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Weird Breast Issues That Aren’t Really Weird At All

August 22, 2011 by

breast changesFrom nipple leakage to uneven sizes, our breasts often confuse or scare us. Most of the time, what appears to be a breast problem isn’t a problem at all, but a completely normal occurrence. Breast information isn’t at the forefront of the news unless it’s connected to cancer, so we don’t receive much information about breast issues that aren’t serious.

The following breast issues are typically normal, even though they may seem odd. Let us stress that if you have questions about any breast issue, or feel that something isn’t right, do not hesitate to call your doctor. Always listen to your gut and intuition.

Uneven breast sizes

If you look closely at other parts of your body that come in pairs, such as your eyes, hands, and feet, you’ll see that each one of the pair is different from the other, and this includes your breasts. Some women may find that one breast is a size or two different from the other, and this is normal.

Lumpy breasts

Have you ever driven yourself crazy because you think you’ve found several lumps during a self-exam? This one can be scary, but for some women, lumps are a normal part of their breast tissue. Called fibrocystic breasts, this noncancerous condition is very common, especially among premenopausal women. Dense breast tissue tends to feel lumpy, which is one more reason to know what is normal for your breasts and do thorough monthly self-exams.

Nipple leakage when you’re not pregnant

Nipple leakage is common, and fluid can be almost any color or consistency. Some women experience spontaneous leakage, while for others, the leakage occurs only if the nipple is stimulated. Rarely, leakage signals something more serious, so check with your doctor if you’re concerned or it regularly occurs spontaneously.

Extra nipples

Some men and women are born with extra nipples, much as female animals have. According to Texas ob-gyn Michael Yang, MD, when a fetus forms, it has a milk line with several nipples that runs from the armpits down to the groin. Extra nipples typically disappear before birth, but some don’t, and their appearance ranges from molelike to actual miniature breasts.

Menstrual cycle-related breast changes

Thank your hormones for those breast changes during the month. Estrogen and progesterone increase and decrease during your cycle, which can cause breast tenderness and nipple soreness. If your breasts are unbearably sore, ask your doctor for advice on nutritional support.

Weight gain or loss from breasts

Speaking of breast changes, women often lament the fact that when they lose weight, it comes from their breasts first. Because breasts are mostly fat, it’s normal for them to change size when you lose weight.

Again, call your doctor with any breast-related concerns or questions.

Filed Under: Health and Wellness Tagged With: , , , , , , , ,

Your Questions About Breast Reconstruction Answered

August 19, 2011 by

nipple sparing mastectomyThe questions below are answered by the breast reconstruction surgeons of The Center for Natural Breast Reconstruction, Dr. James Craigie and Dr. Richard Kline:

If a woman has flap reconstruction, are the nipples reconstructed at the same time or at a later date?

While it is sometimes possible to reconstruct the nipples at the same time, usually for various reasons it is preferable to delay the nipple reconstruction until a later time. Nipples must be positioned very carefully to look their best, and that means the final shape of the breast mound must be stable prior to choosing the nipple position. Tissue flaps must be carefully monitored for several days following the initial reconstruction to assure early detection of any problems, and temporarily leaving extra flap skin on the breast mound helps greatly with this. Additionally, FWIW, the skin that the nipples are reconstructed from, whether flap skin or native breast skin, frequently has no sensation, making it even easier to reconstruct the nipples as a small procedure in the office.

If a woman is a candidate for a nipple-sparing mastectomy, can she have flap reconstruction and retain her nipples?

Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Can you explain what you mean by a muscle-sparing free flap breast reconstruction?

“Muscle-sparing” simply means that NO MUSCLE TISSUE at all is removed. This does not necessarily mean that the muscle suffers no injury, as the blood vessels which nourish the flap usually must be removed from the muscle, but the amount of damage is commonly small enough that the muscle ultimately recovers its function.

What are some criteria that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

For more information on breast reconstruction, visit our website.

