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Ask The Doctor – Will My Weight Impact My Breast Reconstruction Surgery Goal?

August 22, 2014 by

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

QUESTION: Hello, I’m a breast cancer survivor. My doctors will not do a reconstruction because they say I have to lose weight. The medicine I’m taking causes me to have body aches and pains, and I’ve gained weight because of it. I’m also afraid that my cancer will return. I’m financially strained and really feel left behind when it comes to improving my body; I want to feel whole again and wanted. I just turned 50 and have been cancer free since June 2011. I’m excited to have another chance to live, but I want to feel like a whole woman again with complete confidence. What are my options? Thank you for your time.

ANSWER: Hi there, I’m sorry you’re having these problems, but we will help if we can. We have learned from hard experiences that it can be dangerous to do reconstruction with your own tissue (we do not do implant reconstruction, as a rule) in patients who are significantly overweight. That being said, the guidelines for using tissue are not strictly rigid, and it depends to some extent on how the extra fat is distributed in your body. If you would like to investigate further, we could have our nurse Chris or PA Kim call and chat with you. Thanks again for your inquiry. Have a great day!

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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Ask the Doctor – Will Insurance Cover the Reconstruction of My Breasts?

August 8, 2014 by

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

QUESTION: When I had breast cancer in 2010, I didn’t have any insurance. Now, I have great insurance and I want to undergo breast reconstruction. Will insurance cover the reconstruction of my breasts?

ANSWER:  Hi there. Thank you for your question. If you have had a mastectomy for breast cancer reasons and now have insurance, then you should be covered. There is no time limit between having a mastectomy and undergoing breast reconstruction. You should be covered, but make sure you call your insurance company and check what procedures your insurance will take care of.

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: Will Scar Tissue Buildup Be A Concern With The Gap Flap?

July 25, 2014 by

 

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

Question: My wife had a double mastectomy 10 years ago. At that time she had latissimus surgery to fill in her breasts. Since then, we’ve had numerous surgeries, about every 2 years, due to scar tissue building up in 1 of the 2 (or both) breasts that causes tightening and even pain. Will scar tissue buildup be a concern with the Gap Flap? 2. Regarding the Gap Flap procedure, what is the rate of failure that you experience with any of the 4 surgery sites (2 buttocks, 2 breasts)? Thanks.

Answer: Hi — I’m assuming your wife has implants under the latissimus flaps, which would explain the buildup of scar tissue. GAP flaps are generally large enough to make a breast by themselves (obviously, sizes differ among different people), so implants are not needed, and internal scar buildup would be a very rare event. We last calculated our statistics in October of last year. Over 10 years, we did 217 GAPs, 49 as unilateral, 168 as simultaneous bilateral. The GAP flap survival rate was 97% overall. All of the failures were in bilateral cases, but no patient lost both flaps, yielding a simultaneous bilateral flap survival rate of 96.4%. We have done quite a few GAPs since then with no failures (most recently a simultaneous bilateral last week), so the current statistics are actually a little better than that. We don’t bury flaps, and therefore can’t miss (or ignore) a failure, so these are ironclad statistics that could survive a GAO audit. To our knowledge, only Dr. Allen (who invented breast perforator flaps and trained the rest of us), his ex-partners in New Orleans, and ourselves actually do simultaneous bilateral GAP flaps on a routine basis. I’d be happy to discuss your situation further if you wish, just call or email.

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 Natural Breast Reconstruction?

July 18, 2014 by

 

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

Question: I had right breast ductal carcinoma, Stage 2. Two out of 22 lymph nodes had cells. I did a gene test, and had both chemo and radiation. The expanded radiation destroyed it. I had a mastectomy in Charleston, and now I’m ready to have my breasts fixed. I don’t want to have implants. I’d rather have a reconstruction using my own body fat and tissue. What are my options?

Answer: Hi — I’m sorry you’ve had so much trouble, and hopefully things will continue to improve for you. Your history of radiation fortunately has no bearing on our ability to do a reconstruction using only your own tissue. Many of our patients initially had failed implant reconstructions elsewhere, only to be later successfully reconstructed with their own tissue. Please feel free to come by for a consultation if you live locally, or, if you’d rather, we can arrange a phone consultation. Thanks for your inquiry, have a great day!

