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Ask The Doctor-Will you give me your second opinion on insurance coverage?

March 13, 2015 by

This week, Gail Lanter, CPC, of The Center for Natural Breast Reconstruction answers your question.

Question: Do you accept BCBS insurance from Ga? I had a double mastectomy a year ago and breast implant reconstruction. I’ve had to have both taken out their weeks apart due to one being infected and one implant exposed. I would like a second opinion on where to go from here.

Answer: I’d have to see your card and check your plan to be completely certain, but we do participate within the Blue Cross Blue Shield Blue Card Nationwide Network.  Does your card have a little suitcase on the bottom corner that looks like the one below?

BlueCross Blue Shield insurance card example

 

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

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Ask The Doctor-What could be causing the cramps in my breast?

February 27, 2015 by

5987018633_ca7f1c6f97_mThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I am 70 years old, and 5 years ago had a bilateral with reconstruction. Since then, I have had severe cramps in both breasts and they can even tie a knot in my stomach I can feel knot up when I cough. These are not like stomach pains, they are very painful, hard cramps like one experiences in the calf of their legs….I asked my Plastic Surgeon about them, and he just said he had never heard of cramps in breasts. I can cause my breasts to cramp by simply turning over on. My side, raising my arm or reaching around for something…I’m a tough ole broad, but these cramps make me nauseous they hurt so bad…have you any experience with this? Thank you so much for your time.

Answer: Thanks for your question. I’m sorry you’re having a difficult time. Painful cramping suggests muscles are having spasms. Normally the breast does not have muscle but the chest muscle is underneath the breasts and can have spasms for different reasons. The explanation could possibly be related to the type of breast reconstruction. If you have implant reconstruction the implants are often placed under the muscles. If the body rejects the implants or develops scaring that tightens around the implant the distortion can cause muscle spasm. If you had reconstruction using one of your body muscles to rebuild the breast,  that too could possibly be related to the cramping pain. If the muscles from the tummy wall were used to rebuild your breast or breasts that might explain the “knot in your stomach”. I would need more information to let you know what I would recommend. What type of breast reconstruction did you have? Do you have implants and did you have radiation to the breast? Thanks again.

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

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Ask The Doctor-What can be done with unsatisfactory reconstructive surgery results.

February 13, 2015 by

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

Question: I am 3 yrs s/p bilat mast, chemo and L radiation for stage 2 lobular cancer. I received good reconstructive surgery, but I am unhappy with the cold temperature of my breasts and especially with the hardness/immobility of the L breast which had radiation. Can anything be done? Thank you!

Answer: Thanks for your question. When breast reconstruction with implants doesn’t work out, or if the breast feels cold or hard, an option may be replacing the implant with your own fatty tissue. The end result with your own tissue is more natural and permanent. The downside to this approach is it requires starting over, and you need to use  your own fatty tissue. That means an incision that has to heal and a longer recovery time. We frequently take that approach for patients with implant problems. If you would like more info, please let me know.

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

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Ask The Doctor- Do you do 3T MRI of both the abdomen and the chest before a DIEP flap?

February 6, 2015 by

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

orange flowerQuestion: Hello, I was wondering if you do a 3T MRI of both the abdomen and the chest before a DIEP flap? I would rather not have more radiation, because I had mantle radiation when I had Hodgkin’s 20 years ago and developed breast cancer as a result. Also have you heard of an APEX flap? Thank you for your time.

Answer: Thanks for your great question! We perform preoperative MR Angiograms with an open 3T MRI protocol on all possible patients we have who are undergoing breast reconstruction with a DIEP procedure. We do the same for any of the multiple muscle sparing natural tissue reconstruction procedures we regularly perform. We do not perform MR angiogram of the chest. That would not provide us with any useful preoperative planning information. There are quite a few people who cannot have a MRI. People who have metal knee replacements or breast expanders with metal parts are examples of reasons some of our patients cannot have an MRI. In our practice we have found CT angiograms are not as useful and avoid them if we can because of the increased radiation. As you may be aware, your history of previous mantle radiation may also increase your chances for problems with implant breast reconstruction. I agree that a DIEP may be a very good option for you. I hope I answered your question. If you would like more information please let me know.

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

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Ask The Doctor-Is my inward nipple fixable?

January 30, 2015 by

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

Question: 12 years ago, my cancer left me with a inward nipple, and a surgeon is telling me nothing can be done. I find that in today’s medical world that can’t be true. There must be someone who can fix it or make me one. Just wondering. Thank you!

Answer: The procedure to repair a retracted nipple depends on the reason the nipple is retracted. If you have had lumpectomy and radiation and the retraction developed after scar developed, then a procedure to reconstruct the breast may be the best approach. Do you happen to have a breast implant? Other causes are less involved to fix.

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

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Ask The Doctor-Is the DIEP flap procedure an option for me?

January 9, 2015 by

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

Question:I had a bilateral mastectomy with expanders in October of 2013, followed by chemo and radiation. It is now time for my exchange surgery, but I really want the DIEP flap procedure. My plastic surgeon is hesitant to do the surgery. Is a flap procedure even an option at this point?

Answer: Thanks for your question. Yes it is possible and we frequently do replace expanders or implants with DIEP flaps. In other words the extra skin and fatty tissue from the tummy area. Some people may not have extra tissue to use from their tummy or may have had previous surgery (tummy tuck). In that situation we can usually find extra fatty tissue from another area without removing any of your important muscles. If your surgeon does not think you should do that, ask why. There may be a good reason. You can always get a second opinion if you like. Let me know if you would like more information. Thanks again.

