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What to Know Before Seeking Implants as Your Breast Reconstruction Option

January 4, 2013 by

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

I am weighing my options for breast reconstructions and  considering silicone implants. What should I know before I continue—what questions should I ask a doctor?

Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for breast reconstruction, and flaps may be a better alternative in that case.

-Dr. Richard M. Kline Jr.

The Center for Natural Breast Reconstruction.

Have questions for our surgeons? Submit your questions today and get answers straight from our surgical team! No matter where you are in your reconstruction process, we are here to help!

 

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What Would Disqualify a Patient for Breast Reconstruction?

December 28, 2012 by

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

What are some circumstances that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

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

 

 

 

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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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How to Develop Effective New Year’s Resolutions That You Will Keep

January 2, 2012 by

new years resolutions‘Tis the season to make New Year’s resolutions, but all too often they’re broken within a few days or weeks. We came up with a few ways to help make resolutions that you’re more likely to keep.

Do you really need to make resolutions?

For some people, using the word resolution dooms their plans. Maybe you should create a plan, set a goal, or make a decision.

Write it down.

To be successful in hitting your goal or resolution, you need a written plan of action. Take 30 minutes and write down what you want, why you want it, and how you plan to reach it. When your motivation wanes in the coming weeks, you’ll have that to look back on.

Be realistic.

Is losing 50 pounds in 2012 a goal that you can see yourself reaching? How about quitting smoking for the 10th time, or exercising every day? Be honest with yourself and set a goal that you can hit. Maybe 25 pounds, cutting down to ½ pack a day, or exercising three times a week are more realistic goals right now.

Focus on the short term instead of the long term.

Look at what you can do now rather than what you plan to do 6 months or a year from now. Using the examples above, focus on the month of January instead of the entire year. Decide to lose a pound a week, cut down by two cigarettes a day, or take up a new activity like Zumba or walking the dog after dinner.

Break down your resolutions into bite-sized chunks instead of trying to choke down a big goal.

Expect that things may not go the way you planned.

Most good plans have a monkey wrench thrown in at some point, and your New Year’s resolution is no different. Maybe in March you’ll hit a weight loss plateau, or your plan to quit will go up in smoke—how will you handle it? You may decide to make diet or exercise changes, or you may decide to quit smoking again.

You need to be flexible enough to roll with the punches and not feel defeated when things don’t work out as you had planned.

What has helped you to make successful New Year’s Resolutions?

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Feel Confident in the Decisions that You Make with the TalkAboutHealth.com Online Community

December 14, 2011 by

talkabouthealthWhenever an individual is diagnosed with cancer or any other type of disease, they often struggle to find the right information, which, in turn, can make them feel alone and frightened. In an effort to provide personalized answers and a greater understanding for health issues, Murray Jones, founder of TalkAboutHealth, decided to create an online community for people seeking support and medical information and advice.

See below for our exclusive interview with Murray, where he discusses what TalkAboutHealth is and how it benefits individuals seeking support and personalized health advice:

1. What inspired you to start TalkAboutHealth.com?

I was inspired to start TalkAboutHealth based on needs that I saw from being a caregiver to my father, who is a two time melanoma survivor. We had so many questions and it felt impossible to find the right information and then understand it in a limited amount of time. We felt alone and lacked confidence in the decisions we had to make. We needed personalized answers to understand our health situation. We needed perspectives from others like us who had been through similar circumstances. We needed guidance to help find relevant information.

As time passed and I met more people in cancer communities, both medical professionals and survivors, I realized that there was so much knowledge that everyone wanted to share that just needed a place to live and someone to organize it. I thought to myself, I can do that. I can build a website where people can share their experiences.

2. How does TalkAboutHealth.com benefit patients? In other words, what does it offer to patients, survivors, and experts?

Our goal is to help patients get the right information at the right time, so they can understand their health needs and make the right decisions for them. We want to help people feel confident in the decisions they are making, know that they are not alone, and have hope after hearing the stories of others.

To accomplish this, we provide personalized answers from leading medical professionals and experienced survivors. When a patient asks a question, we find and notify the right experts, survivors, and organizations to answer. Each question has answers from several perspectives and provides context and narrative to help the patient.

