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Mastectomy and Breast Reconstruction Questions Answered

January 13, 2012 by

nipple sparing mastectomyThe below questions are answered by Dr. Richard M. Kline, Jr., Charleston breast surgeon for The Center of Natural Breast Reconstruction:

What kind of breast expander do you recommend and employ?

We usually use either Mentor contoured tissue expanders, which have more projection at the bottom than the top, or Mentor round expanders with a remote port. If patients are using tissue expanders only as a “bridge” during post-mastectomy radiation until they can receive a flap reconstruction, then we prefer the remote port model, because it won’t interfere with the MRI we like to get prior to flap surgery to look at the vessels. If the patient is planning on having a permanent implant reconstruction, then the contoured expander (which is not compatible with MRI) may produce a better initial shape.

If I choose immediate breast reconstruction, what happens if it is discovered I need radiation treatment during the mastectomy? What happens then?

It depends on what type of reconstruction you have chosen. If you choose implant reconstruction, radiation doesn’t hurt the tissue expander or implant, although it significantly decreases the chance of achieving an acceptable result. If you have had an immediate flap reconstruction, then learn (unexpectedly) that you need radiation, then the flap may be in serious jeopardy. Experienced oncologic breast surgeons are usually pretty good at anticipating whether a patient will need radiation or not. If significant doubt exists, however, and a flap reconstruction is planned, it is best either place temporary tissue expanders at the time of mastectomy, or delay all reconstruction until after radiation.

What are the disadvantages of postponing breast reconstruction after mastectomy? (scarring, skin sparing options, nipple options)

The only significant disadvantage to postponing reconstruction is potential contraction of skin if a skin-sparing or nipple-sparing mastectomy is used. Depending on the amount of skin present and the ultimate desired breast size, however, this may present a problem for some patients, but not others. The advantages of delaying reconstruction include a decreased incidence of complications, and shorter anesthetics.

For breast reconstruction, what are the options for nipples?

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

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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Feel Confident in the Decisions that You Make with the TalkAboutHealth.com Online Community

December 14, 2011 by

talkabouthealthWhenever an individual is diagnosed with cancer or any other type of disease, they often struggle to find the right information, which, in turn, can make them feel alone and frightened. In an effort to provide personalized answers and a greater understanding for health issues, Murray Jones, founder of TalkAboutHealth, decided to create an online community for people seeking support and medical information and advice.

See below for our exclusive interview with Murray, where he discusses what TalkAboutHealth is and how it benefits individuals seeking support and personalized health advice:

1. What inspired you to start TalkAboutHealth.com?

I was inspired to start TalkAboutHealth based on needs that I saw from being a caregiver to my father, who is a two time melanoma survivor. We had so many questions and it felt impossible to find the right information and then understand it in a limited amount of time. We felt alone and lacked confidence in the decisions we had to make. We needed personalized answers to understand our health situation. We needed perspectives from others like us who had been through similar circumstances. We needed guidance to help find relevant information.

As time passed and I met more people in cancer communities, both medical professionals and survivors, I realized that there was so much knowledge that everyone wanted to share that just needed a place to live and someone to organize it. I thought to myself, I can do that. I can build a website where people can share their experiences.

2. How does TalkAboutHealth.com benefit patients? In other words, what does it offer to patients, survivors, and experts?

Our goal is to help patients get the right information at the right time, so they can understand their health needs and make the right decisions for them. We want to help people feel confident in the decisions they are making, know that they are not alone, and have hope after hearing the stories of others.

To accomplish this, we provide personalized answers from leading medical professionals and experienced survivors. When a patient asks a question, we find and notify the right experts, survivors, and organizations to answer. Each question has answers from several perspectives and provides context and narrative to help the patient.

We then curate and provide structure for all of this information so that it is easy to find. In the future, we will test many different formats to educate—from custom web and email tutorials to working with medical experts on video courses.

3. Why did you decide to make TalkAboutHealth.com a community-based structure, as opposed to a website that featured medical information without the opportunity to ask questions and provide feedback?

For two main reasons:

1. Because the combined knowledge and experiences of the community can have an amazing impact in helping others.

2. Community makes it possible to provided personalized and individualized support.

The purpose of TalkAboutHealth is to be a community where all of us share knowledge, stories, and experiences to support each other.

4. Is there anything else you’d like to add?

I encourage everyone, including medical professionals, to tell their story and share their experiences in whatever format is comfortable for them. It is so important for us to share and support each other. None of us are alone, we need each other. If you share your story, you will help others and find the support you need.

