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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 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.

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

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TDAP Flap Breast Reconstruction Surgery: When and Why to Choose This Option

July 6, 2012 by

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

When would we use the TDAP flap for breast reconstruction and what are the advantages of this procedure?

The TDAP flap or thoracodorsal artery perforator flap is a procedure for reconstructing the breast or partial breast reconstruction and is another of the muscle-sparing flaps.  The procedure allows for the fatty tissue from the side and back to be mobilized and then transferred to the breast without disconnecting its blood supply and performing re‑anastomosis of the small blood vessels.  The tissue that is used is in the area above the latissimus dorsi muscle, which is the largest muscle in the body; however, the procedure does not involve transferring the muscle or destroying the muscle.  The advantages of this procedure are that the tissue can be used for breast reconstruction without performing the microsurgery and without damaging or removing the muscle.  The disadvantages of the procedure are that there is a limited amount of tissue available to use for breast reconstruction and because the blood vessel remains attached and is not divided, there is a limit to the shaping and positioning of the new tissue.  It is most frequently used for reconstruction of a part of a breast, mainly the outside, but in some circumstances can be used for reconstructing the entire breast.  However, this is usually a smaller reconstruction and the amount of skin available is typically limited as well.  The TDAP can be used for transferring fat to the breast at the time of mastectomy or can be used later after mastectomy and the body has healed.

Procedures: Transforming Healthy, Living Tissue
Microsurgery has come a long way since its invention by vascular surgeons in the 1960s. The term refers to any surgery involving a surgical microscope. And it has found one of its best applications in breast reconstruction. Through microsurgery, our skilled surgeons are able to harvest healthy tissue from one part of a womans body and reattach it to the breast area. Through the careful process of attaching blood vessels, microsurgery allows patients to have natural looking breasts made from their own, living tissue. Another benefit is the minimized impact and injury to muscles, allowing patients to enjoy a faster, fuller recovery.

Did you find this post helpful? We’d love to hear from you in our comments section.

 

 

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Am I A Candidate for Natural Breast Reconstruction?

June 29, 2012 by

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

I was diagnosed with breast cancer in 1999 at age 24 (infaltrating ductal, triple negative). I had a lumpectomy with a lymph node dissection, chemotherapy and radiation. I found out I was positive for the BRCA1 mutation in 2008 and had a myomectomy (c section cut) and subsequent full hysterectomy (via davinci) in 2010, since pathology found the mass to be Endometrial Stromal Sarcoma.

I am now considering a mastectomy to decrease my chances of reoccurrence. Would you recommend a prophylactic mastectomy? If so, what type of reconstruction can I have? I prefer natural reconstruction rather than implants, but do not know if I am eligible since I’ve had two abdominal surgeries and do not have a lot of extra tissue anywhere else.

Hi and Thank you for your question. I’m sorry you have been faced with these difficult decisions. Removing as much breast tissue as possible is the most effective thing you can do to reduce your chances of getting breast cancer. I  refer to this type of mastectomy as “risk reduction” because it does not make the chances 0 but is as close as one can get. Your previous tummy surgeries have probably not affected your ability to have natural breast reconstruction, as we have had many people who have had the same types of surgery before using the extra tummy. Even the people who have had surgeries that compromise the tummy we can almost always come up with an option for natural breast reconstruction. Many of our patients have been told they do not have enough extra to use but when we see them we can usually give them a very nice result without implants. I hope this answers your question.

Sincerely,

James Craigie, MD

Center for Natural Breast Reconstruction

 

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

 

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Potential Issues to Watch for After DIEP Flap Breast Reconstruction

April 27, 2012 by

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

What potential issues should I be watching for right after having DIEP flap breast reconstruction?

I am going to split the answer for this into two parts.  First, what you should watch for while you are in the hospital (at which time you will, of course, have lots of help watching for things). Second, what should you watch for when you go home?

When you are in the hospital, we primarily look for changes in the vascular status of the flap.  There are monitors attached to the flap which will within seconds pick up any change in the blood flow to the flap.  If on further evaluation by the nurses, it shows that there is a problem, we will take you back to surgery immediately and attempt to correct the problem.  Fortunately, incidents such as these are rare, but if they do occur.  We have learned that the most important factor is to get to the operating room quickly, in which case we can almost always fix whatever might be wrong.

Thankfully, it is unbelievably rare to have a problem with the blood flow to the flap after going home, although it is not impossible.  Your primary concern should be to follow the specific directions which we have given in terms of positioning and brassiere support.  Most patients still have temperature monitoring strips attach to the flap, and this can serve as useful reassurance to let you know that your flap is fine.  Infections are extremely rare after DIEP flap surgery, but they can occur either at the reconstruction site or at the abdominal donor site.  Wound healing problems are not as rare as infections but may occur.  If you are not radiated, the most likely place to have a wound healing problem is your abdomen.  If you are radiated, it is very common to have a little bit of a wound healing problem where the healthy flap tissue meets the radiated breast skin.  Essentially all wound healing problems can be managed very effectively, so it is not something you need to worry about.

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Ask The Expert Series Spotlights The Center for Natural Breast Reconstruction

April 20, 2012 by

We’re thrilled to share some exciting news with you, today! Our very own Dr. Richard Kline and Dr. James Craigie, Charleston breast surgeons, were recently on ABC News 4 Ask the Experts Series. During this interview the doctors answer questions on air about natural breast reconstruction submitted by viewers .

See below for the interview:

 

For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit our website today for more information.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.

 

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Your DIEP Reconstruction Recovery Process Question Answered

March 16, 2012 by

diep questionsThe below question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

I still feel tightness in my chest and stomach after DIEP reconstruction, when can I expect that to improve?

Tightness in the donor site area or tummy depends on how much tissue was taken to rebuild the breast and how much loose tissue was there to begin with.  The scar that results after the healing process can take approximately 6 months to relax and mature.  Therefore, during recovery, the tissues will be stiff for approximately 3 months and as you begin to do more and exercise more, the areas should slowly become less tight, less swollen, and more natural.  Regarding tightness in your chest, it would be unusual for tightness to exist for very long after having reconstruction with your own tissue.  Usually a new healthy breast made from your own tissue will improve tightness or scarring particularly if someone has had reconstruction with implants prior to using their own tissue.  However, if you have had radiation, those changes can be permanent and there may be residual stiffness, but it is very unusual for people in our practice to complain of tightness in the chest area once everything has healed approximately 3 to 6 months after surgery.

-Dr. James E. Craigie

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