Breast Reconstruction Surgery: 16 Pre-Op Q&As from Our Physician Assistant

Breast reconstruction surgery can be scary. And we know that you’re bound to have questions about what to expect when it comes to the surgery itself and the healing process afterwards.

Thankfully, we have a handful of reconstruction surgery experts at The Center for Natural Breast Reconstruction. We’re thrilled that one of our very own Physician Assistant, Audrey Rowen, PA-C, takes special care to personally answer reconstruction surgery questions asked by our patients. We were particularly impressed by this group of them and wanted to share with you!

If you’re about to have breast reconstruction surgery, or are considering the option, please keep reading! We think you’ll find comfort in the answers below.

1. Where will the scars on my breasts be and will I be able to wear low-cut tops like I did before?

We try to use previous implant scars if we can, but sometimes we need to do things a little differently in order to access the blood vessels behind your breasts.

The incisions we make are generally below the nipple line and should be covered by most clothing. The shape and overall appearance of the breasts after stage 1 is not the final result so things won’t look as you are hoping until after the second stage. But, every person is different, and we will be better able to answer this question at your pre-op marking appointment and after your first surgery has been completed.

2. How long will I be in the surgical bra?

We typically keep our patients in the surgical bra for a minimum of 6-8 weeks and during any strenuous activity after that. After most healing is complete, we can switch you to a front-closing sports bra or other similar bra that provides support without being too tight. Most women wind up wearing a surgical bra through the first 2 stages and may be able to go without a surgical bra after that.

3. I think you said you could make me a C cup. I’d like you to make me as big as you can with what I have to work with.

We will do our best to give you the biggest flaps we can at the first stage. After that we can do fat grafting to increase the size of your breast. 

4. Does more fat in my tummy area make bigger, better breasts?

It can. This doesn’t mean we want you to go out and try to gain a bunch of weight before surgery because you can’t target where you want to store fat. In fact, sometimes the fat goes around your intestines or below your abdominal muscles, and we can’t get to that fat. Women who have larger tummies often have larger flaps, but we can always use liposuction to gather fat from other areas (buttocks, thighs, inner knees, waist area) at subsequent stages to add volume to the breast mounds later.

5. I understand they will not be pretty at first, but will they be lumpy or smooth, or what should I expect about how they are going to look in the beginning?

Every patient is different so the outcomes are not always standard. At the first stage, you will have what we call a “window” where the donor site flap skin is visible on your new breast. This does not mean it is an opening, but rather imagine that a piece of your skin is donor skin while the rest of your breast has your original breast skin.

This is not always permanent as we can sometimes completely close the breast skin on top of the flap, but in some patients who could not have skin-sparing mastectomies, they may always have that section of tummy skin showing.

Things stay pretty swollen for up to 2-3 months so there may be hard or squishy areas that may change throughout your recovery. We try to create a semi-smooth transition from your breast/chest skin to your donor site flap, but our main priority at stage one is to get the blood vessels attached and keep them working.

Things may look a little deformed, asymmetrical, or strange after the first stage, but we fix these issues at stage 2. You are also likely going to have what we call “dog ears” on either side of your abdominal incision from pulling the skin together. This will also be fixed at stage 2.

6. I think you said I wouldn’t need to have mammograms anymore. Is that correct?

Usually, you will not need any mammograms after having a mastectomy with reconstruction. Your oncologist often makes the definitive decision if you are at any increased risk of recurrence or need any routine monitoring. We still highly recommend doing monthly self-breast exams to monitor for any changes. If it does, please notify us or your oncologist/breast surgeon if you find anything of concern.

7. I would like to see some before and after pictures of the different stages and final result. How can I accomplish this? Can you send some to me?

We have some pictures on our website that show you the before and after photos. We do not have any designated photos of the in-between stages to show you, unfortunately. Dr. Kline may have a few extra pictures to show you at your pre-op marking appointment if you wish.

Click here to view our image gallery. 

