Search Results for: implant

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

Question: Had a radical on one side and a more common one on the other due to cancer. Can you help?

Answer:  If you have some extra skin and fat on your abdomen, buttocks, or thighs, then there may be a good chance we can use that to reconstruct you. It can be very difficult or even impossible to reconstruct a radical mastectomy defect with an implant, but if we are able to use your own tissue it could potentially be very straightforward, depending on the particulars of your situation.

I would be happy to call 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!

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

Question: Due to a family history of breast cancer I had a bi-lateral subcutaneous mastectomy with saline implants, all in one surgery. The result was not good. My chest muscles did not stretch/relax, the implants did not drop. Not only are they misshaped they are painful, in that my chest feels tight. My surgeon went into my arm pits and cut the muscles in several places to relieve some of the restriction. There was no relief.

I have indentions in my breasts from that procedure. Using my arms, lifting, vacuuming, etc. is sure to produce more discomfort. I have gained some weight, and wonder if I could use my own fat, including implants to relieve this discomfort and regain some measure of self confidence. In thinking back, I have missed so many things because of the discomfort as well as feeling like a freak, I have absolutely been depressed.

I was widowed in my 30’s,and had this surgery shortly after my husband suddenly died from a MI. I had two young children to take care of and had this surgery as a prevention. My result was so poor…I have never accepted a date. Your opinion will be appreciated. Thank you.

Answer:  Thank you for your question. I’m sorry you are having problems with your breast reconstruction. Specifically regarding your question there are possible options that could help. It is possible that using your own fat and moving your implant from below the chest muscle to above the chest muscle could help improve your result.

One drawback to implants over time is that your body can develop more scar as time goes by. This scar can make the new breasts hard and cause tightness. Some people will not do well with implants because they make more scar than normal. In that case it may be better to rebuild both breasts without implants.  This procedure is more complex but includes removing the implants repairing the chest muscle and rebuilding the new breast with fatty tissue from another part of the body that has extra fat.

I cannot tell you what option is best for you without more specifics about your medical history and previous surgeries. If you would like more information let me know my staff would need to contact you for the details.

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 am having mastectomy in January; I would like to know about the TUG procedure – if it can be performed following a mastectomy or does it have to be done at the time. I should not be receiving chemo or radiation. My surgery is in Houston ( MD Anderson ). I live in the Nashville area.

Answer: We do not recommend the TUG flap under most circumstances. A significant incidence of lower extremity lymphedema has been reported following its use, and it is often not large enough to provide a satisfactory breast mound by itself. In addition, the donor site is prone to wound healing problems, and the donor site scars can be difficult to conceal.

Our first choice for autogenous breast reconstruction is the DIEP flap from the abdomen, which is a tried-and-true technique. If this donor site is not available, we recommend the SGAP donor site from the upper buttock. The sGAP can produce arguably the best breast reconstruction of any donor site, but is difficult to perform, which usually means the patient needs to travel to get the necessary surgical expertise.

The PAP (profunda artery perforator) flap, which comes from the “banana roll” of the posterior thigh, is our choice if neither the DIEP nor sGAP are available or adequate. It provides about as much volume as the TUG, but has far less risk of lymphedema, and a dramatically better donor site scar.

Any of these flaps can be done at the time of mastectomy or later, with the caveat that you never want to let a flap get radiated, as it can “shrivel up” dramatically. There are advantages to doing the flap at the same time, and advantages to waiting, but probably most of the time it is better to do it at the same time, if possible.

For completeness’ sake, it bears mentioning that if you are not receiving radiation, you may be able to get a satisfactory reconstruction with implants. However, even the best implant reconstruction does not approach the “naturalness’ of a reconstruction using your own tissue.

Thanks for your question, and good luck!

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 5/2/16. The plastic surgeon placed expanders on both sides with the intention of doing reconstruction surgery in 6 months. I was diagnosed with pre-cancer stage 0 dcis in situ but genetic testing showed I was positive for the BRCA2 gene which led to the double mastectomy. The left expander had to be removed due to thin tissue that wouldn’t knit together and I had a wound vac in place for 10 days. I was thinking of getting natural reconstruction but since I have the right expander was told that it would have to be removed along with the dog ears skin on both sides. I am 64 and don’t know what to do.

Answer: I’m sorry you have had so much trouble so far.

You have already had trouble with implant (expander) – based reconstruction, and that could make it more likely that you will have trouble in the future with additional attempts at implant reconstruction. Fortunately, however, previous failed attempts at implant reconstruction almost never reduce the chances of having successful reconstruction with your own tissue (assuming that you are otherwise a good candidate for that).

Because you have had a somewhat complicated course thus far, apparently with some tissue loss, I would appreciate the opportunity to evaluate you in person, if possible, before giving you any more specific advice. We will give you our honest opinion about what we believe your best options are, whether using more implants or your own tissue, and then even of you just decide to have your expander removed, you may feel better about your decision. If you wish, we can have our P.A. Kim or nurse Chris call you to discuss your situation further.

Thanks for your question.

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 prophylactic double mastectomy 9 years ago. I am BRCA 1 positive and have lost several family members to both breast and ovarian cancer. I would like to have my silicone implants removed and have the DIEP surgery. However, I don’t know if my insurance will cover this procedure and how being out of state will affect the payment of it if it is covered.

Also, I am one of Jehovah’s Witnesses and I wanted to verify the surgical team is okay with performing bloodless surgery. Maybe this surgery is designed to be bloodless but I wanted to make sure everyone is comfortable with working on Witness patients.

