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A Journey You Don’t Have to Take Alone

April 27, 2011 by
breast cancer survivor

Shirley's book cover

Dear Sister in this Journey,

My name is Shirley. I have just undergone a double mastectomy and breast reconstructive surgery as a result of having breast cancer. I am one of the fortunate ones who did not have to endure chemotherapy, as well.

My cancer was in my left breast, but I chose to have a double mastectomy to mitigate future risk of recurrence.  Based on the reputation and firsthand knowledge I had of Dr. Kline and Dr. Craigie, I chose the Center for Natural Breast Reconstruction to take care of my small, but precious bosoms.

Once the decision was made to move forward with bilateral DIEP reconstruction surgery, I was given a patient handbook that provided information about what to do pre and post surgery. No offense to the medical team that put together a technically comprehensive document, but boy did they leave out a lot of information that would have been helpful! The kinds of things that, really, only a patient would know.

So, I thought I’d write about my personal experiences to share with others—maybe it will help those who are about to undergo a DIEP reconstruction procedure to be more prepared and know more about what to expect. If you would like a copy of my booklet, get in touch with the center at www.naturalbreastreconstruction.com, they’ll be happy to give you one.

It’s all from my perspective and I hope it helps in understanding what will happen. And I hope it helps keep others positive as they face the surgery.

Good luck on your Journey!

Most sincerely,

Shirley Trainor-Thomas

Breast Cancer Survivor

Hodgkin’s Lymphoma Survivor

Reconstruction Success Story

Did you find Shirley’s story inspirational and know of others who will? Share it with your friends on Facebook.

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Exercising as Fun Rather Than Drudgery

April 25, 2011 by

We all know exercise is a vital part of creating a healthy life, but often, we see exercise as another chore we need to finish. Following are some ideas to help you play and have fun with exercising instead of putting it off or dreading it. No matter which exercise you choose, set realistic goals for yourself and focus on fun.

exercisePlay. Do what you enjoy.

If you pick an activity you like, you’ll look forward to doing it regularly, and you’ll be more likely to stick with it long term. It doesn’t matter what it is as long as you’re moving, so be creative. Is there a sport you’ve always wanted to try, or perhaps a form of dancing you enjoy? Did you love to roller skate as a kid? There’s no reason you can’t learn a new sport, dance, or roller skate now.

If you prefer being indoors, you might like weight lifting, yoga, swimming, or Zumba dance. If you’re an outdoors person, try rock climbing, skiing, bicycling, or simply walking. The more you love what you’re doing, the more often you’ll do it, and the more benefits you’ll reap from it.

Make a fun date with yourself.

Decide which time of day you would most enjoy moving, and schedule it in writing. Be realistic—if you’re not a morning person, don’t plan a 6 a.m. workout. Would you enjoy going to a yoga class after work, or taking the dog for a walk after dinner? Decide which days and times suit you best, and start there.

Think of this time as “I get to . . .” instead of “I have to . . .” because your attitude before you exercise will dictate your frame of mind while you’re doing it.

Take it easy at first, and then challenge yourself to do just a little more.

Don’t expect miracles the first day or the first week. Again, be realistic with yourself. Start slowly, and do what you can. If five minutes is your limit today, great—you might be able to go just a little longer tomorrow and do 5 ½ or 6 minutes. By starting slowly, you’ll have a sense of accomplishment without hurting yourself by doing too much, too soon.

Find an exercise buddy.

If you have a friend who makes you laugh or is fun to be with, maybe he or she would like to exercise with you. If you’re going for a walk, take the dog, or walk with your spouse or children. Exercise time can double as family time, and it’s easier to stay motivated when you have other people to exercise with.

Variety is the spice of life.

Nowhere does that saying apply more than to exercise. Varying your workout with new activities will not only keep you motivated, but changing your routine also works different parts of your body. Try something new once a month, and have different activities for the seasons.

What do you do to keep exercise fresh and fun?

