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Increase Breast Size Through DIEP Flap Natural Breast Reconstruction Surgery?

July 20, 2012 by

The below question was answered by Charleston breast surgeon, Dr. James E. Craigie  of The Center for Natural Breast Reconstruction:

Can I increase the previous size of my breast during a DIEP breast reconstruction?

Breast reconstruction requires detailed planning before surgery.  One of the most important considerations is the desire of the patient to either be the same as she was before mastectomy or to change some aspect of the breast.  When there is adequate donor tissue (in the case of a DIEP excess tummy tissue) we may have the opportunity to increase the patient’s bra cup size given adequate planning and adequate donor tissue.  The desire of the outcome is always to be proportional and if someone has more tissue on the tummy we can usually achieve this.  In ideal circumstances, we plan to make the reconstructed breast approximately 20% larger at the first stage than the end goal after the reconstruction process is complete.   During the first stage of surgery, the tissue from the tummy is transferred and the primary goal is to have adequate blood supply and healthy nourished tissue.  The shaping of the breast is secondary to the functioning of the blood vessels during this stage. At the second stage of surgery, in order to create a more natural shape, some tissue may need to be removed or any tissue that did not survive the initial transfer (fat necrosis) removed.

Therefore, when planning the first stage procedure, we try to end up with slightly more than desired.  That gives us the ability to shape the breast and we can always make it slightly smaller at the second procedure; which is a much easier adjustment than making it larger.  So, it is possible to increase the current breast size with the DIEP, but it would depend on the size of the breast prior to the mastectomy and  how much donor tissue is available for reconstruction.

Are you thinking of having reconstructive surgery and have questions or just want more information? Then click here to ask our team, we’d love to hear from you!

 

 

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The Advantages of ICAP Flap Breast Reconstruction and When to Use This Procedure

July 13, 2012 by

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

When would we use the ICAP flap for breast reconstruction and what are the advantages of this procedure?

The TCAP flap is a procedure for reconstructing the breast or partial breast reconstruction and is another of the muscle-sparing flaps. The ICAP does not require microsurgery or reattachment of the blood vessels, but usually the amount of tissue available is small.  In our experience it is most frequently used to perform partial breast reconstruction of mainly the outer side of the breast or to add volume to a previously reconstructed breast or when the resulting size is not as quite as large as desired from the original planned procedure.  An advantage of the ICAP flap is that it removes tissue from the side of the body that is usually in excess and sometimes bothersome following a mastectomy.  It is just above the bra line and the scar, and although it extends to the back, can almost always be covered in a bathing suit or a support type bra.  Again, the ICAP’s best use is in adding additional tissue to an already reconstructed breast or providing small amounts of tissue for partial breast reconstruction.  It typically does not involve microsurgery to reconnect the blood vessels and the blood vessel that nourishes the tissue is conveniently located on the side of the body near the breast just above the bra line.

For more answers to your breast reconstruction questions, visit our Ask the Doctor section of this blog or submit your questions here.

 

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TDAP Flap Breast Reconstruction Surgery: When and Why to Choose This Option

July 6, 2012 by

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

When would we use the TDAP flap for breast reconstruction and what are the advantages of this procedure?

The TDAP flap or thoracodorsal artery perforator flap is a procedure for reconstructing the breast or partial breast reconstruction and is another of the muscle-sparing flaps.  The procedure allows for the fatty tissue from the side and back to be mobilized and then transferred to the breast without disconnecting its blood supply and performing re‑anastomosis of the small blood vessels.  The tissue that is used is in the area above the latissimus dorsi muscle, which is the largest muscle in the body; however, the procedure does not involve transferring the muscle or destroying the muscle.  The advantages of this procedure are that the tissue can be used for breast reconstruction without performing the microsurgery and without damaging or removing the muscle.  The disadvantages of the procedure are that there is a limited amount of tissue available to use for breast reconstruction and because the blood vessel remains attached and is not divided, there is a limit to the shaping and positioning of the new tissue.  It is most frequently used for reconstruction of a part of a breast, mainly the outside, but in some circumstances can be used for reconstructing the entire breast.  However, this is usually a smaller reconstruction and the amount of skin available is typically limited as well.  The TDAP can be used for transferring fat to the breast at the time of mastectomy or can be used later after mastectomy and the body has healed.

