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At What Point During Your Journey Is It Time To See Our Surgical Team?

May 4, 2012 by

time to see a doctorThe below question is answered by Richard M. Kline Jr., M.D., of The Center for Natural Breast Reconstruction.

At what point in the process should a breast cancer patient see a breast reconstruction surgeon?

Opinions on this vary, but I think the prevailing opinion is the sooner the better.  Ideally, the patient would see the reconstructive surgeon even before plans were finalized for treating her cancer.  This is because many times several options are available to the patient, and she may not fully understand the implications of the various options available to her unless she understands what reconstructive options are available in each setting.

A Little Bit About Our Surgical Team :

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?

Do you have a question about breast implants or natural breast reconstruction? Ask our surgical team by clicking HERE.

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Water Soluble Vitamins: What Do They Do and How Do You Get Them?

April 30, 2012 by

vitaminsVitamins are either fat soluble (stored in fat) or water soluble, which means they dissolve in water and must be replenished daily. The fat-soluble vitamins are A, D, E, and K, and the B complex and C vitamins are water soluble.

Vitamin B Complex

The B vitamins, also known as the B complex, are a group of eight vitamins that perform a variety of functions in the body. They help your body’s cell division and metabolism perform at peak efficiency, aid your immune system’s function, and promote healthy hair and skin.

The main sources of the B vitamins are whole grains, beans and legumes (including peanuts), animal products, yeast, and green or cruciferous vegetables. The vitamins are listed below along with their common names and prime sources:

B1: Also known as thiamine, B1 is found in whole grains, cruciferous vegetables, and animal products.

B2: Called riboflavin, this B vitamin is found in dairy products and green vegetables.

B3: Food sources high in niacin include meat, fish, and vegetables.

B5: Find pantothenic acid in animal products and green vegetables. Women may recognize this as an ingredient in beauty products.

B6: Also called pyridoxine, eat plenty of veggies and meat to get your B6.

B7: Biotin (also an ingredient you might recognize from beauty products) is found in animal products and peanuts.

B9: Folic acid is a vital nutrient for a healthy pregnancy and is found in grains and leafy vegetables.

B12: This vitamin, cyanocobalamin, presents challenges to vegetarians and vegans because it is found only in animal products.

Vitamin C

Known as ascorbic acid, vitamin C aids metabolism, fights infections and acts as an antioxidant. It also promotes healing, such as from breast reconstruction surgery,  so we always suggest you ensure you’re getting enough. It’s found primarily in fruits and vegetables, as well as some meats such as liver. Sources high in vitamin C include peppers, berries, rose hips, and parsley.

The water-soluble vitamins are easily supplemented if the diet is deficient, though natural sources are always the best way to ingest them. These vitamins degrade when cooked, so raw foods are preferred. The important thing is that you’re receiving at least the reference daily intake (RDA) each day, as excess B and C vitamins are excreted in the urine.

 

 

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Your Question about Reconstruction Surgery and Lymph Node Transfers Answered

April 6, 2012 by

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

Can a one-sided microsurgical reconstruction be done in conjunction (same surgery) with lymph node transfer?

Lymph nodes can be “piggy-backed” on a DIEP flap, but our impression is that that precludes the ideal positioning of eitherthe nodes or the flap. Additionally, we have concerns that the nodes may not be as well vascularized (have as good a blood supply) that way (rather than doing them as their own separate flap), although extra small blood vessels can sometimes be hooked up to the nodes themselves.

Our preference is to just do the autogenous (your own tissue, no implant) reconstruction first, as some patients with lymphedema will improve with this alone. If they don’t improve, we’ve found that a vascularized lymph node transfer fits in very well with the second stage of the breast reconstruction. Of course, it is possible to do a DIEP or GAP with a separate vascularized lymph node transfer in one setting, but that makes a long procedure about 2 hours longer, so we haven’t pursued it.

-Dr. Richard M. Kline, Jr., MD
Center for Natural  Breast Reconstruction

Share this post with your followers on Twitter. And if you have a question for our breast surgeons, please feel free to submit them here!

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Upcoming Webinar: “Is Natural Breast Reconstruction Right for Me?”

April 2, 2012 by

NBR WebinarWe at The Center for Natural Breast Reconstruction are excited to announce our upcoming webinar, Is Natural Breast Reconstruction Right for Me?, happening Thursday, April 12, at 7:00 p.m. Eastern / 4:00 p.m. Pacific.

Intended for anyone who has been affected by breast cancer (including those who have been recently diagnosed, those currently in treatment, those currently in remission, and family and friends of those with cancer), the no-cost webinar will provide information about women’s options for natural breast reconstruction

Unlike other types of post-mastectomy breast reconstruction, natural breast reconstruction uses tissues from a woman’s body to create natural looking and feeling breasts. The webinar will be hosted by The Center for Natural Breast Reconstruction’s Dr. James Craigie and Dr. Richard M. Kline, Jr.,MD, both of whom specialize in natural breast reconstruction surgery.

