Ask The Doctor – Recovery After a Failed Implant Reconstruction

<alt='failed implant reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had breast cancer twice, and one of my breast implants got a bad infection. My implants had to be removed, and I’ve left them that way since. Now I’m 58 years old, and I’d like to have reconstruction. Is this possible for me at my age and after an infection?

ANSWER: Thanks for your question. While I cannot obviously make precise predictions about our ability to help you without knowing a little more, I can tell you that your situation is actually a very common one. Fortunately, a history of failed implant reconstruction has very little impact on our ability to subsequently reconstruct you with your own tissue, and we have successfully reconstructed many, many women in your situation. If you wish, one of us can give you a call to discuss your situation further, and we can go from there. Have a great day!

— Richard M. Kline, Jr., M.D.    

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



Why Microsurgical Breast Reconstruction?

<alt="pink flower"/>The access to GAP and DIEP procedures is not widespread, only a handful of surgeons have invested the time to learn this intensely specialized microsurgical procedure, and have access to another equally qualified micro-surgeon to provide the required surgical assistance.

To give you an idea of how few of these surgical teams exist, in late 2007 we were one of only three practices in the country that offered simultaneous bilateral GAP reconstruction.  As a result, we see patients from all over the United States seeking this highly successful option, with 30 to 40% of our patients referred to us as a result of repeatedly failed implant reconstructions.

In a critical analysis of 142 GAP procedures published by six physicians at LSU, the GAP procedure is reported as “not easy to learn; however, it does provide a reliable flap and an excellent aesthetic reconstruction.”  The report further states “overall flap survival was 98%”and perhaps most importantly “patient satisfaction with the reconstructed breast and donor site has been excellent.”

A little bit about us:

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the right questions to ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions. Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • How many board certified physicians will be assisting with the first stage of the procedure? Will there be physicians in training (residents) involved with my surgery
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

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

Ask The Doctor – Will My Weight Impact My Breast Reconstruction Surgery Goal?

<alt="pink rose"/>This week, Dr. Richard M. Kline of The Center for Natural Breast Reconstruction answers your question.

QUESTION: Hello, I’m a breast cancer survivor. My doctors will not do a reconstruction because they say I have to lose weight. The medicine I’m taking causes me to have body aches and pains, and I’ve gained weight because of it. I’m also afraid that my cancer will return. I’m financially strained and really feel left behind when it comes to improving my body; I want to feel whole again and wanted. I just turned 50 and have been cancer free since June 2011. I’m excited to have another chance to live, but I want to feel like a whole woman again with complete confidence. What are my options? Thank you for your time.

ANSWER: Hi there, I’m sorry you’re having these problems, but we will help if we can. We have learned from hard experiences that it can be dangerous to do reconstruction with your own tissue (we do not do implant reconstruction, as a rule) in patients who are significantly overweight. That being said, the guidelines for using tissue are not strictly rigid, and it depends to some extent on how the extra fat is distributed in your body. If you would like to investigate further, we could have our nurse Chris or PA Kim call and chat with you. Thanks again for your inquiry. Have a great day!

Dr. Richard Kline

Center for Natural Breast Reconstruction

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

I’m Not Happy With My Implants — Is Flap Surgery Possible?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a double mastectomy last August with immediate expander reconstruction. My expanders were replaced in January with silicone implants and needless to say I’m not thrilled with them. They are hard, cold and I now have ripples across them. My surgeon is going to remove more excess skin in hopes to alleviate the “wrinkling” effect, but I’m honestly not sure if I even want to have this done. I originally wanted to have a tissue transfer (abdominal) but was advised to try the implant route first.

I know that I don’t have a lot of abdominal fat and would probably end up with very small breasts if I went this route instead. I don’t mind the smallness but am concerned on the dangers of having a tissue transfer and wonder if this would be a better, more natural breast for me. I’m not getting the feeling that my surgeon is comfortable with this type of surgery and would like more information on your facility. I feel like I have so many questions that no one can seem to answer. Is there someone that I can reach out to?

A: We would be very happy to discuss your situation with you. It is very rare for someone not to have enough stomach or buttock tissue, especially with subsequent fat grafting, to provide an acceptable breast size. Flap surgery can be a little intimidating, but our success rate over the last ten years is 98.4%. We have helped many women who have started out with implant reconstruction, only to decide that it was not the right choice for them.
Our nurse Chris or P.A. Kim can call to discuss your situation further, if you wish.

Thank you for your question.

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

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

Happy Holidays From All of Us!

Our doctors and staff at the Center for Natural Breast Reconstruction wish you a merry Christmas and holiday season!

It is such a joy to have friends, former patients, and current clients reaching out to us during this time. We hope your week is filled with warmth and cheer for a healthy new year!


Join Us for We Know Women!

We Know Women Event garden partyFor the fourth year, East Cooper Medical Center is hosting an amazing event for women of all ages, the “We Know Women Event: Garden Party” on Thursday, May 9, starting at 5:30 p.m.

