Posts Comments

You are here: Home / Archives for The Center for Natural Breast Reconstruction

How to Eat Out without Blowing Your Healthy Eating Plan

February 13, 2012 by

Eating out doesn’t have to mean watching every morsel you put in your mouth for fear of blowing your eating plan. With just a few tweaks, you can enjoy eating out and still stick to your program.

Say no to the bread, or have just one slice with your meal.

Many restaurants bring out a big basket of bread the moment you sit down, and this bread can wreck your healthy eating plans. If you can’t say no, at least have the bread with your entrée to minimize the damage. Spread real butter on it or dip it in olive oil. If you love bread, ask for darker breads like rye instead of the typical white bread.

Ask for low-starch veggies in place of potatoes or rice.

If your meal comes with potatoes or rice, ask to substitute something else. Low-starch veggies such as green beans, spinach, or broccoli are good choices.

Enjoy plenty of salad with healthy dressing.

Ask the server about your dressing choices. Chances are you can enjoy a healthy, homemade vinaigrette or oil and vinegar. If you have access to a salad bar, don’t be afraid to load up on the greens and veggies, but go easy on the cheese, croutons, and creamy dressing.

If you must have creamy dressing, have it on the side, dip your fork in it, and then take a bite of salad. If you want creamy dressing on a house salad, ask for it on the side.

Put half in a to-go box.

Ask for a to-go box when you order, and put half your meal in it before you start eating. That way you don’t blow your diet, and you can enjoy the rest of the meal the next day. If you’d rather not take anything home, split a meal with your dining companion, or give the leftovers to a friend.

When it comes to dessert, have anything you wish—just take a few bites.

You’ve probably noticed that when you eat a rich, luscious dessert, there comes a point at which it’s too much and you’ve had enough. Why not order any dessert you want and then savor only two or three bites? Again, you can share or take the rest home.

What’s your favorite tip for healthy eating out?

Filed Under: Health and Wellness Tagged With: , , , , , ,

Your Most Frequently Submitted Ask the Doctor Questions Answered

February 10, 2012 by

ask the doctorWe at The Center for Natural Breast Reconstruction look forward to answering your questions each Friday.  We have decided to bring back our most frequently asked questions and once again share the answers with you. The questions below were answered by the team at The Center for Natural Breast Reconstruction.

I’d like to have a mastectomy to reduce my risk of breast cancer.  Will my insurance company pay for it?

Most insurance companies do have criteria under which they will consider a prophylactic mastectomy medically necessary—as a reminder, if they pay for your mastectomy they must also cover a reconstructive procedure of your choice. There are always exceptions to this rule, as outlined in WHCRA 1998, but this law does protect the majority of women insured in the United States.

I’ll highlight some of the actual criteria obtained from medical policy documents from some of the nation’s largest insurers. This is a pretty comprehensive list but it’s always a good idea to consult your plan’s medical policy documents to determine their specific coverage criteria prior to undergoing any medical / surgical procedure.

“BIG INSURANCE CO #1” covers prophylactic mastectomy as medically necessary for the treatment of individuals at high risk of developing breast cancer when any ONE of the following criteria is met:

Individuals with a personal history of cancer as noted below:

Individuals with a personal history of breast cancer when any ONE of the following criteria is met:

