Can I Have an Autologous Fat Transfer After a Lumpectomy?

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.

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!

 

Join Us for We Know Women!

We Know Women Event garden partyFor the fourth year, East Cooper Medical Center is hosting an amazing event for women of all ages, the “We Know Women Event: Garden Party” on Thursday, May 9, starting at 5:30 p.m.

This fun event features live music, health demonstrations and screenings, local vendors with products women love, and wellness discussions with doctors including a question-and-answer panel. Wine tasting and delicious food will be provided, and Babies-R-Us will host a car seat installation demonstration.

Vendors include Grill Charms, Relax the Back, Abide-While, Silpada Designs, The Foot Store, HandPicked, Jonathan Green Prints, Miche Bag, No Wheat Treats, and Whaley’s Photos. The vendors will offer discounts and a variety of giveaways.

The physicians in attendance include Dr. James Craigie and Dr. Richard Kline from The Center for Natural Breast Reconstruction, Dr. Terrence O’Brien, Dr. Ross Rames, and Dr. Lynn Crymes. Topics include breast cancer, natural breast reconstruction, heart disease, cosmetic surgery, hormone therapy for women, and bladder concerns.

 

The “We Know Women Event” is free, but please register by calling 843-884-7031 or by visiting http://www.eastcoopermedctr.com/en-us/cwsapps/findanevent.aspx.

East Cooper Medical Center is located at 2000 Hospital Drive in Mount Pleasant. 

 

A Chance to Heal in Comfort

Cherie Mathews is the founder of healincomfort

Our team at The Center for Natural Breast Reconstruction  welcomes Cherie Mathews, founder of healincomfort, as the featured guest for In Her Words this week. Here is her story:


At the age of 40, Cherie Mathews received the same diagnosis from her doctor that one-in-eight women across America will face – “You have breast cancer”.

Through the shock and horror Cherie made the difficult decision to have a double mastectomy. She faced her enemy in this battle with the same fortitude and resilience as the millions of other brave women warriors that came before and since, after. It wasn’t until the pre-op consultation before her mastectomy that Cherie got angry. When she was told the same thing that nurses still tell their charges today… to just bring something big and loose or one of their husband’s old dress shirts to wear home and to recover in.

“I can tell you first hand that when a woman loses her breasts in her battle against breast cancer she does not ‘feel’ ok wearing her husband’s dress shirt. Mentally, it’s cruel.  Cancer is hard enough! If a sprained elbow gets a sling to heal in, why isn’t there helpful equipment to heal in after a mastectomy?”

 

Something had to change.  A new “standard” in medical equipment for women recovering from breast cancer surgery needed to be created. Cherie Mathews would go on to launch and to provide the very healincomfort post-op recovery kits that she herself was denied. Now, women across the globe benefit from Cherie’s vision and ambition to make certain that no woman would suffer this complication. In this decade, thousands of breast cancer survivors have been spared this unnecessary discomfort. Today, thanks to Cherie, all women have the ability to “healincomfort.”

All healincomfort Kits Include: Healincomfort kits make great gifts for loved ones.

  • Patented healincomfort Shirt – Super soft moisture management material, self-adhering  fasteners (like Velcro®), Four Internal Pockets for Drain Management
  • Advanced Design Hands Free Lanyard Straps – Hands free Independence for Showers and Maneuverability
  • Private Medical Drain Pouch – Manages Drains while wearing Regular Clothing
  • Inspirational Story “My Shadow Story” – Your personal copy to help prepare for the ‘First Look’ after your breast cancer surgery.

 

For more information, visit healincomfort.com for more information.

You can also follow Cherie Mathews on Facebook.

Does Fat Necrosis Make It More Difficult To Detect Cancerous Tumors?

Will a fatty necrosis make it more difficult to detect any new formations of cancer?

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

Q: I am a  7-year Stage I breast cancer survivor.   I’ve had lumpectomy and radiation, with no chemotherapy.

Three years ago, had a bilateral breast reduction. Six months later, developed nipple retraction and a mass. General surgeon (who follows me for BC) was concerned at first and biopsied it twice. The results were negative.  Mammograms have been reported as within normal limits.  

My plastic surgeon (who did the reduction) would like to have yearly MRI’s because he said eventually, this mass will start to calcify, most likely keeping me flagged for biopsies. The general surgeon disagrees and feels it’s been biopsied twice and he would not do any more unless my mammogram changed.

My concern is that this fatty necrosis will hide any new cancer that may form. It’s pretty big area approx. 7.5cmx5cm.  My new internist is not happy with this area and wants me to see another surgeon. So my question is: will this make seeing any new cancer form harder? Is my risk for more necrosis higher if I have it removed since this was the radiated breast and that is what caused the necrosis in the first place? My original surgeon suggested a mastectomy to be 100% sure that nothing would ever get missed. I will be seeing new surgeon next week and would like to have some ideas before I go. I have no problem with another lumpectomy or even a mastectomy if needed.

