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Are Overweight Women Better Candidates for DIEP Flap Reconstruction?

December 9, 2011 by

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

I’ve read that women who are overweight are better candidates for DIEP flaps since they have “extra” to use, what is your opinion?

Many women with high BMIs (exceeding 40) have enjoyed successful flap reconstructions; however, they are at significantly higher risk of developing post operative complications.

It is well-demonstrated in the plastic surgery literature, that people with a significantly higher BMI are far more likely to experience complications than those with a lower BMI. There is no magical “line-in-the-sand” cut-off point, though—many factors, such as proportion of fat, which is intra-abdominal (vs. subcutaneous, which is what can be used in a flap), undoubtedly play a role in determining each person’s risk. Besides wound-healing problems, increased BMI also increases the risk for blood clots, which can, of course, be lethal.

Some lay-posters on blogs have stated that you shouldn’t worry about blood clots because injectable blood thinners will prevent them. This is a VERY DANGEROUS misconception—blood thinners only REDUCE the incidence of blood clots, and nothing can completely prevent them in all patients. We feel that it is your surgeon’s duty to you to assess your individual risks, and propose a plan that will get you through the surgery as safely as possible. Other surgeons, and other patients, may feel differently.

Our practice has demonstrated that it IS possible to have an outstanding safety record, while simultaneously maintaining a high reconstruction success rate. My personal flap survival rate over the last 10 years exceeds 99%, and the overwhelming majority of our patients are pleased that they went through the procedure at our facility. Our primary goal, however, is not to try and push limits by seeing what we can “get away with” in higher-risk patients. Instead, we strive to give everyone the best possible Natural Breast Reconstruction with perforator flaps, while at the same time doing everything possible to ensure their safety.

—Richard M. Kline Jr., M.D.

The Center for Natural Breast Reconstruction

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Step 3 in Quitting Smoking: Taking Effective Actions to Stop

December 7, 2011 by

quit smokingThe one thing that many people don’t understand when it comes to quitting smoking is that addressing the physical addiction to nicotine is not enough. They must also learn to manage the ingrained habits that led them to smoke. People smoke after meals, while driving, and while under stress, to name just three examples. Those urges do not go away simply because the cigarettes are gone.

Quitters need to have a plan for when the habitual part of smoking raises its ugly head. We discussed that a little in our previous post about the 4Ds, but here are a few more tips to master the mental piece of quitting.

Look at your habits.

When did you have your first cigarette of the day? Was it right when you got up, after your shower, or after breakfast? Breaking that habitual urge can be as simple as changing your routine. If you smoked first thing, try going outside for a quick walk instead, or hop into the shower right away.

If your habits don’t change, your chances of staying quit are dramatically lower than if you consciously alter the path of your day.

Have substitutes handy.

If you can’t stop doing something that triggers you to smoke, keep something handy that you can put in your hand or in your mouth. Driving is a strong smoking trigger for many, and most cannot avoid it. Try putting a straw in your hand or a cinnamon toothpick in your mouth. If you find yourself lighting up at a certain intersection on your way to work, find a new route until you’re more secure in your quit.

Enlist help.

If you live with smokers, see what they are willing to do to help you maintain your quit. Having them smoke outside is ideal, since you were likely to smoke with them as part of your habitual conditioning and it’s easier to have them out of sight, out of mind. If they will not go outside, perhaps they would confine their smoking to one room of the house and keep the door closed.

If those you live with don’t smoke, perhaps they can help you identify your smoking habits and ways to break those habits.

You may need to alter your routine for only a few weeks while you master the initial difficulty of quitting, or you may need to change a few things more or less permanently. The main thing to remember is to never take one drag. This is no different from being addicted to any other drug. You would not suggest that an alcoholic or heroin addict has “just one” . . . and you can’t either.

What are your tips to quitting smoking?

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How to Reduce Exposure to Hazardous Chemicals That Have Been Linked to Breast Cancer

December 2, 2011 by

chemicalsOver 400 women are diagnosed with breast cancer each day, and several hazardous chemicals have been linked with breast cancer. While it might not be possible to completely avoid these toxins, here are some ways to reduce your exposure to them.

Eat as naturally as possible.

Our food supply is loaded with artificial ingredients, dyes, hormones, chemicals, additives, and preservatives. Keep your diet as close to its natural state as possible. Shop the perimeter of the store, as much of the chemical-laden “food” is in the center of the store.

When you arrive home with produce, wash it thoroughly. Buy free-range or organic eggs and poultry, grass-fed beef, and wild fish (not farmed).

