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Will I Have Any Breast Sensation After a DIEP Procedure? Will My Insurance Cover My Post-Op Stay?

November 1, 2013 by

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

Q:  I was recently diagnosed with LCIS and then in a second and third look was re-diagnosed with ALH. I am leaning toward undergoing a  double mastectomy and reconstruction.

As a 45 year-old single mother of three, I would like to know a few things regarding your procedure.

1) Is there any nipple stimulation with the stomach flap DIEP procedure?

2) Is the week-long stay in Charleston covered by insurance in addition to inpatient charges?

3) How early can you get an appointment scheduled? My insurance rolls January 31, 2014 and my deductible has been met after my lumpectomy.

A: I am sorry you are having to make these difficult decisions. Regarding your questions:

1) Breast sensation after mastectomy is never normal. The more of your breast and nipple skin that is saved, the better the sensation after surgery. Also, the DIEP tissue has nerve tissue in it and if all goes well with the surgery, sensation can return faster. Again: it is not expected to be 100% normal. Implants have no nerve tissue and scarring can impair nerve healing.

2) There is at least one place that some patients qualify for that is free. Otherwise, lodging is not covered at all by insurance. We do have a list of places that give medical discounts.

3) If you would like an appointment, I will be glad to have my office contact you.

Thank you!

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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What Technique Do You Use For Nipple Reconstruction?

October 25, 2013 by

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

Q:  Can you tell me how successful you have been in doing nipple reconstruction and what technique you use? I had one done from tissue gathered from my own breast, then had fat transferred but it is still flat. Now that I am losing the other breast (2nd mastectomy) I would like to have a protruded nipple even if just a bit on each breast. 

A: I use the “skate flap” technique, although many similar techniques using local tissue exist. There are, in my experience, two potential problems which may cause nipple reconstruction to be unsuccessful.

1) Sometimes, a portion of the flap just dies. This is, to a large extent, unpreventable and unpredictable, as these flaps are too tiny to be based on any known blood vessel. Additionally, the need to put the nipple in the proper location precludes altering its design to potentially improve blood flow.

2) We have learned that it is essential to protect the flap from the pressure of clothing until it is fully healed (at least one month). There are special domed “Tupperware” protectors made just for this purpose.

It helps to make the nipple larger than desired at first. That leaves a little leeway if things go awry, and it only takes a few minutes to reduce a nipple in the office if it ends up being too large.

Hope this helps, good luck.

Q: I have just been diagnosed with breast cancer of the right breast. The surgeon suggest bilateral mastectomy due to family history. Should I meet with a plastic surgeon before the surgery or get a 2nd opinion?

A: Whether or not you ultimately decide to have reconstruction (at the time of mastectomy, or later), you should at least speak with a plastic surgeon beforehand so that you know all of your potential options. Ideally, your breast surgeon already works with one or more plastic surgeons, and can help direct you to one.

 

Dr. Richard Kline

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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Ask the Doctor: Medicare, Scarless Reconstruction, and Options for Smaller Body Types

October 18, 2013 by

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

Q:  I was diagnosed with breast cancer in December 2010 and had a bilateral mastectomy/ stage 3 with 25 malignant lymph nodes removed. My treatment was chemotherapy followed by radiation. The last radiation treatment was September 2011. I have been researching about the DIEP procedure and am very interested in having this done. I am 66 years old. Do you accept Medicare out of state? The facility in San Antonio does not.

A: We will accept Medicare if you are otherwise (medically) a good candidate for the DIEP procedure. We can have our nurse Chris or P.A. Kim call you to get more information, if you like.

 

Q: Can you have scarless breast reconstruction surgery following a double mastectomy for triple negative breast cancer?

A: There’s really no such thing as “scarless” breast reconstruction, although it is often possible to conceal the scars quite effectively. We’d be happy to have our nurse Chris or PA Kim call you to discuss the details of your situation further, if you wish.

 

Q: What can you do for someone who is thin (5’4″, 116 pounds), has had a unilateral, nipple sparing mastectomy with radiation? Desired cup size would be AA or A only.

A: Most patients, even very thin ones, can still be reconstructed using only their own tissue, particularly if they only need one breast reconstructed, and don’t need it to be very large. If you have any excess abdominal skin / fat at all, it is frequently possible to use both sides of the abdomen to reconstruct one breast (stacked DIEP). Sometimes other donor sites are better ( buttocks or posterior thigh), and most patients have some extra fat spread over their bodies that can be added as free fat grafts at a subsequent procedure after the initial flap. It may be easier to tell which donor site(s) is best during an actual examination, but we can usually get a reasonable idea from photos.

