Can You Obtain Perfect Symmetry in Breast Reconstruction?

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

Q: I looked at your gallery  and I’m concerned about what I see as a mismatch in the photo examples. Is this not something you try to achieve?

A: Thank you for your wonderful question!

By “mismatch,” I’m assuming you mean the two breasts do not look the same when reconstruction is completed.

Firstly, we have many patients with very symmetrical breasts following reconstruction, and we could easily put only their pictures on our website, if we wished.

Thus far,  we have chosen to put less-perfect results on our website as well, believing it serves our potential patient population better, for the following several reasons.

In the real world, many patients will not be able to achieve a highly symmetrical result due to prior conditions, or will choose to not go through the multiple surgeries that will be required to get them as close to perfect symmetry as possible. If all patients came to us before their cancer was removed, we would coordinate their surgery with one of our highly experienced breast surgeons, they would nearly all receive nipple-sparing or at least skin-sparing mastectomies, and they would then have the greatest potential for good symmetry in the end.

In actuality, we see many patients from out of town who have already had non-skin-sparing mastectomies (often when nipple-sparing or skin-sparing mastectomies would have treated the cancer just as effectively). In this scenario, they have little potential to have their scar pattern converted to a more favorable one, and commonly need a lot of extra flap skin left in place in the breast. Occasionally a temporary tissue expander can be used to reduce the size of the skin paddle, but this does not always work, especially in radiated patients. If they chose to have a contralateral prophylactic mastectomy, they could then of course choose to have the same type of mastectomy on the other side (which would help symmetry), but many patients understandably do not want to do any more damage to their healthy breast than they have to.

Additionally, many patients are left with permanent changes in their skin from radiation, which can cause permanent color mismatches, as well as excessive tightness in the skin. This can make it very hard to match a radiated side to a non-radiated side, more so in some patients than others. The more times we can operate in this situation, the closer we get, but sometimes ideal symmetry remains elusive.

We want ladies who have already had aggressive mastectomies, who are left with significant radiation damage, or who don’t want to go through many, many surgeries in pursuit of ideal symmetry to know that there is still help for them, without implying to them that they will get a result that is probably not realistic. All busy reconstructive practices have these patients, but not all choose to put them on their websites. It may not be a good marketing decision for us, but we feel it is the most honest way to deal with our prospective patients.

We’d enjoy any feedback you’d care to give us on this topic, as we argue about it a good bit amongst ourselves.


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!

Ask The Expert Series Spotlights The Center for Natural Breast Reconstruction

We’re thrilled to share some exciting news with you, today! Our very own Dr. Richard Kline and Dr. James Craigie, Charleston breast surgeons, were recently on ABC News 4 Ask the Experts Series. During this interview the doctors answer questions on air about natural breast reconstruction submitted by viewers .

See below for the interview:


For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit our website today for more information.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.


Mastectomy and Breast Reconstruction Questions Answered

nipple sparing mastectomyThe below questions are answered by Dr. Richard M. Kline, Jr., Charleston breast surgeon for The Center of Natural Breast Reconstruction:

What kind of breast expander do you recommend and employ?

We usually use either Mentor contoured tissue expanders, which have more projection at the bottom than the top, or Mentor round expanders with a remote port. If patients are using tissue expanders only as a “bridge” during post-mastectomy radiation until they can receive a flap reconstruction, then we prefer the remote port model, because it won’t interfere with the MRI we like to get prior to flap surgery to look at the vessels. If the patient is planning on having a permanent implant reconstruction, then the contoured expander (which is not compatible with MRI) may produce a better initial shape.

If I choose immediate breast reconstruction, what happens if it is discovered I need radiation treatment during the mastectomy? What happens then?

It depends on what type of reconstruction you have chosen. If you choose implant reconstruction, radiation doesn’t hurt the tissue expander or implant, although it significantly decreases the chance of achieving an acceptable result. If you have had an immediate flap reconstruction, then learn (unexpectedly) that you need radiation, then the flap may be in serious jeopardy. Experienced oncologic breast surgeons are usually pretty good at anticipating whether a patient will need radiation or not. If significant doubt exists, however, and a flap reconstruction is planned, it is best either place temporary tissue expanders at the time of mastectomy, or delay all reconstruction until after radiation.

What are the disadvantages of postponing breast reconstruction after mastectomy? (scarring, skin sparing options, nipple options)

The only significant disadvantage to postponing reconstruction is potential contraction of skin if a skin-sparing or nipple-sparing mastectomy is used. Depending on the amount of skin present and the ultimate desired breast size, however, this may present a problem for some patients, but not others. The advantages of delaying reconstruction include a decreased incidence of complications, and shorter anesthetics.

