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Ask The Doctor – I am not happy with the results of my DIEP Flap surgery – Should I get an implant?

August 29, 2014 by

<alt="orange flowers"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Hi, in May 2013, I had my transfer done at the same time as my DIEP flap. In that surgery, I also had a reduction on my left breast. The doctor that did my surgery left and moved somewhere else, so I’ve seen another doctor since. My new doctor tried to fix it, but it’s still messed up. He said he really doesn’t know what to do. As far as the transfer is concerned, I’m not sure it worked. I had another procedure done that helped it at first, but my cancer came back again on my pelvis bone and the chemo has made it worse. I am no longer on chemo, but I will take Herceptin for the rest of my life. Is it possible to remove the fat and put an implant in my breast?

ANSWER: Hi, if you had radiation on the reconstructed side, an implant might not be the best option. It is possible to add an implant to a DIEP to increase the size in order to match the other breast. I personally prefer to perform fat grafting to add more volume when possible. It is harder to match a normal opposite breast with an implant breast reconstruction. Removing fat normally is not the answer to revising the shape unless the fat is not living. This is called fat necrosis and feels hard not soft like normal fat. Also, if you went with an implant on that side the results would be more natural if you had more of your own fat to cover the implant. Otherwise the new breast has no natural tissue to cover it and the end result looks less natural.

James E. Craigie MD

Center for Natural Breast Reconstruction

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

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Ask The Doctor – Will My Weight Impact My Breast Reconstruction Surgery Goal?

August 22, 2014 by

<alt="pink rose"/>This week, Dr. Richard M. Kline of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Hello, I’m a breast cancer survivor. My doctors will not do a reconstruction because they say I have to lose weight. The medicine I’m taking causes me to have body aches and pains, and I’ve gained weight because of it. I’m also afraid that my cancer will return. I’m financially strained and really feel left behind when it comes to improving my body; I want to feel whole again and wanted. I just turned 50 and have been cancer free since June 2011. I’m excited to have another chance to live, but I want to feel like a whole woman again with complete confidence. What are my options? Thank you for your time.

ANSWER: Hi there, I’m sorry you’re having these problems, but we will help if we can. We have learned from hard experiences that it can be dangerous to do reconstruction with your own tissue (we do not do implant reconstruction, as a rule) in patients who are significantly overweight. That being said, the guidelines for using tissue are not strictly rigid, and it depends to some extent on how the extra fat is distributed in your body. If you would like to investigate further, we could have our nurse Chris or PA Kim call and chat with you. Thanks again for your inquiry. Have a great day!

Dr. Richard Kline

Center for Natural Breast Reconstruction

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

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Ask The Doctor – Are There Any Tests To See if My Implants Are Causing My Health Problems?

August 15, 2014 by

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This week, Dr. Richard M. Kline of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had a bilateral mastectomy back in 2000 because of numerous precancerous lumps in my breasts. I had Stage 3 melanoma 8 years prior, and they operated numerous times on me. I decided to have latissimus reconstruction surgery, and since then have had numerous problems. I’m allergic to latex, numerous adhesives, sulfa, and penicillin. I’ve been suffering from fibromyalgia, severe edema throughout my body, and itchiness within the area of my chest wall and breasts. After getting this issue checked out, I was told this was not an implant problem and was sent home. Are there any tests that can check to see if the problems relate to my implants? I had a CT scan done at Mayo Clinic, and they said I had an allergic reaction to what they thought was an antibiotic. Have you seen this before in your patients? Any help would be greatly appreciated. Thank you.

ANSWER: I’m not aware of a test to see if your implants are causing any problems. To my knowledge, there has been no firm connection established between implants and symptoms such as yours, but you should check with your rheumatologist to be sure.

Having said that, we do see many patients who have implant reconstructions along with various complaints such as discomfort, tightness, pain, etc. Although it is obviously difficult to objectively quantify, many of them seem to get significant relief from their symptoms if their implants are removed, and their breasts reconstructed with their own tissue. In all fairness, most of these patients have what would be considered unacceptable reconstructions anyway (hardness and asymmetry being common issues), so it is usually pretty easy for them to decide to have their implants removed and replaced with natural tissue. If your reconstruction is presently aesthetically acceptable to you (other symptoms notwithstanding), then the issue of what to do is significantly less clear-cut.