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Dining Out in The Charleston Area: Mount Pleasant

August 17, 2011 by

charleston restaurantsCharleston is famous for its restaurants! From succulent Lowcountry fine dining to zesty Italian bistros, and quaint barbecue hot spots to vibrant Mexican eateries, Charleston truly is a culinary melting pot.

For many of you who are visiting from out of state, you may not be aware that Charleston is segmented into various different areas that include downtown Charleston, Folly Beach, James Island, Johns Island, Mount Pleasant, North Charleston, West Ashley, and Daniel Island (there are a few other neighboring cities, towns, and islands thrown in there, but these are the main ones). Each and every area in Charleston is home to exciting restaurants, cafes, bars, and pubs that naming them all in one blog post would be way too much. This is why we’ve decided to create a series on Charleston restaurants. Each post in the series will focus on a different area of Charleston and some of the best restaurants found in that area.

This first post will focus on Mount Pleasant, which is located right across the Ravenel Bridge from downtown Charleston.

Below are just 5 of our favorite restaurants and cafes in Mount Pleasant:

Crave: Serving up artisan sandwiches, pasta, steak, and seafood, Crave provides an eclectic mix of various foods that are sure to delight your palette. The atmosphere is casual and the food is moderately priced. One of our favorite dishes is the turkey club sandwich complimented by a mermaid martini!

1968 Riviera Dr # O, Mount Pleasant, SC 29466 / (843) 884-1177 / brunch, lunch, dinner

Mustard seed: For some great food, a casual atmosphere, and excellent service, take a trip to the Mustard Seed. This quaint restaurant features everything from creamy pasta dishes to fresh salads, chicken entrees to mussels and linguine, and much more. The bread that they put on your table at the beginning of dinner is also exceptional and is covered in seasoning and cheese.

1036 Chuck Dawley Boulevard,Mount Pleasant, SC 29464-4178 / (843) 849-0050 / lunch, dinner (not open Sundays)

Yamato: If you love Hibachi-style cooking as much as we do then you’ll definitely want to check out Yamato. With a fun and social atmosphere, great food, huge portions, and silly chefs, Yamato will instantly steal your heart. This restaurant is particularly great for larger groups.

1993 Riviera Drive, Mount Pleasant, SC 29466 / (843) 881-1190 / dinner

Red Drum: With somewhat of a Tex-Mex thing going on Red Drum will add a flair to your night. Serving up excellent culinary masterpieces such as lamb shank, fresh seafood, and enchilada appetizers this elegant restaurant is sure to knock your socks off. Note that Red Drum is considered fine dining and we suggest calling in advance to book a reservation.

803 Coleman Boulevard, Mount Pleasant, SC 29464 / (843) 849-0313 / sunday brunch, dinner (closed Mondays)

Mozzo: This deli is a must when visiting the Charleston area. With a huge selection of artisan sandwiches, pasta salads, cole slaws, and desserts, it can be easy to go overboard when dining at Mozzo. They’re a deli that definitely knows what they’re doing. Some of our favorite sandwiches include the Roma, The Godfather, Fusion, Dig the Fig, and Fat Boy.

730 Coleman Boulevard, Mount Pleasant, SC 29464 / (843) 388-5755 / breakfast, lunch

Some other Mount Pleasant restaurants that we love include Opal, Langdon’s, Jacob’s Kitchen, Basil, Next Door, Sette, and Uno Mas (great margaritas).

Have you ever been to Mount Pleasant? What’s your favorite restaurant in the area?

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How One Cancer Survivor Embraces Life After Cancer

August 8, 2011 by
Debbie Woodbury

Debbie Woodbury

We are not only delighted, but we are also extremely honored to introduce our In Her Words guest blogger for today, Debbie Woodbury. As a cancer survivor, blogger, speaker, and advocate, Debbie has become an inspiration to all women—no matter their age or health history. In our interview with Debbie, she talks about her amazing blog, Where We Go Now, and discusses the benefits she, as well as her loyal readers, receive from reading her blog.

