If I Have Had Natural Breast Reconstruction Do I Need To Have A Yearly Mammogram?

diep and mammogramThe below question is answered by Charleston breast surgeonDr. James E. Craigie. of The Center for Natural Breast Reconstruction:

After having breast reconstruction using the DIEP method do I need to have yearly mammogram?  If so, can the pressure from the procedure cause any damage to the tissue or blood vessels used in the reconstruction?

First of all, following mastectomy and reconstruction with your own tissues, a mammogram is routinely not needed on a regular screening basis.  Screening mammograms are only helpful for normal breast tissue; therefore, in our patients we do not recommend that they have regular screening mammograms.  From time to time, people will be seen in follow up for examination and have areas of the breast feel firm or hard and sometimes the oncologist or other physicians will order mammograms to investigate a specific finding.  This would normally be performed after the first and second stages of the reconstruction process were completed and therefore should pose no risk of injury to the blood vessels that were connected to the breast.

-James E. Craigie, M.D.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by submitting your questions here.

 

Your DIEP Reconstruction Recovery Process Question Answered

diep questionsThe below question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

I still feel tightness in my chest and stomach after DIEP reconstruction, when can I expect that to improve?

Tightness in the donor site area or tummy depends on how much tissue was taken to rebuild the breast and how much loose tissue was there to begin with.  The scar that results after the healing process can take approximately 6 months to relax and mature.  Therefore, during recovery, the tissues will be stiff for approximately 3 months and as you begin to do more and exercise more, the areas should slowly become less tight, less swollen, and more natural.  Regarding tightness in your chest, it would be unusual for tightness to exist for very long after having reconstruction with your own tissue.  Usually a new healthy breast made from your own tissue will improve tightness or scarring particularly if someone has had reconstruction with implants prior to using their own tissue.  However, if you have had radiation, those changes can be permanent and there may be residual stiffness, but it is very unusual for people in our practice to complain of tightness in the chest area once everything has healed approximately 3 to 6 months after surgery.

-Dr. James E. Craigie

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Mastectomy and Breast Reconstruction Questions Answered

nipple sparing mastectomyThe below questions are answered by Dr. Richard M. Kline, Jr., Charleston breast surgeon for The Center of Natural Breast Reconstruction:

What kind of breast expander do you recommend and employ?

We usually use either Mentor contoured tissue expanders, which have more projection at the bottom than the top, or Mentor round expanders with a remote port. If patients are using tissue expanders only as a “bridge” during post-mastectomy radiation until they can receive a flap reconstruction, then we prefer the remote port model, because it won’t interfere with the MRI we like to get prior to flap surgery to look at the vessels. If the patient is planning on having a permanent implant reconstruction, then the contoured expander (which is not compatible with MRI) may produce a better initial shape.

If I choose immediate breast reconstruction, what happens if it is discovered I need radiation treatment during the mastectomy? What happens then?

It depends on what type of reconstruction you have chosen. If you choose implant reconstruction, radiation doesn’t hurt the tissue expander or implant, although it significantly decreases the chance of achieving an acceptable result. If you have had an immediate flap reconstruction, then learn (unexpectedly) that you need radiation, then the flap may be in serious jeopardy. Experienced oncologic breast surgeons are usually pretty good at anticipating whether a patient will need radiation or not. If significant doubt exists, however, and a flap reconstruction is planned, it is best either place temporary tissue expanders at the time of mastectomy, or delay all reconstruction until after radiation.

What are the disadvantages of postponing breast reconstruction after mastectomy? (scarring, skin sparing options, nipple options)

The only significant disadvantage to postponing reconstruction is potential contraction of skin if a skin-sparing or nipple-sparing mastectomy is used. Depending on the amount of skin present and the ultimate desired breast size, however, this may present a problem for some patients, but not others. The advantages of delaying reconstruction include a decreased incidence of complications, and shorter anesthetics.

For breast reconstruction, what are the options for nipples?

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.