During the hour-long event, the surgeons will educate attendees about…

  • Exactly what natural breast reconstruction entails and who is eligible for this type of surgery.
  • The language and shorthand of natural breast reconstruction, defining and explaining what all the natural reconstruction acronyms (including DIEP, GAP, TUG, and SIEA) mean.
  • What patients can expect in terms of hospital stays, recovery time, and scarring.
  • How The Center for Natural Breast Reconstruction handles insurance and what types of insurance we accept.

We’ll also open the phone lines to a live Q&A session with the surgeons and our insurance specialist so attendees can get answers to all their questions related to natural breast reconstruction.

To join us for the webinar, register here.

Note: if you are busy on April 12, register today, and we’ll send you a link to the replay, which you can watch at your convenience.

 

 

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Tips for Improving Recovery and Healing Time

March 2, 2012 by

Healing TimeOn the last edition of Ask the Doctor, we provided you with steps for the most optimal surgical experience. This week we are sharing with you some steps 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 for the Center for Natural Breast Reconstruction’s team? Send them on over, we’d love to hear from you!

 

 

 


 

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Change is in the Air!

February 29, 2012 by

Goodbyes are often bittersweet. While we are sad to see Christina Hobgood Naugle PA-C leave our team, we are proud to welcome a new team member, Kim Kay PA-C! Please take a moment to read the special message from Christina below.

“I am very happy to introduce to you all, Kim Kay PA-C.  Kim will be taking my place at The Center for Natural Breast Reconstruction starting in March.  My husband and I have a good opportunity in South Florida, so I will be returning to my home town.  Kim was a student with Drs Craigie and Kline a couple years ago, so she is a familiar face to The Center for Natural Breast Reconstruction team.  I am very sorry that I am unable to hug each one of you prior to my move, but I could not leave without telling you all “Thank you”.  Thank you for the friendships, and thank you for the life lessons that each of you have provided in the past 3 ½ years.  This experience has been invaluable and the strength I have seen inspiring.  I will keep you all in my thoughts and prayers, and check in with Drs. Craigie and Kline occasionally.

I am leaving confident that Kim will be an excellent addition to The Center for Natural Breast Reconstruction family!
All my best!”

Christina Hobgood Naugle PA-C

Christina,  we wish you the best of luck in South Florida!

 

 

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5 Ways to Reduce Sudden Anxiety

January 25, 2012 by

Sudden anxiety can be frightening and challenging to deal with, and if you’ve ever had it happen, it’s something you hope never to repeat. Following are five ways to deal with a moment of sudden anxiety.

Don’t squelch the first twinges of anxiety, but try to identify their source.

If you feel severe or sudden anxiety begin, you’ll be tempted to ignore the feelings and keep doing what you’re doing. Don’t try to ignore or resist the feelings, but step into them. The moment the anxiety begins, ask yourself what’s happening, and see if you can identify what’s causing the sudden anxiety. If you can, fix the immediate problem; if not, get away from what you’re doing and find a quiet place until the anxiety goes away.

The sooner you can identify and remedy the immediate problem, the faster the anxiety will fade.

Breathe.

Many people tend to hold their breath when they have sudden anxiety, which makes the problem worse. Take a deep, cleansing breath in through your nose—you should feel your abdomen expand—and blow it out forcefully and completely through the mouth. Keep on deep breathing, and you’ll feel your anxiety lessen.

Let the anxiety wash over you.

If the first twinges develop into a full-blown bout of anxiety, let it happen. When you can accept the anxiety, it will go away much faster than if you try to fight it. Think of it as a rush of water that will envelop you for a moment and then fade away.

Don’t leap to conclusions.

Often, people having sudden anxiety let their minds wander and imagine all kinds of possible scenarios. They may think about someone dying, or losing everything they have, which of course increases the anxiety. Clear your mind, as much as you can, and don’t let your thoughts move to places or circumstances that frighten you.

Remember that it’s not forever.

Anxiety passes on its own, but you need to make sure you don’t cause yourself greater harm. Relax as much as you can. That is easier said than done, and if you have frequent anxiety, practicing these steps will become second nature over time.

Do you have any tips for dealing with sudden anxiety?

 

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3 Trending Gym Classes that Will Get You Excited and Toned

January 23, 2012 by

If you enjoy getting out of the house to exercise, you may want to try one of these trendy gym classes.

Zumba

Created by Beto Perez of Colombia, Zumba is a high-energy dance program that gives you amazing fitness benefits. One day, Beto forgot the music for an aerobics class he was teaching, so he improvised with his own music—and Zumba was born. Today, you can choose from Zumba dance, Zumba toning, Zumbatomic for kids, Zumba in the Circuit, and Aqua Zumba classes. You can also purchase DVDs and dance at home.

Exhilarating and fun, Zumba burns hundreds of calories an hour, tones and tightens the body, and makes you feel like you’re at a party.

Pure Barre

Pure Barre’s website claims it to be the fastest, most effective way to change the shape of your body by using small isometric movements while standing at the ballet barre. Pure Barre clients typically see results within a few weeks.

