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Dealing with Juvenile Papillomatosis: Should I Have a Risk-Reduction Mastectomy?

February 22, 2013 by

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

 

 I am getting antsy with my breast health and am concerned for my future cancer risk. I have been diagnosed with juvenile papillomatosis, and have had one benign breast lump removed.

I currently have one lymph node and 5 masses (bilateral) under watch by mammogram/ultrasound every 6 months. I am really considering a prophylactic mastectomy due to my young age (39).

What are your thoughts, and would you recommend this if I were your patient? Also, do you think insurance would cover it in my case?

 

Thank you for your question. Do you have any family members who have had breast or ovarian cancer? Even if the answer is no, some people would consider a risk reduction mastectomy and immediate reconstruction. Multiple papillomas may increase your chance for breast cancer. Frequent screening with exams, ultrasounds mammograms will not prevent cancer. The idea of screening is to find something early.

If you are undergoing high risk surveillance (it seems that you are with all those repeat exams) then you should at least have the conversation with a breast surgeon who has experience with that type of surgery.  

My expertise is in breast reconstruction and one area that we specialize in is breast reconstruction immediately at the time that someone has preventive mastectomy to reduce their chances of developing breast cancer. We work with an expert breast surgeon who performs the mastectomy but preserves the breast skin and nipple. Mastectomy for preventive reasons is very different from mastectomy when cancer has already developed. The reconstruction is different in that we can usually get the best possible result under those circumstances.

I hope I have answered your question please let me know.

–Dr. James Craigie

Center for Natural Breast Reconstruction

 

 Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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Should I Have a Preventive Mastectomy?

February 15, 2013 by

Should I Have a Preventive Mastectomy?The following question is answered by Dr.James Craigie of The Center for Natural Breast Reconstruction.

 

I have no history of breast or ovarian cancer in my family, but my  mother and my sister do have a history of benign masses.  I’ve been told that I will need to frequently monitor any masses  I have or develop… likely for life. 

Every month, I can feel my breast tissue changing and becoming more fibrous (lumpy-bumpy), which makes me very uncomfortable.  I’ve watched a few friends with no cancer risk battle breast cancer recently, and I’m just not willing to allow myself to get to that point if possible. For peace of mind, and reduced cancer risk, I’d be much more comfortable undergoing a major surgery.  

Is this a logical solution given this circumstance, or am I overreacting?

 

Hello,

I have had numerous patients in similar situations decide to have preventive mastectomies and immediate reconstruction. It is a very personal decision to make and I do not feel you are overreacting to at least consider the option. Risk reduction mastectomy is the most effective way one can actively reduce the risk of breast cancer.

James Craigie,MD
Center for Natural Breast Reconstruction

 

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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Best of Ask the Doctor

February 8, 2013 by

charleston breast surgeonsAt The Center for Natural Breast Reconstruction, our mission is to help women everywhere make smart, informed decisions about breast reconstruction and overall healthcare.

Over the years, our surgeons, Dr. James Craigie and Dr. Richard M. Kline, Jr., have answered a wealth of questions about breast reconstructive surgery—from the different kinds of procedures to post-op healing tips.

If you’re searching for a thorough introduction to breast reconstructive surgery, here’s a sample of the invaluable advice our surgeons gave the past year:

Your Questions about Natural Breast Reconstruction and Implants Answered

Scarring After Breast Reconstruction Surgery

Tackling the Challenges of Breast Reconstruction After Lumpectomy and Radiation

The Benefits of DIEP Flap Breast Reconstruction Over Other Reconstructive Options

Is This Normal? Your Post Op Breast Reconstruction Question Answered 

Tips for Improving Recovery and Healing Time

If you are seeking advice about breast cancer, breast reconstruction, or healthcare options, please send your questions our way! We will address all of your questions with detailed and valuable insight straight from our surgeons.

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Can Breast Cancer Return After Breast Reconstruction Surgery?

January 25, 2013 by

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

Is it possible for cancer to come back in a new reconstructed breast?

Hello,

Breast cancer can reoccur in the breast after mastectomy. This can happen with or without reconstruction.  If the reconstruction is done with your own skin and fatty tissue, then the new breast has no real breast tissue and can not develop breast cancer. If breast cancer remains after mastectomy it could possibly grow into the new breast. This is rare but not impossible.

James Craigie,MD
Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

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DIEP Flap Reconstruction Surgery After Capsular Contracture

January 18, 2013 by

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

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

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

-James Craigie

Center for Natural Breast Reconstruction

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

January 11, 2013 by

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

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

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

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

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

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

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

 

 

 

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What Would Disqualify a Patient for Breast Reconstruction?

December 28, 2012 by

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

What are some circumstances 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.

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Wound Healing Post Breast Reconstruction Surgery

November 30, 2012 by

The below question is answered by the Charleston breast surgeon, Dr. James Craigie.

How do you determine when to use a wound vac in place of a traditional drain?

We have discussed the idea of using a wound vac in place of drains.  We have actually determined the use for combining the wound vac and drains under certain circumstances.  Some people have had radiation or have challenging wounds that result from wound healing problems combined with fluid collections caused seromas.  Sometimes drains are needed to evacuate seromas but unfortunately they are not always adequate.  Also, radiated tissues have difficulty healing and wounds developed in radiated tissue sometimes typical wound dressings may not be adequate as well.  We have used the wound vac combined with the drain in order to treat these complex wounds.  We have found that complex wounds are usually a combination of wound separation with fluid collections.  The drain actually passes through the wound vac sponge, the wound vac sponge is then covered with the steel dressing that is connected to a pump and the strong negative pressure generated is greater than the pressure of a normal drain.  This allows a deep pocket of fluid to be dressed with the drain tip and the open skin edge or wound edge to be treated with the sponge.  When the wound vac dressing is changed every 3-5 days, the drain can be backed out slowly and therefore as the wound edge heals, the fluid collection is controlled and the wound eventually heals quicker than other approaches.

-James Craigie, M.D.

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

 

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Could I Be A Candidate for DIEP Reconstruction After Implants?

November 16, 2012 by

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

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

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

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

I hope I have answered your questions.

—James Craigie MD

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

October 19, 2012 by

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

Is Vitamin E of any use on incisions? 

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

-James E. Craigie, M.D.

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

 

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