Ask the Doctor – What Options Do I Have When Removing My Breast Implants?

This week, Audrey Rowen, PA-C, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I had silicone implants in 1988 under skin, which ruptured. In 2012, had bilateral implant exchange with saline implants under muscle. In 2016, the right saline implant ruptured; it was always hard with capsular contraction. I have been trying to find a plastic surgeon who will do a capsulectomy on Rt & Lt… and ideally tissue transfer from my body. (I read the FDA has 356 MDRs of lymphoma including 9 deaths, with saline implants, mostly textured but also smooth.) So, as long as I have a rupture (the right breast is flattened), I may as well have both saline’s removed. Does the fat transfer go under the skin or muscle? Would this be a good option for me at this point? Is the capsulectomy better than the explant-ation? Of course, it also depends on cost! Thank you.

Answer: Thanks for reaching out! I’m sorry to hear that you’ve had quite a lot of trouble with implants over the years. Were your implants placed for reconstruction or for cosmetic purposes? We do a lot with both implant reconstruction and natural tissue, both of which are almost always placed above the muscle. Our office also mostly prefers to use smooth silicone gel implants instead of saline, and we choose not to use textured implants often for a few reasons, one of them being what you researched about the Anaplastic large cell lymphoma.

The biggest question that determines what your best options would be whether you had a breast cancer diagnosis or other factors that would make your case reconstruction vs. cosmetic. Once we get that information from you, I feel we can better give you an idea of what we might be able to do for you.

I look forward to hearing back from you to see how we can help you!

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

Ask the Doctor – I Have Implants But They Feel Horrible And My Reconstruction Looks Terrible. Is There Any Hope After Reconstruction?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question:  I have implants. Do not like them they feel horrible and my reconstruction looks terrible. Is there any hope after reconstruction. I have appointment 2/23/2018.

Answer:  Fortunately, your previous unfortunate experiences with implants in all probability do not affect our ability to get you a satisfactory reconstruction using only your own tissue.

I look forward to meeting with you!

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

Ask the Doctor – Do You Have Experience Replacing Silicone Implants When a Patient is Having a Reaction to Them?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: Do you have experience replacing silicone implants when a patient is having a reaction to them?

Answer:  Thank you for your question.

We have extensive experience replacing implants when patients find them uncomfortable. Most of our experience is with patients who have had mastectomies and reconstruction, but the experience translates to patients who have had cosmetic breast augmentation, as well.

There are many reasons for patients to have problems with implants, some of which we understand, and some of which we probably don’t (yet).

Sometimes the problem can be as simple as the implants have ruptured, and replacing them may solve the problem. While this is very common with older implants (> 25 years old), rupture is much less common with modern gel implants, although it can happen.

Until very recently, breast implants for augmentation were placed exclusively under the pectoralis muscle. We abandoned this approach and started placing implants in front of the muscle (a more anatomically correct location) about three years ago. This is made possible by completely wrapping the implants in Alloderm, which provides strength and padding. Advantages of pre-pectoral (in front of the muscle) placement include less pain, no animation deformity, and a more natural appearance. The primary disadvantage is an increased likelihood of seeing “rippling” in some case. Fat grafting also sometimes necessary to maximize the final appearance. Encouraged by patient acceptance in these cases, we recently starting converting patients with previously placed submuscular implants to pre-pectoral implants. The results thus far, though early, have been very good, with most patients telling us “they feel more like breasts now.”

Of course, not all problems with implants are simply due to submuscular placement. Some people get painful hardening (capsular contracture) regardless of implant position, although the complete Alloderm wrap minimizes the chance of this occurring. Some people just don’t react well to having large foreign objects in them, without being able to narrow down the precise cause further, and these people may not tolerate implants at all. In these situations, if the implants were placed for reconstruction, we have the option of completely removing the implants and replacing them with your own natural tissue taken from your abdomen, buttocks, thighs, etc. This is obviously much more involved than just replacing implants, but the quality of the result is much more natural than an implant reconstruction, and problems after completion of reconstruction are extremely rare..

Any of these techniques could potentially be used for problems after cosmetic breast augmentation, but would involve significant out-of-pocket costs, as insurance will generally not usually cover procedures to correct problems from cosmetic surgery.

