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What Form Of Reconstruction Do You Prefer? What Type of Implants Are Best?

May 3, 2013 by

Ask the DoctorThis week, Dr. Richard M. Kline, Jr. and Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: What form of reconstruction do you prefer and which requires the least amount of procedures?

A: Our practice specializes in breast reconstruction using your own tissue and without sacrificing important muscles and without implants. Our preferred approach is to give women the option that works best for them! This takes into consideration each person’s situation and body type.

We prefer to transfer skin and fatty tissue from the “donor” area a person happens to have extra tissue. Each person’s body has its own form and shape therefore we prefer to make our recommendations based on where each person’s body has extra tissue to work with. Implant breast reconstruction is usually a shorter recovery because there is no donor site that has to heal. The results with implants are not as natural as using your own tissue and people with implant reconstructions generally have more procedures as time goes by because of changes due to the implants etc..

All types of breast reconstruction may involve multiple steps, usually 2 stages. Sometimes minor adjustments may follow depending on many different variables. I hope this answers your question.

James Craigie, MD

The Center for Natural Breast Reconstruction

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Q: Can implants be used for reconstruction for breast cancer patients? If yes, is there a preference among medical practitioners as to whether the implant should be saline or silicone?

A: Implants not only CAN be used, they ARE used the great majority of the time (as opposed to reconstruction with the patient’s own tissue). Natural breast reconstruction with the patient’s own tissue is a longer, more involved procedure than implant reconstruction, with more serious risks, and is not the best choice for everyone.

Patients who have been radiated as part of their breast cancer treatment tolerate implants poorly as a rule, and for them, natural breast reconstruction may be their only hope for restoring symmetry. On the other hand, many patients who could be reconstructed with implants simply prefer to use their own tissue. Breasts reconstructed with your own tissue are warmer, softer, move more naturally, and are generally much closer to the “real thing” than implants. We have made a conscious decision to limit our practice to this type of reconstruction so that we can optimally serve the women who want or need it. However, implants seem to work quite well for the majority of breast cancer patients.

Richard M. Kline, Jr., MD

The Center for Natural Breast Reconstruction

 

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Replacing an Implant With a Flap: Will My Muscles Recover and Function Normally?

March 15, 2013 by

The following question is answered by  Richard Kline of The Center for Natural Breast Reconstruction.

 

Q: My reconstruction consisted of chest muscle to create a pocket for a silicone implant. I have had it since 2004. They used an expander. It was the best choice for me at the time. If the implant is removed and the muscles are fixed, will they recover and function normally? For example, will I be able to do pushups and bench presses again?

 

A:  Thank your for your question. Although the muscle is replaced against the chest wall when an implant is replaced with a flap, it is impossible to duplicate the strength of the original muscle attachment.

Having said that, most patients function quite well with an implant under the muscle, and I’m hesitant to tell you you’ll see dramatic functional improvement if you convert your implant to a flap.

I hope this helps.

 

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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What to Know Before Seeking Implants as Your Breast Reconstruction Option

January 4, 2013 by

The below question is answered by Dr. Richard M. Kline of The Center for Natural Breast Reconstruction.

I am weighing my options for breast reconstructions and  considering silicone implants. What should I know before I continue—what questions should I ask a doctor?

Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for breast reconstruction, and flaps may be a better alternative in that case.

-Dr. Richard M. Kline Jr.

The Center for Natural Breast Reconstruction.

Have questions for our surgeons? Submit your questions today and get answers straight from our surgical team! No matter where you are in your reconstruction process, we are here to help!

 

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Implant Procedure Without Expanders?

December 7, 2012 by

breast implantsThe below question is answered by the Charleston breast surgeons at The Center for Natural Breast Reconstruction.

Is it possible to have a simple implant procedure without expanders if you have a lot of skin tissue left?

Yes, absolutely, if you are willing to have Alloderm (acellular dermis) used to help support the implant.  We specialize microsurgical reconstruction using your own tissue so we don’t actually do this procedure in our practice but there are plastic surgeons in every metropolitan area who do.  If you are in or near the Charleston area we can give you names of surgeons who are especially good at this procedure.    We know many out of our area too if you’d like to identify where you are located we can see if we know anyone to suggest you consult.

–The Center for Natural Breast Reconstruction Team

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Could I Be A Candidate for DIEP Reconstruction After Implants?

November 16, 2012 by

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

I had a bilateral mastectomy and had 850cc silicone implants placed after tissue expansion. I am not happy at all with the result as I had radiation on the right side and that breast is considerably smaller than the left. I am also not happy with the shape and look of the breasts with silicone implants. I currently wear prosthetics in my bra to achieve symmetry and a normal shape. Even with the bra and the prosthetics I am not happy with the result. I am currently a D/DD and would like to maintain that size. Given this situation, could I be a candidate for a DIEP or Stacked DIEP breast reconstruction?

