Dr. James Craigie Answers Your Questions About Natural Breast Reconstruction

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

Do you perform a stacked combination DIEP/SGAP using both to make a breast(s)?

We do on occasion. It may be needed when one area of the body does not have enough tissue to achieve the desired result. This is an unusual situation in our practice we can usually achieve our goals with one area of the body.

There is a lot of discussion about a maximum BMI what about a minimum?

BMI is a guide line that helps the surgeon determine who is at a higher risk for complications. It is not a strict guideline and the final decision is left to the surgeons judgment among other things. Safety is our first priority and studies have definitely linked high BMI to an increased rate of complications without a doubt. Unfortunately  BMI is not a perfect calculation and different doctors may use the information differently. A low BMI is not linked to complications if someone is otherwise fit for surgery. Someone with very little body fat will have a low BMI and possibly not enough tissue to make a very large breast. This does not mean they cannot have a good result. It  may mean they require and combined or stacked flap approach. We have seen many patients who have been told they “don’t have enough tissue” but after consultation can reassure them they can get a very proportional result.

Dr. James Craigie

The Center for Natural Breast Reconstruction

Do you have a question about breast implants or natural breast reconstruction? Submit them here for an answer straight for our surgical team!

Capsular Contracture From Breast Implants

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

I have had two failed breast reconstructions using an implant. First was placed too high up, and the second one anchored down with abdominal advancement flap. After 5 months the implant began to disappear. MRI proved it was not ruptured. Doctors were not worried  and I was told to stop worrying about it, so I continued on with my life. I then developed chest pain, muscle/ligament/joint/back pain and breathlessness when climbing hills or stairs. Eventually after 2 and a half years, I referred back to PS who told me I had a chest wall concavity due to the implant being forced inwardly under pressure from the scar tissue and muscle. The implant size was 770cc. Will this concavity “spring” back into place or will I have it for the rest of my life? Also what effects might this have on my body if my frame is being pushed out of alignment?

Hello,

Thanks for your question. I’m sorry you have had these problems. We see people whose chest wall and ribs become indented due to implants quite frequently. The problem develops because body reacts to the implant by making scar. We call this capsular contracture and in some people it can exert tremendous force due to constant pressure. The process will persist as long as you have an implant. We have not performed scientific studies to prove the ribs return to normal but we have treated hundreds of patients with this type of problem by removing the implants and replacing them with their own tissue with out taking their muscles. This has solved their problems related to implants permanently. I hope this answers your question, let me know

James Craigie, MD
Center for Natural Breast Reconstruction

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

Post Operative Care Tips From Our Team

Healing TimeOur team is constantly being approached with questions on the healing process and post operative care after breast reconstruction surgery. We strive to provide our patients with the information to ensure they achieve the most optimal surgical experience. For Today’s Ask The Doctor post, we are sharing with you some steps and tips we have to help our patients improve their post surgery recovery and healing time !

After Surgery

Family members will receive periodic updates during your surgery.

Following the procedure, you will be moved to a special unit in the hospital where you will be connected to monitoring equipment. There, nurses trained in post operative care of breast reconstruction will monitor you at all times.  Family members can see you during visiting hours.

You will also receive an informative sheet that discusses your specific information and post-operative care.  This likely will include information concerning drain care; it is very important to monitor flow from the drains in a 24-hour period. This guides us on when to remove them.  You will also have a kind of thermometer on your chest, which monitors the flap.  Other specifics and information will be provided in your post-operative packets.

As You Heal

Family and Friends:
Support from loved ones is very helpful. But understand that comments they may make during your recovery can cause you concern. Remember this: We will tell you honestly how you are doing and what we expect your result will be.  Please trust in our knowledge and experience when we discuss your progress with you.

Healing:
You will heal! How quickly depends on factors your genetic background, your overall health and your lifestyle (exercise, smoking, drinking, etc.). Many people believe the surgeon “heals” the patient.  No person can make another heal. Dr Craigie and Dr Kline can facilitate, but not accelerate, the healing process.  But you play the starring role, so your cooperation is key.