I hope this helps some. I would be happy to discuss your situation further with you by phone (1-866-374-2627), or see you in the office whenever convenient.

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

Ask The Doctor – Is it Prudent to Remove the Expanders?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had bilateral nipple sparing mastectomies on 2/9/16 and developed a large necrotic area on the lower pole of my left breast. Air expanders and Alloderm were placed during the surgery and I have also developed redness over the area where the Alloderm is on my right breast. I have been on Keflex 250 mg qid since surgery and Levaquin was added yesterday, 2/26. My surgeon plans to debride the necrosis and perform a skin flap on Friday 3/4. Of course there is no staging of the area under the necrosis at this point. (It turned dusky the day after surgery.)

But I am keen to avoid two surgeries. My questions are these: In your opinion, is it prudent to remove the expanders, allow time for healing and then consider latissimus flap on the left? Under that circumstance, what options are there for healing the wound after debridement? Would closing good skin to good skin be best (I understand distortion is a given) and then flap it later? I will have to be referred for flap surgery and am trying to do diligence on who best to request for this. I am grateful for any advice you might be willing to offer.

Answer:  I’m sorry to hear that you are having a difficult time. From what I can gather from your question it sounds like you have had a difficult time with both breasts. On your left side the healing would be less complicated if you had the expander removed. On the right side if you have an infection then it is possible that the implant may have to be removed.

If the implants are removed then when you have healed you may consider using your own skin and fatty tissue instead of trying another expander. We specialize in breast reconstruction using your own fatty tissue without using implants and without sacrificing your important muscles. That includes the latissimus muscle. I suggest you ask your surgeons if you can consider that route as an option.

I’m sorry I can’t be more specific without more information from you about your situation, previous surgeries and medical history. If you would like more information I could have my office contact you for specifics. Just let me know. Thank you for your question.

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

Ask the Doctor-Can You Fix a Bilateral Mastectomy Gone Wrong?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  Can you fix a bilateral mastectomy gone wrong? My breasts are now hideous to look at and I’m ashamed of my body now. They are lopsided and not even and I’m left with a 2 inch scar across my entire chest.

Answer: It is difficult to know what we might be able to do for you with the information you gave us, but usually something can be done to at least make things somewhat better.

Many of our patients had multiple prior surgeries elsewhere before we met them, and we were able to help many of them. We would be delighted to have one of our clinical staff members to call you to discuss your situation in more detail, if you wish.  Simply call 1-866-374-2627 or e-mail info@naturalbreastreconstruction.com and we can get that arranged for you.

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

Ask the Doctor- Is It Too Late To Have Natural Breast Reconstruction?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had bilateral mastectomies and wanted to do the natural breast procedure but the surgeon wouldn’t even discuss it. Then he totally botched the reconstruction. I look deformed. I still avoid the mirror. A redo was set but was canceled day of surgery because b/p and bipod star were elevated. I want it redone. I would like to have the natural breasts. I have plenty of abdominal tissue. I am diabetic.

AnswerI’m sorry you have had so much trouble with your reconstruction.

Fortunately, previous attempts at implant reconstruction rarely impact our ability to successfully perform a reconstruction with your own tissue. Diabetes increases your risk of some complications, most notably wound healing problems and infections, but it rarely keeps us from doing the reconstruction at all.

If you wish, we can have one of our staff call you to discuss your situation further.

Thanks for your question, and look forward to meeting with you.

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

Ask the Doctor – Why Won’t Insurance Pay For Reconstruction?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I don’t understand why insurance company doesn’t pay for reconstruction if you’ve had a lumpectomy. With radiation, your breasts shrink a lot and you are all out of proportion. I finally did get them to pay for prosthesis and bra.

AnswerThat’s not always the case with a lumpectomy. If the surgery results in a significant defect or radiation negatively impact the tissue, most times we can submit your case to your insurance company along with photos of the affected area and they will indeed cover a reconstruction surgery for you.

We’re happy to chat with you about your specific situation and see what we can do to help you through that process.

