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Will Reconstruction Improve the Shape and Size After My Lumpectomy?

May 2, 2014 by

1426157_white_rose_1This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy and radiation in 2004. The defect in my breast is increasingly more noticeable (clothed) than in the past. Now, I’m interested in reconstruction to improve shape & size of my breast. Do you have any advice?

A: Lumpectomy defects can be challenging, for several reasons. Firstly, the tissue is radiated, which of course makes ANYTHING less likely to work. Secondly, there is no really satisfactory way to reliably replace the volume that was lost, precisely where you want it. Sometimes a small implant can be helpful, but not always. If the defect is large enough,  a microvascular flap of the type we do can be used, but often this seems like overkill for the size of the defect. Free fat grafting (sucking fat from elsewhere and injecting it into the breast) might be as close to an ideal solution as possible, and some surgeons do it currently, but it has not been established with certainty that this does not increase the chance of cancer recurrence, so we are holding off on that procedure until more evidence is in.

In many lumpectomy / radiation breasts the entire breast envelope, including the skin, has shrunken significantly. This often presents the option of re-arranging (with surgery) the remaining breast tissue to improve the shape, then subsequently lifting or reducing the other side to match as closely as possible.

Hope this helps. If you’d like to send pictures, I can possibly give you more specific suggestions. If you’d to speak with our nurse Chris or PA Kim to give them more information, they’d be happy to give you a call.

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!

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Can I Have Natural Breast Reconstruction if I Had Radiation on my Right Side?

January 31, 2014 by

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

Q: Can I get natural breast reconstruction if I have had radiation on my right side? I have had both breasts removed, but the first time the cancer was found I had a lumpectomy and radiation. The next time I had it removed.

A: Natural breast reconstruction with your own tissue is usually the best option for patients who have had radiation. Sometimes (but not always) it can be difficult to get the radiated side to match the non-radiated side as closely as desired because the radiated skin can be much tighter, but the chances of success are still usually much better using your own tissue than using implants.

We’d be happy to have our nurse Chris or PA Kim call to chat with you more about the specifics of your situation, if you wish.

Dr. Richard Kline

Center for Natural Breast Reconstruction

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

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Can I Have Breast Reconstruction After A Lumpectomy? Will Insurance Cover My Reconstruction?

January 24, 2014 by

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

Q: I had a lumpectomy 10 years ago. Can I have reconstruction to fix my breast? The scar is under my left arm and the lump was taken out of the left side of my breast.

A: Thank you for the question! Some women who have had lumpectomy and radiation to treat breast cancer  develop problems with the shape of their breast or problems with one side being smaller than the other. When this happens we recommend breast reconstruction. It is possible to remove the breast tissue and save the nipple and skin. Then at the same procedure  reconstruction with your own fatty tissue is performed. This has the advantage of removing the radiated scar and breast tissue and reduces the theoretical chance of breast cancer coming back in that breast. It should already be very low.

Dr. James Craigie

Q: I had breast cancer in 2002 in my left breast. A lumpectomy was performed and I only had radiation. I had a breast reduction on the right side to match the approxmate size of the left breast, but since then I have gained so much scar tissue around the left breast and it is now much smaller than the right breast. I am 69 years old, but still consider myself to be middle aged and attractive and this bothers me. Will insurance cover these procedures even though it has been over 11 years since the cancer and 10 years since the reduction? I have a Medicare PPO.

A: Insurance will cover almost any reconstruction-related procedures, if you have had the diagnosis of breast cancer.

There are several potential options available to you, depending on your goals. We would be happy to have our nurse Chris or PA Kim call to discuss your situation further,  if you wish.

Dr. Richard Kline

Thanks for your inquiry!

Center for Natural Breast Reconstruction

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

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Should I Get Permanent Sutures to Help My Implant After Lumpectomy?

January 17, 2014 by

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

Q: I had a lumpectomy followed by chemo and radiation treatment. The tumor was on the inner edge of my left breast — basically skin and bone. My plastic surgeon (whom I respect and appreciate) used an implant and Neulasta. He formed a sling and sewed in to my sternum and ribs. I’ve had this procedure done twice. Each time the sutures were absorbed, the skin lifted and resulted in symmastia. I am wondering if non-dissolvable stitches along with sewing the neulasta to the area behind my breast which wasn’t super blasted  — forming a sort of “sail” would be an option. I would be interested in what you think and what solution you might have.

Thank you for your time!

A: We primarily do flap, not implant reconstruction, but I can still offer some insight.

Permanent sutures could possibly help, but if there is long-term significant force on them (which it sounds like there may be), they can work their way through soft tissue and still come loose (just like an orthodontist can move teeth through bone over long time periods). Nonetheless, it’s probably worth a try, especially if you liked the way your breast looked before the sutures dissolved.

There are also some potential options using your own tissue. Unfortunately, replacing the defect with free fat grafts, while technically straightforward, is a little controversial, as there is some concern that this could increase the risk of local recurrence (but this is far from definitively established). There are centers (one in Boston comes to mind) who are doing this as part of a controlled study. Also, depending on the size of the defect and the location of your scars, reconstruction with a small microsurgical flap might be a reasonable (although significantly more complicated) option.

It sounds like you have a good relationship with your surgeon, which is great. Please continue to share your thoughts with him, and I’m confident things will work out for you one way or another.

Dr. Richard Kline

Center for Natural Breast Reconstruction

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

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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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Am I A Candidate for Natural Breast Reconstruction?

June 29, 2012 by

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

I was diagnosed with breast cancer in 1999 at age 24 (infaltrating ductal, triple negative). I had a lumpectomy with a lymph node dissection, chemotherapy and radiation. I found out I was positive for the BRCA1 mutation in 2008 and had a myomectomy (c section cut) and subsequent full hysterectomy (via davinci) in 2010, since pathology found the mass to be Endometrial Stromal Sarcoma.