Dr. Richard Kline

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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Flap Procedure Using Tissue or Muscle–What is My Best Option?

October 4, 2013 by

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

Q:  had a double mastectomy in July 2012. I have one successful implant (right) and the left had to be removed due to infection. I need a flap procedure and want to know which one you usually recommend? I have had a lot of bad ratings for the stomach procedure. 

A: Thank you for the question, and I am sorry you have had problems with your implant.

When implants don’t work out,  usually using your own tissue can be an option to complete the process without using an implant. We specialize in using your own tissue but without sacrificing your muscle. Giving up the tummy muscle can be a problem and may have been part of the reason you have had less than favorable reviews on that subject. We prefer to use the body area that has sufficient tissue to rebuild the breast and take no muscle to do that. We can use the tummy, buttock or thigh tissue. I would be glad to give you more specific recommendations if I had more info. Let me know if you would like my office to contact you for more specifics.

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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I Have Poland’s Syndrome–Am I Candidate for Reconstruction?

August 23, 2013 by

Natural Breast Reconstruction options

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

Q: I am a 56 year-old woman who has Poland’s Sydrome. I have no right breast tissue. Are any of your procedures appropriate for my condition? What is the cost? Because my condition is congenital, I will not be covered by insurance. 

A: I have seen many patients with Poland’s syndrome who we were able to help. As you know, there are many different problems–mild to severe–that can occur. All of our patients who have had reconstruction of their breast due to congenital (Poland’s) problems have been covered by insurance. So don’t give up on getting coverage. I will be glad to give you more information about your situation if you like. My office will be happy to contact you, too. Just let us know.

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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DIEP Flap Procedures: Can You Restore My Original Breast Size? Do You Remove Muscle?

July 12, 2013 by

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

Q: I am having a double mastectomy on August 1st. I want to have a DIEP flap reconstruction, but will have to settle on being half the size I am now because there isn’t an abundance of fatty tissue in my tummy. I am a full C cup now and will probably be a B cup following the reconstruction. Can additional fat be harvested from my buttocks at the time of my initial surgery to make me look like I do now or do I have to wait until Stage 2?

A: There are a few potential ways to look at your situation.

First, it is possible to do DIEPs and GAPs simultaneously (4 separate flaps). We don’t do this, because we have concerns about our ability to monitor the buried flap, but we do know have references to associates who can and we are happy to provide you with this information.

Second, it is possible to inject fat into the DIEP flap, and potentially the mastectomy skin flaps as well (if they are thick enough), as well as in the pectoralis muscle at the time of the DIEP flap. All that together will buy you some extra size, but it’s hard to predict how much.

Finally, you could do fat injections after healing in a subsequent stage(s). I would call this the “tried-and-true” technique, little to lose, much to potentially gain. We are investigating BRAVA as an adjunct to this, but not quite ready to use it yet.

 

Q: What happens if I am getting a DIEP flap done and some muscle has to be removed from my abdominal area?

A: A true DIEP flap never results in the removal of muscle, by definition. Some flap surgeons apparently tell patients they may need to remove a little bit of muscle, and we’re not sure why they say that, because we’ve never found it necessary in many hundreds of flaps.

However, with rare exceptions, the rectus muscle does have to be “disassembled” (and put back together again, of course) to remove the blood vessels, and this can occasionally result in partial loss of muscle function. We work extremely hard in designing each DIEP flap to maximize the blood supply to the flap, while minimizing the potential for loss of muscle function.

We obtain an MR angiogram pre-operation. This  requires an unusually strong 3T MRI for best images, which gives us an excellent “road map” of your individual perforator anatomy. We also frequently use the SPY intraoperative laser fluorescent angiogram to help determine exactly which perforating vessels supply the flap best. Thanks to these technologies, in addition to using the best surgical technique we can, it has been many years since we have encountered any significant functional abdominal wall problems in any of our patients.

Hope this helps!

Dr. Richard M. Kline

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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Are You Comparing Apples to Apples When Weighing Your Breast Reconstruction Options?

January 11, 2013 by

We at The Center for Natural Breast Reconstruction know that the Internet is a great place to read and share information, but it is also a great place to become misinformed. Before making any decisions about your breast health, please make sure to contact a surgeon to discuss all your options and make the most informed decision you can. Keeping with the spirit of the Internet as a research tool, today’s Ask The Doctor Question comes from a discussion forum we participated in on WebMD.com. The answer highlighted below in pink comes from our team and showcases the importance of making sure you really are comparing apples to apples when weighing your breast reconstruction options.