 

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The Three Stages of DIEP / GAP Free Flap Breast Reconstruction

April 22, 2011 by

The below question is answered by Christina Hobgood Naugle, PA-C, of The Center for Natural Breast Reconstruction.

charleston breast surgeons

Christina Hobgood Naugle, PA-C

What are the stages involved in DIEP / GAP free flap breast reconstruction?

The stages of breast free flap reconstruction at our facility can vary depending upon what time in the treatment process we initially meet the patient. The best scenario occurs when the treatment is mastectomy, alone. In those patients, we are able to discuss a skin and possible nipple-sparring mastectomy. This approach means that there is a possibility that the patient would only require one step, although most women are not opposed to a second stage when liposuction, “body contouring,” is involved. Many patients do not have this opportunity, so for them, this process usually involves three stages.

The first stage, being the most involved, is the “technical” stage—the microsurgery element.  After meeting with one of our physicians and discussing the best donor site tissue (tummy, buttocks or inner thigh) the process begins and we relocate the tissue to form a new breast mound. Only the donor site fatty tissue and the blood vessels that nourish that tissue are removed. NO muscle is sacrificed. This blood supply is separated from the body and reconnected to the vessel in the chest wall that once nourished the native breast.

Since the new breast mound is solely relying on the tiny vessels we reconnected initially, we keep you in the hospital for four days to monitor the blood flow into the relocated tissue. This stage of the procedure can require about a six to eight week recovery period, depending upon healing. It varies greatly when women are feeling well enough to return to work or resume the activities they enjoyed prior to surgery.

About three months after Stage One, we may begin discussing each specific patient’s Stage Two.  Three months is the minimum amount of time that we allow. In some cases, we recommend waiting slightly longer than three months (example: radiated tissue, healing issues, or unilateral reconstruction).

Stage Two could be described as the “plastic surgery” side of the breast reconstruction. This is the stage where we fine tune everything that was accomplished in the first procedure, and attempt to improve upon your concerns and how clothes fit. During the first stage, we try our best to achieve symmetry between the two breasts, but sometimes the doctors are limited on the shaping that they are able to accomplish because of the microsurgery portion. Stage Two is about improving symmetry between the two breasts, re-building a nipple if needed, and improving the donor site. This is usually an outpatient hospital procedure but, on the rare occasion, the patient may need to stay overnight.

The procedures performed during this stage vary from person to person, according to their needs. Recovery time varies, too. It could be as little as a day or two weeks, according to the procedures that need to be performed to achieve your desired result.

Three months after your second stage, it is time for your areola tattoo, Stage Three. Women who were able to save their nipple / areola complex at Stage One do not require this stage and are complete at Stage Two. The tattoo is performed in the office under local anesthesia. There is really nothing to this phase. You may drive yourself to the office and expect to be out in one to two hours. It’s really a lot like a social visit and other than exposing your newly tattooed area to public bodies of water like swimming pools, lakes or beaches, there is not much aftercare to speak of. Simple local wound care is all that is required. The risks are minimal and infection and complications are rare.

Many women think of the tattooing as the final hurdle. The best comment I’ve heard was from a woman who stated that after the tattoo healed, she got out of the shower one day and upon looking in the mirror, felt like everything was behind her.

A few other things to keep in mind:

  • Scars look their worse at about three to six months, from that point they should steadily lighten and become less noticeable. It’s hard, but be patient. It takes a while for scars to fully mature and everyone is different.
  • You’ll meet with your surgeon and discuss the best case scenario for you and how to get your breast reconstruction accomplished in as few steps as possible. It is important, even though you are plagued with so many other physicians and concerns, to meet with your surgeon before you have your mastectomy to keep the surgical stages to a minimum. At this point, we’re able to discuss with you your breast surgeon incision site techniques and helpful concepts to improve you final outcome. We also ask your surgeon to weigh the amount of breast tissue removed. It helps for our reconstructive surgeons to know how much breast tissue was removed with your mastectomy and use that number to work toward  rebuilding your new breast, hopefully achieving a symmetrical result earlier in the process to minimize the number of surgical stages.

