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

Question: I had implants put in 33 years ago, got breast cancer, had a lumpectomy, radiation, and got rock hard implants as a result. I just recently decided to have the implants removed and a great deal of scar tissue. They put in expanders that caused me to get an infection. I had to almost beg them to believe me as the pain was horrific. I had a 2nd doctor remove the expanders. I now have a very deformed left breast and a severely drooping right breast. I contacted the doctor who put my implants in years ago. He is no longer in the area, but told me about this procedure.

I guess my question is if this procedure would be successful for me? I do not like the way I look, and it is painful as well. I am a teacher, and would need to know the time frame this would entail. It has been a horrible summer with this ordeal. I almost wish I left the rock-hard implants in. Please let me know what you think. I am very much interested in hearing your thoughts. 

Answer: Thank you very much for your question. I’m sorry you have had so much difficulty. Your situation is unfortunately quite common, but the good news is that natural breast reconstruction with you own tissue can often help dramatically. Fortunately, a history of radiation (&/or multiple failed attempts at implant reconstruction) does not at all decrease the success rate of subsequent reconstruction using only your own tissue. We have successfully reconstructed hundreds of women in your situation.

Our first choice for a donor area, if you have some extra tummy tissue, is the DIEP flap. If you do not have adequate tummy tissue, the buttocks (sGAP flap) is also often an excellent donor area.

It is important to realize that natural tissue reconstruction is not just an operation, but a process. The first operation, the microsurgical transfer of the flaps, is by far the largest. It usually takes 6-8 hours, requires a 4 day hospital stay, and a total stay in Charleston of about a week. Recovery takes approximately 6-8 weeks.

After you have healed fully from the first surgery (usually 6 months if you have been radiated), 1-2 additional surgeries are required to achieve optimum results. These are much less involved, ordinarily requiring only one night in the hospital, and you can usually go back home as soon as you are discharged.

While the process can be lengthy, once you are done, you are REALLY done. Most women reconstructed with their own tissue come to regard their reconstructed breasts as their own, and are finally able to put the issue of breast cancer behind them.

I would be happy to call and discuss your situation in more detail, if you wish, and thanks again 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 bilateral mastectomies with reconstruction in 2007. I recently had my implants replaced due to a capsular contracture on the left side. I now have 495CC contour implants. I love the right side but not much the left. Is there anything that can be done to help?

Answer: There is possibly something that can be done to improve your situation, but it is difficult to say for sure without knowing a little more about what is going on. Some possible things which could make your reconstruction unacceptable include recurrent contracture, inadequate soft tissue cover, or the implant shifting from the proper position.

Additionally, if you are radiated on that side, it can be very difficult to get an acceptable result. We would be happy to call and 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, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  What is the approximate cost and time for this procedure?

Answer: Thanks for your question. I’m sorry I can’t be too specific because there are quite a few variables to consider. Breast reconstruction is covered by insurance and the total cost depends on hospital and doctor charges.

When someone pays out of pocket we get quotes from the hospital based on what surgery is being done. The same thing is true regarding the surgery time. The average for one breast approximately 3-5 hours. The hospital stay is 4 days.

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 currently have breast implants that were done about 9 years ago following a double mastectomy. I want to have the implants removed and redone with my own tissue. I do not know if my insurance will cover this procedure and I need to have a bloodless surgery. My current plastic surgeon recommended that I get someone who specializes in this type of surgery since there aren’t any in our area that do it often enough for him to recommend.

My surgeon also suspected that one of the implants has ruptured and I didn’t know if I should go ahead and have my MRI done here or if I should wait to have it done as part of the surgery that you would perform. I just wanted to avoid duplicating necessary lab and xray work.

Answer:  Hi, thank you for your question. It is our mission to help women restore their bodies after mastectomy. We named our practice the Center for Natural Breast Reconstruction because we specialize in using your own natural tissue. We replace problem implants frequently with fatty tissue (DIEP, sGAP, fat grafting etc…). What do you mean by bloodless surgery? It is very rare for our patients to require blood replacement.

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: Hi, I have widespread DCIS in one breast. I am very interested in reconstruction using my own tissue. I had a lumpectomy but all of the DCIS was not removed. Not all margins were clear. I live in Columbia and if I’m a candidate, I would love to know recovery time as I work full time.

I just have so many questions as I was not expecting to hear I needed a mastectomy. I’m 52 and am probably a B cup at best. I’m not looking to go bigger, etc. I just want to do the best thing to feel normal. I also am considering double mastectomy.

Judy K. told me all about you and has given me so much information on reconstruction. I would love to see if I’m a candidate. I do have a clotting disorder called the prothrombin gene mutation so am usually on Lovenox for a few days after any surgery.

Answer:  We would be more than happy to see you and discuss your options.

Reconstruction is not just one operation, but a process, with the first stage (flap transfer) being by far the largest. The first stage usually requires 4 days in the hospital, and another 2-3 days in town. There isn’t any “magic point” when you are fully healed, but we usually say 6-8 weeks is necessary for recovery. Any subsequent stages typically require only one night in the hospital (at most), and you can leave town the next day.

