Don’t be Haunted, Be Proactive!

While we associate breast cancer with pink and ribbons, it is far from pretty. It’s more like a Haunted House. Some of my friends and family members have been unexpectedly shoved all the way into the darkest Haunted House you can imagine. And even with support, the hallways and rooms are very lonely, grim and scary. It’s a nightmare that’s incredibly emotional and physically taxing on the body and mind. With having the knowledge that I was BRCA2+ carrying a risk of 60-80% chance of ovarian, breast, melanoma and pancreatic cancer I only had to stand in the foyer of that Haunted House and was given the chance to not go any further. My situation was not if but when. Once I was diagnosed with Melanoma, I then made the decision to be have  prophylactic surgeries: a full hysterectomy, bilateral mastectomy and DIEP Flap breast reconstruction (with multiple revisions). In all, I’ve had 8 surgeries in the past 24 months with the last one being 4 weeks ago. It has not been an easy journey. I have experienced setbacks, but I have absolutely no regrets. I have an amazing medical team who has taken me apart and put me back together again! I also could not have done this without my incredible support team who has helped me through the good, bad and ugly. I ultimately knew it was all worth it when I heard my breast surgeon say “you now only have a 2-5% risk of breast and ovarian cancer.” I had the chance at prophylactic surgeries, but many are not given that choice. I tell everyone these personal details not to get sympathy or accolades, but to urge you to get tested for BRCA and other heredity cancers if there is a history of cancer in your family. For reliable testing, visit a genetic counselor or order an at-home test at It’s a simple saliva test that could prevent you from having to unwillingly navigate the gruesome halls of a Haunted House far far away from the world of pink ribbons. My dad was my carrier and he gave me this amazing knowledge before he passed away and now I am making it my mission to encourage others to get tested and to take charge. Fight cancer before it fights you! Be vigilant! There are many resources and options out there to help you find the best path for you.

-J. Gibbons


Will My Insurance Company Pay for a Mastectomy to Reduce My Risk of Breast Cancer?

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


Ask the Doctor- I’ve Completed Radiation. When Is The Right Time To Make A Consultation Appointment To See If I Can Have DIEP Flap Reconstruction?

This week, James E. Craigie MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I had a right mastectomy December 8, 2016, and radiation ended March 2017. Currently, I’m having problems with fluid buildup because the skin cells haven’t healed enough to absorb bodily fluids. When should I set an appointment to see if I can have the DIEP flap reconstruction?

Answer: Thank you for your question. No need to wait for a consult. I could see you anytime. Usually, we wait 3 months after completion of radiation before start DIEP breast reconstruction. Every situation is different. If it is convenient to come for a consult I could evaluate your progress and readiness to proceed. Just let me know if you would like my office to contact you about an appointment.
Thanks again!

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

Ask the Doctor- Can You Do Repair and Nipple Reconstruction Surgery at the Same Time on the Same Breast?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I had hybrid DIEP reconstruction at another facility, and I am disappointed with the results. There have been many issues. For example, my breasts are different shapes and sizes, no node involvement and no microinvasion. The surgeon who did the mastectomy said the path report said the margins were not wide enough and he will need to cut additional skin out during the next surgery. The next surgery is supposed to be to reconstruct the nipple. Can you do both procedures on the same breast at the same time? Please Help!!

Answer: I’m sorry you are having to go through this.

Did you have a complete mastectomy on the left breast or a lumpectomy? If your margins were positive (unbeknownst at the time of surgery, obviously), and you had an immediate DIEP flap, that could be a little complicated to resolve, although I’m sure we could work through it. Given that your scenario is a little bit unusual, it would probably be best if we talked by phone. Please let us know what works for you.

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

Ask The Doctor-Am I a Candidate for the DIEP procedure?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I am interested in the DIEP procedure after my mastectomy 2+ years ago, but wonder if I am a candidate. Would you accept pictures to review, before I would invest in a trip of that distance?

Answer: Thank you for your question. If you are healthy and recovered well from your mastectomies then chances are you could safely have breast reconstruction using your own natural fatty tissue. If you feel that you have extra tummy tissue and would benefit from a tummy tuck approach then the DIEP could be a very good option. The DIEP procedure uses the fatty tissue and skin of the lower tummy. We specialize in breast reconstruction using natural fatty tissue. If a patient does not have enough tummy fat, has already had a tummy tuck or if previous surgery makes the tummy unavailable, then we can still use another area of the body to get natural tissue for breast reconstruction.

We frequently evaluate patients from out of town by looking at photos and getting the important information from them. I can definitely let you know what option would be best for you without having to see you in person. If you want to come for a consult that would be great but we understand that may not be feasible when traveling from a distance.

When patients do travel from out of town we make arrangements in advance and if they are having surgery then I see them in person the day before surgery. I would be glad to have my office staff contact you to let you know how to do the photos. Just let me know. Thanks again for your interest.