8. Will you be lifting my left breast to make it match the right one that doesn’t sag because of the radiation?

We always take radiated breasts into consideration when making the flaps. We sometimes make a radiated breast flap a little larger to account for this, or we lift the non-radiated breast more. Most of this tweaking is done at stage 2 or 3, and there is no hard-and-fast guarantee of how the radiated tissue will do. But, we try our best to give you a symmetrical result.

9. How is the fat grafting accomplished? With needles or what?

Fat grafting is done just like traditional liposuction, but instead of throwing away the fat, it gets strained of any debris, blood vessels, etc., and gets injected back into your body, just below the skin, wherever it is needed.

We only make a small incision through which we insert a cannula that gets shifted around under your skin to collect the fat cells. We make a few incisions in the donor sites that are discussed with you before your surgery and those incisions are closed with a few stitches and a little Dermabond glue on top. The strained fat is then inserted with a special bendable needle that can be shaped to follow around a breast mound or however we need it to go to inject the fat.

10. After the fat grafting, will that fat continue to replenish itself? Like if I gain weight, will my breasts get bigger?

After liposuction, fat accumulation tends to appear in areas other than sites that you have had the fat grafting from. This doesn’t mean you will never get fat in those areas again, but it often finds its way to a few different places. Your breasts will be your own tissue and fat, so if you did gain weight, you could possibly gain weight in your breasts and the same goes for losing weight. 

11. Will my C-section ledge be gone?

We try to take other abdominal scars into consideration when finding the best placement of your new “abdominoplasty” scar. By removing the tissue located on your abdomen, there is a good chance your C-section ledge will resolve, but we cannot guarantee this. It’s another one of those things that depends on the patient, and we will have a better answer for you when we do your pre-op marking.

12. When can I drive?

We don’t want you driving as long as you have drains in (breast or abdominal), which is typically 2-3 weeks. Also, if you are taking any prescription pain medication (Percocet, Dilaudid, Valium), we don’t want you driving until you have switched to taking over-the-counter medications.

We also want to ensure that you feel you can be a defensive driver and not worry that if you had to swerve out of the way, you’d hurt something. Most women sit in the back seat away from the airbag for about 2 weeks and often place a pillow between their chest and the seatbelt to help cushion the pressure from the belt itself.

13. When can I have sex?

We don’t recommend any strenuous activity for several weeks following surgery. I would plan to wait at least 2 weeks and then see what may be tolerated. You don’t want to be using your abdominal muscles for up to 6-8 weeks so you have to be mindful of your limitations. As things heal and you progress in your recovery, you may increase activity as tolerated.

14. Can you also remove the lump of scar tissue from the four drains that were put in my rib area by the other doctors? It makes my bra roll up, and it’s uncomfortable.

Depending on the exact location, we may be able to remove it at the first stage, but it is more likely that we will look into that at second stage as the process of harvesting and grafting the blood vessels is very time-consuming and is the main priority at that time.

15. When will I know if my nipples have to be removed?

This is really a question for your breast surgeon. If you are able to have a nipple sparing mastectomy, we cannot guarantee that your nipples will live as they can sometimes scab over and become necrotic. But, there is also a good chance they will survive. In the event that one or both of your nipples needed to be removed or did not survive, we have multiple options for nipple reconstruction.

16. Can I go ahead and get my flu shot before I have my surgery?

As I am answering this, I don’t believe it is currently flu season, and we would rather not introduce anything into your body this close to surgery. I would wait until 1-2 months after surgery.

Do you have a question about breast reconstruction or post-surgery that you’d like answered from our surgical team? Ask the doctor now 

Life after Mastectomy: Prosthetic Nipples

Being diagnosed with breast cancer and facing a cancer battle can be a long, draining, and scary experience.

While women who beat cancer find themselves overjoyed and grateful, there’s still a part of having breast cancer that tends to linger—especially if they’ve had to go through a mastectomy.

While we know women feel incredibly grateful that they’ve won their battle with cancer and feel they can begin life again, it’s also very common for them to long to feel like their old selves again.

At The Center for Natural Breast Reconstruction, we want all women to feel confident, radiant, and beautiful after a mastectomy, which is why we were so excited to find out about a new non-surgical solution to breast reconstruction—prosthetic nipples.

