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Ask The Doctor – Will My Medical Insurance Policy Cover My Procedure?

November 7, 2014 by

<alt="medical insurance coverage"/>This week , Gail Lanter, CPC, Practice Manager of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I have Buckeye Medical Insurance and I wanted to know if it will cover reconstruction of my right breast after having a lumpectomy and radiation treatment. It left my right breast disfigured, so I need to have this surgery. Thanks!

ANSWER:  I’m happy to try to answer your question for you. Buckeye Medical Insurance looks like it offers a few different types of policies so without knowing which you have I can give you some general information. There are some payers who will not consider reconstruction of lumpectomy defects unless medical necessity has clearly been established. However, the majority of reputable insurers will allow for a reconstruction procedure if a medically necessary lumpectomy results in a significant deformity – as often happens with radiation treatment. Your surgeon’s office should be able to submit all of your documentation, including photos, demonstrating the problem you are having and ask that Buckeye pre-authorize the procedures necessary to reconstruct the area so you have a definitive answer prior to undertaking surgery.

There are many possibilities as far as what procedure to use according to what specific problem you are experiencing. It could be as simple as a scar revision procedure with fat grafting or as complex as the muscle sparing procedures in which we specialize according to how severe the defect. You would definitely want to consult with your plastic surgeon to get a plan as your next step.

Hope that information is useful, and please let us know what else we can do for you. We’re always happy to help!

— Gail Lanter, CPC, Practice Manager 

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 – I Have an Implant But Want Natural Reconstruction

October 31, 2014 by

<alt="natural breast reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had reconstructive surgery on my right breast in 2008. I have a silicone implant, but it feels like a hard lump on my chest. I’m 62 and healthy. I don’t know if my insurance will cover it if I decided to have the natural reconstruction.

ANSWER: Usually your insurance will cover conversion of an unsatisfactory implant reconstruction to a reconstruction using your own tissue with no problem, but we always check first to be sure. If you wish, we can give you a call to discuss your situation in more detail. Many, many people are or have been in your situation, and we are usually able to help.

— Richard M. Kline, Jr., M.D.    

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 – My reconstructed breasts are not well proportioned, can you help?

October 24, 2014 by

<alt=breast reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had a DIEP done at the same time of my mastectomy a few years back. My incisions opened up around both breasts one week after surgery. After about 3 months of my doctor telling me to put Vaseline on them and keep the areas covered, they became very infected. I then got a second opinion.

The next doctor had me on the operating table the next day and probably did a dozen surgeries on me over the next year to get me healed because I was so infected from being open for so long. I’m scared about this, and I’m very self-conscious about my breasts. One of my breasts was set lower on my chest than the other, making wearing bras difficult. The same breast that is positioned lower on my chest is also larger. It is impossible to wear bathing suits comfortably, too. I have to watch how tops are cut on me because they will show that my breasts are uneven. Is there anything your doctors can do to help with this?

ANSWER:  I’m terribly sorry about all the trouble you’ve had – it sounds like a real nightmare. I can’t, of course, guarantee you that we can make you good as new, but I strongly suspect that we can help, as we’ve seen plenty of other patients with similar stories. Probably the best place to start would be to have one of us call you to discuss your situation further, if that’s OK. It would be very helpful if we had some pictures to look at at the time of the conversation, but that’s not essential at this stage. I also suspect you will ultimately benefit from having an MRI at some point, as this is the best way to look for dead fat or other potential problems. Hang in there, no need to lose hope at this point.

— Richard M. Kline, Jr., M.D.    

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 – Can the breast cancer gene develop cancer in fat tissue?

October 10, 2014 by

flower-197343_640 (1)This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Can the breast cancer gene develop cancer in the resisted fat tissue? Is it best to not have any sort of tissue whatsoever in the breast area? I also know fat from the tummy area has been used in reconstructing breasts for 10 years with no known problems as yet, as another solution.