Q: Has anyone had a hard time with breast reconstruction after bilateral mastectomy? I had two infections in my right expander, 2 and 3 months after my surgery. The first we conquered with antibiotics; the 2nd we did not, and I had to have it removed 4 months later. I spent the last 5 months healing from that, and just last week had the expander replaced. Hoping for the best this time! But there is significant skin loss on my right side, and my surgeon wonders if there will be enough stretch to accommodate saline fills to match my other side. And of course we all wonder if THIS expander will behave itself and not get infected. Has anyone had this experience, or one similar? Thanks.

A: Why don’t you go with the DIEP Flap procedure – they use the fat and skin from your abdomen area – I have had no problems from this procedure and I have heard of a couple of people who have had issues with infection with the expanders. Find yourself a Plastic Surgeon who does the DIEP Flap procedure

A: I also had a bilateral mastectomy but had to wait 2 years before reconstruction. I also had the expanders but had no problems, maybe it was too soon after your surgery. I would not recommend a tram flap ,it just sounds like an awful surgery.

A: There is a difference between and DIEP Flap and a trans flap.
The DIEP Flap they only take the fat and skin from your abdomen nothing else – they find a good blood supply at the reconstruction site. The Trans Flap is they take your stomach muscle and pull it up through to the breast cavity and also bring the fat and skin from the abdomen area. I for sure was glad that I did not do the Trans Flap.

A: (The Center For Natural Breast Reconstruction’s Answer) The free TRAM flap sacrifices a portion of the transrectus abdominus muscle (hence the acronym TRAM) but doesn’t tunnel it up through the abdomen. The DIEP flap does not use any of that muscle to transfer the blood supply to the reconstruction site. A skilled micro-surgeon with fellowship training in muscle sparing free flap reconstruction provides a permanent reconstruction option with a successful DIEP without sacrificing needed abdominal musculature. There is A LOT of great information on the web about this and what questions you should ask to make sure you are choosing a microsurgical team who has the experience and at least a 98% success rate. Talk to ladies who have had DIEP, GAP, HIP, SIEA flaps ( but not TRAM, it’s not the same) and see what kind of downtime they have had, you’ll probably find it similar to the amount you have had with the repeated implant/expander problems. Best wishes on your research and recovery.

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

 

 

 

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Implant Procedure Without Expanders?

December 7, 2012 by

breast implantsThe below question is answered by the Charleston breast surgeons at The Center for Natural Breast Reconstruction.

Is it possible to have a simple implant procedure without expanders if you have a lot of skin tissue left?

Yes, absolutely, if you are willing to have Alloderm (acellular dermis) used to help support the implant.  We specialize microsurgical reconstruction using your own tissue so we don’t actually do this procedure in our practice but there are plastic surgeons in every metropolitan area who do.  If you are in or near the Charleston area we can give you names of surgeons who are especially good at this procedure.    We know many out of our area too if you’d like to identify where you are located we can see if we know anyone to suggest you consult.

–The Center for Natural Breast Reconstruction Team

Would you like your breast reconstruction question answered? Just ask us!

 

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The Latest Technology in Preventative Mastectomy Procedures

February 17, 2012 by

Today we are putting a twist on our usual Ask the Doctor series and sharing a video interview with our very own Dr. James Craigie. If a picture is worth a thousand words a video must be worth at least a million, right? With the discovery of the correlation between breast cancer and family history, more and more women and opting for preventative mastectomy procures. Watch as Dr. James Craigie highlights the latest advanced reconstruction techniques offered at The Center for Natural Breast Reconstruction to restore a woman’s natural look.

As part of our weekly ask the doctor series we encourage you to submit your questions to our team or leave a comment below and we will get back to you! For more information on The Center for Natural Breast Reconstruction visit our website. We’d love to hear from you!

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What Are My Options for Uneven Breasts?

October 14, 2011 by

charleston breast surgeonsThe below question is answered by the Charleston breast surgeons at The Center for Natural Breast Reconstruction.

I had TRAM flap reconstruction in 2002 with revision and a follow up surgery in six months later. Since then some shrinkage has occurred in the reconstructive side and I have a hollow area on the upper portion. Do I have options for more normal looking breast without the hollow area?

You potentially have many options to improve your reconstruction. No one solution is perfect for all situations, but some options include repositioning the flap to a higher location, augmenting the hollow area with your own fat grafts (taken usually from abdomen, thigh, or buttocks), or using any excess skin / fat from under your armpit as an additional flap to lift and augment the TRAM (we call this a 5th intercostal artery perforator flap). Some more aggressive options would include placing a small breast implant under the TRAM flap, or adding a whole new microvascular flap from another area, although this is rarely in practice necessary.

Hope this helps. Please feel free to email or call with any additional questions.

–The Center for Natural Breast Reconstruction Team

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