Ask the Doctor-When should a patient should have a flap procedure to rebuild a breast?

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

Question: I have been undergoing reconstruction with implants for the last couple of years. My last surgery was January 26, 2015. I have a z-plasty across the breast under the nipple reconstruction scar, not very aesthetically pleasing. Also left with a left small B, right D and pain when I sneeze in the right implant rib cage area. The small B is fine with me. One other issue that has come up is the outbreak of skin blistering which my doctor cannot account for and is ongoing. My question is how do you determine when a patient should have a flap procedure to rebuild a breast given previous medical history?

Answer:  I’m sorry you are having problems with your reconstruction. The issue of when to abandon implant reconstruction and pursue natural tissue reconstruction is sometimes very straightforward (for instance, if you put a tissue expander in a radiated mastectomy wound, and it falls out during expansion), and sometimes less obvious. Although the majority of non-radiated patients reconstructed with implants do well, a significant minority have problems, some such as you have described, and ultimately pursue reconstruction with their own tissue. The decision is often not just a straightforward medical one, but often is very dependent on what your specific goals are for your reconstructed breasts. We would be happy to talk with you more about the specifics of your specific situation, if you wish. Thanks for your inquiry.

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

After Breast Reconstruction, Do I Still Need an Annual Mammogram?

diep and mammogramThe following question is answered by Charleston breast surgeon, Dr. James E. Craigie. of The Center for Natural Breast Reconstruction:

Q: After having breast reconstruction using the DIEP method, do I need to have an annual mammogram?  If so, can the pressure from the procedure cause any damage to the tissue or blood vessels used in the reconstruction?

A: First of all, following mastectomy and reconstruction with your own tissues, a mammogram is routinely not needed on a regular screening basis.  Screening mammograms are only helpful for normal breast tissue; therefore, in our patients we do not recommend that they have regular screening mammograms.

From time to time, people will be seen in follow up for examination and have areas of the breast feel firm or hard and sometimes the oncologist or other physicians will order mammograms to investigate a specific finding.  This would normally be performed after the first and second stages of the reconstruction process were completed and therefore should pose no risk of injury to the blood vessels that were connected to the breast.

Thank you for your question!

James E. Craigie, M.D.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by submitting your questions here.

Post-Operative Care: What to Expect and Helpful Tips

Post-Op Care and TipsOur team often receives questions on the healing process and post operative care after breast reconstruction surgery. We strive to provide our patients with the information to ensure they achieve the most optimal surgical experience. For today’s Ask The Doctor post, we are sharing with you some tried-and-true steps and tips we have to help our patients improve their post surgery recovery and healing time.

After Surgery

Family members will receive periodic updates during your surgery.

Following the procedure, you will be moved to a special unit in the hospital where you will be connected to monitoring equipment. There, nurses trained in post operative care of breast reconstruction will monitor you at all times.  Family members can see you during visiting hours.

You will also receive an informative sheet that discusses your specific information and post-operative care.  This likely will include information concerning drain care; it is very important to monitor flow from the drains in a 24-hour period. This guides us on when to remove them.  You will also have a kind of thermometer on your chest, which monitors the flap.  Other specifics and information will be provided in your post-operative packets.

As You Heal

Family and Friends:
Support from loved ones is very helpful. But understand that comments they may make during your recovery can cause you concern. Remember this: We will tell you honestly how you are doing and what we expect your result will be.  Please trust in our knowledge and experience when we discuss your progress with you.

You will heal! How quickly depends on factors your genetic background, your overall health and your lifestyle (exercise, smoking, drinking, etc.). Many people believe the surgeon “heals” the patient.  No person can make another heal. Dr Craigie and Dr Kline can facilitate, but not accelerate, the healing process.  But you play the starring role, so your cooperation is key.

You may find swelling of your new breast and abdomen (DIEP) or buttock (GAP) to be troublesome and your clothes may not fit.  Be patient, this swelling will gradually subside and you will feel better in a few weeks.  There will be a certain amount of tightness in the area where the flap was taken from.  This will slowly relax in a few months.

Following Instructions:
Another way to improve healing is by following the instructions given by Dr. Craigie and Dr. Kline’s staff.  We believe “the difference is in the details” and strive to achieve the best possible results for you.  It is imperative that you act as a partner in this process — not a passive participant.  The instructions are designed to give you the best opportunity for healing without delay or surprise.