Swelling:
You may find swelling of your new breast and abdomen (DIEP) or buttock (GAP) to be troublesome and your clothes may not fit.  Be patient, this swelling will gradually subside and you will feel better in a few weeks.  There will be a certain amount of tightness in the area where the flap was taken from.  This will slowly relax in a few months.

Following Instructions:
Another way to improve healing is by following the instructions given by Dr. Craigie and Dr. Kline’s staff.  We believe “the difference is in the details” and strive to achieve the best possible results for you.  It is imperative that you act as a partner in this process — not a passive participant.  The instructions are designed to give you the best opportunity for healing without delay or surprise.

Click here for a complete list of post surgery healing and recovery tips and instructions.

Have questions about post operative breast reconstruction? Or questions in general? Join us on August 28th for our Post Op Pearls Webinar.

 

 

Is This Normal? Your Post Op Breast Reconstruction Question Answered

Post Op Breast ReconstructionThe below question comes all the way from Australia, and is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction!

6 weeks after surgery I had a leak a long my stitches all bright yellow came out when that stopped a week after my scar further round swelled and it started leaking from there. Thats stopping now, is this normal? Will it keep happening, and I think my breast seems to be going smaller?

Hello,

It depends on the type of surgery you had. Drainage from incisions 6 weeks from surgery could be related to  incision healing. If the incision healed without problems and then the drainage occurred it could be a reaction to stitches or from a collection of fluid underneath that is working its way out. Your description might suggest liquefied fat is working its way out. If it is coming from the breast it may stop on its own or could require a procedure to remove all of it. Make you sure you check with your surgeon to make sure there is no infection. I hope this helps answer your question.

James Craigie, MD

Center For Natural Breast Reconstruction

Would you like your breast reconstruction question answered?  Register for our no-cost webinar on August 28th where there will be a live Q and A session!!

 

 

One Breast Cancer Survivor’s New Take on Life: Laugh More and Love Harder

Today we are delighted to share this In her Words post featuring Regina McCray. Diagnosed at only 37 years old,  Regina shares her story with everyone she meets and is a ray of light for women diagnosed with breast cancer.

See below for our inspirational interview with Regina.

Tell us a little bit about your story and how you survived through breast cancer?

I was diagnosed with breast cancer on March 10, 2009 at the age of 37 years old. I had no family history, but because I work as a radiation therapist and see young women with cancer every day I started having mammograms at the age of 35.  My tumor was aggressive and was stage 2, grade 3, with one lymph node involved. I had a right breast mastectomy 3 weeks later and started chemo in April of 2009. I survived because of my faith in God, and the love of my parents and 11 siblings (I am the oldest child).  I also have a great support system of friends, co-workers and family.

You had to experience radiation as part of your treatment plan. What advice or information would you give to other women who need to experience radiation as part of their breast cancer treatment?

About 3 weeks after completing my last chemo treatment ( I did 6 round lasting from April to August) I started radiation, 33 treatments. Radiation only affects the area being treated so my skin got irritated like a bad sunburn, but my aloe vera plant worked wonders. Skin will be sensitive about 2 weeks into treatment and may start to get sore as treatment progresses, but the prescription creams given by the radiation oncologists usually work great. About 3 weeks after completion of treatment (usually 28-33  days Mon.-Fri) the skin will start to get back to normal.  For any woman needing radiation, it’s not as bad as most people think. You don’t feel the treatment, and it normally takes less than 10 minutes to receive treatment. Please don’t let the radiation horror stories scare you out of a treatment that is designed to kill microscopic cancer cells that may have been left behind. It is so worth the peace of mind!

You’ve been a great advocate for The Center for Natural Breast Reconstruction and a wonderful support source for your community. Tell us what you’ve been doing to support women who are experiencing breast cancer or know of someone who is?

