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Can I Have an Autologous Fat Transfer After a Lumpectomy?

May 10, 2013 by

Ask the doctor May 9

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

Q: I am a stage IV breast cancer patient looking for autologous fat transfer to fill in my left breast after a lumpectomy in 2008. Can you please let me know how to proceed regarding consultation and such?

A: I would be glad to have our PA call you for more information or phone consultation. I would also be glad to see you in person if you want to come for an office visit to Charleston. I frequently see patients with similar requests.  In my opinion,  fat injections to repair lumpectomy and radiation deformities is usually not the most effective approach. There are also concerns by experts in this specialty regarding fat injections of the breast after that breast has already developed breast cancer once.

As long as the breast tissue remains then there is a risk–although very small–for the cancer to recur. That is why you still need to monitor that breast for any suspicious changes. The fat injections could make monitoring the breast more difficult and most importantly there could possibly be (not proven definitely yet ) an increase in the risk for recurrence after fat grafting. No one knows this for sure yet, but we are always careful regarding this type of safety issue. I could be more specific and talk to you about alternatives if I had more information and especially if I saw you in person. I hope this helps! Please let us know.

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Q: I have BRCA mutation. I am 25 years old. I want to have mastectomies with reconstruction but don’t really know which would be the right way to go.

A:  I am sorry you are facing such a difficult decision. Fortunately, breast reconstruction after preventive mastectomies allows for more planning before surgery and usually sets the stage for the best possible breast reconstruction result.  There are several reasons for this.

One reason is more of your natural tissue can be saved. It is usually possible to keep your natural nipple and all of the normal breast skin. Other problems related to possible treatments like chemo and radiation are eliminated because the mastectomies are done to remove breast tissue and prevent breast cancer.

The techniques for breast reconstruction are generally the same following preventive mastectomy and mastectomy for cancer.  Implants are used most frequently because of availability and more rapid recovery from the initial surgery. The end results with implants tend to be less natural than with your own tissue and after the process is complete there is a tendency for the results to deteriorate with implants because they are not living tissue. Your body may reject the implants or they may leak or deflate. The results with using your own tissue are generally more natural and more permanent. We specialize in breast reconstruction using your own tissue but without sacrificing your body’s important muscles.  To be more specific about recommendations for you I would need more information. I will be glad to have our office contact you for this information, just let me know.

James Craigie, MD

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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Join Us for We Know Women!

May 8, 2013 by

We Know Women Event garden partyFor the fourth year, East Cooper Medical Center is hosting an amazing event for women of all ages, the “We Know Women Event: Garden Party” on Thursday, May 9, starting at 5:30 p.m.

This fun event features live music, health demonstrations and screenings, local vendors with products women love, and wellness discussions with doctors including a question-and-answer panel. Wine tasting and delicious food will be provided, and Babies-R-Us will host a car seat installation demonstration.

Vendors include Grill Charms, Relax the Back, Abide-While, Silpada Designs, The Foot Store, HandPicked, Jonathan Green Prints, Miche Bag, No Wheat Treats, and Whaley’s Photos. The vendors will offer discounts and a variety of giveaways.

The physicians in attendance include Dr. James Craigie and Dr. Richard Kline from The Center for Natural Breast Reconstruction, Dr. Terrence O’Brien, Dr. Ross Rames, and Dr. Lynn Crymes. Topics include breast cancer, natural breast reconstruction, heart disease, cosmetic surgery, hormone therapy for women, and bladder concerns.

 

The “We Know Women Event” is free, but please register by calling 843-884-7031 or by visiting http://www.eastcoopermedctr.com/en-us/cwsapps/findanevent.aspx.

East Cooper Medical Center is located at 2000 Hospital Drive in Mount Pleasant. 

 

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The Final Touch: Nipple Tattoo and What You Can Expect

May 3, 2013 by

Ask the Doctor Bonus Edition

Our discussion boards have been abuzz recently about the nipple micro pigmentation (tattoo) procedure. Kimberly Kay, PA-C of the Center for Natural Breast Reconstruction provides this comprehensive overview and answers your questions.

