Replacing an Implant With a Flap: Will My Muscles Recover and Function Normally?

The following question is answered by  Richard Kline of The Center for Natural Breast Reconstruction.

 

Q: My reconstruction consisted of chest muscle to create a pocket for a silicone implant. I have had it since 2004. They used an expander. It was the best choice for me at the time. If the implant is removed and the muscles are fixed, will they recover and function normally? For example, will I be able to do pushups and bench presses again?

 

A:  Thank your for your question. Although the muscle is replaced against the chest wall when an implant is replaced with a flap, it is impossible to duplicate the strength of the original muscle attachment.

Having said that, most patients function quite well with an implant under the muscle, and I’m hesitant to tell you you’ll see dramatic functional improvement if you convert your implant to a flap.

I hope this helps.

 

Richard Kline
Center for Natural Breast Reconstruction

 

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DIEP Flap Reconstruction Surgery After Capsular Contracture

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

Does anybody have any idea what the difference is “surgically” when DIEP surgery involves removing an implant that has developed a capsular contracture? That is what my situation is. I’m wondering if the skin that has been stretched over the implant will be removed, or become part of the new flap?

Thirty percent of our patients have previous implant surgery that has failed. During the reconstruction we remove the implant, implant capsule and any Alloderm that may have been used.   We also must return the chest muscle to its natural position because the implant always goes under the muscle. Unfortunately the muscle may be permanently changed from implant surgery. The stretched skin over the implant is allowed to recover and usually not removed.  If the skin initially needed to be stretched by the implant/expander then that indicates breast skin has been removed during the mastectomies. Usually skin from the DIEP will be needed depending on previous radiation and size of the DIEP breast. If the remaining breast skin is thin, tight, too scarred or damaged by radiation we may need to remove more of it at another surgical stage.

-James Craigie

Center for Natural Breast Reconstruction

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Are You Comparing Apples to Apples When Weighing Your Breast Reconstruction Options?

We at The Center for Natural Breast Reconstruction know that the Internet is a great place to read and share information, but it is also a great place to become misinformed. Before making any decisions about your breast health, please make sure to contact a surgeon to discuss all your options and make the most informed decision you can. Keeping with the spirit of the Internet as a research tool, today’s Ask The Doctor Question comes from a discussion forum we participated in on WebMD.com. The answer highlighted below in pink comes from our team and showcases the importance of making sure you really are comparing apples to apples when weighing your breast reconstruction options.

Q: Has anyone had a hard time with breast reconstruction after bilateral mastectomy? I had two infections in my right expander, 2 and 3 months after my surgery. The first we conquered with antibiotics; the 2nd we did not, and I had to have it removed 4 months later. I spent the last 5 months healing from that, and just last week had the expander replaced. Hoping for the best this time! But there is significant skin loss on my right side, and my surgeon wonders if there will be enough stretch to accommodate saline fills to match my other side. And of course we all wonder if THIS expander will behave itself and not get infected. Has anyone had this experience, or one similar? Thanks.

A: Why don’t you go with the DIEP Flap procedure – they use the fat and skin from your abdomen area – I have had no problems from this procedure and I have heard of a couple of people who have had issues with infection with the expanders. Find yourself a Plastic Surgeon who does the DIEP Flap procedure

A: I also had a bilateral mastectomy but had to wait 2 years before reconstruction. I also had the expanders but had no problems, maybe it was too soon after your surgery. I would not recommend a tram flap ,it just sounds like an awful surgery.

A: There is a difference between and DIEP Flap and a trans flap.
The DIEP Flap they only take the fat and skin from your abdomen nothing else – they find a good blood supply at the reconstruction site. The Trans Flap is they take your stomach muscle and pull it up through to the breast cavity and also bring the fat and skin from the abdomen area. I for sure was glad that I did not do the Trans Flap.

A: (The Center For Natural Breast Reconstruction’s Answer) The free TRAM flap sacrifices a portion of the transrectus abdominus muscle (hence the acronym TRAM) but doesn’t tunnel it up through the abdomen. The DIEP flap does not use any of that muscle to transfer the blood supply to the reconstruction site. A skilled micro-surgeon with fellowship training in muscle sparing free flap reconstruction provides a permanent reconstruction option with a successful DIEP without sacrificing needed abdominal musculature. There is A LOT of great information on the web about this and what questions you should ask to make sure you are choosing a microsurgical team who has the experience and at least a 98% success rate. Talk to ladies who have had DIEP, GAP, HIP, SIEA flaps ( but not TRAM, it’s not the same) and see what kind of downtime they have had, you’ll probably find it similar to the amount you have had with the repeated implant/expander problems. Best wishes on your research and recovery.