We love the product so much, we even carry demos in our office for women to try.

So, how exactly did this product come to be and how does it work?

I’m going to let breast cancer survivor and inventor Randi Johnson tell you in her own words.

Here’s her story…

After the shock of my IDC breast cancer diagnosis in 2007, I was hoping for the least invasive corrective surgery. The lump was too large for a lumpectomy, so a unilateral mastectomy was the choice I made. I had a new full-time job and didn’t want to take 6 weeks off for breast reconstruction.

The mastectomy was not very painful and I had a good recovery, but reality hit as bandages came off and I saw “my new normal” in the mirror. I’m not an especially vain person, but it was hard to feel “pretty” for my husband, even though I knew he loved me beyond the disfigurement.

I found myself wearing my prosthetic mastectomy bra to bed at night.

We happened to hear about Dr. Khouri in Miami, FL  who was doing a less invasive type of breast reconstruction surgery. There were no incisions, it was outpatient, and had a lower risk of complications. I only had to miss 3 days of work for each step (4 fat grafting sessions, for me).

Adding to the appeal, was the fact that they would take fat from tummy, thighs and anywhere else I didn’t want it and make a new breast out of it.

What’s not to love about that!

I was amazed to find that Dr. Khouri was in network for my insurance plan. There were still travel expenses etc., but somehow it all worked out.

It felt like I was growing a new breast and hardly had time to think about not having a nipple on that side, but when Dr. Khouri made an impression of my natural nipple and made up a silicone “rough draft” of a nipple for my recon side (for purpose of photos), my husband asked if he could tinker with the idea.

Dr. Khouri was very impressed with the prototype we brought back to show him a few months later. He invited us to display our Naturally Impressive nipple prosthetics as a vendor at a couple of his fat grafting conferences.

We received a great reception as well as some helpful ideas from the international breast surgeon attending.

I was part of an “MD Rounds” event at one of those Fat Graft Conferences and it was exciting to have MDs ask in disbelief (right after they heard my history). “Did you have a mastectomy?” We have heard countless similar stories from our clients about their Naturally Impressive nipples “fooling” others because they look so natural.

Now it’s become my new body image. If I have it off for a day or two, the asymmetrical image in the mirror doesn’t feel like it’s me.

We’ve been serving women through Naturally Impressive, LLC, since January 2010. As a “Mom and Pop” shop, we keep operating costs low and we also get to know many of our clients quite well. It’s an incredible joy! We love it!

No matter what option women choose regarding nipples, Naturally Impressive can be a way to “feel normal” again. For some, this is a great short-term option while waiting for tissue to settle before making a permanent choice. For others, it’s a wonderful non-surgical long-term solution.

If you or someone you care about is longing to feel normal again in the nipple department, check out our website to see the realism, variety and affordability of choices we offer.

Click here to visit the Naturally Impressive website.

You can also call Naturally Impressive, LLC, at 715-829-4488 if you have any questions.

Do you have a favorite post-mastectomy product that makes you feel confident and beautiful?

Share it with us in the comments below!

In Her Words: Moving Forward in a Post-Surgical World

 Everywhere you look, it seems there are blogs, posters, and articles that talk about how to stay positive while battling breast cancer. This is not a bad thing. It’s important for women to be encouraged and think good thoughts as they are dealing with such a serious illness.

However, when our only focus becomes positive reaffirmations and fuzzy pink boas, we forget to talk about another side of having cancer—a side that needs to be discussed.

We forget to talk about the ugly, dark, painful, uncomfortable, and scary side of having cancer.

We know, this isn’t a conversation that anyone enjoys having.

But it’s important.

Why? Because understanding the “uglier” sides of battling cancer is a part of what helps women move forward after their courageous battle.

Betsi Green, a breast cancer survivor and a patient at The Center for Natural Breast Reconstruction, wants to help women who are in the same situation as she was by sharing her story.

She hopes her story will help breast cancer survivors find peace and comfort as they make the transition into a post-surgical world—despite the challenges and discomforts that come with recovery.