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

Ask the Doctor – Would Reconstruction Be Successful For Me?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had implants put in 33 years ago, got breast cancer, had a lumpectomy, radiation, and got rock hard implants as a result. I just recently decided to have the implants removed and a great deal of scar tissue. They put in expanders that caused me to get an infection. I had to almost beg them to believe me as the pain was horrific. I had a 2nd doctor remove the expanders. I now have a very deformed left breast and a severely drooping right breast. I contacted the doctor who put my implants in years ago. He is no longer in the area but told me about this procedure.

I guess my question is if this procedure would be successful for me? I do not like the way I look, and it is painful as well. I am a teacher and would need to know the time frame this would entail. It has been a horrible summer with this ordeal. I almost wish I left the rock-hard implants in. Please let me know what you think. I am very much interested in hearing your thoughts. 

AnswerThank you very much for your question. I’m sorry you have had so much difficulty. Your situation is unfortunately quite common, but the good news is that natural breast reconstruction with your own tissue can often help dramatically. Fortunately, a history of radiation (&/or multiple failed attempts at implant reconstruction) does not at all decrease the success rate of subsequent reconstruction using only your own tissue. We have successfully reconstructed hundreds of women in your situation.

Our first choice for a donor area, if you have some extra tummy tissue, is the DIEP flap. If you do not have adequate tummy tissue, the buttocks (sGAP flap) is also often an excellent donor area.

It is important to realize that natural tissue reconstruction is not just an operation, but a process. The first operation, the microsurgical transfer of the flaps, is by far the largest. It usually takes 6-8 hours, requires a 4-day hospital stay, and a total stay in Charleston of about a week. Recovery takes approximately 6-8 weeks.

After you have healed fully from the first surgery (usually 6 months if you have been radiated), 1-2 additional surgeries are required to achieve optimum results. These are much less involved, ordinarily requiring only one night in the hospital, and you can usually go back home as soon as you are discharged.

While the process can be lengthy, once you are done, you are REALLY done. Most women reconstructed with their own tissue come to regard their reconstructed breasts as their own, and are finally able to put the issue of breast cancer behind them.

I would be happy to call and discuss your situation in more detail if you wish, and thanks again for your question.

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

Ask the Doctor- What Are My Reconstruction Options Using Only My Tissue?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I am 39 years old and seeking options regarding a double mastectomy with reconstruction using only my own tissue. I was treated for an aggressive breast cancer in my left breast 3 years ago; went through neoadjuvant chemo, then a lumpectomy followed by radiation. Due to my lifetime high-risk status, I feel a double mastectomy is necessary using my own tissue for reconstruction.

Answer: Thank you for your question, I am glad to hear that you have completed your breast cancer treatment 3 years ago and are doing well. It is very likely that using your own natural tissue is going to be a very good option for you.

Since you have already had radiation on one side the option of removing the remaining breast tissue and having a preventive mastectomy on the other side is the most effective option to minimize your chance of getting breast cancer again.

Although I imagine it is already very low. Have you had any previous surgery on your tummy? Do you feel that you have extra fatty tissue there or any other area of your body? If so then you can probably achieve a proportional natural tissue result without having to sacrifice your important muscles.

If you like I could arrange a convenient time to answer any other questions by phone. Let me know and I’ll have one of my staff contact you to make arrangements.

Thanks again.

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

Ask the Doctor- Can You Do Repair and Nipple Reconstruction Surgery at the Same Time on the Same Breast?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I had hybrid DIEP reconstruction at another facility, and I am disappointed with the results. There have been many issues. For example, my breasts are different shapes and sizes, no node involvement and no microinvasion. The surgeon who did the mastectomy said the path report said the margins were not wide enough and he will need to cut additional skin out during the next surgery. The next surgery is supposed to be to reconstruct the nipple. Can you do both procedures on the same breast at the same time? Please Help!!

Answer: I’m sorry you are having to go through this.

Did you have a complete mastectomy on the left breast or a lumpectomy? If your margins were positive (unbeknownst at the time of surgery, obviously), and you had an immediate DIEP flap, that could be a little complicated to resolve, although I’m sure we could work through it. Given that your scenario is a little bit unusual, it would probably be best if we talked by phone. Please let us know what works for you.

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