  • Most patients after the first stage have breast mounds and feel comfortable in clothing. If they must delay State Two of their procedure to undergo chemotherapy, build up time off from work, or just desire time with their family, they are not on a time restriction. (Do keep in mind your deductable.)

  • Vanity is not even a consideration in the breast reconstruction process and these surgeries are not cosmetic plastic surgical procedures. It all comes down to trying to get your body back together and make you as happy as possible, so you can move forward with your life and not have the reminder of everything that you have been through and overcome.
  • Procedures in the breast not affected by breast cancer are insurance covered reconstructive procedures, too. When patients have unilateral reconstruction, achieving symmetry is a little bit more complicated. We have to let the newly relocated tissue settle and heal. The second stage surgical procedures in this case can include, breast lift, reduction, and / or minor procedures to fine tune and attempt to achieve symmetry between the native and reconstructed breast.

We like our patients to discuss with us the things that bother them about their reconstructive result. There are usually things we can improve upon, whether it’s a local procedure in our office or an additional stage. The three stages described in this piece are an outline to the overall process.

Breast reconstruction cases vary and affect each individual differently based upon a number of factors. Some people require one stage and others two or three outpatient or minor procedures to return their bodies back to where they are comfortable and confident.  After you overcome the first stage, the rest are just fine tuning by standard outpatient procedures and local procedures. It is all about making you as comfortable and confident as possible.

—Christina Hobgood Naugle, PA-C

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A Look at the Second Annual Warriors Wear Pink MoBo Event

April 20, 2011 by

Guest post by Lee Heyward, owner of the Charleston Style Concierge.

Lee attended the Second Annual Warriors Wear Pink MoBo Event, and was one of the speakers.

See below for Lee’s guest post:

Last week I was honored to be a part of the 2nd Warriors Wear Pink MoBo, where shopping was not only fun, but went to a great cause.  Attendees shopped through a great selection of designer denim, fun accessories, and great spring wardrobe updates to benefit local “warriors” fighting breast cancer. I had the privilege of helping shoppers find and put together great spring outfits.

warriors wear pinkImage to the left of Lee Heyward at the Warriors Wear Pink MoBo Event.

The MoBo was a great way to add fun spring wardrobe updates on any budget. I always teach my clients to keep an open mind when shopping because you never know what you are going to find, and the MoBo was the place to find so many great deals. Shopping here was a fun way to add new pieces to your wardrobe while benefitting an amazing cause.  Pictured here are a few of the many MoBo racks.

Below are images taken at the event of some of the clothing, jewelry, and shoe racks:

breast cancer events

charleston style concierge

Charleston personal stylist

I’m so honored to have had the opportunity to become involved with the Warriors Wear Pink organization. After speaking for only a few minutes with Leslie Moore, the organization’s founder, I had chills and knew I wanted to help however I could. Leslie is a breast cancer survivor and founded Warriors Wear Pink to give other pink warriors inspiration, hope, advice, and a community to reach out to.

breast cancer awareness

For more information about Warriors Wear Pink visit the Warriors Wear Pink Promise Blog or get involved with them on Facebook.  I hope to see you at the next Warriors Wear Pink MoBo!

To find out more about Lee and the Charleston Style Concierge, click here to visit her website.

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Therapeutic Ways to Relieve Stress

April 18, 2011 by

meditationReducing stress is one of the most effective steps you can take to improve your health, and it can be one of the most challenging. Stress is a constant in our lives, but if you’re proactive about managing it, you’ll be surprised at how much better you’ll feel. This post will discuss three very effective ways to relieve stress and reduce health issues.

Yoga

Body postures of varying difficulty and controlled breathing exercises increase your physical flexibility, while meditation helps you focus on being peaceful and calm. This powerful mind / body combination makes yoga an extremely effective stress reliever. Yoga practitioners also enjoy increased strength and balance. Prominent medical facilities such as the Mayo Clinic recognize the role of yoga and meditation in health promotion and stress management.

