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

Question: Due to a family history of breast cancer I had a bi-lateral subcutaneous mastectomy with saline implants, all in one surgery. The result was not good. My chest muscles did not stretch/relax, the implants did not drop. Not only are they misshaped they are painful, in that my chest feels tight. My surgeon went into my arm pits and cut the muscles in several places to relieve some of the restriction. There was no relief.

I have indentions in my breasts from that procedure. Using my arms, lifting, vacuuming, etc. is sure to produce more discomfort. I have gained some weight, and wonder if I could use my own fat, including implants to relieve this discomfort and regain some measure of self confidence. In thinking back, I have missed so many things because of the discomfort as well as feeling like a freak, I have absolutely been depressed.

I was widowed in my 30’s,and had this surgery shortly after my husband suddenly died from a MI. I had two young children to take care of and had this surgery as a prevention. My result was so poor…I have never accepted a date. Your opinion will be appreciated. Thank you.

Answer:  Thank you for your question. I’m sorry you are having problems with your breast reconstruction. Specifically regarding your question there are possible options that could help. It is possible that using your own fat and moving your implant from below the chest muscle to above the chest muscle could help improve your result.

One drawback to implants over time is that your body can develop more scar as time goes by. This scar can make the new breasts hard and cause tightness. Some people will not do well with implants because they make more scar than normal. In that case it may be better to rebuild both breasts without implants.  This procedure is more complex but includes removing the implants repairing the chest muscle and rebuilding the new breast with fatty tissue from another part of the body that has extra fat.

I cannot tell you what option is best for you without more specifics about your medical history and previous surgeries. If you would like more information let me know my staff would need to contact you for the details.

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:  I had a double mastectomy May 24, 2016. My treatment was 5 rounds of chemo and I have completed 9 of 30 radiation treatments. My radiation oncologist had told me that reconstruction can’t be done until 1 year post radiation. I was to start reconstruction at the time of mastectomy but due to 1 positive node that was not done. That was devastating to wake up to that news. I wanted to know if that is true since I have read that a lot of women get expanders and then have radiation. I want reconstructed as soon as it is possible. Any information would be appreciated.

Answer:  I’m sorry things have thus far not worked out ideally, but there is still an excellent chance you can have a satisfactory reconstruction.

Expanders are often put in at the time of mastectomy, whether or not radiation is anticipated, with the goal being to complete expansion before the initiation of radiation. After you are radiated, expansion becomes much more difficult, so much so that many surgeons (including us) will not even attempt it.

The good news is, radiation does not in any way impact our ability to do reconstruction with your own tissue (typically with DIEP flaps, sometimes with sGAP or other flaps). While most surgeons wait for 6 months after the completion of radiation to do flap reconstruction, it can sometime be done successfully as early as one month, depending on how healing is progressing.

I would be happy to call and discuss your situation in more detail if you wish, and thank you very much for your question.

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:  I am having mastectomy in January; I would like to know about the TUG procedure – if it can be performed following a mastectomy or does it have to be done at the time. I should not be receiving chemo or radiation. My surgery is in Houston ( MD Anderson ). I live in the Nashville area.

Answer: We do not recommend the TUG flap under most circumstances. A significant incidence of lower extremity lymphedema has been reported following its use, and it is often not large enough to provide a satisfactory breast mound by itself. In addition, the donor site is prone to wound healing problems, and the donor site scars can be difficult to conceal.

Our first choice for autogenous breast reconstruction is the DIEP flap from the abdomen, which is a tried-and-true technique. If this donor site is not available, we recommend the SGAP donor site from the upper buttock. The sGAP can produce arguably the best breast reconstruction of any donor site, but is difficult to perform, which usually means the patient needs to travel to get the necessary surgical expertise.

The PAP (profunda artery perforator) flap, which comes from the “banana roll” of the posterior thigh, is our choice if neither the DIEP nor sGAP are available or adequate. It provides about as much volume as the TUG, but has far less risk of lymphedema, and a dramatically better donor site scar.

