The Center for Natural Breast Reconstruction Gives Answers to Commonly Asked Breast Reconstruction Questions

Having breast reconstruction surgery is a big decision.

It’s only natural that there may be many questions floating around your head about having this procedure. Questions like…

  • How much does the surgery cost?
  • Will my insurance pay for the surgery?
  • How long will it take me to heal and recover?

In order to get these questions answered, we highly encourage you to schedule an appointment with your doctor to get all the details.

In the meantime, however, our expert surgeons give some great insight into some of the most commonly asked questions.

Here’s what they have to say…

How Many Doctor Visits Does Reconstructive Surgery Take for Out of Town Patients?


Our P.A. Audrey and N.P. Lindsey spend a lot of time on the phone with out-of-town patients (and their local healthcare providers) before we ever see them, making sure that nothing important is overlooked before you make the trip to Charleston.

At some point, our surgeons have a phone consultation with future patients, so that they will have an opportunity to directly ask any questions they wish.

We usually see out of town patients for the first time the day before surgery. On that morning, they get an MR angiogram at Imaging Specialists of Charleston and then bring the disc to our office to help us plan their flap.

We operate the next morning, and our patients usually spend 4 nights in the hospital.  You will typically follow up with your surgeon in our office 2 to 3 days after discharge.

We do our best to minimize the number of follow up visits by remotely managing post-operative care.  Travel is a significant risk factor for blood clots, which is a risk of the surgery (as it is for many other surgeries).

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Why Won’t Insurance Pay for Reconstruction?

Yellow Lily

Original Question: I don’t understand why the insurance company doesn’t pay for reconstruction if you’ve had a lumpectomy. With radiation, your breasts shrink a lot and you are all out of proportion.

Answer: Not getting insurance coverage is not always the case, especially with a lumpectomy.

If the surgery results in a significant defect or radiation negatively impacts the tissue, most times we can submit your case to your insurance company along with photos of the affected area, and they will indeed cover a reconstruction surgery for you.

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Would Reconstruction Be Successful for Me?

two white lilies

Fortunately, a history of radiation (and/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 who have had bad experiences in the past.

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.

Keep reading…

Do you have breast reconstruction questions? Send us your questions here!

What Is the Recovery Period for a DIEP Procedure?

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

Do you have breast reconstruction questions you want answered? Submit them here and get personal answers, straight from our doctors!!

Stop Smoking: How to Avoid Weight Gain Once You Quit

stop smokingNo matter which type of breast surgery you may need, we always recommend that you quit smoking to help speed healing. Many smokers, especially women, fear gaining weight when they quit. While some former smokers do gain a little weight, it is typically no more than a few pounds, and even this gain can largely be avoided with a little planning.

Know that you will be hungrier at first.

According to the Mayo Clinic, smoking reduces your appetite and may increase your metabolism, so when you quit, you’re likely to feel hungrier at first. Keep plenty of healthy snacks around, such as berries, vegetables, cheese, and nuts. The latter two are higher in calories than the others, but they will keep you full longer.

Avoid sugary or high-carbohydrate snacks, such as candy, cookies, chips, and the like. They won’t help you avoid weight gain, and they offer little to no nutritional value.

Watch what you drink.

Soda and fruit juices are loaded with sugar, and even diet soda is not a good idea when you’re trying to lose weight.  Drink water. It will help you detox from the cigarettes, help avoid water retention, and avoid weight gain.

If you don’t like the taste of your tap water, add lemon or lime juice—if you like sparkling water and add lemon and lime juice, it’s almost like drinking a soda without the calories or artificial sweeteners.

Reduce portion sizes at meals.

Eating smaller portions will help you keep your weight under control. Try cutting down your portions by one quarter. If you’re still hungry, have some vegetables or fruit for dessert. Be careful with fruit, as it is high in natural sugars.

Get up and move.

Not only will moving or exercising help you keep your weight down, but it will also help your cravings. Get outside and walk the dog, or take a dance class such as country-western dance or Zumba. You’ll burn calories and help keep your weight where you want it to be.

To keep weight gain down, monitor your weight. You don’t necessarily have to jump on the scale every day; your clothes will tell you how you’re doing. Don’t allow yourself to gain more than two or three pounds before taking action. If you’re watching what you eat and drink and getting more exercise, weight gain after quitting smoking and breast surgery will be a non-issue.