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DIEP Flap Procedure: Is this covered by my insurance?

mental healthThe below question is answered by Charleston breast surgeon, Dr. Richard Kline of The Center for Natural Breast Reconstruction.

I had a double mastectomy last month and am considering the DIEP procedure. My insurance is Aetna PPO and I wanted to know if this is covered. Also, I keep reading about stage 11 follow up to do lipo on the upper abdomen so it is flat like the bottom half ( after surgery) . Is that part of the reconstruction and is it covered by insurance? Thanks

Hi,

I’m almost sure we are in-network for you, but our office will let you know for sure.

We use liposuction to help correct some donor site deformities, such as bulging of the upper abdomen, or fullness of the “muffintop” areas. Often, that fat can be used as graft to enlarge the DIEP flaps, or improve little areas of asymmetry. If we place fat in the breast, we add a code for fat grafting for the insurance company, but we never bill anyone for liposuction per se.

Hope this helps, and thanks for your question.

Richard Kline
Center for Natural Breast Reconstruction

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Could I Be A Candidate for DIEP Reconstruction After Implants?

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

I had a bilateral mastectomy and had 850cc silicone implants placed after tissue expansion. I am not happy at all with the result as I had radiation on the right side and that breast is considerably smaller than the left. I am also not happy with the shape and look of the breasts with silicone implants. I currently wear prosthetics in my bra to achieve symmetry and a normal shape. Even with the bra and the prosthetics I am not happy with the result. I am currently a D/DD and would like to maintain that size. Given this situation, could I be a candidate for a DIEP or Stacked DIEP breast reconstruction?

Thank you for your question. I’m sorry you are having some concerns about the shape and evenness of your breast reconstruction. Because you had radiation on the right side it is almost certain that the two sides will be different to some degree regardless of the type of reconstruction. Unfortunately, when this occurs with implant techniques it is usually more noticeable and nearly impossible to fix long-term as long as the implants are in place. The reason for this is the implants will be treated as foreign material by your body and the right side will always react more severely due to previous radiation even if radiation was done before the mastectomy. Also, the process of scar formation continues as long as the implants are in place, making the firmness, shape change, and stiffness more noticeable to you as time goes by. These are the reasons that women who have implant reconstruction have multiple procedures to revise results as time passes.

Fortunately when someone has had problems of this nature with implants we can frequently solve them by removing the implants and replacing them with their own fatty tissue (DIEP, stacked DIEP). We can do this without taking tummy or back muscles. Immediately the fatty tissue takes on a more natural shape compared to implants. Thirty percent of my patients have had failed implants before we start over and use their own tissue. My opinion and answer to your question is that you could have a DIEP to replace your implants and I can usually predict that many of the implant problems are much improved immediately after the surgery. I cannot predict what size you would be without seeing you but the size depends on how much extra tummy tissue you have as well as any previous surgery.

I hope I have answered your questions.

—James Craigie MD

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The A, B, C’s (and D, DD, E, F’s) of Proper Bra Fitting

It’s estimated that 8 out of 10 women are wearing the wrong size bra. That’s 80%, ladies – shocking! We are delighted today to feature our guest blogger, Cindy Bunce, of Chantilly Lingerie on West Coleman Boulevard in Mt. Pleasant. In this interview, Cindy shares the basics of proper bra fitting.

See below for our interview with Cindy:

How do you find the proper size? What measurements should I be using? 

Our staff is devoted to putting our customers in the correct bra! It is a sad fact that the majority of women are spending time in an unsupportive, improperly fitting bra. At Chantilly we do not use a measuring tape to fit bras because there is more to it than the width of your chest and back, and depending on the bra company, your size may vary.

What are some indications that I might be wearing the wrong size bra?

We begin the fitting with an actual bra and adjust the size by visually checking the fit. If you are constantly pulling your strap down in the back, you are in the wrong bra. If your strap falls off your shoulder, your bra is not fitted properly. Your bra should not give you rolls under your armpit or make it impossible to breathe. A properly fitted bra will make all the difference in how you look and feel.

How important is it to have a professional bra fitting performed?  Is it expensive?

A properly fitted bra will make all the difference in how you look and feel. Our fittings are free, and we offer a large variety of styles, cuts, and colors. Something for everyone! Come see us at Chantilly in Mount Pleasant. You will be glad you did!

Visit Chantilly Lingerie today on West Coleman Boulevard or follow them on facebook!

 About Chantilly Lingerie: Originally from Mt. Pleasant, Letha Polk has owned and operated Chantilly Lingerie for 24 years. Chantilly Lingerie realizes more than anything that form-fitting and flattering clothing is the most important thing to a woman as she shops. That’s why Chantilly Lingerie specializes in finding the undergarment that fits your body. A proper-fitting bra is important for comfort and flattering the figure. Sizes range from a 30 A all the way through to a 40F .

