What Form Of Reconstruction Do You Prefer? What Type of Implants Are Best?

Ask the DoctorThis week, Dr. Richard M. Kline, Jr. and Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: What form of reconstruction do you prefer and which requires the least amount of procedures?

A: Our practice specializes in breast reconstruction using your own tissue and without sacrificing important muscles and without implants. Our preferred approach is to give women the option that works best for them! This takes into consideration each person’s situation and body type.

We prefer to transfer skin and fatty tissue from the “donor” area a person happens to have extra tissue. Each person’s body has its own form and shape therefore we prefer to make our recommendations based on where each person’s body has extra tissue to work with. Implant breast reconstruction is usually a shorter recovery because there is no donor site that has to heal. The results with implants are not as natural as using your own tissue and people with implant reconstructions generally have more procedures as time goes by because of changes due to the implants etc..

All types of breast reconstruction may involve multiple steps, usually 2 stages. Sometimes minor adjustments may follow depending on many different variables. I hope this answers your question.

James Craigie, MD

The Center for Natural Breast Reconstruction

Q: Can implants be used for reconstruction for breast cancer patients? If yes, is there a preference among medical practitioners as to whether the implant should be saline or silicone?

A: Implants not only CAN be used, they ARE used the great majority of the time (as opposed to reconstruction with the patient’s own tissue). Natural breast reconstruction with the patient’s own tissue is a longer, more involved procedure than implant reconstruction, with more serious risks, and is not the best choice for everyone.

Patients who have been radiated as part of their breast cancer treatment tolerate implants poorly as a rule, and for them, natural breast reconstruction may be their only hope for restoring symmetry. On the other hand, many patients who could be reconstructed with implants simply prefer to use their own tissue. Breasts reconstructed with your own tissue are warmer, softer, move more naturally, and are generally much closer to the “real thing” than implants. We have made a conscious decision to limit our practice to this type of reconstruction so that we can optimally serve the women who want or need it. However, implants seem to work quite well for the majority of breast cancer patients.

Richard M. Kline, Jr., MD

The Center for Natural Breast Reconstruction


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

I’m Having Trouble Healing After My DIEP Flap Surgery. Is This Normal?

 This week, we continue with Dr. James Craigie of The Center for Natural Breast Reconstruction answering your questions about DIEP flap surgery. 

Q: I had the DIEP flap surgery for both breasts in February this year. The incision in my stomach area has split and I am being told that this happens to 50% of patients. Is this true? I am told to use wet to dry dressing twice a day. I just don’t know if this is accurate because at the same time I’m told to exercise more? Can you please advise? Thank you for your time.

A: I am sorry you are having problems healing. It is not uncommon after a DIEP procedure to have some healing problems. These range from minor (usually little treatment needed) to more involved (may require a longer time to heal, special wound care or surgery). Because the tummy is pulled together, sometimes tight, an opening in the incision is pulled open even more by tension.

One of the benefits of the DIEP is that your muscles are spared and no artificial mesh over your tummy wall is needed. Therefore infection is usually not a serious problem. Healing may take a while. Take special care but it should not permanently affect the end result. I hope this answers your question and you have a speedy recovery.

James E Craigie, MD

Center for Natural Breast Reconstruction

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

Your Questions About Breast Reconstruction Answered

The below questions are answered by the surgical team at The Center for Natural Breast Reconstruction:

Q: A double mastectomy left me with butcher marks on my chest. The plastic surgeon who was part of the team that performed the mastectomy now proposed to do implants. The existing (very bad) scars will not be in the breast fold but will “cut” the bottom half of the new breasts in two. Could one get rid of these scars when doing a DIEP procedure?

A: We can’t actually “get rid” of scars, but often they can be improved, &/or moved to a less objectionable position. If you wish to send pictures, I could possible give you little more specific information.

Have a great day!

Richard Kline

Center for Natural Breast Reconstruction

Q: I’m having the tram flap done, can you tell me how long after the surgery that it doesn’t work?

A: Hi

It would depend on what type of TRAM procedure you have. If you have microsurgery the first three days are the most important and usually after that the blood supply to the new breast is ok. If no microsurgery is involved it may take longer to know for sure.

James Craigie, MD

Center for Natural Breast Reconstruction

Have questions about breast reconstruction? Submit them here and get answers straight from our surgical team. We’d love to hear from you!

Increase Breast Size Through DIEP Flap Natural Breast Reconstruction Surgery?

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

Can I increase the previous size of my breast during a DIEP breast reconstruction?

