3 Common Questions about Breast Reconstruction Pain and Discomfort

After breast reconstruction surgery, patients are bound to experience some sort of recovery pain or discomfort.

This mild pain often leads patients to ask questions such as…

  • How long will the pain last?
  • Is my pain normal?
  • Should I call my doctor?

At the time, a person’s pain or discomfort might seem unusual or scary…and the last thing we want is for patients to worry.

For that reason, we’ve decided to put together the answers to a few of our most common pain-related questions.

Find out what our surgeons and staff have to say about the following concerns…

What Are Your Suggestions for Muscle Spasms after Breast Reconstruction?

Question: I had breast reconstruction on my left breast in 2006. I have had muscle spasms in it ever since. Recently they have gotten bad again.

Any suggestions?

Answer: I’m sorry you are having problems with your reconstruction.

You didn’t mention if you were reconstructed with an implant or with your own tissue, so I will answer as if you are reconstructed with an implant. Please let me know if I have assumed wrongly.

There are several potential reasons why you could have spasms.

If the implant was placed under the pectoralis chest muscle, it can lead to pains in the pectoralis muscle or other muscles, as the muscle is no longer functioning in precisely the way it was designed to. Most people tolerate the implants well, but there is no question some have more problems than others.

The muscle can also sometimes separate from attachments to the chest wall over time, which could cause changes in symptoms.

Additionally, if you are radiated, this could potentially cause additional problems, as the muscle may be less flexible.

View the full post here.

I’m Having Pain after My Last Latissimus Flap/Implant Reconstruction. What Can I Do Now?

Question: I was diagnosed with breast cancer in 2011 and had a mastectomy on my left side followed by chemo.

In 2014, my mammogram began showing tumors and I would have an ultrasound every time. This caused panic attacks and I choose to have my right breast removed because the type of cancer I had was Stage 4 Aggressive.

In April 2015, I had a bilateral latissimus flat and received implants. Now I am experiencing pain across my back where I was cut and my chest gets uncomfortably tight.

The site of the drainage tube is swollen and doesn’t feel good. I stopped seeing my reconstruction doctor because he did things I was not informed of. I am worried because I do not know what is going on anymore.

Could you please advise me as to what might be going on or what to do?

Answer: I’m sorry you are continuing to have problems, but you are not alone.

I can’t speak about your situation specifically because I haven’t examined you, but here are some thoughts in general about patients with symptoms like yours.

There is no question that many people with implants describe symptoms such as yours. Often, there is no discernible reason why they should feel discomfort, but they do. Nonetheless, many of them feel relief when the implants are removed. This does not mean that you would or should, it is just an observation.

The latissimus flap can be done with or without dividing the nerve that makes it contract. I have known some patients with latissimus flaps done without dividing the nerve to have discomfort associated with the muscle contracting. Some have experienced relief when the nerve was subsequently divided. Obviously, I don’t know if this is your situation or not.

Sometimes people have complex, persistent pain after surgery or injury which is out of all proportion to what would be expected. This can be difficult to treat but thankfully is rare.

When evaluating a patient with symptoms like yours, we usually start with a careful history and physical evaluation.

Sometimes, especially if we have concerns about implant rupture, fluid collections, infection, etc., we then get an MRI and/or CT scan. Following the complete evaluation, we then decide together how to proceed.

View the full post here.

Are These Normal Problems to Have 2 Years after a Breast Reduction?

Question: I had a breast reduction over two years ago. It still feels like I have scar tissue in some areas and nipple tends to be a little sore at times.

Is that normal?

Answer: No, that’s not normal, and I’m sorry you’re having to endure it.

I can’t tell what is going on by your description, but it’s possible that you have some residual dead fat in your breasts which has not been resorbed.

An MRI scan would be the best way to determine this.

It’s also possible that you have pain for no discernible reason, which is unusual, but it happens from time to time. That doesn’t mean it can’t be treated, however, as pain therapists can be very effective in helping manage that type of pain.

View the full post here.

Do you have breast reconstruction questions? Send us your questions here!

Ask The Doctor: I Had A Breast Expander Removed and Can’t Re-start Breast Reconstruction For 6 Months. What Are My Best Options?

Daliahs

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I have started my reconstruction, but had to have one side removed and can’t start on that side for 6 more months. My one side has 80 ml saline in it. What are my best options?

Answer #1: Can you tell me why you had to have one side removed?

Richard M. Kline, Jr., MD

Answer from the patient: It started with a blood clot and just kept getting infecting.  So my surgeon removed it so I could start my chemo and to get the infection cleared up, which it has cleared up completely.  I have started my chemo, which I have 4 to 5 treatments. Then after 6 months from have inflated removed I can start the reconstruction procedure.