In yoga, movements are precise and require concentration, which draws your attention away from your hectic life and quiets your mind, so you release tension and anxiety. In addition to reducing stress, yoga has been proven to help with insomnia, depression, and fatigue. Yoga also lowers blood pressure and is used as a weight loss aid.

Journaling

Often we hide thoughts and feelings that cause stress, and we do our best not to think about them. However, stress is like any other untreated wound in that it becomes larger and more damaging if we don’t take care of it. Journaling, which is simply writing down your thoughts, allows you to express those feelings and understand their effects on your health.

When you see those thoughts on paper—especially after the strong emotions connected to them have passed—they lose their power to upset you, and their hold on your mind is broken. The stress these thoughts caused dissipates as a result. When you look objectively at what is going through your mind, you can define what is causing your stress and take steps to remedy it. For many, the act of writing helps them process their feelings, and that alone helps their stress levels.

Meditation

A quick and easy way to reduce stress, meditation is one mental technique of focusing your attention away from stressful thoughts and situations, giving you a sense of balance and peace. In addition to stress relief, the Mayo Clinic has found that meditation helps with pain management, allergies, binge eating, and sleep problems.

When you meditate, you intentionally move your mind into a new state of relaxation that extends throughout your body. Stressful feelings and thoughts are released as you move into a deeper state of awareness. As you become more proficient in meditation, you control your conscious thoughts more easily and relax more quickly.

To learn yoga, journaling, or meditation, search for classes in your area. Look at the instructors’ websites, or call them, and decide who seems knowledgeable and approachable. Often instructors will offer a class or a visit for low or no cost. Don’t be afraid to try something new to reduce your stress.

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What is Fat Necrosis and Should I Be Concerned About It?

April 15, 2011 by

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

Dr. James Craigie

After my stage one DIEP surgery, I have some lumpy areas that I am told are fat necrosis.  Do they go away or what can you do about them? I am due to have stage two of my surgery soon.

Fat necrosis is a generalized term that results following injury or surgery when fat no longer has an adequate blood supply to survive. When fat does not survive and is in the breast the body develops scar or firmness as part of the healing process. A small amount of fat necrosis may go away on its own and larger amounts may persist indefinitely making the breast feel hard.

Following a DIEP or other muscle sparing breast reconstruction some of the fat transferred to the breast may not receive enough blood supply to survive the healing process. When this happens you may feel small lumps in the new breast about 1 – 2 months after the first surgery, sometimes sooner depending on where the lump is. These are usually small areas that can be removed at the second stage without affecting the end result. This is the most common situation we encounter.

On a larger scale, if something has occurred during the course of surgery and the tissue was transferred with an inadequate blood supply, the entire breast or a major portion of it could develop into fat necrosis. This is the most severe situation and would be considered a major complication or even failure of the procedure. Fortunately, in our experience, this situation is rare and the surgeon will know this has happened and should discuss options for correction.

If someone has a new breast lump and has a history of breast cancer, they are likely to undergo biopsies or have some concern over the area. Lumps that are fat necrosis may make breast exams more difficult or confusing and increase the chance that a new cancer or recurrence goes undetected. So anytime there is obvious fat necrosis after the first stage of surgery, we would make attempts to remove it. Initially, when a patient states they feel a firm area, I always remind them that what they feel on the outside will feel larger than the actual amount of fat necrosis tissue because the body is creating a reaction to the tissue trying to dissolve it.

It should be stressed that even patients who have undergone breast reconstruction should continue to do breast self-examinations. Any surgery on the breast will cause swelling and scarring. In many women who undergo reconstruction with breast implants, the body creates a capsule in response to these implants and all of these scars, capsules, or post surgical changes can feel like lumps and bumps following surgery. Therefore, it is important to know that fat necrosis may become apparent soon after surgery and should stay the same and not enlarge as time goes by. Alert your doctor regarding any breast lump that seems to enlarge. It is also important to know that breast exams will not be useful until after stage one and two are completed and the breast has had several months to recover from the surgery.

