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Ask The Doctor-Is the DIEP flap procedure an option for me?

January 9, 2015 by

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

Question:I had a bilateral mastectomy with expanders in October of 2013, followed by chemo and radiation. It is now time for my exchange surgery, but I really want the DIEP flap procedure. My plastic surgeon is hesitant to do the surgery. Is a flap procedure even an option at this point?

Answer: Thanks for your question. Yes it is possible and we frequently do replace expanders or implants with DIEP flaps. In other words the extra skin and fatty tissue from the tummy area. Some people may not have extra tissue to use from their tummy or may have had previous surgery (tummy tuck). In that situation we can usually find extra fatty tissue from another area without removing any of your important muscles. If your surgeon does not think you should do that, ask why. There may be a good reason. You can always get a second opinion if you like. Let me know if you would like more information. Thanks again.

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

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Ask The Doctor-I am 52 years old and thinking about a bilateral DIEP flap surgery.

January 2, 2015 by

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

Question: I am 52 years old and thinking about a bilateral DIEP flap.

Answer: Thank you for your question. Have you already had a bilateral mastectomy? Do you have a specific question regarding the surgery? If you are thinking about a bilateral DIEP you have been considering options for breast reconstruction. This surgery can be done at the time of mastectomy or it can be done any time after. Also it can be appropriate for patients who have had breast cancer or who are at high risk for breast cancer. We would be glad to contact you for more specific information if you like.  

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

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Ask The Doctor-I have just undergone a nipple sparring bilateral mastectomy, and I’m concerned about the outcome. What are my options?

December 26, 2014 by

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

Question: I am a 49 year old woman, and I have just undergone a nipple sparring bilateral mastectomy with a lat flap & expanders put in. My surgery was on 10/30, so I am at 3 weeks and am having necrosis issues on one nipple and in another area near an incision. I am extremely concerned about the outcome of my results and would love to hear your opinions as to what my options might be? We were actually scheduled for a trip to Charleston in Nov for 5 days that I regretfully had to postpone due to my recent breast cancer diagnosis. Any advice you could give me would be GREATLY appreciated!

Answer: Thank you for your question. I’m sorry your having some healing problems.   I know it can be stressful. It can also seem a lot worse than it really is. It is hard to picture the end result when you are going through the healing phase. When my patients have mastectomy skin healing problems we are very conservative and let the healing progess slowly and manage the wounds carefully. Many times the end result is much better than anticipated. I would be glad to see you when your in town to give you my opinion. Just let us know. We can try to make it convenient, it sounds like you could use a nice vacation. My office can contact you to make arrangements if you like.

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

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Ask The Doctor- What Can Be Done for Inflammation of Scar Tissue?

December 19, 2014 by

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

Question: I have chronic inflammation of scar tissue after having breast cancer surgery and reconstructed surgery. I have been in pain now for over a year. What if anything can been done to for this?

Answer: Thank you for your question. We cannot specifically give you medical advice by email because we would need more information.  You should make sure your surgeons (plastic surgeon and breast) and oncologists know you are having problems right away if you have not already.  They will be familiar with your history and can make sure you have been checked thoroughly.

We specialize in breast reconstruction and frequently help patients having problems with their reconstruction. The effects of radiation and scaring can lead to problems and pain. We help patients with implant problems by replacing their implants with their own fatty tissue. If you would like more information I would need to have my office contact you regarding your specific situation.

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

Just ask!

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Ask The Doctor-I had a double mastectomy in 2008 and now wish I had implants…is it too late?

December 12, 2014 by

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

Question: I had a double mastectomy in 2008 and now wish I had had implants…is it too late?

Answer: Yes, you can have breast reconstruction 8 years after your mastectomies. I have patients who have waited 22 years. Also its up to you and your plastic surgeon which technique is best for you. That includes implants. Thank you for you question!

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

 

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Ask The Doctor-I’m having implant difficulties. Can you help?

December 5, 2014 by

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

Question: I was diagnosed with triple negative breast cancer in my left breast in December of 2010. I had a lumpectomy in January 2011 followed by chemotherapy, a bilateral mastectomy and radiation. I have implants now. The right implant has dropped and the left is hard and contracted. I need help. My 36d has been replaced by 38b and the cups are too big. Please help.

Answer: I’m sorry you’re having problems with your breast reconstruction. Our practice specializes in breast reconstruction using your own tissue and preserving your body’s muscles.  Approximately 30% of our patients have already had implants and we remove them and complete their reconstruction without implants. You may already know that after radiation the chance for complications with implants increases. We have helped many women having similar problems to what you described. I would be glad to give you more specific information about your situation but I would need more information from you. I could talk to you over the phone or you could come for a consult depending on what is most convenient and where you live. Let me know.