Answer #2:  Sorry you’re having trouble. I think your surgeon was wise to remove the expander, you certainly don’t want to delay chemo.

If you weren’t radiated, it may be reasonable to try another expander after finishing chemo. I think the chances of it working may be less than usual since you’ve had trouble before, but nonetheless, it may work next time.

If you would like to forego expanders/implants and have reconstruction with your own tissue, the chance of getting an infection will be much less, and the quality of the reconstructed breasts will be much more natural. The surgery involved is larger, and it’s not for everyone, but once you are done there is essentially nothing to ever go wrong later. Previous unsuccessful reconstruction attempts with implants generally don’t affect our ability to reconstruct you with your own tissue, so if you want to try implants again after chemo, the natural tissue option will still potentially be there if implants don’t work again.

I would be happy to chat with you more about your situation at any time if you wish.

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

Ask the Doctor – What Are My Chances With DIEP Flap Surgery After Several Failed Reconstructions With Tissue Expanders and Implants?

Sunflowers

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I have had several failed reconstructions with tissue expanders and implant. I have also been put on IV antibiotics due to a staph Infection. I am wondering what my chances are with the DIEP Flap.

Answer:  Great news! Your prior failures with implants does not in any way decrease your ability to get soft, warm breasts with DIEP flaps. Many, many, many of our patients have histories of prior failures with implants, some with (10-20) prior failed surgeries, and we have been able to successfully 99+ % of them with only their own tissue. Once the infection from prior implants is eradicated from your body (if you have been healed for at least 6 months, you can generally assume that all the prior infection is gone), then subsequent reconstruction with your own tissue carries only a minuscule fraction of the infection risk of reconstruction with implants. You didn’t mention if you were radiated, but it makes no difference, breasts reconstructed with your own tissue are still extraordinarily unlikely to have problems with infection.

We would love to chat with you and discuss your options further. Looking forward to speaking with you, and thanks for your inquiry.

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

Ask the Doctor – How Far in Advance Should I Begin Planning and Scheduling Surgery and is Travel Afterward a Problem?

Roses and orchids

This week, Gail Lanter, CPC Practice Manager, of The Center for Natural Breast Reconstruction answers your question.

Question: I had a phone consult with Dr. Kline in December and was very impressed with our conversation.  After researching several microsurgeons, I keep coming back to this center as the perfect fit for me. I had bilateral mastectomy in Jan. 2014 due to DCIS and have saline implants under the muscles. I experience constant inflammation, burning, and the right implant has “shifted” (as my PS said) and feels like it is under my armpit. Due to life situations I am not considering surgery until the end of this year or January, 2019.

How many months ahead should I contact you to schedule the surgery? Also, I’d like to talk to someone about getting insurance approval. I have BCBS of Alabama.

Is it possible to come from Decatur, AL to have this done? I do not feel comfortable using anyone closer at this point. Just worried about the travel afterwards. Thank you.

Answer:  We have many women who travel to have surgery so we know how to help you navigate that hurdle.  As far as your timeline, one thing to consider is that this is a staged procedure – typically the first stage is inpatient for 4 days and then outpatient for Stage 2 a few months later.  Sometimes a 3rd stage (outpatient or in office) if you require nipple reconstruction or further revision to get the result you desire. Taking into account your deductible and out of pocket expenses – you may want to make sure you can get all of those stages done within one plan year.  I’ll be happy to run an eligibility inquiry through your insurance plan and we can find out exactly what your benefits are so you’ll know what to expect. Insurance approval should be no problem at all as we are in the Blue Card Network for BCBS plans. Check your insurance card and see if you have a little suitcase on the front with some letters within it.  That will tell you that your plan is a member of that network. If you’d like to send me some basic demographic information i.e. full name, date of birth, address and a copy of your card, I can get that process started for you. We typically have openings within a 2-3 month time period but to reserve the date you really want, I’d choose it as soon as you know what will work for you.  We operate on Tuesday, Wednesday, and Thursday.

Here is a blog post from September discussing the stages of surgery and how we work with patients out of our area.

http://breastreconstructionnetwork.com/ask-the-doctor-how-many-trips-are-required-to-have-reconstruction-with-your-doctors/

I’ve forwarded your e-mail to Dr. Kline to discuss post- operative travel with you.    Have a great day and I’ll look forward to your reply.

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

Ask the Doctor – Do You Recommend ADM for Support? Are There Other Options?

Tulips

This week, Dr. Kline, of The Center for Natural Breast Reconstruction, answers your question about breast reconstruction.