Once the reconstructive process is complete, things should not be changing. Patients should become familiar with any area that feels firm. If there are scars remaining after surgery, the patient should keep track of where they are and monitor them for changes. Changes in size or significant changes of any type should always be brought to the attention of your physician even in a reconstructed breast.

—James Craigie, M.D.

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Is a DIEP Flap Reconstruction Right for You?

April 8, 2011 by

 

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

My plastic surgeon told me that I did not have enough excess tissue in my abdomen to have a DIEP. What can I do now?

That’s a common question, thanks for asking. Many women wonder themselves if they actually have enough tissue for DIEP flap reconstruction, and others are told by their plastic surgeon that they do not. When assessing whether or not a patient’s abdomen can meet their reconstructive needs, several factors need to be taken into account.

First, are we talking about reconstructing one breast, or both breasts? Obviously, reconstructing both breasts takes twice as much tissue as reconstructing one breast. When only one breast is needed, it is possible to use both sides of the abdomen to reconstruct just one breast. This is called a “stacked flap,” which utilizes both sides of the abdomen, with two separate blood supplies, to make just one breast. We routinely do this procedure for patients who just need one breast reconstruction, but require both sides of their abdomen to get the size breast that they desire. It’s more complicated than connecting just one blood supply, but our practice has performed this operation well over a hundred times, with excellent success. In fact, we believe that stacked flaps may be less susceptible to fat necrosis (a complication of DIEP flaps where some of the fat, usually on the edge, dies and gets hard) than ordinary DIEP flaps.

Second, in trying to answer this question, the patient’s desired breast size must be taken into account. A patient who wants both breasts reconstructed to size “D,” but who does not have enough abdominal tissue to make a” D” size breast on each side, might have adequate tissue to make a “B” sized breast on each side. In this situation, if “B” sized breasts would not be acceptable to the patient, then we would usually recommend using the buttocks (a GAP flap) as the donor site.

Use of the buttocks for breast reconstruction, particularly for reconstructing both breasts at the same surgery, is significantly more complicated than using the DIEP flap. Fortunately, we have extensive experience with this procedure, having performed it several hundred times with a 99% success rate. If a patient did not wish to use their buttocks as the donor site, then they would still have the option of accepting a smaller breast size from the abdomen, or they may possibly decide to use implants, foregoing autologous reconstruction altogether.

Finally, for the patient who is told by their surgeon that they do not have enough tissue for a DIEP flap, it is worth noting that it can be extremely difficult for a surgeon who does not routinely perform DIEP flaps to properly assess the amount of donor tissue a patient has available in her abdomen. The thickness of the subcutaneous fat, which is the thickness that can be “pinched” between the skin and the muscle of the abdominal wall, is of paramount importance in assessing how large a breast can be made from the DIEP flap.

In addition, the maximum height of the flap also plays a role in determining what size breast can be made. In assessing how “high” a flap can be safely harvested from the abdomen, it is important to look at how much loose skin is present between the belly button and the bottom of the ribs.  If there is a lot of loose skin in this area, then it will stretch downward more easily to close the lower abdominal wound after harvest of the flap, thus allowing for a larger flap to be obtained. Again, precise assessment of the availability of abdominal donor tissue requires a significant amount of experience on the part of the surgeon, and is ideally performed while examining the patient in person, as opposed to simply looking at photographs.

In closing, to determine if a patient has “enough tissue for a DIEP flap,” we must ask these questions:

  • Are we reconstructing one or both breasts?
  • What size breast are we attempting to reconstruct?
  • What is an experienced surgeon’s assessment of how much tissue can be removed from the abdomen?