  • Diagnosed at age 45 or younger, regardless of family history.
  • Diagnosed at age 50 or younger and EITHER of the following:
    • At least one close blood relative with breast cancer at age 50 or younger.
    • At least one close blood relative with epithelial ovarian, fallopian tube, or primary peritoneal cancer.
  • Diagnosed with two breast primaries (includes bilateral disease or cases where there are two or more clearly separate ipsilateral primary tumors) when the first breast cancer diagnosis occurred prior to age 50.
  • Diagnosed at any age and there are at least two close blood relatives* with breast cancer or epithelial ovarian, fallopian tube, or primary peritoneal cancer diagnosed at any age.
  • Personal history of epithelial ovarian, fallopian tube, or primary peritoneal cancer.
  • Close male blood relative with breast cancer.
  • An individual of ethnicity associated with higher mutation frequency (e.g., founder populations of Ashkenazi Jewish, Icelandic, Swedish, Hungarian, or Dutch).
  • Development of invasive lobular or ductal carcinoma in the contralateral breast after electing surveillance for lobular carcinoma in situ of the ipsilateral breast.
  • Lobular carcinoma in situ confirmed on biopsy.
  • Lobular carcinoma in situ in the contralateral breast.
  • Diffuse indeterminate microcalcifications or dense tissue in the contralateral breast that is difficult to evaluate mammographically and clinically.
  • A large and / or ptotic, dense, disproportionately-sized contralateral breast that is difficult to reasonably match the ipsilateral cancerous breast treated with mastectomy and reconstruction.
  • Personal history of epithelial ovarian, fallopian tube, or primary peritoneal cancer.
  • Personal history of male breast cancer.

Individuals with no personal history of breast or epithelial ovarian cancer when any ONE of the following is met:

  • Known breast risk cancer antigen (BRCA1 or BRCA2), p53, or PTEN mutation confirmed by genetic testing.
  • Close blood relative with a known BRCA1, BRCA2, p53, or PTEN mutation.
  • First- or second-degree blood relative meeting any of the above criteria for individuals with a personal history of cancer.
  • Third-degree blood relative with two or more close blood relatives with breast and / or ovarian cancer (with at least one close blood relative with breast cancer prior to age 50).
  • History of treatment with thoracic radiation.
  • Atypical ductal or lobular hyperplasia, especially if combined with a family history of breast cancer.
  • Dense, fibronodular breasts that are mammographically or clinically difficult to evaluate, several prior breast biopsies for clinical and / or mammographic abnormalities, and strong concern about breast cancer risk.

Who is a close blood  relative? A close blood relative / close family member includes first- , second-, and third-degree relatives.

A first-degree relative is defined as a blood relative with whom an individual shares approximately 50% of his / her genes, including the individual’s parents, full siblings, and children.

A second-degree relative is defined as a blood relative with whom an individual shares approximately 25% of his / her genes, including the individual’s grandparents, grandchildren, aunts, uncles, nephews, nieces, and half-siblings.

A third-degree relative is defined as a blood relative with whom an individual shares approximately 12.5% of his / her genes, including the individual’s great-grandparents and first-cousins.

GET IT IN WRITING: Some of the above criteria may sound like Greek to most of us.  Ultimately the key to finding out if your insurance will consider prophylactic mastectomy in your individual case lies in the hands of yourphysician and you. A comprehensive set of medical records clearly outlining your particular risk along with a request made to your insurance company for written pre-authorization or pre-determination of benefits is the best thing to do to assure if your insurance company will consider your procedure medically necessary.

What are some criteria that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

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

Breast reconstruction cannot be performed until 6 months after a patients’ final radiation treatment. However, chemotherapy varies. Some women have mastectomy & reconstruction immediately and do not start chemotherapy until after that is completed. Some women have to do chemotherapy first and then have mastectomy & 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.

We enjoy answering and educating women on their options for breast reconstruction. If you have a question you would like answered, we’d love to hear from you!

 



 



 

Filed Under: Ask the Doctor Tagged With: , , , , ,

The Perfect Rainy Day in Charleston: What to Do for Fun

February 8, 2012 by

Charleston is one of those places that has so much to do and see that you can have fun even on a rainy day. From the South Carolina Aquarium to the Charleston City Market, here are our favorite dreary day activities.

South Carolina Aquarium

With a daily dive show and exhibits galore, the South Carolina Aquarium is the perfect rainy day activity for all ages. The exhibits take you from the mountains to the sea, and the first one you’ll see, the mountain forest exhibit, features majestic eagles and playful otters frolicking in the hilly forest. You’ll see the flora and fauna in the piedmont, coastal plain, and salt marsh areas before you hit the coast and ocean to have close encounters with sharks and pufferfish.

The Touch Tank allows you to see and touch water creatures such as stingrays and sea urchins. In February, the Aquarium will hold a birdhouse building workshop and a Love under the Sea Valentine’s Day dinner.

