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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 – Are There Any Tests To See if My Implants Are Causing My Health Problems?

August 15, 2014 by

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This week, Dr. Richard M. Kline of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had a bilateral mastectomy back in 2000 because of numerous precancerous lumps in my breasts. I had Stage 3 melanoma 8 years prior, and they operated numerous times on me. I decided to have latissimus reconstruction surgery, and since then have had numerous problems. I’m allergic to latex, numerous adhesives, sulfa, and penicillin. I’ve been suffering from fibromyalgia, severe edema throughout my body, and itchiness within the area of my chest wall and breasts. After getting this issue checked out, I was told this was not an implant problem and was sent home. Are there any tests that can check to see if the problems relate to my implants? I had a CT scan done at Mayo Clinic, and they said I had an allergic reaction to what they thought was an antibiotic. Have you seen this before in your patients? Any help would be greatly appreciated. Thank you.

ANSWER: I’m not aware of a test to see if your implants are causing any problems. To my knowledge, there has been no firm connection established between implants and symptoms such as yours, but you should check with your rheumatologist to be sure.

Having said that, we do see many patients who have implant reconstructions along with various complaints such as discomfort, tightness, pain, etc. Although it is obviously difficult to objectively quantify, many of them seem to get significant relief from their symptoms if their implants are removed, and their breasts reconstructed with their own tissue. In all fairness, most of these patients have what would be considered unacceptable reconstructions anyway (hardness and asymmetry being common issues), so it is usually pretty easy for them to decide to have their implants removed and replaced with natural tissue. If your reconstruction is presently aesthetically acceptable to you (other symptoms notwithstanding), then the issue of what to do is significantly less clear-cut.

Best of luck, and let me know if we can be of any further assistance.

Dr. Richard M. Kline, Jr.

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: Do you have a recommendation for a topical that will help scars heal or fade?

July 4, 2014 by

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

Q: Do you have a recommendation for a topical that will help scars heal or fade?

A: Unfortunately, nothing of which we are aware does this reliably. Avoidance of sun exposure is critically important to give scars their best chance of fading, but no topical preparations routinely make scars better. If scars are heavy or raised, Mederma can help, but it should not be used on scars which are already flat.

 

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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Ask the Doctor: Is there any surgery for a Tram flap patient with a belly bulge, no hernia?

June 20, 2014 by

<img src="image.gif" alt="Pink Flowers" />This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q. Is there any surgery for a Tram flap patient with a belly bulge, no hernia? Breast reconstruction was great and there were no complications. I have heard that mesh can be used, does this flatten the belly, or would I be at risk for complications such as a hernia?

A. Hi Karen, Thank you for your question. If your tummy bulge is due to the TRAM flap procedure then it is possible that repair of the bulge using mesh could help flatten your tummy or repair the bulge. We normally check for a possible hernia by ordering a CT Scan of the tummy wall before planning this type of procedure. The findings help us determine what is the best approach and if we need to use permanent mesh or some other type. If there is no hernia then repairing the bulge should not risk creating a hernia. Depending on the situation, it is possible that the bulge could come back. Prior to this type of repair you should make sure you do all you can to avoid being overweight, as your weight can impact the success of the repair. I hope this answered 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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Should I Have Routine Mammograms After My Breast Reconstruction?

June 7, 2013 by

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

Q:  After my breast reconstruction, I continue to have pain in my  right breast after each mammogram. Last mammogram was two months ago. The pain wasn’t really sharp, but it did hurt where they made my reconstruction incisions. Is this normal? 

A:  I’m sorry you’re having difficulties. If you have had a mastectomy and reconstruction, then usually routine screening mammograms are not necessary. I would suggest asking your cancer doctor if you would be able to avoid screening mammograms altogether. Also: check with the doctor who ordered  your mammogram, as he or she may have had a specific reason for ordering it other than routine screening. You still have to do self-exams, of course, and  be checked for changes.

James Craigie, MD

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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Can I Have an Autologous Fat Transfer After a Lumpectomy?

May 10, 2013 by

Ask the doctor May 9

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

Q: I am a stage IV breast cancer patient looking for autologous fat transfer to fill in my left breast after a lumpectomy in 2008. Can you please let me know how to proceed regarding consultation and such?

A: I would be glad to have our PA call you for more information or phone consultation. I would also be glad to see you in person if you want to come for an office visit to Charleston. I frequently see patients with similar requests.  In my opinion,  fat injections to repair lumpectomy and radiation deformities is usually not the most effective approach. There are also concerns by experts in this specialty regarding fat injections of the breast after that breast has already developed breast cancer once.

As long as the breast tissue remains then there is a risk–although very small–for the cancer to recur. That is why you still need to monitor that breast for any suspicious changes. The fat injections could make monitoring the breast more difficult and most importantly there could possibly be (not proven definitely yet ) an increase in the risk for recurrence after fat grafting. No one knows this for sure yet, but we are always careful regarding this type of safety issue. I could be more specific and talk to you about alternatives if I had more information and especially if I saw you in person. I hope this helps! Please let us know.

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Q: I have BRCA mutation. I am 25 years old. I want to have mastectomies with reconstruction but don’t really know which would be the right way to go.

A:  I am sorry you are facing such a difficult decision. Fortunately, breast reconstruction after preventive mastectomies allows for more planning before surgery and usually sets the stage for the best possible breast reconstruction result.  There are several reasons for this.

One reason is more of your natural tissue can be saved. It is usually possible to keep your natural nipple and all of the normal breast skin. Other problems related to possible treatments like chemo and radiation are eliminated because the mastectomies are done to remove breast tissue and prevent breast cancer.

The techniques for breast reconstruction are generally the same following preventive mastectomy and mastectomy for cancer.  Implants are used most frequently because of availability and more rapid recovery from the initial surgery. The end results with implants tend to be less natural than with your own tissue and after the process is complete there is a tendency for the results to deteriorate with implants because they are not living tissue. Your body may reject the implants or they may leak or deflate. The results with using your own tissue are generally more natural and more permanent. We specialize in breast reconstruction using your own tissue but without sacrificing your body’s important muscles.  To be more specific about recommendations for you I would need more information. I will be glad to have our office contact you for this information, just let me know.

James Craigie, MD

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 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

 

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

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