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Breast Reconstruction Surgeons Answer Your Questions About Reconstructive Surgery

September 9, 2011 by

reconstruction optionsThe question below is answered by Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

What is the difference between breast reconstruction and augmentation?

Breast augmentation is when you increase the size of a normal healthy breast, almost always with saline or silicone gel implants.

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.

What are the pros and cons of a DIEP versus a TRAM flap reconstruction?

The primary advantage of DIEP flaps over TRAM flaps is a far greater potential for preservation of rectus abdominus muscle function, since no muscle is removed with a DIEP, yet one or both rectus muscles is obligatorily completely sacrificed with every TRAM flap. Additionally, since the muscle does not need to be tunneled under the skin to reach the breast area with a DIEP, the shape of the inferior region of the breast can be better defined.

The primary advantage of the TRAM flap over the DIEP flap is that it can be done by one surgeon who does not have the skills or equipment (microscope and special instrumentation) to perform a DIEP flap. While TRAM flaps can sometimes be performed more quickly than DIEP flaps, this is not always the case, and is very dependent upon the skills and experience of the surgeon. In our practice, DIEP flaps are always performed with two fully-trained perforator flap surgeons present, which we believe contributes greatly to the success and timely completion of the surgeries.

Why don’t more plastic surgeons offer the DIEP procedure?

When the DIEP flap was originally presented by Dr. Robert Allen in the 1990s, it was frequently criticized as being too difficult for many surgeons to learn to perform easily. While many more surgeons now offer the DIEP flap, it is still more technically demanding for the surgeon than many other procedures, and can be quite difficult to learn without spending significant time with another surgeon who has considerable experience with the operation.

Do you have a question for the breast surgeons of The Center for Natural Breast Reconstruction? If so, we’d love to hear from you. Click here to ask us!

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Breast’s Anatomy: What Makes Up a Breast?

August 31, 2011 by
Image to the left taken from emedicine.medscape.com.

Breasts are milk-producing (mammary) glands surrounded by fat and are attached to the front of the chest by ligaments. The breast rests on the pectoralis major chest muscle, but has no muscle tissue itself. The fat in the breasts determines their shape and size, which varies among women even though the size of the mammary gland system is relatively standard. In addition, women commonly have one breast that is larger than the other.

Breasts begin developing between the ages of 9 and 14 for most girls, and signal the start of puberty. Breast tissue is highly sensitive to the hormones estrogen, progesterone, and prolactin throughout the menstrual cycle. While breastfeeding, prolactin triggers milk production within the breast, and its anatomy is simple yet complex.

Lobules, Alveoli, and Ducts

Breasts have 15 to 20 sections known as lobes or lobules that converge at the nipple. Each lobule consists of hollow sacs called alveoli, and the lobules are connected through ducts. The final collection area for milk is known as the main duct.

During breastfeeding, prolactin stimulates the alveoli to pull nutrients from the woman’s blood to produce breast milk, and oxytocin causes the alveoli to release the milk through the mammary ducts to the nipple.

Nipple

Also known as the mammary papilla, the nipple is the outlet for the mammary ducts and where milk is secreted.

Areola

Often included when referring to the nipple, the areola is the round pigmented area surrounding the nipple. During breastfeeding, small bumps on the areola known as Montgomery glands produce an oily substance that cleans and lubricates the nipple.

Lymph Nodes and Ducts

The lymphatic system helps fight infection by capturing and excreting pathogens and toxins through lymph nodes and ducts. These nodes are found near the breast, in the armpit, and behind the breastbone. Often, axillary (armpit) lymph nodes are removed during mastectomy.

Cooper’s Ligament

This ligament is often called “nature’s bra” because it lifts the breast and prevents it from sagging.

For a slideshow on breast anatomy, visit http://www.mayoclinic.com/health/breast-cancer-early-stage/BC00001.

Have questions about breast cancer? Visit our blog’s Ask the Doctor section.

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Do You Know Your Breast Reconstruction Options?

August 24, 2011 by

breast reconstruction optionsWe’re thrilled to share some exciting news with you, today! Dr. Richard Kline, Charleston breast surgeon, and the lovely Leslie Haywood, owner of Grill Charms™ and breast cancer survivor, were recently interviewed on one of our local Charleston news channels. During this interview, Leslie shares her inspirational story of breast cancer survival and how she chose to have the breast surgeons of The Center for Natural Breast Reconstruction perform her natural breast reconstruction.

Dr. Richard Kline of The Center for Natural Breast Reconstruction spoke about breast reconstruction options for women who are currently undergoing treatment for breast cancer or who have had a mastectomy.