This fun event features live music, health demonstrations and screenings, local vendors with products women love, and wellness discussions with doctors including a question-and-answer panel. Wine tasting and delicious food will be provided, and Babies-R-Us will host a car seat installation demonstration.

Vendors include Grill Charms, Relax the Back, Abide-While, Silpada Designs, The Foot Store, HandPicked, Jonathan Green Prints, Miche Bag, No Wheat Treats, and Whaley’s Photos. The vendors will offer discounts and a variety of giveaways.

The physicians in attendance include Dr. James Craigie and Dr. Richard Kline from The Center for Natural Breast Reconstruction, Dr. Terrence O’Brien, Dr. Ross Rames, and Dr. Lynn Crymes. Topics include breast cancer, natural breast reconstruction, heart disease, cosmetic surgery, hormone therapy for women, and bladder concerns.


The “We Know Women Event” is free, but please register by calling 843-884-7031 or by visiting

East Cooper Medical Center is located at 2000 Hospital Drive in Mount Pleasant. 


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!

Is It Normal to Experience Pain Years After a TRAM Flap Surgery?

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

Q: I had tram flap surgery 6 years ago for one breast in Atlanta at Emory with a good plastic surgeon. I am experiencing horrible pain under my breast and around my upper rib cage where it has been mostly numb for all these years. It feels like 1000 bees are stinging me all the time. It also feels like something has pulled loose. There’s a bruised feeling as well. I wonder if the nerves are just now growing back which is causing the pain? My breast is very heavy. Is it possible to “re-do” this breast to relieve the constant pain? Or is this “normal” after six years? I am miserable.


A:  I’m sorry you’re having so much trouble.

It is certainly possible that something could have “pulled loose,” although, as you might suspect, it would be a little unusual after all this time. Also, while there is no theoretical time limit on how long sensory nerves can take to grow back, it would also be unusual to have that process stretch out this long.

Probably the best idea is to go back and see your original plastic surgeon. She or he may wish to obtain a CT scan, MRI, or some other type of imaging study, depending on your physical findings. If nothing unusual is detected, she may possibly send you to a pain therapist for treatment.

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!

Exclusive Recipe: Dr. Richard Kline’s Guacamole

We had such a great response to our Health Benefits of Avocados article this week, that our very own Dr. Richard M. Kline, Jr. decided to share his sensational guacamole recipe!


The Best Guacamole

Note from Dr. Kline: “Precise quantities of ingredients are not specified, because everyone’s taste is different.”


Ripe Haas avocados (forget the big green “water” avocados, no flavor) – should deform easily to touch, but not be mushy. If you can’t get proper ripe avocados, probably best to abandon guacamole for that day. Peel, remove pits, quarter.

Onions, green or yellow, chopped fine

Fresh garlic, peeled and crushed

Fresh cilantro, chopped fine

Fresh basil, chopped fine

Olive oil

Ground cumin

Lemon &/or lime juice, freshly squeezed


Tabasco sauce

Rotel medium hot canned tomatoes. I usually use one can for (6-7) big avocados, but adjust as you like. You can use fresh tomatoes if they are good, but the Rotels are packed with flavor, and very reliable.


Put all the above in a mixing bowl.

The proper consistency of the final product is important. I’ve found great success in first crushing the mixture with a Zyliss potato masher.

The wire “squiggles” almost magically crush the ingredients to a nearly-perfect consistency. If you want a little creamier mixture, you can then follow with a portable electric mixer until desired consistency is reached. I hate dirtying up a food processor or blender just to make guacamole, and this does a better job, anyway.

My favorite chips are Garden of Eatin’ or Bearitos blue corn chips. Yes, they have 7 grams of fat per serving, but the taste is unbeatable! Guiltless Gourmet baked blue corn chips are a healthier alternative, but the total culinary experience is not quite the same.


Stay tuned for Dr. Kline’s salsa recipe later this season!

How Long Does a DIEP Flap Procedure Take? What Is the Recovery Time?

This week Charleston breast surgeons Dr. James Craigie and Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answer your questions about DIEP flap surgery. 


Q: Approximately how long does the DIEP flap surgery take on one breast?


A: Thanks for your question.

A unilateral DIEP typically takes from 3-6 hours, depending on whether you already have had a mastectomy, and on how complicated the microvascular anatomy of your particular flap turns out to be.

Richard M. Kline, MD

Center for Natural Breast Reconstruction

Q: I do not personally know anyone that has had DIEP flap surgery. What should I expect within the first two to three weeks of recovery after DIEP flap surgery?

A: The first 4 days will be in the hospital, the next three weeks you will be very mobile but no driving. After one month your drains will be out and you will feel much better. Over the next 6-8 weeks you should be getting back to normal. Let me know we will be glad to let you talk to one of our patients who is in a similar situation.

See you soon.

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!