Tour the Yorktown

The focal point of the Patriots Point Naval and Maritime Museum is the World War II aircraft carrier USS Yorktown. The museum is home to a fleet of National Historic Landmark ships and the Cold War Memorial. Patriots Point also houses the Congressional Medal of Honor Society and Medal of Honor Museum.

Aboard the Yorktown, you can tour the flight deck and bridge, living quarters, brig, and engine room. The Charleston Navy Shipyard Museum and Medal of Honor Museum are on board, and individual memorials are scattered around the ship. The hangar bay holds vintage aircraft, and if you’d like to try flying yourself, you’ll want to try the flight simulator.

Kiln Time

If you’re artistically inclined and would like to paint your own pottery—or your kids would—Kiln Time is a great way to spend a rainy afternoon. You’ll find a large collection of pottery that you can decorate or paint, and then Kiln Time will fire them and have them ready in just a few days. What a fun way to spend some family time!

Historical Charleston City Market

The Charleston City Market has been part of Charleston’s history for over two centuries. The majestic Market Hall building houses the Daughters of the Confederacy museum. Grab your umbrella and head to this amazing open-air market that sells everything from jewelry to food to sweetgrass baskets. With over 100 vendors, the market has something for everyone, and is the perfect place to have a coffee and watch people. Take a carriage ride, relax, and enjoy Charleston.

Do you have any suggestions for a perfect way to spend a rainy day in Charleston?

 

 

Filed Under: All Things Charleston Tagged With: , , , , , , ,

What is a Breast MRI and How is it Done?

February 3, 2012 by

Unlike a mammogram, which uses x-rays to create images of the breast, breast MRI uses magnets and radio waves to produce detailed 3-dimensional images of the breast tissue. Before the test, you may need to have a contrast solution (dye) injected into your arm through an intravenous line. The solution will help any potentially cancerous breast tissue show up more clearly.

Cancers need to increase their blood supply in order to grow. On a breast MRI, the contrast tends to become more concentrated in areas of cancer growth, showing up as white areas on an otherwise dark background. This helps the radiologist determine which areas could possibly be cancerous. More tests may be needed after breast MRI to confirm whether or not any suspicious areas are actually cancer.

For the breast MRI, you lie on your stomach on a padded platform with cushioned openings for your breasts. Each opening is surrounded by a breast coil, which is a signal receiver that works with the MRI unit to create the images. The platform then slides into the center of the tube-shaped MRI machine. You won’t feel the magnetic field and radio waves around you, but you will hear a loud thumping sound. You will need to be very still during the test, which takes around 30 to 45 minutes.

Because the technology uses strong magnets, it is essential that you remove anything metal — jewelry, snaps, belts, earrings, zippers, etc. — before the test. The technologist also will ask you if you have any metal implanted in your body, such as a pacemaker or artificial joint.

Where to have breast MRI?

It’s important to have breast MRI done at a facility with:

  • MRI equipment designed specifically for imaging the breasts. Not all imaging centers have this; instead, many have MRIs used for scanning the head, chest, or abdomen.
  • The ability to perform MRI-guided breast biopsy. If the breast MRI reveals an abnormality, you’ll want to have an MRI-guided breast biopsy (a procedure to remove any suspicious tissue for examination) right away. Otherwise, you’ll need to have a breast MRI again at another facility that offers an immediate MRI-guided breast biopsy.

See the MRI at The Charleston Breast Center Below

 

Filed Under: Ask the Doctor Tagged With: , , , , , ,

How to Enhance Your Mood with Environmental Changes

January 30, 2012 by

Your mood is linked with your surroundings, and a change in your environment can make a tremendous difference in your feelings. To calm or enhance your mood, try some of these simple modifications to your environment.

Soothing colors.

Color has an amazing ability to affect mood. We know someone whose employer painted the office walls a deep reddish-burgundy color. She said it was far from calming; in fact, she noticed a difference in her stress levels compared with the previous color, which was pale lavender. The color also hurt her eyes until she was used to it. Soothing colors, such as pale blue and green, improve your mood and reduce stress. Think of how calm you are in nature and the colors you see.