Here’s Betsi’s story in her own words…

“Cancer is ugly.  Cancer is raw.  Cancer is painful.  Cancer is more than simply losing your hair.” – Betsi Green

On the first of November, Dr. Paul Baron did a right skin sparing modified radical mastectomy with lymphatic mapping and sentinel node biopsy. In short that means Dr. Baron removed my right breast and a handful of lymph nodes.

In the operating room, Dr. James Craigie inserted an expander where my breast had been. The expander, as its name suggests, is used to expand the skin and keep the tissue viable for the reconstruction surgery.

During surgery, the expander is filled with air.  Shortly after surgery, in a follow up appointment, the expander is filled with a saline solution.  This is done in the surgeon’s office.  The syringe is inserted in the center of the expander.

Let’s talk about the expander.  It wasn’t painful. It was uncomfortable. It was very uncomfortable.

It was difficult to bend over.  I felt like I had a brick on my chest.  It was difficult to have water from the shower hit my tender skin. It was difficult to have material touching my skin.

Did I say it was uncomfortable?

The skin felt very thin and pulled, which I expected, just didn’t expect it to be as tight as it felt.  Sleeping with the expander kept me to my left side or on my back.

It wasn’t until the first week of December, I noticed something was wrong.  The bottom half of my expander had turned red.

Anytime you have a foreign object in your body, you want to keep a close eye on how it looks and/or feels.  This bright red color told me something, and it was not good.

I did not feel any different.  I had no pain.  The uncomfortableness of the expander remained. These days, I really didn’t care what my chest looked like.  However, in this case, looks mattered and I “kept an eye” on it.  I was hoping it would simply go away on its own.

It turned out my expander was infected.

I share this with you for one particular reason:  SPEAK UP!  If you are uncomfortable, go see your team. If you think something is wrong…it probably is!  There are things they can do to help the comfort level.

Don’t be shy.  You are (or should be) in control of your cancer journey as much as possible. The doctors and their staff are not mind readers.  Let them know if you need an “adjustment”.

Ask them how they can help you be more comfortable.

The cancer dance is an ongoing experience.  My dance has been ongoing since June 2016.  It will continue thru the 2017 calendar year.  One appointment, one diagnosis, one doctor, one surgery, one chemotherapy treatment, and one CT scan does not complete the experience.

There are a lot of ugly things that can happen as you recover from your battle with breast cancer. But if you know about them, and speak up, you will be able to get the help you need.

You can make a huge difference in how your own personal cancer treatments affect you.

Be confident and as comfortable as possible as you move forward thru your own individual journey. And by all means…keep moving forward.

-Betsi Green

Check out Betsi’s blog and read more about her journey here.

Do you have any words of wisdom on recovering from breast cancer? Share them below!

 

Finding Beauty after Breast Cancer

 

Chances are you’ve heard the saying, “Beauty is more than skin deep.”

It’s a phrase that we hope you take to heart; however, we know that uncontrollable life circumstances, such as a battle with breast cancer, can affect the way you view yourself.

This is especially true for women after a mastectomy.

It’s no secret that many women find it difficult to cope with the major physical changes that occur after this type of surgery.

Changes that, unfortunately, can lead to a negative body image and a decreased sense of personal beauty.

We here at The Center for Natural Breast Reconstruction want to remind you that no matter what has happened in your life, you are a strong, powerful, and beautiful woman.

Beauty IS more than skin deep.

We hope you don’t ever forget the following qualities that make you beautiful both inside and out.

Personality

One of the most attractive qualities a woman can have is a fun, kind, loving, and positive personality.

Show the world how beautiful you are by the way you act, speak, and relate to others. Just be you, and your radiance will certainly shine through.

Put your positivity into action.

For the next 7 days, write down the things in your life that you’re most grateful for.

This list can include things like family, friends, pets, and hobbies. Reflect on those things every day.

Hobbies/Skills

Everyone is given special gifts and talents to share.

These gifts make you special and unlike anyone else in the universe.

It doesn’t matter if you’re a wonderful cook, a talented musician, or work well with children.

You can use these gifts to make a beautiful impact on someone else’s life.

What talents or skills have you been blessed with? List them out.

