Ask the Doctor- What Are My Reconstruction Options Using Only My Tissue?

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

Question: I am 39 years old and seeking options regarding a double mastectomy with reconstruction using only my own tissue. I was treated for an aggressive breast cancer in my left breast 3 years ago; went through neoadjuvant chemo, then a lumpectomy followed by radiation. Due to my lifetime high-risk status, I feel a double mastectomy is necessary using my own tissue for reconstruction.

Answer: Thank you for your question, I am glad to hear that you have completed your breast cancer treatment 3 years ago and are doing well. It is very likely that using your own natural tissue is going to be a very good option for you.

Since you have already had radiation on one side the option of removing the remaining breast tissue and having a preventive mastectomy on the other side is the most effective option to minimize your chance of getting breast cancer again.

Although I imagine it is already very low. Have you had any previous surgery on your tummy? Do you feel that you have extra fatty tissue there or any other area of your body? If so then you can probably achieve a proportional natural tissue result without having to sacrifice your important muscles.

If you like I could arrange a convenient time to answer any other questions by phone. Let me know and I’ll have one of my staff contact you to make arrangements.

Thanks again.

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

Ask the Doctor – I Am 3 Years Post Mastectomy With Radiation On My Right Side And I Am Interested In The Diep Flap Surgery.

This week, Audrey Rowen, PA-C, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question:  I am interested in the DIEP flap surgery. I am 3 years post mastectomy with radiation on my right side. I am 56 years old and live in Columbia and I have spoken with one of your patients who was happy with her breast reconstruction. I would like to make an appointment.

Answer: Thank you for reaching out to us! My name is Audrey and I am the physician assistant here at the practice. We would be happy to make an appointment for you to come and see us! Which days work best for you? Our normal clinic days are Monday, Tuesday, and Friday. If you’d prefer to schedule over the phone vs. email, feel free to call our office at 843-849-8418 anytime over the next few days and we can set that up for you.

Did you have bilateral mastectomies or just the right side? Are you interested in bilateral DIEP reconstruction? Once we get you on the schedule, we like to try getting some of your records in regards to your oncology and surgery history so it is a huge help if you could get us the names of our Oncologist, PCP, and breast surgeon so we can start requesting those records before your appointment. I am also happy to chat with you over the phone if there are any questions you would like answered before you make the trip out to see us.

Please let us know which days and times work best for you to schedule an appointment and let me know what other ways I can help! We look forward to meeting you soon!

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

Ask the Doctor- I Am Not Eligible For Diep Surgery. Can I Have Gap Surgery At The Same Time As I Have Both Breasts Removed?

This week, Richard Kline, MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question:  I learned from my doctor at MUSC yesterday that I do not have enough fat and am therefore not a candidate for DIEP surgery. He suggested I make an appointment with you before my surgery for mastectomy.  I do not have clean margins in my right breast after lumpectomy and I have chosen to have both breasts removed. If I am eligible for GAP, is there any difference with having it done at the same time or later? I am 70 years old, healthy, an avid tennis player, with no chemo or radiation needed.

Answer: We have done about 300 GAP flaps with a 95.7% success rate. There are actually advantages to having the GAP surgery done at a later date, as it is a much more involved and lengthy surgery than the DIEP.
I would be delighted to see you at any time, evaluate your donor sites, and discuss options in more detail.

Thanks for contacting us, and I look forward to hearing from you.

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

Ask the Doctor- Can You Do Repair and Nipple Reconstruction Surgery at the Same Time on the Same Breast?

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

Question: I had hybrid DIEP reconstruction at another facility, and I am disappointed with the results. There have been many issues. For example, my breasts are different shapes and sizes, no node involvement and no microinvasion. The surgeon who did the mastectomy said the path report said the margins were not wide enough and he will need to cut additional skin out during the next surgery. The next surgery is supposed to be to reconstruct the nipple. Can you do both procedures on the same breast at the same time? Please Help!!

Answer: I’m sorry you are having to go through this.

Did you have a complete mastectomy on the left breast or a lumpectomy? If your margins were positive (unbeknownst at the time of surgery, obviously), and you had an immediate DIEP flap, that could be a little complicated to resolve, although I’m sure we could work through it. Given that your scenario is a little bit unusual, it would probably be best if we talked by phone. Please let us know what works for you.

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

Ask the Doctor- Are Implants Still an Option after Radiation? I Have Expanders Now that Were Placed At the Time of Mastectomy.

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

Question: I had a double mastectomy in January 2017. Expanders were placed at that time. I had radiation March-May. Postponed reconstruction until June 2018. Are implants still an option?

Answer: Implants may still be an option, but it’s going to depend on several things, probably the most important of which is how much you were expanded prior to radiation. It can be next to impossible to expand skin after it is radiated, although occasionally it seems to work. If you were expanded, and are tolerating the expanders well, then hopefully it would be straightforward to remove the expanders and place permanent implants. In addition to placing permanent implants, fat grafting can often significantly enhance the quality of your reconstruction.

