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Ask the Doctor: Smoking, Risks During Reconstruction, Researching Your Options

July 19, 2013 by

Ask the Doctor July 18This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I need to have breast reconstruction due to breast cancer occurring twice since 1999. I’m scared because I can’t quit smoking. The surgeon will not perform the procedure unless I quit. Are there any surgeons who will perform reconstruction even though I am a smoker?

A: Surely there are some physicians who will do reconstruction while you’re smoking, but we are not among them. This policy is only because we have personal experience dealing with the many months of wound healing problems (and tears) that commonly follow this type of surgery performed on smokers.

Smoking  isn’t just bad, it’s absolutely terrible. If you want all of your wounds to fall apart, leaving you miserable for months, there may be no better way to accomplish it than to smoke during your reconstruction. The good news is, if you stop for one month before and 3 months after your surgery (with absolutely no cheating), you can often have successful surgery.

 

Q: I am, after total mastectomy performed 12 months ago, scheduled for reconstruction. My age is 59 and I do not have any emotional concerns about being without a breast. However, I would like to stop wearing epiteze, and would like to not worry that it will show in summer. My concern is whether the long-lasting and repeated reconstruction (several operations, including making the healthy breast smaller) represents too big of a risk to my health. After anesthesia last year, I experienced problems with forgetting and lack of focus for about 3 months. Also, what about the operation and healing stress to the overall body? I would hate to start a new health problem because of reconstruction. What is the general risk apart from risks mentioned here?

A: The risks you are worried about are probably not so much from the surgery, but more from the anesthesia. I would suggest you discuss your concerns with your primary care provider. We can advise you about risks such as bleeding, blood clots, infection, etc., but these do not usually result in the problems you describe.

 

Q: Am I putting my health at risk in order to research the best reconstruction method before surgery?

A: No, I think you are looking out for your health by doing careful research in advance. Please let us know if we can help you

 

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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A Chance to Heal in Comfort

March 27, 2013 by

Cherie Mathews is the founder of healincomfort

Our team at The Center for Natural Breast Reconstruction  welcomes Cherie Mathews, founder of healincomfort, as the featured guest for In Her Words this week. Here is her story:


At the age of 40, Cherie Mathews received the same diagnosis from her doctor that one-in-eight women across America will face – “You have breast cancer”.

Through the shock and horror Cherie made the difficult decision to have a double mastectomy. She faced her enemy in this battle with the same fortitude and resilience as the millions of other brave women warriors that came before and since, after. It wasn’t until the pre-op consultation before her mastectomy that Cherie got angry. When she was told the same thing that nurses still tell their charges today… to just bring something big and loose or one of their husband’s old dress shirts to wear home and to recover in.

“I can tell you first hand that when a woman loses her breasts in her battle against breast cancer she does not ‘feel’ ok wearing her husband’s dress shirt. Mentally, it’s cruel.  Cancer is hard enough! If a sprained elbow gets a sling to heal in, why isn’t there helpful equipment to heal in after a mastectomy?”

 

Something had to change.  A new “standard” in medical equipment for women recovering from breast cancer surgery needed to be created. Cherie Mathews would go on to launch and to provide the very healincomfort post-op recovery kits that she herself was denied. Now, women across the globe benefit from Cherie’s vision and ambition to make certain that no woman would suffer this complication. In this decade, thousands of breast cancer survivors have been spared this unnecessary discomfort. Today, thanks to Cherie, all women have the ability to “healincomfort.”

All healincomfort Kits Include: Healincomfort kits make great gifts for loved ones.

  • Patented healincomfort Shirt – Super soft moisture management material, self-adhering  fasteners (like Velcro®), Four Internal Pockets for Drain Management
  • Advanced Design Hands Free Lanyard Straps – Hands free Independence for Showers and Maneuverability
  • Private Medical Drain Pouch – Manages Drains while wearing Regular Clothing
  • Inspirational Story “My Shadow Story” – Your personal copy to help prepare for the ‘First Look’ after your breast cancer surgery.

 

For more information, visit healincomfort.com for more information.

You can also follow Cherie Mathews on Facebook.

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Replacing an Implant With a Flap: Will My Muscles Recover and Function Normally?

March 15, 2013 by

The following question is answered by  Richard Kline of The Center for Natural Breast Reconstruction.

 

Q: My reconstruction consisted of chest muscle to create a pocket for a silicone implant. I have had it since 2004. They used an expander. It was the best choice for me at the time. If the implant is removed and the muscles are fixed, will they recover and function normally? For example, will I be able to do pushups and bench presses again?

 

A:  Thank your for your question. Although the muscle is replaced against the chest wall when an implant is replaced with a flap, it is impossible to duplicate the strength of the original muscle attachment.

Having said that, most patients function quite well with an implant under the muscle, and I’m hesitant to tell you you’ll see dramatic functional improvement if you convert your implant to a flap.

I hope this helps.

 

Richard 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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What to Know Before Seeking Implants as Your Breast Reconstruction Option

January 4, 2013 by

The below question is answered by Dr. Richard M. Kline of The Center for Natural Breast Reconstruction.

I am weighing my options for breast reconstructions and  considering silicone implants. What should I know before I continue—what questions should I ask a doctor?

Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for breast reconstruction, and flaps may be a better alternative in that case.

-Dr. Richard M. Kline Jr.

The Center for Natural Breast Reconstruction.

Have questions for our surgeons? Submit your questions today and get answers straight from our surgical team! No matter where you are in your reconstruction process, we are here to help!

 

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What Would Disqualify a Patient for Breast Reconstruction?

December 28, 2012 by

The question below is answered by Charleston breast surgeon Dr. James Craigie, of The Center for Natural Breast Reconstruction.

