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Natural Breast Reconstruction: What Are My Options If I Have Scarring?

February 1, 2013 by

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

I lost my implants in 07 due to an infection from my lymphedema. I had both removed and didn’t have reconstruction since the prior surgery was a failure. I have scaring from radiation in 2001. I’d like to think about reconstruction again BUT afraid of failure due to the scaring. Do I have options? Really would rather not have implants, I’ve both types, didn’t like either but would accept silicon over saline.

Hello,

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. If you’d like more info, we could have our nurse Chris call you. If you wanted to send pictures, that would also be very helpful.

Thanks for your inquiry.

Richard Kline
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.

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DIEP Flap Procedure: Is this covered by my insurance?

December 14, 2012 by

mental healthThe below question is answered by Charleston breast surgeon, Dr. Richard Kline of The Center for Natural Breast Reconstruction.

I had a double mastectomy last month and am considering the DIEP procedure. My insurance is Aetna PPO and I wanted to know if this is covered. Also, I keep reading about stage 11 follow up to do lipo on the upper abdomen so it is flat like the bottom half ( after surgery) . Is that part of the reconstruction and is it covered by insurance? Thanks

Hi,

I’m almost sure we are in-network for you, but our office will let you know for sure.

We use liposuction to help correct some donor site deformities, such as bulging of the upper abdomen, or fullness of the “muffintop” areas. Often, that fat can be used as graft to enlarge the DIEP flaps, or improve little areas of asymmetry. If we place fat in the breast, we add a code for fat grafting for the insurance company, but we never bill anyone for liposuction per se.

Hope this helps, and thanks for your question.

Richard Kline
Center for Natural Breast Reconstruction

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Breast Reconstruction After Lumpectomy and Radiation

November 2, 2012 by

The below questions are answered by Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction.

Can I have a breast reconstruction two years after the lumpectomy and radiation?

Absolutely! While reconstruction with implants after radiation (even if lumpectomy and not a whole mastectomy were performed) can often be problematic (if not impossible), the chance of getting a successful reconstruction using your own tissue is very high. In the simplest scenario, it is usually possible to use tissue from the abdomen or buttocks to simply “replace” the breast tissue lost from lumpectomy and radiation.

Alternatively, sometimes a better result can be obtained if the lumpectomy is converted to a mastectomy prior to reconstruction. Finally, if the survivor is in a high-risk group for developing another breast cancer, she may wish to consider whether bilateral mastectomy is advisable prior to reconstruction. Usually reconstructing a lumpectomy defect will require only one side of the abdomen, so if the other side is not needed for reconstruction, it will be removed for symmetry and discarded.

What tips do you share with your patients for them to achieve the very best results from breast reconstruction?

1. Have a positive attitude! Patients who are excited about their reconstruction frequently do very well and tolerate any “bumps in the road” much better.

2. Education. Try to become very familiar with your desired type of reconstruction, both through reading and discussing it with patients who have been through it already. Knowing what to expect allays fears and makes everything easier.

3. If time permits, maximize your body’s fitness through diet and exercise, to the extent that you are comfortable doing so.

—Richard M. Kline Jr., M.D.

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Complications From Vascularized Lymph Node Transfer

September 21, 2012 by

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

I am recovering from a DIEP flap reconstruction and lymph node transfer. I had breast cancer when I was very young and have had lymphedema for 25 years. I was so happy to hear that there was a surgery that possibly could correct the swelling in my arm that I jumped on it with out really researching. I am two weeks into my recovery and I have noticed swelling in my leg and groin. The groin I think is normal for a surgery site. However, the swelling in my leg Im afraid is the onset of lymphedema. I would appreciate any information you could share with me on this .

Hello,

Sorry you are having problems.

As your surgeon probably explained to you prior to surgery, vascularized lymph node transfer is experimental surgery, and no one really knows how often it works, if at all, and what the complication rates are.

As your surgeon also probably explained, lower extremity lymphedema is a potential risk of the node harvest. We strictly limit our node dissection to the area lateral to the superficial inferior epigastric vein and superior to the inguinal ligament, and have thus far had no problems with lower extremity lymphedema developing after the procedure. You may wish to consult with your surgeon about having bioimpedance analysis of your affected lower extremity performed to determine whether early lymphedema is actually present. If it is, then prompt institution of treatment may be advisable.

Richard Kline

Center for Natural Breast Reconstruction

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

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Your Questions About Breast Reconstruction Answered

August 31, 2012 by


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!


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Around the Harbor: A Guide to Experiencing Charleston by Sea

July 11, 2012 by

Charleston is our favoite place to be during the summer months, with its great beaches and waterways helping to temper the heat. If you’re looking to experience our beautiful city from another vantage point, consider taking a cruise around the Charleston Harbor. You will truly get a feel for life in this city by the sea. While you’re out there, you might even encounter some dolphins playing in your wake!