Buy BPA-free products.

The less plastic you have in your life, the better, but at a minimum, you should avoid bisphenol-A (BPA). BPA is a hormone disruptor found in plastic food and drink containers, as well as in canned food, including infant formula cans. BPA leaches from the plastic or can into the food. Look at the bottom of your plastic containers. Throw away any with the number 7. Plastics with the numbers 1, 2, and 4 do not contain BPA.

Use glass for food storage and cooking when possible, and never microwave food in plastic or Styrofoam.

Avoid furniture made with the flame retardant PBDE.

While flame retardants have a purpose and have saved lives, one type of flame retardant, polybrominated diphenyl ether, or PBDE, has been linked to breast cancer. When buying furniture, look for items with a different flame retardant, or buy organically manufactured when possible.

Use solvent-free cleaning products.

Antibacterial and harsh chemical cleansers are not necessary. The more natural you can go when you clean, the better. Ammonia, bleach, and any cleanser containing a solvent are hazardous to everyone in the home. Hydrogen peroxide, vinegar, lemon juice, and baking soda make excellent cleansers, and a quick Google search will yield plenty of recipes and ideas to use them.

If you prefer other cleansers, buy green cleaners made with safer ingredients, which can be found in any health food store or online.

Clean out your cosmetics.

Makeup is full of additives, chemicals, and synthetic hormones that no one needs. Toss out your liquid or cream foundation and use mineral makeup. It’s better for your skin and covers just as well as the pore-cloggers you’re used to. Mineral makeup companies also sell eyeshadow, mascara, blush, lipstick, and lip gloss.

Stop the antibacterial foolishness.

Contrary to popular belief and TV commercials, antibacterial soap is not necessary and does more harm than good. The truth is that any soap is antibacterial, and you can find natural or organic soap at health food stores or online.

Know the ingredients of everything you buy, no matter who you’re buying from, as marketing pros often give you the illusion that something is natural or organic when it isn’t.

What tips do you have for reducing chemicals and toxins?

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How One Woman Discovered the Positive Outcomes of Reconstruction Surgery and Cancer

November 30, 2011 by

Today’s In Her Words post comes to us from a past patient of The Center for Natural Breast Reconstruction, Jakki Grimball. Jakki is a breast cancer survivor who lived in Columbia, SC and traveled to Charleston to receive her DIEP reconstructive surgery. Today, her and her husband live in Charleston where her husband is the director of The Neighborhood House, an organization providing services for people in need, including food pantry, soup kitchen, emergency assistance, sewing classes, resume writing, and more.

See below for our interview with Jakki:

What type of reconstruction surgery did you have and how do you feel about the results?

I had the DIEP flap procedure done October 2007 by Dr. Craigie. The outcome far outweighs the surgery and recovery time. I am very pleased with the results and having a tummy tuck as an added benefit!

Would you make the same decision again if you could go back?

I would definitely make the same decision. I had a friend who had implants and she now wishes she had done the DIEP flap procedure. She’s had several complications. Of course, I believe I had the best plastic surgeon in South Carolina perform my surgery.

What advice would you give to women who have undergone a mastectomy or double mastectomy and are unsure about natural breast reconstruction?

I would and have advised women to have the DIEP flap surgery. It is far better to have natural breast reconstruction than to have a foreign substance placed in the body. I realize advances have been made in breast implants and there are fewer adverse effects; however, I believe that using my own tissue left little opportunity for infections and other complications. I have never regretted having the surgery or choosing Dr. Craigie as my surgeon.

In what ways has breast cancer both negatively and positively affected your life?

The only negative affect breast cancer had in my life was the mastectomy and the chemotherapy. I firmly believe God has a purpose for everything and having breast cancer made me more aware of how fragile life can be. Breast cancer brought my family and friends closer and I hate to say it, but it weeded out those who were truly not my friends. I found out I had breast cancer three days before my wedding and I gave my fiancé the chance to cancel the wedding. He told me he would marry me at my bedside if necessary. So the diagnosis also brought us closer together. I now cherish every moment and I don’t sweat the small stuff (sometimes not even the big stuff).

You and your husband recently relocated from Columbia, SC to Charleston, SC where your husband is the Executive Director of Neighborhood House. Tell us a little bit about this non-profit organization and how it helps the community.

Click here to view a document from The Neighborhood House, outlining their mission and daily services to the community.

Share this post with your friends on Twitter.