ANSWER:  There are two ways to transfer the fat – as a single large “flap” with its own blood supply, which has been done in one form or another since the 1980’s (most recently the DIEP), or as fat “grafts”, which means taking the small particles harvested during liposuction and injecting them into the breast area through a needle. “Flaps” are time-tested, and no ill effects have been observed. “Grafts” may well be just as safe when used in breast tissue, but don’t have the benefit of having been used for decades yet, so we’re not absolutely sure. For many years it was taboo to inject fat grafts into

For many years it was taboo to inject fat grafts into breasts, because people were afraid the fat would adversely affect the radiologists’ ability to interpret mammograms. A few years ago, a consensus was reached that there really wasn’t much impact on reading mammograms, so people began cautiously injecting fat into breasts for various reasons (reconstruction as well as cosmetic augmentation).

Since we began using fat grafts more, we have learned that it does some interesting things. Fat is potentially a rich source of stem cells, which can transform into different cell types under certain conditions. As one example, we have observed that fat grafts sometimes seem to produce remarkable beneficial changes in previously radiated skin, and this is thought to possibly be due to stem cell effects. On the other hand, there is at least one study purporting to show an increased risk of local recurrence when fat grafts are used to reconstruct partial breast defects after lumpectomy.

The study is controversial, but it has raised concerns among many surgeons about injecting fat into breast tissue in general. No one is quite sure what is potentially going on with stem cells in fat grafts, and no one is quite sure how they may affect residual malignant or pre-malignant cells in breast tissue. The potential ramifications are enormous, because while DIEP and other flaps are large, complicated procedures, fat grafting is extraordinarily easy, and a there is a lot of interest in it for that reason alone.

I haven’t read a good explanation of why fat transferred with its own blood supply (flaps) should behave differently than fat particles which induce a blood supply to grow into them (grafts), but that doesn’t mean there isn’t a difference. To complicate it further, when a flap is transferred (or even when a breast reduction is done), small particles of fat are de-vascularized initially but ultimately survive as grafts, yet no problems have been observed to date.

I realize now that you were probably just asking about flaps (maybe DIEP – of which we have done many hundreds). However, we do periodically get inquiries about fat grafting into breast tissue, and people sometimes want to know why we are so “behind the times” when I tell them we don’t do it.you were probably just asking about flaps (maybe DIEP – of which we have done many hundreds). However, we do periodically get inquiries about fat grafting into breast tissue, and people sometimes want to know why we are so “behind the times” when I tell them we don’t do it.

Hope this helps.

— Richard M. Kline, Jr., M.D.    

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 – Recovery After a Failed Implant Reconstruction

October 3, 2014 by

<alt='failed implant reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had breast cancer twice, and one of my breast implants got a bad infection. My implants had to be removed, and I’ve left them that way since. Now I’m 58 years old, and I’d like to have reconstruction. Is this possible for me at my age and after an infection?

ANSWER: Thanks for your question. While I cannot obviously make precise predictions about our ability to help you without knowing a little more, I can tell you that your situation is actually a very common one. Fortunately, a history of failed implant reconstruction has very little impact on our ability to subsequently reconstruct you with your own tissue, and we have successfully reconstructed many, many women in your situation. If you wish, one of us can give you a call to discuss your situation further, and we can go from there. Have a great day!

— Richard M. Kline, Jr., M.D.    

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: Lymphedema and Lymph Node Transfer

September 26, 2014 by

<alt="3 pink roses"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I’ve had breast cancer and developed lymphedema after my mastectomy.  I recently heard about Lymph Node Transfer surgery.  Does it work?  I’m scheduled for a DIEP breast reconstruction, can it be done at the same time?

ANSWER: Lymphedema is a very difficult problem that results when a patient has had breast cancer and has to undergo surgical removal of the lymph nodes under the arm as part of their surgical treatment for breast cancer. There are other causes of lymphedema but our specific interest has been in patients who have had breast cancer.

Lymphedema can be a very debilitating process; it remains a terrible problem worldwide, for all types of reasons. There is still much to be learned about why some people develop lymphedema and others do not. It appears that lymphedema is directly related to several factors in our breast cancer patients. It is directly related to having the lymph nodes removed from under the arm and seems to develop from the scarring that occurs under the arm following mastectomy and / or axillary dissection.