Dancer and choreographer Carrie Rezabek Dorr created Pure Barre 10 years ago to help women and men achieve a strong, lean body. The Pure Barre technique does not involve any high-impact jumping and requires intense focus to do properly, much as yoga and meditation do. The exercises work the abdominals and lower body. Classes are small, and the exercises move along swiftly, driven by the music.

Spinning

The ideal way for bicyclists to stay in shape in the off-season, spinning is indoor cycling that anyone can do. It’s adaptable to every level of fitness and experience. Most spinners burn about 500 calories per class, and spinning differs from simply riding an indoor bike in the energy and enthusiasm of the instructor, the support from the group, and the motivating music.

According to the website, spinning has five core movements. Seated flat builds your stamina, seated climb works your lower body, and standing flat helps improve core strength.  The standing climb defines leg muscles, and jumps help you become more coordinated.

Have you tried any of these gym workouts?

 

 

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Mastectomy and Breast Reconstruction Questions Answered

January 13, 2012 by

nipple sparing mastectomyThe below questions are answered by Dr. Richard M. Kline, Jr., Charleston breast surgeon for The Center of Natural Breast Reconstruction:

What kind of breast expander do you recommend and employ?

We usually use either Mentor contoured tissue expanders, which have more projection at the bottom than the top, or Mentor round expanders with a remote port. If patients are using tissue expanders only as a “bridge” during post-mastectomy radiation until they can receive a flap reconstruction, then we prefer the remote port model, because it won’t interfere with the MRI we like to get prior to flap surgery to look at the vessels. If the patient is planning on having a permanent implant reconstruction, then the contoured expander (which is not compatible with MRI) may produce a better initial shape.

If I choose immediate breast reconstruction, what happens if it is discovered I need radiation treatment during the mastectomy? What happens then?

It depends on what type of reconstruction you have chosen. If you choose implant reconstruction, radiation doesn’t hurt the tissue expander or implant, although it significantly decreases the chance of achieving an acceptable result. If you have had an immediate flap reconstruction, then learn (unexpectedly) that you need radiation, then the flap may be in serious jeopardy. Experienced oncologic breast surgeons are usually pretty good at anticipating whether a patient will need radiation or not. If significant doubt exists, however, and a flap reconstruction is planned, it is best either place temporary tissue expanders at the time of mastectomy, or delay all reconstruction until after radiation.

What are the disadvantages of postponing breast reconstruction after mastectomy? (scarring, skin sparing options, nipple options)

The only significant disadvantage to postponing reconstruction is potential contraction of skin if a skin-sparing or nipple-sparing mastectomy is used. Depending on the amount of skin present and the ultimate desired breast size, however, this may present a problem for some patients, but not others. The advantages of delaying reconstruction include a decreased incidence of complications, and shorter anesthetics.

For breast reconstruction, what are the options for nipples?

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

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

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Breast Implant Alternatives to Adding Volume, Shape, and Projection to a Breast

December 23, 2011 by

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

In July 2010 I had I-GAP reconstruction. The results are awful. Do you have techniques that can work with a flap and add volume, shape, and projection to a partially recreated breast without the use of implants?

Sorry to hear about your problem, but it’s not terribly unusual to not have quite enough tissue after flap reconstruction. That’s actually good for you, because it means we have some experience dealing with this. The most desirable techniques to try, and in what order, depend on your body type and preferences, but here are some options:

1) Fat grafts: Your fat from anywhere you don’t want it can be harvested with liposuction and injected into the breast mounds in the desired areas. Survival of the fat is not strictly predictable, but often a significant amount remains permanently. Several sessions may be required, however.

2) Vth intercostal artery perforator flap: This is a fancy name we give when we utilize the extra roll of skin and fat that a lot of patients have (& hate) on the side of their chest behind the breast, under the armpit. It is left attached at the front, the skin is removed, and the flap is tunneled under the skin at the side of the breast, then across the top of the breast as far as it will reach. Besides making the breast bigger, this technique has the particular advantages of covering the upper border of the pectoralis muscle (often visible just under the skin after reconstruction), and lifting the breast in what is often a very aesthetically pleasing way. The disadvantage is that it adds a scar under the arm from where the flap was taken.

3) Additional perforator flaps: No one likes to hear this, but sometimes it is the best answer. We have always been able to find suitable blood vessels and add flaps successfully whenever we have had to try this, and the results have been favorable. Definitely not the first choice for most people, but good to know it’s a tried-and-true technique if you absolutely need it.

4) Finally, a small implant under a too small but otherwise healthy flap is often surprisingly well-tolerated, even in radiated patients. Not for everyone, but an option that has been used quite successfully in some instances, nonetheless.

We went through our “iGAP phase” some years ago, and abandoned it not because of the reconstructive results, but because we decided the sGAP donor site resulted in far more favorable buttock aesthetics.

–Dr. Richard M. Kline, Jr.

Share this post with your followers on Twitter. And if you have a question for our breast surgeons, please feel free to send us an email!

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