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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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Are you Practicing Safe Breast Health?

October 17, 2011 by

reconstructive surgeryIn November 2010, the U.S. Preventative Services Task Force changed their mammogram guidelines from annually after age 40 to biannually starting at age 50. They also recommended stopping breast self-exams. Their reasoning was that less-frequent mammograms are just as effective in detecting cancer, and self-exams lead to increased and unnecessary doctors’ visits and procedures.

As you can imagine, this created quite a stir among doctors, especially those who have had patients between the ages of 40 and 50 with breast cancer detected by mammogram or self-exams. The data on mammogram effectiveness is conflicting, and women are left wondering about the ramifications of waiting until 50 for their first mammogram. Some physicians and women also wonder whether cost savings plays a role in the recommendations, though the USPSTF says it did not.

Mammograms are the standard of care in detecting breast cancer, and are the best tool we have for early detection. Its technology continues to improve, and currently, digital mammograms are in use in some areas. Most doctors continue to recommend self-exams and annual screenings for patients over 40, with high-risk patients starting mammograms earlier. The American Cancer Society also reviewed its guidelines last year, and it stands by the age of 40 to begin annual mammograms but neither recommended nor discouraged monthly self-exams.

Women under 50 tend to have denser breasts, making tumors difficult to see with mammograms, so for them self-exams are crucial. Most doctors will tell you that they’ve had many, many women find their own lumps during self-exams, and women know better than anyone else does what is normal for their breasts. Doing monthly self-exams is the best way to get to know your breasts so that if a lump does occur, you can detect it as soon as possible and treat it.

We encourage you to talk to your doctor about your individual risk factors and decide which mammogram schedule makes sense for you.

For more information on the USPSTF guidelines, as well as the ACOG revised guidelines for Pap smears, visit http://www.womenshealthmag.com/health/breast-health.

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What Are My Options for Uneven Breasts?

October 14, 2011 by

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

I had TRAM flap reconstruction in 2002 with revision and a follow up surgery in six months later. Since then some shrinkage has occurred in the reconstructive side and I have a hollow area on the upper portion. Do I have options for more normal looking breast without the hollow area?

You potentially have many options to improve your reconstruction. No one solution is perfect for all situations, but some options include repositioning the flap to a higher location, augmenting the hollow area with your own fat grafts (taken usually from abdomen, thigh, or buttocks), or using any excess skin / fat from under your armpit as an additional flap to lift and augment the TRAM (we call this a 5th intercostal artery perforator flap). Some more aggressive options would include placing a small breast implant under the TRAM flap, or adding a whole new microvascular flap from another area, although this is rarely in practice necessary.

Hope this helps. Please feel free to email or call with any additional questions.

–The Center for Natural Breast Reconstruction Team

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“Get Your Squeeze On!” How One Woman Is Spreading Awareness about Mammograms

October 5, 2011 by

When we heard that our former patient, Lee McCracken was launching her own line of tees to help raise money and spread the word for breast cancer awareness, we were thrilled!

We interviewed Lee on her new endeavor with her fabulous “Yes, Ma’am! mammograms are a must” tees and also discovered a little bit about her journey through breast cancer and life after cancer.

Read this inspirational interview below (NOTE: all images in this post were provided by and are owned by Lee McCracken):

1. You started the “Yes, Ma’am! mammograms are a must” tees. Tell us a little about this unique tee and what inspired you to create it? Where do funds go for those who purchase the tee?

I admit it—I NEVER liked getting a mammogram. But then I discovered I disliked breast cancer even more! I’m a two-year survivor and a former patient of The Center for Natural Breast Reconstruction. This year, my girlfriends and I decided to be a little more organized for the Komen Race for the Cure in our home city of Charlotte, NC. We needed a name and a T-shirt.

So, I began brainstorming.

I tried to think of a fun phrase that was upbeat and also inspirational. “Yes, Ma’am! mammograms are a must” popped into my head one day in May. Of course, the apostrophe in ma’am is the pink ribbon! My girlfriends encouraged me to merchandise the tee on a local, regional—and, dare I say, national—level.