Have any questions about TalkAboutHealth or want to learn more? Visit TalkAboutHealth.com or contact Murray directly at murray@talkabouthealth.com.

Filed Under: Ask the Doctor, Health and Wellness Tagged With: , , , , , , , , , , ,

Step 3 in Quitting Smoking: Taking Effective Actions to Stop

December 7, 2011 by

quit smokingThe one thing that many people don’t understand when it comes to quitting smoking is that addressing the physical addiction to nicotine is not enough. They must also learn to manage the ingrained habits that led them to smoke. People smoke after meals, while driving, and while under stress, to name just three examples. Those urges do not go away simply because the cigarettes are gone.

Quitters need to have a plan for when the habitual part of smoking raises its ugly head. We discussed that a little in our previous post about the 4Ds, but here are a few more tips to master the mental piece of quitting.

Look at your habits.

When did you have your first cigarette of the day? Was it right when you got up, after your shower, or after breakfast? Breaking that habitual urge can be as simple as changing your routine. If you smoked first thing, try going outside for a quick walk instead, or hop into the shower right away.

If your habits don’t change, your chances of staying quit are dramatically lower than if you consciously alter the path of your day.

Have substitutes handy.

If you can’t stop doing something that triggers you to smoke, keep something handy that you can put in your hand or in your mouth. Driving is a strong smoking trigger for many, and most cannot avoid it. Try putting a straw in your hand or a cinnamon toothpick in your mouth. If you find yourself lighting up at a certain intersection on your way to work, find a new route until you’re more secure in your quit.

Enlist help.

If you live with smokers, see what they are willing to do to help you maintain your quit. Having them smoke outside is ideal, since you were likely to smoke with them as part of your habitual conditioning and it’s easier to have them out of sight, out of mind. If they will not go outside, perhaps they would confine their smoking to one room of the house and keep the door closed.

If those you live with don’t smoke, perhaps they can help you identify your smoking habits and ways to break those habits.

You may need to alter your routine for only a few weeks while you master the initial difficulty of quitting, or you may need to change a few things more or less permanently. The main thing to remember is to never take one drag. This is no different from being addicted to any other drug. You would not suggest that an alcoholic or heroin addict has “just one” . . . and you can’t either.

What are your tips to quitting smoking?

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How to Reduce Exposure to Hazardous Chemicals That Have Been Linked to Breast Cancer

December 2, 2011 by

chemicalsOver 400 women are diagnosed with breast cancer each day, and several hazardous chemicals have been linked with breast cancer. While it might not be possible to completely avoid these toxins, here are some ways to reduce your exposure to them.

Eat as naturally as possible.

Our food supply is loaded with artificial ingredients, dyes, hormones, chemicals, additives, and preservatives. Keep your diet as close to its natural state as possible. Shop the perimeter of the store, as much of the chemical-laden “food” is in the center of the store.

When you arrive home with produce, wash it thoroughly. Buy free-range or organic eggs and poultry, grass-fed beef, and wild fish (not farmed).

Buy BPA-free products.

The less plastic you have in your life, the better, but at a minimum, you should avoid bisphenol-A (BPA). BPA is a hormone disruptor found in plastic food and drink containers, as well as in canned food, including infant formula cans. BPA leaches from the plastic or can into the food. Look at the bottom of your plastic containers. Throw away any with the number 7. Plastics with the numbers 1, 2, and 4 do not contain BPA.

Use glass for food storage and cooking when possible, and never microwave food in plastic or Styrofoam.

Avoid furniture made with the flame retardant PBDE.

While flame retardants have a purpose and have saved lives, one type of flame retardant, polybrominated diphenyl ether, or PBDE, has been linked to breast cancer. When buying furniture, look for items with a different flame retardant, or buy organically manufactured when possible.

Use solvent-free cleaning products.

Antibacterial and harsh chemical cleansers are not necessary. The more natural you can go when you clean, the better. Ammonia, bleach, and any cleanser containing a solvent are hazardous to everyone in the home. Hydrogen peroxide, vinegar, lemon juice, and baking soda make excellent cleansers, and a quick Google search will yield plenty of recipes and ideas to use them.

If you prefer other cleansers, buy green cleaners made with safer ingredients, which can be found in any health food store or online.

Clean out your cosmetics.

