Don’t be Haunted, Be Proactive!

While we associate breast cancer with pink and ribbons, it is far from pretty. It’s more like a Haunted House. Some of my friends and family members have been unexpectedly shoved all the way into the darkest Haunted House you can imagine. And even with support, the hallways and rooms are very lonely, grim and scary. It’s a nightmare that’s incredibly emotional and physically taxing on the body and mind. With having the knowledge that I was BRCA2+ carrying a risk of 60-80% chance of ovarian, breast, melanoma and pancreatic cancer I only had to stand in the foyer of that Haunted House and was given the chance to not go any further. My situation was not if but when. Once I was diagnosed with Melanoma, I then made the decision to be have  prophylactic surgeries: a full hysterectomy, bilateral mastectomy and DIEP Flap breast reconstruction (with multiple revisions). In all, I’ve had 8 surgeries in the past 24 months with the last one being 4 weeks ago. It has not been an easy journey. I have experienced setbacks, but I have absolutely no regrets. I have an amazing medical team who has taken me apart and put me back together again! I also could not have done this without my incredible support team who has helped me through the good, bad and ugly. I ultimately knew it was all worth it when I heard my breast surgeon say “you now only have a 2-5% risk of breast and ovarian cancer.” I had the chance at prophylactic surgeries, but many are not given that choice. I tell everyone these personal details not to get sympathy or accolades, but to urge you to get tested for BRCA and other heredity cancers if there is a history of cancer in your family. For reliable testing, visit a genetic counselor or order an at-home test at Color.com. It’s a simple saliva test that could prevent you from having to unwillingly navigate the gruesome halls of a Haunted House far far away from the world of pink ribbons. My dad was my carrier and he gave me this amazing knowledge before he passed away and now I am making it my mission to encourage others to get tested and to take charge. Fight cancer before it fights you! Be vigilant! There are many resources and options out there to help you find the best path for you.

-J. Gibbons

 

Will My Insurance Company Pay for a Mastectomy to Reduce My Risk of Breast Cancer?

Ask the Doctor – What Can Be Done To Fix a Previous Radiated Breast with Implant?

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

Question: What can be done for a 2004 radiated breast with implant. As common, it has encapsulated to a high degree and is painful, misshaped and raised, looking very unnatural. Thank you

Answer:  Without question, the course of action most likely to work is to remove the implant and proceed with reconstruction using your own tissue. If you still have breast tissue remaining, it can be removed by a breast surgeon at the same time that your healthy tissue is transferred.

The most common source for the new tissue (the “flap”) is the abdomen, which is usually harvested as a DIEP flap. If the abdomen is not available or not adequate, then the buttocks (“sGAP flap”) can often be used. Our success rates over the last 13 years are 99.07% using the DIEP flap, and 95.7% using the sGAP flap. The initial surgery requires on average 4 nights in the hospital, but subsequent stages are much easier.

If you can’t or don’t want to use your own tissue, there are a couple of other options which may offer some hope, although the chances of success are nowhere near as good as using your own tissue. One is a course of hyperbaric oxygen, which has been shown to bring new blood vessels to the radiated tissue.

Another potential option, which must be regarded as experimental at this point, would be to completely cover the implant with acellular dermal matrix, or “ADM” (Alloderm being the most commonly used variety). This material has some efficacy in preventing contracture, but the effect would be less pronounced in radiated tissue.

Hope this helps. I would be happy to discuss your situation further with you, if you wish.

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

Ask the Doctor – What Are the Pros & Cons of Reconstructive Breast Surgery?

yellow flowers

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

Question:  What are the pros & cons of reconstructive breast surgery?

Answer: Thanks for your question. Ultimately the pros for breast reconstruction include restoration of a woman’s body following surgical removal of part or all of her breast/breasts. Surgery to remove the breast is performed to prevent or treat breast cancer. The ultimate goal of reconstruction is to restore physical well being and quality of life. Breast reconstruction using your own natural tissue provides the opportunity to achieve the most natural results. Even restoring breast sensation is possible (not guaranteed and not necessarily complete) using your own natural tissue. The cons of natural tissue are that the patient must donate the natural tissue from another part of the body. That means scars and healing in more than one area of the body. Surgery always requires down time, recovery and time away from working etc.. Also reconstruction almost always requires more than one surgery.