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

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Ask The Doctor-What are the Reconstruction Options for an Overweight Person Who Had Radiation

November 28, 2014 by

pink flowerThis week ,Richard M. Kline, Jr., MD , of The Center for Natural Breast Reconstruction answers your question.

Question: What are reconstruction options for me as an overweight person who had radiation?

Answer: Thanks for your question. Knowing only that you are overweight and have had radiation, I can only speak in generalities, but it may be of some interest to you.

 

Radiated patients are far less likely to tolerate implants than non-radiated patients, so that may mean that you could be better served by natural breast reconstruction with your own tissue. While it can be extraordinarily difficult (sometimes impossible, actually) to achieve a satisfactory delayed reconstruction with implants in a radiated patient, radiation commonly has almost no impact on our ability to reconstruct you with your own tissue, since we are bringing fresh non-radiated tissue to the area.

 

Additionally, implants are only commonly manufactured up to a volume of 800 cc. While this may seem like a lot (and actually is a lot, when used for cosmetic augmentation), it often falls far short of the volume requirements needed by a large patient for a complete reconstruction. Fortunately, there is no firm limit on how large a natural tissue flap can be transferred, except for how much tissue is available. We have in the past transferred flaps in the (1500 – 2000) cc range with success.

Of course, extra weight (also depending to some extent on how it is distributed) can bring additional risks. Extra weight brings an increased risk of blood clots (which can be fatal), and an increased risk of wound healing problems. As a very rough guideline, and, again, with the knowledge that how the fat is distributed makes some difference, we start to get concerned when the BMI exceeds 30 and approaches 35. This doesn’t necessarily mean that surgery can’t be done, just that all of an individual’s specific risk factors and options must be scrutinized very closely before making specific recommendations.

 

I hope this has been of some help. Please feel free to call or email if you would like more information.

 

 

 

 

 

 

 

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Happy Thanksgiving!

November 27, 2014 by

Thanksgiving - What Are You Thankful For?

Happy Thanksgiving to all of our faithful blog readers, Facebook friends, and Twitter followers.  

We sincerely hope you have the most blessed of days, safe travels, and happy hearts as you celebrate.   

  Most of all we are thankful for you!   

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Ask The Doctor – Will My Medical Insurance Policy Cover My Procedure?

November 7, 2014 by

<alt="medical insurance coverage"/>This week , Gail Lanter, CPC, Practice Manager of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I have Buckeye Medical Insurance and I wanted to know if it will cover reconstruction of my right breast after having a lumpectomy and radiation treatment. It left my right breast disfigured, so I need to have this surgery. Thanks!

ANSWER:  I’m happy to try to answer your question for you. Buckeye Medical Insurance looks like it offers a few different types of policies so without knowing which you have I can give you some general information. There are some payers who will not consider reconstruction of lumpectomy defects unless medical necessity has clearly been established. However, the majority of reputable insurers will allow for a reconstruction procedure if a medically necessary lumpectomy results in a significant deformity – as often happens with radiation treatment. Your surgeon’s office should be able to submit all of your documentation, including photos, demonstrating the problem you are having and ask that Buckeye pre-authorize the procedures necessary to reconstruct the area so you have a definitive answer prior to undertaking surgery.

There are many possibilities as far as what procedure to use according to what specific problem you are experiencing. It could be as simple as a scar revision procedure with fat grafting or as complex as the muscle sparing procedures in which we specialize according to how severe the defect. You would definitely want to consult with your plastic surgeon to get a plan as your next step.

Hope that information is useful, and please let us know what else we can do for you. We’re always happy to help!

— Gail Lanter, CPC, Practice Manager 

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

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Ask The Doctor – I Have an Implant But Want Natural Reconstruction

October 31, 2014 by

<alt="natural breast reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had reconstructive surgery on my right breast in 2008. I have a silicone implant, but it feels like a hard lump on my chest. I’m 62 and healthy. I don’t know if my insurance will cover it if I decided to have the natural reconstruction.

ANSWER: Usually your insurance will cover conversion of an unsatisfactory implant reconstruction to a reconstruction using your own tissue with no problem, but we always check first to be sure. If you wish, we can give you a call to discuss your situation in more detail. Many, many people are or have been in your situation, and we are usually able to help.

— Richard M. Kline, Jr., M.D.    

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

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