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: Questions About Reconstruction Surgery Years After A Mastectomy

June 27, 2014 by

<img src="image.gif" alt=A pink rose" />This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I have been cancer free for 4 years, and have been very undecided about reconstruction. My surgery removed the underside of my right breast. I am very lumpy and the scar is very hard. Would I need to have a reduction in the other side or can the surgery site be repaired? I am “usually” a D in size currently. Also, is this surgery considered a “tummy tuck” type operation?

A:  You have several potential options, depending on your present physical situation, and your wishes.

I’m assuming you are radiated (please correct me if I’m wrong). With this in mind, an implant to increase the size of the right breast is not likely to work. Increasing the size of the right breast with a DIEP flap (I assume this is what you meant by “tummy tuck”) is potentially a large operation for a lumpectomy defect, but sometimes it is actually the best option.

If you don’t mind being smaller than you were, reducing the size of the left breast may well be your best (and simplest) option to get better symmetry. That’s probably all I should try to say without knowing more details about your particular situation. We’d be happy to have our nurse Chris or PA Kim call you to discuss your situation further, if you wish. Thanks for your question, and have a great day!

Q: I had bilateral mastectomy in 2011, but didn’t have insurance. Now that I do have insurance, can I get reconstructive surgery? And how do I go about it?

A:  Thanks for your question. There is no time limit to when you can have reconstruction surgery. Your next step would be to start researching what kind of procedure would achieve your goals. If you’d like a permanent reconstructive procedure, the ones we offer might be what you are looking for. We use excess tissue of your abdomen, buttock or upper thigh and transfer that along with it’s blood supply to build a new warm natural breast.

Richard M. Kline, Jr., MD
The Center for Natural Breast Reconstruction

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After Multiple Grafting Procedures, What Are My Options to Finish My Reconstruction?

May 30, 2014 by

1401377_roseThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a RB mastectomy in 2008. Since January 2013 I have had 6 micro-fat grafting procedures with my current surgeon. After the fifth procedure, some of my radiated skin failed. The sixth procedure was Apr 4, 2014 and he sewed up the open wound, did a reverse abdominoplasty fat transfer to create a breast fold, and transferred some fat. I am not confident that my skin will stretch sufficiently to finish this process satisfactorily with additional fat transfer and want another opinion, and to evaluate other procedures, before I proceed.

My belly fat is still intact but would be the next place to go. Several patients I’ve corresponded with online have been in a similar position and recommended Dr. Richard Kline. Any advice?

A: Thank you for your question and I am sorry you are having problems. You mentioned that your tummy fat was intact. Does that mean no lipo in that area? If so using the tummy skin and fat may be a good option. Other options include fat from the buttock or thigh. We will have Chris from our office contact you for some additional information and photos. We can then set up a consult via Skype or phone with myself or Dr. Kline. Thank you again for your question.

Q: I would like to set up a consultation about the possibility of replacing my implants from breast reconstruction after a bilateral mastectomy with my own tissue. I’m not happy with the results of my reconstruction.

A: I’m sorry you are having problems with your implants. I will be glad to have my office contact you and schedule a consultation. They will need to get some information about your situation etc. We do frequently treat women who have had implant problems. Approximately 1/3 of our patients have come to us because of implant problems. We specialize in replacing your implants with your own tissue and preserving your muscles.

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 There a Time Limit on my Breast Reconstruction Options?

May 9, 2014 by

1418214_blue_flowerThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a right mastectomy in May 1995 with 12 nodes removed at age 42. Then I received chemo for 3 months. Can I still have a reconstruction done at this point? How long is the recovery time? I work as a nurse on a cruise ship and am often 3-4 months away from home with varying times home (anywhere from 10 days to 3 months).

A: Thank you for your question. There is no time limit for breast reconstruction after having a mastectomy. The recovery depends in general on what type of reconstruction you had. If you did not have radiation you may have the option of implant reconstruction or reconstruction with your own tissue. Recovery from using your own tissue in general in longer and for our patients 8 weeks after stage one is typical. With more info I could be more specific. Let us know we could contact you for more details.

Q: I had a flap with reconstruction about 17 years ago. The right side is smaller than the left, and I would like to get them back to the same size, as well as get my nipple finished on the reconstruction. Is this still possible?

