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Can a Mammogram Hurt My TRAM Flap?

April 5, 2013 by

Can a mammogram hurt my tram flap?

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

 

Q: I have an 18-year TRAM (Transverse Rectus Abdominis Myocutaneous) flap. Recently I have found a perpendicular ridge about an inch from my sternum. It feels like a lump. I have had an ultrasound and now they want to do an MRI and an mammogram. They found nothing on the ultrasound. My concern is the mammogram. Could this cut off blood supply to my TRAM flap? I would like to ask my original doctor but he is strictly doing plastics. Thank you for your help!

 

A: While it’s not impossible, a mammogram is highly unlikely to hurt your TRAM flap, especially after this length of time. Certainly it is important to find out what the lump is, anyway.

Good luck, let us know if we can be of any help.

 

 Richard M. Kline, Jr., 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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How Long Does a DIEP Flap Procedure Take? What Is the Recovery Time?

March 22, 2013 by

This week Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answer your questions about DIEP flap surgery. 

 

Q: Approximately how long does the DIEP flap surgery take on one breast?

 

A: Thanks for your question.

A unilateral DIEP typically takes from 3-6 hours, depending on whether you already have had a mastectomy, and on how complicated the microvascular anatomy of your particular flap turns out to be.

Richard M. Kline, MD

Center for Natural Breast Reconstruction

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Q: I do not personally know anyone that has had DIEP flap surgery. What should I expect within the first two to three weeks of recovery after DIEP flap surgery?

A: The first 4 days will be in the hospital, the next three weeks you will be very mobile but no driving. After one month your drains will be out and you will feel much better. Over the next 6-8 weeks you should be getting back to normal. Let me know we will be glad to let you talk to one of our patients who is in a similar situation.

See you soon.

James E 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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Should I Have a Preventive Mastectomy?

February 15, 2013 by

Should I Have a Preventive Mastectomy?The following question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

 

I have no history of breast or ovarian cancer in my family, but my  mother and my sister do have a history of benign masses.  I’ve been told that I will need to frequently monitor any masses  I have or develop… likely for life. 

Every month, I can feel my breast tissue changing and becoming more fibrous (lumpy-bumpy), which makes me very uncomfortable.  I’ve watched a few friends with no cancer risk battle breast cancer recently, and I’m just not willing to allow myself to get to that point if possible. For peace of mind, and reduced cancer risk, I’d be much more comfortable undergoing a major surgery.  

Is this a logical solution given this circumstance, or am I overreacting?

 

Hello,

I have had numerous patients in similar situations decide to have preventive mastectomies and immediate reconstruction. It is a very personal decision to make and I do not feel you are overreacting to at least consider the option. Risk reduction mastectomy is the most effective way one can actively reduce the risk of breast cancer.

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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Natural Breast Reconstruction: What Are My Options If I Have Scarring?

February 1, 2013 by

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

I lost my implants in 07 due to an infection from my lymphedema. I had both removed and didn’t have reconstruction since the prior surgery was a failure. I have scaring from radiation in 2001. I’d like to think about reconstruction again BUT afraid of failure due to the scaring. Do I have options? Really would rather not have implants, I’ve both types, didn’t like either but would accept silicon over saline.

Hello,

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. If you’d like more info, we could have our nurse Chris call you. If you wanted to send pictures, that would also be very helpful.

Thanks for your inquiry.

Richard Kline
Center for Natural Breast Reconstruction

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

 

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Can Breast Cancer Return After Breast Reconstruction Surgery?

January 25, 2013 by

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

Is it possible for cancer to come back in a new reconstructed breast?

Hello,

Breast cancer can reoccur in the breast after mastectomy. This can happen with or without reconstruction.  If the reconstruction is done with your own skin and fatty tissue, then the new breast has no real breast tissue and can not develop breast cancer. If breast cancer remains after mastectomy it could possibly grow into the new breast. This is rare but not impossible.

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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Are You Comparing Apples to Apples When Weighing Your Breast Reconstruction Options?

