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

June 29, 2018 by

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!

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Ask The Doctor: I Had A Breast Expander Removed and Can’t Re-start Breast Reconstruction For 6 Months. What Are My Best Options?

June 8, 2018 by

Daliahs

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

Question: I have started my reconstruction, but had to have one side removed and can’t start on that side for 6 more months. My one side has 80 ml saline in it. What are my best options?

Answer #1: Can you tell me why you had to have one side removed?

Richard M. Kline, Jr., MD

Answer from the patient: It started with a blood clot and just kept getting infecting.  So my surgeon removed it so I could start my chemo and to get the infection cleared up, which it has cleared up completely.  I have started my chemo, which I have 4 to 5 treatments. Then after 6 months from have inflated removed I can start the reconstruction procedure.

Answer #2:  Sorry you’re having trouble. I think your surgeon was wise to remove the expander, you certainly don’t want to delay chemo.

If you weren’t radiated, it may be reasonable to try another expander after finishing chemo. I think the chances of it working may be less than usual since you’ve had trouble before, but nonetheless, it may work next time.

If you would like to forego expanders/implants and have reconstruction with your own tissue, the chance of getting an infection will be much less, and the quality of the reconstructed breasts will be much more natural. The surgery involved is larger, and it’s not for everyone, but once you are done there is essentially nothing to ever go wrong later. Previous unsuccessful reconstruction attempts with implants generally don’t affect our ability to reconstruct you with your own tissue, so if you want to try implants again after chemo, the natural tissue option will still potentially be there if implants don’t work again.

I would be happy to chat with you more about your situation at any time if you wish.

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

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Ask the Doctor – Would I Be A Candidate For DIEP Flap Surgery After Previous Expanders Are Removed And Will You Accept VA Insurance?

May 11, 2018 by

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

Question: I had a bilateral mastectomy with reconstruction and I am terribly dissatisfied with my care so far. 11 Months later, the expanders are still painful. I will be asking to have them removed this week.

I have 2 questions for you. After I  have the expanders removed would I still be a candidate for the DIEP flap? I am still going to chemo (Herceptin) which will run until the end of November, provided there are no more setbacks. My second question is, do you accept VA insurance? One form of payment is through the VA another is Veteran’s Choice. I am not sure which would cover outside care. I look forward to your response.

Answer: I’m sorry you have had so much trouble, but there is a very good chance that we can help you.

Your previous unfortunate experience with expanders does not in any way decrease our ability to successfully reconstruct you with DIEP flaps. The blood vessels which we use to vascularize your flaps are well below the area where tissue expanders are placed, and we have successfully reconstructed literally hundreds of patients in your situation. One potential advantage to having the expanders removed sooner rather than later is that we get an MRI angiogram on all patients who are scheduled for perforator flap breast reconstruction, and most breast tissue expanders are not MRI-compatible. If they use a little magnet to find the port before they fill your expanders, then you can’t get an MRI with those expanders in place.

We have worked with the VA many times in the past, and Gail, our insurance expert, will contact you to investigate your situation further.

Thank you very much for your inquiry, and I look forward to meeting you.

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

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

May 4, 2018 by

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!

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

April 27, 2018 by

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!

 

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

April 20, 2018 by

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!

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

April 13, 2018 by

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!

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Ask the Doctor – I Was Recently Diagnosed With Cancer. When Is The Optimal Time for Natural Reconstruction If Radiation Treatment Is Planned?

March 2, 2018 by

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

Question: I am a newly diagnosed cancer patient in Atlanta.  I am scheduled for a left side mastectomy a week from today.  Mammography and MRI found pretty extensive DCIS on the left side of the left breast extending to and abutting the chest wall.  I am likely to require radiation treatment because of the proximity to the chest wall.  My plan is to have a tissue expander put in at the time of surgery.  I cannot get myself comfortable with the idea of an implant although my plastic surgeon here has said I am too thin for a natural reconstruction procedure.  I am interested in revisiting this and/or maybe getting a second opinion after the mastectomy.  My question is when the optimal time for a natural reconstruction would be when radiation treatment is planned?  Should it be done at the same time as the mastectomy ideally or after radiation treatment?  Thank you.