 

A:  I’m sorry to hear you’re having so much trouble.

It’s outside of my area of expertise to advise you whether calcifications from fat necrosis can mask a tumor recurrence, but I just called our breast imaging radiologist and asked. She said fat necrosis definitely makes imaging “more challenging,” and you may require ultrasound and/or MRI in addition to mammography in the future, should you choose to leave the mass in place.

I CAN advise you that the risk for wound healing problems (including more fat necrosis) is certainly higher in a radiated breast, so the answer to the second part of your question is yes, you could end up with additional fat necrosis after surgery.

Even a mastectomy will not reduce your risk of another cancer to zero, as some breast cells are frequently left behind, but it will reduce your risk significantly. We would be happy to put you in touch with one of our surgical oncologists who specializes in breast disease, if you would like to get more specific information about risk reduction.

Hope this helps, and feel free to call or email with any more questions.

 

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!

How to Tell the People In Your Life About Your Diagnosis

When it comes to telling others about a breast cancer diagnosis, there are numerous reasons patients have difficulty putting to words what they’ve learned. Saying it aloud means it’s real—but it also begins the process of coping.

At The Center for Natural Breast Reconstruction, we know how tumultuous telling loved ones about a diagnosis can be. Here are some ways you can ease into sharing the information with your family and friends.

Take your time. Though it’s important to share this information with the people closest to you, know that you can tell them when the time feels right for you. You don’t have to do it all at once, and you don’t have to tell everyone. Prioritize the people you need to tell first. You can tell them to share the news with others by phone or e-mail, or you can do it yourself.

Tell your children. The sooner you inform your kids that you have breast cancer, the better. Be direct and make sure to use the word: “Mom has cancer.” They need to hear it from you—your explanation will be far less scary than what they will imagine is happening. If they have questions, simply answer them and move on.

Tell your parents. As with your children, the sooner your parents know you have breast cancer, the quicker they can adapt to the situation. Speaking up may not be easy. After all, no one wants to cause their parents pain and anguish, especially if they are elderly. But if you do plan on telling your parents, you can enlist the support of a sibling or close family friend to help you break the news.

Need more encouragement? Find out how other women dealt with their breast cancer diagnoses

What Is the Recovery Period for a DIEP Procedure?

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

Do you have breast reconstruction questions you want answered? Submit them here and get personal answers, straight from our doctors!!

Breast Reconstruction After Lumpectomy and Radiation

The below questions are answered by Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

Can I have a breast reconstruction two years after the lumpectomy and radiation?

Absolutely! While reconstruction with implants after radiation (even if lumpectomy and not a whole mastectomy were performed) can often be problematic (if not impossible), the chance of getting a successful reconstruction using your own tissue is very high. In the simplest scenario, it is usually possible to use tissue from the abdomen or buttocks to simply “replace” the breast tissue lost from lumpectomy and radiation.

Alternatively, sometimes a better result can be obtained if the lumpectomy is converted to a mastectomy prior to reconstruction. Finally, if the survivor is in a high-risk group for developing another breast cancer, she may wish to consider whether bilateral mastectomy is advisable prior to reconstruction. Usually reconstructing a lumpectomy defect will require only one side of the abdomen, so if the other side is not needed for reconstruction, it will be removed for symmetry and discarded.

What tips do you share with your patients for them to achieve the very best results from breast reconstruction?

1. Have a positive attitude! Patients who are excited about their reconstruction frequently do very well and tolerate any “bumps in the road” much better.

2. Education. Try to become very familiar with your desired type of reconstruction, both through reading and discussing it with patients who have been through it already. Knowing what to expect allays fears and makes everything easier.

3. If time permits, maximize your body’s fitness through diet and exercise, to the extent that you are comfortable doing so.

—Richard M. Kline Jr., M.D.

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Reducing Risk: Common Factors that Affect Your Risk of Breast Cancer

breast cancer risksThe American Cancer Society estimates that the lifetime risk of a woman developing breast cancer to be 13% in 2012—more than one in 8. Furthermore, 75% of all women with breast cancer today have no known risk factors, or anything that would potentially increase a person’s chance of developing cancer.

Though having a cancer risk factor, or even several of them, does not necessarily mean that a person will get cancer, it’s always a good idea to reduce risk as much as possible. Some of the factors associated with breast cancer—such as being a woman, age, and genetics—can’t be changed. Other factors, like maintaining a healthy weight, exercising, not smoking cigarettes, and eating nutritious food, are dictated by a person’s choices. By choosing the healthiest lifestyle options, you can make sure your breast cancer risk is as low as possible, and find empowerment in your good decisions.

