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I Have Had Breast Cancer Three Times–Am I Still A Candidate for Reconstruction?

June 13, 2014 by

Spring-flowers-pink-pretty-1-jpgThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I have had breast cancer three times. A lumpectomy (right) in 2001, a mastectomy (right) 2003, and mastectomy (left) 2008. I’ve only received radiation in my right breast. Am I still a good candidate for the reconstruction?

A: Thank you for your question, I’m sorry you have had to go through breast cancer   three times. Depending on your overall health and any other types of surgery you could  be able to have breast reconstruction. As you may know already it is not extremely rare for women to have breast cancer in one breast and later have it in the other side. It is definitely less likely than having it on one side only. It is also not unusual for women to undergo bilateral breast reconstruction. To determine if you should undergo surgery we would need to have a bit more info about your overall health. My office can contact you if you like.

Dr. James Craigie

Center for Natural Breast Reconstruction

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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After Multiple Grafting Procedures, What Are My Options to Finish My Reconstruction?

May 30, 2014 by

1401377_roseThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a RB mastectomy in 2008. Since January 2013 I have had 6 micro-fat grafting procedures with my current surgeon. After the fifth procedure, some of my radiated skin failed. The sixth procedure was Apr 4, 2014 and he sewed up the open wound, did a reverse abdominoplasty fat transfer to create a breast fold, and transferred some fat. I am not confident that my skin will stretch sufficiently to finish this process satisfactorily with additional fat transfer and want another opinion, and to evaluate other procedures, before I proceed.

My belly fat is still intact but would be the next place to go. Several patients I’ve corresponded with online have been in a similar position and recommended Dr. Richard Kline. Any advice?

A: Thank you for your question and I am sorry you are having problems. You mentioned that your tummy fat was intact. Does that mean no lipo in that area? If so using the tummy skin and fat may be a good option. Other options include fat from the buttock or thigh. We will have Chris from our office contact you for some additional information and photos. We can then set up a consult via Skype or phone with myself or Dr. Kline. Thank you again for your question.

Q: I would like to set up a consultation about the possibility of replacing my implants from breast reconstruction after a bilateral mastectomy with my own tissue. I’m not happy with the results of my reconstruction.

A: I’m sorry you are having problems with your implants. I will be glad to have my office contact you and schedule a consultation. They will need to get some information about your situation etc. We do frequently treat women who have had implant problems. Approximately 1/3 of our patients have come to us because of implant problems. We specialize in replacing your implants with your own tissue and preserving your muscles.

Dr. James Craigie

Center for Natural Breast Reconstruction

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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Bring On the Blues!

May 23, 2014 by

“Are you contracted with my insurance company?”

That’s always one of the first questions asked by our prospective patients. If your Blue Cross Blue Shield plan is a member of the “Blue Card” network then the answer is “YES” and you can rest assured there will be no surprises and you will get the best benefit available to you through our practice, our chosen hospital, and any ancillary services. We never utilize providers outside of the network for our Blue Cross Blue Shield patients.

100 million members — 1-in-3 Americans – rely on Blue Cross Blue Shield companies for access to safe, quality, and affordable healthcare. Operating and offering healthcare coverage in all 50 states, the District of Columbia and Puerto Rico, the 37 Blue Cross and Blue Shield companies cover 100 million Americans.  Nationwide, more than 96% of hospitals and 92% of professional providers contract with Blue Cross and Blue Shield companies — more than any other insurer.

The Blues® currently serve 85% of Fortune 100 companies and 76% of Fortune 500 companies.  Moreover, the Blues have enrolled more than half of all U.S. federal workers, retirees and their families, making the Federal Employee Program the largest single health plan group in the world.

bluesHow can you tell if your plan is part of the “Blue Card” network?

– Alpha Prefix – Three characters in the first position of the identification number.