Now think about the things you’ve been able to accomplish because of those gifts.

Start a journal and write about your accomplishments on a daily basis.

It’s also fun to think about how you can impact someone else with your talents.

Can you cook someone in need a meal, help tutor a child in school, or simply be a compassionate friend to someone in need?

Write down a list of how you can use your gifts to brighten someone else’s day.

Relationships

You can always find true beauty in the relationships you build with others.

Don’t forget to look around at all of your friends and family who love and support you. They surely see beauty when they look back at you.

Quality relationships take time and effort. If you’re able to, plan time during your week to get together with the ones you love.

Go out to lunch, take a walk, or go grab coffee. If you’re unable to go out, pick up the phone, or write a handwritten thank-you card to show someone how much he or she is appreciated.

What qualities do you think makes a woman beautiful? Share them below!

Mastectomy: Your Questions Answered

pink flowerYou just found out that you might need a mastectomy.

First, we’re so sorry to hear that. We understand what an overwhelming and emotional time this is for you and your family.

A lot of thoughts and feelings start to rush through your head when you hear the diagnosis, and it’s difficult to focus and ask the questions you need to ask.

In this article, we’re sharing some common questions patients ask about mastectomies so that we can help you get all of the necessary information that you need.

What are the three levels of mastectomy?

Let’s start with understanding the three levels of mastectomy:

1) A total mastectomy removes the breast tissue, nipple, areola, and some skin around the incision. This procedure commonly follows cancers that occur in two or more areas of the breast or those that extend beyond a biopsy’s edges.

2) A modified radical is similar to a total mastectomy, but includes an axillary dissection or sentinel node biopsy. This is now the most commonly performed mastectomy.

3) Previously, the radical mastectomy was the most common procedure—removing muscle, lymph nodes, and skin. However, now this is rarely performed.

Do I really need a mastectomy?

In some cases, a lumpectomy with radiation is as effective as mastectomy.

Given the choice, most American women choose a mastectomy—even when the outcomes of the two procedures will yield the same result. As with any surgical procedure, it’s always advisable to get a second opinion from a surgeon in a different practice.

Recent advances in the mastectomy procedure help save normal body tissue, such as the breast skin and areola, that doesn’t necessarily need to be removed in every patient. Every patient’s circumstances are unique and so are mastectomies. For instance, preventive mastectomies are different than mastectomies for cancer or when lumpectomies don’t work.

Will my nipple be removed, and will there be scaring?

It depends on the individual’s situation, however, it is possible to have a mastectomy and save the nipple.

There are also situations when a mastectomy is done with a “hidden” or “scarless” approach.

Advances in microsurgery and breast surgery allow surgeons to perform mastectomies with hidden scars, similar to a breast lift or augmentation procedure, 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), where the relocated tissue fills in and shapes the breast.

Ask if your plastic surgeon works with a breast surgeon who considers these options when planning your mastectomy. Also if a reconstruction is scheduled immediately following mastectomy and you have completed chemotherapy and/or radiation, the mastectomy may be done in a way to make the overall result of your reconstruction better.

Have more questions? Our doctors are happy to provide their expertise.

What to Look For in a Breast Reconstruction Surgeon

picture of roseAs you face the prospect of mastectomy and possibly reconstruction, it’s important that you feel you’re in good hands.

We suggest that patients look for these four characteristics in their ideal plastic surgeon: skill, compassion, rapport, and honesty.

When interviewing surgeons (something you should definitely do!) for microsurgical breast reconstruction, ask the following questions:

Question #1: Are you a microsurgeon? Where and by whom were you trained in this specialty?

You will want to know exactly what the doctor’s specialty is and where his training took place.

Question #2: How many microsurgeries have you performed? And how often do you perform them?

You want to know that your surgeon is very familiar and well versed with your particular surgery.

Question #3: What is your success rate?

Not only is this an important question to ask in regard to the surgeon’s skill level, but it’s also important to ask about the overall success rate of the surgery you’re looking into, by any surgeon.

Question #4: Can you arrange for me to speak with some of your patients who have had the procedure I am seeking?