Family History: Though you cannot change your heritage or genetics, being aware of your family’s history means you’re more inclined to protect yourself against diseases that are prevalent in your family tree. Research shows that women with close relatives who’ve been diagnosed with breast cancerhave a higher risk of developing the disease. If you’ve had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average. A family history of cancer of the ovaries, cervix, uterus, or colon increases your risk. Female descendants of Eastern and Central European Jews (Ashkenazi) also face increased risk. Caucasian women are at a slightly higher risk of developing breast cancer than are African-American, Asian, Hispanic, and Native American women. The exception to this is African-American women, who are more likely to have breast cancer than whites under the age of 40. If you inherited risk, you can minimize its development by making healthy lifestyle choices, such as not smoking, adhering to a nutritious diet, exercising, and abstaining from alcohol.

  • Alcohol Consumption: Compared to nondrinkers, women who consume one alcoholic drink a day have a very small increase in risk, and those who have 2 to 5 drinks daily have a 15% higher risk than women who do not drink. That risk goes up another 10% for each additional drink women have regularly each day. (Note: one drink equals 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor). Research shows that alcohol of any sort can increase levels of estrogen and other hormones associated with hormone-receptor-positive breast cancer. Alcohol also may increase breast cancer risk by damaging DNA in cells. The bottom line is that regularly drinking alcohol can harm your health, even if you don’t binge drink or get drunk.
  • Smoking: Smoking causes a number of diseases and is linked to a higher risk of breast cancer in younger, premenopausal women. Research also demonstrates that there may be link between very heavy second-hand smoke exposure and breast cancer risk in postmenopausal women. Smoking also can increase complications from breast cancer treatment, including damage to the lungs from radiation therapy, difficulty healing after surgery and breast reconstruction, and an increased risk of blood clots when taking hormonal therapy medicines. To reduce your risk associated with smoking, the only solution is to quit smoking [http://breastreconstructionnetwork.com/stop-smoking-series-all-about-tobacco-quitlines/] immediately.
  • Diet and Nutrition: Diet is thought to be a main contributor for about 30% to 40% of all cancers. Though no food or diet can prevent you from getting breast cancer, some foods can boost your immune system and help keep your risk for breast cancer as low as possible. Getting the nutrients you need from a variety of fruits, vegetables, legumes, and whole grains can give your body the energy it needs to fight off infection and disease. Eating food grown without pesticides may also protect against unhealthy cell changes associated with pesticide use. Additionally, avoiding high-fat diets can also decrease breast cancer risk factors. Overweight women are thought to be at higher risk for breast cancer because the extra fat cells produce estrogen, which can cause extra breast cell growth and lead to the development of breast cancer.
  • Exercise: Research shows that exercising regularly at a moderate or intense level for 4 to 7 hours per week can lower the risk of breast cancer. Exercise consumes and controls blood sugar and limits insulin spikes in the bloodstream—an important preventative measure considering insulin is a hormone affects how breast cells grow and behave. People who exercise regularly tend to be healthier and are more likely to maintain a healthy weight. As we mentioned earlier, extra fat produces more estrogen. When breast cells are exposed to extra estrogen over time, the risk of developing breast cancer is higher Limiting fat in your diet is necessary for good health, and it is equally important to burn extra fat cells with exercise as an additional preventative measure.

What are some ways you combat the risk of developing breast cancer?

Breast Cancer Awareness Month: Where Will We Be?

Join The Center for Natural Breast Reconstruction throughout the month of October for National Breast Cancer Awareness Month! Our team will be attending all the collaborative events around Charleston that promote breast cancer awareness, share information on the disease, and promote treatment and reconstructive services.

Although many incredible strides have been made in breast cancer awareness and treatment, there remains much to be accomplished. Become part of the national dialogue on breast cancer, and help women around the world get informed about breast health when you join us for these special events:

  • BRA Day USA: Come celebrate our first BRA Day USA on Wednesday, October 17, 2012 aboard the dockside Carolina Belle on 10 Wharfside Street, Charleston, SC. BRA Day is an initiative designed to promote education, awareness, and access regarding post-mastectomy breast reconstruction. BRA Day USA is a collaborative effort between The Center for Natural Breast Reconstruction, plastic surgeons specializing in breast surgery, nurse navigators, medical device industry representatives, breast cancer patients and families, and breast cancer support groups. Join us for a little retail therapy, some great food, and outstanding prizes. Admission is free but limited to the venue capacity of 250. To secure your spot, be sure to RSVP to info@naturalbreastreconstruction.com.
  • Komen Race: The largest sequence of 5K run / walks in the world, the Susan G. Komen Race for the Cure®.  Series benefits education, research, and treatment programs for breast cancer. Three-fourths of the money raised by the Lowcountry Affiliate is invested into local projects, while the remainder supports national research programs. The 2012 Komen Lowcountry Race for the Cure® takes place Saturday, October 20, 2012 at the Family Circle Tennis Center in Daniels Island, SC. Enjoy the option of running or walking—by yourself or with a team—or you can sleep in for the Cure. Registration fees are $25 for individuals, $20 for team members, and $35 for sleepers. The registration fee includes the official Komen Race for the Cure® t-shirt and bib. If you’re a breast cancer survivor, let the organizers know, and you’ll receive a pink survivors t-shirt, hat, and bib! Check out www.KomenLowcountry.org to register and be part of an extraordinary cause!
  • Annual FORCE Conference: From October 18–20, 2012, we’ll be in Orlando, Florida for FORCE’s Against Hereditary Cancer Conference, a forum on hereditary breast and ovarian cancer. Join us as well as cancer survivors, high-risk individuals, those with a BRCA gene mutation or family history of cancer, and health care providers who treat high-risk patients. The conference will feature keynote speakers, exhibits, receptions, support groups, health and well-being assessments, and even a pool party! Come join the fun and learn more here: http://www.facingourrisk.org/events/annual_conference/index.php.