Procedures: Transforming Healthy, Living Tissue
Microsurgery has come a long way since its invention by vascular surgeons in the 1960s. The term refers to any surgery involving a surgical microscope. And it has found one of its best applications in breast reconstruction. Through microsurgery, our skilled surgeons are able to harvest healthy tissue from one part of a womans body and reattach it to the breast area. Through the careful process of attaching blood vessels, microsurgery allows patients to have natural looking breasts made from their own, living tissue. Another benefit is the minimized impact and injury to muscles, allowing patients to enjoy a faster, fuller recovery.

Did you find this post helpful? We’d love to hear from you in our comments section.

 

 

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Am I A Candidate for Natural Breast Reconstruction?

June 29, 2012 by

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

I was diagnosed with breast cancer in 1999 at age 24 (infaltrating ductal, triple negative). I had a lumpectomy with a lymph node dissection, chemotherapy and radiation. I found out I was positive for the BRCA1 mutation in 2008 and had a myomectomy (c section cut) and subsequent full hysterectomy (via davinci) in 2010, since pathology found the mass to be Endometrial Stromal Sarcoma.

I am now considering a mastectomy to decrease my chances of reoccurrence. Would you recommend a prophylactic mastectomy? If so, what type of reconstruction can I have? I prefer natural reconstruction rather than implants, but do not know if I am eligible since I’ve had two abdominal surgeries and do not have a lot of extra tissue anywhere else.

Hi and Thank you for your question. I’m sorry you have been faced with these difficult decisions. Removing as much breast tissue as possible is the most effective thing you can do to reduce your chances of getting breast cancer. I  refer to this type of mastectomy as “risk reduction” because it does not make the chances 0 but is as close as one can get. Your previous tummy surgeries have probably not affected your ability to have natural breast reconstruction, as we have had many people who have had the same types of surgery before using the extra tummy. Even the people who have had surgeries that compromise the tummy we can almost always come up with an option for natural breast reconstruction. Many of our patients have been told they do not have enough extra to use but when we see them we can usually give them a very nice result without implants. I hope this answers your question.

Sincerely,

James Craigie, MD

Center for Natural Breast Reconstruction

 

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

 

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What Changes Can I Expect After an SGAP Procedure?

June 22, 2012 by

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

What changes will I notice, if any, from an SGAP procedure after the first stage?

That is an extremely variable thing, some patients scarcely notice a difference in their buttocks after harvest of an SGAP from one side, while other patients noticed a significant difference.  In almost all situations, the buttock shape will not be optimized however after the first stage, whether it is a unilateral or bilateral SGAP.  The second stage of the SGAP, which can occur as early as three months after the first stage, typically involves a fairly extensive revision of the GAP flap donor site.  Our present feeling is that the GAP flap scar is ideally placed as high as possible, so that it may fit within most bathing suits, but still fit comfortably under shorts.

Learn More About Our Surgical Team

The Center for Natural Breast Reconstruction was created by two surgeons, Dr. James Craigie and Dr. Richard Kline. Through their work at East Cooper Plastic Surgery, they saw patients benefit from breakthroughs in microsurgery and breast reconstruction. Their combined skills helped women achieve the very best results possible.

The result: a center devoted completely to helping women gain the breast shape and fullness they seek, without the loss of muscle or use of artificial implants.

Dr. Richard M. Kline Jr., MD

Home: James Island

Education: M.D., Medical University of South Carolina; B.S., Furman University

Residencies: The Cleveland Clinic, Louisiana State University Medical Center

Specialties: Perforator flap breast reconstruction

Certification: American Board of Plastic Surgery

Personal: Married with two children

Dr. Kline trained in microsurgery with Dr. Robert Allen, who was pioneering the DIEP, SIEA, and GAP flaps at LSU while Dr. Kline was a plastic surgery resident. “We knew that he (Dr. Allen) was on to something very exciting,” remembers Dr. Kline, “but I doubt anyone back then foresaw just how sought-after those procedures would become.”

After completing his training, Dr. Kline spent several years in full-time academic surgical practice, first at LSU in New Orleans, then at the Medical University of South Carolina, during which time he performed the first successful DIEP flap in the southeastern United States. He entered private practice in 2000, and the practice rapidly became a regional referral center for complex microsurgical reconstruction. The practice has since evolved to focus almost exclusively on microsurgical breast reconstruction. “Our passion” says Dr. Kline “is restoring women’s body image after mastectomy using only their own natural tissue. We and our entire staff feel very privileged to be able to use our skills to help so many people in this way.”

A Charleston native, Dr. Kline lives near his childhood home and his parents. His wife, Elizabeth, is a thoracic surgeon, and the two met in the operating room. They have two children, daughter Bellamy and son Mahlon.