January 11, 2013 by

We at The Center for Natural Breast Reconstruction know that the Internet is a great place to read and share information, but it is also a great place to become misinformed. Before making any decisions about your breast health, please make sure to contact a surgeon to discuss all your options and make the most informed decision you can. Keeping with the spirit of the Internet as a research tool, today’s Ask The Doctor Question comes from a discussion forum we participated in on WebMD.com. The answer highlighted below in pink comes from our team and showcases the importance of making sure you really are comparing apples to apples when weighing your breast reconstruction options.

Q: Has anyone had a hard time with breast reconstruction after bilateral mastectomy? I had two infections in my right expander, 2 and 3 months after my surgery. The first we conquered with antibiotics; the 2nd we did not, and I had to have it removed 4 months later. I spent the last 5 months healing from that, and just last week had the expander replaced. Hoping for the best this time! But there is significant skin loss on my right side, and my surgeon wonders if there will be enough stretch to accommodate saline fills to match my other side. And of course we all wonder if THIS expander will behave itself and not get infected. Has anyone had this experience, or one similar? Thanks.

A: Why don’t you go with the DIEP Flap procedure – they use the fat and skin from your abdomen area – I have had no problems from this procedure and I have heard of a couple of people who have had issues with infection with the expanders. Find yourself a Plastic Surgeon who does the DIEP Flap procedure

A: I also had a bilateral mastectomy but had to wait 2 years before reconstruction. I also had the expanders but had no problems, maybe it was too soon after your surgery. I would not recommend a tram flap ,it just sounds like an awful surgery.

A: There is a difference between and DIEP Flap and a trans flap.
The DIEP Flap they only take the fat and skin from your abdomen nothing else – they find a good blood supply at the reconstruction site. The Trans Flap is they take your stomach muscle and pull it up through to the breast cavity and also bring the fat and skin from the abdomen area. I for sure was glad that I did not do the Trans Flap.

A: (The Center For Natural Breast Reconstruction’s Answer) The free TRAM flap sacrifices a portion of the transrectus abdominus muscle (hence the acronym TRAM) but doesn’t tunnel it up through the abdomen. The DIEP flap does not use any of that muscle to transfer the blood supply to the reconstruction site. A skilled micro-surgeon with fellowship training in muscle sparing free flap reconstruction provides a permanent reconstruction option with a successful DIEP without sacrificing needed abdominal musculature. There is A LOT of great information on the web about this and what questions you should ask to make sure you are choosing a microsurgical team who has the experience and at least a 98% success rate. Talk to ladies who have had DIEP, GAP, HIP, SIEA flaps ( but not TRAM, it’s not the same) and see what kind of downtime they have had, you’ll probably find it similar to the amount you have had with the repeated implant/expander problems. Best wishes on your research and recovery.

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

 

 

 

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Wound Healing Post Breast Reconstruction Surgery

November 30, 2012 by

The below question is answered by the Charleston breast surgeon, Dr. James Craigie.

How do you determine when to use a wound vac in place of a traditional drain?

We have discussed the idea of using a wound vac in place of drains.  We have actually determined the use for combining the wound vac and drains under certain circumstances.  Some people have had radiation or have challenging wounds that result from wound healing problems combined with fluid collections caused seromas.  Sometimes drains are needed to evacuate seromas but unfortunately they are not always adequate.  Also, radiated tissues have difficulty healing and wounds developed in radiated tissue sometimes typical wound dressings may not be adequate as well.  We have used the wound vac combined with the drain in order to treat these complex wounds.  We have found that complex wounds are usually a combination of wound separation with fluid collections.  The drain actually passes through the wound vac sponge, the wound vac sponge is then covered with the steel dressing that is connected to a pump and the strong negative pressure generated is greater than the pressure of a normal drain.  This allows a deep pocket of fluid to be dressed with the drain tip and the open skin edge or wound edge to be treated with the sponge.  When the wound vac dressing is changed every 3-5 days, the drain can be backed out slowly and therefore as the wound edge heals, the fluid collection is controlled and the wound eventually heals quicker than other approaches.

-James Craigie, M.D.