Undergoing radiation of the arm or axilla increases this risk. However, there are many people who undergo removal of the lymph nodes and radiation that do not develop lymphedema. There are also people who have mastectomy, have lymph nodes removed followed by radiation, and don’t develop lymphedema until many years after their surgery. That is the main reason that patients are warned to pay particular attention to their arm if they have had removal of any lymph nodes.

It is also possible that someone could get lymphedema even after simply having a sentinel node removed. A sentinel node procedure (lymphadenectomy) is a way to examine the lymph node without having to remove more than one or two. The whole idea of examining only the sentinel node is to lower the risk for lymphedema, but even with the sentinel node procedure, there is still a chance of developing lymphedema. Our practice became interested in options to help breast cancer patients with lymphedema as we see many who are suffering from the symptoms of this process while undergoing breast reconstruction.

Our practice specializes in microsurgical free flap breast reconstruction utilizing skin, underlying tissue, and microscopic blood vessels that transport life-giving blood to the reconstructed breast. This procedure is commonly referred to as the DIEP if using the abdomen or a GAP if using the buttock tissue. The muscles of the abdominal wall are left intact as it is the removal of the muscles of the abdominal wall that can lead to problems in the donor area, like hernias and bulging, as well as a more involved extended recovery. The lower tummy wall is the most common area that we transfer and it’s also an area where lymph nodes are present. Therefore, over the first decade this surgery was being done, we would encounter lymph nodes in the area of the blood vessels, as well as fatty tissue.

It became obvious that we could transfer lymph nodes on the blood vessels as we refine our technique for microsurgery. Due to the lack of effective treatment for lymphedema, for years surgeons doing perforator flaps have taken on this challenge and are trying to come up with ideas and techniques to treat it. We began doing an extensive amount of research, spanning the globe, looking for information on procedures that may help these patients. In 2005, we formed a group known as the Group for the Advancement of Breast Reconstruction, known as GABRs, and we included members throughout the world who had had a unique experience with our type of breast reconstruction.

We encountered one individual who had 15-years of experience with what is now known as “vascularized lymph node transfer” for the treatment of lymphedema. Initially, Dr. Robert Allen had attempted lymph node transfer during breast reconstruction and the biggest concern was how to transfer lymph nodes from one area of the body to treat lymphedema but not to create lymphedema in the donor area. In 2006, the GABRs met in Beijing, China and invited Corrine Becker, a surgeon from France who had a long history of experience with vascularized lymph node transfer.

She presented her work and through communication and travel to Paris to work with her, members of the GABRs group began to gain experience and learn more of her technique. The biggest hurdle that we were able to overcome was learning how to select the lymph nodes that could be removed as the donor lymph nodes and use those for breast reconstruction without causing lymphedema of the leg. We spent an extensive amount of time discussing her techniques and reviewing her results, as well as her publications.

We then made arrangements for her to travel to South Carolina and actually performed surgery on our own patients with her as an assistant surgeon. Since that time we have been very encouraged by the results with vascularized lymph node transfer as an effective treatment for reduction of the symptoms of lymphedema. We feel very excited but yet are very cautious about all results. It is important that patients realize that this procedure is still evolving and that there are risks involved, but to date we have had very good results and no serious complications.

Improvement of symptoms with vascularized lymph node transfer can occur immediately; however, they also may take up to 2 years to be appreciated. In most of our patients, the indicators of success are different. For the majority, the goal was to improve the edema, lessen the need to wear compression garments on a regular basis, and to eliminate the risk for frequent infections, which are the typical problems that those affected by lymphedema experience.

In order to lower the risk for complications and to closely study our results in conjunction with other colleagues who perform this procedure, we prefer to perform vascularized lymph node transfer as an isolated procedure. It can be done at the time of breast reconstruction; however, there is a chance that some people with mild lymphedema who undergo breast reconstruction may have improvement without lymph node transfer. Therefore, in order to closely study our results, we perform the breast reconstruction first followed by vascularized lymph node transfer as the second step. When the results are complete, we can determine whether it was the reconstruction or the transferred lymph nodes that gave the end result. It is important again to reemphasize that the main risk for of the surgery is that the transfer may not work. It is possible that if the transfer did not work resulting in more scar, the lymphedema could worsen.