Thank you for your question. I’m sorry you are having some concerns about the shape and evenness of your breast reconstruction. Because you had radiation on the right side it is almost certain that the two sides will be different to some degree regardless of the type of reconstruction. Unfortunately, when this occurs with implant techniques it is usually more noticeable and nearly impossible to fix long-term as long as the implants are in place. The reason for this is the implants will be treated as foreign material by your body and the right side will always react more severely due to previous radiation even if radiation was done before the mastectomy. Also, the process of scar formation continues as long as the implants are in place, making the firmness, shape change, and stiffness more noticeable to you as time goes by. These are the reasons that women who have implant reconstruction have multiple procedures to revise results as time passes.

Fortunately when someone has had problems of this nature with implants we can frequently solve them by removing the implants and replacing them with their own fatty tissue (DIEP, stacked DIEP). We can do this without taking tummy or back muscles. Immediately the fatty tissue takes on a more natural shape compared to implants. Thirty percent of my patients have had failed implants before we start over and use their own tissue. My opinion and answer to your question is that you could have a DIEP to replace your implants and I can usually predict that many of the implant problems are much improved immediately after the surgery. I cannot predict what size you would be without seeing you but the size depends on how much extra tummy tissue you have as well as any previous surgery.

I hope I have answered your questions.

—James Craigie MD

 Would you like your breast reconstruction question answered? Just ask us!

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Capsular Contracture From Breast Implants

September 28, 2012 by

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

I have had two failed breast reconstructions using an implant. First was placed too high up, and the second one anchored down with abdominal advancement flap. After 5 months the implant began to disappear. MRI proved it was not ruptured. Doctors were not worried  and I was told to stop worrying about it, so I continued on with my life. I then developed chest pain, muscle/ligament/joint/back pain and breathlessness when climbing hills or stairs. Eventually after 2 and a half years, I referred back to PS who told me I had a chest wall concavity due to the implant being forced inwardly under pressure from the scar tissue and muscle. The implant size was 770cc. Will this concavity “spring” back into place or will I have it for the rest of my life? Also what effects might this have on my body if my frame is being pushed out of alignment?

Hello,

Thanks for your question. I’m sorry you have had these problems. We see people whose chest wall and ribs become indented due to implants quite frequently. The problem develops because body reacts to the implant by making scar. We call this capsular contracture and in some people it can exert tremendous force due to constant pressure. The process will persist as long as you have an implant. We have not performed scientific studies to prove the ribs return to normal but we have treated hundreds of patients with this type of problem by removing the implants and replacing them with their own tissue with out taking their muscles. This has solved their problems related to implants permanently. I hope this answers your question, let me know

James Craigie, MD
Center for Natural Breast Reconstruction

Get answers to your questions about breast reconstruction straight from our surgical team! Submit your questions here today.

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Can Natural Breast Reconstruction Correct Pain, Cosmetic and Functional Issues Caused by Implants?

August 10, 2012 by

The below question is answered by Richard M. Kline Jr., M.D. of The Center for Natural Breast Reconstruction.

I am 44 yrs old. I had a lumpectomy/chemo/radiation for my left breast in 2003 and I  had a mastectomy on my right breast 2009. I went ahead and did a prophylactic left mastectomy as part of my reconstruction process. I had a Latissimus dorsi muscle flap on my left breast and started the process in September of 2009. Apparently, some nerve that was to be severed was not and I now have constant spasm/pain that I of course, still need to camouflage in my clothing choices. The implant is not under the flap, its just below my collar bone. Now, is it possible to reverse this type of surgery as the symptoms are painful/disabling? Can this type of surgery be revised? Is there any other option for me for function/pain/cosmetic-symmetry?

Thanks

Hello,

Sorry to hear about your problems. I obviously can’t say for sure what you need based on this limited history, but here are a few thoughts.

If you are referring to the thoracodorsal nerve that “runs” the latissimus, that can certainly be divided with additional surgery. However, I can’t say for sure that that is the source of your pain. If your implant is very high, and especially if it is hard, you may have capsular contracture, which can be very uncomfortable, especially in a radiated area. It is also possible that the spasms are in your pectoralis major muscle, which is (or should be) in front of the implant.

If you have adequate donor tissue in your abdomen or buttocks, it may well be possible to “discard” your entire L reconstructed breast, and replace it with a breast made entirely of your own tissue. We have done this many times in similar scenarios, and most patients seem to be significantly happier afterwards. However, I must stress that operating for symptoms of discomfort is not guaranteed to work, and involves other risks.

If you’d like to send photos of potential donor areas, or have our nurse or PA call you for more info, we’ll be happy try and give you more specific advice.

Richard Kline

Center for Natural Breast Reconstruction

Best of luck to you, and please feel free to ask any more questions you may have.

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What are the Symptoms of Capsular Contracture from an Implant?