See below for the interview:

If you want to learn even more about Leslie Haywood’s story (and get a chuckle from her hilarious narrative), click here to view one of our recent blog interviews with her.

For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit The Center for Natural Breast Reconstruction website at http://www.naturalbreastreconstruction.com/.

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What Are My Reconstruction Options After a Lumpectomy?

August 12, 2011 by

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

What are the options for reconstruction surgery after a bilateral lumpectomy?

Great question! Your options would be very similar to those you would have if you had a mastectomy. Keep in mind that if your lumpectomy was followed by radiation, the behavior of the radiated skin and tissue can complicate a reconstruction procedure utilizing implants and your best option may be to use your own tissue to restore your breast size and shape. Nonetheless, it’s your plastic surgeon’s responsibility to tell you all of the options available to you and let you choose how to proceed. Also, discuss with your surgeon any procedure that may need to be done on your unaffected breast to achieve symmetry.

Here’s my short list of options:

1. Tissue expanders and subsequent replacement with permanent implants. Ask about silicone vs. saline implants. How about the use of a skin and tissue replacement like fat or a dermal matrix (like Alloderm)?

2. Autologeous reconstruction with latissimus flap (back). Will implants be needed, as well?

3. TRAM flap (transverse rectus abdominus muscle). Uses the muscle, skin, and fat of the abdomen to rebuild the breast. Make sure you have been told of the risks involved in removing this muscle.

4. DIEP, SIEA (deep inferior epigastric perforator or superficial inferior epigastric artery). Uses the skin and fat of the abdomen to rebuild the breast but leaves the muscle of the abdomen intact.

5. GAP (gluteal artery perforator). Uses the skin and fat from the upper (inferior) or lower (superior) buttocks. Like the DIEP, no muscle is removed for this procedure.

6. TUG (transverse upper gracilis). Inner thigh donor area, utilizes skin, fat, and muscle of the upper inner thigh.

7. Intercostal perforator. Utilizes skin and fat from under the arm.

8. Maybe you’re happy with the size of your post-lumpectomy breast but would like the shape addressed. Procedures such as mastopexy or reduction mammaplasty on the unaffected breast may be the procedures to investigate.

9. If it’s a small defect, a simple fat transfer from another part of your body may remedy the problem.

Best Wishes,

The Center for Natural Breast Reconstruction Team

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Spotlight on Upstate Women’s Show

August 3, 2011 by
Image above taken from the Upstate Women’s Show website.

The 4th annual Upstate Women’s Show takes place August 26–28 at the TD Convention Center (formerly the Carolina First Center) in Greenville, SC. For three days, women can shop, watch fashion shows, attend cooking and fitness demonstrations, and just have fun with other women. Whether you’re a teen, a single woman, a mom, or a retiree, you’ll find plenty of fun, treats, and excitement at the show.

Over 300 vendors will show and demonstrate their products for women, and the exhibitor list includes Aloette Cosmetics, Carolina Pet Chef, Massage Envy, Chocolate Dreams, and The Children’s Museum. Products and services available range from jewelry to closet organization systems and baby gifts to a variety of artwork.

One of the exhibitors, My Girlfriend’s Closet, is working with Safe Harbor, an organization that helps women and children in need. If you drop off gently used accessories at Safe Harbor’s booth, you’ll receive a coupon for My Girlfriend’s Closet, and proceeds go to Safe Harbor.

Special areas of the show include . . .

  • Corley Entertainment Stage, with fashion shows, music, and comedy.
  • BI-LO Cooking Stage, with live cooking demonstrations.
  • Lift Your Spirits, a sampling area for wine and cuisine.
  • Cureton Photography Booth, offering free photos.
  • Go Active! Kids Area, with crafts, games, and sports.
  • Haywood Hall Man Cave, a lounge for the men to hang out while you explore.

The day wouldn’t be complete without some fun contests. To win a free bedroom makeover with Vern Yip of HGTV, visit www.WMYI.com from August 8–19 and upload a picture of your bedroom. Listeners will vote on the top three bedrooms that need a makeover, and Vern will choose the winner, who will receive a 15-minute consultation, a $1,000 gift certificate, and a queen mattress set.

Win an iPad on the SCBT Treasure Hunt. You’ll find a playing card in the bag you receive at the show. Visit the booths of the 8 sponsors on the card, and return it to the SCBT booth to enter the drawing.