You don’t have to repaint your home—adding splashes of soothing colors can be very helpful. For example, buy some blue pillows or green curtains, or find an art print of a relaxing scene. Bright artwork can cheer you up not only by its colors, but also by its design. If you work from home, perhaps a blue mouse or purple post-its will help your mood.

Relaxing music.

Sound affects us to our core, and our moods reflect the vibration of the music. If you don’t care for a particular type of music, your mood will change for the worse if you hear it, and then if you hear music you love, your mood will improve—and both changes happen very quickly.

To relax and soothe yourself, try listening to yoga music or to an instrumental radio or satellite TV station. Classical music can be intense for some, yet soothing for others.

Living things.

Watching living things move and grow is incredibly soothing and relaxing. If you don’t have a pet, perhaps now is the time to adopt one. Stroking a cat or a dog reduces blood pressure and increases endorphins. Watching fish is so relaxing that you may find yourself mesmerized.

If you’d rather not have a pet, surround yourself with live plants. Not only will they clean the air in your home, but they’ll also give you a touch of nature and a splash of color. Good choices are ferns, bamboo palms, spider plants, and African violets.

How do you create a soothing environment?

 

 

 

 

Filed Under: Health and Wellness Tagged With: , , , , , , ,

Your Questions about DIEP Flap Breast Reconstruction Answered

January 27, 2012 by

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

What are the most common reasons a diep flap will fail?

Specifics may vary from case to case and practice to practice, but all failures involve interruption of the blood supply. This can be caused from a clot forming at the arterial or venous anastomosis, or from a conformational change in the blood vessel which produces “kinking” and subsequent interruption of blood supply. Most surgical teams experience dramatically lower failure rates as their experience expands, and it can get very difficult to determine precise reasons for failure (and ways to prevent it) when failure is a very rare event, i.e., success rates of 98-99%, which is typical for experienced surgeons. The best teams will nonetheless strive, whenever they have a failure, to find some “take home message” which they can use to hopefully further minimize their failure rate.

If you had a failure with Diep on one side does that increase your chances of failing again if another flap procedure were done in the future?

In our experience, no, although in a large enough series it may. We have always been able to use the internal mammary vessels, supplied through collaterals, to successfully supply blood to a second flap after an initial flap failed. Generally speaking, the collateral supply to the internal mammary from one intercostal artery is probably sufficient to supply a new flap. I do think that it is advisable, however, to wait at least 3 months following an initial flap failure before attempting a second flap, as this gives time for tissue edema to resolve, and serum protein levels to return to normal.

My Diep Flap failed on one side. I wound up with a silicone implant on the right side, and it is not healing quickly. What should I be watching for ?

That depends on what you mean by “not healing quickly.” If you have an unhealed wound, then something is really wrong, and you should see your surgeon. If it simply hurts or “doesn’t feel right,” then it may improve with time, or you may be developing capsular contracture (a common problem with implants), which may not go away. If you still want a flap, you may well still be able to have one from your buttock or elsewhere.

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



 

Filed Under: Ask the Doctor Tagged With: , , , , , ,

5 Ways to Reduce Sudden Anxiety

January 25, 2012 by

Sudden anxiety can be frightening and challenging to deal with, and if you’ve ever had it happen, it’s something you hope never to repeat. Following are five ways to deal with a moment of sudden anxiety.

Don’t squelch the first twinges of anxiety, but try to identify their source.

If you feel severe or sudden anxiety begin, you’ll be tempted to ignore the feelings and keep doing what you’re doing. Don’t try to ignore or resist the feelings, but step into them. The moment the anxiety begins, ask yourself what’s happening, and see if you can identify what’s causing the sudden anxiety. If you can, fix the immediate problem; if not, get away from what you’re doing and find a quiet place until the anxiety goes away.

The sooner you can identify and remedy the immediate problem, the faster the anxiety will fade.

Breathe.

