What’s Next if My First Attempt at DIEP Flap Breast Reconstruction Fails?

The below question was answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr., MD of The Center for Natural Breast Reconstruction:

If the first DIEP flap breast reconstruction fails what are my options?

This is a rare scenario, but in our practice we generally recommend waiting 3 months for the body to recover, then using another area of tissue, most commonly the buttock to perform the reconstruction.  The failure of the first reconstructive attempt does not seem to adversely affect the success rate of the second reconstructive attempt. We have in the past sometimes attempted to perform the salvage reconstruction at an earlier date, but we have come to feel that the patients do better overall if they are allowed a period of healing before proceeding with the next surgery.

What is DIEP Flap Reconstruction?

Perforator  flaps and natural breast reconstruction represent the state-of-the-art in breast reconstruction. The DIEP flap is the most frequently used type of  perforator surgery for breast reconstruction because of the tummy tuck benefit  that can be part of the process. Doctors  borrow skin and tissue from your abdomen, and use it to create a soft, warm,  living breast.

It starts  with an incision along the bikini line similar to a tummy tuck incision.  Surgeons remove the necessary skin, soft tissue, and tiny feeding blood  vessels. The blood vessels are matched to supplying vessels at the mastectomy  site and reattached under a microscope. Tissue is then transformed into a new  breast mound.

Our refined technique provides all the necessary  tissue to build a breast, without removing the abdominal muscles. In addition  to reconstructing the breast, the contour of the abdomen is often improved –  much like a tummy tuck.

Have questions for our team? Send them on over, we’d love to hear from you!

 

East Cooper Medical Center’s We Know Women Event

The Center for Natural Breast Reconstruction was thrilled to participate in the East Cooper Medical Center’s We Know Women Event on Thursday, May 17th.This was the third annual We Know Women Event which featured physician panel talks, one-on-one Q&A with physicians, retail therapy with more than 20 vendors and a wine tasting compliments of Whole Foods Market. Our very own Dr. James Craigie served on the panel “Save the Tatas:  Breast Cancer-Diagnosis to Treatment” alongside Dr. Baron of The Charleston Breast Center and others. We had an Ask The Doctor table set up on the lawn where we raffled off a beach bag filled with goodies. Although the rain did make its way to the event, uninvited, we didn’t let it stop us, as we came prepared with CNBR logo ponchos. See below for a look back at this years event!

Click here to watch Dr. Craigie answer questions on natural breast reconstruction.

Check out our pictures below for all the fun we had!

Dr. Craigie answering questions during the panel discussion-Save the Tatas: Breast Cancer-Diagnosis to Treatmen

Other panelists joining Dr. Craigie included – Dr. Lisa Baron – Charleston Breast Center, Dr. Jennifer Beatty – General Surgery Dr. Matthew Beldner – Hematology/Oncology

Fresh pink gerbers, just like our logo!!

It pays to come prepared!!! (With ponchos)

Amy McCarthy, winner of our big beach tote filled with goodies that we raffled off!

Make sure to like our Facebook page to stay up to date on all our events and happenings!

 

At What Point During Your Journey Is It Time To See Our Surgical Team?

time to see a doctorThe below question is answered by Richard M. Kline Jr., M.D., of The Center for Natural Breast Reconstruction.

At what point in the process should a breast cancer patient see a breast reconstruction surgeon?

Opinions on this vary, but I think the prevailing opinion is the sooner the better.  Ideally, the patient would see the reconstructive surgeon even before plans were finalized for treating her cancer.  This is because many times several options are available to the patient, and she may not fully understand the implications of the various options available to her unless she understands what reconstructive options are available in each setting.

A Little Bit About Our Surgical Team :

Co-directors Dr. Richard M. Kline and Dr. James E. Craigie are certified by The American Board of Plastic Surgery. Both surgeons have trained under Dr. Robert J. Allen, a pioneer in breast reconstruction using the DIEP, SIEA, and GAP flaps. Dr. Craigie completed a microsurgical breast reconstruction fellowship dedicated to muscle sparing techniques (directed by Robert J. Allen, M.D.). Dr. Kline completed his residency at LSU while Dr. Allen was developing these techniques.

Our entire surgical team is dedicated to remaining at the forefront of breast reconstruction surgery to provide excellent care and results for each individual patient. Because of this commitment, the practice consistently earns referrals from our patients, as well as from other surgeons throughout the United States.

Knowing the RIGHT Questions to Ask:

When searching for a surgeon to perform your microsurgical breast reconstruction, it’s important to ask him or her the right questions.