Breast reconstruction using implants is generally less natural than using natural fatty tissue that contains healthy blood vessels and nerves. The advantage of implant reconstruction is that surgery is not required in another area of the body and there are fewer scars in areas of the body other than the breast. Long-term, reconstructions with implants require more revisions due to implant problems and are generally less permanent than using your own tissue.

There are always individual factors and expectations that may change the pros and cons. Hopefully, this brief synopsis has answered your question. Please 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!

Ask the Doctor – How Long Should You Have a Breast Expander In?

pink and white flowers

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

Question: How long should you have a breast expander in?

Answer: There is no “one size fits all” answer to your question.

In many cases, expansion can be achieved, and the permanent implant placed, in 2-3 months (more commonly 3).

In other cases, expansion may take longer, or sometimes other factors such as radiation may cause delays in removing the expander and placing the permanent implant. Whenever possible, however, expansion should be completed before the beginning of radiation, because the expansion of radiated skin ranges from difficult to impossible.

I do not think that having expanders in for long periods is likely to cause any lasting problem, although the chance of them deflating goes up. I met a patient recently who, for various reasons, had had an expander placed by another surgeon in place for 15 years. She appeared none the worse for it, we placed a permanent implant, and she is doing well.

Hope this helps, I’d be happy to chat with you if you wish.

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

Ask the Doctor -After Two Different Types Of Reconstruction Over The Years, What Can I Do To Regain Some Symmetry?

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

Question: I had my first mastectomy in 1991 with a tram flap reconstruction. My second mastectomy was in 2004 with an s-gap reconstruction. In the last few years, my breasts have become increasingly uneven and have shifted on my chest. Is there something I can do to my reconstructed breasts to regain some sort of symmetry?

Answer:  Without knowing any more specifics of your situation, I can state in general terms that asymmetry after reconstruction is very, very common and that there are a host of techniques which we routinely use to minimize asymmetry as much as possible. Some of these techniques are fat grafting, reduction, contour alteration, and position changing. We have currently performed almost 1700 perforator flap reconstructions, and we likely have significant experience dealing with situations very similar to yours. I would be happy to see you in consultation any time or chat on the phone if you wish.

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

Ask the Doctor – Exams Of My Implants Have Shown Nothing Wrong But Increasing Symptoms Have Me Very Worried. Is There Anything I Can Do?

Daisies

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

Question: I have pain on the side of my breast where an implant was attached at reconstruction surgery in 1987. It has always hurt but recently has become much worse. Inflammation increases with sinus and allergy problems.

The implants are still soft so my recent visit to a plastic surgeon was uneventful. As I am 75 years old, they would not remove them. MRIs have shown they are not leaking. The pain keeps me on edge thinking something is very wrong. What are my options?

Answer:  I’m sorry you are having problems so long after your surgery.

I don’t think you necessarily have to just accept your situation. You can have very bad, and painful scarring internally, especially with old implants, even if they are not ruptured. Additionally, if you are otherwise healthy, there is no reason you couldn’t have them removed, even at 75. I’m not saying that this would solve your problems (although it may), but don’t discount the option just because of your age. For what it’s worth, we have actually done DIEP flaps successfully on patients your age, and that is a much larger procedure than removing implants.

I would be happy to speak with you 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!

Ask the Doctor – Could Odd Pains In My Body Be The Consequence Of an Old Abdominal Flap Surgery Following A Halstead Radical Mastectomy?

Poppy in a feild

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

Question:  In 1987, I had abdominal flap surgery following a Halstead radical mastectomy. I keep wondering what is NOW going on in my body! When I feel odd pains I wonder if it could be repercussions of that surgery so long ago.

Answer:  Thank you for your question. If you had your surgery in 1987 and you had reconstruction using your abdominal tissue then I will assume that you had a Tram procedure. That surgery relies on partially removing the muscle from the abdominal wall. Not having the muscle in place can cause problems later in life. People can have pain or bulging of the tummy and even hernias. Of course not all patients have those problems. If your problems are in the tummy area then that is a possibility. If your problems are in the area of your breast or mastectomy then you should consider seeing a breast surgeon that specializes in doing mastectomies to make sure all is well with regard to your breast area. You could also see the doctor who follows you regarding your breast cancer history. Scaring from a “Halstead” mastectomy especially after radiation could cause aches and pains later in life. Regardless of what it might be you should definitely be seen by your doctor so they could do a complete evaluation of your symptoms. After an evaluation they could make more specific recommendations. I hope his information helps. Let me know if you have further questions.