See below for our exclusive interview with Debbie:

1. Where We Go Now is a completely unique blog that acts like a community and resource for women. Who is Where We Go Now for and what benefits do you hope readers get from visiting your blog?

Thank you so much for inviting me to lend my voice to In Her Words.  WhereWeGoNow.com was created for cancer survivors exploring the gifts and losses of life beyond cancer. The idea for the site came from my own journey. About nine months after my mastectomy, I startled to realize I was keeping a tally in my head of the changes cancer was bringing me. Although I was excruciatingly aware of the losses, I was begrudgingly recognizing gifts. When I could ignore the gifts no longer, I decided to write them down side by side with the losses.

The losses were obvious, but there were a surprising number of gifts. Introspection, closer relationships, discovering yoga and meditation, making new friends, becoming aware of the present moment, learning to say “yes” to myself, and writing—just to name a few.

That list is now the heart of WhereWeGoNow.com. We’ve all taken major, earth-shattering losses, but I hope readers visiting WhereWeGoNow.com are inspired to recognize cancer’s gifts in their own lives. The most beautiful entries readers have posted are found at the Community Gifts and Losses List page. My Gifts and Losses List helped me find emotional healing and balance after cancer and I hope readers visiting WhereWeGoNow.com receive the same benefit.

2. What benefits do you receive from blogging about your life after cancer? (i.e. clarity, joy in helping others, etc.)

With each blog post I write, I still manage to surprise myself by writing down a thought I didn’t know I had until it hit the screen. Blogging brings me a deeper understanding of what I went through, and continue to experience, because of cancer.

Blogging also taught me that survivorship is a multi-faceted, life-long journey. I’ve blogged about my “beautiful,” eloquent cancer scars; yoga; how giving back to others helped me heal from cancer depression; awful summers and moving beyond them; my first survivors’ walk, the best thing anyone ever said to me about my cancer, and so much more.

Of all the posts I’ve written so far, however, I probably learned the most from the one I wrote about gratitude. I learned in writing that post, which I also gave as a speech, that I never would have recognized cancer’s gifts without gratitude, cancer’s first and most important gift to me.

The most wonderful part of blogging is getting comments back from my readers. It’s so gratifying to know my experiences have struck a chord with other survivors and perhaps made a difference in how they approach their survivorship. I will never say that cancer itself is a gift, because it is not. But recognizing the gifts it brought and continues to bring into my life is very healing for me.

Stay tuned for Part II of our interview with Debbie, which will publish this Wednesday, August 10!

About Debbie Woodbury:

Debbie Woodbury is a cancer survivor, blogger, speaker, and advocate. She entered the diagnostic and treatment phases of breast cancer in 2008. When she completed treatment in 2009, she was left to deal with cancer’s emotional impact. With the support of family, friends, and wonderful oncology therapists, she was able to create her Gifts and Losses List and eventually realize that “Survival > Existence.” The Gifts and Losses List became the heart of WhereWeGoNow.com, a community of survivors sharing the gifts and losses of lives lived beyond cancer.

Connect with Debbie on Twitter and Facebook.

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How One Entrepreneur Didn’t Let Breast Cancer Get In The Way of Her Success

July 25, 2011 by

Leslie with her girls.

When Grill Charms™ creator, Leslie Haywood, agreed to participate in a guest interview for our blog we were ecstatic to share her story with our blog readers. We KNOW you are going to love her story.

We’ve known Leslie Haywood for over a year now and, to date, she has been one of our favorite patients! When Leslie was diagnosed with breast cancer, she came to the team at The Center for Natural Breast Reconstruction to receive a breast reconstruction procedure from Dr. Craigie. And something sort of funny happened. She made her first Grill Charms™ sale topless in the doctor’s office! But I won’t spoil the story for you (and there’s even a SPECIAL OFFER, just for you, our blog readers, at the end of this blog post!).