The Upstate Women’s Show runs Friday, August 26 and Saturday, August 27 from 9 a.m. to 6 p.m. and Sunday, August 28 from 12 p.m. to 5 p.m. Parking is $5, and tickets are $8 for adults and $4 for children ages 6–12. To save $2 on admission, bring 5 canned goods for Harvest Hope Food Bank.

For more information, visit http://shegreenville.com/.

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Tips for Post Surgical Clothing for Breast Reconstructive Surgery

July 29, 2011 by
breast reconstruction

Chris Murakami RN, CNOR, & Christina Hobgood Naugle, PA-C

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

I am having a SGAP breast reconstruction in a few weeks. Do I need to buy post op surgical bras? If so, which kind and can I get a prescription for insurance purposes? Also, I heard people use various bras / camisoles with pockets for drains. Have you heard of those or think they are helpful? Do you think button down shirts are something I need to get? Anything else?

No need to buy any special bra, vest, or camisole in advance. Our hospital, East Cooper Regional Medical Center, provides a soft cotton vest with drain pockets as well as a surgical bra that acts as a post operative surgical dressing. Let them know if you feel like you need an extra for when you leave the hospital and they are great about sharing another with you.

Absolutely, I would make sure I had button down shirts and loose clothing that you can easily get in and out of. You’ll have some limitation of lifting your arms above your head so button down shirts are easiest to get on and off without lifting your arms. Some women choose to wear loose sundresses; others track suit pants or cotton shorts. Whatever you are comfortable in is fine, but keep in mind we won’t want you wearing anything right away that could potentially put any pressure on your suture lines.

Here are more helpful hints:

If you are having a DIEP breast reconstruction, abdominal swelling limits clothing choices. Wear loose-fitting garments to the hospital. Women should avoid fitted, zippered pants and skirts because they probably won’t zip when it’s time to leave. Even clothing with snug elastic waistbands may be uncomfortable. A loose chemise or drop waist dress or jumper is a good choice.

Slacks or skirts with elastic in the back and a smooth band in the front may be slightly more comfortable than those with a totally elastic waistband.

Consider clothing that doesn’t wrinkle easily. Resting and naps are necessary while recuperating.

Cotton underwear breathes and is absorbent and comfortable next to the skin. Cotton’s fiber ends help the fabric stand away from the sensitive incision area rather than hug it, as some textured, synthetic fabrics do. If you don’t already have cotton briefs, buy a pair a size larger than your normal size. A little extra room adds comfort during recuperation. For waistline incisions, bikini cut styles may be better, while full cut panties and shorts might be preferred for incisions in the lower abdomen and buttocks.

Loose-fitting nightgowns and nightshirts are comfortable, especially when made from absorbent, breathable cotton or cotton-blends. If you prefer pajamas, select those with drawstrings. Elastic waists may be less comfortable for some people depending on swelling, tenderness, and location of incision. Sweatpants or crew pants are a comfortable change from bed wear, especially those with drawstrings, which allow some flexibility at the waistline.

Flat soled shoes that slip on your feet rather than tie are great to have, too, as you may be limited in your ability to bend over and tie your shoes.

If you do need to have a special bra after your incision lines have healed, we are happy to provide a prescription. We’ve had lots of our patients rave about Nordstrom’s for post mastectomy bras. Not only do the kind folks there provide a professional fitting for mastectomy patients, but they also handle the insurance paperwork for you too!

—Chris Murakami RN, CNOR, & Christina Hobgood Naugle, PA-C

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Low-Fat Ways to Spice up Any Dish

July 22, 2011 by

low-fat dishesOne criticism of low-fat diets is boredom and blandness, because fat adds flavor to meals. Spices and condiments can add all the flavor you want without adding extra calories or contributing to health issues.

When using spices, don’t be afraid to experiment. One way to know if a spice is right for your dish is to do the sniff test. Smell the spice, and you’ll be able to tell right away if it’s right for the meal you’re planning. We’ve searched our spice rack to bring you some fresh ideas to create new flavors without fat.

Meat and poultry

Even low-fat cuts of meat benefit from thoughtful use of spices. Try tenderizing and then marinating your meat overnight before cooking. You can find plenty of commercial marinades in a variety of flavors, but some have high fructose corn syrup or excess sodium, so be sure to read all labels. Try using steak sauce, beer, wine, soy sauce, or fruit juice. Marinade recipes abound online and provide variety.

Spice and seasoning blends such as Mrs. Dash, Nature’s Seasons, and seasoned salt and pepper take a simple cut of meat or poultry and make it taste like a gourmet masterpiece. Instead of simply sprinkling the spice, try rubbing it into the meat directly. Single spices that pack a flavor punch include garlic, dill, sage, rosemary, and cinnamon. You can also add vegetables during cooking, such as mushrooms and onions.