Thankfully, to date, we have not experienced this complication. Other complications are damage to the blood vessels under the arm or the nerves under the arm. Therefore, our preference is to have an oncologic surgeon, who performs axillary dissection, release the scar under arm.  At the same surgical setting, after the scar is released, we perform the transfer by removing very specialized lymph nodes from the outer and lower abdominal wall or outer upper leg. We preserve the lymph nodes of the inside leg. These are the ones that drain the lower extremity and therefore, we feel that the risk for lymphedema of the donor area is reduced.

At this point, we have received some very exciting results along with some mixed results and continue to follow our patients very closely. We have had no patients with any serious complications and no patients at this point with lymphedema of the donor site. We are hopeful that the future holds vascularized lymph node transfer as an effective option for people with lymphedema following breast cancer surgery.

We plan to continue to devote and focus our energies on a surgical solution while simultaneously not exposing people to excess risk of additional problems. Once again, we do have to admit that the surgery, although giving some promising results, is  still evolving at this point and we choose to proceed with caution in the best interest of our patients.

— James Craigie, M.D.

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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Why Microsurgical Breast Reconstruction?

September 19, 2014 by

<alt="pink flower"/>The access to GAP and DIEP procedures is not widespread, only a handful of surgeons have invested the time to learn this intensely specialized microsurgical procedure, and have access to another equally qualified micro-surgeon to provide the required surgical assistance.

To give you an idea of how few of these surgical teams exist, in late 2007 we were one of only three practices in the country that offered simultaneous bilateral GAP reconstruction.  As a result, we see patients from all over the United States seeking this highly successful option, with 30 to 40% of our patients referred to us as a result of repeatedly failed implant reconstructions.

In a critical analysis of 142 GAP procedures published by six physicians at LSU, the GAP procedure is reported as “not easy to learn; however, it does provide a reliable flap and an excellent aesthetic reconstruction.”  The report further states “overall flap survival was 98%”and perhaps most importantly “patient satisfaction with the reconstructed breast and donor site has been excellent.”

A little bit about us:

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the right questions to ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions. Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • How many board certified physicians will be assisting with the first stage of the procedure? Will there be physicians in training (residents) involved with my surgery
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

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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In Her Words: Liz Munn’s Story of Survival

September 16, 2014 by

The Center for Natural Breast Reconstruction is so proud to publish this moving article featuring Liz Munn, a breast cancer survivor who’s passionate about educating others about breast cancer and finding funding for uninsured women. Thank you, Liz, for sharing your story with the world.

You’re coming up on the first anniversary of your breast cancer diagnosis, tell us about your year.
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I learned a great deal about myself this year. I have come to appreciate the things that are important to me a little more, and of course that includes my family and friends. I think this year taught me not to waste time with things that aren’t as important as others. It provided with me focus and gave me strength I didn’t know I had.

How do you feel like a collaborative team of physicians/surgeons was important to your recovery?

This process takes dedication. I would say that’s also the perfect word to describe this team. There is nothing easy about the process and it can be trying. But this team was dedicated to seeing a successful outcome for me from the start. No question was too small, and they supported me the entire way through. I can’t say enough about how well I was treated and supported by everyone involved. My husband and I are so thankful to have had that type of support. I appreciated being able to see the entire team at one location; it helped when I was recovering and my energy was a hot commodity.

Did you speak to anyone who had reconstruction prior to choosing your procedure?  Did you find this helpful?

When I was diagnosed, it was overwhelming for me. My sister worked with a patient of Dr. Craigie’s and we had several long conversations about the procedure. She had a complicated case. Her treatment involved multiple surgeries and some delays with reconstruction for treatment options. Even after all she had been through she still felt this was the best option for her. She was very supportive and understanding of the difficult decisions that I needed to make for myself. My main concern was for my long-term results and the best possible outcome. With the risks and benefits of reconstruction in mind, I knew it was the right decision for me. The success rate for natural reconstruction was extremely high and I was a good candidate for the surgery. I was so glad to have others (who had been through the surgery) to talk to, and it was a huge comfort for me.

You, like many of our patients, feel a need to give back.  We understand your passion is promoting the importance of screening mammograms and finding funding for those who might be uninsured, what’s your plan to get the word out?