How One Breast Cancer Survivor Found Hope by Making Informed and Proactive Decisions

breast reconstructionThe team at The Center for Natural Breast Reconstruction is honored to share with you an In Her Words post written by a recent patient of ours, Linda Burkholder. She is an inspiration to all women who are facing breast cancer or who are at risk for hereditary breast cancer.

See below for Linda’s story:

Breast cancer—you can’t say I didn’t see it coming, but being the eternal optimist, I hoped I would dodge the bullet.  Several members of my family have died from breast cancer, including my grandmother, mother, aunt, and sister. After my sister died in 2006, I began to seriously consider prophylactic surgery. I quickly learned that there is little support in the medical community or among friends for this procedure.

After a benign biopsy two years ago I found F.O.R.C.E. (Facing Our Risk of Cancer Empowered) on the Internet.  F.O.R.C.E. is a support group for those with hereditary breast and ovarian cancer. They posted an application for a scholarship to their annual conference. I applied and much to my surprise I was granted an expense paid trip to the conference in Orlando in 2010. I can’t tell you how that changed my life. I learned so much about everything I wanted to know about breast cancer and I met several plastic surgeons who stood out to me, especially Dr. Kline from The Center for Natural Breast Reconstruction. I made a mental note to keep him in mind and took home a beach towel with his phone number splashed across it.

During the next year I struggled with my decision to have prophylactic surgery. Intellectually, I knew what to do, but emotionally I was really struggling. I joined a local F.O.R.C.E. group and kept learning and thinking and meeting cancer survivors, assuming I would have surgery when I felt more comfortable with the idea. Fast forward to June 2011. It was time for my annual mammogram. I told my family doctor I also wanted an MRI, to which she reluctantly agreed. To make a long story short, the mammogram came back normal, but the MRI showed a 1.2 cm questionable spot—a spot, I was told, because of its location, would never have been seen on any mammogram. It was a Stage 1 cancer.

This was almost 2 years to the date from my previous benign lumpectomy. In July, 2011 I had a second lumpectomy performed by one of the most respected surgeons in my area. Without consulting me she automatically scheduled me for radiation. I refused the radiation because I felt that all treatment was my decision and I wanted to consult with an oncologist first. Also, I had learned at the F.O.R.C.E. convention that radiated tissue is harder to reconstruct and I already knew I ultimately wanted mastectomies with natural breast reconstruction, not implants.

When I told the surgeon I didn’t want implants, she hit the ceiling. Clearly, no one had ever before challenged her standard treatment plan. Thanks to F.O.R.C.E., I was empowered. The next convention was two weeks away and I knew this would be where I would make my final decision, and it was. I talked with EVERY plastic surgeon at the conference. I spoke with Kathy Steligo, author of The Breast Reconstruction Guidebook, for 45 minutes at the round table breakfast. I had read her book for the third time on the plane to Orlando two days before. After the conference I came back to my hometown and started chemotherapy. I also scheduled my surgery for November at The Center for Natural Breast Reconstruction.

After consulting with my oncologist, I elected to have bilateral mastectomies with autologous reconstruction. In September my husband and I made a trip to South Carolina to meet with Dr. Kline and Dr. Baron, the general surgeon. I wanted my husband to meet my doctors. I wanted to make sure I had his full support and I wanted to make sure any lingering questions by either of us were answered.

After that meeting I was sure I wanted to go forward with the DIEP procedure. I felt very confident that everything would be alright. On November 30, 2011 I had the procedure. It was an 8-hour surgery, and everything went very well. I was in East Cooper Medical Center for four days. My nurses were great, especially Angela. I thought of her as my special angel since she was able to anticipate what was needed before being asked and was especially kind. She really took good care of me.

