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Charleston Breast Surgeon Answers Your Implant and Insurance Questions

January 6, 2012 by

charleston breast surgeonsThe below questions are answered by Dr. James Craigie of The Center for Natural Breast Reconstruction

Should a woman have an MRI follow up every two years after implants to check on things? I’ve been told this.

Let’s go to the source of that information for the best answer . . .

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants . . .

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic.  Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here: http://www.mentorwwllc.com/Documents/gel-PIDS.pdf

Does insurance generally cover redoing of nipples and tattooing?  I’m not completely satisfied with the result of my nipple reconstruction procedure.

Great question . . . Let’s address the insurance portion first. If your health insurance covers mastectomy, it must cover reconstruction throughout all phases. There are some that do not have to abide by this rule, (WHCRA 1998) but they are few and far between. Some may limit the number of times you can undergo a procedure at their expense. The best way to assure they will pay for your procedure is to call the insurance company each time and make sure you have benefits available for the procedure you desire.

Nipple reconstructions can deteriorate over time. Those that seem a little too prominent at first tend to flatten out after a while and may no longer project enough to suit a patient.  Tattoos fade, especially when applied to skin that has a large amount of scar. This being said, repeat nipple reconstructions are a quick procedure routinely performed with local anesthesia and it’s not unusual to require a touch up tattoo.

—James E. Craigie, M.D.

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Breast Implant Alternatives to Adding Volume, Shape, and Projection to a Breast

December 23, 2011 by

charleston breast surgeonsThe below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

In July 2010 I had I-GAP reconstruction. The results are awful. Do you have techniques that can work with a flap and add volume, shape, and projection to a partially recreated breast without the use of implants?

Sorry to hear about your problem, but it’s not terribly unusual to not have quite enough tissue after flap reconstruction. That’s actually good for you, because it means we have some experience dealing with this. The most desirable techniques to try, and in what order, depend on your body type and preferences, but here are some options:

1) Fat grafts: Your fat from anywhere you don’t want it can be harvested with liposuction and injected into the breast mounds in the desired areas. Survival of the fat is not strictly predictable, but often a significant amount remains permanently. Several sessions may be required, however.

2) Vth intercostal artery perforator flap: This is a fancy name we give when we utilize the extra roll of skin and fat that a lot of patients have (& hate) on the side of their chest behind the breast, under the armpit. It is left attached at the front, the skin is removed, and the flap is tunneled under the skin at the side of the breast, then across the top of the breast as far as it will reach. Besides making the breast bigger, this technique has the particular advantages of covering the upper border of the pectoralis muscle (often visible just under the skin after reconstruction), and lifting the breast in what is often a very aesthetically pleasing way. The disadvantage is that it adds a scar under the arm from where the flap was taken.

3) Additional perforator flaps: No one likes to hear this, but sometimes it is the best answer. We have always been able to find suitable blood vessels and add flaps successfully whenever we have had to try this, and the results have been favorable. Definitely not the first choice for most people, but good to know it’s a tried-and-true technique if you absolutely need it.

4) Finally, a small implant under a too small but otherwise healthy flap is often surprisingly well-tolerated, even in radiated patients. Not for everyone, but an option that has been used quite successfully in some instances, nonetheless.

We went through our “iGAP phase” some years ago, and abandoned it not because of the reconstructive results, but because we decided the sGAP donor site resulted in far more favorable buttock aesthetics.

–Dr. Richard M. Kline, Jr.

Share this post with your followers on Twitter. And if you have a question for our breast surgeons, please feel free to send us an email!

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Answering Your Breast Implant Questions

November 18, 2011 by

dr. richard klineThe question below is answered by Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction

I had cancer in my left breast 15 yrs. ago, had the lump taken out, then developed a rather large cyst in the same breast. I had the cyst removed, which left me with only half a breast. I also had 8 weeks of radiation. I wanted a breast implant but the doctor said I couldn’t get one. Since it has been so long, could I now get one? I am 75 but still don’t feel good about my breast. I wear a breast form, but it’s not the same.