Which of these events will you attend this month? Let us know in the comments section and we’ll see you there!

Post Op Pearls Webinar: Share and Tell

Post Op Pearls panel members: Debbie, Chris, Kim Gail and Shirley

We couldn’t be more thrilled with the success of our second webinar titled,  Post-Op Pearls: Recovery, Healing, and Healthful Insights from Past Patients and Specialistswhich happened on Thursday, August 28th. During the hour long webinar our panel, which included both past patients and specialists, shared information, personal tips and stories, and answered questions about breast reconstruction surgery. We’ve received an overwhelming amount of emails from women sharing their thoughts and feelings about this event and we’ve shared them with you below.

” The preparation and recovery tips were most helpful to me at this time since I am having surgery this November. I receive lots of information on reconstruction online, from you, FORCE, Johns Hopkins, and family members doing research or going through diagnoses/treatment.The only thing I do not have my head wrapped around yet is the multiple steps to completion.  I am only allowing myself to deal with step one right now.  I will figure the rest (nipple/no nipples, touch up procedures, etc) out later.

 THANK YOU ALL!”

” Just wanted to say how much my husband and I enjoyed the last webinar.  I liked hearing other patients comments on their recovery, it helps you know that your recovery is normal.  Thanks to all of you for all you do for us, the patients and our family. You make something that started out “bad” turn into a very pleasant experience.  I know that people here in Lexington get tired of hearing me talk about ya’ll but they have also been passing on my experience to their friends and have been recommending ya’ll to anyone they know that can benefit from the God given talent the Dr. Kline and Dr. Craigie share with their patients.

 Thanks again for everything “

” The topics that interest me the most are about the options available to those who do not have the option for DIEP reconstruction.  What are the remaining options, how many stages will it take to get to a finished “product”; what complications might happen; recovery assistance, return to work timeline, and so on. Initially, I got my reconstruction information from my breast cancer surgeon and then local plastic surgeons.  When I researched those options on the Internet I found there were more options available than what was locally available.  In my area, there are no plastic surgeons as well trained and as skilled as Dr. Kline and Dr. Craigie.  I have found the information provided by everyone at The Center for Natural Breast Reconstruction to be outstanding. The doctors and all of the staff are so willing to provide all the pros and cons of procedures and situations. They make recommendations that may or may not fit one’s situation but that information can be reviewed and let the individual make their own informed choice.  For me they have been the “light at the end of the tunnel. “

 I think the webinars are very helpful.  I only wish the person talking could be seen “live”.  The PowerPoint is helpful but would be so much more enhanced if one could see the actual speaker. I would like to learn more about the what is too much to expect from reconstruction surgery.  I was not eligible for a DIEP and had a I-GAP at one hospital and an S-GAP with Dr. Kline.  The S-GAP went so much better.  Now he is cleaning up all the mess from the I-GAP.  What type of breast volume, project, and shape is realistic under such circumstances?  I know each is unique to the individual, I’m throwing out this as a question on general terms. After bad experiences, I trolled the Internet to find doctors that could perform the type of reconstruction I wanted and needed.  I only found a couple of groups that fit my criteria. The Center for Natural Breast Reconstruction fit my criteria.  What questions should a breast cancer patient list/ask and have answered when seeking someone to provide the most options for reconstruction? I love all of you.  

You are the best!!!  So is East Cooper Hospital!!!! “

Through webinars we are able to continue our mission to help hundreds of women understand their breast reconstruction options and make informed choices about the option that fits in their lives. Whether you joined us live, listened to the replay, or regrettably missed out, we encourage you to share feedback and let us know what aspects of breast reconstruction you want to know about so we can serve you better. We’re sure to be hosting another webinar in the near future so stay tuned, you don’t want to miss out!

Let us know your thoughts in the comments section below or send our team an email today!