Makeup is full of additives, chemicals, and synthetic hormones that no one needs. Toss out your liquid or cream foundation and use mineral makeup. It’s better for your skin and covers just as well as the pore-cloggers you’re used to. Mineral makeup companies also sell eyeshadow, mascara, blush, lipstick, and lip gloss.

Stop the antibacterial foolishness.

Contrary to popular belief and TV commercials, antibacterial soap is not necessary and does more harm than good. The truth is that any soap is antibacterial, and you can find natural or organic soap at health food stores or online.

Know the ingredients of everything you buy, no matter who you’re buying from, as marketing pros often give you the illusion that something is natural or organic when it isn’t.

What tips do you have for reducing chemicals and toxins?

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How One Woman Discovered the Positive Outcomes of Reconstruction Surgery and Cancer

November 30, 2011 by

Today’s In Her Words post comes to us from a past patient of The Center for Natural Breast Reconstruction, Jakki Grimball. Jakki is a breast cancer survivor who lived in Columbia, SC and traveled to Charleston to receive her DIEP reconstructive surgery. Today, her and her husband live in Charleston where her husband is the director of The Neighborhood House, an organization providing services for people in need, including food pantry, soup kitchen, emergency assistance, sewing classes, resume writing, and more.

See below for our interview with Jakki:

What type of reconstruction surgery did you have and how do you feel about the results?

I had the DIEP flap procedure done October 2007 by Dr. Craigie. The outcome far outweighs the surgery and recovery time. I am very pleased with the results and having a tummy tuck as an added benefit!

Would you make the same decision again if you could go back?

I would definitely make the same decision. I had a friend who had implants and she now wishes she had done the DIEP flap procedure. She’s had several complications. Of course, I believe I had the best plastic surgeon in South Carolina perform my surgery.

What advice would you give to women who have undergone a mastectomy or double mastectomy and are unsure about natural breast reconstruction?

I would and have advised women to have the DIEP flap surgery. It is far better to have natural breast reconstruction than to have a foreign substance placed in the body. I realize advances have been made in breast implants and there are fewer adverse effects; however, I believe that using my own tissue left little opportunity for infections and other complications. I have never regretted having the surgery or choosing Dr. Craigie as my surgeon.

In what ways has breast cancer both negatively and positively affected your life?

The only negative affect breast cancer had in my life was the mastectomy and the chemotherapy. I firmly believe God has a purpose for everything and having breast cancer made me more aware of how fragile life can be. Breast cancer brought my family and friends closer and I hate to say it, but it weeded out those who were truly not my friends. I found out I had breast cancer three days before my wedding and I gave my fiancé the chance to cancel the wedding. He told me he would marry me at my bedside if necessary. So the diagnosis also brought us closer together. I now cherish every moment and I don’t sweat the small stuff (sometimes not even the big stuff).

You and your husband recently relocated from Columbia, SC to Charleston, SC where your husband is the Executive Director of Neighborhood House. Tell us a little bit about this non-profit organization and how it helps the community.

Click here to view a document from The Neighborhood House, outlining their mission and daily services to the community.

Share this post with your friends on Twitter.

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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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Are you Practicing Safe Breast Health?

October 17, 2011 by

reconstructive surgeryIn November 2010, the U.S. Preventative Services Task Force changed their mammogram guidelines from annually after age 40 to biannually starting at age 50. They also recommended stopping breast self-exams. Their reasoning was that less-frequent mammograms are just as effective in detecting cancer, and self-exams lead to increased and unnecessary doctors’ visits and procedures.

As you can imagine, this created quite a stir among doctors, especially those who have had patients between the ages of 40 and 50 with breast cancer detected by mammogram or self-exams. The data on mammogram effectiveness is conflicting, and women are left wondering about the ramifications of waiting until 50 for their first mammogram. Some physicians and women also wonder whether cost savings plays a role in the recommendations, though the USPSTF says it did not.

Mammograms are the standard of care in detecting breast cancer, and are the best tool we have for early detection. Its technology continues to improve, and currently, digital mammograms are in use in some areas. Most doctors continue to recommend self-exams and annual screenings for patients over 40, with high-risk patients starting mammograms earlier. The American Cancer Society also reviewed its guidelines last year, and it stands by the age of 40 to begin annual mammograms but neither recommended nor discouraged monthly self-exams.

Women under 50 tend to have denser breasts, making tumors difficult to see with mammograms, so for them self-exams are crucial. Most doctors will tell you that they’ve had many, many women find their own lumps during self-exams, and women know better than anyone else does what is normal for their breasts. Doing monthly self-exams is the best way to get to know your breasts so that if a lump does occur, you can detect it as soon as possible and treat it.