Question:  I underwent a left skin-sparing mastectomy for DCIS in 2010. I also had immediate free tram reconstruction. My entire lateral mammary and inframammary fold were removed. I have significant pain, rupturing of blood vessels on the skin and I have to wear a bra at all times. I have been told I need an ADM for support to the breast as well as tacking of mastectomy tissue to the chest wall. Is this the procedure you recommend for this or do I have other options? I need surgery ASAP.

Answer:  I’m sorry that you are experiencing these problems.

The options which you have mentioned, placement of ADM and suturing skin to the chest wall, may well be what you need, but it is impossible for me to say so definitively without first evaluating you in person. If you would like to (securely) send pictures for review this may be helpful, but, again, a final recommendation cannot be made without actually in-person assessing factors such as skin laxity (or lack thereof) and flap characteristics (consistency, shape, volume, etc). For what it’s worth, however, I have never personally encountered a patient with completely natural breast reconstruction with contour problems which required the placement of ADM to correct, but that doesn’t mean it can’t happen.

We have certainly had women travel to Charleston with complaints very similar to yours, and have successful surgery here. However, it may be worth your while to consult with other experienced surgeons in your immediate geographic area first, as the techniques we are discussing can ordinarily be competently performed by any capable plastic surgeon with significant breast reconstruction experience. If you decide to come here, however, we will be pleased to help you any way we can.

Thanks for your question, and have a great day!

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

The Center for Natural Breast Reconstruction Gives Answers to Commonly Asked Breast Reconstruction Questions

Having breast reconstruction surgery is a big decision.

It’s only natural that there may be many questions floating around your head about having this procedure. Questions like…

  • How much does the surgery cost?
  • Will my insurance pay for the surgery?
  • How long will it take me to heal and recover?

In order to get these questions answered, we highly encourage you to schedule an appointment with your doctor to get all the details.

In the meantime, however, our expert surgeons give some great insight into some of the most commonly asked questions.

Here’s what they have to say…

How Many Doctor Visits Does Reconstructive Surgery Take for Out of Town Patients?

Poinsetta

Our P.A. Audrey and N.P. Lindsey spend a lot of time on the phone with out-of-town patients (and their local healthcare providers) before we ever see them, making sure that nothing important is overlooked before you make the trip to Charleston.

At some point, our surgeons have a phone consultation with future patients, so that they will have an opportunity to directly ask any questions they wish.

We usually see out of town patients for the first time the day before surgery. On that morning, they get an MR angiogram at Imaging Specialists of Charleston and then bring the disc to our office to help us plan their flap.

We operate the next morning, and our patients usually spend 4 nights in the hospital.  You will typically follow up with your surgeon in our office 2 to 3 days after discharge.

We do our best to minimize the number of follow up visits by remotely managing post-operative care.  Travel is a significant risk factor for blood clots, which is a risk of the surgery (as it is for many other surgeries).

Keep reading…

Why Won’t Insurance Pay for Reconstruction?

Yellow Lily

Original Question: I don’t understand why the insurance company doesn’t pay for reconstruction if you’ve had a lumpectomy. With radiation, your breasts shrink a lot and you are all out of proportion.

Answer: Not getting insurance coverage is not always the case, especially with a lumpectomy.

If the surgery results in a significant defect or radiation negatively impacts the tissue, most times we can submit your case to your insurance company along with photos of the affected area, and they will indeed cover a reconstruction surgery for you.

Keep reading…

Would Reconstruction Be Successful for Me?

two white lilies

Fortunately, a history of radiation (and/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 who have had bad experiences in the past.

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.

Keep reading…

Do you have breast reconstruction questions? Send us your questions here!

Ask the Doctor – I Was Recently Diagnosed With Cancer. When Is The Optimal Time for Natural Reconstruction If Radiation Treatment Is Planned?

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

Question: I am a newly diagnosed cancer patient in Atlanta.  I am scheduled for a left side mastectomy a week from today.  Mammography and MRI found pretty extensive DCIS on the left side of the left breast extending to and abutting the chest wall.  I am likely to require radiation treatment because of the proximity to the chest wall.  My plan is to have a tissue expander put in at the time of surgery.  I cannot get myself comfortable with the idea of an implant although my plastic surgeon here has said I am too thin for a natural reconstruction procedure.  I am interested in revisiting this and/or maybe getting a second opinion after the mastectomy.  My question is when the optimal time for a natural reconstruction would be when radiation treatment is planned?  Should it be done at the same time as the mastectomy ideally or after radiation treatment?  Thank you.