After surgery, chemo, and radiation, I wanted to get my life, and body back so I joined support groups and started sharing my story with newly diagnosed women to help them get through the initial shock.  I speak to lots of my patients about my experience in order to let them know that they can get through it. I did a talk at my church to bring awareness to breast cancer, and I tell everyone that I come in contact with that if they know anyone that is battling this disease and need someone to talk to, they can call me anytime, day or night.

How has your life changed since being diagnosed with breast cancer?

Breast cancer has changed my life in so many ways, I never thought that something so painful, could make me a better person. I am grateful for the little things. I tell the people I love that I love them more often, and I don’t take for granted that I will have the chance of a tomorrow.  I live each day to the fullest, not caring nearly as much about pleasing others as I do about pleasing God and being happy.  I travel now and see places that I only dreamed about before, because now I know that tomorrow is not promised.  Even if I don’t make it to retirement,  God has given me today and I am enjoying Life! I laugh more and love harder.

What type of breast reconstruction did you have and would you recommend it to other women who might be contemplating natural breast reconstruction?

In May of 2010,  about 14 months after being diagnosed with breast cancer I went into the hospital for bilateral natural breast reconstruction along with a left mastectomy. Dr James Craigie (along with Dr Kline) performed the DIEP flap procedure  taking
fat and blood vessels from my tummy to make my beautiful new breasts. This procedure helped me feel whole again! I am so pleased with the results that I tell my patients, support group sisters, and anyone that is considering reconstruction that this is the way to go. My breasts feel like a part of my body, and I even have some feeling in them, not to mention they look great and I can wear a bathing suit and anything else, and look and feel great with my new girls and my flat tummy! I highly recommend the procedure and for anyone contemplating reconstruction please call Dr. Craigie’s office. He is in my opinion, the best Dr. on the planet. Skillful, patient, and his bedside manner is better than any other physician that you will ever meet. The staff is also awesome, courteous, patient and helpful.  I think the team from The Center for Natural Reconstruction was put here by God to give women like me a second chance, and they will always have a place in my heart!

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Around the World in Charleston: Best Ethnic Dining

In Charleston,  we like to give our taste buds a little adventure, and luckily, we don’t have to jet-set far for a bite of global cuisine. With our local restaurants showcasing classic dishes the world-over, all we have to do is decide where our hunger will take us next! Here are some of our favorite places to dine the world right in our beloved Lowcountry:

  • Basil: When we’re in the mood for authentic Thai cuisine,  only Basil will do. Whether it’s peanut-sauce-glazed satay, their famed basil rolls, curries, or Pad Prik, no other Thai restaurant comes close to Basil’s dishes or their lush, sophisticated ambiance. Be sure to top off your delicious meal with one of their signature cocktails—a perfect nightcap.
  • Zia Taqueria: Looking for something a little south of the border? Zia is an authentic Mexican taqueria offering regional Mexican, Southerwestern, and Tex-Mex cuisine and beverage with only natural ingredients. Be sure to try the savory tortas, carne asada, and baja fish —you’ll never forget that wonderful baja sauce!
  • Tabbuli: To sum up the magic of Tabbuli in a word: babaghanoush. Their fire-roasted rendition of this beloved eggplant appetizer is worth the trip alone! Of course, we stay for their glorious salads—fattoush, tabbuli, and the tahini salad. And the falafel. And the kabobs. Who are we kidding—we love it all.
  • La Fourchette: This French bistro will have your heart before you can say moules a la bretonne (their steamed mussels with shallots in a buttery garlic and white wine sauce). For the vegetarian diner, they offer a plethora of soups and salads, as well as an otherworldly delicious eggplant dish, replete with tomatoes, zucchini, and goat cheese, all in a decadent leek sauce. Don’t leave without sampling their succulent cheeses, paired perfectly with any wine from their full list!

Which ethnic eateries have you sampled in Charleston?

 

What are the Symptoms of Capsular Contracture from an Implant?

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

What are the symptoms of capsular contracture from an implant?