Top 5 Spas in Charleston

Charleston SpasIf you’re in Charleston for a consultation or breast reconstruction surgery, we recommend the following spas for a bit of pampering or relaxation.

The Spa at Charleston Place

With its beautiful views and airy rooms, The Spa at Charleston Place is one of our favorites. The massage therapy options themselves are incredible: Swedish, deep tissue, warm stone, reflexology, and Moroccan oil. Skin care treatments include a decadent 24-karat gold facial and a diamond facial. Peppermint rosemary body scrubs, spa manis and pedis, and yin and yang classes are only a few of the dozens of possibilities for pampering.

Treatments for men and children are available, and if you stay at the hotel, you have use of the state-of-the-art health club with salt-water pool and Jacuzzi.

Stella Nova

Stella Nova takes facials to the next level with their Rx Infusion facial, which provides results fast with medical-grade ingredients that reduce rosacea and fine lines. This facial includes a penetrating serum and soothing mask. The Micro Mini Peel helps combat aging and firms the skin, while the Purifying Complexion facial reduces blemishes and deep cleans pores. The Cure Carboxi-Express and O2 Awakening infuse pores with oxygen to detoxify the skin.

Full-body treatments include a head-to-toe massage and salt scrub, a lavender-scented body wrap, African Red Tea Body Cocktail, and a sweet, luxurious sugar scrub. If you’re visiting with friends, book the VIP Spa Suite to enjoy the butler service and choice of delicious food and drink while you’re being pampered.

Simply Your Spa

An intimate day spa and yoga studio, Simply Your Spa offers a variety of packages that give you the best of the best in spa services. The Simply Your Sampler includes a Swedish massage, Quick Results Facial, Express Manicure, and Express Pedicure. For the ultimate in spa, The Pleasure Seeker Package offers a Swedish massage, Herbology Body Treatment, Simply Your Signature Facial, and Sea Spa Manicure and Pedicure. The Ultimate Feet Treat Package pampers your feet with a shea butter reflexology foot massage, followed by a Sea Spa Pedicure.

Simply Your Spa also offers lash and brow tinting, spray tan, and yoga and Zumba classes, as well as professional skin care, makeup, and doggie bath products for sale. Men’s and couples’ packages are available, and Simply Your Spa caters to brides, grooms, and groups.

Urban Nirvana

With an invitation to come into your own, Urban Nirvana is a day spa with a difference: their treatments use luxurious products rarely seen anywhere else. In addition to prenatal and hot stone massages, they offer a spectacular hand and foot massage, a scalp and full-body massage with citrus extracts, a paraffin massage, a warm rubdown, and an aromatherapy massage with your choice of intoxicating scents such as oolong and mandarin.

Urban Nirvana’s reclined-seating hydrotherapy tub and seven-head Vichy Shower offer unsurpassed luxury and relaxation. Body treatments such as a seaweed detox, a coffee body mask, and cocoa shea-butter wrap are treats for the body, mind, and soul. A full-service salon provides hair care and waxing by seasoned professionals.

Seeking Indigo

Integrating holistic wellness and lifestyle, Seeking Indigo has a yoga studio, Pilates center, organic café, and detox center that offer biofeedback, yoga, massage, organic facials, and Ayurvedic treatments. In addition to reiki and pulsed electromagnetic field therapy, the spa has unique treatments not seen anywhere else. The Charleston Hyperbaric Chamber delivers oxygen to the body at the cellular level and allows the body to heal itself. Seeking Indigo’s far infrared sauna heats you from the inside out, reducing blood pressure and detoxifying the body.

The spa also offers fashion from local designers ranging from vintage to modern, jewelry of all types, books, music, art, and exotic treasures for sale.

Which spas appeal to you, and why?


How to Keep Your Tresses Healthy and Radiant

healthy hair tipsHaving a healthy head of hair is easier than you might think. It all starts with your diet and ends with what you put on your hair. Following are a few tips to create the healthy hair you’ve always wanted.

Your hair is what you eat.

One of the easiest ways for doctors to see if their patients eat a healthy diet is to look at their hair. What you eat dictates how healthy your hair is from the inside out.

When it comes to nourishing your hair, get your nutrients from food, and use supplements such as multivitamins only as an insurance policy. Other concoctions that promise thicker, fuller hair don’t give your body anything you can’t give yourself through good food choices.