If you end up not getting a reconstruction you like with implants, the good news is that none of what you have been through impacts your chances of getting a quality reconstruction with your own natural tissue. We have successfully reconstructed many, many hundreds of radiated patients with DIEP, sGAP, and other natural tissue flaps.

Hope this helps, please let us know if you would like additional information.

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

Ask the Doctor-What are Your Suggestions For Muscle Spasms After Breast Reconstruction?

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

Question: I had breast reconstruction on my left breast in 2006. I have had muscle spasms in it ever since. Recently they have gotten bad again. Any suggestions?

Answer: I’m sorry you are having problems with your reconstruction.
You didn’t mention if you were reconstructed with an implant or with your own tissue, so I will answer as if you are reconstructed with an implant. Please let me know if I have assumed wrongly.

There are several potential reasons why you could have spasms. If the implant was placed under the pectoralis chest muscle, it can lead to pains in the pectoralis muscle or other muscles, as the muscle is no longer functioning in precisely the way it was designed to. Most people tolerate the implants well, but there is no question some have more problems than others. The muscle can also sometimes separate from attachments to the chest wall over time, which could cause changes in symptoms. Additionally, If you are radiated, this could potentially cause additional problems, as the muscle may be less flexible.

If you can, I would contact your original plastic surgeon, as he or she is probably in the best position to evaluate your symptoms. I would also be happy to discuss your situation with you further by phone, if you wish.

Thanks for your question.

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

Ask the Doctor- I’m Unhappy With My Reconstructive Result from Another Surgeon – Are You Able to Make It Look More Natural?

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

Question: Three years ago, I had a double mastectomy and am now cancer free. My plastic surgeon did a terrible job with the reconstruction. The left side implant is way off to the outer side and looks larger than the right side. The right side is way too far to the outside. There is zero cleavage. Is there any way to re position the implants more to the natural position of the breast ? I do not expect perfect but don’t like looking like a botched job. Thank you.

Answer:  I’m glad to hear you have been cancer free and have your treatment for breast cancer behind you. At the Center for Natural Breast Reconstruction it is part of our mission to help women move on with their lives after breast cancer. We focus our efforts on helping women get their bodies back together with permanent ”natural results”.

I’m sorry you are disappointed with your reconstruction. If you have had radiation then it may be very hard to have your breasts match with implant reconstruction. If you have not had radiation then perhaps your implants could be revised or adjusted for an improvement. Unfortunately these corrections are all too often temporary. It is possible that using your own fatty tissue would be a more permanent option without implants.

Sometimes it is hard to start over with another approach but it may be necessary if you desire a more natural and permanent result. If you would like more information about natural breast reconstruction with your own tissue let me know.

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

Ask the Doctor- Are These Normal Problems To Have 2 Years after a Breast Reduction?

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

Question: I had a breast reduction over two years ago. It still feels like I have scar tissue in some areas and nipple tends to be a little sore at times. Is that normal?

Answer: No, that’s not normal, and I’m sorry you’re having to endure it.

I can’t tell what is going on by your description, but it’s possible that you have some residual dead fat in your breasts which has not been resorbed. An MRI scan would be the best way to determine this. It’s also possible that you have pain for no discernible reason, which is unusual, but it happens from time to time. That doesn’t mean it can’t be treated, however, as pain therapists can be very effective in helping manage that type of pain.

I would be happy to help you any way I can, but it would be best if you first returned to the surgeon who did your reduction and let her / him know of your concerns. If that doesn’t work, please let me know.

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

Ask the Doctor-It’s Been 30 Years Since My Modified Radical Mastectomy and I am 65 Years Old. Am I Still a Candidate for DIEP?

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

Question: It has been 30 years since my modified radical mastectomy and I am 65 years old. Am I still a candidate for DIEP.

Answer: If you are in reasonably good health, you may well be a wonderful candidate for natural breast reconstruction with a DIEP, sGAP, or other flap. We have restored many ladies’ breasts many, many years after their mastectomy(ies), and they usually do very well after surgery. It is actually advantageous to enter into the reconstructive operation fully healed, as this speeds operating time, as well as recovery. I would be delighted to speak with you about your options by phone, if you wish, or you are welcome to come for a consultation at any time.

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

Ask the Doctor- I am Currently on a Diet to Lose Weight. Will My Breasts Get Smaller Too?

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

Question: I am currently on a diet to lose weight. Will my breasts get smaller too?

Answer: Depending on how much  weight you lose you might notice a change. It should be minimal and proportional. You can’t “spot”reduce any one area  of the body. Therefore if you lose a moderate amount of weight you should have no problem.

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