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

 

Ask the Doctor – Can I Have Large, Under Muscle Implants Replaced With Smaller Ones? Will This Make Them More Comfortable?

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

Question: I’ve had my breast tissues removed and I now have implants. They are under my muscles, too large and very uncomfortable. Is there anything you can do to fix this and make a smaller implant? I am very unhappy with the way my breasts look, This is contributing to already very low self-esteem issues. Can you help me? What are my options?

Answer:  There is an excellent chance that we can help you. The country is currently undergoing a paradigm shift in implant-based breast reconstruction, with more and more surgeons placing the implants in front of the muscle, rather than behind. This allows for numerous potential advantages, and few disadvantages. We have been converting patients with unsatisfactory sub-muscular reconstructions to reconstructions in front of the muscle for a few years, with generally good-to-excellent results.

Another option is to remove your implants and re-build your breasts only with your own natural tissue, usually from tummy or buttocks. This is a larger operation than implant reconstruction but obviously results in an even more natural result.

I would be happy to discuss your situation further with you by phone, if you wish, or see you in my office when convenient.

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 – What Are My Chances With DIEP Flap Surgery After Several Failed Reconstructions With Tissue Expanders and Implants?

Sunflowers

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

Question: I have had several failed reconstructions with tissue expanders and implant. I have also been put on IV antibiotics due to a staph Infection. I am wondering what my chances are with the DIEP Flap.

Answer:  Great news! Your prior failures with implants does not in any way decrease your ability to get soft, warm breasts with DIEP flaps. Many, many, many of our patients have histories of prior failures with implants, some with (10-20) prior failed surgeries, and we have been able to successfully 99+ % of them with only their own tissue. Once the infection from prior implants is eradicated from your body (if you have been healed for at least 6 months, you can generally assume that all the prior infection is gone), then subsequent reconstruction with your own tissue carries only a minuscule fraction of the infection risk of reconstruction with implants. You didn’t mention if you were radiated, but it makes no difference, breasts reconstructed with your own tissue are still extraordinarily unlikely to have problems with infection.

We would love to chat with you and discuss your options further. Looking forward to speaking with you, and thanks for your inquiry.

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

Ask the Doctor – How Far in Advance Should I Begin Planning and Scheduling Surgery and is Travel Afterward a Problem?

Roses and orchids

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

Question: I had a phone consult with Dr. Kline in December and was very impressed with our conversation.  After researching several microsurgeons, I keep coming back to this center as the perfect fit for me. I had bilateral mastectomy in Jan. 2014 due to DCIS and have saline implants under the muscles. I experience constant inflammation, burning, and the right implant has “shifted” (as my PS said) and feels like it is under my armpit. Due to life situations I am not considering surgery until the end of this year or January, 2019.

How many months ahead should I contact you to schedule the surgery? Also, I’d like to talk to someone about getting insurance approval. I have BCBS of Alabama.

Is it possible to come from Decatur, AL to have this done? I do not feel comfortable using anyone closer at this point. Just worried about the travel afterwards. Thank you.

Answer:  We have many women who travel to have surgery so we know how to help you navigate that hurdle.  As far as your timeline, one thing to consider is that this is a staged procedure – typically the first stage is inpatient for 4 days and then outpatient for Stage 2 a few months later.  Sometimes a 3rd stage (outpatient or in office) if you require nipple reconstruction or further revision to get the result you desire. Taking into account your deductible and out of pocket expenses – you may want to make sure you can get all of those stages done within one plan year.  I’ll be happy to run an eligibility inquiry through your insurance plan and we can find out exactly what your benefits are so you’ll know what to expect. Insurance approval should be no problem at all as we are in the Blue Card Network for BCBS plans. Check your insurance card and see if you have a little suitcase on the front with some letters within it.  That will tell you that your plan is a member of that network. If you’d like to send me some basic demographic information i.e. full name, date of birth, address and a copy of your card, I can get that process started for you. We typically have openings within a 2-3 month time period but to reserve the date you really want, I’d choose it as soon as you know what will work for you.  We operate on Tuesday, Wednesday, and Thursday.

Here is a blog post from September discussing the stages of surgery and how we work with patients out of our area.

http://breastreconstructionnetwork.com/ask-the-doctor-how-many-trips-are-required-to-have-reconstruction-with-your-doctors/

I’ve forwarded your e-mail to Dr. Kline to discuss post- operative travel with you.    Have a great day and I’ll look forward to your reply.

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