Ask The Doctor – Is it Prudent to Remove the Expanders?

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

Question: I had bilateral nipple sparing mastectomies on 2/9/16 and developed a large necrotic area on the lower pole of my left breast. Air expanders and Alloderm were placed during the surgery and I have also developed redness over the area where the Alloderm is on my right breast. I have been on Keflex 250 mg qid since surgery and Levaquin was added yesterday, 2/26. My surgeon plans to debride the necrosis and perform a skin flap on Friday 3/4. Of course there is no staging of the area under the necrosis at this point. (It turned dusky the day after surgery.)

But I am keen to avoid two surgeries. My questions are these: In your opinion, is it prudent to remove the expanders, allow time for healing and then consider latissimus flap on the left? Under that circumstance, what options are there for healing the wound after debridement? Would closing good skin to good skin be best (I understand distortion is a given) and then flap it later? I will have to be referred for flap surgery and am trying to do diligence on who best to request for this. I am grateful for any advice you might be willing to offer.

Answer:  I’m sorry to hear that you are having a difficult time. From what I can gather from your question it sounds like you have had a difficult time with both breasts. On your left side the healing would be less complicated if you had the expander removed. On the right side if you have an infection then it is possible that the implant may have to be removed.

If the implants are removed then when you have healed you may consider using your own skin and fatty tissue instead of trying another expander. We specialize in breast reconstruction using your own fatty tissue without using implants and without sacrificing your important muscles. That includes the latissimus muscle. I suggest you ask your surgeons if you can consider that route as an option.

I’m sorry I can’t be more specific without more information from you about your situation, previous surgeries and medical history. If you would like more information I could have my office contact you for specifics. Just let me know. Thank you for your question.

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

Ask the Doctor-Can You Fix a Bilateral Mastectomy Gone Wrong?

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

Question:  Can you fix a bilateral mastectomy gone wrong? My breasts are now hideous to look at and I’m ashamed of my body now. They are lopsided and not even and I’m left with a 2 inch scar across my entire chest.

Answer: It is difficult to know what we might be able to do for you with the information you gave us, but usually something can be done to at least make things somewhat better.

Many of our patients had multiple prior surgeries elsewhere before we met them, and we were able to help many of them. We would be delighted to have one of our clinical staff members to call you to discuss your situation in more detail, if you wish.  Simply call 1-866-374-2627 or e-mail info@naturalbreastreconstruction.com and we can get that arranged for you.

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

Ask the Doctor- Is It Too Late To Have Natural Breast Reconstruction?

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

Question: I had bilateral mastectomies and wanted to do the natural breast procedure but the surgeon wouldn’t even discuss it. Then he totally botched the reconstruction. I look deformed. I still avoid the mirror. A redo was set but was canceled day of surgery because b/p and bipod star were elevated. I want it redone. I would like to have the natural breasts. I have plenty of abdominal tissue. I am diabetic.

AnswerI’m sorry you have had so much trouble with your reconstruction.

Fortunately, previous attempts at implant reconstruction rarely impact our ability to successfully perform a reconstruction with your own tissue. Diabetes increases your risk of some complications, most notably wound healing problems and infections, but it rarely keeps us from doing the reconstruction at all.

If you wish, we can have one of our staff call you to discuss your situation further.

Thanks for your question, and look forward to meeting with you.

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

Ask the Doctor – Why Won’t Insurance Pay For Reconstruction?

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

Question: I don’t understand why 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. I finally did get them to pay for prosthesis and bra.

AnswerThat’s not always the case with a lumpectomy. If the surgery results in a significant defect or radiation negatively impact 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.

We’re happy to chat with you about your specific situation and see what we can do to help you through that process.

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

Ask the Doctor – Would Reconstruction Be Successful For Me?

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. 

AnswerThank 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 your 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!

Ask the Doctor- What Are My Reconstruction Options Using Only My Tissue?