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The ultimate goal of the reconstructive surgeon is not only to restore the three dimensional breast mound but also to recreate the nipple areola complex.  Some women choose not to undergo nipple/areola reconstruction, it’s a personal choice.

Micro pigmentation (tattoo) is used to re-create the color of the areola and nipple and is often the final step in the breast reconstruction process.   A variety of colors and color combinations are used to create a dimensional or projected look.  Here is a basic idea of what to expect:

1. The entire nipple/areola is shaded with the color you choose.

2. Then the original color is darkened with a slightly darker shade and a special needle is used to create the bumpy “Montgomery Gland” look of a natural breast. 

3. Finally, a little darker shade is used to give the nipple a projected look.

It sounds like a pretty straightforward procedure, right?  Given that the shades you can choose from are numerous, the process itself takes may require some needle changes & stroke techniques to be precise; we like for you to plan to spend at least an hour or two with us on your tattoo procedure day.

Nipple Tattoo Procedure

Be aware, the process is not always painless, so it’s beneficial that the procedure be done in a medical office setting if you think you may require a clinician to administer a local anesthetic prior to the procedure.   The addition of the local anesthetic Lidocaine with Epinephrine has the benefit of reducing bleeding at the tattoo site thus keeping more of the pigment from leaving the tissue.   And the procedure is not without risk.  You should be provided with an informed consent document prior to undertaking this procedure that outlines contraindications and possible complications (i.e. – allergic reaction, contact dermatitis, etc).

Nipple Tattoo 2

Our nurses and PA’s at The Center for Natural Breast Reconstruction receive specialized training through the PMT/Permark Training School Midwest in the Art of Nipple Areola Micro pigmentation.  Their instructor, Kathy Jones, is the Director of the Permark Training School and a board certified plastic surgical nurse with close to 20 years experience in the plastic surgery field.   Since, 1994 she has taught micro pigmentation to hundreds of practitioners in the United States and abroad and is a popular micro pigmentation lecturer.

The tattooing procedure is billed to your insurance company as a part of the reconstruction process since it is performed in our medical facility under the direction of our surgeons.  Touch up procedures may be required as some tattoos tend to fade with time, more so on scarred tissue.  If you have additional questions you’d like answered about the “nipple tattoo” process….please send them in.

Be sure to check out our gallery for more photos!

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

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What Form Of Reconstruction Do You Prefer? What Type of Implants Are Best?

May 3, 2013 by

Ask the DoctorThis week, Dr. Richard M. Kline, Jr. and Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: What form of reconstruction do you prefer and which requires the least amount of procedures?

A: Our practice specializes in breast reconstruction using your own tissue and without sacrificing important muscles and without implants. Our preferred approach is to give women the option that works best for them! This takes into consideration each person’s situation and body type.

We prefer to transfer skin and fatty tissue from the “donor” area a person happens to have extra tissue. Each person’s body has its own form and shape therefore we prefer to make our recommendations based on where each person’s body has extra tissue to work with. Implant breast reconstruction is usually a shorter recovery because there is no donor site that has to heal. The results with implants are not as natural as using your own tissue and people with implant reconstructions generally have more procedures as time goes by because of changes due to the implants etc..

All types of breast reconstruction may involve multiple steps, usually 2 stages. Sometimes minor adjustments may follow depending on many different variables. I hope this answers your question.

James Craigie, MD

The Center for Natural Breast Reconstruction

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Q: Can implants be used for reconstruction for breast cancer patients? If yes, is there a preference among medical practitioners as to whether the implant should be saline or silicone?

A: Implants not only CAN be used, they ARE used the great majority of the time (as opposed to reconstruction with the patient’s own tissue). Natural breast reconstruction with the patient’s own tissue is a longer, more involved procedure than implant reconstruction, with more serious risks, and is not the best choice for everyone.

Patients who have been radiated as part of their breast cancer treatment tolerate implants poorly as a rule, and for them, natural breast reconstruction may be their only hope for restoring symmetry. On the other hand, many patients who could be reconstructed with implants simply prefer to use their own tissue. Breasts reconstructed with your own tissue are warmer, softer, move more naturally, and are generally much closer to the “real thing” than implants. We have made a conscious decision to limit our practice to this type of reconstruction so that we can optimally serve the women who want or need it. However, implants seem to work quite well for the majority of breast cancer patients.