I am now considering a mastectomy to decrease my chances of reoccurrence. Would you recommend a prophylactic mastectomy? If so, what type of reconstruction can I have? I prefer natural reconstruction rather than implants, but do not know if I am eligible since I’ve had two abdominal surgeries and do not have a lot of extra tissue anywhere else.

Hi and Thank you for your question. I’m sorry you have been faced with these difficult decisions. Removing as much breast tissue as possible is the most effective thing you can do to reduce your chances of getting breast cancer. I  refer to this type of mastectomy as “risk reduction” because it does not make the chances 0 but is as close as one can get. Your previous tummy surgeries have probably not affected your ability to have natural breast reconstruction, as we have had many people who have had the same types of surgery before using the extra tummy. Even the people who have had surgeries that compromise the tummy we can almost always come up with an option for natural breast reconstruction. Many of our patients have been told they do not have enough extra to use but when we see them we can usually give them a very nice result without implants. I hope this answers your question.

Sincerely,

James Craigie, MD

Center for Natural Breast Reconstruction

 

Would you like your breast reconstruction question answered? Just ask us!

 

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Ask The Expert Series Spotlights The Center for Natural Breast Reconstruction

April 20, 2012 by

We’re thrilled to share some exciting news with you, today! Our very own Dr. Richard Kline and Dr. James Craigie, Charleston breast surgeons, were recently on ABC News 4 Ask the Experts Series. During this interview the doctors answer questions on air about natural breast reconstruction submitted by viewers .

See below for the interview:

 

For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit our website today for more information.

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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Answering Your Breast Implant Questions

November 18, 2011 by

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

I had cancer in my left breast 15 yrs. ago, had the lump taken out, then developed a rather large cyst in the same breast. I had the cyst removed, which left me with only half a breast. I also had 8 weeks of radiation. I wanted a breast implant but the doctor said I couldn’t get one. Since it has been so long, could I now get one? I am 75 but still don’t feel good about my breast. I wear a breast form, but it’s not the same.

It is sometimes possible to reconstruct a lumpectomy defect with an implant, but your history of radiation makes success less likely. To some extent, the size of the implant you would require, and the amount of radiation injury you have sustained, influence the chances for success. Flap surgery, while significantly more involved, is ideal for use in radiated tissues, as it allows us to use healthy, non-radiated tissue to replace what is missing. Age, in and of itself, does not affect the success of either surgery, as long as you are generally healthy.

—Dr. Richard M. Kline, Jr.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by emailing us at blog@naturalbreastreconstruction.com.

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Do You Know Your Breast Reconstruction Options?

August 24, 2011 by

breast reconstruction optionsWe’re thrilled to share some exciting news with you, today! Dr. Richard Kline, Charleston breast surgeon, and the lovely Leslie Haywood, owner of Grill Charms™ and breast cancer survivor, were recently interviewed on one of our local Charleston news channels. During this interview, Leslie shares her inspirational story of breast cancer survival and how she chose to have the breast surgeons of The Center for Natural Breast Reconstruction perform her natural breast reconstruction.

Dr. Richard Kline of The Center for Natural Breast Reconstruction spoke about breast reconstruction options for women who are currently undergoing treatment for breast cancer or who have had a mastectomy.

See below for the interview:

If you want to learn even more about Leslie Haywood’s story (and get a chuckle from her hilarious narrative), click here to view one of our recent blog interviews with her.

For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit The Center for Natural Breast Reconstruction website at http://www.naturalbreastreconstruction.com/.

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What Are My Reconstruction Options After a Lumpectomy?

August 12, 2011 by

DIEP flapThe below question is answered by The Center For Natural Breast Reconstruction team:

What are the options for reconstruction surgery after a bilateral lumpectomy?

Great question! Your options would be very similar to those you would have if you had a mastectomy. Keep in mind that if your lumpectomy was followed by radiation, the behavior of the radiated skin and tissue can complicate a reconstruction procedure utilizing implants and your best option may be to use your own tissue to restore your breast size and shape. Nonetheless, it’s your plastic surgeon’s responsibility to tell you all of the options available to you and let you choose how to proceed. Also, discuss with your surgeon any procedure that may need to be done on your unaffected breast to achieve symmetry.

Here’s my short list of options:

1. Tissue expanders and subsequent replacement with permanent implants. Ask about silicone vs. saline implants. How about the use of a skin and tissue replacement like fat or a dermal matrix (like Alloderm)?

2. Autologeous reconstruction with latissimus flap (back). Will implants be needed, as well?

3. TRAM flap (transverse rectus abdominus muscle). Uses the muscle, skin, and fat of the abdomen to rebuild the breast. Make sure you have been told of the risks involved in removing this muscle.

4. DIEP, SIEA (deep inferior epigastric perforator or superficial inferior epigastric artery). Uses the skin and fat of the abdomen to rebuild the breast but leaves the muscle of the abdomen intact.

5. GAP (gluteal artery perforator). Uses the skin and fat from the upper (inferior) or lower (superior) buttocks. Like the DIEP, no muscle is removed for this procedure.

6. TUG (transverse upper gracilis). Inner thigh donor area, utilizes skin, fat, and muscle of the upper inner thigh.

7. Intercostal perforator. Utilizes skin and fat from under the arm.

8. Maybe you’re happy with the size of your post-lumpectomy breast but would like the shape addressed. Procedures such as mastopexy or reduction mammaplasty on the unaffected breast may be the procedures to investigate.

9. If it’s a small defect, a simple fat transfer from another part of your body may remedy the problem.

Best Wishes,

The Center for Natural Breast Reconstruction Team

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