I believe everyone has a gift, and my gift is helping people grow their businesses. I plan to hold an annual training webinar through my website with all proceeds going to Lowcountry Komen. I was so fortunate to have great health insurance and live in a place that has amazing healthcare available, but not everyone is in that situation. I believe that mammograms and available choices for treatment and reconstruction are the most important things women can receive from her health provider. However, many women are afraid to see a doctor or don’t understand the process. Knowledge and choice are truly powerful things, and I know that Lowcountry Komen supports these ideals.

I am also willing to discuss my personal journey with anyone at any time. Sometimes seeing that it is possible to get better, and knowing that it does get easier, gives you the courage and energy to take care of yourself.

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Ask The Doctor – Are There Any Tests To See if My Implants Are Causing My Health Problems?

August 15, 2014 by

<alt="Pink Flowers in a Field"/>

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

QUESTION: I had a bilateral mastectomy back in 2000 because of numerous precancerous lumps in my breasts. I had Stage 3 melanoma 8 years prior, and they operated numerous times on me. I decided to have latissimus reconstruction surgery, and since then have had numerous problems. I’m allergic to latex, numerous adhesives, sulfa, and penicillin. I’ve been suffering from fibromyalgia, severe edema throughout my body, and itchiness within the area of my chest wall and breasts. After getting this issue checked out, I was told this was not an implant problem and was sent home. Are there any tests that can check to see if the problems relate to my implants? I had a CT scan done at Mayo Clinic, and they said I had an allergic reaction to what they thought was an antibiotic. Have you seen this before in your patients? Any help would be greatly appreciated. Thank you.

ANSWER: I’m not aware of a test to see if your implants are causing any problems. To my knowledge, there has been no firm connection established between implants and symptoms such as yours, but you should check with your rheumatologist to be sure.

Having said that, we do see many patients who have implant reconstructions along with various complaints such as discomfort, tightness, pain, etc. Although it is obviously difficult to objectively quantify, many of them seem to get significant relief from their symptoms if their implants are removed, and their breasts reconstructed with their own tissue. In all fairness, most of these patients have what would be considered unacceptable reconstructions anyway (hardness and asymmetry being common issues), so it is usually pretty easy for them to decide to have their implants removed and replaced with natural tissue. If your reconstruction is presently aesthetically acceptable to you (other symptoms notwithstanding), then the issue of what to do is significantly less clear-cut.

Best of luck, and let me know if we can be of any further assistance.

Dr. Richard M. Kline, Jr.

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: Will Scar Tissue Buildup Be A Concern With The Gap Flap?

July 25, 2014 by

 

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

Question: My wife had a double mastectomy 10 years ago. At that time she had latissimus surgery to fill in her breasts. Since then, we’ve had numerous surgeries, about every 2 years, due to scar tissue building up in 1 of the 2 (or both) breasts that causes tightening and even pain. Will scar tissue buildup be a concern with the Gap Flap? 2. Regarding the Gap Flap procedure, what is the rate of failure that you experience with any of the 4 surgery sites (2 buttocks, 2 breasts)? Thanks.

Answer: Hi — I’m assuming your wife has implants under the latissimus flaps, which would explain the buildup of scar tissue. GAP flaps are generally large enough to make a breast by themselves (obviously, sizes differ among different people), so implants are not needed, and internal scar buildup would be a very rare event. We last calculated our statistics in October of last year. Over 10 years, we did 217 GAPs, 49 as unilateral, 168 as simultaneous bilateral. The GAP flap survival rate was 97% overall. All of the failures were in bilateral cases, but no patient lost both flaps, yielding a simultaneous bilateral flap survival rate of 96.4%. We have done quite a few GAPs since then with no failures (most recently a simultaneous bilateral last week), so the current statistics are actually a little better than that. We don’t bury flaps, and therefore can’t miss (or ignore) a failure, so these are ironclad statistics that could survive a GAO audit. To our knowledge, only Dr. Allen (who invented breast perforator flaps and trained the rest of us), his ex-partners in New Orleans, and ourselves actually do simultaneous bilateral GAP flaps on a routine basis. I’d be happy to discuss your situation further if you wish, just call or email.

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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