Many people tend to hold their breath when they have sudden anxiety, which makes the problem worse. Take a deep, cleansing breath in through your nose—you should feel your abdomen expand—and blow it out forcefully and completely through the mouth. Keep on deep breathing, and you’ll feel your anxiety lessen.

Let the anxiety wash over you.

If the first twinges develop into a full-blown bout of anxiety, let it happen. When you can accept the anxiety, it will go away much faster than if you try to fight it. Think of it as a rush of water that will envelop you for a moment and then fade away.

Don’t leap to conclusions.

Often, people having sudden anxiety let their minds wander and imagine all kinds of possible scenarios. They may think about someone dying, or losing everything they have, which of course increases the anxiety. Clear your mind, as much as you can, and don’t let your thoughts move to places or circumstances that frighten you.

Remember that it’s not forever.

Anxiety passes on its own, but you need to make sure you don’t cause yourself greater harm. Relax as much as you can. That is easier said than done, and if you have frequent anxiety, practicing these steps will become second nature over time.

Do you have any tips for dealing with sudden anxiety?

 

Filed Under: Health and Wellness Tagged With: , , , , , , ,

3 Trending Gym Classes that Will Get You Excited and Toned

January 23, 2012 by

If you enjoy getting out of the house to exercise, you may want to try one of these trendy gym classes.

Zumba

Created by Beto Perez of Colombia, Zumba is a high-energy dance program that gives you amazing fitness benefits. One day, Beto forgot the music for an aerobics class he was teaching, so he improvised with his own music—and Zumba was born. Today, you can choose from Zumba dance, Zumba toning, Zumbatomic for kids, Zumba in the Circuit, and Aqua Zumba classes. You can also purchase DVDs and dance at home.

Exhilarating and fun, Zumba burns hundreds of calories an hour, tones and tightens the body, and makes you feel like you’re at a party.

Pure Barre

Pure Barre’s website claims it to be the fastest, most effective way to change the shape of your body by using small isometric movements while standing at the ballet barre. Pure Barre clients typically see results within a few weeks.

Dancer and choreographer Carrie Rezabek Dorr created Pure Barre 10 years ago to help women and men achieve a strong, lean body. The Pure Barre technique does not involve any high-impact jumping and requires intense focus to do properly, much as yoga and meditation do. The exercises work the abdominals and lower body. Classes are small, and the exercises move along swiftly, driven by the music.

Spinning

The ideal way for bicyclists to stay in shape in the off-season, spinning is indoor cycling that anyone can do. It’s adaptable to every level of fitness and experience. Most spinners burn about 500 calories per class, and spinning differs from simply riding an indoor bike in the energy and enthusiasm of the instructor, the support from the group, and the motivating music.

According to the website, spinning has five core movements. Seated flat builds your stamina, seated climb works your lower body, and standing flat helps improve core strength.  The standing climb defines leg muscles, and jumps help you become more coordinated.

Have you tried any of these gym workouts?

 

 

Filed Under: Health and Wellness Tagged With: , , , , , , ,

Having a Positive Outlook on Life Before, During, & After Breast Cancer: Interview with Leslie Haywood

July 27, 2011 by
Leslie Haywood

Leslie Haywood

We are SO excited to share with you Part II of our interview with Leslie Haywood, creator of Grill Charms™. For those of you who have not yet read Part I of this interview, Leslie shared her story as a breast cancer survivor and explained how she started a successful company while undergoing treatments.

We absolutely love how Leslie can be so inspirational and funny at the same time!

If you missed Part I of this interview, click here.

See below for Part II of our exclusive and highly inspirational (not to mention, hilarious!) interview with Leslie Haywood:

1. Your first Grill Charms™ sale was somewhat unexpected! Tell us where you were and how you sold your first Grill Charms™.

Oh yes! My most memorable sale to date! I was in the office for my final “procedure,” if you will. I was in The Center for Natural Breast Reconstruction office for my nice pinkish brown tattoo. As you can imagine, I have known all the folks at Dr. Craigie’s office  for over a year by then (and  pretty intimately I must say), so in an effort to help me think about anything other than what she was doing, the nurse asked about how my brand new business was going. Her distraction technique worked! I instantly forgot the discomfort and gave her the complete rundown of Grill Charms™, ending with: “I have a set to show you in my purse over there!”