The face of the under-insured and uninsured woman has changed. Given this economic climate, many women, naturally, are putting their children first before seeing to their own healthcare needs. I want to help fund mammograms for women who don’t have health insurance. Locally, 15% (or $3 of every $20 tee sold) is going to the Carolinas Breast Cancer Fund to help women who are qualified by the Mecklenburg County Health Department.

Individuals, groups, and retail outlets who sell the tee in other cities may designate a charity in their community to receive the funds. Anyone interested should connect with me via e-mail: sales@yesmaamtee.com.

yes maam tees

2. What do you hope to accomplish through selling the “Yes, Ma’am!” tee? In other words, what is your vision for the future of the tee and its effect on women?

Wouldn’t it be fun if women all over started wearing their “Yes, Ma’am! mammograms are a must” tees to the coffee house, grocery store, and gym? It makes a sassy statement in Southern style, and people take notice. I’ve seen women look at my tee and then kind of shake their head, almost to say, “Oh yeah, I need to schedule that.”

The Facebook page is generating interest from all over the country. The tee has fans from California to Oklahoma and Florida to Vermont.

A cancer nurse once told me that when breast cancer is caught in Stages 0-1, treatment can be so much easier and survival rates soar. Let’s strive for 100% early detection!

3. What inspired you to start your own freelance writing / editing business, Joyfullee Written, at the age of 49 and what do you provide others with through this business?

I’ve been writing and editing for more than 25 years, sometimes as a freelancer and other times on staff with a local lifestyle or parenting magazine. The formal launch this summer of Joyfullee Written was my birthday gift to myself. I will turn 50 in October and, not only have I survived breast cancer, but I have also survived several other heartbreaking losses. I’m also working on a book—an inspirational memoir about self-discovery and spiritual preservation through motherhood and menopause. Joyfullee Written comes from the fact that all my inspiration and strength spills from the fountain of God’s grace.

Joyfullee Written provides professional writing / editing services to magazines and businesses. I enjoy meeting people and helping them reach their audience through a well-crafted, targeted message. And, with a passion for lifelong learning, this is helping me to keep discovering new things every day.

4. What is the one thing you want all women to know about breast cancer?

The earlier it’s detected the more treatment options women have! I HATE when I hear someone say “I’m a year overdue for my mammogram.” My Stage 1 breast cancer was caught by a mammogram, and I was fortunate not to have to endure chemo or radiation. I know everyone is busy and mammos sometimes are uncomfortable, but it’s crazy to take such a risk.

All my family members and friends know: Get Your Squeeze On!

lee mccrackenAbout Lee McCracken:

Lee McCracken lives with her husband, Stuart, of 28 years in Denver, N.C., a suburb of Charlotte. She has a 19-year-old daughter, Megan, and a 10-year-old Bichon Frise, Benny. She enjoys gardening, photography, reading and traveling. Lee’s girlfriends keep her sane!

Love the Yes, Ma,am! mammograms are a must tees? Buy one today and help spread awareness for mammograms!

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Handling Breast Implant Infections: What You Need to Know

September 30, 2011 by

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

What is the usual process for handling infections with breast reconstruction when tissue expanders are used?

Infections can occur following any type of surgery. The risk of getting an infection after breast reconstruction is low because the immune system can help defend the body from bacteria if they have invaded and are trying to multiply. Antibiotics can also be used, specifically to fight different types of bacteria, following certain surgical procedures. These antibiotics are sometimes given preventively.

When an infection does occur it is because the defense mechanisms have been compromised and the invading bacteria grow. Specifically with implants the bacteria may enter through a wound healing problem. They attach to the implant shell and hide from the bloodstream that normally delivers the body’s immune response, as well as antibiotics.