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

Ask The Doctor – My reconstructed breasts are not well proportioned, can you help?

<alt=breast reconstruction"/>This week, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I had a DIEP done at the same time of my mastectomy a few years back. My incisions opened up around both breasts one week after surgery. After about 3 months of my doctor telling me to put Vaseline on them and keep the areas covered, they became very infected. I then got a second opinion.

The next doctor had me on the operating table the next day and probably did a dozen surgeries on me over the next year to get me healed because I was so infected from being open for so long. I’m scared about this, and I’m very self-conscious about my breasts. One of my breasts was set lower on my chest than the other, making wearing bras difficult. The same breast that is positioned lower on my chest is also larger. It is impossible to wear bathing suits comfortably, too. I have to watch how tops are cut on me because they will show that my breasts are uneven. Is there anything your doctors can do to help with this?

ANSWER:  I’m terribly sorry about all the trouble you’ve had – it sounds like a real nightmare. I can’t, of course, guarantee you that we can make you good as new, but I strongly suspect that we can help, as we’ve seen plenty of other patients with similar stories. Probably the best place to start would be to have one of us call you to discuss your situation further, if that’s OK. It would be very helpful if we had some pictures to look at at the time of the conversation, but that’s not essential at this stage. I also suspect you will ultimately benefit from having an MRI at some point, as this is the best way to look for dead fat or other potential problems. Hang in there, no need to lose hope at this point.

— Richard M. Kline, Jr., M.D.    

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

Ask the Doctor: Lymphedema and Lymph Node Transfer

<alt="3 pink roses"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I’ve had breast cancer and developed lymphedema after my mastectomy.  I recently heard about Lymph Node Transfer surgery.  Does it work?  I’m scheduled for a DIEP breast reconstruction, can it be done at the same time?

ANSWER: Lymphedema is a very difficult problem that results when a patient has had breast cancer and has to undergo surgical removal of the lymph nodes under the arm as part of their surgical treatment for breast cancer. There are other causes of lymphedema but our specific interest has been in patients who have had breast cancer.

Lymphedema can be a very debilitating process; it remains a terrible problem worldwide, for all types of reasons. There is still much to be learned about why some people develop lymphedema and others do not. It appears that lymphedema is directly related to several factors in our breast cancer patients. It is directly related to having the lymph nodes removed from under the arm and seems to develop from the scarring that occurs under the arm following mastectomy and / or axillary dissection.

Undergoing radiation of the arm or axilla increases this risk. However, there are many people who undergo removal of the lymph nodes and radiation that do not develop lymphedema. There are also people who have mastectomy, have lymph nodes removed followed by radiation, and don’t develop lymphedema until many years after their surgery. That is the main reason that patients are warned to pay particular attention to their arm if they have had removal of any lymph nodes.

It is also possible that someone could get lymphedema even after simply having a sentinel node removed. A sentinel node procedure (lymphadenectomy) is a way to examine the lymph node without having to remove more than one or two. The whole idea of examining only the sentinel node is to lower the risk for lymphedema, but even with the sentinel node procedure, there is still a chance of developing lymphedema. Our practice became interested in options to help breast cancer patients with lymphedema as we see many who are suffering from the symptoms of this process while undergoing breast reconstruction.

Our practice specializes in microsurgical free flap breast reconstruction utilizing skin, underlying tissue, and microscopic blood vessels that transport life-giving blood to the reconstructed breast. This procedure is commonly referred to as the DIEP if using the abdomen or a GAP if using the buttock tissue. The muscles of the abdominal wall are left intact as it is the removal of the muscles of the abdominal wall that can lead to problems in the donor area, like hernias and bulging, as well as a more involved extended recovery. The lower tummy wall is the most common area that we transfer and it’s also an area where lymph nodes are present. Therefore, over the first decade this surgery was being done, we would encounter lymph nodes in the area of the blood vessels, as well as fatty tissue.

It became obvious that we could transfer lymph nodes on the blood vessels as we refine our technique for microsurgery. Due to the lack of effective treatment for lymphedema, for years surgeons doing perforator flaps have taken on this challenge and are trying to come up with ideas and techniques to treat it. We began doing an extensive amount of research, spanning the globe, looking for information on procedures that may help these patients. In 2005, we formed a group known as the Group for the Advancement of Breast Reconstruction, known as GABRs, and we included members throughout the world who had had a unique experience with our type of breast reconstruction.

We encountered one individual who had 15-years of experience with what is now known as “vascularized lymph node transfer” for the treatment of lymphedema. Initially, Dr. Robert Allen had attempted lymph node transfer during breast reconstruction and the biggest concern was how to transfer lymph nodes from one area of the body to treat lymphedema but not to create lymphedema in the donor area. In 2006, the GABRs met in Beijing, China and invited Corrine Becker, a surgeon from France who had a long history of experience with vascularized lymph node transfer.