By the time the nurse was done waving her buzzing magic wand all over my reconstructed girl parts, she said “I need 5!”  I immediately jumped off the table (still half dressed), showed her the set out of my purse, and right then and there, with my cell phone calculator (yep, still topless) I totaled up everything plus tax and she wrote the check on the spot. After our business transaction was done, she helped me with the bandage / pad etc. and I put my clothes back on. I can’t imagine any other sale being quite as “interesting” as this one. Obviously I’m not opposed to be doing business topless, but thankfully I have not had to resort to that since!

 

Grill Charms pink collection

Grill Charms Pink Collection

5. How did you decide which type of breast reconstruction surgery you wanted?

Because of my family history, I feel like I was at an “advantage” (if you can call it that!). I have had YEARS to consider and decide how I would handle a breast cancer diagnosis. Back when my mother had her treatment and reconstruction, there were very few options and she pretty much did what she was told (mastectomy and implant).

I saw what 20 years had done to her reconstruction and had always wanted better for myself. I didn’t like the idea of an implant being in me for all eternity and also knew that I wanted “symmetry” for the rest of my life, so both boobs would HAVE TO GO! The fact that my “baby pooch” would be used to make my new breasts and the fact that I’d have the stomach I used to have in my 20’s, was a BONUS!

Oh, another little story about the surgery (**For those of you who know me, you know I’m the queen of TMI, so you’ll have to excuse my “frankness” when it comes to what some might view as sensitive topics. I apologize if my candor and tone offends anyone.).  Okay… so when the decision was made and we knew that “natural breast reconstruction” was the way to go, and that “belly fat” was where my new breasts were going to come from, I talked to my husband about “size.”  He said “porn star, please” and I said “NO WAY,” but I did want something to show off.  I really wanted to make sure that Dr. Craigie had enough “material” to work with, so I went on an 8-week eating FRENZY!

My family would watch me getting 2nds and 3rds of my favorite food, STEAK! They’d say “Leslie . . . slow down there girl!” and my reply was always the same, “Shut up! I’M MAKING BOOBIES!” For those 8 weeks, food and I had a magical relationship! Ahhh…. I miss those days!

Now what I DID NOT take into account with natural breast reconstruction was how my breasts would look after the surgery. With my tummy flat and my new natural breasts a fabulous B+ maybe C, I wanted do right by my “second chance” and  eat right and exercise to keep it. I have never been more fit in all my life! BUT, because the new breasts are “all natural,” when I started to lose all that “boobie making weight” and toned everything up, my new breasts acted exactly like my old ones. There was a little shrinkage factor! So now I’m more like an A+ to a B-, but I have never been happier with my body and I have never been more in shape in my entire life! Just look how awesome they are! THANKS Dr. Baron for saving my life and thanks Dr.Craigie for making me look and feel better than ever!

6. What would you tell women who have had a mastectomy or are planning on undergoing one about natural breast reconstruction?

You owe it to yourself to at least learn about natural breast reconstruction and fully understand this option. Knowledge is power and you will never regret finding out about what you don’t know. There has not been a single SECOND that I wish that I had done things any differently. Natural breast reconstruction was the absolute best option for me, NO QUESTION!

About Leslie Haywood and Grill Charms™:

Leslie Haywood is founder and President of Charmed Life Products, LLC, and inventor of Grill Charms™. Leslie was a stay-at-home mom when a very spicy light bulb moment thrust her into the entrepreneurial ring. During the start up phase of her company, she was diagnosed with breast cancer, but still managed to launch her product on store shelves within 18 months and is now sold in over 400 stores internationally. She has been featured numerous times on CNBC, various local and regional news programs, as well as ABC’s prime time reality TV show Shark Tank seasons I and II. Her story and product have publicized in such magazines as Everyday with Rachael Ray, Parenting magazine, Health magazine, Inventors Digest, and was also featured on The Today Show. All the while she is mindful of “the cause,” whether it’s giving back through “The Pink Collection” of her gift and grilling accessory Grill Charms™, or her work as Honorary Chair for The Race for the Cure .