Eat a balanced diet of the following foods to nourish your hair:

  • Salmon, flaxseed, nuts, and seeds for omega-3 fatty acids.
  • Meat, dairy, and poultry for high-quality protein.
  • Fruits and vegetables, especially dark green and carrots, for vitamins A and C.
  • Nuts, seeds, eggs, and beans for trace minerals such as biotin and zinc.

If you eat a poor diet, your hair will suffer because it’s not getting the nutrients it needs.

Use a gentle shampoo and conditioner.

As it cleanses, shampoo strips the natural oils that make your hair shiny and healthy, so you put conditioner on it to bring back the shine and promote softness. Many shampoos have harsh detergents called sulfates, and two of the most common are sodium laureth sulfate (SLES) and sodium lauryl sulfate (SLS). These ingredients create the suds we’re used to, but they also cause  your hair to lose moisture and can fade color.

Sulfate-free hair cleansing can take many forms: sulfate-free shampoos, cleansing conditioners, and natural hair soaps. Any of these choices are much gentler to your hair, and you’ll be amazed at how much softer and healthier your hair looks and feels.

Try hair treatments.

Especially if you blow dry, curl, or straighten your hair, regular hair treatments can dramatically improve the look and feel of your hair. Your hairdresser can recommend treatments, and stores carry a large variety, ranging from hot oil vials to deep conditioning packs.

You don’t need to wash every day.

Women who switch from washing their hair every day to every other day report that their hair is stronger, silkier, and healthier than those who wash every day. It’s simply not necessary for most women to wash their hair daily. Often, women who believed their hair was oily find that after a short adjustment period, they are able to wash less frequently, and some use dry shampoo in between washings.

What do you do to keep your hair healthy?

10 Questions to Ask Your Breast Surgeon

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.

Is It Normal to Suffer With Abdominal Hernias After Reconstruction Surgery?

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

Is it routine to suffer with abdominal hernias after reconstruction surgery? Is it possible to correct this so there will be no more hernias or surgeries?

Sorry to hear about your problem.

It’s certainly NOT routine, at least not with experienced surgeons doing muscle sparing reconstruction (such as the DIEP flap). Unfortunately, however, it can occasionally happen under the best of circumstances, and we always warn patients about this risk, although I haven’t had a patient with a hernia in several years. Depending on the particular circumstances, it should almost always be possible to fix it, although in the worst cases it could require the implantation of permanent plastic mesh. A worst-case scenario would be a patient who is significantly overweight, with a large volume of intra-abdominal fat, which would push heavily against the muscular abdominal wall from the inside. However, even this situation should be correctable. If your plastic surgeon isn’t comfortable fixing it, then a general surgeon may be (although general surgeons typically refer the WORST hernias to plastic surgeons).

Good luck, and please feel free to ask more questions if you need more information.

—Dr. Richard M. Kline, Jr.

New Surgery Performed to Help Cure Lymphedema Resulting from Breast Cancer Treatment

breast reconstructionA recent New York Times article discussed an amazing breakthrough in breast cancer treatment: curing lymphedema by transferring lymph nodes from other parts of the body.

Lymphedema is obstruction or swelling of the lymph nodes and is commonly caused by mastectomy with surrounding lymph node removal. As lymphatic drainage of the arm flows through the axillary (armpit) area, removal of lymph nodes there causes arm soreness and swelling because lymphatic fluid cannot move or drain normally.

The procedure, autologous vascularized lymph node transfer, replaces the missing lymph nodes with a small number of nodes from another area of the patient’s body, such as the groin. Surgeons must be careful not to harvest too many nodes from any one part of the body, or they risk causing lymphedema in that area.

The riskiest part of the surgery is removing scar tissue to make room for the new nodes and to improve lymphatic drainage. Critics say removing this tissue may affect the blood vessels and nerves in the arm. However, women with lymphedema often report that dealing with soreness and swelling is worse than coping with the cancer. Proponents of the surgery note that doctors often overlook the physical and emotional effects of lymphedema.

As the controversial surgery is still considered experimental, it is typically reserved for patients who do not respond to other treatments. The procedure’s classification as experimental means it is rarely performed in the United States, and insurance is not likely to cover its high cost. While proponents say it cures some patients and improves the lives of others, opponents counter that its results are inconsistent—it works for some and not for others.