– Suitcase Iconee characters in the first 

Here is how the program works:

  • We submit our claim to Blue Cross Blue Shield of South Carolina (BCBSSC)
  • BCBSSC electronically forwards the claim to the patients home plan
  • Patients home plan verifies eligibility, applies benefits, and returns claim to BCBSSC
  • BCBSSC applies pricing according to our contract and sends remittance and payment to us

If you are still uncertain or if your card looks a little different than the sample here, just give us a call and we’ll be happy to check it out for you. We have insurance experts on staff that can answer these kinds of questions quickly and efficiently. Our office is contracted with most major insurers including United Healthcare, Cigna, Medicare, Aetna, Humana, Coventry and many, many more. We’ve never met an insurance company we couldn’t work something out with.

Have a FANTASTIC DAY!

Gail Lanter, CPC

Center for Natural Breast Reconstruction

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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Mastectomies and Expanders: Your Questions Answered

April 25, 2014 by

Ask the DoctorThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: Both my mother and my aunt have been diagnosed with breast cancer. If I were to get a mastectomy, would it be covered by insurance in the state of Pennsylvania?

A: The situation with “high risk” patients and prophylactic mastectomy seems to be evolving. If you are tested and found to have the BRCA gene, most or all insurers seem to be covering mastectomy and reconstruction. Even if you do not have the BRCA gene, but have a strong family history such that your medical oncologist recommends mastectomy, your insurer may well cover it. There may be other laws specific to this in the state of Pennsylvania of which I am not aware, but possibly Gail, our office manager and insurance specialist, can help you more.

Q: I had breast cancer in my right breast, and received a double mastectomy in November. They placed expanders in both. I didn’t have any trouble on the left side. However, six surgeries later, I opted to have my right-side expander removed. It feels better. However, I am now scared to undergo reconstruction due to this past trouble with my right expander. I still have the expander in my left breast. Any advice for me? Is it common to have trouble with expanders?

A: Sorry you are having trouble.

Unfortunately, trouble with expanders is pretty common. It’s more likely if you were radiated on the “problem” side, but it also happens with some regularity even if you aren’t radiated.

Fortunately, previous trouble with expander or implant-based reconstruction does not adversely affect your ability to have natural breast reconstruction using your own tissue. Many of our patients come with stories very similar to your own, some already having had over 10 surgeries, and almost all have subsequently achieved satisfactory, natural-feeling reconstructions without the use of implants.

I think there is an excellent chance that we can help you. If you wish, we can have our nurse Chris or P.A. Kim call you to discuss the specifics of your situation in more detail.

Dr. Richard Kline

Center for Natural Breast Reconstruction

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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What Are My Options for Nipple Reconstruction?

April 4, 2014 by

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I’m four months post-reconstruction and am looking at nipple possibilities. Do you also create 3-D nipples, or refer your patients to a specific tattoo artist? Do you have a preferred prosthetic nipple source?

A: Thanks for your question. We perform nipple reconstruction first, using skin from the new breast. When that heals, our nurse or physician assistant do the tattoo. You can do either both or none of the above. I know there are resources for prosthetic nipples but I have no knowledge of what company provides them. I think 3-D refers to the tattoo technique performed without the nipple reconstruction. The color technique creates the apparent nipple. Therefore if you do not want to have a procedure to make the nipple, you could have the tattoo alone with 3-D coloring. Unfortunately, I’m not sure who does that particular tattoo technique.

Dr. James Craigie

Center for Natural Breast Reconstruction

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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I’m Not Happy With My Implants — Is Flap Surgery Possible?

March 28, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a double mastectomy last August with immediate expander reconstruction. My expanders were replaced in January with silicone implants and needless to say I’m not thrilled with them. They are hard, cold and I now have ripples across them. My surgeon is going to remove more excess skin in hopes to alleviate the “wrinkling” effect, but I’m honestly not sure if I even want to have this done. I originally wanted to have a tissue transfer (abdominal) but was advised to try the implant route first.

I know that I don’t have a lot of abdominal fat and would probably end up with very small breasts if I went this route instead. I don’t mind the smallness but am concerned on the dangers of having a tissue transfer and wonder if this would be a better, more natural breast for me. I’m not getting the feeling that my surgeon is comfortable with this type of surgery and would like more information on your facility. I feel like I have so many questions that no one can seem to answer. Is there someone that I can reach out to?