We encourage you to talk to your doctor about your individual risk factors and decide which mammogram schedule makes sense for you.

For more information on the USPSTF guidelines, as well as the ACOG revised guidelines for Pap smears, visit http://www.womenshealthmag.com/health/breast-health.

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“Get Your Squeeze On!” How One Woman Is Spreading Awareness about Mammograms

October 5, 2011 by

When we heard that our former patient, Lee McCracken was launching her own line of tees to help raise money and spread the word for breast cancer awareness, we were thrilled!

We interviewed Lee on her new endeavor with her fabulous “Yes, Ma’am! mammograms are a must” tees and also discovered a little bit about her journey through breast cancer and life after cancer.

Read this inspirational interview below (NOTE: all images in this post were provided by and are owned by Lee McCracken):

1. You started the “Yes, Ma’am! mammograms are a must” tees. Tell us a little about this unique tee and what inspired you to create it? Where do funds go for those who purchase the tee?

I admit it—I NEVER liked getting a mammogram. But then I discovered I disliked breast cancer even more! I’m a two-year survivor and a former patient of The Center for Natural Breast Reconstruction. This year, my girlfriends and I decided to be a little more organized for the Komen Race for the Cure in our home city of Charlotte, NC. We needed a name and a T-shirt.

So, I began brainstorming.

I tried to think of a fun phrase that was upbeat and also inspirational. “Yes, Ma’am! mammograms are a must” popped into my head one day in May. Of course, the apostrophe in ma’am is the pink ribbon! My girlfriends encouraged me to merchandise the tee on a local, regional—and, dare I say, national—level.

The face of the under-insured and uninsured woman has changed. Given this economic climate, many women, naturally, are putting their children first before seeing to their own healthcare needs. I want to help fund mammograms for women who don’t have health insurance. Locally, 15% (or $3 of every $20 tee sold) is going to the Carolinas Breast Cancer Fund to help women who are qualified by the Mecklenburg County Health Department.

Individuals, groups, and retail outlets who sell the tee in other cities may designate a charity in their community to receive the funds. Anyone interested should connect with me via e-mail: sales@yesmaamtee.com.

yes maam tees

2. What do you hope to accomplish through selling the “Yes, Ma’am!” tee? In other words, what is your vision for the future of the tee and its effect on women?

Wouldn’t it be fun if women all over started wearing their “Yes, Ma’am! mammograms are a must” tees to the coffee house, grocery store, and gym? It makes a sassy statement in Southern style, and people take notice. I’ve seen women look at my tee and then kind of shake their head, almost to say, “Oh yeah, I need to schedule that.”

The Facebook page is generating interest from all over the country. The tee has fans from California to Oklahoma and Florida to Vermont.

A cancer nurse once told me that when breast cancer is caught in Stages 0-1, treatment can be so much easier and survival rates soar. Let’s strive for 100% early detection!

3. What inspired you to start your own freelance writing / editing business, Joyfullee Written, at the age of 49 and what do you provide others with through this business?

I’ve been writing and editing for more than 25 years, sometimes as a freelancer and other times on staff with a local lifestyle or parenting magazine. The formal launch this summer of Joyfullee Written was my birthday gift to myself. I will turn 50 in October and, not only have I survived breast cancer, but I have also survived several other heartbreaking losses. I’m also working on a book—an inspirational memoir about self-discovery and spiritual preservation through motherhood and menopause. Joyfullee Written comes from the fact that all my inspiration and strength spills from the fountain of God’s grace.

Joyfullee Written provides professional writing / editing services to magazines and businesses. I enjoy meeting people and helping them reach their audience through a well-crafted, targeted message. And, with a passion for lifelong learning, this is helping me to keep discovering new things every day.

4. What is the one thing you want all women to know about breast cancer?

The earlier it’s detected the more treatment options women have! I HATE when I hear someone say “I’m a year overdue for my mammogram.” My Stage 1 breast cancer was caught by a mammogram, and I was fortunate not to have to endure chemo or radiation. I know everyone is busy and mammos sometimes are uncomfortable, but it’s crazy to take such a risk.

All my family members and friends know: Get Your Squeeze On!

lee mccrackenAbout Lee McCracken:

Lee McCracken lives with her husband, Stuart, of 28 years in Denver, N.C., a suburb of Charlotte. She has a 19-year-old daughter, Megan, and a 10-year-old Bichon Frise, Benny. She enjoys gardening, photography, reading and traveling. Lee’s girlfriends keep her sane!