Richard M. Kline, Jr., MD

The 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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Natural Breast Reconstruction: What Are My Options If I Have Scarring?

February 1, 2013 by

The below question is answered by Dr. Richard M. Kline of The Center for Natural Breast Reconstruction.

I lost my implants in 07 due to an infection from my lymphedema. I had both removed and didn’t have reconstruction since the prior surgery was a failure. I have scaring from radiation in 2001. I’d like to think about reconstruction again BUT afraid of failure due to the scaring. Do I have options? Really would rather not have implants, I’ve both types, didn’t like either but would accept silicon over saline.

Hello,

Natural Breast Reconstruction almost certainly represents your best chance for a successful reconstruction, even with your past unfortunate experiences. If you have adequate donor tissue in your abdomen, buttocks, or thighs, there is an excellent chance that it can be used for your reconstruction. Your past surgeries and history of radiation may affect the final appearance of your breasts due to effects on your skin, but they usually have no impact on our ability to successfully transfer your donor tissue using microvascular techniques. If you’d like more info, we could have our nurse Chris call you. If you wanted to send pictures, that would also be very helpful.

Thanks for your inquiry.

Richard Kline
Center for Natural Breast Reconstruction

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

 

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What Is the Recovery Period for a DIEP Procedure?

November 9, 2012 by

I’m getting ready to have reconstruction surgery in Mount Pleasant and the procedure I’m having consists of the tissue being taken from my abdominal area. How long is the recovery period for this procedure versus having the tissue taken from my back?

If the tissue from the abdomen is being transferred as a DIEP flap, you will probably require 4 – 8 weeks for recovery, of which less than one week will probably be spent in the hospital (usually 4 days in our practice). If the tissue is being transferred as a pedicled TRAM flap (in which your abdominal rectus muscle is sacrificed to carry blood for the flap), the time quoted by your surgeon for recovery may be about the same, but some patients may complain of discomfort for considerably longer periods. With either procedure, some patients will heal faster, and some will heal more slowly, not surprisingly.

When you say tissue is taken from your back, I assume you mean a latissimus muscle flap will be used. This is generally done in conjunction with a prosthetic implant being placed, as the latissimus muscle rarely has enough bulk to make a breast by itself. Generally speaking, a reconstruction using the latissimus is easier to recover from than one using the abdomen, because the latissimus is not used constantly for activities such maintaining posture and breathing. Additionally, at least two other muscles, the teres major and the pectoralis major, have functions which strongly overlap the function of the latissimus, and they are able to “take over for it” to some extent. There are no muscles which duplicate the function of the rectus abdominus quite as closely.

—Richard M. Kline Jr., M.D

Do you have breast reconstruction questions you want answered? Submit them here and get personal answers, straight from our doctors!!

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Post Op Pearls Webinar: Share and Tell

September 10, 2012 by

Post Op Pearls panel members: Debbie, Chris, Kim Gail and Shirley

We couldn’t be more thrilled with the success of our second webinar titled,  Post-Op Pearls: Recovery, Healing, and Healthful Insights from Past Patients and Specialists, which happened on Thursday, August 28th. During the hour long webinar our panel, which included both past patients and specialists, shared information, personal tips and stories, and answered questions about breast reconstruction surgery. We’ve received an overwhelming amount of emails from women sharing their thoughts and feelings about this event and we’ve shared them with you below.

” The preparation and recovery tips were most helpful to me at this time since I am having surgery this November. I receive lots of information on reconstruction online, from you, FORCE, Johns Hopkins, and family members doing research or going through diagnoses/treatment.The only thing I do not have my head wrapped around yet is the multiple steps to completion.  I am only allowing myself to deal with step one right now.  I will figure the rest (nipple/no nipples, touch up procedures, etc) out later.

 THANK YOU ALL!”