A: We would be very happy to discuss your situation with you. It is very rare for someone not to have enough stomach or buttock tissue, especially with subsequent fat grafting, to provide an acceptable breast size. Flap surgery can be a little intimidating, but our success rate over the last ten years is 98.4%. We have helped many women who have started out with implant reconstruction, only to decide that it was not the right choice for them.
Our nurse Chris or P.A. Kim can call to discuss your situation further, if you wish.

Thank you for your question.

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

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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Help! Is This Long-Term Pain After Breast Reconstruction Normal?

March 21, 2014 by

DIEP flapThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions when considering reconstruction or pain after reconstruction.

Q: I had flap surgery in October 2010. Since then, I have experienced pain to the touch in that area, all day, almost every day. Is this normal? 

A: I’m sorry you are having pain in your reconstructed breast. If you have not had your surgeon examine you, that should be your first step to get to the cause of the pain. After breast reconstruction is completed, the new breast should not be painful.  Some people who have implant reconstruction can have pain related to capsular contracture or implant rejection.

If I had more details about your situation, I could possibly give you more information. I would strongly recommend that you make sure your surgeon and or oncologist thoroughly look in to the cause of the pain. I would also not wait a long time to do this. Let me know if you would like to give me more info.

 

Q: I’m considering breast reconstruction. How long will it take for breast to look normal? What are the differences in the different types of procedures?

A: Thank you for your question. All types of breast reconstruction require time to complete and almost always more than one surgery. Depending on the circumstances, some patients may require chemotherapy and/or radiation. If this is the case, treatments can delay the completion of the process. I tell my patients to allow 3-6 months after any procedure for the results to settle and swelling to resolve.

There are generally two types of reconstruction: implant reconstruction and reconstruction using your own tissue. Implants are generally less natural and for some patients, the results are less permanent. Using your own tissue can be grouped into procedures that sacrifice muscles in the body and those that preserve muscle and use only skin and fat. The latter muscle-sparing procedures are our specialty and require expertise in a specific type of microsurgery.                

I hope this helps! Let me know if you need more info.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Can You Perform a Buried DIEP Flap Procedure Utlizing Expanders?

December 27, 2013 by

The following question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

Q: I have had bilateral mastectomies without radiation. Cancer was in the left breast and I have been cancer-free for over a year.

I may be interested in DIEP reconstructive surgery. However, I am having trouble finding a surgeon to perform a buried flap utilizing expanders and my current mastectomy scars.

It is bad enough to have to have a large ugly scar across my abdomen, but to have my breast look like patches with two scars each is even more horrible than having cancer! It is even more disfiguring than the mastectomy and is not doing any woman a favor by making their self confidence and self image even worse. Are buried DIEP flaps one of the procedures that you perform?

A: Thank you for your question. I am sorry you are having difficulty finding a surgeon to address your situation. Every person’s situation is unique and if I had more info I could be more specific to you. However, I think I can help clarify why you are having a difficulties finding a surgeon to address your concerns:

During a mastectomy surgery, it is the breast surgeon removing the breast who has a major impact on subsequent reconstruction options. If no reconstruction was performed at the same time, then the surgeon was obligated to remove excess breast skin in order for the mastectomy incisions to heal without complications. It is important to understand the breast shape is determined by the breast skin that surrounds the new DIEP breast. If surgery removed the skin, then it has got to be replaced in some way.

In your question you spoke of tissue expansion. This technique does not create new skin but stretches the remaining skin. It also stretches the chest muscle and the muscle does not recover. Also, it’s important to note that some people will reject the tissue expander and have problems expanding the breast scar. In my opinion the technique of expanding the skin and later rebuilding the breast with a DIEP works best when the surgeons work together and extra skin is saved by the breast surgeon. Please try not to be discouraged! We have helped many women in your type of situation regain their self-confidence and their body image after mastectomy.