It is sometimes possible to reconstruct a lumpectomy defect with an implant, but your history of radiation makes success less likely. To some extent, the size of the implant you would require, and the amount of radiation injury you have sustained, influence the chances for success. Flap surgery, while significantly more involved, is ideal for use in radiated tissues, as it allows us to use healthy, non-radiated tissue to replace what is missing. Age, in and of itself, does not affect the success of either surgery, as long as you are generally healthy.

—Dr. Richard M. Kline, Jr.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by emailing us at blog@naturalbreastreconstruction.com.

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Handling Breast Implant Infections: What You Need to Know

September 30, 2011 by

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

What is the usual process for handling infections with breast reconstruction when tissue expanders are used?

Infections can occur following any type of surgery. The risk of getting an infection after breast reconstruction is low because the immune system can help defend the body from bacteria if they have invaded and are trying to multiply. Antibiotics can also be used, specifically to fight different types of bacteria, following certain surgical procedures. These antibiotics are sometimes given preventively.

When an infection does occur it is because the defense mechanisms have been compromised and the invading bacteria grow. Specifically with implants the bacteria may enter through a wound healing problem. They attach to the implant shell and hide from the bloodstream that normally delivers the body’s immune response, as well as antibiotics.

The management of this type of infection is difficult and almost always requires removing the implant. When the infection resolves and the area is healthy, then it is possible to restart the process. Usually it is 3 to 6 months before it is safe to try another implant. It is occasionally possible to save the implant when the infection has been caught early and treated with antibiotics and surgery to wash the implant pocket and to put a new one in. This approach usually involves antibiotics for a long time and uncertainty about recurrence of the infection weeks or months later when the powerful antibiotics have been discontinued.

It is important to realize that the antibiotics may resolve the outward signs of infection at first, but it only takes the surviving bacteria hiding on the implant to restart the infection when the antibiotics have been discontinued. With each new infection the bacteria may become more difficult to control because of resistance to the antibiotics. At this point, it is usually my advice to consider a new option for breast reconstruction that does not involve an implant. Usually the skin and fat can be transferred from the tummy, buttock or thighs. This can be done without sacrificing any of the important muscles. In my practice, 30 % of my patients have had problems with implants and we can successfully replace implant problems with healthy tissue and obtain a permanent natural result.

—Dr. James Craigie

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Are Implant Problems Affecting Your Life?

May 25, 2011 by

implant problemsBelow is an In Her Words post from one of our patients who came to us with implant problems. Read her story below:

I am so thankful to Dr. Craigie and Dr. Kline and Christina for making me feel at ease. Meeting someone for the first time and having surgery the same week was a lot to take in, but thanks to everyone, including The Center for Natural Breast Reconstruction staff, Christine, and Gillian. And a special, big thank you to Gail for helping me with my insurance and all the conversations we had prior to my office visit with Dr. Craigie. Gail, thank you for making me feel like a person not a number, you are wonderful!

I cannot say enough about the results from my surgery! It was absolutely fantastic to say the least! I am amazed how natural I look! I really am excited to have my follow-up. Can it get any better? I do not have the pain in my breasts or the hardness and pulling from the implant anymore. I can lift my arms straight up over my head now! I noticed that I don’t have the flu-like feeling anymore—it’s gone!

Before coming to Dr. Craigie’s office, I have had five painful surgeries with implants and expanders going wrong with infections, plus lengthy hospital stays and home care. This was over a period of four years—four years taken out of not only my life but also my family’s life. Just think of how much time and money was wasted on paying insurance companies when I could have had only one surgery and a follow-up! If I only knew there was an alternative option before having my first implants.

My goal is to get the word out. Women need to know that you do have an alternative, besides using implants. Utilizing the body’s own tissue! Again, I was never given this option.