The management of this type of infection is difficult and almost always requires removing the implant. When the infection resolves and the area is healthy, then it is possible to restart the process. Usually it is 3 to 6 months before it is safe to try another implant. It is occasionally possible to save the implant when the infection has been caught early and treated with antibiotics and surgery to wash the implant pocket and to put a new one in. This approach usually involves antibiotics for a long time and uncertainty about recurrence of the infection weeks or months later when the powerful antibiotics have been discontinued.

It is important to realize that the antibiotics may resolve the outward signs of infection at first, but it only takes the surviving bacteria hiding on the implant to restart the infection when the antibiotics have been discontinued. With each new infection the bacteria may become more difficult to control because of resistance to the antibiotics. At this point, it is usually my advice to consider a new option for breast reconstruction that does not involve an implant. Usually the skin and fat can be transferred from the tummy, buttock or thighs. This can be done without sacrificing any of the important muscles. In my practice, 30 % of my patients have had problems with implants and we can successfully replace implant problems with healthy tissue and obtain a permanent natural result.

—Dr. James Craigie

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Mastectomy and Uneven Breast Size: What Are Your Options?

September 23, 2011 by

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

Because of failed implant / expander surgery (3rd degree burn damage) from radiation, I underwent a second reconstruction procedure with DIEP flaps earlier this year and a revision three months later. I have not yet had my nipples created. There is still about a cup size difference in my breasts as well as a hollow part of the cancerous breast at the top. Is this still able to be fixed as part of reconstruction procedure or do I have to live with this? Currently, I wear a prosthetic to try and even them out but it doesn’t take care of the hollow area.

Sorry to hear about your problem. If I understand you correctly, you had a mastectomy for cancer on one side and a prophylactic mastectomy on the other side, then had radiation to the cancerous side, followed by bilateral DIEP flaps.

A size mismatch in that scenario is fairly common, even when the initial flaps weigh the same, for a number of potential reasons. The cancer surgeons are sometimes more aggressive with their mastectomies on the cancerous side, and the radiation sometimes seems to cause loss of additional tissue volume. Additionally, localized fat necrosis can occur within one or both of the flaps, which would decrease their size.

As you might expect, there is no perfect one-size-fits-all solution for this. The easiest solution might be to lift the flap on the cancer side to fill the hollow part, and then reduce the other side to match.  Autologous fat injections to the areas of tissue deficiency are sometimes surprisingly effective and long-lasting, even in the face of radiation, but there is no way to tell if the fat will survive without just going ahead and trying it.

We have significant experience using the excess skin and fat, which many people have beneath their armpit to augment the upper / outer areas of the breast mound, using this tissue as a flap based on the 5th intercostal artery. This technique often carries the added benefit of lifting and rounding the breast mound. While we are not fans of using implants in the face of radiation, the presence of a healthy flap sometimes means a small implant to make up the size difference will be better tolerated. As a last resort, another perforator flap from another donor site could be added to the first flap, but we have rarely found this to be necessary.

I would advise you against having your nipple reconstructions until you are satisfied with the state of the breast mounds, because significant later work on the breast mounds may change the nipple position or orientation.

-Richard M. Kline, Jr. M.D.

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

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10 Questions to Ask Your Breast Surgeon

September 16, 2011 by

breast surgeryUndergoing any type of surgery is stressful. But the best way to reduce your fears, stresses, and concerns is to do your research and be prepared both before and after surgery. It’s important to understand possible complications during and after surgery, as well as details on the actual procedure.

For patients who are considering breast reconstruction surgery, it’s important to talk with your doctor about your concerns. Some of the most important questions to ask include . . .

1.     Why are you recommending this procedure?

2.     What are the risks? How do they compare with the benefits?

3.     How do I prepare for surgery?

4.     What type of anesthesia will I have?

5.     What happens during and right after surgery?

6.     Who do I talk to about breast reconstruction?

7.     How long will I be in the hospital?

8.     Are there possible complications?

9.     When can I go back to work and resume normal activities?

10.  What are the risks of lymphedema?

Did you find this post helpful? We’d love to hear from you in our comments section.