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Can I Use Vitamin E on Incisions Resulting from Breast Reconstruction Surgery?

vitamin e on incisionsThe below question is answered by Charleston breast surgeon, Dr. James Craigie, of The Center for Natural Breast Reconstruction.

Is Vitamin E of any use on incisions? 

Scarguard or silicone sheeting may be a better alternative.  There are several things, scientific improvements, which helps the appearance of scars. Silicone is probably the most effective.  Silicone works by an unknown mechanism to help soften raised or severe scars regardless of how old they are.  The other technique proven to work is massage.  Topical massage can help the scars whether they are new or old and combined with silicone is probably the most useful combination treatment for difficult scars.  Scarguard is a product that contains silicone, comes in a liquid form is painted on like fingernail polish, and because of the silicone component it is effective for some scars.  Regarding Vitamin E, there have been some studies to hint that it may help with scar formation and some people find a benefit in taking vitamin E orally from a capsule or rubbing it into a scar.  However, it may be that massage is more effective than the Vitamin E.  In summary, the best answer is that all of these techniques can help.  They must be used at the appropriate time so it is always best to ask your surgeon for guidance as to when the best time to begin scar therapy would is.  Also, it is important to know that no technique will make scars disappear completely.  The goal with these treatments is either to minimize the severity of the scar or to improve its appearance.

-James E. Craigie, M.D.

Have questions about breast reconstruction options? Submit them here and get answers straight from our surgical team!

 

How One Woman Took Action Against Breast Cancer

Sue Young (right) pictured with Patricia Simon.

Today, the team at The Center for Natural Breast Reconstruction is honored to share with you an In Her Words post written by a dear friend, breast cancer survivor and active advocate, and the latest recipient of the Charlene Daughtry Award from Komen Lowcountry, Sue Young. She is an inspiration to all women who are facing breast cancer and proves there is strength in numbers and together we can get through anything.

 Read below for our interview with Sue.

1. You are a great advocate and an active volunteer for Susan G. Komen for the Cure  Lowcountry. Tell us what you’ve been doing to support women who are experiencing breast cancer or know of someone who is?

I’m a huge advocate of finding out everything you can about your options once you are told you have cancer.  Most people, me included, don’t really think about it until it happens to you or someone you care about.  I started volunteering with Komen after being diagnosed and reading Nancy Brinker’s book, “Winning the Race – Taking Charge of Breast Cancer”.  I was inspired to be a part of their story, their work.  Because of my diagnosis and participation, I have met and become friends with a number of people spanning all the facets of cancer.  I met doctors, nurses, volunteers, film directors, dragon boaters, comedians, politicians, fund-raisers, hospital and other medical administrators, survivors and co-survivors, and sadly, people that eventually would lose their battle.  Having met so many new and diverse people that I wouldn’t have met otherwise, when someone comes to me with questions about cancer, I can tell them what I’ve learned or connect them with people who know much more than that.  I may not be able to answer every question, but I know someone who knows.  The more you know about what you’ll deal with, the better equipped you are to make it down that “pink ribbon” road.  It’s a journey to say the least, and it is so much easier when you don’t have to take the trip alone.    I’ve always had a volunteer spirit, it’s nice to be there when someone needs you.  My mother taught us by example; she always responded when a “need” was presented.  From giving the postman a mayonnaise jar of iced water every day to raising funds to air-condition our elementary school, Mama took action.  She’s 81 and still going strong!

2. You are truly an inspiration to women who have been affected by breast cancer! Tell us how you managed to stay positive and embody the selflessness volunteer spirit while undergoing breast cancer treatment. What inspired you to keep moving forward? 

I was able to stay positive through my cancer treatments in three ways:

1.) I had an amazing support group.  My husband, Tom, was loving, caring, and understanding.  He was committed to me and my well-being through it all.  My family and friends went the extra mile, supporting my decisions, helping with the special things, and keeping the routine things in order.

2.) I had a super medical team.  Everyone, from the doctors to their staff was on their “A-game.”  They were educated, they were professional, they were caring, they were patient, they had a plan and they guided me through every step, every phase.  I felt like I was their only patient, but I knew they were being everything they were to me to others every day.

3.) Each time I started to sink into a depression, God sent someone into my life that seemed to have a bigger battle than I did.  I was reminded on more than a few occasions that I was not alone and that I had the tools to take the next step.  There was always someone that didn’t have the support group, didn’t have the medical team, didn’t get the positive answers that I got.

