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

May 22, 2015 by

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!

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

May 15, 2015 by

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!

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

May 8, 2015 by

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!

 

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Natural Breast Reconstruction: Your Questions Answered

May 5, 2015 by

FAQ on keyboard

Each week, we have women from all over the state, region, and country reaching out to us with questions on whether or not natural breast reconstruction is right for them. We understand there are a lot of factors to consider, and it’s important to find a resource you can trust.

Our doctors at The Center for Natural Breast Reconstruction—and our staff—do our very best to answer all questions we receive. Our team’s goal is to be as helpful as possible during this process and help you make the decision that’s right for you.

In the spirit of educating you and your loved ones, our doctors came up with this list of the most frequently asked questions just for our blog readers.

[Note: If you have a question you’d like answered, Click here to fill out our Ask the Doctor form!]

How long after chemotherapy or radiation should I wait before reconstruction?

Breast reconstruction cannot be performed until 6 months after a patient’s final radiation treatment. However, chemotherapy varies. Some women have mastectomy and reconstruction immediately and do not start chemotherapy until after that is completed. Some women have to do chemotherapy first and then have mastectomy and reconstruction. Others have their mastectomy, have chemotherapy, and wait to have reconstruction. Planning and timing is based on the type of cancer, pathology, oncology recommendation, and the patient preference.

Can natural breast reconstruction be done if my mastectomy was last year?

Although immediate reconstruction has advantages, procedures can also be done years after a mastectomy.

Will the areas where tissue was removed look different?

Although scars will be present, the shape may be improved. Many of our “flap” procedures involve the removal of tissue from other parts of the body. The resulting “tummy tuck” or “buttocks lift” can re-contour these areas for a more youthful, attractive appearance.

Is natural breast reconstruction covered by insurance?

The Women’s Health and Cancer Rights Act of 1998 provides protection to patients who choose to have breast reconstruction in connection with a mastectomy. The federal law applies to those covered under group health insurance plans and those with individual health insurance coverage. You should check with your insurance provider for coverage details. Our administrative staff can also help you with reimbursement questions.

To learn more, click here.

Always consult with your doctor if you have any questions or concerns. Make an appointment with one of our physicians today.

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Ask The Doctor-What is the best next step after losing an implant on the radiated side?

May 1, 2015 by

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

Question: I had both breasts removed with stage 4 cancer. The left breast with the silicone wouldn’t stay closed, so the plastic surgeon did a tram flap with muscle from my abdomen. So now one breast has silicon and the other has muscle from my adomen. I didn’t get nipples on my breast. Is there anything else I can do to improve this mess.

Answer: Thank you for your question. After losing an implant on the radiated side, the best next step is to reconstruct that breast with natural tissue. Which you did. As you are aware complications with implants increase when radiation is needed. Since you already have an implant on the other side. it will tend to be different from the tram side. Options include adjusting the shape of both breasts vs. replacing the other implant with natural tissue from another area of your body. We recommend doing this without using any of your muscles, only skin and fat either from the thigh area or buttock area. If you are happy with the implant breast reconstruction and don’t want to start over and go through another extensive reconstruction using natural tissue then it may be possible to adjust the TRAM reconstruction in a way that helps. You can always have nipple reconstruction if you desire, and that can be done as a minor procedure alone or possibly combined with revision of the reconstruction. I could give you more specific information about your options if you would like to give me a few more specific details. Thanks again for the question, let me know if I you would like more information.

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

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Ask The Doctor-Can I have reconstruction surgery with a low immune system and infection?

April 17, 2015 by

purple 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!

*Before we post to the blog, we double check to ensure we respond to each person who submits a question personally so that you receive the information you need first.

 

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Ask The Doctor-What can be done about infected implants?

April 10, 2015 by

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

Question: I had implants, and they got infected. I had six operations I’m in New York right now, but I’m on my way to South Carolina. I would like to come in so I could see what can be done. Thank you.

Answer: I’m sorry your having problems with your implants. We have helped many women who have lost implants due to infection. Let us know when your in town, and I’ll be glad to see you.

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

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Ask The Doctor-Does lipomodelling make breasts more natural looking?

April 3, 2015 by

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

Question: Do doctors do lipomodelling of the affected breast to make it more natural looking? Implant does not help. Thanks.

Answer: Thanks for your question. We perform fat grafting as part of the breast reconstruction process. If you had breast reconstruction with an implant and the results are not natural, fat grafting can help. There are some situations that require removing the implant in order to get a more natural result. Let me know if you need more info.

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

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Ask The Doctor-Will my pectoral muscles will return to normal after I have my implants removed?

March 27, 2015 by

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

Question: I had a mastectomy with reconstruction using saline implants. I am considering having the implants removed, and am wondering if my pectoral muscles will return to normal.

Answer: Thank you for your question. If you are planning to have your implants removed, then are you planning to have any further reconstruction? Frequently, tissue expanders and breast implants used for breast reconstruction are placed under the chest muscle. If you are having problems with your chest muscles because of the breast implants, it is likely that some of the  problems would improve or possibly go away completely if you have the implants removed. On the other hand, it is very unlikely that your muscles will ever go completely back to normal after they have been lifted up and or divided to cover an implant. In my practice we keep the implants above the muscle. When this is possible the muscle is not disrupted at all. When we have a patient who has had problems with their implants, we can usually help them by removing the implant and capsule and reattaching the muscle. We then perform the breast reconstruction with the new breast on top of the muscle. If you  choose to have breast reconstruction after problems with implants, then replacing them with your own fatty tissue can be a great option. Let me know if you need more information. Thanks again for your question!

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

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Ask The Doctor-Is it possible to do a flap reconstruction after first surgeon tried expander on radiated breast on a smoker?

March 20, 2015 by

flowerThis week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question.

Question: Is it possible to do a flap reconstruction after first surgeon tried expander on radiated breast on a smoker who had quit 7 weeks before surgery? 4 weeks later I still have open wounds almost the size of a quarter.

Answer: Thanks for your excellent question.

Fortunately, previous breast surgery, no matter how extensive, rarely impacts our ability to do a flap reconstruction using your own tissue. In fact,  a healthy, non-radiated flap is often beneficial in improving the quality of the radiated tissue around it.

As you seem to already be aware, nicotine is an absolute “no-no” when having surgery, and also when trying to heal a chronic wound. Nicotine causes the microscopic blood vessels in your tissue to clamp down, just like shutting off a valve, which deprives the healing tissues of oxygen. Usually, however, nicotine levels are unmeasurable after a full month of exposure cessation.

We have treated several chronic wounds in patients with failed implant reconstructions, and we have always felt that it was best to get the wound healed before proceeding with flap reconstruction. Achieving healing in these situations is often not straightforward,  but we have thus far eventually been successful. Sometimes retained foreign material (such as Alloderm) can play a role in keeping the wound open, and sometimes there is just not enough skin left in the radiated area. Rarely, deep infection of the bone or cartilage can be an issue, although this is unusual.

If you wish, we can set up a phone consultation to discuss your specific circumstances in more detail.

Best of luck, and thanks again for your question.

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

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