She presented her work and through communication and travel to Paris to work with her, members of the GABRs group began to gain experience and learn more of her technique. The biggest hurdle that we were able to overcome was learning how to select the lymph nodes that could be removed as the donor lymph nodes and use those for breast reconstruction without causing lymphedema of the leg. We spent an extensive amount of time discussing her techniques and reviewing her results, as well as her publications.

We then made arrangements for her to travel to South Carolina and actually performed surgery on our own patients with her as an assistant surgeon. Since that time we have been very encouraged by the results with vascularized lymph node transfer as an effective treatment for reduction of the symptoms of lymphedema. We feel very excited but yet are very cautious about all results. It is important that patients realize that this procedure is still evolving and that there are risks involved, but to date we have had very good results and no serious complications.

Improvement of symptoms with vascularized lymph node transfer can occur immediately; however, they also may take up to 2 years to be appreciated. In most of our patients, the indicators of success are different. For the majority, the goal was to improve the edema, lessen the need to wear compression garments on a regular basis, and to eliminate the risk for frequent infections, which are the typical problems that those affected by lymphedema experience.

In order to lower the risk for complications and to closely study our results in conjunction with other colleagues who perform this procedure, we prefer to perform vascularized lymph node transfer as an isolated procedure. It can be done at the time of breast reconstruction; however, there is a chance that some people with mild lymphedema who undergo breast reconstruction may have improvement without lymph node transfer. Therefore, in order to closely study our results, we perform the breast reconstruction first followed by vascularized lymph node transfer as the second step. When the results are complete, we can determine whether it was the reconstruction or the transferred lymph nodes that gave the end result. It is important again to reemphasize that the main risk for of the surgery is that the transfer may not work. It is possible that if the transfer did not work resulting in more scar, the lymphedema could worsen.

Thankfully, to date, we have not experienced this complication. Other complications are damage to the blood vessels under the arm or the nerves under the arm. Therefore, our preference is to have an oncologic surgeon, who performs axillary dissection, release the scar under arm.  At the same surgical setting, after the scar is released, we perform the transfer by removing very specialized lymph nodes from the outer and lower abdominal wall or outer upper leg. We preserve the lymph nodes of the inside leg. These are the ones that drain the lower extremity and therefore, we feel that the risk for lymphedema of the donor area is reduced.

At this point, we have received some very exciting results along with some mixed results and continue to follow our patients very closely. We have had no patients with any serious complications and no patients at this point with lymphedema of the donor site. We are hopeful that the future holds vascularized lymph node transfer as an effective option for people with lymphedema following breast cancer surgery.

We plan to continue to devote and focus our energies on a surgical solution while simultaneously not exposing people to excess risk of additional problems. Once again, we do have to admit that the surgery, although giving some promising results, is  still evolving at this point and we choose to proceed with caution in the best interest of our patients.

— James Craigie, M.D.

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

Ask The Doctor: I’m looking for a surgeon that performs DIEP procedures.

<alt="pink roses"/>This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your question.

QUESTION: I was diagnosed with lobular carcinoma in situ breast cancer and am looking for a surgeon that does DIEP, sensory nerve reconstruction, and vascular lymph node transfer. Does your team perform these procedures?

ANSWER: We have been specializing in the procedures you asked about since 2002. If you would like to have me give you my opinion about your specific situation let me know. My partner and I have performed approximately 1,200 muscle sparing breast reconstructions together. We also reconnect sensory nerves and are experienced in vascularized lymph node transfer. We do phone consults if you’re interested in discussing this more. Thank you!

James E. Craigie MD

Center for Natural Breast Reconstruction

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

Best of Ask the Doctor

charleston breast surgeonsAt The Center for Natural Breast Reconstruction, our mission is to help women everywhere make smart, informed decisions about breast reconstruction and overall healthcare.

Over the years, our surgeons, Dr. James Craigie and Dr. Richard M. Kline, Jr., have answered a wealth of questions about breast reconstructive surgery—from the different kinds of procedures to post-op healing tips.

If you’re searching for a thorough introduction to breast reconstructive surgery, here’s a sample of the invaluable advice our surgeons gave the past year:

Your Questions about Natural Breast Reconstruction and Implants Answered

Scarring After Breast Reconstruction Surgery

Tackling the Challenges of Breast Reconstruction After Lumpectomy and Radiation

The Benefits of DIEP Flap Breast Reconstruction Over Other Reconstructive Options

Is This Normal? Your Post Op Breast Reconstruction Question Answered 

Tips for Improving Recovery and Healing Time

If you are seeking advice about breast cancer, breast reconstruction, or healthcare options, please send your questions our way! We will address all of your questions with detailed and valuable insight straight from our surgeons.

What Is the Recovery Period for a DIEP Procedure?

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!!