Below are a few questions to ask:

  • Are you a microsurgeon? Where and by whom were you trained in this specialty?
  • How many microsurgeries have you performed? And how often do you perform them?
  • What is your success rate?
  • Can you arrange for me to speak with some of your patients who have had the procedure I am seeking? (Candidates should speak with people of similar ages and lifestyles).
  • How long do you anticipate I will be under anesthesia for the procedure?
  • 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
  • Will I have to sign a consent that if a physician is unable to complete the procedure, I will have to consent to a TRAM/Free TRAM?

Do you have a question about breast implants or natural breast reconstruction? Ask our surgical team by clicking HERE.

One Woman’s Journey to DO Something About Her BRCA Status

Julie Moon
We at The Center for Natural Breast Reconstruction are delighted to share this In her Words post featuring Julie Moon, who is a 34 year old BRCA 1 positive breast cancer previvor. Julie wants other women to be educated, which is why she began the blog  Say it Anyway, where she shares her unique story and journey.

See below for our interview with Julie.

What type of reconstruction surgery did you have and how do you feel about the results?

I had a bilateral nipple sparing mastectomy and immediate SGAP reconstruction.  I am so excited about having natural looking breasts made from my own body that will be with me for the rest of my life and never have to be replaced.   I am so grateful to have found Dr. Craigie and his staff.  I knew as soon as I met them that I was in good hands.

Breast cancer runs in your family at what point did you decide to undergo preventative breast surgery?

I found out in 2007 that I was BRCA 1 positive.  I decided then that I would go ahead and have my third child and breastfeed her as long as she needed. I participated in the Atlanta Susan G Komen 3Day For The Cure in 2011 and I was moved over that weekend to DO something about my BRCA status.  I met with Dr. Craigie in December and had my surgery Feb 1, 2012.

What advice would you give to women who have undergone a mastectomy or double mastectomy and are unsure about natural breast reconstruction?

I would recommend that women look at lots of pictures.  I would recommend that they ask specific questions to other women who have undergone the procedure.  I found so much great information from the women at the FORCE.  I would also encourage them to not be afraid to travel to another city to get the procedure that they really desire.  I have three children and a very busy entrepreneur husband.  It was A LOT of work to organize all the friends, family and babysitters needed to care for my family while I was out of town for my surgery.  It was all so very worth it.

In what ways has breast cancer both negatively and positively affected your life?

I feel very blessed to be one of the women who actually knows what cancer was coming after me and be able to eliminate that risk before it knocked on my door.  My grandmother was a breast cancer survivor.  She was not lucky enough to be able to have had natural breast reconstruction and now as a grown woman I am able to see how that must have affected her life so dramatically.  My aunt died from complications of her chemotherapy that was treating her breast cancer.  My mom was smart enough to have a bilateral and reconstruction before they found cancer but ironically she already had it growing in her breast undetected.  My BRCA status has taught me how to face something ugly in the face and not be afraid of it but battle it with the best army I could find.

Have questions for Julie? Submit them here! Be sure to check out her blog for tons of educational resources.

Best Dining Views in Downtown Charleston

rooftop diningWe at The Center for Natural Breast Reconstruction love our city! Charleston, South Carolina, is full of rich historical and cultural beauty. Whether you’re in town for breast reconstruction surgery or you’ve lived here for years, enjoy the best of what Charleston has to offer by checking out these excellent dining rooms with a view during your next dinner out.

Fleet Landing Restaurant

Constructed by the U.S. Navy in 1942 as a departure point for sailors, Fleet Landing offers diners stunning views of the Charleston Harbor. The restaurant lies within a 6,000-square-foot, hurricane-proof structure that went unused for decades following World War Two. In 2004, visionary Tradd Newton realized his dream of reinventing the striking space, and Fleet Landing was born.

Today, diners enjoy seafood dishes in a rich historical setting. Fleet Landing offers lunch and dinner seven days a week, plus brunch on Saturdays and Sundays. Menu and reservation information are available here.

Vendue Inn

Even if you aren’t staying at the Vendue Inn during your time in Charleston, be sure to visit the Rooftop Bar and Restaurant atop the building. Named Charleston’s best bar five years in a row by the Charleston City Paper, Rooftop offers sweeping views of the city’s harbor and historic downtown.

Cozy during any season, the Rooftop boasts outdoor heaters in the chilly months and luxurious sunshine during the rest of the year. Visit seven days a week, 11:30 a.m. – 12:30 a.m., with live music in the evenings. Menu information is available here.