Only by taking all of the above into account can a meaningful answer to the question be obtained. We believe that effective communication between the patient and the reconstructive team, in this situation and in most others, is often the key to a successful and happy outcome.

—Richard M. Kline, Jr., M.D.

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Fabulous Shopping for a Fabulous Cause: The Second Warriors Wear Pink Event

April 6, 2011 by
Image to the left taken from WarriorsWearPink.com.

Support a great cause by coming out to the 2nd Warriors Wear Pink MoBo event, happening Thursday, April 7 from 5:30 p.m. to 8:30 p.m. The event takes place at the Tanner Hall Amenities Center in Tanner Hall Plantation and features fabulous guests including the Charleston Style Concierge, Lee Heyward; Elizabeth Quinton of EQMake Up; Sumner Little of Stella & Dot Jewelry; and the Rosita Jones Studio.

This is going to be an amazing night full of fun, shopping, and socializing! Those who attend the event will be helping to support local breast cancer survivors and those affected by breast cancer. Attendees can shop some great deals for an exceptional cause while listening to great music, socializing with family and friends, and enjoying a glass of wine and snacks.

Some of the items being sold at this event will include high-end, gently used clothing and fashionable accessories at great deals. Part of the proceeds will be given to locals affected by breast cancer, as well as the Warriors Wear Pink Foundation. Lee Heyward, the Charleston Style Concierge, will offer style expert assistance to shoppers looking to get some insight on wardrobe creations and pairings.

Don’t miss out on this great event to help support our brave local survivors and give to a wonderful cause!

For additional questions about the event, contact Leslie Crawford Moore at 843.708.1918.

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Who’s on Your Team?

March 30, 2011 by

breast surgeonsGO TEAM! Lots of phrases are used to describe a team concept. Some people call it “Multidisciplinary Breast Team, “Breast Cancer Team Conference,” “Breast Health Team,” “Cancer Clinic Team,” or, the one I like the LEAST, “Tumor Board” (ick!).

These teams are the groups of doctors, P.A.s, nurses, and therapists—basically everyone who would be involved in treating a patient with a breast cancer diagnosis—who meet to coordinate the best care for you. Yes, YOU and your unique self! They talk about your individual case, bounce ideas and treatment plans off of one another, and come to a consensus about what treatment would be best at beating your type of breast cancer. All of the members of this team may not necessarily be the providers treating you, which is a good thing for a wide perspective of opinions, but may include breast radiologist, general surgeon, breast surgeon, surgical oncologist, plastic surgeon, pathologist, medical oncologist, oncology nurse, radiation oncologist, social worker, financial aid counselor, and an oncology psychiatrist.

If you are in a community that does not have a team or you would like to be presented to a team prior to beginning treatment, just ask that one be found for you. Most hospitals have one and some exist that are composed of a group of providers in the community with a particular interest in breast cancer and breast health.

What is A Breast Cancer Navigator?

A breast cancer navigator is a term that hopefully most of us don’t know and won’t learn in our lives. But simply stated, this person, usually an oncology nurse, is there to help you from the time of your breast cancer diagnosis through the treatment maze to the end of your breast cancer journey. Consider her the person who reads the map while you are trying to drive the car, or perhaps if we keep in line with navigator, she sits on the stern of the boat and tells you when and how to row.

We like to think of her as more of a concierge at a really cool classy hotel (no tips required!!). She’s right there at check-in if you need her. But when you want to leave the hotel, she’s the go-to girl. She’s informative and has all the great information on the BEST places to go in town. Sometimes, she might even give you a little side information on the places that people have given her rave reviews about.

The Center for Natural Breast Reconstruction now has a new breast cancer navigator on board at our favorite “hotel,” the new East Cooper Regional Medical Center. We’re confident that once gets the hang of the lowcountry, she’ll be the best concierge in town! You’ll be able to call her for the best rates during your stay, ask her about what kind of post-op care you might need, and what types of support services are available during your time in Charleston. She’ll always be available to our clients.

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