This is a great way to communicate with others who can give you advice on what to expect, post op recovery, and information on their experience with the doctor. It’s important to note that candidates should speak with people of similar ages and lifestyles.

Question #5: How long do you anticipate I will be under anesthesia for the procedure?

It’s important for the surgeon to walk you through what to expect the day of the procedure—this way there will be no surprises, and you can also let your caregiver know the time commitment.

Question #6: 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?

Be sure to know exactly who will be involved in the procedure and why your doctor has chosen them to participate in the surgery.

Question #7: Will I have to sign a consent form saying, if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

Always know exactly what you’re signing and agreeing to, and make sure you’re comfortable with the contract. 

Have a question for our doctors? Message them here

Ask The Doctor-Is it common to not be able to have reconstruction surgery with a low immune system?

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

Question: I have had three surgeries already. 2 to remove cancer and 1 reconstruction. I can’t have the last one because of infection in left breast where the cancer was—plus I keep getting sick because my immune system is low. Is this common if I just had radiation in the infected area?

Answer:  I’m sorry you are having problems. If you are having an infection after radiation, it would definitely be best to hold off on your reconstruction until your immune system has recovered and the infection is gone. Radiation treatments definitely increase the chance of getting an infection. If you have an implant in place already, it may need to be removed to resolve any infection. Once that has occurred you can still proceed with breast reconstruction at a later time when you have recovered.

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

Ask The Doctor- Do you improve the existing breast during reconstruction?

red and yellow flowersThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had my cancer treatments and mastectomy at MD Anderson Cancer Center in Houston, TX. My oncologist there told me that my existing breast would be reduced and lifted during the reconstruction of the right breast. Do you improve the existing breast during reconstruction?

Answer: Thanks for your question. Yes it is often necessary to adjust the opposite breast to match the reconstruction and achieve symmetry. In our practice we often perform that step during the second stage. 

Let me know if you have additional questions or if you want to chat about your specific situation with one of our clinical staff members. We’re always happy to help!

 

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

Ask The Doctor-Do you have a maximum BMI for breast reconstruction surgeries?

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

Question: Do you have a maximum BMI for breast reconstruction surgeries?

Answer: Thanks for your question. The risk for some complications associated with breast reconstruction can be elevated in patients who are overweight. We use BMI as a general guideline to evaluate someone’s risks for complications before surgery. We consider more than the BMI and look at the type of surgery being performed and any other individual risk factors each person may have. When the BMI is 30 or more we discuss weight loss before surgery to lower the chances of significant wound healing problems and or a  DVT ( blood clots in the legs). A DVT can be a life threatening problem so we take the risk very seriously and do anything possible to make surgery as safe as possible.

I hope I answered your question let me know if you need more information.

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

Ask The Doctor-Will you help me find somewhere that I can have a mastectomy and reconstruction surgery at the same time?

bee on a flowerThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I’ve just found out I have breast cancer and have to have a mastectomy.  There is no one in my little city that does the DIEP surgery.  Can you help me find somewhere to go so I can have my mastectomy and reconstruction at the same time?

Answer: Thanks for your question. There are specialized types of breast reconstruction that may not always be available to patients in every city. It is very common for patients to travel out of state to our practice because of our specialized training and the procedures we perform. When someone has to have a mastectomy, it may be possible to start the reconstruction at the same time. The advantages are several and include fewer surgical procedures, saving your breast skin and nipple sparing mastectomy. We use a multi- disciplinary approach and work with expert breast surgeons who can evaluate our patients to ensure they are having the most up to date treatment and are ok to have the mastectomy and reconstruction together. If it is determined that radiation treatments are needed after mastectomy, then we might recommend reconstruction at a later time when the radiation is complete. At the appropriate time, it can still be possible to have natural breast reconstruction and the most up to date breast reconstruction procedures. 

Our practice is committed to taking care of women who must go through a mastectomy and who desire knowing all their possible options for breast reconstruction. 

We make ourselves available to patients with time sensitive needs and will do anything we can to help people who may need to travel out of town for specialized state of the art breast reconstruction.

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