Dr. James E. Criagie

Home: James Island

Education: M.D. Medical University of South Carolina: B.S. Erskine College

Residencies: Medical University of South Carolina; Fellowship. Louisiana State University Medical Center

Specialties: Muscle sparing Breast reconstruction with the patient’s own fatty tissue

Certifications: American Board of Plastic Surgery

Personal: Married with two children

Some of Dr. James Craigie’s earliest memories are of afternoons spent at hospitals with his father, a general surgeon. “I liked to go with him on call and see the things that he did,” Dr. Craigie says. Today, Dr. Craigie is an accomplished surgeon himself, conducting 70-100 breast reconstruction surgeries each year, along with all types of body contouring and cosmetic breast surgery that is part of the process of breast reconstruction. “As plastic surgeon’s we use techniques that are often cosmetic in nature but included as part of the reconstructive process. My main goal is to help people,” he says.

His constant aim is to bring state-of-the-art techniques and the best possible results. Before joining our practice, Dr. Craigie opened a general plastic surgery practice in North Carolina and completed advanced training in micro-vascular breast reconstruction in New Orleans. He is one of a limited number of doctors who perform the specialized surgery, considered the “gold standard” in breast reconstruction techniques. “To do this complicated surgery, you have to have extensive training and a strong commitment.” Dr. Craigie says. “We saw a real need for this procedure, that many women could be helped.”

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.

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A Journey of Power and Purpose

June 20, 2012 by

We are so happy to share with you another In Her Words post, this time with Blaire Holloway, a breast cancer survivor and reconstruction success story!

Blaire was a patient of ours at The Center for Natural Breast Reconstruction and shared her inspirational journey in last month’s issue of Lowcountry Health & Wellness Magazine and we would like to share this article with our readers!

See below for Blaire’s Story (*Don’t forget to grab a downloadable copy of Low Country Health & Wellness Magazine at their website)

Click the article below to be taken to the full online version.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you downloaded the June issue of Lowcountry Health & Wellness Magazine? If not, click here.

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The Affordable Care Act’s Day(s) in Court

June 18, 2012 by

The Supreme Court heard arguments about the Obama Administration’s Affordable Care Act earlier this spring, and is expected to hand down a decision regarding the healthcare law any day now. Here’s a look at how various possible decisions could affect the state of healthcare in the United States.

Option 1: The Supreme Court Rules the Affordable Care Act Is Good to Go

The main argument against the Affordable Care Act challenges its so-called individual mandate, which, if enacted, would require all Americans to have health insurance (through the government, employers, or an individually purchased plan). If the individual mandate is given the green light, then…

  • Uninsured Americans will have to purchase health insurance by a certain deadline or face a penalty charged at tax time.
  • Health insurance companies will be required to make insurance coverage available to everyone, including those with preexisting conditions.
  • Low-income Americans (those with household incomes up to 138% of the poverty line) will qualify for government assistance for medical insurance (possibly in the form of Medicaid).

The individual mandate could be good news for women with breast cancer who have been denied coverage or reimbursement for treatment, because it will require insurers to cover them regardless of their current or former health.

But most health professionals, regardless of their political affiliation, agree that the individual mandate is far from an ideal system.

Option 2: The Supreme Court Strikes Down the Individual Mandate

If the Supreme Court rules that the individual mandate is unconstitutional, the Affordable Care Act may be doomed. Without the guarantee that all Americans buy health coverage, there is no incentive for health insurance providers to make coverage available to those with breast cancer and other potentially costly conditions.

Without the individual mandate, the health insurance landscape in the U.S. may remain as it is for the immediately foreseeable future.

More Reasonable Healthcare Down the Road?

Some commentators on the health care hearings have suggested that there might be greener pastures ahead for health insurance in the States. It seems that a dismissal of the individual mandate could, by some analyses, pave the way to a single-payer insurance system, under which all Americans would be covered by the federal government, regardless of job or health status.

While most Americans agree that the current state of health insurance in this country is far from ideal, few understand how important comprehensive coverage is better than those who have had life altering illnesses like breast cancer and major procedures such as breast reconstruction.

 

 

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Back to Bras: Adjusting to Bras After Reconstructive Surgery

June 8, 2012 by

post surgery braThe below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

How soon can I wear a regular bra after the first stage surgery?