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

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Ask The Doctor- What Can Be Done for Inflammation of Scar Tissue?

December 19, 2014 by

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

Question: I have chronic inflammation of scar tissue after having breast cancer surgery and reconstructed surgery. I have been in pain now for over a year. What if anything can been done to for this?

Answer: Thank you for your question. We cannot specifically give you medical advice by email because we would need more information.  You should make sure your surgeons (plastic surgeon and breast) and oncologists know you are having problems right away if you have not already.  They will be familiar with your history and can make sure you have been checked thoroughly.

We specialize in breast reconstruction and frequently help patients having problems with their reconstruction. The effects of radiation and scaring can lead to problems and pain. We help patients with implant problems by replacing their implants with their own fatty tissue. If you would like more information I would need to have my office contact you regarding your specific situation.

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

Just ask!

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Ask The Doctor-What are the Reconstruction Options for an Overweight Person Who Had Radiation

November 28, 2014 by

pink flowerThis week ,Richard M. Kline, Jr., MD , of The Center for Natural Breast Reconstruction answers your question.

Question: What are reconstruction options for me as an overweight person who had radiation?

Answer: Thanks for your question. Knowing only that you are overweight and have had radiation, I can only speak in generalities, but it may be of some interest to you.

 

Radiated patients are far less likely to tolerate implants than non-radiated patients, so that may mean that you could be better served by natural breast reconstruction with your own tissue. While it can be extraordinarily difficult (sometimes impossible, actually) to achieve a satisfactory delayed reconstruction with implants in a radiated patient, radiation commonly has almost no impact on our ability to reconstruct you with your own tissue, since we are bringing fresh non-radiated tissue to the area.

 

Additionally, implants are only commonly manufactured up to a volume of 800 cc. While this may seem like a lot (and actually is a lot, when used for cosmetic augmentation), it often falls far short of the volume requirements needed by a large patient for a complete reconstruction. Fortunately, there is no firm limit on how large a natural tissue flap can be transferred, except for how much tissue is available. We have in the past transferred flaps in the (1500 – 2000) cc range with success.

Of course, extra weight (also depending to some extent on how it is distributed) can bring additional risks. Extra weight brings an increased risk of blood clots (which can be fatal), and an increased risk of wound healing problems. As a very rough guideline, and, again, with the knowledge that how the fat is distributed makes some difference, we start to get concerned when the BMI exceeds 30 and approaches 35. This doesn’t necessarily mean that surgery can’t be done, just that all of an individual’s specific risk factors and options must be scrutinized very closely before making specific recommendations.

 

I hope this has been of some help. Please feel free to call or email if you would like more information.

 

 

 

 

 

 

 

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Ask The Doctor – My reconstructed breasts are not well proportioned, can you help?

October 24, 2014 by

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

QUESTION: I had a DIEP done at the same time of my mastectomy a few years back. My incisions opened up around both breasts one week after surgery. After about 3 months of my doctor telling me to put Vaseline on them and keep the areas covered, they became very infected. I then got a second opinion.

The next doctor had me on the operating table the next day and probably did a dozen surgeries on me over the next year to get me healed because I was so infected from being open for so long. I’m scared about this, and I’m very self-conscious about my breasts. One of my breasts was set lower on my chest than the other, making wearing bras difficult. The same breast that is positioned lower on my chest is also larger. It is impossible to wear bathing suits comfortably, too. I have to watch how tops are cut on me because they will show that my breasts are uneven. Is there anything your doctors can do to help with this?

ANSWER:  I’m terribly sorry about all the trouble you’ve had – it sounds like a real nightmare. I can’t, of course, guarantee you that we can make you good as new, but I strongly suspect that we can help, as we’ve seen plenty of other patients with similar stories. Probably the best place to start would be to have one of us call you to discuss your situation further, if that’s OK. It would be very helpful if we had some pictures to look at at the time of the conversation, but that’s not essential at this stage. I also suspect you will ultimately benefit from having an MRI at some point, as this is the best way to look for dead fat or other potential problems. Hang in there, no need to lose hope at this point.

— 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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Why Microsurgical Breast Reconstruction?

September 19, 2014 by

<alt="pink flower"/>The access to GAP and DIEP procedures is not widespread, only a handful of surgeons have invested the time to learn this intensely specialized microsurgical procedure, and have access to another equally qualified micro-surgeon to provide the required surgical assistance.

To give you an idea of how few of these surgical teams exist, in late 2007 we were one of only three practices in the country that offered simultaneous bilateral GAP reconstruction.  As a result, we see patients from all over the United States seeking this highly successful option, with 30 to 40% of our patients referred to us as a result of repeatedly failed implant reconstructions.

In a critical analysis of 142 GAP procedures published by six physicians at LSU, the GAP procedure is reported as “not easy to learn; however, it does provide a reliable flap and an excellent aesthetic reconstruction.”  The report further states “overall flap survival was 98%”and perhaps most importantly “patient satisfaction with the reconstructed breast and donor site has been excellent.”

A little bit about us:

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the right questions to ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions. Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • How many board certified physicians will be assisting with the first stage of the procedure? Will there be physicians in training (residents) involved with my surgery
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

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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