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Breast Reconstruction Surgeons Answer Your Questions About Reconstructive Surgery

September 9, 2011 by

reconstruction optionsThe question below is answered by Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

What is the difference between breast reconstruction and augmentation?

Breast augmentation is when you increase the size of a normal healthy breast, almost always with saline or silicone gel implants.

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.

What are the pros and cons of a DIEP versus a TRAM flap reconstruction?

The primary advantage of DIEP flaps over TRAM flaps is a far greater potential for preservation of rectus abdominus muscle function, since no muscle is removed with a DIEP, yet one or both rectus muscles is obligatorily completely sacrificed with every TRAM flap. Additionally, since the muscle does not need to be tunneled under the skin to reach the breast area with a DIEP, the shape of the inferior region of the breast can be better defined.

The primary advantage of the TRAM flap over the DIEP flap is that it can be done by one surgeon who does not have the skills or equipment (microscope and special instrumentation) to perform a DIEP flap. While TRAM flaps can sometimes be performed more quickly than DIEP flaps, this is not always the case, and is very dependent upon the skills and experience of the surgeon. In our practice, DIEP flaps are always performed with two fully-trained perforator flap surgeons present, which we believe contributes greatly to the success and timely completion of the surgeries.

Why don’t more plastic surgeons offer the DIEP procedure?

When the DIEP flap was originally presented by Dr. Robert Allen in the 1990s, it was frequently criticized as being too difficult for many surgeons to learn to perform easily. While many more surgeons now offer the DIEP flap, it is still more technically demanding for the surgeon than many other procedures, and can be quite difficult to learn without spending significant time with another surgeon who has considerable experience with the operation.

Do you have a question for the breast surgeons of The Center for Natural Breast Reconstruction? If so, we’d love to hear from you. Click here to ask us!

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Breast’s Anatomy: What Makes Up a Breast?

August 31, 2011 by
Image to the left taken from emedicine.medscape.com.

Breasts are milk-producing (mammary) glands surrounded by fat and are attached to the front of the chest by ligaments. The breast rests on the pectoralis major chest muscle, but has no muscle tissue itself. The fat in the breasts determines their shape and size, which varies among women even though the size of the mammary gland system is relatively standard. In addition, women commonly have one breast that is larger than the other.

Breasts begin developing between the ages of 9 and 14 for most girls, and signal the start of puberty. Breast tissue is highly sensitive to the hormones estrogen, progesterone, and prolactin throughout the menstrual cycle. While breastfeeding, prolactin triggers milk production within the breast, and its anatomy is simple yet complex.

Lobules, Alveoli, and Ducts

Breasts have 15 to 20 sections known as lobes or lobules that converge at the nipple. Each lobule consists of hollow sacs called alveoli, and the lobules are connected through ducts. The final collection area for milk is known as the main duct.

During breastfeeding, prolactin stimulates the alveoli to pull nutrients from the woman’s blood to produce breast milk, and oxytocin causes the alveoli to release the milk through the mammary ducts to the nipple.

Nipple

Also known as the mammary papilla, the nipple is the outlet for the mammary ducts and where milk is secreted.

Areola

Often included when referring to the nipple, the areola is the round pigmented area surrounding the nipple. During breastfeeding, small bumps on the areola known as Montgomery glands produce an oily substance that cleans and lubricates the nipple.

Lymph Nodes and Ducts

The lymphatic system helps fight infection by capturing and excreting pathogens and toxins through lymph nodes and ducts. These nodes are found near the breast, in the armpit, and behind the breastbone. Often, axillary (armpit) lymph nodes are removed during mastectomy.

Cooper’s Ligament

This ligament is often called “nature’s bra” because it lifts the breast and prevents it from sagging.

For a slideshow on breast anatomy, visit http://www.mayoclinic.com/health/breast-cancer-early-stage/BC00001.

Have questions about breast cancer? Visit our blog’s Ask the Doctor section.

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