” Just wanted to say how much my husband and I enjoyed the last webinar.  I liked hearing other patients comments on their recovery, it helps you know that your recovery is normal.  Thanks to all of you for all you do for us, the patients and our family. You make something that started out “bad” turn into a very pleasant experience.  I know that people here in Lexington get tired of hearing me talk about ya’ll but they have also been passing on my experience to their friends and have been recommending ya’ll to anyone they know that can benefit from the God given talent the Dr. Kline and Dr. Craigie share with their patients.

 Thanks again for everything “

” The topics that interest me the most are about the options available to those who do not have the option for DIEP reconstruction.  What are the remaining options, how many stages will it take to get to a finished “product”; what complications might happen; recovery assistance, return to work timeline, and so on. Initially, I got my reconstruction information from my breast cancer surgeon and then local plastic surgeons.  When I researched those options on the Internet I found there were more options available than what was locally available.  In my area, there are no plastic surgeons as well trained and as skilled as Dr. Kline and Dr. Craigie.  I have found the information provided by everyone at The Center for Natural Breast Reconstruction to be outstanding. The doctors and all of the staff are so willing to provide all the pros and cons of procedures and situations. They make recommendations that may or may not fit one’s situation but that information can be reviewed and let the individual make their own informed choice.  For me they have been the “light at the end of the tunnel. “

 I think the webinars are very helpful.  I only wish the person talking could be seen “live”.  The PowerPoint is helpful but would be so much more enhanced if one could see the actual speaker. I would like to learn more about the what is too much to expect from reconstruction surgery.  I was not eligible for a DIEP and had a I-GAP at one hospital and an S-GAP with Dr. Kline.  The S-GAP went so much better.  Now he is cleaning up all the mess from the I-GAP.  What type of breast volume, project, and shape is realistic under such circumstances?  I know each is unique to the individual, I’m throwing out this as a question on general terms. After bad experiences, I trolled the Internet to find doctors that could perform the type of reconstruction I wanted and needed.  I only found a couple of groups that fit my criteria. The Center for Natural Breast Reconstruction fit my criteria.  What questions should a breast cancer patient list/ask and have answered when seeking someone to provide the most options for reconstruction? I love all of you.  

You are the best!!!  So is East Cooper Hospital!!!! “

Through webinars we are able to continue our mission to help hundreds of women understand their breast reconstruction options and make informed choices about the option that fits in their lives. Whether you joined us live, listened to the replay, or regrettably missed out, we encourage you to share feedback and let us know what aspects of breast reconstruction you want to know about so we can serve you better. We’re sure to be hosting another webinar in the near future so stay tuned, you don’t want to miss out!

Let us know your thoughts in the comments section below or send our team an email today!

 

 

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Is This Normal? Your Post Op Breast Reconstruction Question Answered

August 17, 2012 by

Post Op Breast ReconstructionThe below question comes all the way from Australia, and is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction!

6 weeks after surgery I had a leak a long my stitches all bright yellow came out when that stopped a week after my scar further round swelled and it started leaking from there. Thats stopping now, is this normal? Will it keep happening, and I think my breast seems to be going smaller?

Hello,

It depends on the type of surgery you had. Drainage from incisions 6 weeks from surgery could be related to  incision healing. If the incision healed without problems and then the drainage occurred it could be a reaction to stitches or from a collection of fluid underneath that is working its way out. Your description might suggest liquefied fat is working its way out. If it is coming from the breast it may stop on its own or could require a procedure to remove all of it. Make you sure you check with your surgeon to make sure there is no infection. I hope this helps answer your question.

James Craigie, MD

Center For Natural Breast Reconstruction

Would you like your breast reconstruction question answered?  Register for our no-cost webinar on August 28th where there will be a live Q and A session!!

 

 

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Upcoming Webinar: Post-Op Pearls: Recovery, Healing, and Healthful Insights from Past Patients and Specialists

August 13, 2012 by

We at The Center for Natural Breast Reconstruction are excited to announce our upcoming webinar, Post-Op Pearls: Recovery, Healing, and Healthful Insights from Past Patients and Specialists, happening Tuesday, August 28, at 7:00 p.m. Eastern / 4:00 p.m. Pacific.