After my discharge from the hospital my husband and I stayed in Charleston another 10 days. I got a handicapped room at a local long-stay hotel. There was a handicapped shower and a recliner in the room. I really appreciated that recliner and I slept in it most nights. It helped to keep my feet elevated.  Every day, at least one time, I took a short, slow walk up and down the hall for exercise. I saw Dr. Kline 3 times during the next 10 days and he assured me everything was fine and my breasts looked “beautiful”—although at that time I didn’t think they looked so beautiful. Now, 5 weeks later, I can see how nicely everything is shaping up and I don’t think I will require a lot of revision at the Stage 2 procedure. I am glad I chose the DIEP procedure. The recovery is long, but it is worth it.

Did I ever seriously consider implants? The answer is yes, because implants represented the path of least resistance. I could have had the surgery done locally and I wouldn’t have had the additional expense of the trip from Indiana to South Carolina. Also, I would have had my entire support system around me. In making my decision I talked to many women who had implants and it seemed to me that they either loved them or hated them. Those that loved them seemed to love them only after 2-3 additional procedures due to complications. Everyone complained about the fills being painful and some found the implants to be cold or uncomfortable. Also there was the risk of capsular contracture and the necessity of replacing the implants every 10-15 years. I also talked with many women I met through F.O.R.C.E. who had flap procedures. I saw their results and they were fabulous. Short of a few fading scars, you could not tell that their breasts were not original. All of them seemed quite pleased with their new breasts.

Yes, recovery is a bit prolonged with DIEP. You definitely need someone very devoted to you to help out those first few weeks. I needed help getting up and down, showering, dressing, and emptying my surgical drains. My husband helped me with everything, dispensed my medications and gave me a blood thinning shot daily. I could do very little without his assistance the first 10 days following surgery, and I slept much of the time. Still, I was able to get around slowly and even went out to local restaurants my two weeks in Charleston. I also had pain medication, which made life bearable.

As the weeks have progressed, I feel my strength slowly returning. I am not yet 100% but I am planning to return to my job part-time on January 9th, with hopes of returning fulltime the following week. For anyone considering a flap procedure but fearful of the recovery, I would advise them that it is doable. It’s not as bad as you think. A certain amount of fear is normal if, like me, you have never had a major surgery. But for me, everything went fine, even though I am 59 years of age, older than any one I have met who had DIEP. So, I think if I can do it, anyone can.

My only regret is that I didn’t come to my decision for prophylactic surgery before I got cancer. Time ran out to make that decision but I am thankful my cancer was found early and I am thankful for my husband of 29 years, Larry, was by my side supporting me every step of the way. I would advise anyone facing cancer to not panic, do your homework, and be very proactive in your treatment. Learn everything about breast cancer that you can so you can understand your options. Choose your doctors carefully. Get second opinions and do what YOU think is best for you. You have many options; don’t let anyone take any of them away from you. Make your own decisions.

Having cancer has changed my view of life. It seems much more precious and much more vulnerable than before. I am thankful for a second chance and thankful that I had so many options that my mother and grandmother did not have. My mother had radical mastectomies, which are very disfiguring. I am glad that I still look much like I did before. I had nipple-sparing surgery and when I look at my breasts I still see me in there. I can’t wait to see the results following my final revisions. I am very grateful for Dr. Kline, Chris Murakami, RN and Clinical Coordinator, and all the staff at The Center for Natural Breast Reconstruction for a very positive reconstructive experience.

About Linda Burkholder

My name is Linda Burkholder and I have lived in Kokomo, Indiana the past 22 years. I am the proud mother of two adult children, a daughter 23 years-old and a son age 21. I have been married to my husband, Larry, for 29 years. I work fulltime at Indiana University as an Administrative Secretary to the Dean of the School of Public and Environmental Affairs. I love animals and have two Pembroke Welsh Corgis and four cats. In my spare time I enjoy reading and knitting.

Do you have a question for one of our doctors? Ask us!

Charleston Breast Surgeon Answers Your Implant and Insurance Questions

charleston breast surgeonsThe below questions are answered by Dr. James Craigie of The Center for Natural Breast Reconstruction

Should a woman have an MRI follow up every two years after implants to check on things? I’ve been told this.

Let’s go to the source of that information for the best answer . . .

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants . . .

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic.  Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here: http://www.mentorwwllc.com/Documents/gel-PIDS.pdf

Does insurance generally cover redoing of nipples and tattooing?  I’m not completely satisfied with the result of my nipple reconstruction procedure.

Great question . . . Let’s address the insurance portion first. If your health insurance covers mastectomy, it must cover reconstruction throughout all phases. There are some that do not have to abide by this rule, (WHCRA 1998) but they are few and far between. Some may limit the number of times you can undergo a procedure at their expense. The best way to assure they will pay for your procedure is to call the insurance company each time and make sure you have benefits available for the procedure you desire.

Nipple reconstructions can deteriorate over time. Those that seem a little too prominent at first tend to flatten out after a while and may no longer project enough to suit a patient.  Tattoos fade, especially when applied to skin that has a large amount of scar. This being said, repeat nipple reconstructions are a quick procedure routinely performed with local anesthesia and it’s not unusual to require a touch up tattoo.

—James E. Craigie, M.D.

Does Lymphedema Affect Success of Breast Reconstruction?

breast reconstructionThe below question is answered by the team at The Center for Natural Breast Reconstruction:

Does having lymphedema (arm and trunk) affect success of breast reconstruction?

We primarily have experience using perforator flaps for breast reconstruction, so I’ll answer from that perspective. Arm lymphedema does not directly affect breast reconstruction, although there are reports of arm lymphedema improving after reconstruction using your own tissue (such as DIEP, GAP, or other perforator flaps). Trunk lymphedema (including breast), while not affecting the survival of the flap, can result in prolonged edema of the breast skin overlying the flap, leaving the reconstructed breast with a heavy, “wooden” character. We have seen this edema gradually resolve in some patients, however, over a period of up to two years, and it is possible that the flap is actually helping with this.

For more answers to your breast reconstruction questions, visit our Ask the Doctor section of this blog.

Top 3 Holiday Related Activities to Enjoy in Charleston

festival of lightsImage to the left taken from the Charleston County Park & Recreation Commission website.

 

Charleston comes alive during the holidays, and enchanting activities for all ages abound. Here are just a few of the festive holiday celebrations to enjoy right now.

Holiday Festival of Lights
James Island County Park, November 10, 2011–January 1, 2012

With over 2 million lights, the Holiday Festival of Lights is a must-see event. Set up as a 3-mile driving tour or a fun-filled train ride, the Festival of Lights also offers several activities besides twinkling lights, such as marshmallow roasts, gift shops, carousel rides, life-size greeting cards, and a tree lighting.

The driving tour is $12 per car, and the train ride is $3 per person. Children under 2 are admitted free.

Charleston Christmas Sleigh Ride 2011
Charleston Harbor, December 1–31, 2011

Every night in December excluding Christmas, Thriller Charleston hosts sleigh rides by boat to look at the Christmas lights and decorations. You’ll depart from Shem Creek in Mt. Pleasant and see the sights in Charleston, James Island, and Mt. Pleasant. As you drink hot cocoa, you’ll hear charming stories of Charleston’s Christmas customs. You keep your travel mug and rain poncho.

Sleigh rides are $45 for adults and $35 for children ages 5–12. Children under 5 are admitted free, but do not receive the hot chocolate or rain poncho.

What’s your favorite Charleston holiday tradition?

Can Breast Reconstruction Improve A Woman’s Psychological and Sexual Wellbeing?

DIEP flapIn a recent article, titled Advanced Post-Mastectomy Breast Reconstruction Improves Women’s Psychosocial and Sexual Wellbeing, by CANCER Online Journal, a study found that “After a mastectomy, women who undergo breast reconstruction with tissue from their own abdomen experience significant gains in psychological, social, and sexual wellbeing as soon as three weeks after surgery.” (CANCER Online Journal: http://www.canceronlinejournal.com/newsroom)

The study was performed by Toni Zhong, MD, MHS, of the University Health Network Breast Restoration Program in collaboration with several others at the Memorial Sloan Kettering Cancer Center in New York City. They surveyed 51 women who were preparing for their MS-TRAM or DIEP flap reconstructive surgery during the months between June 2009 and November 2010.