Breast reconstruction requires detailed planning before surgery.  One of the most important considerations is the desire of the patient to either be the same as she was before mastectomy or to change some aspect of the breast.  When there is adequate donor tissue (in the case of a DIEP excess tummy tissue) we may have the opportunity to increase the patient’s bra cup size given adequate planning and adequate donor tissue.  The desire of the outcome is always to be proportional and if someone has more tissue on the tummy we can usually achieve this.  In ideal circumstances, we plan to make the reconstructed breast approximately 20% larger at the first stage than the end goal after the reconstruction process is complete.   During the first stage of surgery, the tissue from the tummy is transferred and the primary goal is to have adequate blood supply and healthy nourished tissue.  The shaping of the breast is secondary to the functioning of the blood vessels during this stage. At the second stage of surgery, in order to create a more natural shape, some tissue may need to be removed or any tissue that did not survive the initial transfer (fat necrosis) removed.

Therefore, when planning the first stage procedure, we try to end up with slightly more than desired.  That gives us the ability to shape the breast and we can always make it slightly smaller at the second procedure; which is a much easier adjustment than making it larger.  So, it is possible to increase the current breast size with the DIEP, but it would depend on the size of the breast prior to the mastectomy and  how much donor tissue is available for reconstruction.

Are you thinking of having reconstructive surgery and have questions or just want more information? Then click here to ask our team, we’d love to hear from you!



What Changes Can I Expect After an SGAP Procedure?

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

What changes will I notice, if any, from an SGAP procedure after the first stage?

That is an extremely variable thing, some patients scarcely notice a difference in their buttocks after harvest of an SGAP from one side, while other patients noticed a significant difference.  In almost all situations, the buttock shape will not be optimized however after the first stage, whether it is a unilateral or bilateral SGAP.  The second stage of the SGAP, which can occur as early as three months after the first stage, typically involves a fairly extensive revision of the GAP flap donor site.  Our present feeling is that the GAP flap scar is ideally placed as high as possible, so that it may fit within most bathing suits, but still fit comfortably under shorts.

Learn More About Our Surgical Team

The Center for Natural Breast Reconstruction was created by two surgeons, Dr. James Craigie and Dr. Richard Kline. Through their work at East Cooper Plastic Surgery, they saw patients benefit from breakthroughs in microsurgery and breast reconstruction. Their combined skills helped women achieve the very best results possible.

The result: a center devoted completely to helping women gain the breast shape and fullness they seek, without the loss of muscle or use of artificial implants.

Dr. Richard M. Kline Jr., MD

Home: James Island

Education: M.D., Medical University of South Carolina; B.S., Furman University

Residencies: The Cleveland Clinic, Louisiana State University Medical Center

Specialties: Perforator flap breast reconstruction

Certification: American Board of Plastic Surgery

Personal: Married with two children

Dr. Kline trained in microsurgery with Dr. Robert Allen, who was pioneering the DIEP, SIEA, and GAP flaps at LSU while Dr. Kline was a plastic surgery resident. “We knew that he (Dr. Allen) was on to something very exciting,” remembers Dr. Kline, “but I doubt anyone back then foresaw just how sought-after those procedures would become.”

After completing his training, Dr. Kline spent several years in full-time academic surgical practice, first at LSU in New Orleans, then at the Medical University of South Carolina, during which time he performed the first successful DIEP flap in the southeastern United States. He entered private practice in 2000, and the practice rapidly became a regional referral center for complex microsurgical reconstruction. The practice has since evolved to focus almost exclusively on microsurgical breast reconstruction. “Our passion” says Dr. Kline “is restoring women’s body image after mastectomy using only their own natural tissue. We and our entire staff feel very privileged to be able to use our skills to help so many people in this way.”

A Charleston native, Dr. Kline lives near his childhood home and his parents. His wife, Elizabeth, is a thoracic surgeon, and the two met in the operating room. They have two children, daughter Bellamy and son Mahlon.

Dr. James E. Criagie

Home: James Island

Education: M.D. Medical University of South Carolina: B.S. Erskine College

Residencies: Medical University of South Carolina; Fellowship. Louisiana State University Medical Center

Specialties: Muscle sparing Breast reconstruction with the patient’s own fatty tissue

Certifications: American Board of Plastic Surgery

Personal: Married with two children

Some of Dr. James Craigie’s earliest memories are of afternoons spent at hospitals with his father, a general surgeon. “I liked to go with him on call and see the things that he did,” Dr. Craigie says. Today, Dr. Craigie is an accomplished surgeon himself, conducting 70-100 breast reconstruction surgeries each year, along with all types of body contouring and cosmetic breast surgery that is part of the process of breast reconstruction. “As plastic surgeon’s we use techniques that are often cosmetic in nature but included as part of the reconstructive process. My main goal is to help people,” he says.