We ordinarily keep patients on Lovenox for at least a full week after surgery. If you have a clotting disorder, we may extend that, based upon your hematologist’s recommendations.

If you would like to see an experienced breast oncologic surgeon also at the time of your visit, we can easily arrange that.

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 mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had.

The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast. I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere.

As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much!

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best. Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue.

If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles. The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

Question:  Thank you very much for taking the time to answer my email!

I appreciate the options you are giving me without sacrificing the muscles of my body. I wasn’t so thrilled about that kind of surgery. As I read your website, I understand that you do that surgery. Do you see good long-term results with DIEP or sGAP?

Answer: Yes. When using your own fatty tissue the long-term results are typically the most natural of all the options. When the process is successfully completed the fatty tissue is living tissue that never deteriorates. In other words the results should be permanent. Implant techniques tend to deteriorate over time due to the fact that the implant is not living tissue. Implants can leak, move out of position or need to be removed secondary to infections.

Also the body can reject them because they are a foreign body. Long term results from techniques that remove or sacrifice important muscles can have long term problems associated with removing the muscle. Furthermore the breast is not made of muscle so muscle should not be needed to make a new natural breast after mastectomy. Every situation is different and perfect results are not guaranteed with any approach. No one technique is best for every individual.

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: Hi! I had a mastectomy in 2009 along with chemotherapy and radiation. I had a consultation with a plastic surgeon in New Brunswick Canada and she gave me the options for reconstruction. At that time, I couldn’t have implants because of the radiation I had. The only option left, as I remember, was to take a muscle from my back along with fat from my stomach and recreate a breast.

I didn’t choose that option because I was scared of removing a muscle from my back and putting it elsewhere. As I can see in the description of your website, there seems to be surgeries that do not require muscles. Am I right? May I have more information please? I can’t go to your clinic because it is far away but I would like to do more research on this. Thank you very much! 

Answer:  Thank you for your question. I agree that your options for reconstruction could be limited in some ways due to your radiation. Implants and radiation are more prone to problems and the results are less likely to be good or permanent. Using your own natural tissue would likely be a better option. Actually your own fatty tissue would be best.

Sacrificing important muscles should also NOT be necessary. The fatty tissue from the lower tummy is the most commonly used donor tissue. If someone doesn’t have enough tummy fatty tissue then we can use fatty tissue from other areas as an alternative. You should ask your surgeons about using your own fat without sacrificing your muscles.

The procedure name is DIEP. The DIEP is a procedure using the tummy tissue but not the tummy muscles. Another approach that utilizes the buttock fat without sacrificing the muscle is called the sGAP. That would be the best place to start looking in to the subject. Let me know if you have more questions.

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 trying to find a surgeon that can repair an already breast reconstructed breast that was done 5 years ago.

Answer:  Thank you for your question. The answer is yes, I frequently revise breast reconstruction that was performed elsewhere. Whether your previous surgeon is no longer available or if you would like a second opinion I would be glad to help.

My practice specializes in breast reconstruction of all types and we frequently see patients who have failed a previous attempt at breast reconstruction. If it would be convenient for you to come for a consultation let me know and someone from my office will contact you for more details. If not convenient for you to come for a consult we could talk over the phone. Let me know if I can help.

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: Hi, I am 19 years old and 13 months ago I had a benign lump removed from my right breast. Since then, my right breast has increased in size significantly but my left one has not. My left breast is a full size smaller than my right breast and I’m very self-conscious about it.

I want to get a procedure done that will even them out. I’m just having a hard time finding the right doctor to do it, and I’m unsure how much the insurance will cover. If you could help me with the insurance policies and what your surgeons could do for me, I would greatly appreciate it. Thank you so much.

Answer:  Thanks for your question!

It is difficult to sort out exactly what is going on and what would need to be done based on your brief description, but we would be more than happy to see you in the office and evaluate your situation (medical and insurance).

While your insurance company may not be obligated to cover any treatment without the diagnosis of breast cancer, that does not automatically mean that they won’t.

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 have breast cancer Stage 1 grade2 in my right breast. The surgeons here want to use my latissimus dorsi muscle for reconstruction. This is unacceptable to me because I am very active and snow ski and garden etc.

I think this method runs too much of a risk to my future ability to do things I like to do. I had lipo on my lower abdomen years ago. I do have more than enough fat on my upper abdomen. Can that be used? I am not comfortable with what I have been told so far.

Answer: Thank you for your excellent question! I’m sorry you are having to go through breast reconstruction and breast cancer treatment. You make a very good point and I agree that you should not need to sacrifice your bodies important muscles in order to restore your body after having mastectomy.

In some circumstances it may be necessary but you should know that there are options that use your own natural fatty tissue without sacrificing your important muscles. You should also anticipate that you can continue to be active as before surgery. In our practice we frequently help patients who have had tummy lipo or other surgeries that make the tummy fat inadequate.

We can also use fatty tissue from the buttock or thigh area without sacrificing muscles or using silicone breast implants. 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!