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

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

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

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

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

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

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

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

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

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

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

Thanks for your question!

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

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

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

Question: I was wondering what insurance would cover breast reconstructive surgery that’s due to having Poland Sydrome? My case I where I was born with out having my right breast muscle and a smaller areola.

Answer:  I would be happy to check into your specific insurance company medical policy if you want to share that information. I’ll just need basic demographic information (I’ve attached a form you can use to provide what I’ll need) and a copy of the front and back of your insurance card. I’m not sure from the phrasing of your question if you currently have coverage or if you are researching to find out which insurance would offer coverage, could you clarify? I can help either case.

The good news is that we’ve been able to get breast reconstruction for Poland’s syndrome covered for past patients and certainly know how to navigate the process to make that happen for you. Feel free to give me a call or send info via e-mail. I’m always happy to help – and I do love a challenge !!) Have a great day and I look forward to your reply.

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

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

Question: Hello, I hope you can help me with my dilemma, I did my full mastectomy and put the breast implant on Feb 2 2017, since then my body did not heal, still in pain, hardness and tightness in my breast but the other problem my stomach got big it looks like I’m 5mnth pregnant, the surgeon and specialist told me it’s because of the pain medicine but I know my body it’s just not the medicine something else, this problem is preventing me from doing the things I do in life, don’t want to go out anymore because of what I look like, please help me.

Answer:  I’m sorry you are having such a rough time. Sadly, it is not unusual for women to feel like the implants “don’t belong”, and describe unpleasant symptoms such as yours, although many women seem to tolerate them well. I’m not sure what to make of your stomach issues – pain medicine can certainly constipate you, but whether that explains your problem, I can’t know.

I would suggest that you first address these issues with your local plastic surgeon, as he/she is in the best position to help you. If that doesn’t work, I would be more than happy to see you in our office in Charleston, where hopefully I could make some more definitive recommendations.

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

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

Question: Do you do breast implant removal?

Answer:  Thank you for your question regarding implant removal. Yes we do frequently remove breast implants. There are many different situations when it might be necessary. In general there are two categories of scenarios. Cosmetic reasons (implants originally placed to enhance the normal breast) and reconstruction ( rebuilding the breast after it has been removed for cancer treatment and or prevention) reasons. If you would like to let me know more about the specific details of your question I could give you more specific information. Thanks again.

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

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

Question: Can I see a picture of the expander before it goes into the body?

Answer:  Absolutely! Thanks for your question Mary Lou. Tissue expanders come from a myriad of manufacturers in a wide variety of sizes; each with different shell styles and features. This photo shows two that we have on hand now as samples.

The one on the right with the tabs is by Natrelle and the smaller on the left with no tabs is from Mentor.   The magnetic disc in the middle of each is the fill area.   Are there specific questions you would like answered about breast reconstruction with tissue expanders.  We’re happy to help!

Question: Thank you for the picture of the two different tissue expanders. The expander that is on the left, that comes to a point- is there metal in the frame of it to keep it’s shape? Thank you again for the information.

Answer: No ma’am, there is no support system. Just a shell. Expanders like these start empty and are made to be replaced with permanent implants. The expansion process and saline within is what gives the shape. The only metal is in the magnetic disc used to locate the port during that process.
Hope that helps!

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

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

Question: I had a breast augmentation 12 years ago at the age of 21. I am now 33 and after having my son I went up another 1-2 cups sizes. I’m not sure what my options are but I would like the implants removed completely if possible. Do your surgeons only work with cancer patients? The reason I ask is while I’m not a cancer patient I do have health issues including severe osteoporosis and an undiagnosed connective tissue disorder. I really need a doctor that is knowledgeable about the effects of implants over time and how this could be possibly affecting me now or in the future. Thank you.

Answer:  Yes, we do a lot of cosmetic breast surgery, some on its own, and some as an adjunct to breast reconstruction.
There is no demonstrated statistical relationship between breast implants and systemic health issues, but this does not mean it cannot ever be an issue in a given patient (although it may be impossible to prove). If you want the implants out, there is no reason that they cannot come out. Of course, you MAY find the cosmetic appearance of the breasts less favorable without the implants, but some of your concerns could potentially be addressed with additional breast surgery, such as lifting. Sometimes procedures such as lifting the breasts can be performed at the same time the implants are removed, but other times it is safer to let the breasts heal for a few months, then return to do the additional surgery.

I would be happy to see you to discuss further, if you wish, and thanks for your question.

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

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

Question: Why do expanders have to be used when breast are removed and the pocket is empty and ready to be filled with an implant?

Answer:  It is not always necessarily to place expanders at the time of mastectomies, but in many situations it is a safer choice than immediately putting in an implant. Even if the breast surgeon leaves the nipples and removes no skin at all, the skin is not always healthy, as the blood flow is invariably at least somewhat compromised after mastectomy. Placing an implant very poorly perfused skin would put additional pressure on the skin from within, and quite possibly cause skin to die that otherwise would have lived. With an expander, we have the option of placing no fill at all at the initial surgery, thus minimizing additional pressure on the skin. In actual practice, sometimes the skin’s blood supply is so poor we don’t even put in an expander right away, but rather return to the operating room several weeks or months later to begin reconstruction.

Having said the above, I do agree it is nice if the final implant can be placed under healthy skin flaps immediately. However, it should only be done under ideal circumstances.

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

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

Question: I had tram flap surgery 5 years ago for one breast in Sacramento at Kaiser with the Chief of plastic surgery. I am experiencing horrible pain under my breast and around the side of the breast as well. It also feels like 1000 bees are stinging me all the time. It also feels VERY heavy and not a part of my body. I’m in constant discomfort and I HATE it. Is it possible to “just remove this tram flap altogether? I am miserable and wish I had never had the surgery!

Answer:   I’m sorry you are having so much trouble. Discomfort such as yours is very rare, especially when you are reconstructed with your own tissue, but unfortunately it can happen.

Firstly, I would advise you to discuss this with your original plastic surgeon, if at all possible.

It may well be possible to remove the TRAM flap, but there is unfortunately no guarantee that this will help the pain. Has the pain always been there, or is it new? Has the appearance of the reconstruction changed? Is there any drainage, redness, or other symptoms? Imaging studies, such a contrasted MRI, may be useful. While it is not always possible to determine the origin of pain, I think it greatly increases the chances of success if the situation is studied carefully prior to taking action.

I would be happy to discuss your situation further, if you wish.

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

This week, James E. Craigie, M.D., of The Center for Natural Breast Reconstruction answers your question.

Question: I’ve had a mastectomy on right side and am ready for breast reconstruction and enhancement on the left side. I am small framed,thin and a very active mid 60 year old. I am having trouble deciding on saline or silicone implants. My expander feels very hard and I don’t want that for implant.

Answer:   Thanks for your question. It is important for you to know that permanent implants (saline and silicone) are softer than the expander. Expanders are designed with metal ports and thicker shells so they can stand up to the expanding process. Silicone implants are definitely softer than saline filled and are generally preferred for breast reconstruction. My recommendation is that you ask your plastic surgeon to show you each type and let you feel for yourself prior to your surgery.

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