Answer:  Hi and thanks for your question. Sounds to me like you are on track for doing things the right way. If you need radiation we would not want you to have natural tissue reconstruction until after your radiation treatment. Possibly 3 months after radiation is complete. In the meantime having the expander placed immediately after the mastectomy (same procedure). Then you can remove the expander later at the time of your natural tissue reconstruction. I would be glad to give you my opinion I frequently see patients who other doctors say they don’t have enough tissue. Frequently we can get a nice result with natural tissue. Let me know if you have other questions or would like to talk over the phone.

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

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Ask the Doctor – Is It Common To Have Breast Reconstruction Done At The Same Time As A Mastectomy?

February 23, 2018 by

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

Question: My dear friend has recently been diagnosed with stage 1 breast cancer – estrogen driven. Cells were found in the ducts but negative in lymph flow.  She has been scheduled for a mastectomy and she has decided to have both removed. She has been informed that she will need to have a hysterectomy soon after. I am an RN having worked in-house bedside with patients for 25 years. She is to be scheduled for surgery later this week and has been told reconstructive surgery for both breasts will be done as the surgery is completed. Is this commonly done? The patients I worked with generally had the reconstruction after chemo and radiation.  What is your professional insight?  She is terribly afraid and she has 11 and 8 yr old sons.

Answer: Yes, it is very common to have reconstruction done at the same time as the mastectomy. While there may be a slight increase in the complication rate doing it this way, most people feel that the advantages of doing them together outweigh any potential disadvantages. The one time that we would NEVER do immediate reconstruction is if the patient wanted natural tissue reconstruction, but we thought there was some chance that she would be radiated, as we NEVER want to radiate the transferred tissue. I do not wish to speak for your friend’s oncologists, but the two most frequent reasons for receiving radiation are 1) one or more positive lymph nodes, or 2) a tumor greater than 5 cm in largest dimension. Even if we know that radiation is to be received postoperatively, however, there is no problem reconstructing with implants or tissue expanders at the same time as mastectomies, and there may, in fact, be some potential advantages, primarily in terms of the quality of the final result.

I certainly understand your concern and your friend’s concern, but there is every reason to think that she will do well. If I can be of any assistance by talking to her or anyone else, please let me know, I would be happy to do so.

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

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Ask the Doctor – What Options Do I Have When Removing My Breast Implants?

February 16, 2018 by

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

Question: I had silicone implants in 1988 under skin, which ruptured. In 2012, had bilateral implant exchange with saline implants under muscle. In 2016, the right saline implant ruptured; it was always hard with capsular contraction. I have been trying to find a plastic surgeon who will do a capsulectomy on Rt & Lt… and ideally tissue transfer from my body. (I read the FDA has 356 MDRs of lymphoma including 9 deaths, with saline implants, mostly textured but also smooth.) So, as long as I have a rupture (the right breast is flattened), I may as well have both saline’s removed. Does the fat transfer go under the skin or muscle? Would this be a good option for me at this point? Is the capsulectomy better than the explant-ation? Of course, it also depends on cost! Thank you.

Answer: Thanks for reaching out! I’m sorry to hear that you’ve had quite a lot of trouble with implants over the years. Were your implants placed for reconstruction or for cosmetic purposes? We do a lot with both implant reconstruction and natural tissue, both of which are almost always placed above the muscle. Our office also mostly prefers to use smooth silicone gel implants instead of saline, and we choose not to use textured implants often for a few reasons, one of them being what you researched about the Anaplastic large cell lymphoma.

The biggest question that determines what your best options would be whether you had a breast cancer diagnosis or other factors that would make your case reconstruction vs. cosmetic. Once we get that information from you, I feel we can better give you an idea of what we might be able to do for you.

I look forward to hearing back from you to see how we can help you!

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

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