We then curate and provide structure for all of this information so that it is easy to find. In the future, we will test many different formats to educate—from custom web and email tutorials to working with medical experts on video courses.

3. Why did you decide to make TalkAboutHealth.com a community-based structure, as opposed to a website that featured medical information without the opportunity to ask questions and provide feedback?

For two main reasons:

1. Because the combined knowledge and experiences of the community can have an amazing impact in helping others.

2. Community makes it possible to provided personalized and individualized support.

The purpose of TalkAboutHealth is to be a community where all of us share knowledge, stories, and experiences to support each other.

4. Is there anything else you’d like to add?

I encourage everyone, including medical professionals, to tell their story and share their experiences in whatever format is comfortable for them. It is so important for us to share and support each other. None of us are alone, we need each other. If you share your story, you will help others and find the support you need.

Have any questions about TalkAboutHealth or want to learn more? Visit TalkAboutHealth.com or contact Murray directly at murray@talkabouthealth.com.

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Common Breast Reconstruction Questions Answered

November 11, 2011 by

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

1. I had my second part to breast reconstruction and had necrosis removed, but I still have the hardness. How can it be treated? They did liposuction.

If necrosis was removed and there is still hardness, then it is most likely from either 1) additional / remaining fat necrosis, or 2) edema (can feel hard, especially likely in radiated tissue). In either case, resolution is likely without additional surgery, if you wait long enough (may take 1 – 2 years), although breasts will be smaller in either case. If pain is present, and fat necrosis is still present, then surgery to remove the rest of the dead fat may be indicated.

2. I am considering silicone implants for breast reconstruction. What should I know before I proceed—what questions should I ask?

Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for breast reconstruction, and flaps may be a better alternative in that case.

—Dr. Richard M. Kline, Jr.

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Your Questions About Breast Reconstruction Answered

August 19, 2011 by

nipple sparing mastectomyThe questions below are answered by the breast reconstruction surgeons of The Center for Natural Breast Reconstruction, Dr. James Craigie and Dr. Richard Kline:

If a woman has flap reconstruction, are the nipples reconstructed at the same time or at a later date?

While it is sometimes possible to reconstruct the nipples at the same time, usually for various reasons it is preferable to delay the nipple reconstruction until a later time. Nipples must be positioned very carefully to look their best, and that means the final shape of the breast mound must be stable prior to choosing the nipple position. Tissue flaps must be carefully monitored for several days following the initial reconstruction to assure early detection of any problems, and temporarily leaving extra flap skin on the breast mound helps greatly with this. Additionally, FWIW, the skin that the nipples are reconstructed from, whether flap skin or native breast skin, frequently has no sensation, making it even easier to reconstruct the nipples as a small procedure in the office.

If a woman is a candidate for a nipple-sparing mastectomy, can she have flap reconstruction and retain her nipples?

Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Can you explain what you mean by a muscle-sparing free flap breast reconstruction?

“Muscle-sparing” simply means that NO MUSCLE TISSUE at all is removed. This does not necessarily mean that the muscle suffers no injury, as the blood vessels which nourish the flap usually must be removed from the muscle, but the amount of damage is commonly small enough that the muscle ultimately recovers its function.

What are some criteria that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

For more information on breast reconstruction, visit our website.

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How Long Should I Wait to Have a DIEP Flap After Radiation?

May 13, 2011 by

Dr. James Craigie

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

How long should I wait to have a DIEP flap after radiation?

Radiation therapy is part of the treatment of breast cancer and will affect the results of breast reconstruction. The treatments can miraculously kill some growing cancer cells but they also change the area of the body left behind after surgery.

All of the elements of the body can be affected: blood vessels, scarring, healing function, and appearance.  The effects of radiation occur in two phases. Short term occurs during and immediately after the treatments. Elective surgery at this time is not possible, for obvious reasons. The long term effects develop after the early “burn-like” injury “settles down.” The long term reaction occurs for approximately the first six months.

The experience can be widely different from one person to the next. We have experienced difficulties with the receiving blood vessels after radiation when we did not wait for the body to recover from both long and short term damage. These types of problems could possibly increase the chance for the new breast to fail. Avoiding these problems may be possible by waiting and that is why the long recovery is needed before reconstruction is started.

—Dr. James Craigie

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