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10 Questions to Ask Your Breast Surgeon

September 16, 2011 by

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.

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Does Radiation Affect My Options For Breast Reconstruction?

June 3, 2011 by
Dr. James Craigie

Dr. James Craigie

The question below is answered by Dr. James Craigie of The Center for Natural Breast Reconstruction.

I am not sure if I will need radiation after my mastectomy. What factors should I consider before going ahead with breast reconstruction?

Radiation therapy is part of the treatment for breast cancer for some but not all patients. To determine if it is necessary for any individual, the details of the cancer or the final path results must be known. The most common situation for radiation after mastectomy is based on the size of the cancer and the number of positive lymph nodes.

When a patient would benefit from radiation the treatment may affect the options for breast reconstruction as well as the timing of the reconstruction. There are several advantages to starting the breast reconstruction at the time of the mastectomy. These include: the breast surgeon can save more of the breast skin or even the nipple and this can set the stage for the best possible result, and avoiding an extra step and an extra recovery period.

If radiation will definitely be needed after mastectomy then I do not recommend immediate natural breast reconstruction because the radiation can possibly damage the new breast. In this situation the reconstruction would start approximately 6 months following radiation. These decisions are best made following the advice of your oncologist, breast surgeon, and plastic surgeon all working together. For this reason I am a strong advocate of the multi-specialty breast conference where each patient can be presented to all the specialists at once so they can share their opinions right away. Cooperation between experts can ensure better results and more options for each patient.

It is important to remember that if you need radiation for the treatment of breast cancer it does not mean you cannot have a very good result with natural breast reconstruction. It may however determine the order and timing of when the breast reconstruction should begin.

—James E. Craigie, MD

 

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Your Insurance and Financial Options for Breast Reconstruction: Know Your Options

April 13, 2011 by

Post by Gail Lanter, CPC Office Manager

Image to the left taken from The United States Department of Labor website.

A large part of my day is spent answering questions for women who are exploring their breast reconstruction options. These ladies are all potential patients of our practice and my mission is to help them make educated, informed decisions regarding a procedure, location, and time that are right for them. Ultimately, the discussion always turns to the insurance and financial part of the surgical procedure.

I’ll be honest. Sometimes the questions are surprising and a bit alarming when it comes to this end of things. There are women out there who are not aware of WHCRA 1998, the law that empowers women to elect to have the breast reconstruction procedure of their choice. In short, it states that if their insurance company covers mastectomy . . ., they have to cover your elected breast reconstruction procedure and any procedure required to achieve symmetry if you only have one affected breast.

Of course, just like anything else, there are always exceptions, but I would venture to say it covers the majority of women in the U.S. Read it here. It’s a law designed to protect your rights, and it’s important to know if you have had or are facing mastectomy.

***It’s not cosmetic surgery. Plastic surgery for breast reconstruction after mastectomy is a functional issue, not a vanity item. You don’t have to have artificial implants if you don’t want them. The options are endless. Sure, some women are limited in their options, simply because there are medical and health issues some women face that may not make them candidates for some of the surgical procedures. But in general, there is something out there for just about everyone. It’s not a one- time shot either. You’ve tried implants, great, they worked out for you and you are happy. HOORAY! DONE!

If you’ve tried them and they didn’t work out, (i.e. you developed capsular contracture, a post operative infection, couldn’t bear the tissue expansion process, whatever the reason) you can choose to go another route. It’s completely up to you. Read, go online, ask your friends, ask someone in your support group, and get a 2nd and 3rd opinion. Sometimes it’s not easy to find the alternatives, but sooner or later you will find something that works for you. Ask a bunch of questions, and in turn, you’ll get a bunch of answers and opinions to consider. Don’t be afraid to travel—sometimes your local surgeon may not offer all of the breast reconstruction techniques that are available, new ones are developed all the time.

Think of it this way: I’m an excellent softball player, but if you are looking for someone for your basketball team, I’m not your girl. But, being a good pal, I’ll ask around and find you someone who will be a wonderful addition to your team. It’s what friends do for one another.

So ask your current surgeon, tell him or her that as much as you appreciate all they have done for you, you’d like to know if there are procedures available beyond what they offer. If they are good guys / girls, they’ll lead you in the right direction if they are out of options for you.

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Who Can Have a Skin-Sparing and Nipple-Sparing Mastectomy and Why?

April 1, 2011 by

**We are delighted to introduce our guest blogger, Dr. Paul Baron, MD F.A.C.S of Cancer Specialists of Charleston. Dr. Baron shares with us his insight on who can have a skin-sparing and nipple-sparing mastectomy and why.

See below for Dr. Baron’s guest post:

The best cosmetic results from breast reconstruction are clearly in patients who still keep much of the original skin of the breast. It leads to a more normal shape, appearance, and texture. In the past, the fear was that the cancer overlying a breast tumor needed to be removed; even if the cancer was far away from the skin in the back of the breast. All mastectomies were done with a large horizontal elliptical incision that removed a large segment of skin extending from the sternum to the lateral chest. The nipple and areola were removed at the same time as there was concern that the cancer could march up the ducts and be left behind if the nipple is left behind.  As a result, there was not enough pliable tissue to allow placement of an implant or tissue flap under the skin. The reconstruction could only be done by stretching the skin first with a tissue expander or leaving a large island of skin with the attached underlying flap of tissue (TRAM, latissimus, DIEP, or GAP). The result was a very unnatural breast reconstruction.

We now know that in most mastectomies, virtually all the skin overlying the breast can be left behind as long as the cancer is not immediately underneath it. In this case, we still remove a small patch of overlying skin. The most common incision for a skin-sparing mastectomy goes just around the areola with an extension inferiorly (kind of like a tennis racket shape), or a horizontal ellipse that is half the distance of the more traditional mastectomy incision. The resulting reconstruction is more natural in appearance as there is a very small scar and often no visible island of skin.

Another approach gaining in popularity is a nipple-sparing mastectomy. In this case, the entire breast is removed through an incision that completely leaves the nipple and areola intact. There are many ways to make this incision. Clearly these patients have the most normal appearing breast reconstruction. Also, to relieve the concern of cancer cells being left in the ducts, we actually core out the ducts as they enter the nipple. The shell of the nipple is left behind and as a result, often looks better than the nipple reconstruction.

We will not perform a nipple-sparing mastectomy if the cancer is close to the nipple. Also, if a patient had a prior mastectomy in which the nipple and areola were removed with one breast, we will usually remove the contra lateral nipple at the time of prophylactic mastectomy so the reconstruction result is symmetrical. It should also be pointed out that in most cases in which the nipple is left behind, it does not have normal sensation. It can have sensation to touch and temperature, but lose erotic sensation.

We have made huge strides in breast cancer surgery. For patients requiring or choosing mastectomy, the final reconstructed version can have a natural reconstruction as a result of usually leaving the skin behind as part of a skin-sparing mastectomy. We have improved this even more by performing nipple-sparing mastectomies. The optimum result is when the breast surgeon works as a team with the plastic surgeon in planning the type of mastectomy from a cancer point of view, and the orientation of the incision from a cosmetic point of view.

About Dr. Paul Baron:

Dr. Baron is Board Certified in General Surgery and completed a Surgical Oncology Fellowship at Memorial Sloan-Kettering Cancer Center in New York City. He is a graduate from the Boston University Six-Year Medical Program. Dr. Baron subsequently completed a residency in General Surgery at the Medical College of Virginia.

Cancer Specialists of Charleston – www.cancerspecialistsofcharleston.com

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