Any of these flaps can be done at the time of mastectomy or later, with the caveat that you never want to let a flap get radiated, as it can “shrivel up” dramatically. There are advantages to doing the flap at the same time, and advantages to waiting, but probably most of the time it is better to do it at the same time, if possible.

For completeness’ sake, it bears mentioning that if you are not receiving radiation, you may be able to get a satisfactory reconstruction with implants. However, even the best implant reconstruction does not approach the “naturalness’ of a reconstruction using your own tissue.

Thanks for your question, and good luck!

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: I had a double mastectomy 5/2/16. The plastic surgeon placed expanders on both sides with the intention of doing reconstruction surgery in 6 months. I was diagnosed with pre-cancer stage 0 dcis in situ but genetic testing showed I was positive for the BRCA2 gene which led to the double mastectomy. The left expander had to be removed due to thin tissue that wouldn’t knit together and I had a wound vac in place for 10 days. I was thinking of getting natural reconstruction but since I have the right expander was told that it would have to be removed along with the dog ears skin on both sides. I am 64 and don’t know what to do.

Answer: I’m sorry you have had so much trouble so far.

You have already had trouble with implant (expander) – based reconstruction, and that could make it more likely that you will have trouble in the future with additional attempts at implant reconstruction. Fortunately, however, previous failed attempts at implant reconstruction almost never reduce the chances of having successful reconstruction with your own tissue (assuming that you are otherwise a good candidate for that).

Because you have had a somewhat complicated course thus far, apparently with some tissue loss, I would appreciate the opportunity to evaluate you in person, if possible, before giving you any more specific advice. We will give you our honest opinion about what we believe your best options are, whether using more implants or your own tissue, and then even of you just decide to have your expander removed, you may feel better about your decision. If you wish, we can have our P.A. Kim or nurse Chris call you to discuss your situation further.

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

Question: I had breast reduction surgery a few months ago and have developed fat necrosis. I keep reading it may resolve, I’m scared it won’t! My right breast has a 4″ X 1.5″ area of it. Is that considered a large area? I’ve read that only small areas have a chance of resolving on their own. I keep massaging the area and applying heat. Is the icy hot patch a good option for heat?

Answer: Fat necrosis usually resolves on its own, but it is true that large areas may persist indefinitely. If the area is not painful, it probably does no harm, other than potentially complicating mammograms and breast exams. If it concerns you, however, you may wish to consider having it removed. There are no firm guidelines, but large areas persisting more than 6-12 months are less likely to go away on their own.

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

Question: I had a prophylactic double mastectomy 9 years ago. I am BRCA 1 positive and have lost several family members to both breast and ovarian cancer. I would like to have my silicone implants removed and have the DIEP surgery. However, I don’t know if my insurance will cover this procedure and how being out of state will affect the payment of it if it is covered.

Also, I am one of Jehovah’s Witnesses and I wanted to verify the surgical team is okay with performing bloodless surgery. Maybe this surgery is designed to be bloodless but I wanted to make sure everyone is comfortable with working on Witness patients.

Answer: Thank you for your question. Yes we frequently help women who have problems with their implant breast reconstruction. If you feel like you have extra tummy tissue there is a very good chance that removing the implants repairing the chest muscle and rebuilding the breasts with the DIEP procedure would be our recommendation.

I am very familiar with the Jehovah witness faith regarding surgery and blood products. I have quite a few patients and would be glad to discuss this with you. Let me know if you have more questions or if you would like to arrange a time to discuss your situation.

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: After having surgery, radiation treatment left my breast very small so I want to know if I may be a candidate for a procedure to rebuild my self-esteem. I had a complete mastectomy after the radiation on the right breast.

Answer: Yes there is definitely a chance that you could have your breasts reconstructed. After radiation I would usually recommend options that use your body’s own natural tissues because after radiation implant options are higher risk for problems. If you still have your left breast but it has developed shape problems because of surgery and radiation then there are options that can help. It may be best to rebuild both breasts at the same time to achieve better symmetry.

After radiation we usually wait a period of time (approx. 3 months) before performing reconstruction. Any time after that is usually ok. For more specific information I would require more of the details of your situation, medical history and prior surgery history. Thanks for your question. I hope this helps. Let me know if you would like more information.

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