Breast reconstruction is restoring the form of a breast that has been damaged, partially removed, or completely removed. Breast reconstruction is almost always done after treatment for breast cancer, although there are some birth defects that can result in the need for breast reconstruction. Breast reconstruction can be performed with implants (the same ones used for breast augmentation), or with the body’s own excess tissue (usually from the abdomen or buttocks), thus avoiding the need to place foreign objects in the body.

The study found that these women who experienced breast reconstruction “reported significant improvements in psychological, social, and sexual wellbeing just three weeks after surgery,” according to the article.

Although The Center for Natural Breast Reconstruction has not performed a formal study on the feelings that patients experience post breast reconstructive surgery, we have found that many of them feel a sense of improved psyche and self-esteem. Just ask Leslie Haywood who underwent breast reconstruction with the Charleston breast surgeons of The Center for Natural Breast Reconstruction: “I have never been happier with my body and I have never been more in shape in my entire life!”

If you know of someone who would be interested in hearing about this study, visit the CANCER Online Journal newsroom where the article will soon publish to: http://www.canceronlinejournal.com/newsroom

Mastectomy and Uneven Breast Size: What Are Your Options?

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

Because of failed implant / expander surgery (3rd degree burn damage) from radiation, I underwent a second reconstruction procedure with DIEP flaps earlier this year and a revision three months later. I have not yet had my nipples created. There is still about a cup size difference in my breasts as well as a hollow part of the cancerous breast at the top. Is this still able to be fixed as part of reconstruction procedure or do I have to live with this? Currently, I wear a prosthetic to try and even them out but it doesn’t take care of the hollow area.

Sorry to hear about your problem. If I understand you correctly, you had a mastectomy for cancer on one side and a prophylactic mastectomy on the other side, then had radiation to the cancerous side, followed by bilateral DIEP flaps.

A size mismatch in that scenario is fairly common, even when the initial flaps weigh the same, for a number of potential reasons. The cancer surgeons are sometimes more aggressive with their mastectomies on the cancerous side, and the radiation sometimes seems to cause loss of additional tissue volume. Additionally, localized fat necrosis can occur within one or both of the flaps, which would decrease their size.

As you might expect, there is no perfect one-size-fits-all solution for this. The easiest solution might be to lift the flap on the cancer side to fill the hollow part, and then reduce the other side to match.  Autologous fat injections to the areas of tissue deficiency are sometimes surprisingly effective and long-lasting, even in the face of radiation, but there is no way to tell if the fat will survive without just going ahead and trying it.

We have significant experience using the excess skin and fat, which many people have beneath their armpit to augment the upper / outer areas of the breast mound, using this tissue as a flap based on the 5th intercostal artery. This technique often carries the added benefit of lifting and rounding the breast mound. While we are not fans of using implants in the face of radiation, the presence of a healthy flap sometimes means a small implant to make up the size difference will be better tolerated. As a last resort, another perforator flap from another donor site could be added to the first flap, but we have rarely found this to be necessary.

I would advise you against having your nipple reconstructions until you are satisfied with the state of the breast mounds, because significant later work on the breast mounds may change the nipple position or orientation.

-Richard M. Kline, Jr. M.D.

Would you like your breast reconstruction question answered? Just ask us!

Breast Cancer Survivor Shares Reconstruction Success Story

according to shirleyWe are so happy to share with you another In Her Words post, this time with Shirley Trainor-Thomas, a breast cancer survivor, Hodgkin’s lymphoma survivor, and reconstruction success story!

Shirley was a patient of ours at The Center for Natural Breast Reconstruction and we are delighted to share her story with you.

See below for the interview (*Don’t forget to download a copy of According to Shirley, a short story / information booklet written by Shirley about her breast reconstruction experience):

When you were diagnosed with breast cancer in your left breast, you chose to have a double mastectomy. What influenced this decision? In other words, what factors did you consider when deciding whether or not to have a double mastectomy?

