what you think and what solution you might have.

Thank you for your time!

A: We primarily do flap, not implant reconstruction, but I can still offer some insight.

Permanent sutures could possibly help, but if there is long-term significant force on them (which it sounds like there may be), they can work their way through soft tissue and still come loose (just like an orthodontist can move teeth through bone over long time periods). Nonetheless, it’s probably worth a try, especially if you liked the way your breast looked before the sutures dissolved.

There are also some potential options using your own tissue. Unfortunately, replacing the defect with free fat grafts, while technically straightforward, is a little controversial, as there is some concern that this could increase the risk of local recurrence (but this is far from definitively established). There are centers (one in Boston comes to mind) who are doing this as part of a controlled study. Also, depending on the size of the defect and the location of your scars, reconstruction with a small microsurgical flap might be a reasonable (although significantly more complicated) option.

It sounds like you have a good relationship with your surgeon, which is great. Please continue to share your thoughts with him, and I’m confident things will work out for you one way or another.

Dr. Richard Kline

Center for Natural Breast Reconstruction

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

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Can Small Implants Be Used with Flap Surgery for Added Volume?

July 5, 2013 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: Can small implants be used with flap surgery for added volume?

A: The short answer is “yes, sometimes.”


We have had good success augmenting flaps with reasonable-sized implants in non-radiated patients. In radiated patients, it’s still sometimes possible, but it’s very dependent on how much of the breast mound is covered with flap skin versus radiated breast skin, and what the quality (the technical term is “compliance”) of the radiated breast skin is. Every case is different.

Our nurse or PA can provide you with more information upon request. 

Hope this helps!

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

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

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Removing Expanders and Getting Implants: How Severe is This Surgery?

June 21, 2013 by

This week, Dr. Richard M. Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  I am interested in having tissue expanders removed and putting in permanent implants. How severe is this surgery?

A. Thank you for your question!

We don’t do implant surgery very often, but removing the expander and placing the permanent implants is, generally speaking, pretty straightforward.

 The second stage of expander implant reconstruction involves the removal of the tissue expander, followed by placement of the implant, and creation of the final breast shape. This is an outpatient procedure, performed by opening the mastectomy scar (no new incisions are made) and removing the expander. Before placing the final implant, changes that need to be made to the implant pocket are addressed. These can include repositioning the implant on the chest wall, improving the inframammary fold, using Alloderm or  Strattice to address areas of thin skin, and revising or removing the capsule as needed. The final implant is then placed in the pocket, and the incision is closed. Drains are usually not needed. Placement of the implant will result in a softer, more natural breast as compared to the tissue expander.  According to which of the above procedures are to be performed, you can expect to spend 2 to 4 hours in the operating room.

Feel free to forward any other questions you may have…..We’re always happy to help!

Richard M. Kline, MD

Center For Natural Breast Reconstruction

 

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

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