What are some circumstances that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

Have a question about breast reconstruction question you’d like answered? Just ask us!

 

 

 

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Implant Procedure Without Expanders?

December 7, 2012 by

breast implantsThe below question is answered by the Charleston breast surgeons at The Center for Natural Breast Reconstruction.

Is it possible to have a simple implant procedure without expanders if you have a lot of skin tissue left?

Yes, absolutely, if you are willing to have Alloderm (acellular dermis) used to help support the implant.  We specialize microsurgical reconstruction using your own tissue so we don’t actually do this procedure in our practice but there are plastic surgeons in every metropolitan area who do.  If you are in or near the Charleston area we can give you names of surgeons who are especially good at this procedure.    We know many out of our area too if you’d like to identify where you are located we can see if we know anyone to suggest you consult.

–The Center for Natural Breast Reconstruction Team

Would you like your breast reconstruction question answered? Just ask us!

 

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Could I Be A Candidate for DIEP Reconstruction After Implants?

November 16, 2012 by

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

I had a bilateral mastectomy and had 850cc silicone implants placed after tissue expansion. I am not happy at all with the result as I had radiation on the right side and that breast is considerably smaller than the left. I am also not happy with the shape and look of the breasts with silicone implants. I currently wear prosthetics in my bra to achieve symmetry and a normal shape. Even with the bra and the prosthetics I am not happy with the result. I am currently a D/DD and would like to maintain that size. Given this situation, could I be a candidate for a DIEP or Stacked DIEP breast reconstruction?

Thank you for your question. I’m sorry you are having some concerns about the shape and evenness of your breast reconstruction. Because you had radiation on the right side it is almost certain that the two sides will be different to some degree regardless of the type of reconstruction. Unfortunately, when this occurs with implant techniques it is usually more noticeable and nearly impossible to fix long-term as long as the implants are in place. The reason for this is the implants will be treated as foreign material by your body and the right side will always react more severely due to previous radiation even if radiation was done before the mastectomy. Also, the process of scar formation continues as long as the implants are in place, making the firmness, shape change, and stiffness more noticeable to you as time goes by. These are the reasons that women who have implant reconstruction have multiple procedures to revise results as time passes.

Fortunately when someone has had problems of this nature with implants we can frequently solve them by removing the implants and replacing them with their own fatty tissue (DIEP, stacked DIEP). We can do this without taking tummy or back muscles. Immediately the fatty tissue takes on a more natural shape compared to implants. Thirty percent of my patients have had failed implants before we start over and use their own tissue. My opinion and answer to your question is that you could have a DIEP to replace your implants and I can usually predict that many of the implant problems are much improved immediately after the surgery. I cannot predict what size you would be without seeing you but the size depends on how much extra tummy tissue you have as well as any previous surgery.

I hope I have answered your questions.

—James Craigie MD

 Would you like your breast reconstruction question answered? Just ask us!

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What Is the Recovery Period for a DIEP Procedure?

November 9, 2012 by

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

Do you have breast reconstruction questions you want answered? Submit them here and get personal answers, straight from our doctors!!

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BRAdayUSA 2012: A Photo Journey Recap

October 24, 2012 by

We are thrilled with the turn out and success of our BRAdayUSA event held last week aboard the Carolina Belle in Downtown Charleston! The night was filled with great people, food, a little retail therapy and outstanding raffle prizes. The Center for Natural Breast Reconstruction team couldn’t be prouder to have hosted our own BRA Day event for the first time this year, or to raise awareness of a cause we so firmly believe in.

If you couldn’t make it this year, or just want to relive the great moments, we’d like to share some of our favorite pictures from the night with you below!

Guest enjoying the hors d’oeuvres and mingling on the top deck!

What a beautiful night spent in the Charleston harbor.

The Premier Design Jewelry booth featuring fabulous baubles.

Some of our guest enjoying a little retail therapy in the cabin.

The Radberry Nails with nail creations to match any mood!

We cannot say thank you enough to all of the wonderful businesses that donated beautiful raffle items for this year’s event. Without you, this event would not have been the success it was! For a complete list of the participating vendors click here

For more pictures from this year’s event make sure to visit our facebook page!

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Join Us for BRA Day USA

October 8, 2012 by

bra dayCome celebrate our first BRA Day USA on Wednesday, October 17, 2012 aboard the dockside Carolina Belle on 10 Wharfside Street, Charleston, SC ! We’re happy to promote Breast Reconstruction Awareness Day, or BRA Day, which is an initiative designed to increase education, awareness, and access regarding post-mastectomy breast reconstruction.

Created to inform women of their choices and options for breast reconstruction, the campaign also strives to make reconstructive education and services available to all women, regardless of age, financial status, or race. Studies show that 7 out of 10 women are never informed about post-mastectomy reconstructive surgery, and the statistics are even lower for minorities. However, with BRA Day events appearing all over the world, hopefully those numbers will soon be a thing of the past.

Though BRA Day initially launched in Canada, it quickly became an international campaign and grassroots collaboration between plastic surgeons specializing in breast surgery, nurse navigators, medical device industry representatives, breast cancer patients and families, and breast cancer support groups. Together, these participants coordinate BRA Day events that include question and answer sessions, lectures, flash mobs, fundraising parties, advertising campaigns, and community events.

The Center for Natural Breast Reconstruction team couldn’t be prouder to host our own BRA Day event for the first time this year, or to raise awareness of a cause we so firmly believe in. Help spread the word about reconstruction options, and join us for a little retail therapy, some great food, and outstanding prizes. Admission is free but limited to the venue capacity of 250.

To secure your spot, be sure to RSVP to info@naturalbreastreconstruction.com. We’ll see you on the Carolina Belle Wednesday, October 17th!

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