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

 

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Complications From Vascularized Lymph Node Transfer

September 21, 2012 by

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

I am recovering from a DIEP flap reconstruction and lymph node transfer. I had breast cancer when I was very young and have had lymphedema for 25 years. I was so happy to hear that there was a surgery that possibly could correct the swelling in my arm that I jumped on it with out really researching. I am two weeks into my recovery and I have noticed swelling in my leg and groin. The groin I think is normal for a surgery site. However, the swelling in my leg Im afraid is the onset of lymphedema. I would appreciate any information you could share with me on this .

Hello,

Sorry you are having problems.

As your surgeon probably explained to you prior to surgery, vascularized lymph node transfer is experimental surgery, and no one really knows how often it works, if at all, and what the complication rates are.

As your surgeon also probably explained, lower extremity lymphedema is a potential risk of the node harvest. We strictly limit our node dissection to the area lateral to the superficial inferior epigastric vein and superior to the inguinal ligament, and have thus far had no problems with lower extremity lymphedema developing after the procedure. You may wish to consult with your surgeon about having bioimpedance analysis of your affected lower extremity performed to determine whether early lymphedema is actually present. If it is, then prompt institution of treatment may be advisable.

Richard Kline

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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Ask The Doctor: Guest, Dr. Lisa Baron Answers Your Question on Breast Health

September 14, 2012 by

Today we are pleased to present Dr Lisa Baron, of The Charleston Breast Center as a guest author on this editon of, Ask The Doctor.  See below as Dr. Baron answers a question submitted to our site.

I really need advice.  I recently relocated to Charleston, SC & just saw a new oncologist.  When I lived in CT, my breast surgeon would do an annual digital mammogram & breast ultrasound since I have dense breasts.  I’m pretty sure that my former surgeon had said that there are new guidelines that state that if breasts are dense, a breast ultrasound should be done also.  My new oncologist in SC is only planning on doing an annual digital mammogram. Has anyone heard of these new guidelines stating that a breast ultrasound should be done in addition to a mammogram if breasts are dense?  I also have very cystic breasts with a density of 50-75%.

I think the confusion regarding additional testing with mammography for dense breast tissue centers around the fact that South Carolina and Connecticut handle breast cancer screening differently.  Recently the state of Connecticut enacted laws requiring insurance companies to provide screening ultrasound and/or MRI for those women who have dense breast tissue.  In Connecticut these additional screening tests are to be included in the patient’s screening test benefits and not subjected to any co-pays or out of pocket payments.  In addition, in Connecticut the patient is required to be informed of her breast tissue density and the additional screening tests  available to her (ultrasound, MRI).  However,  the state of South Carolina does not mandate the insurance companies to follow these protocols (or the patient to be informed about her breast density), therefore, you will likely be responsible for any co-pays and deductibles.  You should check with you current insurance carrier to determine how these additional tests will be covered.

 Hope this helps,

 Lisa

Have questions about breast reconstruction options? Submit them here and get answers straight from our surgical team!

 

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Your Questions About Breast Reconstruction Answered

August 31, 2012 by


The below questions are answered by the surgical team at The Center for Natural Breast Reconstruction:

Q: A double mastectomy left me with butcher marks on my chest. The plastic surgeon who was part of the team that performed the mastectomy now proposed to do implants. The existing (very bad) scars will not be in the breast fold but will “cut” the bottom half of the new breasts in two. Could one get rid of these scars when doing a DIEP procedure?

A: We can’t actually “get rid” of scars, but often they can be improved, &/or moved to a less objectionable position. If you wish to send pictures, I could possible give you little more specific information.

Have a great day!

Richard Kline

Center for Natural Breast Reconstruction

Q: I’m having the tram flap done, can you tell me how long after the surgery that it doesn’t work?

A: Hi

It would depend on what type of TRAM procedure you have. If you have microsurgery the first three days are the most important and usually after that the blood supply to the new breast is ok. If no microsurgery is involved it may take longer to know for sure.

James Craigie, MD

Center for Natural Breast Reconstruction

Have questions about breast reconstruction? Submit them here and get answers straight from our surgical team. We’d love to hear from you!


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