I’m Not Happy With My Implants — Is Flap Surgery Possible?

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

Q: I had a double mastectomy last August with immediate expander reconstruction. My expanders were replaced in January with silicone implants and needless to say I’m not thrilled with them. They are hard, cold and I now have ripples across them. My surgeon is going to remove more excess skin in hopes to alleviate the “wrinkling” effect, but I’m honestly not sure if I even want to have this done. I originally wanted to have a tissue transfer (abdominal) but was advised to try the implant route first.

I know that I don’t have a lot of abdominal fat and would probably end up with very small breasts if I went this route instead. I don’t mind the smallness but am concerned on the dangers of having a tissue transfer and wonder if this would be a better, more natural breast for me. I’m not getting the feeling that my surgeon is comfortable with this type of surgery and would like more information on your facility. I feel like I have so many questions that no one can seem to answer. Is there someone that I can reach out to?

A: We would be very happy to discuss your situation with you. It is very rare for someone not to have enough stomach or buttock tissue, especially with subsequent fat grafting, to provide an acceptable breast size. Flap surgery can be a little intimidating, but our success rate over the last ten years is 98.4%. We have helped many women who have started out with implant reconstruction, only to decide that it was not the right choice for them.
Our nurse Chris or P.A. Kim can call to discuss your situation further, if you wish.

Thank you for your question.

Dr. Richard M. Kline

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!

Replacing an Implant With a Flap: Will My Muscles Recover and Function Normally?

The following question is answered by  Richard Kline of The Center for Natural Breast Reconstruction.


Q: My reconstruction consisted of chest muscle to create a pocket for a silicone implant. I have had it since 2004. They used an expander. It was the best choice for me at the time. If the implant is removed and the muscles are fixed, will they recover and function normally? For example, will I be able to do pushups and bench presses again?


A:  Thank your for your question. Although the muscle is replaced against the chest wall when an implant is replaced with a flap, it is impossible to duplicate the strength of the original muscle attachment.

Having said that, most patients function quite well with an implant under the muscle, and I’m hesitant to tell you you’ll see dramatic functional improvement if you convert your implant to a flap.

I hope this helps.


Richard Kline
Center for Natural Breast Reconstruction


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

What to Know Before Seeking Implants as Your Breast Reconstruction Option

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

I am weighing my options for breast reconstructions and  considering silicone implants. What should I know before I continue—what questions should I ask a doctor?

Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for breast reconstruction, and flaps may be a better alternative in that case.

-Dr. Richard M. Kline Jr.

The Center for Natural Breast Reconstruction.

Have questions for our surgeons? Submit your questions today and get answers straight from our surgical team! No matter where you are in your reconstruction process, we are here to help!


Could I Be A Candidate for DIEP Reconstruction After Implants?

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

I had a bilateral mastectomy and had 850cc silicone implants placed after tissue expansion. I am not happy at all with the result as I had radiation on the right side and that breast is considerably smaller than the left. I am also not happy with the shape and look of the breasts with silicone implants. I currently wear prosthetics in my bra to achieve symmetry and a normal shape. Even with the bra and the prosthetics I am not happy with the result. I am currently a D/DD and would like to maintain that size. Given this situation, could I be a candidate for a DIEP or Stacked DIEP breast reconstruction?

Thank you for your question. I’m sorry you are having some concerns about the shape and evenness of your breast reconstruction. Because you had radiation on the right side it is almost certain that the two sides will be different to some degree regardless of the type of reconstruction. Unfortunately, when this occurs with implant techniques it is usually more noticeable and nearly impossible to fix long-term as long as the implants are in place. The reason for this is the implants will be treated as foreign material by your body and the right side will always react more severely due to previous radiation even if radiation was done before the mastectomy. Also, the process of scar formation continues as long as the implants are in place, making the firmness, shape change, and stiffness more noticeable to you as time goes by. These are the reasons that women who have implant reconstruction have multiple procedures to revise results as time passes.

Fortunately when someone has had problems of this nature with implants we can frequently solve them by removing the implants and replacing them with their own fatty tissue (DIEP, stacked DIEP). We can do this without taking tummy or back muscles. Immediately the fatty tissue takes on a more natural shape compared to implants. Thirty percent of my patients have had failed implants before we start over and use their own tissue. My opinion and answer to your question is that you could have a DIEP to replace your implants and I can usually predict that many of the implant problems are much improved immediately after the surgery. I cannot predict what size you would be without seeing you but the size depends on how much extra tummy tissue you have as well as any previous surgery.

