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

Question: I had breast reduction surgery a few months ago and have developed fat necrosis. I keep reading it may resolve, I’m scared it won’t! My right breast has a 4″ X 1.5″ area of it. Is that considered a large area? I’ve read that only small areas have a chance of resolving on their own. I keep massaging the area and applying heat. Is the icy hot patch a good option for heat?

Answer: Fat necrosis usually resolves on its own, but it is true that large areas may persist indefinitely. If the area is not painful, it probably does no harm, other than potentially complicating mammograms and breast exams. If it concerns you, however, you may wish to consider having it removed. There are no firm guidelines, but large areas persisting more than 6-12 months are less likely to go away on their own.

Thanks for your question.

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 double mastectomy 9 years ago. I am BRCA 1 positive and have lost several family members to both breast and ovarian cancer. I would like to have my silicone implants removed and have the DIEP surgery. However, I don’t know if my insurance will cover this procedure and how being out of state will affect the payment of it if it is covered.

Also, I am one of Jehovah’s Witnesses and I wanted to verify the surgical team is okay with performing bloodless surgery. Maybe this surgery is designed to be bloodless but I wanted to make sure everyone is comfortable with working on Witness patients.

Answer: Thank you for your question. Yes we frequently help women who have problems with their implant breast reconstruction. If you feel like you have extra tummy tissue there is a very good chance that removing the implants repairing the chest muscle and rebuilding the breasts with the DIEP procedure would be our recommendation.

I am very familiar with the Jehovah witness faith regarding surgery and blood products. I have quite a few patients and would be glad to discuss this with you. Let me know if you have more questions or if you would like to arrange a time to discuss your situation.

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: After having surgery, radiation treatment left my breast very small so I want to know if I may be a candidate for a procedure to rebuild my self-esteem. I had a complete mastectomy after the radiation on the right breast.

Answer: Yes there is definitely a chance that you could have your breasts reconstructed. After radiation I would usually recommend options that use your body’s own natural tissues because after radiation implant options are higher risk for problems. If you still have your left breast but it has developed shape problems because of surgery and radiation then there are options that can help. It may be best to rebuild both breasts at the same time to achieve better symmetry.

After radiation we usually wait a period of time (approx. 3 months) before performing reconstruction. Any time after that is usually ok. For more specific information I would require more of the details of your situation, medical history and prior surgery history. Thanks for your question. I hope this helps. Let me know if you would like 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: 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. 

Answer: Thank 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 you 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!

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

Question:  I had bilateral mastectomies with reconstruction in 2007. I recently had my implants replaced due to a capsular contracture on the left side. I now have 495CC contour implants. I love the right side but not much the left. Is there anything that can be done to help?

Answer: There is possibly something that can be done to improve your situation, but it is difficult to say for sure without knowing a little more about what is going on. Some possible things which could make your reconstruction unacceptable include recurrent contracture, inadequate soft tissue cover, or the implant shifting from the proper position.

Additionally, if you are radiated on that side, it can be very difficult to get an acceptable result. We would be happy to call and discuss your situation further, if you wish.

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:  What is the approximate cost and time for this procedure?

Answer: Thanks for your question. I’m sorry I can’t be too specific because there are quite a few variables to consider. Breast reconstruction is covered by insurance and the total cost depends on hospital and doctor charges.

When someone pays out of pocket we get quotes from the hospital based on what surgery is being done. The same thing is true regarding the surgery time. The average for one breast approximately 3-5 hours. The hospital stay is 4 days.

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 currently have breast implants that were done about 9 years ago following a double mastectomy. I want to have the implants removed and redone with my own tissue. I do not know if my insurance will cover this procedure and I need to have a bloodless surgery. My current plastic surgeon recommended that I get someone who specializes in this type of surgery since there aren’t any in our area that do it often enough for him to recommend.

My surgeon also suspected that one of the implants has ruptured and I didn’t know if I should go ahead and have my MRI done here or if I should wait to have it done as part of the surgery that you would perform. I just wanted to avoid duplicating necessary lab and xray work.

Answer:  Hi, thank you for your question. It is our mission to help women restore their bodies after mastectomy. We named our practice the Center for Natural Breast Reconstruction because we specialize in using your own natural tissue. We replace problem implants frequently with fatty tissue (DIEP, sGAP, fat grafting etc…). What do you mean by bloodless surgery? It is very rare for our patients to require blood replacement.

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: Hi, I have widespread DCIS in one breast. I am very interested in reconstruction using my own tissue. I had a lumpectomy but all of the DCIS was not removed. Not all margins were clear. I live in Columbia and if I’m a candidate, I would love to know recovery time as I work full time.

I just have so many questions as I was not expecting to hear I needed a mastectomy. I’m 52 and am probably a B cup at best. I’m not looking to go bigger, etc. I just want to do the best thing to feel normal. I also am considering double mastectomy.

Judy K. told me all about you and has given me so much information on reconstruction. I would love to see if I’m a candidate. I do have a clotting disorder called the prothrombin gene mutation so am usually on Lovenox for a few days after any surgery.

Answer:  We would be more than happy to see you and discuss your options.

Reconstruction is not just one operation, but a process, with the first stage (flap transfer) being by far the largest. The first stage usually requires 4 days in the hospital, and another 2-3 days in town. There isn’t any “magic point” when you are fully healed, but we usually say 6-8 weeks is necessary for recovery. Any subsequent stages typically require only one night in the hospital (at most), and you can leave town the next day.

We ordinarily keep patients on Lovenox for at least a full week after surgery. If you have a clotting disorder, we may extend that, based upon your hematologist’s recommendations.

If you would like to see an experienced breast oncologic surgeon also at the time of your visit, we can easily arrange that.

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 mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had.

The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast. I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere.

As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much!

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best. Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue.

If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles. The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

Question:  Thank you very much for taking the time to answer my email!

I appreciate the options you are giving me without sacrificing the muscles of my body. I wasn’t so thrilled about that kind of surgery. As I read your website, I understand that you do that surgery. Do you see good long-term results with DIEP or sGAP?

Answer: Yes. When using your own fatty tissue the long-term results are typically the most natural of all the options. When the process is successfully completed the fatty tissue is living tissue that never deteriorates. In other words the results should be permanent. Implant techniques tend to deteriorate over time due to the fact that the implant is not living tissue. Implants can leak, move out of position or need to be removed secondary to infections.

Also the body can reject them because they are a foreign body. Long term results from techniques that remove or sacrifice important muscles can have long term problems associated with removing the muscle. Furthermore the breast is not made of muscle so muscle should not be needed to make a new natural breast after mastectomy. Every situation is different and perfect results are not guaranteed with any approach. No one technique is best for every individual.

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