Read below for Part I of our exclusive interview with Leslie:

1. You are truly an inspiration to women who have been affected by breast cancer! You started your own company, Grill Charms™, and had mommy responsibilities, all while you were undergoing treatment for breast cancer. Tell us how you managed to stay positive and what inspired you to keep moving forward with your business during this difficult time.

Yes, two months into starting my company I was diagnosed with breast cancer. I can’t say it was much of a surprise. My first introduction to breast cancer was 1989 when at the tender age of 16 my 30-something-year-old parents told us that my mother had breast cancer. By the time they caught it, she was stage IV and the doctors told her she had 6 months to live.

In the months that followed,  my parents along with their best friends stayed up nights and weekends trying to figure out how my father, who was a master chief on nuclear submarines in the Navy, and only home 6 months out of the year was going to raise his 10, 12 and 16 year- old daughters alone. I had been living with the reality that there was a high probably that someday; I too might be facing this disease. The fact that it happened shortly after I started on my quest to conquer the world one cookout at a time, was a bit of a nuance however!

It wasn’t long when the sentinel node biopsy showed that THIS cancer would not kill me. We knew early on that I would not have to make plans for my daughters’ lives without a mother. I think it was during this time that people started thinking I was in denial. Here I was, diagnosed with breast cancer at the age of 34 with 1 and 3 year old daughters, a brand new company and yet I was truly the happiest women on earth. “You mean to tell me doctor, that I have breast cancer and you didn’t give me an expiration date??!?!”

Non terminal breast cancer . . . what a precious, precious gift I was given! Now that it is all said and done, I’ve got two brand new pieces / parts (and let’s face it . . .  after nursing two babies, they weren’t much to write home about anyway), a bonus tuck (THANK YOU DR. CRAIGIE!) and most importantly . . . I get to live. I always viewed them as a pair of B-sized ticking time bombs anyways, so good riddance. There was certainly no time to dwell on THAT, I had steaks to save and taste buds to rescue! By the way . . . about my mom . . . the doctors underestimated her… my mother is still here, 23 years cancer free!

2. Grill Charms™ are adorable and perfect for individuals who love to host outdoor parties. What are Grill Charms and how do they work?

Why thank you! Grill Charms™ offers an entirely new concept in outdoor entertaining. They are dime-sized solid stainless steel charms that are placed in your food BEFORE grilling. The serrated stems hold them in securely while flipping, moving, and grilling food like you normally do. Grill Charms™ are you use in food prior to cooking to distinguish spices and flavors, steak temperatures, or to avoid health or allergy issues. Grill Charms™ identifies your food before, during, and after grilling so when dinner comes off the grill, simply look for your Grill Charm™, and everyone knows which one is theirs. With four collections for different purposes, they are the perfect gift for Father’s Day, birthdays, groomsmen, Valentine’s Day, other holidays, and housewarming or hostess gifts—you name it!

3. You started a Pink Collection of Grill Charms™, which we absolutely love! Tell us about these charms and where the proceeds go.

For a truly unique grilling and dining experience, The Pink Collection has six different charms so food can be personalized prior to grilling to distinguish spices and flavors, to avoid health, or allergy concerns or for any reason you can dream up! There is a hot new party trend with this collection, and that is the “Season Your Own” cook-out. This is where the host provides the meat, the guests pick their Grill Charm™, then choose from a variety of sauces or rubs that the host has set out. Guests flavor their meat any way they wish and nobody, including the grill master, needs to know or care how it’s seasoned.

 

The Pink Collection

The Pink Collection of Grill Charms™

When the food is served off the grill, folks simply look for their Grill Charm™. With people watching every penny, it’s more important than ever that when they splurge on buying that filet, or carefully choose that chicken breast to spend their hard-earned money on, that it’s cooked and seasoned exactly the way they want it.  And with The Pink Collection, I donate 10% of the proceeds to The Breast Cancer Research Foundation, as well as my local Komen Foundation.

This collection also helps with health or allergy issues. With Grill Charms™, if someone has a specific health or dietary need (such as needing a no-sodium, low-sugar, or possibly a gluten-free spice alternative), Grill Charms™ makes it easy for people to identify their food before, during, and after grilling, without any confusion or effort on the part of the grill master.