I hope I have answered your questions.

—James Craigie MD

 Would you like your breast reconstruction question answered? Just ask us!

Top Fitness Equipment to Help Increase Strength

We’ve found so many different types of great fitness equipment that we had to share them with you. All of them will help you increase strength, get in shape, and feel better. Any sporting goods store or website will have a range of equipment. Pick your favorite and start!

Fitness balls

These fun PVC plastic balls give you a total body workout, and simply sitting on them while working and watching TV will strengthen your core (abdominals and lower back) and stretch your muscles. Look for a burst-resistant ball that comes with its own pump and a DVD or booklet outlining exercises.

Fitness balls come in different sizes and are gauged by the user’s height, so be sure to read the packaging or website information before buying. When you sit on the fully inflated ball, your knees should be bent at a 90-degree angle—if they aren’t, move up or down one size. If you’re heavy for your height, you may need to go one ball size bigger, or if you’re very light, you may need one size smaller.

Medicine balls

Medicine balls are smaller than fitness balls, and they’re weighted to help you improve strength in your hands, arms, core, and legs. Use them as an alternative to weights, or simply play catch with them. These bouncy balls come in a wide variety of sizes and are typically made of rubber for easy grip.

Resistance cables

Also known as toning cables, toning tubes, or resistance tubes, resistance cables are a convenient, inexpensive alternative to free weights or machines. Typically made of latex or rubber, they have handle grips, and you can use more than one to increase the resistance. Many are versatile enough to strengthen any area of your body, depending on how they’re used.

Jump rope

Still as fun as they were when you were a kid, a jump rope gives you a cardio workout with a twist: the handles hold weights to help you strengthen and tone your arms, shoulders, and back.

Wobble boards and stability discs

Much like the fitness balls, these flat boards and rounded discs help you strengthen your upper and lower body while improving your stamina, stability, and balance. Wobble boards are typically used during yoga or Pilates work to strengthen your core and legs. Stability discs can be used sitting, kneeling, lying, or standing, and you have the option of inflating them to your desired size.

Have you tried any of these fitness helpers, and how did you like them?


Charleston Breast Surgeon Answers Your Implant and Insurance Questions

charleston breast surgeonsThe below questions are answered by Dr. James Craigie of The Center for Natural Breast Reconstruction

Should a woman have an MRI follow up every two years after implants to check on things? I’ve been told this.

Let’s go to the source of that information for the best answer . . .

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants . . .

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic.  Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here: http://www.mentorwwllc.com/Documents/gel-PIDS.pdf

Does insurance generally cover redoing of nipples and tattooing?  I’m not completely satisfied with the result of my nipple reconstruction procedure.

Great question . . . Let’s address the insurance portion first. If your health insurance covers mastectomy, it must cover reconstruction throughout all phases. There are some that do not have to abide by this rule, (WHCRA 1998) but they are few and far between. Some may limit the number of times you can undergo a procedure at their expense. The best way to assure they will pay for your procedure is to call the insurance company each time and make sure you have benefits available for the procedure you desire.

Nipple reconstructions can deteriorate over time. Those that seem a little too prominent at first tend to flatten out after a while and may no longer project enough to suit a patient.  Tattoos fade, especially when applied to skin that has a large amount of scar. This being said, repeat nipple reconstructions are a quick procedure routinely performed with local anesthesia and it’s not unusual to require a touch up tattoo.

—James E. Craigie, M.D.

Breast Implant Alternatives to Adding Volume, Shape, and Projection to a Breast

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

In July 2010 I had I-GAP reconstruction. The results are awful. Do you have techniques that can work with a flap and add volume, shape, and projection to a partially recreated breast without the use of implants?

Sorry to hear about your problem, but it’s not terribly unusual to not have quite enough tissue after flap reconstruction. That’s actually good for you, because it means we have some experience dealing with this. The most desirable techniques to try, and in what order, depend on your body type and preferences, but here are some options:

1) Fat grafts: Your fat from anywhere you don’t want it can be harvested with liposuction and injected into the breast mounds in the desired areas. Survival of the fat is not strictly predictable, but often a significant amount remains permanently. Several sessions may be required, however.

