Ask The Doctor-Will you help me find somewhere that I can have a mastectomy and reconstruction surgery at the same time?

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

Question: I’ve just found out I have breast cancer and have to have a mastectomy.  There is no one in my little city that does the DIEP surgery.  Can you help me find somewhere to go so I can have my mastectomy and reconstruction at the same time?

Answer: Thanks for your question. There are specialized types of breast reconstruction that may not always be available to patients in every city. It is very common for patients to travel out of state to our practice because of our specialized training and the procedures we perform. When someone has to have a mastectomy, it may be possible to start the reconstruction at the same time. The advantages are several and include fewer surgical procedures, saving your breast skin and nipple sparing mastectomy. We use a multi- disciplinary approach and work with expert breast surgeons who can evaluate our patients to ensure they are having the most up to date treatment and are ok to have the mastectomy and reconstruction together. If it is determined that radiation treatments are needed after mastectomy, then we might recommend reconstruction at a later time when the radiation is complete. At the appropriate time, it can still be possible to have natural breast reconstruction and the most up to date breast reconstruction procedures. 

Our practice is committed to taking care of women who must go through a mastectomy and who desire knowing all their possible options for breast reconstruction. 

We make ourselves available to patients with time sensitive needs and will do anything we can to help people who may need to travel out of town for specialized state of the art breast reconstruction.

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


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!

Can I Have Reconstruction After Recurrence of Cancer? Should I Go to My Local Surgeon or Elsewhere?

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

Q: I have been diagnosed with a second primary breast cancer in the right breast. 13 years ago it was IDC now DCIS. What are my reconstruction options? 

A: I’m sorry you are having to deal with a recurrence. Glad to hear it is DCIS. I imagine you had radiation before and could have mastectomy with immediate reconstruction. If you like I will have my office contact you for a few more details.  I would be glad to set up a phone consult so you could get my opinion right away.

Dr. James Craigie


Q: I was referred by a coworker who was a patient. I’ve had a bilateral mastectomy, expanders and two sets of implants (taken out due to capsular contracture). My plastic surgeon said my body just isn’t taking to the implants and suggests I try DIEP flap reconstruction. My plastic surgeon does them, but my coworker said she recommends more experience. At this point I am torn. She suggested I contact you. I live in Florida and I am very comfortable with my surgeon, but understand the more you do, the better you are. I’ve also had a gastric bypass 10 years ago and I am scheduled for a hysterectomy (via DaVinci robot) Oct 2nd.

A: Thanks for your inquiry, and sorry for the trouble you’ve had.

Having said that, more surgeon experience, having two microsurgeons involved, and using a hospital with a dedicated flap team does potentially provide benefits, probably most so in terms of shorter operating times and increased flap survival rates. We have presently done about 1030 DIEP and GAP flaps, with a 98.4% survival rate, and we would be happy to see you at any time.

However, I would suggest that you consider discussing your concerns with your plastic surgeon, and if he still feels confident he can do it, I think I would give him the benefit of the doubt. Even if you ultimately decide to have your surgery elsewhere, it would be very helpful to have him on board with your decision.

Dr. Richard M. Kline, Jr.

Center for Natural Breast Reconstruction

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