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Ask The Doctor-Will surgery help my scar tissue?

January 23, 2015 by

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

Question: I have scar tissue in my right breast from a horse bite that occurred when I was about 11 years old. I am now 43. Each year it has caused doctors to require repeated mammograms , ultrasounds, and non MRI’s. Now they are recommending I have a biopsy or have the scar tissue removed. I was wondering about having it removed by a plastic surgeon to decrease scaring. Do you think that is possible?

Answer: Sorry you are having problems with your scar. Did you have surgery after your horse bite accident? Did the injury lead to your breasts being uneven? I think you have a very good question and its possible that a plastic surgeon could help. Because of the nature of the injury it is possible that the scar could be removed and the breast reshaped in the process to allow healing to occur in a more favorable way and create a more favorable scar. I would need more information to give you more specific answers. I would be glad to see you in consult or if that’s not convenient, have my office contact you for more specific details and possible photos. Let me know. Thank you 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-Should I have a preventative mastectomy?

January 16, 2015 by

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

Question: I am 60. I have had a core bio in right breast, and my maternal aunt had breast cancer. My left breast is became two sizes bigger than right, and I have fibefib. Cystic diseases. Last year my mamo showed no cancer, but I am about a 36 c in right breast and 38c in left. It’s painful. Should I be proactive and have both removed since already in right? I have had a core bio for two lumps showed benign. Thanks

Answer: Thanks for your question. Women who are at an increased risk for breast cancer and/or who have difficult breasts to screen for breast cancer do sometimes consider preventive mastectomies. Certainly not every woman in your situation would do that. In order for you to make a decision you should discuss your specific situation with a breast surgical oncologist. They could give you more specifics about your risks. Other considerations are quality of life issues. Having to undergo frequent biopsies or repeat imaging are all reasons some of our patients tell us they have preventive mastectomies. Finally, the options for breast reconstruction available to you can make a difference to you in your decision. We can give you more specifics about those options if you like. We have all our patients discuss their risks with one of the breast oncologist and geneticists we work with. Let me know if I can help in any way.

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 the DIEP flap procedure an option for me?

January 9, 2015 by

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

Question:I had a bilateral mastectomy with expanders in October of 2013, followed by chemo and radiation. It is now time for my exchange surgery, but I really want the DIEP flap procedure. My plastic surgeon is hesitant to do the surgery. Is a flap procedure even an option at this point?

Answer: Thanks for your question. Yes it is possible and we frequently do replace expanders or implants with DIEP flaps. In other words the extra skin and fatty tissue from the tummy area. Some people may not have extra tissue to use from their tummy or may have had previous surgery (tummy tuck). In that situation we can usually find extra fatty tissue from another area without removing any of your important muscles. If your surgeon does not think you should do that, ask why. There may be a good reason. You can always get a second opinion if you like. Let me know if you would like more information. Thanks again.

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 am 52 years old and thinking about a bilateral DIEP flap surgery.

January 2, 2015 by

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

Question: I am 52 years old and thinking about a bilateral DIEP flap.

Answer: Thank you for your question. Have you already had a bilateral mastectomy? Do you have a specific question regarding the surgery? If you are thinking about a bilateral DIEP you have been considering options for breast reconstruction. This surgery can be done at the time of mastectomy or it can be done any time after. Also it can be appropriate for patients who have had breast cancer or who are at high risk for breast cancer. We would be glad to contact you for more specific information if you like.  

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 have just undergone a nipple sparring bilateral mastectomy, and I’m concerned about the outcome. What are my options?

December 26, 2014 by

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

Question: I am a 49 year old woman, and I have just undergone a nipple sparring bilateral mastectomy with a lat flap & expanders put in. My surgery was on 10/30, so I am at 3 weeks and am having necrosis issues on one nipple and in another area near an incision. I am extremely concerned about the outcome of my results and would love to hear your opinions as to what my options might be? We were actually scheduled for a trip to Charleston in Nov for 5 days that I regretfully had to postpone due to my recent breast cancer diagnosis. Any advice you could give me would be GREATLY appreciated!

Answer: Thank you for your question. I’m sorry your having some healing problems.   I know it can be stressful. It can also seem a lot worse than it really is. It is hard to picture the end result when you are going through the healing phase. When my patients have mastectomy skin healing problems we are very conservative and let the healing progess slowly and manage the wounds carefully. Many times the end result is much better than anticipated. I would be glad to see you when your in town to give you my opinion. Just let us know. We can try to make it convenient, it sounds like you could use a nice vacation. My office can contact you to make arrangements if you like.

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 Can Be Done for Inflammation of Scar Tissue?

December 19, 2014 by

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

Question: I have chronic inflammation of scar tissue after having breast cancer surgery and reconstructed surgery. I have been in pain now for over a year. What if anything can been done to for this?