Love the Yes, Ma,am! mammograms are a must tees? Buy one today and help spread awareness for mammograms!

Filed Under: In Her Words Tagged With: , , , , , , , ,

Celebrating National Hereditary Breast and Ovarian Cancer Week

September 21, 2011 by
Image to the left taken from the FacingOurRisk.org website.

In the United States, at least one million people carry genes, such as the BRCA or breast cancer gene, that put them at risk for cancer. In 2010, a Congressional resolution created National Hereditary Breast and Ovarian Cancer (HBOC) Week.

From September 25–October 2, 2011, HBOC Week raises awareness of hereditary cancer and recognizes those affected, including those with a family history of cancer, ovarian and breast cancer survivors, and previvors, those with a high risk of cancer who have not yet developed it.

Previvor Day is Wednesday, September 28, 2011, and a free teleconference with inspirational speaker and previvor Merit Gest will be held at noon EST. This event will focus on empowering previvors to understand the complex choices they face and make decisions about their health. To register, visit http://meritgest.com/national-previvor-day-september-28-2011.html.

HBOC Week falls in the week transitioning from Ovarian Cancer Awareness Month to Breast Cancer Awareness Month. During HBOC Week, Passing the Torch Ceremonies across the country pass a ceremonial flame from an ovarian cancer survivor to a breast cancer survivor to commemorate the transition.

The group FORCE (Facing Our Risk of Cancer Empowered) is a community dedicated to fighting hereditary breast and ovarian cancer, and it has chapters throughout the U.S. Events during HBOC Week are scheduled by local FORCE groups and can be found at http://www.facingourrisk.org/events/HBOCWeekEvents.php. This year, chapters will be sponsoring walk / runs, film screenings, conferences, discussions, and charity events.

FORCE’s website offers the latest information and research on HBOC, and features webinars, books, and movies, as well as support to hereditary cancer victims and their families. FORCE holds an annual conference and HBOC forum during the summer, and focuses on cancer advocacy, education, and peer support. Visitors to the site will find inspiring artwork and blogs, a tribute wall, and the latest news about HBOC.

For more information, or to find out how you can help, visit http://www.facingourrisk.org.

Filed Under: Health and Wellness, Upcoming Events Tagged With: , , , , , , , , ,

Breast’s Anatomy: What Makes Up a Breast?

August 31, 2011 by
Image to the left taken from emedicine.medscape.com.

Breasts are milk-producing (mammary) glands surrounded by fat and are attached to the front of the chest by ligaments. The breast rests on the pectoralis major chest muscle, but has no muscle tissue itself. The fat in the breasts determines their shape and size, which varies among women even though the size of the mammary gland system is relatively standard. In addition, women commonly have one breast that is larger than the other.

Breasts begin developing between the ages of 9 and 14 for most girls, and signal the start of puberty. Breast tissue is highly sensitive to the hormones estrogen, progesterone, and prolactin throughout the menstrual cycle. While breastfeeding, prolactin triggers milk production within the breast, and its anatomy is simple yet complex.

Lobules, Alveoli, and Ducts

Breasts have 15 to 20 sections known as lobes or lobules that converge at the nipple. Each lobule consists of hollow sacs called alveoli, and the lobules are connected through ducts. The final collection area for milk is known as the main duct.

During breastfeeding, prolactin stimulates the alveoli to pull nutrients from the woman’s blood to produce breast milk, and oxytocin causes the alveoli to release the milk through the mammary ducts to the nipple.

Nipple

Also known as the mammary papilla, the nipple is the outlet for the mammary ducts and where milk is secreted.

Areola

Often included when referring to the nipple, the areola is the round pigmented area surrounding the nipple. During breastfeeding, small bumps on the areola known as Montgomery glands produce an oily substance that cleans and lubricates the nipple.

Lymph Nodes and Ducts

The lymphatic system helps fight infection by capturing and excreting pathogens and toxins through lymph nodes and ducts. These nodes are found near the breast, in the armpit, and behind the breastbone. Often, axillary (armpit) lymph nodes are removed during mastectomy.

Cooper’s Ligament

This ligament is often called “nature’s bra” because it lifts the breast and prevents it from sagging.

For a slideshow on breast anatomy, visit http://www.mayoclinic.com/health/breast-cancer-early-stage/BC00001.

Have questions about breast cancer? Visit our blog’s Ask the Doctor section.

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