I cannot thank you enough Dr. Craigie and Dr. Kline for your skilled surgical talents and dedication in this field that made me look and feel like a women again!

Sincerely,
D.N South Amherst, Ohio

Do you know of someone whose life is affected by implant problems? Share this story with them.

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Can I Have My Current Implant Removed to Receive a Muscle-Sparing Free Flap Breast Reconstruction?

May 20, 2011 by

dr. richard kline

Dr. Richard M. Kline, Jr.

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

I had reconstruction with implants after my breast cancer diagnosis in 2009. How hard is it to go back and do breast reconstruction with a flap? What would the recovery time be?  Also, does insurance give you a hard time about taking out the implants and revising having a flap?

It’s no trouble at all to remove implants and replace them with a muscle sparing free flap breast reconstruction. We’ve done it successfully hundreds of times. Unfortunately, roughly 30% of women who come to us are seeking conversion from a failed or unsatisfactory implant based reconstruction. Recovery time after flaps is usually 6 – 8 weeks, although some ladies recover much faster. I don’t think insurance usually gives you a hard time—once you’ve started the reconstruction process, they seem to follow through until you are finally content with your reconstructed breast.

—Richard M. Kline Jr., M.D

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Breast Reconstruction Awareness Day is October 16: Learn your rights.

October 16, 2019 by

When you’re diagnosed with breast cancer, you are given so much information to digest about your diagnosis and treatment it can, at times, be overwhelming. But it’s not over yet. What about the information you need to decide if you’re going to have breast reconstruction after a mastectomy or lumpectomy? Unfortunately, not every woman is given all of their options in order to make this very important decision.

To help change this, the American Society of Plastic Surgeons (ASPS) and The Plastic Surgery Foundation (The PSF) have designated October 16 as the eighth annual BRADay – Breast Reconstruction Awareness Day in hopes to build awareness around breast reconstruction options. According to http://www.breastreconusa.org, less than a quarter (23 percent) of women know all of the breast reconstruction options that are available to them after mastectomy.

“Thanks to the Women’s Health and Cancer Rights Act of 1998 (WHCRA), almost every woman is legally entitled to have breast reconstruction after mastectomy,” said Richard M Kline Jr., MD of The Center for Natural Breast Reconstruction. “Once you are aware of that, you should then understand what your all of your reconstruction options are, including implant based reconstruction, DIEP Flap, GAP Flap, and Profunda Artery

Perforator (PAP) Flap. Each procedure has its advantages and disadvantages so weigh them carefully.”

Once you are given your options for breast reconstruction, you need to decide which one is best for you and you will probably have a ton of questions. Make certain that you are consulting with a board certified plastic surgeon who is willing to answer all of them and share photos of post-operative results. The more informed you are with the answers you receive, the more comfortable you will be with your final decision.

All women who are candidates for breast reconstruction should receive treatment in a safe and timely manner.  Remember that this is your breast cancer journey and you should do what’s right for you. Keep in mind that only 19 percent of women understand that the timing of your treatment for breast cancer and the timing of the decision to undergo reconstruction greatly impacts their options and results.

For more information on Breast Reconstruction Awareness Day, visit breastreconusa.org. 

 

Filed Under: Breast Cancer Awareness, In Her Words

Q&A: Ask the Doctor

September 27, 2019 by
Ask the Doctor: Q&A
Q: Three years ago, I had a double mastectomy and am now cancer-free. Unfortunately, my
plastic surgeon did a terrible job with the reconstruction. The left side implant is way off to the
outer side and looks larger than the right. The right side is way too far to the outside. There is
zero cleavage. Is there any way to re-position the implants to the more natural position of the
breast? I do not expect perfect but don’t like looking like a botched job. Please let me know if
your team can help. Thank you.
A: Congratulations on becoming cancer-free. At the Center for Natural Breast Reconstruction it
is part of our mission to help women move on with their lives after breast cancer. We focus our
efforts on helping women get their bodies back together with permanent “natural results.”
I’m sorry you are disappointed with your reconstruction results. If you have had radiation
previously, then it may be more difficult to have your breasts match with implant reconstruction.
If you have not had radiation then perhaps your implants could be revised or adjusted for an
improved appearance.
It is possible that using your own fatty tissue would be a more permanent option without
implants. Sometimes it is hard to start over with another approach but it may be necessary if
you desire a more natural and permanent result. If you would like more information about
natural breast reconstruction with your own tissue let me know.
We are here to help!
James Craigie MD
Filed Under: Ask the Doctor, In Her Words