Pavilion Bar

Described as a “rooftop oasis,” the Pavilion Bar is located on top of the luxurious Market Pavilion Hotel. Pavilion patrons can sip signature cocktails while enjoying views of historic downtown Charleston and the waterfront. The bar also boasts a cascading waterfall to relax patrons.

Private parties and individuals can enjoy the elegant Pavilion every day between 11:30 a.m. and 12:30 a.m., but should be sure to consult the bar’s dress code. Menu and other details are available here .

 

Eat Your Way to a Whiter Smile

white smileHealth professionals agree that maintaining healthy teeth and gums is an important part of overall health. Why? Firstly, because dental problems (such as tooth decay and gingivitis) have been linked to heart and kidney troubles, and secondly because having healthy teeth boosts a person’s self-image and self esteem.

Plus, a white smile can make a person look as much as 10 years younger, estimate some dentists. Here’s a primer on what you should eat and avoid to keep your pearly whites looking their best.

Food Choices to Keep Your Teeth Strong

The good news is that foods that are good for your teeth are also good for the rest of your body, so you won’t have to rehash your entire diet to help improve your smile. Keep these dos and don’ts in mind as you shop for your next meal.

  • DO choose crunchy fruits and vegetables. Chewing these foods promotes the production of saliva, which helps flush decay-causing bacteria from your mouth. Apples, carrots, celery, and cauliflower are especially potent grime-busters.
  • DO include dairy products in your daily diet. Dairy foods (including milk, yogurt, and cheese) contain lactic acid, which helps protect your teeth from decay. Hard cheeses are especially powerful in the fight against tooth decay, as they polish the teeth.
  • DO try a natural tooth buffer. Orange peels rubbed against the teeth, followed by a water rinse, can help improve whiteness over a period of months.
  • DO brush and floss after meals. Food left in the teeth provides a constant source of energy for smile-damaging bacteria. Brushing or flossing the food away will keep bacteria from flourishing.
  • DON’T consume foods that could stain your clothes. The same dyes can discolor your teeth over time. To stain inducers include coffee, tea, blueberries, soy sauce, and red wine. If you consume these foods, be sure to rinse and brush your teeth to minimize the damage.
  • DON’T use tobacco products, which stain.
  • DON’T consume refined sugars. Soda, candy, and other foods that contain refined sugar are especially hard on your teeth, as they provide a ready source of energy to decay-inducing bacteria. Even foods with natural sugars (including fruit) feed bacteria, and should be rinsed from teeth shortly after consumption.
  • DON’T consume very hot or very cold foods. The temperature fluctuations cause tooth enamel to expand and contract, which allows stains to penetrate.

Whether you’re adopting healthy habits as part of your breast cancer recovery or simply hoping to improve your overall wellness, taking care of your teeth should be a top priority

 

Our Recommendations for Post Surgical Clothing After Breast Reconstructive Surgery

post operativeThe below question is answered by the team at the The Center for Natural Breast Reconstruction.

I am having a SGAP breast reconstruction in a few weeks. Do I need to buy post op surgical bras? If so, which kind and can I get a prescription for insurance purposes? Also, I heard people use various bras / camisoles with pockets for drains. Have you heard of those or think they are helpful? Do you think button down shirts are something I need to get? Anything else?

No need to buy any special bra, vest, or camisole in advance. Our hospital, East Cooper Regional Medical Center, provides a soft cotton vest with drain pockets as well as a surgical bra that acts as a post operative surgical dressing. Let them know if you feel like you need an extra for when you leave the hospital and they are great about sharing another with you.

Absolutely, I would make sure I had button down shirts and loose clothing that you can easily get in and out of. You’ll have some limitation of lifting your arms above your head so button down shirts are easiest to get on and off without lifting your arms. Some women choose to wear loose sundresses; others track suit pants or cotton shorts. Whatever you are comfortable in is fine, but keep in mind we won’t want you wearing anything right away that could potentially put any pressure on your suture lines.

Here are more helpful hints:

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.

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!

Thank you,

The team at The Center for Natural Breast 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!

 

Stop Smoking: How to Avoid Weight Gain Once You Quit

stop smokingNo matter which type of breast surgery you may need, we always recommend that you quit smoking to help speed healing. Many smokers, especially women, fear gaining weight when they quit. While some former smokers do gain a little weight, it is typically no more than a few pounds, and even this gain can largely be avoided with a little planning.