Seafood

Lemon pepper and fresh-squeezed citrus fruit enhance seafood, as do low-sugar, low-fat tartar sauce and cocktail sauce. Most spice companies produce spice blends specifically for seafood, and for a real treat, add a little parmesan before baking.

Vegetables

Veggies are an important staple of a low-fat diet because of their fiber and low calorie count. Spice blends are delicious on vegetables, and some spices that add a unique flavor include marjoram, nutmeg, onion, and cinnamon. Think outside the box when using spices. Perhaps an apple pie or pumpkin pie spice would work with squash. Instead of butter and sour cream for baked potatoes, try some low-fat plain yogurt with chives, salt, and fresh-ground pepper.

Be sure to keep an eye on sodium, high-fructose corn syrup, and hydrogenated fat when you’re spicing up your food. The main rule in using spices is that there is no right or wrong. Use the spices you like in combinations that make sense to you. You never know what delicious spice blends you’ll create.

Do you have any low-fat ways to spice up a dish? We’d love to hear about them in our comments section!

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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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Tricks to Enjoy Yummy Beers and Wine without Packing on the Pounds

July 11, 2011 by

light alcoholWhen you’re watching your weight, one of the first things you normally reduce or eliminate is alcohol. While drinking too much can cause weight gain and other issues, moderate consumption of alcohol is good for your heart. You don’t need to deprive yourself to keep your weight down and stay healthy—you just need to do a little planning.

Often, small changes are all you need to make your favorite drinks healthier. For example, if you enjoy beer, you might like the new low-calorie and low-carb light beers. Most of the domestic beer makers have low-calorie options, such as Budweiser Select, Michelob Ultra, Miller Genuine Draft 64, and Aspen Edge. These beers vary in alcohol content.

If you prefer wine, lighter whites such as Chardonnay, Pinot Noir, and Chablis tend to be lower in calories than reds. White Zinfandel is also a good choice. Sweet dessert wines such as Port and Madeira contain high levels of sugar and alcohol and are high in calories.

The calories in mixed drinks and cocktails often come from the mixers you choose. While sweet liqueurs such as crème de menthe are high in calories by themselves, if you add high-calorie juices or cream, you can go from 100 calories to over 500 in no time. If you choose a drink that combines several types of alcohol, the calories will also climb.

The simpler the drink, the better. An average shot of 80-proof alcohol is around 100 calories before you add anything. Asking for diet soda pop, water, or diet tonic will help keep your calorie count down. Gin and tonic, rum and diet coke, and whiskey and water may not be very exciting, but their calorie counts are low. You could opt for shots of liqueur or flavored vodka, or order them on the rocks.

Some drinks have spawned their own low-calorie versions. For example, a skinny margarita leaves out the syrupy mix of the regular margarita. Ordering the regular-sized margarita instead of the fishbowl-sized margarita will help your weight stay where you want it. Some super-sized drinks can have 1,000 calories or more.

To reduce your consumption of alcohol and related calories, consider drinking a glass of water or simple mocktail between drinks, and skip the munchies at the bar. After a few drinks, your inhibitions are low, which also affects your resolve to watch yourself. If you know you’re going out one night, skip snacks or eat light during the day to save up calories for later. Eat before you go out so you aren’t tempted to eat high-calorie bar snacks.

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Is It Normal to Suffer With Abdominal Hernias After Reconstruction Surgery?

July 1, 2011 by

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

Is it routine to suffer with abdominal hernias after reconstruction surgery? Is it possible to correct this so there will be no more hernias or surgeries?

Sorry to hear about your problem.

It’s certainly NOT routine, at least not with experienced surgeons doing muscle sparing reconstruction (such as the DIEP flap). Unfortunately, however, it can occasionally happen under the best of circumstances, and we always warn patients about this risk, although I haven’t had a patient with a hernia in several years. Depending on the particular circumstances, it should almost always be possible to fix it, although in the worst cases it could require the implantation of permanent plastic mesh. A worst-case scenario would be a patient who is significantly overweight, with a large volume of intra-abdominal fat, which would push heavily against the muscular abdominal wall from the inside. However, even this situation should be correctable. If your plastic surgeon isn’t comfortable fixing it, then a general surgeon may be (although general surgeons typically refer the WORST hernias to plastic surgeons).

Good luck, and please feel free to ask more questions if you need more information.

—Dr. Richard M. Kline, Jr.

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