Best of luck, and let me know if we can be of any further assistance.

Dr. Richard M. Kline, Jr.

Center for Natural Breast Reconstruction

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

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Ask the Doctor – Will Insurance Cover the Reconstruction of My Breasts?

August 8, 2014 by

<alt="pink flower"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: When I had breast cancer in 2010, I didn’t have any insurance. Now, I have great insurance and I want to undergo breast reconstruction. Will insurance cover the reconstruction of my breasts?

ANSWER:  Hi there. Thank you for your question. If you have had a mastectomy for breast cancer reasons and now have insurance, then you should be covered. There is no time limit between having a mastectomy and undergoing breast reconstruction. You should be covered, but make sure you call your insurance company and check what procedures your insurance will take care of.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask The Doctor – Can A Saline Implant Leak Long After Surgery?

August 1, 2014 by

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

QUESTION: Can a saline implant slowly leak approximately 16 months after surgery? Also, can a bacterial or fungal infection occur during this time? I am hearing and feeling a gurgling sound in my right breast which I believe is fluid. I am concerned because I read that an implant can leak out and cause fungal and bacteria infections.

ANSWER: Thank you for your question! A saline implant can leak at any time after surgery. The leak can be slow or sudden. Eventually, you would notice the size go down. Implants are normally filled with sterile saline that would not cause an infection. If you have an infection it most likely would not be from the fluid that was in the implant. Usually that fluid is absorbed by the body after a leak and causes no medical problems. The best way to get an accurate answer would be to report what you are experiencing to your surgeon who performed the implant surgery.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask the Doctor: Will Scar Tissue Buildup Be A Concern With The Gap Flap?

July 25, 2014 by

 

<alt="pink lotus flower"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Question: My wife had a double mastectomy 10 years ago. At that time she had latissimus surgery to fill in her breasts. Since then, we’ve had numerous surgeries, about every 2 years, due to scar tissue building up in 1 of the 2 (or both) breasts that causes tightening and even pain. Will scar tissue buildup be a concern with the Gap Flap? 2. Regarding the Gap Flap procedure, what is the rate of failure that you experience with any of the 4 surgery sites (2 buttocks, 2 breasts)? Thanks.

Answer: Hi — I’m assuming your wife has implants under the latissimus flaps, which would explain the buildup of scar tissue. GAP flaps are generally large enough to make a breast by themselves (obviously, sizes differ among different people), so implants are not needed, and internal scar buildup would be a very rare event. We last calculated our statistics in October of last year. Over 10 years, we did 217 GAPs, 49 as unilateral, 168 as simultaneous bilateral. The GAP flap survival rate was 97% overall. All of the failures were in bilateral cases, but no patient lost both flaps, yielding a simultaneous bilateral flap survival rate of 96.4%. We have done quite a few GAPs since then with no failures (most recently a simultaneous bilateral last week), so the current statistics are actually a little better than that. We don’t bury flaps, and therefore can’t miss (or ignore) a failure, so these are ironclad statistics that could survive a GAO audit. To our knowledge, only Dr. Allen (who invented breast perforator flaps and trained the rest of us), his ex-partners in New Orleans, and ourselves actually do simultaneous bilateral GAP flaps on a routine basis. I’d be happy to discuss your situation further if you wish, just call or email.

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask the Doctor: What Are My Options for Natural Breast Reconstruction?

July 18, 2014 by

 

<alt="pink peony"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I had right breast ductal carcinoma, Stage 2. Two out of 22 lymph nodes had cells. I did a gene test, and had both chemo and radiation. The expanded radiation destroyed it. I had a mastectomy in Charleston, and now I’m ready to have my breasts fixed. I don’t want to have implants. I’d rather have a reconstruction using my own body fat and tissue. What are my options?