3. You are the 2012 recipient of the Charlene Daughtry Award from Komen Lowcountry. Tell me a little about this award and what it means to you personally.

I saw the first recipient receive the award at my first Komen Survivor Celebration in October, 2005.  I’d never met Charlene and she had already lost her battle with cancer.  I don’t know that I remember who got it the first couple of years.  It didn’t really became personal to me until  it was awarded to Lucy Spears.  I’d worked with her on a couple of Komen projects.  She was a tremendous volunteer with unending energy and drive – still is.  Bonnie Hancock received it the next year; I served on a committee with her for several years.  Again, selflessness embodied.  Gene Glave received the award last year . . . her last Survivor Celebration.  The Komen Board chose each of these women because they carry on Charlene Daughtry’s dream, her enthusiasm, her courage.  Me?  Part of this group?  I fear I don’t measure up, but I am honored, and I am humbled to be included.  Charlene, the recipients I know, and myself – our common threads?  Breast cancer, a desire to share our stories, our experience, and our courage with others.  Just like the candle-lighting ceremony at each Survivor Celebration, it’s about igniting your own light and passing it on to others.

4. What is the one thing you want all women to know about breast cancer?

Look for it!  Catch it early!  Deal with it!  Do not ignore it!  Know you are not alone.  There’s help every step of the way.

5. You have achieved so much and given back since being diagnosed with cancer. What is next for you in life? 

We’re still a few years from retirement, but that’s the next big thing.  Tom and I want to travel.  We’ve been to some wonderful places already: Jamaica, Hawaii, Barbados. We want to take some longer trips to see more of America up-close.  Of course, we’ll be planning those around small trips to Rock Hill to see my sister’s growing family.  Her third grandchild is due in March.  I want to make sure Kaylee (2-1/2), Wyatt (3 months) and G-baby #3 know they have great-grandparents and a great-aunt and great-uncle in Charleston.  I’m sure I’ll still find time for Komen.  Wouldn’t it be nice if Kaylee didn’t have to worry about breast cancer?

 

Capsular Contracture From Breast Implants

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

I have had two failed breast reconstructions using an implant. First was placed too high up, and the second one anchored down with abdominal advancement flap. After 5 months the implant began to disappear. MRI proved it was not ruptured. Doctors were not worried  and I was told to stop worrying about it, so I continued on with my life. I then developed chest pain, muscle/ligament/joint/back pain and breathlessness when climbing hills or stairs. Eventually after 2 and a half years, I referred back to PS who told me I had a chest wall concavity due to the implant being forced inwardly under pressure from the scar tissue and muscle. The implant size was 770cc. Will this concavity “spring” back into place or will I have it for the rest of my life? Also what effects might this have on my body if my frame is being pushed out of alignment?

Hello,

Thanks for your question. I’m sorry you have had these problems. We see people whose chest wall and ribs become indented due to implants quite frequently. The problem develops because body reacts to the implant by making scar. We call this capsular contracture and in some people it can exert tremendous force due to constant pressure. The process will persist as long as you have an implant. We have not performed scientific studies to prove the ribs return to normal but we have treated hundreds of patients with this type of problem by removing the implants and replacing them with their own tissue with out taking their muscles. This has solved their problems related to implants permanently. I hope this answers your question, let me know

James Craigie, MD
Center for Natural Breast Reconstruction

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Complications From Vascularized Lymph Node Transfer

The below question is answered by Richard M. Kline Jr., M.Dof The Center for Natural Breast Reconstruction.

I am recovering from a DIEP flap reconstruction and lymph node transfer. I had breast cancer when I was very young and have had lymphedema for 25 years. I was so happy to hear that there was a surgery that possibly could correct the swelling in my arm that I jumped on it with out really researching. I am two weeks into my recovery and I have noticed swelling in my leg and groin. The groin I think is normal for a surgery site. However, the swelling in my leg Im afraid is the onset of lymphedema. I would appreciate any information you could share with me on this .

Hello,

Sorry you are having problems.

As your surgeon probably explained to you prior to surgery, vascularized lymph node transfer is experimental surgery, and no one really knows how often it works, if at all, and what the complication rates are.

As your surgeon also probably explained, lower extremity lymphedema is a potential risk of the node harvest. We strictly limit our node dissection to the area lateral to the superficial inferior epigastric vein and superior to the inguinal ligament, and have thus far had no problems with lower extremity lymphedema developing after the procedure. You may wish to consult with your surgeon about having bioimpedance analysis of your affected lower extremity performed to determine whether early lymphedema is actually present. If it is, then prompt institution of treatment may be advisable.

Richard Kline

Center for Natural Breast Reconstruction

Get answers to your questions about breast reconstruction straight from our surgical team! Submit your questions here today.