About Leslie Haywood and Grill Charms™:

Leslie Haywood is founder and President of Charmed Life Products, LLC, and inventor of Grill Charms™. Leslie was a stay-at-home mom when a very spicy light bulb moment thrust her into the entrepreneurial ring. During the start up phase of her company, she was diagnosed with breast cancer, but still managed to launch her product on store shelves within 18 months and is now sold in over 400 stores internationally. She has been featured numerous times on CNBC, various local and regional news programs, as well as ABC’s prime time reality TV show Shark Tank seasons I and II. Her story and product have publicized in such magazines as Everyday with Rachael Ray, Parenting magazine, Health magazine, Inventors Digest, and was also featured on The Today Show. All the while she is mindful of “the cause,” whether it’s giving back through “The Pink Collection” of her gift and grilling accessory Grill Charms™, or her work as Honorary Chair for The Race for the Cure .

Leslie’s Special Offer:

***Put “natural” in the coupon code of www.grillcharms.com for 10% off!***

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Visiting Charleston? Here’s What You Should Do: Part II

July 18, 2011 by

charleston scIf you missed Part I of this post, click here.

See below for the rest of our top 10 things to see and do in Charleston list:

6. Golf: World-renowned for its exceptional golfing scene, Charleston has been attracting avid golfers to its lush greens for years. In fact, Charleston is so well-known for its golf that The PGA of America’s 94th PGA Championship in August 2012 will be held at the famous Ocean Course at Kiawah Island Golf Resort, located just outside Charleston.

7. Magnolia Plantation and Gardens: Explore the stunning gardens and manicured landscapes of Magnolia Plantation as you learn about the area’s history that dates back to the Civil War. You can even enjoy a trip around the plantation on a nature train or boat tour. And after you’ve explored all that the plantation has to offer, stop by their petting zoo!

8. Shopping on King Street: Boutiques galore, King Street is one of the hottest shopping districts in all of Charleston. With a variety of shoe, accessory, jewelry, and clothing boutiques to visit, you’ll always find something new and exciting that you can’t find anywhere else. In addition to one-of-a-kind boutiques, King Street also features some well-known stores including Gucci, Lacoste, Pottery Barn, Sunglass Hut, J.Crew, and more.

9. Downtown Carriage Ride: Take in the sights, sounds, and aromas of downtown Charleston on a charming carriage ride through the historic district. Whether you want your own personal Charleston carriage ride or would prefer to embark on a group tour, the option is up to you. During these tours, your guide will point out some interesting and unique facts about Charleston’s history that you would have never known by simply walking around downtown on your own.

10. Art Walks: Every first Friday of the month, downtown Charleston plays host to a delightful art walk. Depending on where the art walk is held that month, people can visit a variety of galleries (after hours between 5:30 and 8 p.m.), while sipping on free wine, cheeses, and light snacks. The artistic creations found in the art galleries throughout Charleston range everywhere from photography to colored pencil, and various painting mediums to intricate sculptures. And for art walks happening on Broad Street, keep an eye out for Zan Smith, an artist who creates unique frog sculptures that are unique to Charleston!

Have you ever been to Charleston? If so, what’s your favorite part about this wonderful city?

Filed Under: All Things Charleston Tagged With: , , ,

What is Capsular Contracture?

July 15, 2011 by

breast reconstruction

The below question is answered by The Center For Natural Breast Reconstruction team:

I’m considering implant-based breast reconstruction. My surgeon mentioned a “risk of capsular contracture.” What exactly is that?

Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.
The occurrence of capsular contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule tightens and squeezes the breast implant; as such, it is a medical complication that can be very painful and discomforting, and might distort the aesthetics of the breast implant and the breast.

Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.
Moreover, because capsular contracture is a consequence of the immune system defending the patient’s bodily integrity and health, it might reoccur, even after the requisite corrective surgery for the initial incidence.