2) Vth intercostal artery perforator flap: This is a fancy name we give when we utilize the extra roll of skin and fat that a lot of patients have (& hate) on the side of their chest behind the breast, under the armpit. It is left attached at the front, the skin is removed, and the flap is tunneled under the skin at the side of the breast, then across the top of the breast as far as it will reach. Besides making the breast bigger, this technique has the particular advantages of covering the upper border of the pectoralis muscle (often visible just under the skin after reconstruction), and lifting the breast in what is often a very aesthetically pleasing way. The disadvantage is that it adds a scar under the arm from where the flap was taken.

3) Additional perforator flaps: No one likes to hear this, but sometimes it is the best answer. We have always been able to find suitable blood vessels and add flaps successfully whenever we have had to try this, and the results have been favorable. Definitely not the first choice for most people, but good to know it’s a tried-and-true technique if you absolutely need it.

4) Finally, a small implant under a too small but otherwise healthy flap is often surprisingly well-tolerated, even in radiated patients. Not for everyone, but an option that has been used quite successfully in some instances, nonetheless.

We went through our “iGAP phase” some years ago, and abandoned it not because of the reconstructive results, but because we decided the sGAP donor site resulted in far more favorable buttock aesthetics.

–Dr. Richard M. Kline, Jr.

Share this post with your followers on Twitter. And if you have a question for our breast surgeons, please feel free to send us an email!

Common Breast Reconstruction Questions Answered

dr. richard klineThe below questions are answered by Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

1. I had my second part to breast reconstruction and had necrosis removed, but I still have the hardness. How can it be treated? They did liposuction.

If necrosis was removed and there is still hardness, then it is most likely from either 1) additional / remaining fat necrosis, or 2) edema (can feel hard, especially likely in radiated tissue). In either case, resolution is likely without additional surgery, if you wait long enough (may take 1 – 2 years), although breasts will be smaller in either case. If pain is present, and fat necrosis is still present, then surgery to remove the rest of the dead fat may be indicated.

2. I am considering silicone implants for breast reconstruction. What should I know before I proceed—what questions should I ask?

Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for breast reconstruction, and flaps may be a better alternative in that case.

—Dr. Richard M. Kline, Jr.

What is Capsular Contracture?

breast reconstruction

The below question is answered by The Center For Natural Breast Reconstruction team:

I’m considering implant-based breast reconstruction. My surgeon mentioned a “risk of capsular contracture.” What exactly is that?

Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.
The occurrence of capsular contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule tightens and squeezes the breast implant; as such, it is a medical complication that can be very painful and discomforting, and might distort the aesthetics of the breast implant and the breast.

Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.
Moreover, because capsular contracture is a consequence of the immune system defending the patient’s bodily integrity and health, it might reoccur, even after the requisite corrective surgery for the initial incidence.

The degree of an incidence of capsular contracture is graded using the four-grade Baker scale:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

–The Center for Natural Breast Reconstruction team

Loved this post? Why not like us on Facebook?

Are Implant Problems Affecting Your Life?

implant problemsBelow is an In Her Words post from one of our patients who came to us with implant problems. Read her story below:

I am so thankful to Dr. Craigie and Dr. Kline and Christina for making me feel at ease. Meeting someone for the first time and having surgery the same week was a lot to take in, but thanks to everyone, including The Center for Natural Breast Reconstruction staff, Christine, and Gillian. And a special, big thank you to Gail for helping me with my insurance and all the conversations we had prior to my office visit with Dr. Craigie. Gail, thank you for making me feel like a person not a number, you are wonderful!

I cannot say enough about the results from my surgery! It was absolutely fantastic to say the least! I am amazed how natural I look! I really am excited to have my follow-up. Can it get any better? I do not have the pain in my breasts or the hardness and pulling from the implant anymore. I can lift my arms straight up over my head now! I noticed that I don’t have the flu-like feeling anymore—it’s gone!

Before coming to Dr. Craigie’s office, I have had five painful surgeries with implants and expanders going wrong with infections, plus lengthy hospital stays and home care. This was over a period of four years—four years taken out of not only my life but also my family’s life. Just think of how much time and money was wasted on paying insurance companies when I could have had only one surgery and a follow-up! If I only knew there was an alternative option before having my first implants.

My goal is to get the word out. Women need to know that you do have an alternative, besides using implants. Utilizing the body’s own tissue! Again, I was never given this option.

I cannot thank you enough Dr. Craigie and Dr. Kline for your skilled surgical talents and dedication in this field that made me look and feel like a women again!

D.N South Amherst, Ohio

Do you know of someone whose life is affected by implant problems? Share this story with them.