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Ask The Doctor-What can be done about hard breasts?

March 6, 2015 by

8404745471_aa5de5fd5f_mThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I have had a natural breast reconstruction. I have several places in both breasts that are hard. I also have a hole in the right breast that needs tissue. Will the hard places soften as time goes by? I am considering having tissue taken from my groins to fill the cavity. I also have to have the tummy tuck closed. Please advise. Part of me is thinking to have all the tissue removed. The hard areas feel like armor. Thanks. What do you recommend?

Answer: Thanks for your question, I’m sorry you’re having difficulties. How long ago did you have breast reconstruction? Have you had a second stage yet? If you had reconstruction with your own fatty tissue, sometimes some of the fat may not survive and can cause hard lumps. The lumps will soften with time but usually not completely go away  unless they are small. We usually remove any hard lumps at the second stage procedure about 3 months following the first surgery. If most of the fat is hard then sometimes we might need to add more fat to the breast to give it shape, or start over with tissue from another area. The thigh area is another possible area to get fat if needed depending on your situation. We avoid taking the groin muscles when we use the thigh fat to rebuild the breast. Let me know how long ago you had your surgery. Time may improve your situation and hopefully you won’t feel like you need to go back to having no breasts.

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-What could be causing the cramps in my breast?

February 27, 2015 by

5987018633_ca7f1c6f97_mThis week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I am 70 years old, and 5 years ago had a bilateral with reconstruction. Since then, I have had severe cramps in both breasts and they can even tie a knot in my stomach I can feel knot up when I cough. These are not like stomach pains, they are very painful, hard cramps like one experiences in the calf of their legs….I asked my Plastic Surgeon about them, and he just said he had never heard of cramps in breasts. I can cause my breasts to cramp by simply turning over on. My side, raising my arm or reaching around for something…I’m a tough ole broad, but these cramps make me nauseous they hurt so bad…have you any experience with this? Thank you so much for your time.

Answer: Thanks for your question. I’m sorry you’re having a difficult time. Painful cramping suggests muscles are having spasms. Normally the breast does not have muscle but the chest muscle is underneath the breasts and can have spasms for different reasons. The explanation could possibly be related to the type of breast reconstruction. If you have implant reconstruction the implants are often placed under the muscles. If the body rejects the implants or develops scaring that tightens around the implant the distortion can cause muscle spasm. If you had reconstruction using one of your body muscles to rebuild the breast,  that too could possibly be related to the cramping pain. If the muscles from the tummy wall were used to rebuild your breast or breasts that might explain the “knot in your stomach”. I would need more information to let you know what I would recommend. What type of breast reconstruction did you have? Do you have implants and did you have radiation to the breast? Thanks again.

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- If you choose natural breast reconstruction as opposed to implants is there sensation in the breast?

February 20, 2015 by

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

Question: If you choose natural breast reconstruction as opposed to implants is there sensation in the breast? Is there sensation with nipple sparing? What is the rate of success with natural reconstruction? Thank you.

Answer: As a general rule, there is no erogenous sensation after any type of breast reconstruction, although in isolated circumstances some people do seem to get that back, or something like it. Most of the skin is usually completely numb initially, but may regain some feeling after months, or even years. Even after nipple-sparing mastectomy, there is usually no sensation. While it is theoretically possible for the nerves to grow back, it is rare to get normal feeling back, even after a prolonged period. The flap survival rate after natural breast reconstruction is approximately 98%. Completion of reconstruction usually requires 2 or 3 surgeries in all, but they tend to get sequentially shorter and less involved. Once you have competed natural breast reconstruction, however, your breasts will usually continue to improve on their own for many years. This is in sharp contrast to implant-based reconstruction, where the quality of the reconstruction often tends to deteriorate over time. Thank you for your question.

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

(**Note to our readers: We really do personally reply to all questions sent through our website within 24 to 48 hours directly to the e-mail provided by the sender. We want you to receive your answer quickly, so please assure that you are entering your information correctly so that you receive the personal answer to your question and do not have to wait for it to be published as an Ask The Doctor Q & A.) 

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Ask The Doctor-Are the lymph nodes disturbed during DIEP flap reconstruction?

February 20, 2015 by

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

Question: After a DIEP flap reconstruction, the top part of my tummy above the incision protrudes over the scar-especially in the evening. Is this a lymph issue or edema? Are the lymph glands disturbed in the abdomen with this kind of surgery?

Answer: Thanks for your question. During a typical DIEP procedure the lymph nodes that serve the tummy area are not removed and the lymphatic fluid can move in the normal direction. It is possible to have lymphedema of the tummy area after a DIEP but it certainly is not very common. It would be more likely if someone had multiple tummy surgeries and scars before the DIEP procedure. In my patients I see that their tummy wall and tummy incision may be swollen for 3-4 months after the surgery. If someone has healing problems, infections or a seroma (pocket of fluid underneath the incision), then swelling can be more prolonged. If someone has persistent swelling and none of the above issues for 6 months then I would consider having a therapist who has experience treating lymphedema see them for possible lymphatic massage treatments. Let me know if you need more information, thanks again.