Capsular contracture is commonly described using the four-grade Baker Scale.

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

The symptoms can be varying from mild to severe.  Mild capsular contracture may only be detectable by your surgeon.  If the process worsens and becomes severe it may lead to changes in the breast that a person easily could tell themselves.  In other words, the shape may change, the breast may become different in shape, and clothes may begin to fit differently.  The breast may become hard and the skin and tissue over the implant can change in appearance and color.  The most severe problem related to capsular contracture would be pain and discomfort that may eventually limit the range of motion and movement of the shoulder and upper body.  Some patients relate symptoms that they describe as an “iron bra” across the chest when the scar is so thick and tight.  The chest feels like it is wrapped in something as wrapped in an “iron bra” all the way around.  Sometimes the process can worsen and actually press in, move the muscles away from the breast area, and change the shape of the ribs.  This would be the most severe form of capsular contracture and at that point we would recommend removing the implant and replacing the reconstruction with a muscle-sparing procedure.

Did you find this post helpful? We’d love to hear from you in our comments section.

What are the Next Steps if Capsular Contracture Occurs from a Breast Implant?

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

What are the next steps if capsular contracture occurs from a breast implant?

The next step would depend on how severe the capsular contracture is.  All implants will develop a capsule and this may slowly lead to changes in the shape or in the most severe cases painful scarring and hardness.  When symptoms develop it may be necessary to surgically intervene.  The next step would depend on whether the patient has had radiation and the available options for reconstruction.  The first step and the least involved regarding surgery would be capsulotomy or release of the scar. Sometimes the healing process, whether there was an infection or a bruise around the breast, could have increased the risk for capsular contracture. Other times it may simply be the body’s reaction to an implant.  If after capsulotomy or capsulectomy the contracture has not resolved, the next step would be to consider moving additional healthy tissue to cover the implant or to remove the implant and replace it with your own tissue.  30% of our patients who choose to undergo autologeous reconstruction have had prior implant reconstruction and their bodies have developed severe capsular contracture.  If someone has had radiation, the capsular contracture will be more severe and most likely once problems develop the problems will continue.  Therefore, when multiple capsular contracture procedures have been necessary; our recommendation would be to consider removing the implant and replacing it with your own tissue using a muscle-sparing procedure.  Your own tissue would not develop capsular contracture and it is the most successful way to solve problems resulting from implant reconstruction.

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

Perseverance: The Valuable Lesson Breast Cancer Taught One Survivor

Today’s In Her Words post comes to us from a past patient of The Center for Natural Breast Reconstruction, Carlette Holmes. Carlette, is a breast cancer survivor who lives in Anderson, SC and traveled to Charleston to receive her reconstructive surgery. Today, Carlette and her childhood best friend partake in a culinary partnership entitled, Buffa’s Cheese Biscuits. The recipe for these delicious biscuits come from Buffa, a cook for Carlette’s grandmother while she was growing up.

See below for out interview with Carlette and to learn more about Buffa’s Cheese Biscuits. All images included are courtesy of Carlette Holmes.

1.  Buffa’s Cheese biscuits, even the name just melts in your mouth. Can you tell me a little bit about these delicious biscuits and where the recipe came from?

I think my grandmother found the recipe in a Jr. League cookbook and gave it to Buffa to try. They were a staple after that. They were always on hand in a covered dish as you came into the kitchen. Everyone who came in knew they were there & grabbed a handful. Buffa’s were always good but often different…. sometimes “short” as she would call them, sometimes crispy, sometimes light and puffy or sometimes dark and crumbly. I know now it could have been due to the humidity on any given day. One challenge I faced was to get them to turn out the same every time. Family and  friends didn’t seem to care, but I felt it was important when I started selling them.

2. It seems you spent a lot of time in the kitchen with Buffa, do you have a favorite memory with her?

My conversations with Buffa are favorite memories. She loved to talk while she cooked and could tell a great story. Often, I would shell peas or snap beans while she “held court”. I loved to “help” her make jams and preserves.

