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

Question: Should the same physician do the mastectomy as does the reconstruction? Your thoughts?? I am undergoing chemo, will have bilateral mastectomy, radiation then reconstruction?

Answer: Generally speaking, the mastectomy should be done by a general surgeon, and the reconstruction should be done by a plastic surgeon. Often, the mastectomy and stage I of the reconstruction can be done at the same time, but not always. It is done this way for several reasons:

1) It would be difficult for one surgeon to stay up-to-date and proficient at both breast cancer management and breast reconstruction

2) There may be subtle unwanted bias when doing the mastectomy (i.e., extent of tissue removal) if the surgeon knows he also has to do the reconstruction

3) It is more fatiguing for one surgeon to do both procedures, and this could have undesirable consequences.

If you know that you are going to have radiation, then most likely the plastic surgeon will either do nothing, or place a tissue expander at the time of surgery. If you are going to attempt permanent implant reconstruction, the plastic surgeon may try to place the permanent implant before the initiation of radiation, or may leave the inflated tissue expander in place until after you have healed from radiation (usually about 6 months).

If you are planning to have natural tissue reconstruction, the expanders can be removed and flap transfers done after healing from radiation. Natural tissue reconstruction is usually not done at the same time as the reconstruction if radiation is planned, as the radiation can severely damage the transferred tissue.

Hope this helps, please let us know if we can answer any more questions.

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: Is your team capable of reconnecting nerves as well as oxygenated blood supply during DIEP flap?

Answer: Yes, any DIEP surgeon is easily capable of connecting nerves, if the situation is favorable. Firstly, DIEP flaps must be designed based on optimizing the blood supply, not the nerves – otherwise, the flap would not survive. Having said that, many, but not all, DIEP flaps will have a usable sensory nerve as part of the flap, which can be connected to an intercostal or pectoral cutaneous nerve during the procedure, if the geometry of the flap is favorable for it.

If the flap has a useful sensory nerve which will not reach the intercostal nerve, a nerve graft can be used to bridge the gap, but this takes additional time, and could potentially impact the overall flap success rate.

Connecting nerves is technically significantly less demanding than connecting blood vessels, but the results are less consistent – even in the face of what looks like a technically adequate nerve repair, the nerve fibers may not grow through the anastomosis, resulting in a “nerve success rate” significantly less than the 99% vascular success rate obtained by most DIEP surgeons.

Achieving erogenous sensation in a reconstructed breast is a very worthwhile goal, and I am sure that progress will continue to be made in this area. However, while we are happy to attempt it if the patient desires it, we do not want to overstate the chances of success.

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:  Just diagnosed with Ductal Carcinoma in Situ. 76-year-old fairly fit, in good health. Interested in mastectomy and reconstruction. Have had 4 mid-line abdominal surgeries. Suggestions on which reconstruction?

Answer: If you have no strong preferences for using your own tissue, you may be a candidate for implant reconstruction, as appears there a good chance you will not need radiation. Implants have the advantage of requiring no major operations (compared to flap surgery), and are well-tolerated by many people. Every major city has plastic surgeons who are experienced in implant reconstruction.

However, many people simply would rather use their own tissue. Fortunately, midline surgeries do not usually impact our ability to use any otherwise available abdominal tissue. We can tell with virtual certainty if adequate vessels are available with an MRI angiogram, if there is any question. If your abdominal tissue ended up not being adequate, you may have extra tissue in your buttocks which we could use.

We would be happy to call and discuss your situation in more detail, if you wish.

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: Do you perform mastectomy and reconstruction at the same time?

Answer: We are often able to perform mastectomy and natural breast reconstruction at the same time, but not always. One thing we do not want to do is radiate a reconstruction done with your own tissue, as this can result in it shriveling up very badly. If there is a significant chance that radiation will be required as part of your breast cancer treatment, then we either defer any reconstruction until later, or put in a temporary tissue expander until radiation is completed.

Some of the reasons that you can require radiation include a larger tumor, or any lymph node involvement. Our breast cancer surgeons are quite good at predicting if radiation will be needed, and we rely on them to tell us if it is safe to do reconstruction at the same time as mastectomy.