The degree of an incidence of capsular contracture is graded using the four-grade Baker scale:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

–The Center for Natural Breast Reconstruction team

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Visiting Charleston? Here’s What You Should Do: Part I

July 13, 2011 by

Charleston vacationWhether you’re a Charleston resident, visiting Charleston for some rest and relaxation, or coming to Charleston to visit The Center for Natural Breast Reconstruction, there are tons of wonderful activities to take part in, no matter your special interests.

Here is our list of top 10 things to do and see while visiting Charleston, SC:

1. The Aquarium: For all ages, the South Carolina Aquarium is an aquatic wonderland! Filled with exotic species and local creatures alike, the Aquarium offers visitors the opportunity to view a nice assortment of some of the world’s most enchanting animals. One of our favorite features of the South Carolina Aquarium is their Sea Turtle Hospital, where they house injured sea turtles and rehabilitate them before releasing them back into their natural habitat. We also love the river otter and albino alligator exhibits.

2. Ghost Tours: For a little spook, embark on an exciting ghost tour around downtown Charleston to get a feel for why Charleston is known as a haunted city. Some of the ghost tours include dungeon, graveyard, and old jail tours.

3. Wine Strolls at Middleton Plantation: Every Wednesday, up until November 16, Middleton Plantation hosts an exciting Wine Stroll where visitors can delight in tasting a broad selection of wines and stroll through the plantation’s pristine gardens. Tickets are $15 per adult and are a bargain, in our minds!

4. Relaxing on the Beach: From Folly Beach to Isle of Palms, there is a nice selection of beaches to find pure bliss on. Each beach has its own ambiance and nearby attractions, which makes Charleston perfect for all travelers. No matter which beach you choose to visit, you can’t go wrong!

5. Downtown Dining: When it comes to downtown dining, there are dozens upon dozens of options to choose from. It’s impossible to pick one as your favorite. But, some of our absolute favorites include: Cru Café, Hominy Grill, Carolina’s, Peninsula Grill, Fleet Landing, Mercato, Rue de Jean, and the list goes on and on! There are lots of options when it comes to pricing, as well. Restaurants range everywhere, from fine dining to casual eateries.

Stay tuned for Part II of this post where we share five more of our favorite things to do while visiting Charleston.

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Don’t Live in Charleston But Still Want a State-of-the-Art Breast Reconstruction?

June 17, 2011 by

Chris MurakamiThe question below is answered by Chris Murakami, RN, CNOR, and Clinical Supervisor (seen to the left) of The Center for Natural Breast Reconstruction.

I live in Florida and would like to come to Charleston to have a bilateral S-GAP by Dr. Kline and Dr. Craigie. Do I need to come in for a consultation first and then come back at a later date to have the surgery or can it be done all in one trip? Please tell me how this is typically handled.

Great question! There are many ways to approach this situation and do our best to try to minimize the number of trips you need to make to Charleston. You are more than welcome to come and have a face to face consult with your surgeon and then make a second trip for surgery. For some women, that is the scenario they prefer. However, since many of our patients do have to travel to access the state-of-the-art procedures offered by our expert surgeons, we’re prepared to perform your first consultation by telephone.

During this call, we talk about the procedure you are interested in and ask some screening questions to ensure you have no medical contraindication. Once this has been established, we’ll set up a time for you to talk with the surgeon of your choice and you’ll both decide which donor site might be the best to use for your breast reconstruction. Your next step would be to notify us when you would like to proceed with the surgical procedure.

When we’ve settled on a surgical date, we order as much of your pre-operative testing in your hometown as we can. The results of this testing is sent to our office two weeks prior to your surgery day. These tests include blood work, urinalysis, EKG, and Chest X-ray. Go ahead and schedule a full physical with your family doctor or internal medicine doctor and obtain a statement of medical clearance for your estimated length of surgical time.

While all of this medical work is happening, our administrative staff has been diligently working behind the scenes, checking insurance benefits and completing all of the pre-certification processes your insurance company may require.