Well, I am not sure I know what a regular bra is.  Sport bras are very similar to the bras which we use in the hospital and we often recommend the people transition to sport bras.  I think most patients could wear almost anything they wanted, even an underwire, somewhere from 1-2 months after surgery, although this may not be as comfortable as some other options.

If you do need to have a special bra after your incision lines have healed, we are happy to provide a prescription. We’ve had lots of our patients rave about Nordstrom’s for post mastectomy bras. Not only do the kind folks there provide a professional fitting for mastectomy patients, but they also handle the insurance paperwork for you too!

Here are more helpful hints for post surgery clothing:

If you are having a DIEP breast reconstruction, abdominal swelling limits clothing choices. Wear loose-fitting garments to the hospital. Women should avoid fitted, zippered pants and skirts because they probably won’t zip when it’s time to leave. Even clothing with snug elastic waistbands may be uncomfortable. A loose chemise or drop waist dress or jumper is a good choice.

Slacks or skirts with elastic in the back and a smooth band in the front may be slightly more comfortable than those with a totally elastic waistband.

Consider clothing that doesn’t wrinkle easily. Resting and naps are necessary while recuperating.

Cotton underwear breathes and is absorbent and comfortable next to the skin. Cotton’s fiber ends help the fabric stand away from the sensitive incision area rather than hug it, as some textured, synthetic fabrics do. If you don’t already have cotton briefs, buy a pair a size larger than your normal size. A little extra room adds comfort during recuperation. For waistline incisions, bikini cut styles may be better, while full cut panties and shorts might be preferred for incisions in the lower abdomen and buttocks.

Loose-fitting nightgowns and nightshirts are comfortable, especially when made from absorbent, breathable cotton or cotton-blends. If you prefer pajamas, select those with drawstrings. Elastic waists may be less comfortable for some people depending on swelling, tenderness, and location of incision. Sweatpants or crew pants are a comfortable change from bed wear, especially those with drawstrings, which allow some flexibility at the waistline.

Flat soled shoes that slip on your feet rather than tie are great to have, too, as you may be limited in your ability to bend over and tie your shoes.

Are you thinking of having reconstructive surgery and have questions or just want more information? Then click here to ask our team, we’d love to hear from you!

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The Only Safe Tan: Tips to Achieve a Perfect Faux Tan

June 4, 2012 by

self tanningA golden tan is the perfect summer accessory. But devoting yourself to achieving that enviable glow is both time consuming and damaging to your skin. At The Center for Natural Breast Reconstruction, we prefer to use the healthy alternative to sunbathing—faux tanning.

Applying sunless tanner can seem very daunting, but it’s as easy as four simple steps.

1. Exfoliate

Many women fear sunless tanner because it can streak and leave orange patches when applied incorrectly. Proper exfoliation prior to application will help smooth the skin and prepare it to accept the tanner evenly.

2. Moisturize

Another reason sunless tanner can appear fake is due to improper moisturization beforehand. Dry skin, especially on your elbows and knees, will absorb more tanner than the rest of your skin, so be sure to moisturize those areas well.

3. Use Gloves

To avoid ending up with bright orange palms, wear thin, tight-fitting rubber or latex gloves during the application process. After you have tanned the rest of your body, place a small amount on the backs of your hands, and rub them together before briefly interlacing your fingers.

4. Buff

If you see any spots that are drying slightly darker than the rest of your skin, take a cotton pad and gently buff the offending area—it will help blend your tan more evenly.

These simple tips will help you to achieve that perfect summer glow—without the damaging effects of the sun! Flaunt those faux tans with confidence, ladies.

 

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Will An SGAP Procedure Help With My Lymphedema?

June 1, 2012 by

sgapThe following submission below is answered by Dr. Richard M. Kline Jr., MD, of The Center for Natural Breast Reconstruction.

Will a SGAP help with lymphedema?

There is some indication that patients with lymphedema may benefit from having an autogenous reconstruction, and this is one reason why we have elected in our practice not to perform vascularized lymph node transfer at the same time as breast reconstruction.

About Our Procedures

Microsurgery has come a long way since its invention by vascular surgeons in the 1960s. The term refers to any surgery involving a surgical microscope. And it has found one of its best applications in breast reconstruction. Through microsurgery, our skilled surgeons are able to harvest healthy tissue from one part of a womans body and reattach it to the breast area. Through the careful process of attaching blood vessels, microsurgery allows patients to have natural looking breasts made from their own, living tissue. Another benefit is the minimized impact and injury to muscles, allowing patients to enjoy a faster, fuller recovery.

View an animation of our procedures here.

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