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Ask the Doctor: What Are My Options for Natural Breast Reconstruction?

July 18, 2014 by

 

<alt="pink peony"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I had right breast ductal carcinoma, Stage 2. Two out of 22 lymph nodes had cells. I did a gene test, and had both chemo and radiation. The expanded radiation destroyed it. I had a mastectomy in Charleston, and now I’m ready to have my breasts fixed. I don’t want to have implants. I’d rather have a reconstruction using my own body fat and tissue. What are my options?

Answer: Hi — I’m sorry you’ve had so much trouble, and hopefully things will continue to improve for you. Your history of radiation fortunately has no bearing on our ability to do a reconstruction using only your own tissue. Many of our patients initially had failed implant reconstructions elsewhere, only to be later successfully reconstructed with their own tissue. Please feel free to come by for a consultation if you live locally, or, if you’d rather, we can arrange a phone consultation. Thanks for your inquiry, have a great day!

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask the Doctor: What Are My Options For Post-Op Reconstruction Using Implants?

July 11, 2014 by

<alt="pink dahlia"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I’m 42 years old, and I have a surgery this month for breast reconstruction. Due to my genetic history, a plastic surgeon will be performing a double mastectomy. I want to know what my options are for post-op reconstruction? Thanks.

Answer: Hi — Thanks for the information about your planned surgery. If you have requested using your own tissue and were told that was not a good option for you, then you certainly can get a second opinion. You stated that your mastectomies were for preventive reasons, which gives you the time to consider all possibilities. Before having surgery you should feel good about your decision and be confident you know all your options. You have excellent surgeons and I know you will do well.

One advantage of using an implant is that you don’t require an incision anywhere else on your body in order to donate the tissue to make the new breasts. Using your own tissue requires a longer recovery and more healing. The donor area ends up healing with a scar. If you don’t need a tummy tuck or have “excess” tissue in your thighs or buttocks then you may not want a scar in these areas. You should also know that it is not necessary to sacrifice any of your muscles in order to use your own tissue. Finally, it is important to know that if you have implant reconstruction and it does not work out you can still use your own tissue later–even years later! Most likely it will work out and you will have an excellent result and speedy recovery. I hope this has helped. Let us know if you have more unanswered questions. If you would like a second opinion, you could set up an appointment in our office, or we could also consult over the phone if you cannot make the trip to Charleston.

Dr. James Craigie
Center for Natural Breast Reconstruction

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

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Ask the Doctor: Questions About Reconstruction Surgery Years After A Mastectomy

June 27, 2014 by

<img src="image.gif" alt=A pink rose" />This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I have been cancer free for 4 years, and have been very undecided about reconstruction. My surgery removed the underside of my right breast. I am very lumpy and the scar is very hard. Would I need to have a reduction in the other side or can the surgery site be repaired? I am “usually” a D in size currently. Also, is this surgery considered a “tummy tuck” type operation?

A:  You have several potential options, depending on your present physical situation, and your wishes.

I’m assuming you are radiated (please correct me if I’m wrong). With this in mind, an implant to increase the size of the right breast is not likely to work. Increasing the size of the right breast with a DIEP flap (I assume this is what you meant by “tummy tuck”) is potentially a large operation for a lumpectomy defect, but sometimes it is actually the best option.

If you don’t mind being smaller than you were, reducing the size of the left breast may well be your best (and simplest) option to get better symmetry. That’s probably all I should try to say without knowing more details about your particular situation. We’d be happy to have our nurse Chris or PA Kim call you to discuss your situation further, if you wish. Thanks for your question, and have a great day!

Q: I had bilateral mastectomy in 2011, but didn’t have insurance. Now that I do have insurance, can I get reconstructive surgery? And how do I go about it?

A:  Thanks for your question. There is no time limit to when you can have reconstruction surgery. Your next step would be to start researching what kind of procedure would achieve your goals. If you’d like a permanent reconstructive procedure, the ones we offer might be what you are looking for. We use excess tissue of your abdomen, buttock or upper thigh and transfer that along with it’s blood supply to build a new warm natural breast.

Richard M. Kline, Jr., MD
The Center for Natural Breast Reconstruction

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Ask the Doctor: Is there any surgery for a Tram flap patient with a belly bulge, no hernia?

June 20, 2014 by

<img src="image.gif" alt="Pink Flowers" />This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q. Is there any surgery for a Tram flap patient with a belly bulge, no hernia? Breast reconstruction was great and there were no complications. I have heard that mesh can be used, does this flatten the belly, or would I be at risk for complications such as a hernia?

A. Hi Karen, Thank you for your question. If your tummy bulge is due to the TRAM flap procedure then it is possible that repair of the bulge using mesh could help flatten your tummy or repair the bulge. We normally check for a possible hernia by ordering a CT Scan of the tummy wall before planning this type of procedure. The findings help us determine what is the best approach and if we need to use permanent mesh or some other type. If there is no hernia then repairing the bulge should not risk creating a hernia. Depending on the situation, it is possible that the bulge could come back. Prior to this type of repair you should make sure you do all you can to avoid being overweight, as your weight can impact the success of the repair. I hope this answered your question.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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How Long Do I Need to Wait To Have a DIEP Flap Procedure After Radiation?

January 3, 2014 by

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

Q: How long should I wait to have a DIEP flap after radiation?

A: Radiation therapy is part of the treatment of breast cancer and will affect the results of breast reconstruction. The treatments can miraculously kill some growing cancer cells but they also change the area of the body left behind after surgery.