Leslie’s Special Offer:

***Put “natural” in the coupon code of www.grillcharms.com for 10% off!***

If you loved this post as much as we did, share it with your friends on Facebook.

Filed Under: In Her Words Tagged With: , , , , , , , , ,

Is a DIEP Flap Reconstruction Right for You?

April 8, 2011 by

 

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

My plastic surgeon told me that I did not have enough excess tissue in my abdomen to have a DIEP. What can I do now?

That’s a common question, thanks for asking. Many women wonder themselves if they actually have enough tissue for DIEP flap reconstruction, and others are told by their plastic surgeon that they do not. When assessing whether or not a patient’s abdomen can meet their reconstructive needs, several factors need to be taken into account.

First, are we talking about reconstructing one breast, or both breasts? Obviously, reconstructing both breasts takes twice as much tissue as reconstructing one breast. When only one breast is needed, it is possible to use both sides of the abdomen to reconstruct just one breast. This is called a “stacked flap,” which utilizes both sides of the abdomen, with two separate blood supplies, to make just one breast. We routinely do this procedure for patients who just need one breast reconstruction, but require both sides of their abdomen to get the size breast that they desire. It’s more complicated than connecting just one blood supply, but our practice has performed this operation well over a hundred times, with excellent success. In fact, we believe that stacked flaps may be less susceptible to fat necrosis (a complication of DIEP flaps where some of the fat, usually on the edge, dies and gets hard) than ordinary DIEP flaps.

Second, in trying to answer this question, the patient’s desired breast size must be taken into account. A patient who wants both breasts reconstructed to size “D,” but who does not have enough abdominal tissue to make a” D” size breast on each side, might have adequate tissue to make a “B” sized breast on each side. In this situation, if “B” sized breasts would not be acceptable to the patient, then we would usually recommend using the buttocks (a GAP flap) as the donor site.

Use of the buttocks for breast reconstruction, particularly for reconstructing both breasts at the same surgery, is significantly more complicated than using the DIEP flap. Fortunately, we have extensive experience with this procedure, having performed it several hundred times with a 99% success rate. If a patient did not wish to use their buttocks as the donor site, then they would still have the option of accepting a smaller breast size from the abdomen, or they may possibly decide to use implants, foregoing autologous reconstruction altogether.

Finally, for the patient who is told by their surgeon that they do not have enough tissue for a DIEP flap, it is worth noting that it can be extremely difficult for a surgeon who does not routinely perform DIEP flaps to properly assess the amount of donor tissue a patient has available in her abdomen. The thickness of the subcutaneous fat, which is the thickness that can be “pinched” between the skin and the muscle of the abdominal wall, is of paramount importance in assessing how large a breast can be made from the DIEP flap.

In addition, the maximum height of the flap also plays a role in determining what size breast can be made. In assessing how “high” a flap can be safely harvested from the abdomen, it is important to look at how much loose skin is present between the belly button and the bottom of the ribs.  If there is a lot of loose skin in this area, then it will stretch downward more easily to close the lower abdominal wound after harvest of the flap, thus allowing for a larger flap to be obtained. Again, precise assessment of the availability of abdominal donor tissue requires a significant amount of experience on the part of the surgeon, and is ideally performed while examining the patient in person, as opposed to simply looking at photographs.

In closing, to determine if a patient has “enough tissue for a DIEP flap,” we must ask these questions:

  • Are we reconstructing one or both breasts?
  • What size breast are we attempting to reconstruct?
  • What is an experienced surgeon’s assessment of how much tissue can be removed from the abdomen?

Only by taking all of the above into account can a meaningful answer to the question be obtained. We believe that effective communication between the patient and the reconstructive team, in this situation and in most others, is often the key to a successful and happy outcome.

—Richard M. Kline, Jr., M.D.

Filed Under: Ask the Doctor Tagged With: , , , , , , ,
« Previous Page
Next Page »