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What To Do If Fear Is Keeping You From Undergoing Breast Reconstruction

November 25, 2011 by

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

I am scheduled for reconstruction on the 29th. I feel as though I shouldn’t go through with it because, for one, I am 58 years old and secondly because I am scared that I will not be pleased. Thirdly, I heard that it is very painful and is worse than the bilateral mastectomy I had. I am so confused as to what to do.

Firstly, if you are scared, and feel strongly that you shouldn’t do it, then DON’T—END OF DISCUSSION! We’re talking about a quality-of-life surgery, not life-saving surgery. Attitude about the outcome is far too important to risk going into it feeling like you shouldn’t.

Having said that, unless you have a serious medical condition making the surgery dangerous, diabetes, or inadequate donor sites (I assume we’re talking about DIEP or GAP flaps), statistics suggest it might not be as bad as you fear.

Age is of no consequence—some of our happiest DIEP patients (and best healers) have been in their 70s.

Satisfaction with the final outcome is critically dependent upon realistic expectations, which can only be arrived at through careful preoperative discussion with your surgeon, and ideally, also through discussion with other patients.

Perforator flap surgery IS more painful than mastectomy, but pain is a relative thing. A few patients say it is terrible, most say it was about what they expected, and a few say they had almost no pain, even the day after surgery. I can think of one patient out of hundreds who suggested she might not have gone through it if she knew how bad the recovery would be.

Best of luck to you, and please feel free to ask any more questions.

—Dr. Richard M. Kline, Jr.

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Answering Your Breast Implant Questions

November 18, 2011 by

dr. richard klineThe question below is answered by Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction

I had cancer in my left breast 15 yrs. ago, had the lump taken out, then developed a rather large cyst in the same breast. I had the cyst removed, which left me with only half a breast. I also had 8 weeks of radiation. I wanted a breast implant but the doctor said I couldn’t get one. Since it has been so long, could I now get one? I am 75 but still don’t feel good about my breast. I wear a breast form, but it’s not the same.

It is sometimes possible to reconstruct a lumpectomy defect with an implant, but your history of radiation makes success less likely. To some extent, the size of the implant you would require, and the amount of radiation injury you have sustained, influence the chances for success. Flap surgery, while significantly more involved, is ideal for use in radiated tissues, as it allows us to use healthy, non-radiated tissue to replace what is missing. Age, in and of itself, does not affect the success of either surgery, as long as you are generally healthy.

—Dr. Richard M. Kline, Jr.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by emailing us at blog@naturalbreastreconstruction.com.

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Common Breast Reconstruction Questions Answered

November 11, 2011 by

dr. richard klineThe below questions are answered by Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

1. I had my second part to breast reconstruction and had necrosis removed, but I still have the hardness. How can it be treated? They did liposuction.

If necrosis was removed and there is still hardness, then it is most likely from either 1) additional / remaining fat necrosis, or 2) edema (can feel hard, especially likely in radiated tissue). In either case, resolution is likely without additional surgery, if you wait long enough (may take 1 – 2 years), although breasts will be smaller in either case. If pain is present, and fat necrosis is still present, then surgery to remove the rest of the dead fat may be indicated.

2. I am considering silicone implants for breast reconstruction. What should I know before I proceed—what questions should I ask?

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.

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Nerve Recovery and Breast Reconstructive Surgery

November 4, 2011 by

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

How long does it take for nerves to recover and for full skin sensation to return after reconstructive surgery?

During any surgery, numerous sensory nerves, generally too small to have names, are invariably cut. Depending on the extent of the surgery, this can result in numbness of the skin or other areas. This is not typically regarded as a complication, but rather an essentially inescapable result of making an incision in the body. Most of the little divided nerves literally “wither away,” and other sensory nerves eventually grow in to take their place, restoring sensation once again. This process can take anywhere from a few months to 1 – 2 years. There is no limit on how late sensation can be regained, but the longer, beyond 1 – 2 years numbness, lasts, the less likely it is that sensation will spontaneously return. Occasionally, numbness can persist indefinitely, although this is uncommon.

In addition to numbness, other symptoms such as discomfort, hypersensitivity, or chronic pain can also result as a consequence of nerve damage following any surgery. Thankfully, these complications are much rarer then numbness. While it can be very difficult to ascertain exactly what mechanism is causing discomfort, some possibilities include traction or tethering of nerves by scar tissue, or formation of a “neuroma,” which is a painful little ball of tissue at the end of a regenerating nerve.