Answer: Thank you for your question. Yes we frequently help women who have problems with their implant breast reconstruction. If you feel like you have extra tummy tissue there is a very good chance that removing the implants repairing the chest muscle and rebuilding the breasts with the DIEP procedure would be our recommendation.

I am very familiar with the Jehovah witness faith regarding surgery and blood products. I have quite a few patients and would be glad to discuss this with you. Let me know if you have more questions or if you would like to arrange a time to discuss your situation.

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: After having surgery, radiation treatment left my breast very small so I want to know if I may be a candidate for a procedure to rebuild my self-esteem. I had a complete mastectomy after the radiation on the right breast.

Answer: Yes there is definitely a chance that you could have your breasts reconstructed. After radiation I would usually recommend options that use your body’s own natural tissues because after radiation implant options are higher risk for problems. If you still have your left breast but it has developed shape problems because of surgery and radiation then there are options that can help. It may be best to rebuild both breasts at the same time to achieve better symmetry.

After radiation we usually wait a period of time (approx. 3 months) before performing reconstruction. Any time after that is usually ok. For more specific information I would require more of the details of your situation, medical history and prior surgery history. Thanks for your question. I hope this helps. Let me know if you would like more information.

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 implants put in 33 years ago, got breast cancer, had a lumpectomy, radiation, and got rock hard implants as a result. I just recently decided to have the implants removed and a great deal of scar tissue. They put in expanders that caused me to get an infection. I had to almost beg them to believe me as the pain was horrific. I had a 2nd doctor remove the expanders. I now have a very deformed left breast and a severely drooping right breast. I contacted the doctor who put my implants in years ago. He is no longer in the area, but told me about this procedure.

I guess my question is if this procedure would be successful for me? I do not like the way I look, and it is painful as well. I am a teacher, and would need to know the time frame this would entail. It has been a horrible summer with this ordeal. I almost wish I left the rock-hard implants in. Please let me know what you think. I am very much interested in hearing your thoughts. 

Answer: Thank you very much for your question. I’m sorry you have had so much difficulty. Your situation is unfortunately quite common, but the good news is that natural breast reconstruction with you own tissue can often help dramatically. Fortunately, a history of radiation (&/or multiple failed attempts at implant reconstruction) does not at all decrease the success rate of subsequent reconstruction using only your own tissue. We have successfully reconstructed hundreds of women in your situation.

Our first choice for a donor area, if you have some extra tummy tissue, is the DIEP flap. If you do not have adequate tummy tissue, the buttocks (sGAP flap) is also often an excellent donor area.

It is important to realize that natural tissue reconstruction is not just an operation, but a process. The first operation, the microsurgical transfer of the flaps, is by far the largest. It usually takes 6-8 hours, requires a 4 day hospital stay, and a total stay in Charleston of about a week. Recovery takes approximately 6-8 weeks.

After you have healed fully from the first surgery (usually 6 months if you have been radiated), 1-2 additional surgeries are required to achieve optimum results. These are much less involved, ordinarily requiring only one night in the hospital, and you can usually go back home as soon as you are discharged.

While the process can be lengthy, once you are done, you are REALLY done. Most women reconstructed with their own tissue come to regard their reconstructed breasts as their own, and are finally able to put the issue of breast cancer behind them.

I would be happy to call and discuss your situation in more detail, if you wish, and thanks again for your question.

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 mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had.

The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast. I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere.

As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much!

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best. Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue.

If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles. The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

Question:  Thank you very much for taking the time to answer my email!

I appreciate the options you are giving me without sacrificing the muscles of my body. I wasn’t so thrilled about that kind of surgery. As I read your website, I understand that you do that surgery. Do you see good long-term results with DIEP or sGAP?

Answer: Yes. When using your own fatty tissue the long-term results are typically the most natural of all the options. When the process is successfully completed the fatty tissue is living tissue that never deteriorates. In other words the results should be permanent. Implant techniques tend to deteriorate over time due to the fact that the implant is not living tissue. Implants can leak, move out of position or need to be removed secondary to infections.

Also the body can reject them because they are a foreign body. Long term results from techniques that remove or sacrifice important muscles can have long term problems associated with removing the muscle. Furthermore the breast is not made of muscle so muscle should not be needed to make a new natural breast after mastectomy. Every situation is different and perfect results are not guaranteed with any approach. No one technique is best for every individual.

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: Hi! I had a mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had. The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast.

I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere. As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much! 

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best.

Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue. If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles.

The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

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 have breast cancer Stage 1 grade2 in my right breast. The surgeons here want to use my latissimus dorsi muscle for reconstruction. This is unacceptable to me because I am very active and snow ski and garden etc.

I think this method runs too much of a risk to my future ability to do things I like to do. I had lipo on my lower abdomen years ago. I do have more than enough fat on my upper abdomen. Can that be used? I am not comfortable with what I have been told so far.

Answer: Thank you for your excellent question! I’m sorry you are having to go through breast reconstruction and breast cancer treatment. You make a very good point and I agree that you should not need to sacrifice your bodies important muscles in order to restore your body after having mastectomy.

In some circumstances it may be necessary but you should know that there are options that use your own natural fatty tissue without sacrificing your important muscles. You should also anticipate that you can continue to be active as before surgery. In our practice we frequently help patients who have had tummy lipo or other surgeries that make the tummy fat inadequate.

We can also use fatty tissue from the buttock or thigh area without sacrificing muscles or using silicone breast implants. Let me know if you would like more information.

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