Click here for a complete list of post surgery healing and recovery tips and instructions.

Have questions about post operative breast reconstruction? Or questions in general? Contact us today!

What Technique Do You Use For Nipple Reconstruction?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  Can you tell me how successful you have been in doing nipple reconstruction and what technique you use? I had one done from tissue gathered from my own breast, then had fat transferred but it is still flat. Now that I am losing the other breast (2nd mastectomy) I would like to have a protruded nipple even if just a bit on each breast. 

A: I use the “skate flap” technique, although many similar techniques using local tissue exist. There are, in my experience, two potential problems which may cause nipple reconstruction to be unsuccessful.

1) Sometimes, a portion of the flap just dies. This is, to a large extent, unpreventable and unpredictable, as these flaps are too tiny to be based on any known blood vessel. Additionally, the need to put the nipple in the proper location precludes altering its design to potentially improve blood flow.

2) We have learned that it is essential to protect the flap from the pressure of clothing until it is fully healed (at least one month). There are special domed “Tupperware” protectors made just for this purpose.

It helps to make the nipple larger than desired at first. That leaves a little leeway if things go awry, and it only takes a few minutes to reduce a nipple in the office if it ends up being too large.

Hope this helps, good luck.

Q: I have just been diagnosed with breast cancer of the right breast. The surgeon suggest bilateral mastectomy due to family history. Should I meet with a plastic surgeon before the surgery or get a 2nd opinion?

A: Whether or not you ultimately decide to have reconstruction (at the time of mastectomy, or later), you should at least speak with a plastic surgeon beforehand so that you know all of your potential options. Ideally, your breast surgeon already works with one or more plastic surgeons, and can help direct you to one.


Dr. Richard Kline

Center for Natural Breast Reconstruction

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

Ask the Doctor: Medicare, Scarless Reconstruction, and Options for Smaller Body Types

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  I was diagnosed with breast cancer in December 2010 and had a bilateral mastectomy/ stage 3 with 25 malignant lymph nodes removed. My treatment was chemotherapy followed by radiation. The last radiation treatment was September 2011. I have been researching about the DIEP procedure and am very interested in having this done. I am 66 years old. Do you accept Medicare out of state? The facility in San Antonio does not.

A: We will accept Medicare if you are otherwise (medically) a good candidate for the DIEP procedure. We can have our nurse Chris or P.A. Kim call you to get more information, if you like.


Q: Can you have scarless breast reconstruction surgery following a double mastectomy for triple negative breast cancer?

A: There’s really no such thing as “scarless” breast reconstruction, although it is often possible to conceal the scars quite effectively. We’d be happy to have our nurse Chris or PA Kim call you to discuss the details of your situation further, if you wish.


Q: What can you do for someone who is thin (5’4″, 116 pounds), has had a unilateral, nipple sparing mastectomy with radiation? Desired cup size would be AA or A only.

A: Most patients, even very thin ones, can still be reconstructed using only their own tissue, particularly if they only need one breast reconstructed, and don’t need it to be very large. If you have any excess abdominal skin / fat at all, it is frequently possible to use both sides of the abdomen to reconstruct one breast (stacked DIEP). Sometimes other donor sites are better ( buttocks or posterior thigh), and most patients have some extra fat spread over their bodies that can be added as free fat grafts at a subsequent procedure after the initial flap. It may be easier to tell which donor site(s) is best during an actual examination, but we can usually get a reasonable idea from photos.

Dr. Richard Kline

Center for Natural Breast Reconstruction


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

Flap Procedure Using Tissue or Muscle–What is My Best Option?

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answer your questions.

Q:  had a double mastectomy in July 2012. I have one successful implant (right) and the left had to be removed due to infection. I need a flap procedure and want to know which one you usually recommend? I have had a lot of bad ratings for the stomach procedure. 

A: Thank you for the question, and I am sorry you have had problems with your implant.

When implants don’t work out,  usually using your own tissue can be an option to complete the process without using an implant. We specialize in using your own tissue but without sacrificing your muscle. Giving up the tummy muscle can be a problem and may have been part of the reason you have had less than favorable reviews on that subject. We prefer to use the body area that has sufficient tissue to rebuild the breast and take no muscle to do that. We can use the tummy, buttock or thigh tissue. I would be glad to give you more specific recommendations if I had more info. Let me know if you would like my office to contact you for more specifics.

Dr. James Craigie

Center for Natural Breast Reconstruction


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