“It’s not good, princess.” Those were the exact words Dr. Bob Flowers used when he called to tell me the results of my biopsy. I promptly informed him that it was not the right answer! And after I caught my breath, I asked what we were going to do about it. He said he would get me to a surgeon that very day. True to his word, my husband and I were in Dr. Stan Wilson’s office that afternoon and we started discussing options. I was a bit of a difficult case because many years ago I had Hodgkin’s lymphoma and radiation to my entire torso—which is what likely caused my breast cancer. There was a lot of discussion among physicians and tests that were taken to make sure we had all of the information we needed to make the best decision.

The waiting to get answers and opinions that would lead to a plan was excruciating. All I could think about was breast cancer and I spent endless hours on the Internet trying to learn everything I could about my diagnosis and choices. My husband and I were in a fog.

Long story short, it appeared that chemo and mastectomy was my option. But, Dr. Wilson wasn’t totally convinced chemo was the really indicated and sent my tissue to have the Oncotype test.   As we waited on those results, we were moving forward with the chemo option. On a Thursday evening, I was preparing for surgery to take place the next morning to have a port put in—and at 8:00 pm, Dr. Wilson called with the Oncotype results—they were great. We opted to not have chemo.

Because other cells in my breasts were described as “busy” by the pathologist, I knew there was a chance of cancer striking my other breast. Given the painful waiting and emotional impact we went through, my husband and I said that we need to eliminate the chance of having to go through this again. Playing into that decision was that I was aware of the DIEP reconstruction option. I’m lucky, not everyone knows about that option and most people have to do a lot of research to find it or the right surgeon. I knew right out of the gate that the only person I would allow to do this procedure was Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

2. What type of reconstruction surgery did you have and how do you feel about the results? Would you make the same decision again if you could go back?

I had DIEP. The great thing for me is that I went into surgery with bosoms and came out with bosoms—and a flat tummy. Bi-lateral mastectomy and reconstruction were done in one surgery.

Recovery was frustrating. As Dr. Kline kept telling me, “It’s a process.” No matter what he told me, I was convinced I would be back to normal in just a few weeks. Okay, so it took longer.  I got tired easily and couldn’t stand up straight for a while because of the stomach incision. But, my job requires travel and I was able to get on an airplane six weeks after surgery and get back to work.

My energy level took some time to return—it’s a big surgery. But, if faced with the same decision today, knowing what I know, I absolutely would do it again.

My bosoms are perfect.

Unfortunately, I didn’t have enough tummy fat to make them bigger than they were (my one chance—had I known, I would have eaten a lot more over the years!). Even my oncologist has marveled at how real they look and feel. But I would only allow Dr. Kline and Dr. Craigie to do it. I’ve read some horror stories online about women who went to surgeons who either weren’t trained properly or didn’t have the skill level needed for microsurgery. I actually communicate with women around the country to share my experience and to alert them that they really need to investigate their surgeon’s success record.

3. You decided to write a short story / information booklet about your breast reconstruction experience titled According to Shirley. Why did you choose to write this book and what do you hope readers will get from reading it?

I love Dr. Kline and his entire staff. But, when planning for surgery they gave me a booklet of what to do and expect. After going through the experience, I let them know they left A LOT of information out! It was written by medical professionals who never actually experienced the procedure. When I told them that the information was technically good, but needed to include more practical information, they said fine—write one. So I did. It’s really meant to give women a better idea of what to expect throughout the process and to keep positive about the experience.

4. What advice would you give to women who have undergone a mastectomy or double mastectomy and are unsure about natural breast reconstruction?

Research, research , research. Unfortunately, not all plastic surgeons will present options that they are not capable of providing, such as DIEP. Talk to several surgeons and get a feel for the success rate of the surgeon. Talk to their patients. It’s a major procedure. Women need to know how many procedures the surgeon has done and what his or her success rates are.

Have you downloaded your copy of According to Shirley? If not, click here.