Answer: Thank you for your question. We cannot specifically give you medical advice by email because we would need more information.  You should make sure your surgeons (plastic surgeon and breast) and oncologists know you are having problems right away if you have not already.  They will be familiar with your history and can make sure you have been checked thoroughly.

We specialize in breast reconstruction and frequently help patients having problems with their reconstruction. The effects of radiation and scaring can lead to problems and pain. We help patients with implant problems by replacing their implants with their own fatty tissue. If you would like more information I would need to have my office contact you regarding your specific situation.

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 double mastectomy in 2008 and now wish I had implants…is it too late?

December 12, 2014 by

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

Question: I had a double mastectomy in 2008 and now wish I had had implants…is it too late?

Answer: Yes, you can have breast reconstruction 8 years after your mastectomies. I have patients who have waited 22 years. Also its up to you and your plastic surgeon which technique is best for you. That includes implants. Thank you for you 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’m having implant difficulties. Can you help?

December 5, 2014 by

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

Question: I was diagnosed with triple negative breast cancer in my left breast in December of 2010. I had a lumpectomy in January 2011 followed by chemotherapy, a bilateral mastectomy and radiation. I have implants now. The right implant has dropped and the left is hard and contracted. I need help. My 36d has been replaced by 38b and the cups are too big. Please help.

Answer: I’m sorry you’re having problems with your breast reconstruction. Our practice specializes in breast reconstruction using your own tissue and preserving your body’s muscles.  Approximately 30% of our patients have already had implants and we remove them and complete their reconstruction without implants. You may already know that after radiation the chance for complications with implants increases. We have helped many women having similar problems to what you described. I would be glad to give you more specific information about your situation but I would need more information from you. I could talk to you over the phone or you could come for a consult depending on what is most convenient and where you live. Let me know.

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 the Reconstruction Options for an Overweight Person Who Had Radiation

November 28, 2014 by

pink flowerThis week ,Richard M. Kline, Jr., MD , of The Center for Natural Breast Reconstruction answers your question.

Question: What are reconstruction options for me as an overweight person who had radiation?

Answer: Thanks for your question. Knowing only that you are overweight and have had radiation, I can only speak in generalities, but it may be of some interest to you.

 

Radiated patients are far less likely to tolerate implants than non-radiated patients, so that may mean that you could be better served by natural breast reconstruction with your own tissue. While it can be extraordinarily difficult (sometimes impossible, actually) to achieve a satisfactory delayed reconstruction with implants in a radiated patient, radiation commonly has almost no impact on our ability to reconstruct you with your own tissue, since we are bringing fresh non-radiated tissue to the area.

 

Additionally, implants are only commonly manufactured up to a volume of 800 cc. While this may seem like a lot (and actually is a lot, when used for cosmetic augmentation), it often falls far short of the volume requirements needed by a large patient for a complete reconstruction. Fortunately, there is no firm limit on how large a natural tissue flap can be transferred, except for how much tissue is available. We have in the past transferred flaps in the (1500 – 2000) cc range with success.

Of course, extra weight (also depending to some extent on how it is distributed) can bring additional risks. Extra weight brings an increased risk of blood clots (which can be fatal), and an increased risk of wound healing problems. As a very rough guideline, and, again, with the knowledge that how the fat is distributed makes some difference, we start to get concerned when the BMI exceeds 30 and approaches 35. This doesn’t necessarily mean that surgery can’t be done, just that all of an individual’s specific risk factors and options must be scrutinized very closely before making specific recommendations.

 

I hope this has been of some help. Please feel free to call or email if you would like more information.

 

 

 

 

 

 

 

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Ask The Doctor-Can I Get Trans (TRAM) Flap Surgery if I Am Overweight?

November 14, 2014 by

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

Question: I’ve been told I cannot get Trans Flap surgery because I am overweight. In fact, the practice said there was nothing they could do for me. Is that so for you also?

 Answer:It is true that a person’s weight can be an important factor in the chances for serious complications during breast reconstruction. Specifically for a TRAM flap procedure the risks can potentially be life threatening! One of the most serious complications that can happen with any surgery is a blood clot in the leg veins that can become a blood clot to the lungs. This is called a pulmonary embolus. It is  true that the risk for this type of blood clot is increased in people who are seriously overweight. It does not mean that a patient has to be their ideal weight but at a certain weight the risk goes up. In order to completely answer your question I would need to know how much you weigh and how tall you are. Also your overall health and any other medical problems like diabetes or high blood pressure. If you were also a smoker that has a major impact on the risks. We look at each patient’s body mass index to determine if we should have the patient lose weight before surgery. We also like to evaluate each individual and the overall situation not just the weight alone. The body mass index is a general guide and we work with each patient to determine individual goals for their weight in order to make sure the risks are as low as possible. I hope I answered your question, let me know if you need more information.

Thanks for your question!

-James E. Craigie, MD

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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