August 3, 2012 by

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

What are the symptoms of capsular contracture from an implant?

Capsular contracture is commonly described using the four-grade Baker Scale.

  • Grade I — the breast is normally soft and appears natural in size and shape
  • Grade II — the breast is a little firm, but appears normal.
  • Grade III — the breast is firm and appears abnormal
  • Grade IV — the breast is hard, painful to the touch, and appears abnormal

The symptoms can be varying from mild to severe.  Mild capsular contracture may only be detectable by your surgeon.  If the process worsens and becomes severe it may lead to changes in the breast that a person easily could tell themselves.  In other words, the shape may change, the breast may become different in shape, and clothes may begin to fit differently.  The breast may become hard and the skin and tissue over the implant can change in appearance and color.  The most severe problem related to capsular contracture would be pain and discomfort that may eventually limit the range of motion and movement of the shoulder and upper body.  Some patients relate symptoms that they describe as an “iron bra” across the chest when the scar is so thick and tight.  The chest feels like it is wrapped in something as wrapped in an “iron bra” all the way around.  Sometimes the process can worsen and actually press in, move the muscles away from the breast area, and change the shape of the ribs.  This would be the most severe form of capsular contracture and at that point we would recommend removing the implant and replacing the reconstruction with a muscle-sparing procedure.

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What are the Next Steps if Capsular Contracture Occurs from a Breast Implant?

July 27, 2012 by

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

What are the next steps if capsular contracture occurs from a breast implant?

The next step would depend on how severe the capsular contracture is.  All implants will develop a capsule and this may slowly lead to changes in the shape or in the most severe cases painful scarring and hardness.  When symptoms develop it may be necessary to surgically intervene.  The next step would depend on whether the patient has had radiation and the available options for reconstruction.  The first step and the least involved regarding surgery would be capsulotomy or release of the scar. Sometimes the healing process, whether there was an infection or a bruise around the breast, could have increased the risk for capsular contracture. Other times it may simply be the body’s reaction to an implant.  If after capsulotomy or capsulectomy the contracture has not resolved, the next step would be to consider moving additional healthy tissue to cover the implant or to remove the implant and replace it with your own tissue.  30% of our patients who choose to undergo autologeous reconstruction have had prior implant reconstruction and their bodies have developed severe capsular contracture.  If someone has had radiation, the capsular contracture will be more severe and most likely once problems develop the problems will continue.  Therefore, when multiple capsular contracture procedures have been necessary; our recommendation would be to consider removing the implant and replacing it with your own tissue using a muscle-sparing procedure.  Your own tissue would not develop capsular contracture and it is the most successful way to solve problems resulting from implant reconstruction.

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Your Questions about Natural Breast Reconstruction and Implants Answered

March 9, 2012 by

implantsThe following submission below is answered by Dr. James E. Craigie, of The Center for Natural Breast Reconstruction.

I had breast reconstruction in 2009 with implants and am unhappy with the result.  How hard is it to go back and do reconstruction with your own tissue?  What is the recovery time and does insurance give you a hard time if you need to do this?

Sorry that you are having so many problems with your implants, here are several things you need to know.  First of all, if someone required a mastectomy and their insurance company offers coverage for mastectomy; there is a federal law that mandates that insurance company to cover breast reconstruction.  If one technique did not work for you or failed, you are still eligible for another technique.  In our practice, 30% of our patients who undergo reconstruction with their own tissue have had failed implants.  Implant failure can be many different things.  Some people lose their implants because of infection; some have had radiation effects that contributed to rejection of the implant or hardness, while others simply have a result that is not satisfactory to them.  Other factors such as problems with implant itself or leakage can be reasons for implant failure as well.  Depending on exactly what your situation and original surgery was, the challenges of reconstruction following implants can include repair of the chest muscle, removal of leaking silicone, or removal of Alloderm if that product had been used during the initial reconstruction.  All of these things do make the reconstruction more challenging, but certainly our most successful technique to solve this problem is to remove the implants, any leaking implant material, the Alloderm, and the hard capsule that had formed around the implant and replace all of this with your own healthy living tissue.   Our preferred way to do this utilizes muscle-sparing techniques such as the DIEP or GAP, using just your fatty tissue to replace the implants.  Compared to someone who has not had failed implants, you may require an additional one or two revision stages of surgery and may require more time to allow the results to settle and overcome the effects of the previous surgeries.  These issues do make the process more complex, but the success rate among our patients is very high and the completed result is permanent and natural feeling which our patients who have had implant failures report to be their main goal. The recovery time for these types of surgeries is always patient dependent and generally longer than surgeries utilizing implants but our patients are usually back to work anywhere between 4 to 6 weeks.  I hope this has answered your questions and if you have any others I can answer, please feel free to forward them to us.

Do you have a question about breast implants or natural breast reconstruction? Submit your questions here to be answered by our team!

 

 

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