A: You can always have your reconstruction completed. There is no time limit in general. In order to proceed, we need to know what type of breast reconstruction you received 17 years ago (for instance, implant or using your own tissue). If you contact our office with more details, but we’re happy to discuss your options.  Thanks for your question!

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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Will Reconstruction Improve the Shape and Size After My Lumpectomy?

May 2, 2014 by

1426157_white_rose_1This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy and radiation in 2004. The defect in my breast is increasingly more noticeable (clothed) than in the past. Now, I’m interested in reconstruction to improve shape & size of my breast. Do you have any advice?

A: Lumpectomy defects can be challenging, for several reasons. Firstly, the tissue is radiated, which of course makes ANYTHING less likely to work. Secondly, there is no really satisfactory way to reliably replace the volume that was lost, precisely where you want it. Sometimes a small implant can be helpful, but not always. If the defect is large enough,  a microvascular flap of the type we do can be used, but often this seems like overkill for the size of the defect. Free fat grafting (sucking fat from elsewhere and injecting it into the breast) might be as close to an ideal solution as possible, and some surgeons do it currently, but it has not been established with certainty that this does not increase the chance of cancer recurrence, so we are holding off on that procedure until more evidence is in.

In many lumpectomy / radiation breasts the entire breast envelope, including the skin, has shrunken significantly. This often presents the option of re-arranging (with surgery) the remaining breast tissue to improve the shape, then subsequently lifting or reducing the other side to match as closely as possible.

Hope this helps. If you’d like to send pictures, I can possibly give you more specific suggestions. If you’d to speak with our nurse Chris or PA Kim to give them more information, they’d be happy to give you a call.

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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Mastectomies and Expanders: Your Questions Answered

April 25, 2014 by

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

Q: Both my mother and my aunt have been diagnosed with breast cancer. If I were to get a mastectomy, would it be covered by insurance in the state of Pennsylvania?

A: The situation with “high risk” patients and prophylactic mastectomy seems to be evolving. If you are tested and found to have the BRCA gene, most or all insurers seem to be covering mastectomy and reconstruction. Even if you do not have the BRCA gene, but have a strong family history such that your medical oncologist recommends mastectomy, your insurer may well cover it. There may be other laws specific to this in the state of Pennsylvania of which I am not aware, but possibly Gail, our office manager and insurance specialist, can help you more.

Q: I had breast cancer in my right breast, and received a double mastectomy in November. They placed expanders in both. I didn’t have any trouble on the left side. However, six surgeries later, I opted to have my right-side expander removed. It feels better. However, I am now scared to undergo reconstruction due to this past trouble with my right expander. I still have the expander in my left breast. Any advice for me? Is it common to have trouble with expanders?

A: Sorry you are having trouble.

Unfortunately, trouble with expanders is pretty common. It’s more likely if you were radiated on the “problem” side, but it also happens with some regularity even if you aren’t radiated.

Fortunately, previous trouble with expander or implant-based reconstruction does not adversely affect your ability to have natural breast reconstruction using your own tissue. Many of our patients come with stories very similar to your own, some already having had over 10 surgeries, and almost all have subsequently achieved satisfactory, natural-feeling reconstructions without the use of implants.

I think there is an excellent chance that we can help you. If you wish, we can have our nurse Chris or P.A. Kim call you to discuss the specifics of your situation in more detail.

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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Tram Reconstruction and Recurring Cancer in Breasts–How Should I Proceed?

April 18, 2014 by

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

Ask the DoctorQ: I had a mastectomy on my left breast with the tram–which partially failed–then Latisimis Dorsi surgery. I now have breast cancer in my right breast. What is the likelihood of decent symmetry and matching both breast shapes during this procedure?

A: I’m sorry to hear about your new diagnosis. In our practice, we have treated quite a few people referred to us with similar situations. We do not perform tram reconstruction but instead use the skin and fat of the lower tummy without taking the tummy muscle. If we have a patient that later develops a second breast cancer we would use skin and fat from either the upper buttock or the back of the upper thigh below the buttock. This can create a very good match for the tummy fat or a tram reconstruction. I would be glad to give you a more detailed answer with more specific information about your situation, let me know. I do think you most likely have good options without needing to give up any other important muscles. For more specific answers I will need to have my staff contact you for more details about your medical history.

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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