Ask the Doctor: Q&A


I am interested in DIEP and live in N.C., but before I go any further, I have questions. I’m a healthy, 43-year-old female; married with children; I work, and I’m a non-smoker. I was recently diagnosed with multi-centric DCIS in my right breast. MRI enhancing revealed a left breast lesion, and a biopsy will be scheduled soon. Genetic testing came back negative. A local plastic surgery consult indicated sufficient abdominal tissue to create a breast mound. My first question — who are the breast surgeons that your office works with? Would they do a sentinel node biopsy as my surgeon has recommended? Second, could the mastectomy and DIEP occur during a single surgery? Third, do you coordinate care with my current breast surgeon? I anticipate that if the lesion on the left is also DCIS, I would opt for a lumpectomy and radiation on that side since the area is small, and do it locally with my current breast surgeon. Finally, how would I start the process of moving forward with a consult with your office for DIEP?


Hi, Kay,

Thank you for your question, I am sorry you have to go through surgery. It seems you have already gotten a lot of good information about your possible treatment and reconstruction. Our practice has specialized in breast reconstruction using natural fatty tissue and procedures such as the DIEP flap since 2002. My partner and I have performed nearly 2000 breast reconstructions using natural tissue with an overall success rate of 99%. We work with several breast surgeons who we collaborate with on every patient. We are also accustomed to patients having to travel to us from out of state and have had patients come from 48 of the 50 states. We understand the difficulties associated with what you are going through and our mission is to help people in your situation. You have some excellent questions so I will answer them in list format. 

1. Who are the breast surgeons that your office works with?

We work with multiple breast surgeons who we are familiar with and collaborate with to offer our patients the options that are best for each individual situation.  Drs. Megan Baker, Jennifer Fiorinni, and Jennifer Beatty are excellent breast surgeons who we work with. Would they do a sentinel node biopsy as my surgeon has recommended I have done? Yes, they would and frequently do prior to mastectomy to determine if radiation is needed after mastectomy.

2. Could the mastectomy and DIEP Flap occur during a single surgery?

Yes, absolutely! We feel this is very important to get the best result and to minimize the number of surgeries needed.

3.  Do you coordinate care with my current breast surgeon? I anticipate that if the lesion on the left is also DCIS that I would opt for lumpectomy and radiation on that side since it is a small area and would do that locally with my current breast surgeon.

Yes, we coordinate with our patient’s home breast surgeons. For what treatment is best we also rely on the opinion of the breast surgeon here. In your situation it may be best to consider possibly having both breasts removed and then reconstructing both at the same time with the same technique. That approach allows us to achieve better symmetry between the breasts. Sometimes after a lumpectomy and radiation, the breast can develop an abnormal shape that is not desirable and difficult — if not impossible — to match with the opposite breast. The problems might not surface until after radiation and are then nearly impossible to repair. When we use the DIEP flap, it is often available for each breast and therefore makes for a great match. We can discuss this more if you like.

4. How would I start the process of moving forward with a consult with your office for DIEP?

Just let me know if you would like to see me for a consult in person or make an appointment to talk over the phone. Most of the time, we can plan and answer questions before an actual visit in person. My staff can contact you to schedule an appointment and gather additional information.

I hope that I have answered your questions, let me know if you have other questions.

Thank you,

James Craigie, MD


What is a BRCA Test and Do I Need One?

Dear Friends,

Since our physicians and staff members are attending The Joining FORCEs 2011 Conference this weekend, we thought we’d answer a question that pertains to this event.  Hope to see some of you at the conference in Orlando this weekend.

According to the American Association for Clinical Chemistry, “In the general population, the lifetime risk of developing breast cancer is approximately 12% and the lifetime risk of developing ovarian cancer is about 1.4%. The risks increase with age.”

So how can you tell if you are at risk for breast cancer? One way is through a BRCA test.

What is a BRCA test?

There are a variety of BRCA-1 and BRCA-2 mutations present in individuals around the world, and a BRCA-1 and BRCA-2 test is used to detect various mutations in the genes. Some of these mutations are seen in individuals who have a high risk of developing breast and ovarian cancer. If you have a relative who has been diagnosed with breast or ovarian cancer, you would be a good candidate to receive a BRCA test to determine if you carry the same gene mutation. However, a BRCA test is not recommended for the general public. It is only recommended for individuals who have a close relative(s) that has been diagnosed with breast or ovarian cancer, especially before the age of 50.

It’s important to note that there are options for individuals who receive a positive result on their BRCA test and there are ways to help prevent the onset of breast or ovarian cancer. Just because someone receives a positive result on their BRCA test, doesn’t mean they will definitely develop breast or ovarian cancer. The positive result means that they are at higher risk of developing these cancers.

It’s also important to note that if an individual receives a negative result from the BRCA test, this doesn’t completely rule out the development of breast or ovarian cancer in the individual for the future. This is because the BRCA test can only detect if a person has a hereditary breast cancer or ovarian gene mutation.

If you found this post helpful and have more questions about breast cancer and testing for breast cancer, click here to contact us.


Why It’s Important to Get Out of the House and Experience Life

happy lifeIt’s been said that as you get older, you won’t regret what you’ve done, but what you haven’t done. It’s easy to stay home and hibernate, and you certainly need time alone to reflect and think, but you also need to connect—with people, with things, with places, and most important, with yourself.

Life is full of abundance and beauty, and it always has exciting adventures for you to discover. Some are as simple as hearing the tinkle of children’s laughter or watching a tulip emerge from the frost. Other experiences, such as camping in the mountains or going to a rock concert, fill all your senses with wonder and delight. Trying something new is stimulating and memorable, and it makes you feel truly alive as it enriches your life.

It’s easy to fall into the rut of staying in the house and watching TV or reading, and the thought of trying new things can be daunting. However, when you’re ready, adventure begins the moment you open your door. New experiences don’t have to be complicated or expensive. Anything you haven’t seen, heard, felt, or tasted is brand new to you. Following are ten simple and inexpensive ideas to try.

  • Take a different route when you run errands, and try a new store or dry cleaner.
  • Plan a short road trip, and discover an area of your city or county you’ve never seen.
  • Drive with some friends or family to a nearby town and park your car, get out, and explore.
  • Go window shopping.
  • Plant your favorite flowers in your yard or in a window box.
  • Call a friend and try a new coffee shop or restaurant. Splurge on food or drink you’ve never tasted before.
  • Go to the theater and watch a movie from a genre you’re not familiar with. Try a new snack while you’re there.
  • Think about attractions or landmarks your town is famous for. Have you ever seen them? If not, go.
  • Take a class in something you’ve always wanted to learn, such as a foreign language, cooking, or writing.
  • Imagine yourself doing an activity you’ve always been hesitant to try, such as riding a roller coaster or racing go-karts. Then do it.

Once you start exploring the world around you, you’ll be hooked and want more. What adventures are you ready to try?