We’ve created this event for anyone seeking answers, comfort, and information at any stage of the journey through breast cancer. The no-cost webinar features a panel of our past patients, nurses, and practitioners from The Center for Natural Breast Reconstruction who will share their stories and valuable counsel on what to expect during recovery.

With the belief that every woman deserves to feel natural, healthy, and beautiful after her mastectomy, we offer this panel to help other women make an informed and confident decision when it comes to their treatment and breast reconstruction options.

During the hour-long event, the panel will explore…

  • Each woman’s journey, including her diagnosis, surgery, post-op recuperation, and a reflection on how her life has been affected by her treatments.
  • Advice for newly diagnosed women, from post-op clothing to the recovery process.
  • How to discuss your options and decisions with family and friends.
  • The secret to self-confidence post-diagnosis.
  • Any questions you have during our live Q & A session.

We’ll also open the phone lines for a live Q & A session with the panel so attendees can get answers to all their questions about treatment options, recovery, and natural breast reconstruction.

To join us for the webinar, register here.

Meet Our Panel:

Shirley Trainor-Thomas 

 Her story: A senior vice-president at GuideStar Clinical Trials management, Shirley, was diagnosed with breast cancer in January 2010 when she was 49 years old. After exploring all possible treatment options, she chose to have a double mastectomy and reconstruction in the same surgery with The Center for Natural Breast Reconstruction. Though the cancer was found in her left breast, the pathology showed overactive cells in both. Having been treated for Hodgkin’s lymphoma with radiation to her chest as a teenager, susceptibility motivated her preventative decision.
Debbie Roland 

 Her story: At 58 years old, Debbie Roland is a mother of three, a grandmother with six grandchildren, and the director of the Calhoun County Museum and Cultural Center since 1983. Before she knew about The Center for Natural Breast Reconstruction, a cancer diagnosis led to the removal of her right breast only—even though she wanted both removed, she was discouraged against it. A miserable recovery slowly ensued. After years of feeling off-balance, she met Dr. Kline at The Center for Natural Breast Reconstruction, and after her surgery in January 2012, life has never been happier.

Chris Murakami, RN, CNOR  

and

Kimberly Kay, PA-C

 Chris’ story: In addition to being a mother of three, Chris also has almost twenty years of nursing experience, mostly in the hospital setting. Her patients at The Center for Natural Breast Reconstruction are the most rewarding part of her job.
Kimberly’s story: A native of the Charleston area, Kimberly is a mother who graduated from the Medical University of South Carolina PA program. Having worked in family practice, OB/GYN, and urgent care, she is well suited to the special patients she meets at The Center for Natural Breast Reconstruction. She’s found a true calling here where she can pursue her primary interest: women’s health.

 

Note: if you are busy on August 28, register today, and we’ll send you a link to the replay, which you can watch at your convenience.

 

 

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What are the Next Steps if Capsular Contracture Occurs from a Breast Implant?

July 27, 2012 by

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

What are the next steps if capsular contracture occurs from a breast implant?

The next step would depend on how severe the capsular contracture is.  All implants will develop a capsule and this may slowly lead to changes in the shape or in the most severe cases painful scarring and hardness.  When symptoms develop it may be necessary to surgically intervene.  The next step would depend on whether the patient has had radiation and the available options for reconstruction.  The first step and the least involved regarding surgery would be capsulotomy or release of the scar. Sometimes the healing process, whether there was an infection or a bruise around the breast, could have increased the risk for capsular contracture. Other times it may simply be the body’s reaction to an implant.  If after capsulotomy or capsulectomy the contracture has not resolved, the next step would be to consider moving additional healthy tissue to cover the implant or to remove the implant and replace it with your own tissue.  30% of our patients who choose to undergo autologeous reconstruction have had prior implant reconstruction and their bodies have developed severe capsular contracture.  If someone has had radiation, the capsular contracture will be more severe and most likely once problems develop the problems will continue.  Therefore, when multiple capsular contracture procedures have been necessary; our recommendation would be to consider removing the implant and replacing it with your own tissue using a muscle-sparing procedure.  Your own tissue would not develop capsular contracture and it is the most successful way to solve problems resulting from implant reconstruction.

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

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