Obviously, if you don’t have cancer, but are contemplating mastectomies for risk reduction alone, there should be no chance of needing radiation, and reconstruction can be done at the same time without any worries.

Hope this helps, please let us know if we can be of further assistance.

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: Have there been any improvements in the shape of silicone implants in the last 13 years? I had my reconstruction done then and have never been able to find a bra that fits. They are too round with no “apex’, or point to fill in the front of my bra.

Answer: Thank you for your question. Yes there have been improvements made regarding breast implants over the last decade. The silicone inside is more “cohesive” which in general means the implants hold their shape better and are probably less likely to leak over time. Also the implant companies are frequently coming up with different options or sizes for patients.

If you are not satisfied with the results of your breast reconstruction I recommend you follow-up with your surgeon to discuss what bothers you and if any of the newer implants would help.

If it is not possible for you to see the surgeon who performed your surgery let me know and with more information I could give you my opinion.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 double mastectomy and final saline implants on February 26 2016. Dr has to redo because breasts aren’t symmetrical. I have felt lousy since surgery.

After reading a forum of women experiencing side effects with implants rash fatigue, pain in shoulders arms and back.

I was wondering if I can still have natural breast reconstruction after having implants. Please let me know at your earliest convenience. Thank you

Answer: We have done natural reconstruction on hundreds of women who started with implants, so don’t despair.The easiest way to proceed would be for us to call you and discuss your situation in more detail, 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:  I’m wanting to know if there are any new options. I’ve had both breasts removed in 2013. Had another surgery to put in expanders. Got cellulitis. Had another surgery to remove infection.  There was none there. Spent a week in the hospital. Came home on a IV drip. Had expanders removed. Left me badly scarred on left side.

Doctor says he can give me something to put in a bra, but it would look good. My stomach has bad stretch marks so that skin is no good. I have plenty of fat. Just wondering if there’s anything new out there. So tired of living like this.

Answer: Thank you for your question. I am sorry you had such a difficult time with your expanders. Usually when someone has to have them removed due to infection we recommend using their own tissue instead of implants. The skin and fatty tissue from different areas of the body can be used to reconstruct a natural breast form.

Even though you have stretch marks it does not mean that the extra skin and fatty tissue cannot be used for breast reconstruction. If you don’t have enough tissue in the tummy area then perhaps another area of the body can be used.

If you would like more information let us know. I can have our staff contact you for specifics about your situation. 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:  My doctor wants to do a DIEP FLAP but my insurance doesn’t advise it. I want my breast to look normal so could you help me? 

Answer: Your insurance company should not be in the business of recommending or not recommending medical care, although they may agree to pay or refuse to pay for certain procedures. By law, if you have had breast cancer, they must generally cover the cost of the reconstruction of your choice, whether it’s DIEP, implants, or whatever.

A lot of factors go into determining how natural your breast reconstruction can look, with perhaps the most important factor being the type of mastectomy performed. Generally speaking, nipple-sparing mastectomies have the potential to look the very best, followed by skin-sparing mastectomies.

Even non-skin-sparing mastectomies can sometimes be reconstructed with a very natural appearance, however, it just depends on a lot of things such as whether you are radiated, the quality of your scars, overall symmetry, etc.

If you would like to give us more specifics on your situation we would be happy to help you all we can, and thank you 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 stage 1 of my Diep done in NY. I would like to have stage 2 completed closer to home as I live just outside of Charlotte. We have our insurance policy with Bc/Bs.

I had some minor healing issues but now I am doing well. I am not happy with how my breasts and body look post Diep. My original surgery was December 1 2015. Thank you.

Answer: I’m sorry you are not happy with your breasts / body now, but things often don’t look too great after stage I, so don’t despair.

I liken stage I to throwing one or two lumps of clay on the chest and waiting for them to “stick”, then at stage II we actually come back and make something pretty out of them.

We would be delighted to help you in any way we can. Our nurse Chris or P.A. Kim will call you soon to get 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 have an expander and I notice there are soft spots on the front of my breast. Does this mean there is something wrong?

Answer: The best thing to do would be to ask your surgeon about the spots on your breast.

The soft spots that you described don’t sound worrisome but unless we did your surgery and are familiar with your situation then we have no way to knowing if anything is wrong.

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