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

Question: I am 39 years old and seeking options regarding a double mastectomy with reconstruction using only my own tissue. I was treated for an aggressive breast cancer in my left breast 3 years ago; went through neoadjuvant chemo, then a lumpectomy followed by radiation. Due to my lifetime high-risk status, I feel a double mastectomy is necessary using my own tissue for reconstruction.

Answer: Thank you for your question, I am glad to hear that you have completed your breast cancer treatment 3 years ago and are doing well. It is very likely that using your own natural tissue is going to be a very good option for you.

Since you have already had radiation on one side the option of removing the remaining breast tissue and having a preventive mastectomy on the other side is the most effective option to minimize your chance of getting breast cancer again.

Although I imagine it is already very low. Have you had any previous surgery on your tummy? Do you feel that you have extra fatty tissue there or any other area of your body? If so then you can probably achieve a proportional natural tissue result without having to sacrifice your important muscles.

If you like I could arrange a convenient time to answer any other questions by phone. Let me know and I’ll have one of my staff contact you to make arrangements.

Thanks again.

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

Ask the Doctor- I’ve Completed Radiation. When Is The Right Time To Make A Consultation Appointment To See If I Can Have DIEP Flap Reconstruction?

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

Question: I had a right mastectomy December 8, 2016, and radiation ended March 2017. Currently, I’m having problems with fluid buildup because the skin cells haven’t healed enough to absorb bodily fluids. When should I set an appointment to see if I can have the DIEP flap reconstruction?

Answer: Thank you for your question. No need to wait for a consult. I could see you anytime. Usually, we wait 3 months after completion of radiation before start DIEP breast reconstruction. Every situation is different. If it is convenient to come for a consult I could evaluate your progress and readiness to proceed. Just let me know if you would like my office to contact you about an appointment.
Thanks again!

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

Ask the Doctor- I’m Having Pain After My Last Latissimus Flap/Implant Reconstruction. What Can I Do Now?

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

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.

Hope this helps at least a little. I would be happy to chat with you further by phone about your specific problem or see you in person if you can come for a visit.

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

Ask the Doctor- Can You Do Repair and Nipple Reconstruction Surgery at the Same Time on the Same Breast?

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

Question: I had hybrid DIEP reconstruction at another facility, and I am disappointed with the results. There have been many issues. For example, my breasts are different shapes and sizes, no node involvement and no microinvasion. The surgeon who did the mastectomy said the path report said the margins were not wide enough and he will need to cut additional skin out during the next surgery. The next surgery is supposed to be to reconstruct the nipple. Can you do both procedures on the same breast at the same time? Please Help!!

Answer: I’m sorry you are having to go through this.

Did you have a complete mastectomy on the left breast or a lumpectomy? If your margins were positive (unbeknownst at the time of surgery, obviously), and you had an immediate DIEP flap, that could be a little complicated to resolve, although I’m sure we could work through it. Given that your scenario is a little bit unusual, it would probably be best if we talked by phone. Please let us know what works for you.

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

Ask the Doctor- Are Implants Still an Option after Radiation? I Have Expanders Now that Were Placed At the Time of Mastectomy.

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

Question: I had a double mastectomy in January 2017. Expanders were placed at that time. I had radiation March-May. Postponed reconstruction until June 2018. Are implants still an option?

Answer: Implants may still be an option, but it’s going to depend on several things, probably the most important of which is how much you were expanded prior to radiation. It can be next to impossible to expand skin after it is radiated, although occasionally it seems to work. If you were expanded, and are tolerating the expanders well, then hopefully it would be straightforward to remove the expanders and place permanent implants. In addition to placing permanent implants, fat grafting can often significantly enhance the quality of your reconstruction.

If you end up not getting a reconstruction you like with implants, the good news is that none of what you have been through impacts your chances of getting a quality reconstruction with your own natural tissue. We have successfully reconstructed many, many hundreds of radiated patients with DIEP, sGAP, and other natural tissue flaps.

Hope this helps, please let us know if you would like additional information.

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