Charleston Harbor Tours

Step aboard the “Carolina Belle” and immerse yourself in the history of maritime life with Charleston Harbor Tours! This 90-minute tour comes with a well-educated tour guide who will point out some of Charleston’s most historic landmarks and tell the fascinating stories behind them. You can also purchase a carriage or plantation tour package when booking a harbor tour.

Spirit Line Cruises

Tour Ft. Sumter, have dinner, and sail around the harbor with the same cruise company! Spirit Line Cruises offers private charters, three-hour dinner cruises, and even wedding receptions. This company offers something for the history buff and socialite alike.

Charleston Dolphin and Eco Tours

Looking for something a little less historical? Grab your family and see Charleston’s watery wildlife up close and personal! Charleston Dolphin and Eco Tours offers fun for the whole family, with nature-oriented tours and harbor cruises. Choose the perfect excursion for your family, and enjoy the ride!

About Charleston:

The Charleston area is home to wonderful resources for our patients and their families. If you are traveling here for surgery, rest assured that we have world-class medical and post-operative facilities. Patients of the Center for Natural Breast Reconstruction are cared for at the East Cooper Medical Center, a state-of-the-art regional hospital, located very near to our offices.

The region is also filled with hotels, villas and homes available for short- or long-term rental.

Charleston is routinely ranked one of the nation’s most beloved destinations. And we’ve also been voted most polite so often, that we’ve politely pulled out of the competition. Charleston enjoys a temperate climate, a vibrant historic district, wide beaches, majestic homes and a friendly ambiance. No matter the season, there are plenty of things to see and do here.

You can get more information about Charleston and its’ harbor tours and cruises at the Charleston Area Convention and Visitor’s Bureau.

 

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Scarring After Breast Reconstruction Surgery

June 15, 2012 by

The below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

Is there anything you do to diminish the scars resulting from all of the reconstruction processes?

Generally speaking the quality of the scar is not affected by the surgeon’s technique, and is unfortunately completely dependent upon the patient’s biochemistry.  Having said that, there are some scar patterns, which are more favorable than others, in terms of allowing patients to wear different styles and types of garments without displaying scars.  In a best case scenario, every patient would have a nipple sparing mastectomy where scars readily conceal beneath most swimsuits, although this is unfortunately not possible.  The next best scenario is to have skin sparing mastectomies with a nipple reconstruction, which can still result in a scar pattern which can be readily hidden under most swim wear and in most types of clothing.

More Information on Scarless Mastectomy/Hidden Scar Mastectomy Procedures

Advances in microsurgery and breast surgery allow us to perform mastectomy with hidden scars as in a breast lift or augmentation, without leaving scars on the breast skin. Patients who are candidates for this surgery preserve their breast skin – including the nipple and areola.

This technique begins with an incision under the arm, under the breast fold, around the nipple or down the bottom of the breast below the bra line. Reconstruction involves using a one of the perforator flap techniques (DIEP, SIEA or GAP), with the relocated tissue filling in and shaping the breast.

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Will An SGAP Procedure Help With My Lymphedema?

June 1, 2012 by

sgapThe following submission below is answered by Dr. Richard M. Kline Jr., MD, of The Center for Natural Breast Reconstruction.

Will a SGAP help with lymphedema?

There is some indication that patients with lymphedema may benefit from having an autogenous reconstruction, and this is one reason why we have elected in our practice not to perform vascularized lymph node transfer at the same time as breast reconstruction.

About Our Procedures

Microsurgery has come a long way since its invention by vascular surgeons in the 1960s. The term refers to any surgery involving a surgical microscope. And it has found one of its best applications in breast reconstruction. Through microsurgery, our skilled surgeons are able to harvest healthy tissue from one part of a womans body and reattach it to the breast area. Through the careful process of attaching blood vessels, microsurgery allows patients to have natural looking breasts made from their own, living tissue. Another benefit is the minimized impact and injury to muscles, allowing patients to enjoy a faster, fuller recovery.

View an animation of our procedures here.

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Exploring the Recovery Process after DIEP Breast Reconstruction

May 18, 2012 by

The below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

What is the recovery process like for DIEP flap breast reconstruction?

Generally speaking, patients can sit in a chair the day after surgery, they are walking by 2 days after surgery, and they leave the hospital on the fourth day after surgery.   We ask you to sleep on your back for a minimum of a month, sometimes longer (depending on the size of the flaps), and to avoid vigorous physical activity for at least 6-8 weeks.  Most people seem to feel like they are well on their way to recovery within 2 months, although obviously healing goes on for a significantly longer.  However, everyone is different, and some patients recover more rapidly, other seems to take a little more time.  We feel that the optimal approach is to let you speak to other patients who have been through the process, so that they may share their experiences directly with you.

Below are some additional tips for optimal post surgical experience.

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 for surgical team at The Center for Natural Breast Reconstruction? Send them on over, we’d love to hear from you!

 

 

 

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