Ask the Doctor: Q&A

June 10, 2019 by

Woman walking on beach

Q: I am an eight-year breast cancer survivor. I had a great breast doctor but my plastic surgeon botched my right breast. No implants – it was a latissimus dorsi reconstruction. My right breast is flat as can be, and I do suffer from scar tissue pain. I can be doing the simplest of things that should not cause pain, but the pain is excruciating. My current breast doctor tells me I will have to live with it. I’m so glad I didn’t have a procedure on my left breast. Do you ever come across patients with painful scar tissue? Would reconstruction repair the tissue? I’d love to hear your thoughts. Thank you for taking the time to read my note. It’s surgeons such as yourselves who give people hope!

GOD BLESS

 

A: Greetings!

I’m sorry you are having trouble with your reconstruction, both appearance and comfort-wise.

The latissimus flap is not commonly large enough to be able to provide an acceptable breast mound by itself. Traditionally, a breast implant is placed under the flap to provide increased bulk and projection. We also have found that sequentially grafting a patient’s own fat into the latissimus and surrounding tissue can sometimes provide an adequate breast mound, thus avoiding potential complications associated with breast implants.

Pain after breast reconstruction is fortunately less common after using your own tissue than after using implants, but it still can occur. It often can be difficult to determine what is causing the pain, but many times measures can be taken after careful assessment to improve the situation.

I would be happy to chat with you by phone in more detail about your situation, if you wish. Please let us know what we can do to help.

Sincerely,

Richard M. Kline, Jr., MD

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Q&A #2: May 2019

May 27, 2019 by

Q:
I had a bilateral mastectomy in October 2016. I finished radiation on the right side in January 2017, and underwent bilateral latissimus flap reconstruction in August 2017. I had capsular contracture (when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant) on the right side and the implant changed out in March 2018. Once again, I have capsular contracture on the same side. What do I do? They are absolutely not even close to symmetrical. I am only 46. I am kind of thinking that I should just forget reconstruction even though I don’t really want to go flat.

A:
Without knowing all of the details about your situation, I think there is a reasonable chance you have some good options left. Here are a few potential ones:
1. We have reconstructed more than 1,800 breasts with natural tissue alone (no implants) using the abdomen or buttocks. If you have any tissue in those areas, that is our most frequently used option.
2. We have, on several occasions, reconstructed breasts with latissimus flaps alone, with added free-fat grafts, which can sometimes double (or more) the size of the latissimus flap, and make implants unnecessary.
3. For the last 4 1/2 years, we have done all of our implant reconstructions exclusively in front of the muscle, using a full Alloderm (specially preserved donor skin) wrap. This has completely changed our outlook on implant breast reconstruction, and has on occasion produced surprisingly good results – even in radiated breasts. I have converted several “implant-behind-the-muscle” patients (some who already had latissimus flaps) to in-front-of-the-muscle, and they all feel that it is a significant improvement. Free-fat grafting can also be added to implant-based reconstruction to improve shape, size and overall naturalness.
There is absolutely nothing wrong with going flat if you are sure that is what you want to do, but it might be premature for you to decide to do that only because you don’t think you have any other options. I would be delighted to discuss your situation in more detail by phone, if you wish, or see you in person for a consultation.
Thanks for your question! We look forward to hearing from you.

Best,
Dr. Richard M Kline JR MD

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