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

Question: I live in Florida. I had breast cancer 15 years ago and had lumpectomy (r) breast and radiation. My right breast is much smaller than the left and is scarred . I would like to make both breasts symmetrical even and lifted. I have been told because of radiation treatment the right breast would not heal properly?

Answer: Thank you for your question. You  are correct that after radiation the breast tissue will not heal normally following surgery to correct asymmetry. Because the radiation impairs healing attempts to lift or change the breast shape often don’t work. Using an implant to increase the breast size is high risk for implant related problems. If surgery is attempted and a healing complication occurs, then the scaring and the result is often worse.

Two possible options for someone in general include:

1) Fat grafting to the radiated breast 

2) Completion mastectomy to remove the radiated tissue and reconstruction of the entire breast with your own fatty tissue. Option 1 would only be helpful for mild to  moderate shape problems and option 2 would be more involved but in my opinion the most helpful approach.

Let me know if you would like more information about these approaches.

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

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

Question: I have implants over the muscle. One has extreme scar tissue around it that has made it hard and very painful. If I remove them and go under the muscle, is there less chance that this will happen again, and would I need a mesh material to have that procedure performed?

Answer: Thank you for your question. I am thinking that your implants were placed for breast augmentation, please correct me if I’m wrong. In general releasing the scar and repositioning the implants under the muscle may help the problem. Placing the implant under the muscle mainly provides more of your own tissue to cover the implant, which can be helpful for some people. Unfortunately it does not guarantee the problem wont recur. Depending on the cause of the problem this approach may be successful 50% of the time. The use of any type of mesh is not a recommended treatment specifically for scarring around an implant but there are some types of mesh like materials that can help for other types of implant problems. I would need more information about your situation to be more specific. Let me know if you would like to give me some more details. Thanks again.

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

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

Question: I had a direct implant after a mastectomy and have had pain from under my arm to the implant along the scar tissue for 4 months. Should I have a 2nd surgery to remove the scar tissue/neuroma?

Answer: Thank you for your question. It is important for the doctor who did your reconstruction to examine you for any specific causes of the pain. If there is no other reason for you to have surgery on the breast, you could consider a nerve block to see if it is a neuroma. If the block did not last, then considering surgery would be next. If you had any other reason for surgery on the breast (capsular contraction for example), then you might skip the block and ask your surgeon if the scar could be removed during the surgery.

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

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

Question: I had a prophylactic bilateral mastectomy and tram flap done at MD Anderson in 2004. I have had numerous problems since. Last week, I was in a car accident which I had severe bruising to my sternum and a bruise across my left breast caused by the seatbelt. I feel swollen and bruised in both breast and under my arms. Could I have problems with my breasts this long after the surgery? The pain I am having is much like how it felt after the surgery. Thank you in advance for any advice that you could give me.

Answer: Sorry you had some problems, but glad to hear you survived the accident. Most likely your breasts will be fine. Once the body heals after the tram procedure the blood supply grows in to the new breast, and it should heal like any other part of the body. It is possible that the bruising could cause some fat necrosis. It will take some time for the bruising to resolve then you can have your doctor check your breasts for scaring.

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

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

Question: About 10 years ago, I had a prophylactic, skin-sparing, bi-lateral mastectomy, an an immediate reconstruction with a TRAM flap, using the latissamus dorsi muscles. However, the muscle was never cut. The muscle is going from my back around my side, it has since filled with fluid. The issue is, when I exercise it pulls, and it’s very painful. I spoke to one surgeon to cut the muscle, and he said I’d need to know where all the nerves are. Is it possible to give me mobility in my arms again?

Answer: Thank you for your question. It is possible to detach the muscle from the nerve or reposition the muscle so it does not pull as much on the breast when you exercise. In the processes, scar may be released and that may help with the mobility of your arms. Unfortunately, it is hard to say for sure because the latissimus muscle is involved with moving your arms, and the surgery to release the muscle will not return it to is normal function. The good news is that you could most likely get an improvement. I could tell you more if I were to see you or perhaps review photos of your breast reconstruction. Let me know if you need more information.

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

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

Question: Great to meet you and your wonderful staff yesterday. We thought we had asked every question possible, but we got in the car and my aunt asked the question I didn’t think of! How long will the surgery take/be under anesthesia? First procedure and second?

Answer: It was my pleasure to meet you yesterday! Thank you for coming! The time under anesthesia for the first step would range between 3-5 hours. The times vary depending on the microsurgery and the type of connections we may need to make to have a healthy new breast the size required to meet your expectations. The second stage is also variable and ranges from 1.5hrs to 3 hrs. Thanks for your question. Let me know if you have any additional questions

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