Also, please understand that in order to undergo the procedure you mentioned would require another surgery when the expanders are placed and the skin and muscle stretched over six months or sometimes less. When the stretching was completed then the DIEP procedure would be done but would require another two surgeries. It is unknown whether your body would stretch well and the process could be more complicated.

Most of our patients want to have reconstruction with their own tissue and do not want to sacrifice any important muscles. Our goal is to restore our patients’ self esteem and not simply scar their bodies and put them together with “patches.” Please let me know if you would like any more specific information we may need to touch base with you by phone.

James E. Craigie, M.D.

Center for Natural Breast Reconstruction

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by submitting your questions here.

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Will My Previous Surgeries Compromise My Chances for a DIEP Procedure?

December 13, 2013 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  I am BRCA 1 positive and researching prophylactic mastectomy with immediate reconstruction. As far as I can find out, DIEP is not available in TN. I am planning to have a bilateral salpingo oophorectomy at some point in the near future and have had 2 previous C-sections. Does that exclude me from being a DIEP candidate?

A: Thanks for your question. Most likely your previous  surgeries have not compromised your chances for DIEP breast reconstruction. In fact, I see patients frequently who have been told they can not have a DIEP, and in fact it works quite well. I would be glad to get more info and could be more specific. Let me know.

 Q: I’m considering implant-based breast reconstruction. My surgeon mentioned a “risk of capsular contracture.” What exactly is that?

A: Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.

The occurrence of capsular contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule tightens and squeezes the breast implant; as such, it is a medical complication that can be very painful and discomforting, and might distort the aesthetics of the breast implant and the breast.

Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.

Moreover, because capsular contracture is a consequence of the immune system defending the patient’s bodily integrity and health, it might reoccur, even after the requisite corrective surgery for the initial incidence.

The degree of an incidence of capsular contracture is graded using the four-grade Baker scale:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Post-Operative Care: What to Expect and Helpful Tips

November 8, 2013 by

Post-Op Care and TipsOur team often receives questions on the healing process and post operative care after breast reconstruction surgery. We strive to provide our patients with the information to ensure they achieve the most optimal surgical experience. For today’s Ask The Doctor post, we are sharing with you some tried-and-true steps and tips we have to help our patients improve their post surgery recovery and healing time.

After Surgery

Family members will receive periodic updates during your surgery.

Following the procedure, you will be moved to a special unit in the hospital where you will be connected to monitoring equipment. There, nurses trained in post operative care of breast reconstruction will monitor you at all times.  Family members can see you during visiting hours.

You will also receive an informative sheet that discusses your specific information and post-operative care.  This likely will include information concerning drain care; it is very important to monitor flow from the drains in a 24-hour period. This guides us on when to remove them.  You will also have a kind of thermometer on your chest, which monitors the flap.  Other specifics and information will be provided in your post-operative packets.

As You Heal

Family and Friends:
Support from loved ones is very helpful. But understand that comments they may make during your recovery can cause you concern. Remember this: We will tell you honestly how you are doing and what we expect your result will be.  Please trust in our knowledge and experience when we discuss your progress with you.

Healing:
You will heal! How quickly depends on factors your genetic background, your overall health and your lifestyle (exercise, smoking, drinking, etc.). Many people believe the surgeon “heals” the patient.  No person can make another heal. Dr Craigie and Dr Kline can facilitate, but not accelerate, the healing process.  But you play the starring role, so your cooperation is key.

Swelling:
You may find swelling of your new breast and abdomen (DIEP) or buttock (GAP) to be troublesome and your clothes may not fit.  Be patient, this swelling will gradually subside and you will feel better in a few weeks.  There will be a certain amount of tightness in the area where the flap was taken from.  This will slowly relax in a few months.

Following Instructions:
Another way to improve healing is by following the instructions given by Dr. Craigie and Dr. Kline’s staff.  We believe “the difference is in the details” and strive to achieve the best possible results for you.  It is imperative that you act as a partner in this process — not a passive participant.  The instructions are designed to give you the best opportunity for healing without delay or surprise.

Click here for a complete list of post surgery healing and recovery tips and instructions.

Have questions about post operative breast reconstruction? Or questions in general? Contact us today!

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