Ask the Doctor- Are These Normal Problems To Have 2 Years after a Breast Reduction?

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

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.

I would be happy to help you any way I can, but it would be best if you first returned to the surgeon who did your reduction and let her / him know of your concerns. If that doesn’t work, please let me know.

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

Our Surgeons Show Support for National Breast Cancer Awareness Month

October is National Breast Cancer Awareness month. And it’s important that we take the time to remember those who have lost their lives to breast cancer, support those who are battling it, and celebrate those who have won their cancer battle.

One of the ways The Center for Natural Breast Reconstruction likes to celebrate is to get involved in community events that are focused on breast cancer awareness.

This year we’ve been invited to participate in a series of Breast Cancer symposiums. We are thrilled that two of our surgeons, Dr. Craigie and Dr. Kline, will be included in the panel for these discussions.

All of the Charleston, SC, community is invited to attend these talks, and we encourage you to attend if you are able!

Check out the details below…

East Cooper Breast Cancer Symposium – October 4

The first Breast Cancer educational symposium will be held at the East Cooper Medical Center. The event will take place in the classrooms at the hospital, limiting registration to about 40 people.

During this event, a panel of medical experts will be talking about a variety of breast cancer topics, from treatment and prevention to reconstructive surgeries and life after breast cancer.

The facility will be serving boxed dinners for participants to enjoy during the panel talk, which will take place from 6:00 p.m. to around 8:00 p.m.

Space is limited, so if you’re interested in attending please call the East Cooper Medical Center at (888) 417-1377 to find out how to register for the event.

Breast Reconstruction Awareness Day Talks – October 17, 18, and 19

To celebrate Breast Reconstruction Awareness Day (BRA day), three talks on breast reconstruction will be held over the course of three days—October 17, 18, and 19.

All three events will feature medical professionals and surgeons who are active members of Roper’s breast cancer team. The topics of discussion will focus on reconstructive breast surgery.

A few featured topics include…

  • A presentation on fat grafting.
  • A discussion on Micro Autologous.
  • A talk on lymph node transfer.

The first talk will be held on Tuesday, October 17, at 6:30 p.m. at Roper Mount Pleasant in Classrooms 1, 2, and 3. For more information, click here.

The second talk will be held on Wednesday, October 18, at 6:30 p.m. at Roper Bon Secours St. Francis, Mall Classrooms 1, 2, and 3. For more information, click here.

The third talk will be held on Thursday, October 19, at 6:30 p.m. at Roper Hospital, Irene Dixon Auditorium. For more information, click here.

Please note that the same talks will be given each night, so it’s only necessary to attend one event if you have an interest in going.

On behalf of our entire staff, we wish you a happy National Breast Cancer Awareness month. And to those of you who are currently battling breast cancer, our thoughts are with you.

Do you have any National Breast Cancer Awareness month activities on your schedule that you’re excited about?

Share them with us in the comments below!

Ask the Doctor-It’s Been 30 Years Since My Modified Radical Mastectomy and I am 65 Years Old. Am I Still a Candidate for DIEP?

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

Question: It has been 30 years since my modified radical mastectomy and I am 65 years old. Am I still a candidate for DIEP.

Answer: If you are in reasonably good health, you may well be a wonderful candidate for natural breast reconstruction with a DIEP, sGAP, or other flap. We have restored many ladies’ breasts many, many years after their mastectomy(ies), and they usually do very well after surgery. It is actually advantageous to enter into the reconstructive operation fully healed, as this speeds operating time, as well as recovery. I would be delighted to speak with you about your options by phone, if you wish, or you are welcome to come for a consultation at any time.

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

Ask the Doctor- I am Currently on a Diet to Lose Weight. Will My Breasts Get Smaller Too?

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

Question: I am currently on a diet to lose weight. Will my breasts get smaller too?

Answer: Depending on how much  weight you lose you might notice a change. It should be minimal and proportional. You can’t “spot”reduce any one area  of the body. Therefore if you lose a moderate amount of weight you should have no problem.

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

Ask the Doctor-Are Your Doctors Experienced with Tuberous Breast Deformities and Repair Without Breast Implants?

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

Question: Are any of your doctors experienced with tuberous breast deformities and repair without breast implants?

Answer: We don’t have specific experience with tuberous breast deformities, but I am nonetheless optimistic that we can address your concerns. The cornerstone for tuberous breast deformity reconstruction is reduction of the nipple areolar complex.

This is straightforward, and the remaining part of the equation, enlargement of the breast mound, is also well defined. If you do not want to use implants, but also want to be larger, you may have to accept some additional scars associated with transfer of natural tissue.

Otherwise, there are no particular problems. I would be happy to 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!

Ask the Doctor – How Many Trips are Required to Have Reconstruction with Your Doctors

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

Question: I’ve had implants since a 2004 mastectomy following breast cancer diagnosis. I’m healthy, but feel that my implants have shifted and I’m considering a redo. I live in Colorado, and wonder how the system works for out of town patients. How many trips are required to have reconstruction with your docs?

Answer: By “considering a redo,” I’m assuming you mean replacing your implants with your own natural tissue.

Our P.A. Audrey and N.P. Lindsey spend a lot of time on the phone with out-of-town patients (and their local health care providers) before we ever see them, making sure that nothing important is overlooked before you make the trip. I recommend that at some point you and I also have a phone consultation, so that you will have an opportunity to directly ask me any questions you wish. We usually see you for the first time the day before surgery. On that morning, you get an MRI angiogram at Imaging Specialists of Charleston, then bring the disc to our office to help us plan your flap. We operate the next morning, and you usually spend 4 nights in the hospital. We recommend that you stay in town another 5 nights, if possible, although this is not absolutely required.