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

(**Note to our readers: We really do personally reply to all questions sent through our website within 24 to 48 hours directly to the e-mail provided by the sender. We want you to receive your answer quickly, so please assure that you are entering your information correctly so that you receive the personal answer to your question and do not have to wait for it to be published as an Ask The Doctor Q & A.) 

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Ask The Doctor-Should I have a preventative mastectomy?

January 16, 2015 by

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

Question: I am 60. I have had a core bio in right breast, and my maternal aunt had breast cancer. My left breast is became two sizes bigger than right, and I have fibefib. Cystic diseases. Last year my mamo showed no cancer, but I am about a 36 c in right breast and 38c in left. It’s painful. Should I be proactive and have both removed since already in right? I have had a core bio for two lumps showed benign. Thanks

Answer: Thanks for your question. Women who are at an increased risk for breast cancer and/or who have difficult breasts to screen for breast cancer do sometimes consider preventive mastectomies. Certainly not every woman in your situation would do that. In order for you to make a decision you should discuss your specific situation with a breast surgical oncologist. They could give you more specifics about your risks. Other considerations are quality of life issues. Having to undergo frequent biopsies or repeat imaging are all reasons some of our patients tell us they have preventive mastectomies. Finally, the options for breast reconstruction available to you can make a difference to you in your decision. We can give you more specifics about those options if you like. We have all our patients discuss their risks with one of the breast oncologist and geneticists we work with. Let me know if I can help in any way.

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 the DIEP flap procedure an option for me?

January 9, 2015 by

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

Question:I had a bilateral mastectomy with expanders in October of 2013, followed by chemo and radiation. It is now time for my exchange surgery, but I really want the DIEP flap procedure. My plastic surgeon is hesitant to do the surgery. Is a flap procedure even an option at this point?

Answer: Thanks for your question. Yes it is possible and we frequently do replace expanders or implants with DIEP flaps. In other words the extra skin and fatty tissue from the tummy area. Some people may not have extra tissue to use from their tummy or may have had previous surgery (tummy tuck). In that situation we can usually find extra fatty tissue from another area without removing any of your important muscles. If your surgeon does not think you should do that, ask why. There may be a good reason. You can always get a second opinion if you like. Let me know if you would like more information. Thanks again.

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-I am 52 years old and thinking about a bilateral DIEP flap surgery.

January 2, 2015 by

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

Question: I am 52 years old and thinking about a bilateral DIEP flap.

Answer: Thank you for your question. Have you already had a bilateral mastectomy? Do you have a specific question regarding the surgery? If you are thinking about a bilateral DIEP you have been considering options for breast reconstruction. This surgery can be done at the time of mastectomy or it can be done any time after. Also it can be appropriate for patients who have had breast cancer or who are at high risk for breast cancer. We would be glad to contact you for more specific information if you like.  

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-I have just undergone a nipple sparring bilateral mastectomy, and I’m concerned about the outcome. What are my options?

December 26, 2014 by

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

Question: I am a 49 year old woman, and I have just undergone a nipple sparring bilateral mastectomy with a lat flap & expanders put in. My surgery was on 10/30, so I am at 3 weeks and am having necrosis issues on one nipple and in another area near an incision. I am extremely concerned about the outcome of my results and would love to hear your opinions as to what my options might be? We were actually scheduled for a trip to Charleston in Nov for 5 days that I regretfully had to postpone due to my recent breast cancer diagnosis. Any advice you could give me would be GREATLY appreciated!

Answer: Thank you for your question. I’m sorry your having some healing problems.   I know it can be stressful. It can also seem a lot worse than it really is. It is hard to picture the end result when you are going through the healing phase. When my patients have mastectomy skin healing problems we are very conservative and let the healing progess slowly and manage the wounds carefully. Many times the end result is much better than anticipated. I would be glad to see you when your in town to give you my opinion. Just let us know. We can try to make it convenient, it sounds like you could use a nice vacation. My office can contact you to make arrangements if you like.

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- What Can Be Done for Inflammation of Scar Tissue?

December 19, 2014 by

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

Question: I have chronic inflammation of scar tissue after having breast cancer surgery and reconstructed surgery. I have been in pain now for over a year. What if anything can been done to for this?

Answer: Thank you for your question. We cannot specifically give you medical advice by email because we would need more information.  You should make sure your surgeons (plastic surgeon and breast) and oncologists know you are having problems right away if you have not already.  They will be familiar with your history and can make sure you have been checked thoroughly.

We specialize in breast reconstruction and frequently help patients having problems with their reconstruction. The effects of radiation and scaring can lead to problems and pain. We help patients with implant problems by replacing their implants with their own fatty tissue. If you would like more information I would need to have my office contact you regarding your specific situation.

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-I had a double mastectomy in 2008 and now wish I had implants…is it too late?

December 12, 2014 by

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

Question: I had a double mastectomy in 2008 and now wish I had had implants…is it too late?

Answer: Yes, you can have breast reconstruction 8 years after your mastectomies. I have patients who have waited 22 years. Also its up to you and your plastic surgeon which technique is best for you. That includes implants. Thank you for you question!

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

 

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