A French physician, Dr. Corrine Becker, is the pioneer of the procedure, and claims a high success rate in Europe and other areas of the world. The surgery gives hope to patients with congenital lymphedema as well as cancer. A double-blinded randomized clinical trial of lymph node transfer will begin in the near future to collect more data on its effectiveness.

Doctors from The Center for Natural Breast Reconstruction observed Dr. Becker during two trips she has made to the United States, and they participated in the meeting and live surgery symposium discussed in the article.

Click here to view the New York Times article.

What is an MRA and What is it For?

Dr. Richard M. Kline, Jr.

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

Why am I scheduled to have a MRA prior to my DIEP surgery? What is it and what is it for?

Preoperative imaging of perforating vessels by CTA (computerized tomographic angiogram) or MRA (magnetic resonance angiogram) is probably the most significant development in perforator flap breast reconstruction in the last 5 – 10 years.

Some of the potential advantages of preoperative imaging (with CTA or MRA) include:

1. Shortened operating time, due to knowing in advance where the desired perforating vessels are located.

2. Decreased damage to the rectus muscle, due to being able to select perforating vessels with the shortest intramuscular course. This is particularly important because it can decrease the chance of a major motor nerve to the muscle being divided. A few fortunate patients have an unusual anatomic situation in which a large perforating vessel actually goes between the two muscles, which can allow harvest with no damage to the muscle at all; this is instantly recognizable on preoperative imaging.

3. Decreased fat necrosis, due to being able to select the largest perforator.

4. Advanced recognition of those few cases when the SIEA, not the DIEP, might actually be the preferred blood supply for the flap (the same tissue would still be used)

5. Advanced recognition of those very rare instances where the deep inferior epigastric system has been divided form past surgery, or where all usable perforating vessels have been damaged by previous abdominal liposuction.

CTA has the advantage of being most readily available, but also exposes the patient to radiation. MRA does not expose the patient to radiation, but we have found that only a very strong MRI (3 tesla, or 3T) can give us images with enough detail to be really useful for preoperative planning. MRA still requires the administration of intravenous contrast agents, which can rarely have undesirable side effects. On the horizon is MRA without the need for any injection—it’s not quite here yet, but its coming.

We are very fortunate to work with a very skilled group of radiologists with a 3T MRI who are very interested in and skilled at obtaining images for our breast flap patients. We obtain preoperative imaging on all patients preoperatively, whether they are scheduled for a DIEP or GAP flap. If a patient has a contraindication for an MRI / MRA (ferrous metal implanted in the body is the most common), then we obtain a CTA.

—Dr. Richard M. Kline, Jr.

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Are Implant Problems Affecting Your Life?

implant problemsBelow is an In Her Words post from one of our patients who came to us with implant problems. Read her story below:

I am so thankful to Dr. Craigie and Dr. Kline and Christina for making me feel at ease. Meeting someone for the first time and having surgery the same week was a lot to take in, but thanks to everyone, including The Center for Natural Breast Reconstruction staff, Christine, and Gillian. And a special, big thank you to Gail for helping me with my insurance and all the conversations we had prior to my office visit with Dr. Craigie. Gail, thank you for making me feel like a person not a number, you are wonderful!

I cannot say enough about the results from my surgery! It was absolutely fantastic to say the least! I am amazed how natural I look! I really am excited to have my follow-up. Can it get any better? I do not have the pain in my breasts or the hardness and pulling from the implant anymore. I can lift my arms straight up over my head now! I noticed that I don’t have the flu-like feeling anymore—it’s gone!

Before coming to Dr. Craigie’s office, I have had five painful surgeries with implants and expanders going wrong with infections, plus lengthy hospital stays and home care. This was over a period of four years—four years taken out of not only my life but also my family’s life. Just think of how much time and money was wasted on paying insurance companies when I could have had only one surgery and a follow-up! If I only knew there was an alternative option before having my first implants.

My goal is to get the word out. Women need to know that you do have an alternative, besides using implants. Utilizing the body’s own tissue! Again, I was never given this option.

I cannot thank you enough Dr. Craigie and Dr. Kline for your skilled surgical talents and dedication in this field that made me look and feel like a women again!

D.N South Amherst, Ohio

Do you know of someone whose life is affected by implant problems? Share this story with them.