We’d like you to arrive in Charleston a day or two prior to your surgery date. If a breast surgeon is needed to perform a mastectomy we ask you to come two days prior. You would meet with him / her on the day you arrive, in case any testing needs to be ordered by their office.

The day prior to your surgery date is usually the busiest for you, but we try to coordinate all of your pre-operative activities to be as convenient as possible. You would have various appointments scheduled for you, including a pre-operative interview at the surgical hospital, an MRA to map the blood vessels we plan to use for surgery, and a pre-operative marking appointment and consultation with our surgeon that day before surgery.

Once the surgery day arrives, you would report to the hospital at 6:00 am. Our staff and physicians will obtain contact information for your caregivers and keep them updated on the progress of your surgery throughout your time in the operating room. Once the operation has completed and you have recovered from anesthesia, you would be transferred to the women’s services floor of the hospital for the remainder of your four-day hospitalization. Each room is private and has a twin bed in case you have someone who plans to stay with you throughout your hospital stay.

When you have been discharged from the hospital, we ask that you stay in the Charleston area for a few more days, just to assure all is well and we are easily accessible to you. We ask you to come to your first post operative appointment two days after your discharge and again on the day prior to your planned return home. You may still have donor site drains that need to be removed when you return home and we are happy to help you find a medical professional to do that for you if you don’t have a physician in your hometown who is willing to help.

Once you are home, we’re available to you 24/7 to discuss any concerns you may have, but generally, at this point, you have a viable reconstruction that should heal uneventfully. You can look forward to another visit to Charleston only when or if you require a second stage of surgery after a three-month healing period. This procedure would typically be an outpatient procedure and you might just schedule yourself some “tourist time” to enjoy our beautiful city.

—Chris Murakami, RN, CNOR, Clinical Supervisor

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What is an MRA and What is it For?

June 10, 2011 by

Dr. Richard M. Kline, Jr.

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

Why am I scheduled to have a MRA prior to my DIEP surgery? What is it and what is it for?

Preoperative imaging of perforating vessels by CTA (computerized tomographic angiogram) or MRA (magnetic resonance angiogram) is probably the most significant development in perforator flap breast reconstruction in the last 5 – 10 years.

Some of the potential advantages of preoperative imaging (with CTA or MRA) include:

1. Shortened operating time, due to knowing in advance where the desired perforating vessels are located.

2. Decreased damage to the rectus muscle, due to being able to select perforating vessels with the shortest intramuscular course. This is particularly important because it can decrease the chance of a major motor nerve to the muscle being divided. A few fortunate patients have an unusual anatomic situation in which a large perforating vessel actually goes between the two muscles, which can allow harvest with no damage to the muscle at all; this is instantly recognizable on preoperative imaging.

3. Decreased fat necrosis, due to being able to select the largest perforator.

4. Advanced recognition of those few cases when the SIEA, not the DIEP, might actually be the preferred blood supply for the flap (the same tissue would still be used)

5. Advanced recognition of those very rare instances where the deep inferior epigastric system has been divided form past surgery, or where all usable perforating vessels have been damaged by previous abdominal liposuction.

CTA has the advantage of being most readily available, but also exposes the patient to radiation. MRA does not expose the patient to radiation, but we have found that only a very strong MRI (3 tesla, or 3T) can give us images with enough detail to be really useful for preoperative planning. MRA still requires the administration of intravenous contrast agents, which can rarely have undesirable side effects. On the horizon is MRA without the need for any injection—it’s not quite here yet, but its coming.

We are very fortunate to work with a very skilled group of radiologists with a 3T MRI who are very interested in and skilled at obtaining images for our breast flap patients. We obtain preoperative imaging on all patients preoperatively, whether they are scheduled for a DIEP or GAP flap. If a patient has a contraindication for an MRI / MRA (ferrous metal implanted in the body is the most common), then we obtain a CTA.

—Dr. Richard M. Kline, Jr.

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