My least favorite memories are those of grease fires and exploding pressure cookers. I am scared for life, and to this day I don’t like to fry in my kitchen. The first time I tried to fry fish for Edmund is was slightly boiled and awful.

3. You have been making these biscuits for your family and friends for years. What was the turning point for you to finally give in and brand Buffa’s Cheese Biscuits to the public?

I think the turning point was surviving breast cancer. My best friend since 7th grade, and partner in BCB, Lide Vandiver, had been after me for years to brand them, but I had a family to take care of and businesses to help my husband, Edmund run. My 2 daughters, Sally Cade and Brelyn, were in college when I was diagnosed. I got through my treatment and I had been thinking of reconstruction options. I had heard horror stories of implants, expanders and that procedure, and I didn’t think that was an option for me. I researched DIEP flap surgery and was so impressed with the procedure. I truly believe that God led me to The Center for Natural Breast Reconstruction. I called another surgeon and was told that they didn’t take my insurance. They directed me to the The Center for Natural Breast Reconstruction. I called and got Gail on the phone. This was on the day that I took my last chemo treatment. Gail talked to me for over an hour that day. It felt right and I am thrilled with my decision. As you can probably tell, I don’t let much grass grow under my feet and DIEP flap seemed to me like the best & fastest way to get through the reconstruction process and move on.

4. How did you decide upon what reconstructive option was right for you?

I was pretty excited about getting rid of my C-Section Pooch. It was just the right size to make C-cups.

5. How has your decision to undergo breast reconstruction impacted your life moving forward?

I saw the picture Dr. Craigie took of me the day I came to him… on the day I got my tattoos. That was start to finish in a flash. It was definitely a process, but one that I wouldn’t trade for anything. I can remember, 6 weeks after my DIEP flap surgery, sitting on the beach in my bathing suit and feeling comfortable and “normal”. I took out my cell phone and called The Center for Natural Breast Reconstruction to leave Dr. Craigie a message of thanks. I don’t have words to describe how good that felt after living with one breast for 6 months. Now they were both gone, but they were there. How amazing! DIEP flap has allowed me to move on. I know myself, and that I would worry if I had not had both breasts removed even though the cancer was only in one. It has been a great decision… nothing to stuff in my bra, no implants to worry about, just my C-Section pooch made into breasts. Dr. Craigie is a real artist (not to mention a gifted surgeon). I am still amazed at how real they look.

6. What advice do you have for women who have a passion, and want to turn that passion into a business?

I think my advice would be to persevere. Lide and I hit obstacles almost every day, but we just have to work through them. I think maybe that fighting cancer taught me a lesson in this. Every day brought it’s obstacles,  but I had no choice but to keep moving forward.

Click here to see where you can pick up Buffa’s Cheese Biscuits near you or place your order online!

 

 

 

The Advantages of ICAP Flap Breast Reconstruction and When to Use This Procedure

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

When would we use the ICAP flap for breast reconstruction and what are the advantages of this procedure?

The TCAP flap is a procedure for reconstructing the breast or partial breast reconstruction and is another of the muscle-sparing flaps. The ICAP does not require microsurgery or reattachment of the blood vessels, but usually the amount of tissue available is small.  In our experience it is most frequently used to perform partial breast reconstruction of mainly the outer side of the breast or to add volume to a previously reconstructed breast or when the resulting size is not as quite as large as desired from the original planned procedure.  An advantage of the ICAP flap is that it removes tissue from the side of the body that is usually in excess and sometimes bothersome following a mastectomy.  It is just above the bra line and the scar, and although it extends to the back, can almost always be covered in a bathing suit or a support type bra.  Again, the ICAP’s best use is in adding additional tissue to an already reconstructed breast or providing small amounts of tissue for partial breast reconstruction.  It typically does not involve microsurgery to reconnect the blood vessels and the blood vessel that nourishes the tissue is conveniently located on the side of the body near the breast just above the bra line.

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