Ask The Doctor-Can my daughter do mastectomy and reconstruction at the same time?

1562198683_8cd8cb5876_zThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: My daughter was diagnosed with DCIS and Stage 2 in lymph nodes. She’s taking 6 rounds of chemo. She may need a mastectomy and then radiation. If she needs reconstruction, can she do mastectomy and reconstruction at same time?

Answer: Thank you for your question; I’m sorry to hear your daughter is going through treatment for DCIS. If she needs to have radiation after her mastectomies, then it is possible to start the reconstruction process at the time of the mastectomies. In general, most would recommend immediate reconstruction with an implant or expander. After the radiation, the reconstruction can be continued with a permanent implant, or her own tissue depending on what option is best for her.

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

Can You Obtain Perfect Symmetry in Breast Reconstruction?

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

Q: I looked at your gallery  and I’m concerned about what I see as a mismatch in the photo examples. Is this not something you try to achieve?

A: Thank you for your wonderful question!

By “mismatch,” I’m assuming you mean the two breasts do not look the same when reconstruction is completed.

Firstly, we have many patients with very symmetrical breasts following reconstruction, and we could easily put only their pictures on our website, if we wished.

Thus far,  we have chosen to put less-perfect results on our website as well, believing it serves our potential patient population better, for the following several reasons.

In the real world, many patients will not be able to achieve a highly symmetrical result due to prior conditions, or will choose to not go through the multiple surgeries that will be required to get them as close to perfect symmetry as possible. If all patients came to us before their cancer was removed, we would coordinate their surgery with one of our highly experienced breast surgeons, they would nearly all receive nipple-sparing or at least skin-sparing mastectomies, and they would then have the greatest potential for good symmetry in the end.

In actuality, we see many patients from out of town who have already had non-skin-sparing mastectomies (often when nipple-sparing or skin-sparing mastectomies would have treated the cancer just as effectively). In this scenario, they have little potential to have their scar pattern converted to a more favorable one, and commonly need a lot of extra flap skin left in place in the breast. Occasionally a temporary tissue expander can be used to reduce the size of the skin paddle, but this does not always work, especially in radiated patients. If they chose to have a contralateral prophylactic mastectomy, they could then of course choose to have the same type of mastectomy on the other side (which would help symmetry), but many patients understandably do not want to do any more damage to their healthy breast than they have to.

Additionally, many patients are left with permanent changes in their skin from radiation, which can cause permanent color mismatches, as well as excessive tightness in the skin. This can make it very hard to match a radiated side to a non-radiated side, more so in some patients than others. The more times we can operate in this situation, the closer we get, but sometimes ideal symmetry remains elusive.

We want ladies who have already had aggressive mastectomies, who are left with significant radiation damage, or who don’t want to go through many, many surgeries in pursuit of ideal symmetry to know that there is still help for them, without implying to them that they will get a result that is probably not realistic. All busy reconstructive practices have these patients, but not all choose to put them on their websites. It may not be a good marketing decision for us, but we feel it is the most honest way to deal with our prospective patients.

We’d enjoy any feedback you’d care to give us on this topic, as we argue about it a good bit amongst ourselves.


Dr. Richard M. Kline, Jr.

Center for Natural Breast Reconstruction

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

Experiencing Cosmetic Problems After Breast Reconstruction?

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

Q: I recently had breast surgery. I think my nipples are positioned too high up, and one breast is harder than the other. What can I do? 

A: Usually asymmetries in this situation can at least be improved, although it is often best let a few months (at least) pass first for the tissues to heal. If one breast is hard, it could mean that you have a significant fat necrosis under the skin, although there could be other reasons. I would strongly urge you to see your surgeon and share your concerns with him or her.

Q: In December 2011 I had a bilateral mastectomy with immediate tissue expanders, followed by silicone implant and nipple tattoo. My problem is that I have developed the “double bubble” look, rippling and contractors bilaterally.

I am 63 and realize that my age does reflect my outcome, however, I just need to know if I am alone or if you have patients that experience this? All of the pics I have seen have really great results and none of them look like me!

I am facing another surgery now to remove these implants and replace them with a different shape. I forgot to mention the cleft/ledge above each implant. They tried fat grafting but it was minorly successful. I need advice and have searched the internet with no success. Can you help?

A: Your situation is far from unique, especially if you don’t have much thickness of soft tissue cover over the implants. Rippling, implant malposition (double-bubble), and contracture are unfortunately fairly common problems even after cosmetic breast augmentation, and can be yet more common after reconstruction.

Our practice is limited to fully autologous breast reconstruction using perforator flaps (DIEP, sGAP, PAP). The surgery to replace the implants with your own tissue is long (6-8 hrs), and carries risks not associated with implant reconstruction alone, so it is not for everyone. Having said that, we have successfully removed implants and replaced them with flaps hundreds of times, and it can work very well indeed (especially if you have a good flap donor area).

There are some additional options your surgeons might consider, if you don’t want to pursue complete implant removal and replacement with your own tissue. These include the addition of latissimus flaps to the implant reconstruction, or potentially the addition of acellular dermal matrix (Alloderm, etc.) to cover the implants. We don’t perform these procedures, but they are commonly available in almost all areas, and can bring extra “cover” over the implants.



 Dr. Richard M. Kline, Jr

Center for Natural Breast Reconstruction

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

I Found Lumps After Reconstruction Surgery–Could I Possibly Have Breast Cancer Again?

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

Q: I had breast reconstruction surgery 5 years ago.

Upon my 5-year check up, three lumps were found on my left breast. I had an ultrasound, then an MRI. I just received a call from my general physician informing me that I need a biopsy done due to fat necrosis on my left breast. Meanwhile, I have found many more lumps on both breasts. I’m waiting for my plastic surgeon to return from vacation to schedule a biopsy. I’m extremely nervous. Could I possibly have breast cancer again? Why do they need to do a biopsy? 

A: Although I don’t know what type of mastectomy or reconstruction you had, at least microscopic amounts of breast tissue are left after any mastectomy, so it’s still theoretically possible to develop  cancer. This is very unlikely in most cases, however. If you just had lumpectomy with radiation, it’s much more common. Fat necrosis after reconstruction with your own tissue is pretty common, but it’s unusual to have it show up after five years. If you had radiation after your reconstruction, however, that could help explain the late changes you note.

 Dr. Richard M. Kline, Jr

Center for Natural Breast Reconstruction

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