Answer: Hi — I’m sorry you’ve had so much trouble, and hopefully things will continue to improve for you. Your history of radiation fortunately has no bearing on our ability to do a reconstruction using only your own tissue. Many of our patients initially had failed implant reconstructions elsewhere, only to be later successfully reconstructed with their own tissue. Please feel free to come by for a consultation if you live locally, or, if you’d rather, we can arrange a phone consultation. Thanks for your inquiry, have a great day!

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask the Doctor: What Are My Options For Post-Op Reconstruction Using Implants?

July 11, 2014 by

<alt="pink dahlia"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

Question: I’m 42 years old, and I have a surgery this month for breast reconstruction. Due to my genetic history, a plastic surgeon will be performing a double mastectomy. I want to know what my options are for post-op reconstruction? Thanks.

Answer: Hi — Thanks for the information about your planned surgery. If you have requested using your own tissue and were told that was not a good option for you, then you certainly can get a second opinion. You stated that your mastectomies were for preventive reasons, which gives you the time to consider all possibilities. Before having surgery you should feel good about your decision and be confident you know all your options. You have excellent surgeons and I know you will do well.

One advantage of using an implant is that you don’t require an incision anywhere else on your body in order to donate the tissue to make the new breasts. Using your own tissue requires a longer recovery and more healing. The donor area ends up healing with a scar. If you don’t need a tummy tuck or have “excess” tissue in your thighs or buttocks then you may not want a scar in these areas. You should also know that it is not necessary to sacrifice any of your muscles in order to use your own tissue. Finally, it is important to know that if you have implant reconstruction and it does not work out you can still use your own tissue later–even years later! Most likely it will work out and you will have an excellent result and speedy recovery. I hope this has helped. Let us know if you have more unanswered questions. If you would like a second opinion, you could set up an appointment in our office, or we could also consult over the phone if you cannot make the trip to Charleston.

Dr. James Craigie
Center for Natural Breast Reconstruction

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

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Ask the Doctor: Do you have a recommendation for a topical that will help scars heal or fade?

July 4, 2014 by

<img src="pink flower" alt=" " />

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: Do you have a recommendation for a topical that will help scars heal or fade?

A: Unfortunately, nothing of which we are aware does this reliably. Avoidance of sun exposure is critically important to give scars their best chance of fading, but no topical preparations routinely make scars better. If scars are heavy or raised, Mederma can help, but it should not be used on scars which are already flat.

 

Dr. James Craigie

Center for Natural Breast Reconstruction

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

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Ask the Doctor: Questions About Reconstruction Surgery Years After A Mastectomy

June 27, 2014 by

<img src="image.gif" alt=A pink rose" />This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I have been cancer free for 4 years, and have been very undecided about reconstruction. My surgery removed the underside of my right breast. I am very lumpy and the scar is very hard. Would I need to have a reduction in the other side or can the surgery site be repaired? I am “usually” a D in size currently. Also, is this surgery considered a “tummy tuck” type operation?

A:  You have several potential options, depending on your present physical situation, and your wishes.

I’m assuming you are radiated (please correct me if I’m wrong). With this in mind, an implant to increase the size of the right breast is not likely to work. Increasing the size of the right breast with a DIEP flap (I assume this is what you meant by “tummy tuck”) is potentially a large operation for a lumpectomy defect, but sometimes it is actually the best option.

If you don’t mind being smaller than you were, reducing the size of the left breast may well be your best (and simplest) option to get better symmetry. That’s probably all I should try to say without knowing more details about your particular situation. We’d be happy to have our nurse Chris or PA Kim call you to discuss your situation further, if you wish. Thanks for your question, and have a great day!

Q: I had bilateral mastectomy in 2011, but didn’t have insurance. Now that I do have insurance, can I get reconstructive surgery? And how do I go about it?

A:  Thanks for your question. There is no time limit to when you can have reconstruction surgery. Your next step would be to start researching what kind of procedure would achieve your goals. If you’d like a permanent reconstructive procedure, the ones we offer might be what you are looking for. We use excess tissue of your abdomen, buttock or upper thigh and transfer that along with it’s blood supply to build a new warm natural breast.

Richard M. Kline, Jr., MD
The Center for Natural Breast Reconstruction

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