All of the elements of the body can be affected: blood vessels, scarring, healing function, and appearance.  The effects of radiation occur in two phases. Short term occurs during and immediately after the treatments. Elective surgery at this time is not possible, for obvious reasons. The long term effects develop after the early “burn-like” injury “settles down.” The long term reaction occurs for approximately the first six months.

The experience can be widely different from one person to the next. We have experienced difficulties with the receiving blood vessels after radiation when we did not wait for the body to recover from both long and short term damage. These types of problems could possibly increase the chance for the new breast to fail. Avoiding these problems may be possible by waiting and that is why the long recovery is needed before reconstruction is started.

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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Join Us Tomorrow for Ask the Doctors LIVE

August 5, 2013 by

At the Center for Natural Breast Reconstruction, we know that women’s bodies and emotional selves are inextricably linked. There isn’t a question we haven’t been asked, or a concern we haven’t helped women and their loved ones manage.

We’re here to help you navigate the sometimes-confusing world of natural breast reconstruction, in a live phone call with our doctors tomorrow!

After the news about Angelina Jolie’s preventative double mastectomy, we’ve had a flood of questions about options in reconstructive surgery, and now we want to answer as many questions as we can at once.

Because part of our mission is to help you make informed decisions about breast reconstruction, our Drs. Craigie and Kline are going to answer questions on a free, live call!

Ask the Doctors LIVE

Click Here to Register and Listen

Join us tomorrow, August 6 at 7 p.m. Eastern / 4 p.m. Pacific.

You’ll hear from the doctors about several different topics, such as how to choose a breast reconstruction surgeon, reconstruction surgery options, financial issues, differences among procedures, post-surgery care, intimacy issues, and anything else you may have been wondering about.

Don’t miss this opportunity to hear from the doctors about your breast reconstruction options. Register now for the call, as space is limited. Hope to see you there!

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Can Small Implants Be Used with Flap Surgery for Added Volume?

July 5, 2013 by

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

Q: Can small implants be used with flap surgery for added volume?

A: The short answer is “yes, sometimes.”


We have had good success augmenting flaps with reasonable-sized implants in non-radiated patients. In radiated patients, it’s still sometimes possible, but it’s very dependent on how much of the breast mound is covered with flap skin versus radiated breast skin, and what the quality (the technical term is “compliance”) of the radiated breast skin is. Every case is different.

Our nurse or PA can provide you with more information upon request. 

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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Can Upper Stomach Fat Be Used For Breast Reconstruction?

June 28, 2013 by

Ask the Doctor

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

Q: Can upper stomach fat (fat around the rib cage) be used for breast reconstruction if liposuction was performed on the stomach area below the belly button? What if my liposuction was done more than ten years ago?

A: Liposuction is only a relative contraindication for DIEP flaps, as the necessary blood vessels may well still be present. An MR angiogram is often very useful in determining if adequate perforating vessels are available.

Additionally, it is often possible to use fat from anywhere on the body to reconstruct breasts with the aid of the BRAVA system. The use of the BRAVA with fat grafting is not yet FDA-approved, but it looks very promising for women who either have no good flap donor sites, or don’t want large incisions.

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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Removing Expanders and Getting Implants: How Severe is This Surgery?

June 21, 2013 by

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

Q:  I am interested in having tissue expanders removed and putting in permanent implants. How severe is this surgery?

A. Thank you for your question!

We don’t do implant surgery very often, but removing the expander and placing the permanent implants is, generally speaking, pretty straightforward.

 The second stage of expander implant reconstruction involves the removal of the tissue expander, followed by placement of the implant, and creation of the final breast shape. This is an outpatient procedure, performed by opening the mastectomy scar (no new incisions are made) and removing the expander. Before placing the final implant, changes that need to be made to the implant pocket are addressed. These can include repositioning the implant on the chest wall, improving the inframammary fold, using Alloderm or  Strattice to address areas of thin skin, and revising or removing the capsule as needed. The final implant is then placed in the pocket, and the incision is closed. Drains are usually not needed. Placement of the implant will result in a softer, more natural breast as compared to the tissue expander.  According to which of the above procedures are to be performed, you can expect to spend 2 to 4 hours in the operating room.

Feel free to forward any other questions you may have…..We’re always happy to help!

Richard M. Kline, MD

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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Dealing with Juvenile Papillomatosis: Should I Have a Risk-Reduction Mastectomy?

February 22, 2013 by

 The following question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

 

 I am getting antsy with my breast health and am concerned for my future cancer risk. I have been diagnosed with juvenile papillomatosis, and have had one benign breast lump removed.

I currently have one lymph node and 5 masses (bilateral) under watch by mammogram/ultrasound every 6 months. I am really considering a prophylactic mastectomy due to my young age (39).

What are your thoughts, and would you recommend this if I were your patient? Also, do you think insurance would cover it in my case?

 

Thank you for your question. Do you have any family members who have had breast or ovarian cancer? Even if the answer is no, some people would consider a risk reduction mastectomy and immediate reconstruction. Multiple papillomas may increase your chance for breast cancer. Frequent screening with exams, ultrasounds mammograms will not prevent cancer. The idea of screening is to find something early.

If you are undergoing high risk surveillance (it seems that you are with all those repeat exams) then you should at least have the conversation with a breast surgeon who has experience with that type of surgery.  

My expertise is in breast reconstruction and one area that we specialize in is breast reconstruction immediately at the time that someone has preventive mastectomy to reduce their chances of developing breast cancer. We work with an expert breast surgeon who performs the mastectomy but preserves the breast skin and nipple. Mastectomy for preventive reasons is very different from mastectomy when cancer has already developed. The reconstruction is different in that we can usually get the best possible result under those circumstances.

I hope I have answered your question please let me 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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