Know that you will be hungrier at first.

According to the Mayo Clinic, smoking reduces your appetite and may increase your metabolism, so when you quit, you’re likely to feel hungrier at first. Keep plenty of healthy snacks around, such as berries, vegetables, cheese, and nuts. The latter two are higher in calories than the others, but they will keep you full longer.

Avoid sugary or high-carbohydrate snacks, such as candy, cookies, chips, and the like. They won’t help you avoid weight gain, and they offer little to no nutritional value.

Watch what you drink.

Soda and fruit juices are loaded with sugar, and even diet soda is not a good idea when you’re trying to lose weight.  Drink water. It will help you detox from the cigarettes, help avoid water retention, and avoid weight gain.

If you don’t like the taste of your tap water, add lemon or lime juice—if you like sparkling water and add lemon and lime juice, it’s almost like drinking a soda without the calories or artificial sweeteners.

Reduce portion sizes at meals.

Eating smaller portions will help you keep your weight under control. Try cutting down your portions by one quarter. If you’re still hungry, have some vegetables or fruit for dessert. Be careful with fruit, as it is high in natural sugars.

Get up and move.

Not only will moving or exercising help you keep your weight down, but it will also help your cravings. Get outside and walk the dog, or take a dance class such as country-western dance or Zumba. You’ll burn calories and help keep your weight where you want it to be.

To keep weight gain down, monitor your weight. You don’t necessarily have to jump on the scale every day; your clothes will tell you how you’re doing. Don’t allow yourself to gain more than two or three pounds before taking action. If you’re watching what you eat and drink and getting more exercise, weight gain after quitting smoking and breast surgery will be a non-issue.

 

 

Your Question about Reconstruction Surgery and Lymph Node Transfers Answered

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

Can a one-sided microsurgical reconstruction be done in conjunction (same surgery) with lymph node transfer?

Lymph nodes can be “piggy-backed” on a DIEP flap, but our impression is that that precludes the ideal positioning of eitherthe nodes or the flap. Additionally, we have concerns that the nodes may not be as well vascularized (have as good a blood supply) that way (rather than doing them as their own separate flap), although extra small blood vessels can sometimes be hooked up to the nodes themselves.

Our preference is to just do the autogenous (your own tissue, no implant) reconstruction first, as some patients with lymphedema will improve with this alone. If they don’t improve, we’ve found that a vascularized lymph node transfer fits in very well with the second stage of the breast reconstruction. Of course, it is possible to do a DIEP or GAP with a separate vascularized lymph node transfer in one setting, but that makes a long procedure about 2 hours longer, so we haven’t pursued it.

-Dr. Richard M. Kline, Jr., MD
Center for Natural  Breast Reconstruction

Share this post with your followers on Twitter. And if you have a question for our breast surgeons, please feel free to submit them here!

Upcoming Webinar: “Is Natural Breast Reconstruction Right for Me?”

NBR WebinarWe at The Center for Natural Breast Reconstruction are excited to announce our upcoming webinar, Is Natural Breast Reconstruction Right for Me?, happening Thursday, April 12, at 7:00 p.m. Eastern / 4:00 p.m. Pacific.

Intended for anyone who has been affected by breast cancer (including those who have been recently diagnosed, those currently in treatment, those currently in remission, and family and friends of those with cancer), the no-cost webinar will provide information about women’s options for natural breast reconstruction

Unlike other types of post-mastectomy breast reconstruction, natural breast reconstruction uses tissues from a woman’s body to create natural looking and feeling breasts. The webinar will be hosted by The Center for Natural Breast Reconstruction’s Dr. James Craigie and Dr. Richard M. Kline, Jr.,MD, both of whom specialize in natural breast reconstruction surgery.

During the hour-long event, the surgeons will educate attendees about…

  • Exactly what natural breast reconstruction entails and who is eligible for this type of surgery.
  • The language and shorthand of natural breast reconstruction, defining and explaining what all the natural reconstruction acronyms (including DIEP, GAP, TUG, and SIEA) mean.
  • What patients can expect in terms of hospital stays, recovery time, and scarring.
  • How The Center for Natural Breast Reconstruction handles insurance and what types of insurance we accept.

We’ll also open the phone lines to a live Q&A session with the surgeons and our insurance specialist so attendees can get answers to all their questions related to natural breast reconstruction.

To join us for the webinar, register here.

Note: if you are busy on April 12, register today, and we’ll send you a link to the replay, which you can watch at your convenience.