His constant aim is to bring state-of-the-art techniques and the best possible results. Before joining our practice, Dr. Craigie opened a general plastic surgery practice in North Carolina and completed advanced training in micro-vascular breast reconstruction in New Orleans. He is one of a limited number of doctors who perform the specialized surgery, considered the “gold standard” in breast reconstruction techniques. “To do this complicated surgery, you have to have extensive training and a strong commitment.” Dr. Craigie says. “We saw a real need for this procedure, that many women could be helped.”

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

East Cooper Medical Center’s We Know Women Event

The Center for Natural Breast Reconstruction was thrilled to participate in the East Cooper Medical Center’s We Know Women Event on Thursday, May 17th.This was the third annual We Know Women Event which featured physician panel talks, one-on-one Q&A with physicians, retail therapy with more than 20 vendors and a wine tasting compliments of Whole Foods Market. Our very own Dr. James Craigie served on the panel “Save the Tatas:  Breast Cancer-Diagnosis to Treatment” alongside Dr. Baron of The Charleston Breast Center and others. We had an Ask The Doctor table set up on the lawn where we raffled off a beach bag filled with goodies. Although the rain did make its way to the event, uninvited, we didn’t let it stop us, as we came prepared with CNBR logo ponchos. See below for a look back at this years event!

Click here to watch Dr. Craigie answer questions on natural breast reconstruction.

Check out our pictures below for all the fun we had!

Dr. Craigie answering questions during the panel discussion-Save the Tatas: Breast Cancer-Diagnosis to Treatmen

Other panelists joining Dr. Craigie included – Dr. Lisa Baron – Charleston Breast Center, Dr. Jennifer Beatty – General Surgery Dr. Matthew Beldner – Hematology/Oncology

Fresh pink gerbers, just like our logo!!

It pays to come prepared!!! (With ponchos)

Amy McCarthy, winner of our big beach tote filled with goodies that we raffled off!

Make sure to like our Facebook page to stay up to date on all our events and happenings!


One Woman’s Journey to DO Something About Her BRCA Status

Julie Moon
We at The Center for Natural Breast Reconstruction are delighted to share this In her Words post featuring Julie Moon, who is a 34 year old BRCA 1 positive breast cancer previvor. Julie wants other women to be educated, which is why she began the blog  Say it Anyway, where she shares her unique story and journey.

See below for our interview with Julie.

What type of reconstruction surgery did you have and how do you feel about the results?

I had a bilateral nipple sparing mastectomy and immediate SGAP reconstruction.  I am so excited about having natural looking breasts made from my own body that will be with me for the rest of my life and never have to be replaced.   I am so grateful to have found Dr. Craigie and his staff.  I knew as soon as I met them that I was in good hands.

Breast cancer runs in your family at what point did you decide to undergo preventative breast surgery?

I found out in 2007 that I was BRCA 1 positive.  I decided then that I would go ahead and have my third child and breastfeed her as long as she needed. I participated in the Atlanta Susan G Komen 3Day For The Cure in 2011 and I was moved over that weekend to DO something about my BRCA status.  I met with Dr. Craigie in December and had my surgery Feb 1, 2012.

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

I would recommend that women look at lots of pictures.  I would recommend that they ask specific questions to other women who have undergone the procedure.  I found so much great information from the women at the FORCE.  I would also encourage them to not be afraid to travel to another city to get the procedure that they really desire.  I have three children and a very busy entrepreneur husband.  It was A LOT of work to organize all the friends, family and babysitters needed to care for my family while I was out of town for my surgery.  It was all so very worth it.

In what ways has breast cancer both negatively and positively affected your life?

I feel very blessed to be one of the women who actually knows what cancer was coming after me and be able to eliminate that risk before it knocked on my door.  My grandmother was a breast cancer survivor.  She was not lucky enough to be able to have had natural breast reconstruction and now as a grown woman I am able to see how that must have affected her life so dramatically.  My aunt died from complications of her chemotherapy that was treating her breast cancer.  My mom was smart enough to have a bilateral and reconstruction before they found cancer but ironically she already had it growing in her breast undetected.  My BRCA status has taught me how to face something ugly in the face and not be afraid of it but battle it with the best army I could find.

Have questions for Julie? Submit them here! Be sure to check out her blog for tons of educational resources.