We actually discourage you coming back for follow-up visits, as travel is a significant risk factor for blood clots, which is a risk of the surgery (as it is for many other surgeries). If you have a local health care provider who can help with drain management (plastic surgeon, breast surgeon, primary care, etc.) that is helpful, but certainly not essential.  We stay in close contact with you via telephone and secure messaging to manage your post operative period.  You’ll send updates and photos on a routine basis and discuss your progress with our clinical staff.

Most of the time it will take at least 2-3 surgeries to complete the reconstructive process. If you are not radiated, these can be done as closely as 3 months apart (although they can be delayed as long as you wish). None of the subsequent surgeries are anywhere near as big as the initial surgery, and usually you can get by with just two nights in Charleston.

Hope this is helpful, and I hope I get the opportunity to meet you.

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

Ask the Doctor- I’m Looking For a Plastic Surgeon that Specializes in Microvascular Breast Reconstruction. Are You in my Insurance Network and Do I Have to Make a Huge Down Payment Before Surgery?

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

Question: I am looking for a p.s. who specializes in microvas. breast recon. I had dcis in 2014 lumpectomy with 6 weeks rads followed by bilat mast. 2016 with immed. recon with expanders then implants in March. Then I got a serious infection in the left (rad) breast, had implant removed and refused to do have lat flap done.

I am thin and one ps said I might be able to do a bodylift type or one where they take from my backside and use an implant on both sides. I do not want the implant I have now. It is subpec and is painful. Can someone help? I have anthem bc/bs and you are out of network.

I do not have 8500 to have this done at another location. My insurance is agreeable to a pay if the it is in network. I can’t afford much out of pocket. We are low middle class, but don’t qualify for help.

Answer:  Hi and thanks for your inquiry. Glad you found us – you’ve definitely found a team that specializes in microvascular breast reconstruction. Regarding your insurance, does your card have a little suitcase on the lower corner of your card? If so, we’re actually in network for you utilizing the Blue Card program through our contract with BCBS of S.C.

I’m happy to check into that and assure that is the case if you would like. I’d only need a copy of the front and back of your card and some basic demographic information like – Name of insured on card and birthday if different from yours, your birthday, and address. I can run eligibility in a matter of minutes once I’ve received the information.

Also, I am sure that one of our physicians will be sending an answer to the remainder of your question very soon.

I look forward to your reply, we’d love to help you!

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

Ask the Doctor- I am Unhappy with my Previous Bilateral Mastectomy with Reconstruction Using Implants. Are you Able to Fix it?

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

Question: I’m not happy with the results of my bilateral mastectomy with reconstruction using implants. Reaching out to see if it can be fixed.

Answer:  It is very likely that we could help you with your unsatisfactory reconstruction, either by using your own tissue, or by revising your implant reconstruction. I will be happy to discuss your situation in more detail by phone, 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-My Sister Had a Mastectomy 4 Months Ago and Is Almost Done with Chemo. Is it Too Late for Reconstruction?

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

Question: I have a sister whom had a mastectomy 4 months ago. She has 2 more chemo treatments left. She is now sorry she did not have reconstruction, and wants to know if it can be done-after the chemo and no flap was made.

Answer:   We routinely do flap surgery breast reconstruction long after mastectomies and other treatment, sometimes many years later, with great success. I would be happy to see your sister in consultation, or speak with her by phone, whenever she feels she is ready. We can discuss her situation in more detail, and review all of her options, at that time.

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

Ask the Doctor-I Had DIEP Surgery that Failed and Have No Left Breast. What are my Options Now for Reconstruction?

This week, Richard M. Kline, Jr., MD and James Craigie, MD of The Center for Natural Breast Reconstruction answers your question.

Question: I had left implant removed due to contracture. ( double mastectomy and left radiation) Just had DIEP surgery that failed so now have no left breast. I am thin , especially now with little belly removed. What are my options for reconstruction now?

Answer:  I’m sorry you are having such difficulty getting a satisfactory reconstruction. As you know, given your history of radiation and prior problems, you are unlikely to ever get a successful reconstruction of the left breast with an implant.

When the DIEP is not available, the next option is often the sGAP flap (from the buttocks). This is far less widely available than the DIEP flap, but we have performed about 300, with a 95.7% success rate (our DIEP success rate is a little higher, at 99.08%). Other options include the PAP flap, from the posterior upper thigh, the anterolateral thigh flap, and the latissimus flap. The latissimus is rarely large enough to use by itself, and is usually combined with an implant; unfortunately, in a radiated tissue bed, the implant still often does not work well, even with a latissimus covering it.

Sometimes we can do two smaller flaps at the same time to reconstruct one breast. This is more difficult with a previous flap failure, as the recipient vessels are a little harder to reach, but we have done it successfully in some cases.

Over the last few years we have gained extensive experience augmenting the size of natural tissue flaps with fat grafting. This basically means we first do a natural tissue flap, then come back a few months later and do liposuction (yes, it can be a problem getting fat in some people), then inject the fat with specially designed needles into the flap. On some occasions, we have essentially doubled the size of flaps, although our ability to do this obviously varies with different patients’ body types. We have successfully made small “C” breast mounds even with latissimus alone + fat grafting, however.

I would be happy to chat with you by phone, or see you in person and discuss your options further, if you wish.

Thanks for your question!

Answer #2:  I’m sorry to hear you have had a difficult time. I’m sure you still have options. If I had additional information about the size of your natural breast and your body weight I could perhaps be more specific. In our practice we use your own fatty tissue without muscle sacrifice. If the DIEP did not work out then possibly thigh, or buttock fat or a combination of the two would be an option.


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