Answer:  Hi and thanks for your question. Sounds to me like you are on track for doing things the right way. If you need radiation we would not want you to have natural tissue reconstruction until after your radiation treatment. Possibly 3 months after radiation is complete. In the meantime having the expander placed immediately after the mastectomy (same procedure). Then you can remove the expander later at the time of your natural tissue reconstruction. I would be glad to give you my opinion I frequently see patients who other doctors say they don’t have enough tissue. Frequently we can get a nice result with natural tissue. Let me know if you have other questions or would like to talk over the phone.

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

Ask the Doctor – Is It Common To Have Breast Reconstruction Done At The Same Time As A Mastectomy?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: My dear friend has recently been diagnosed with stage 1 breast cancer – estrogen driven. Cells were found in the ducts but negative in lymph flow.  She has been scheduled for a mastectomy and she has decided to have both removed. She has been informed that she will need to have a hysterectomy soon after. I am an RN having worked in-house bedside with patients for 25 years. She is to be scheduled for surgery later this week and has been told reconstructive surgery for both breasts will be done as the surgery is completed. Is this commonly done? The patients I worked with generally had the reconstruction after chemo and radiation.  What is your professional insight?  She is terribly afraid and she has 11 and 8 yr old sons.

Answer: Yes, it is very common to have reconstruction done at the same time as the mastectomy. While there may be a slight increase in the complication rate doing it this way, most people feel that the advantages of doing them together outweigh any potential disadvantages. The one time that we would NEVER do immediate reconstruction is if the patient wanted natural tissue reconstruction, but we thought there was some chance that she would be radiated, as we NEVER want to radiate the transferred tissue. I do not wish to speak for your friend’s oncologists, but the two most frequent reasons for receiving radiation are 1) one or more positive lymph nodes, or 2) a tumor greater than 5 cm in largest dimension. Even if we know that radiation is to be received postoperatively, however, there is no problem reconstructing with implants or tissue expanders at the same time as mastectomies, and there may, in fact, be some potential advantages, primarily in terms of the quality of the final result.

I certainly understand your concern and your friend’s concern, but there is every reason to think that she will do well. If I can be of any assistance by talking to her or anyone else, please let me know, I would be happy to do so.

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

Ask the Doctor – What Options Do I Have When Removing My Breast Implants?

This week, Audrey Rowen, PA-C, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I had silicone implants in 1988 under skin, which ruptured. In 2012, had bilateral implant exchange with saline implants under muscle. In 2016, the right saline implant ruptured; it was always hard with capsular contraction. I have been trying to find a plastic surgeon who will do a capsulectomy on Rt & Lt… and ideally tissue transfer from my body. (I read the FDA has 356 MDRs of lymphoma including 9 deaths, with saline implants, mostly textured but also smooth.) So, as long as I have a rupture (the right breast is flattened), I may as well have both saline’s removed. Does the fat transfer go under the skin or muscle? Would this be a good option for me at this point? Is the capsulectomy better than the explant-ation? Of course, it also depends on cost! Thank you.

Answer: Thanks for reaching out! I’m sorry to hear that you’ve had quite a lot of trouble with implants over the years. Were your implants placed for reconstruction or for cosmetic purposes? We do a lot with both implant reconstruction and natural tissue, both of which are almost always placed above the muscle. Our office also mostly prefers to use smooth silicone gel implants instead of saline, and we choose not to use textured implants often for a few reasons, one of them being what you researched about the Anaplastic large cell lymphoma.

The biggest question that determines what your best options would be whether you had a breast cancer diagnosis or other factors that would make your case reconstruction vs. cosmetic. Once we get that information from you, I feel we can better give you an idea of what we might be able to do for you.

I look forward to hearing back from you to see how we can help you!

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

Ask the Doctor – Who Do I Ask About My Cancer Treatment, My Plastic Surgeon, Breast Surgeon, Or Oncologist?

This week, Audrey Rowen, PA-C, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: Who do I ask about my cancer treatment, my plastic surgeon, breast surgeon, or oncologist?

Answer: Thanks for reaching out to us! That is typically a question we would defer to an oncologist to answer as they can calculate your overall risk for recurrence and how different surgical vs. medical treatments can impact that risk. Technically a lumpectomy is only removing the cancerous area, leaving the rest of your breast tissue intact, so by surface area, a lumpectomy leaves more breast tissue that could potentially develop a new breast cancer, where a mastectomy is an attempt to remove all breast tissue.

The options for reconstruction are much more plentiful with mastectomy vs lumpectomy, but that shouldn’t necessarily sway you either way. If we can answer any reconstruction questions about whichever option for cancer treatment that you may choose, please let us know. But definitely, chat with your oncologist about what they feel is your best option for overall survival.

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