Nerves irritated by adjacent scarring may be helped by massage, injection of local anesthetics, or simply the passage of time. Neuromas, which are thankfully extremely rare following breast surgery, usually result in pain when pressure is applied to a very specific location, and can be much harder to treat. Surprisingly, additional surgery is often not effective in treating these rare cases of chronic pain, and referral to a Pain Therapist for injectable nerve blocks may be the most effective option.

If you want to learn more about breast reconstruction, visit us on Facebook.

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Improving Your Self-Esteem after Mastectomy

November 2, 2011 by

breast reconstructionA mastectomy affects you not only physically, but also mentally and emotionally. Many women feel like a vital part of them has been taken away, and their self-esteem suffers as a result. If these feelings aren’t resolved, they can lead to depression and other issues. It’s important that if they surface, you recognize them and know you can find help.

Focus on the positive.

While the surgery itself may not be a positive thing, focusing on being optimistic helps your self-esteem. You may decide on breast reconstruction and feel excited about having new breasts, or you may be heartened by the fact that you’re now a breast cancer survivor and can move forward with your life. Often, mastectomy patients find that the smallest things, such as a drive in the mountains or a sunrise, bring them joy.

Allow yourself to grieve.

You’ve had a loss, and it’s likely to provoke the same feelings of grief as losing a loved one. You may feel denial or anger, which is perfectly normal. Allow yourself to experience those feelings instead of minimizing them or holding them inside. If you feel the need for a grief counselor, ask your doctor or religious professional for a referral. A hospice bereavement counselor may also be a good choice.

Talk it out before, during, and after.

Whether you feel relief that the cancer is gone, grief over losing a part of your body, or hesitation in allowing your partner to see you right after your mastectomy, talk it out with someone you trust. Many women confide in their partners first, while others may turn to a family member, fellow breast cancer survivor, or therapist.

Find someone you feel comfortable with, and don’t be afraid to express yourself. The more you bring out in the open, the better you’ll feel.

Consider breast reconstruction as soon as possible.

Many patients look at natural breast reconstruction as their chance to finally have the breasts they’ve always wanted. They become very involved in learning what the surgery entails and what their options are. In fact, reconstruction often improves our patients’ self-esteem because their new breasts signal a new beginning, which is exciting and empowering.

In fact, our happiest patients are those who choose to have reconstruction at the same time as mastectomy, which reduces self-esteem issues.

Treat yourself.

This is the time to celebrate the amazing, unique woman you are. Be kind to yourself, and treat yourself to what you desire as often as you can. Travel, go shopping, and pursue those dreams.

If you’re a survivor, what advice can you give?

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Can Breast Reconstruction Improve A Woman’s Psychological and Sexual Wellbeing?

October 21, 2011 by

DIEP flapIn a recent article, titled Advanced Post-Mastectomy Breast Reconstruction Improves Women’s Psychosocial and Sexual Wellbeing, by CANCER Online Journal, a study found that “After a mastectomy, women who undergo breast reconstruction with tissue from their own abdomen experience significant gains in psychological, social, and sexual wellbeing as soon as three weeks after surgery.” (CANCER Online Journal: http://www.canceronlinejournal.com/newsroom)

The study was performed by Toni Zhong, MD, MHS, of the University Health Network Breast Restoration Program in collaboration with several others at the Memorial Sloan Kettering Cancer Center in New York City. They surveyed 51 women who were preparing for their MS-TRAM or DIEP flap reconstructive surgery during the months between June 2009 and November 2010.

Breast reconstruction is restoring the form of a breast that has been damaged, partially removed, or completely removed. Breast reconstruction is almost always done after treatment for breast cancer, although there are some birth defects that can result in the need for breast reconstruction. Breast reconstruction can be performed with implants (the same ones used for breast augmentation), or with the body’s own excess tissue (usually from the abdomen or buttocks), thus avoiding the need to place foreign objects in the body.

The study found that these women who experienced breast reconstruction “reported significant improvements in psychological, social, and sexual wellbeing just three weeks after surgery,” according to the article.

Although The Center for Natural Breast Reconstruction has not performed a formal study on the feelings that patients experience post breast reconstructive surgery, we have found that many of them feel a sense of improved psyche and self-esteem. Just ask Leslie Haywood who underwent breast reconstruction with the Charleston breast surgeons of The Center for Natural Breast Reconstruction: “I have never been happier with my body and I have never been more in shape in my entire life!”

If you know of someone who would be interested in hearing about this study, visit the CANCER Online Journal newsroom where the article will soon publish to: http://www.canceronlinejournal.com/newsroom

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