For breast reconstruction, what are the options for nipples?

If nipple preservation can be successfully employed, then this may give the best outcome in some cases. Not all attempted nipple-sparing mastectomies are successful, however, and many nipples have failed to survive after this procedure. Nipple reconstruction using local skin flaps has proven to be highly reliable, and tattooing of the areolas can produce very realistic results.

Do you have a question for the Charleston breast surgeons at The Center for Natural Breast Reconstruction? We’d love to hear from you.

How One Breast Cancer Survivor Found Hope by Making Informed and Proactive Decisions

breast reconstructionThe team at The Center for Natural Breast Reconstruction is honored to share with you an In Her Words post written by a recent patient of ours, Linda Burkholder. She is an inspiration to all women who are facing breast cancer or who are at risk for hereditary breast cancer.

See below for Linda’s story:

Breast cancer—you can’t say I didn’t see it coming, but being the eternal optimist, I hoped I would dodge the bullet.  Several members of my family have died from breast cancer, including my grandmother, mother, aunt, and sister. After my sister died in 2006, I began to seriously consider prophylactic surgery. I quickly learned that there is little support in the medical community or among friends for this procedure.

After a benign biopsy two years ago I found F.O.R.C.E. (Facing Our Risk of Cancer Empowered) on the Internet.  F.O.R.C.E. is a support group for those with hereditary breast and ovarian cancer. They posted an application for a scholarship to their annual conference. I applied and much to my surprise I was granted an expense paid trip to the conference in Orlando in 2010. I can’t tell you how that changed my life. I learned so much about everything I wanted to know about breast cancer and I met several plastic surgeons who stood out to me, especially Dr. Kline from The Center for Natural Breast Reconstruction. I made a mental note to keep him in mind and took home a beach towel with his phone number splashed across it.

During the next year I struggled with my decision to have prophylactic surgery. Intellectually, I knew what to do, but emotionally I was really struggling. I joined a local F.O.R.C.E. group and kept learning and thinking and meeting cancer survivors, assuming I would have surgery when I felt more comfortable with the idea. Fast forward to June 2011. It was time for my annual mammogram. I told my family doctor I also wanted an MRI, to which she reluctantly agreed. To make a long story short, the mammogram came back normal, but the MRI showed a 1.2 cm questionable spot—a spot, I was told, because of its location, would never have been seen on any mammogram. It was a Stage 1 cancer.

This was almost 2 years to the date from my previous benign lumpectomy. In July, 2011 I had a second lumpectomy performed by one of the most respected surgeons in my area. Without consulting me she automatically scheduled me for radiation. I refused the radiation because I felt that all treatment was my decision and I wanted to consult with an oncologist first. Also, I had learned at the F.O.R.C.E. convention that radiated tissue is harder to reconstruct and I already knew I ultimately wanted mastectomies with natural breast reconstruction, not implants.

When I told the surgeon I didn’t want implants, she hit the ceiling. Clearly, no one had ever before challenged her standard treatment plan. Thanks to F.O.R.C.E., I was empowered. The next convention was two weeks away and I knew this would be where I would make my final decision, and it was. I talked with EVERY plastic surgeon at the conference. I spoke with Kathy Steligo, author of The Breast Reconstruction Guidebook, for 45 minutes at the round table breakfast. I had read her book for the third time on the plane to Orlando two days before. After the conference I came back to my hometown and started chemotherapy. I also scheduled my surgery for November at The Center for Natural Breast Reconstruction.

After consulting with my oncologist, I elected to have bilateral mastectomies with autologous reconstruction. In September my husband and I made a trip to South Carolina to meet with Dr. Kline and Dr. Baron, the general surgeon. I wanted my husband to meet my doctors. I wanted to make sure I had his full support and I wanted to make sure any lingering questions by either of us were answered.

After that meeting I was sure I wanted to go forward with the DIEP procedure. I felt very confident that everything would be alright. On November 30, 2011 I had the procedure. It was an 8-hour surgery, and everything went very well. I was in East Cooper Medical Center for four days. My nurses were great, especially Angela. I thought of her as my special angel since she was able to anticipate what was needed before being asked and was especially kind. She really took good care of me.

After my discharge from the hospital my husband and I stayed in Charleston another 10 days. I got a handicapped room at a local long-stay hotel. There was a handicapped shower and a recliner in the room. I really appreciated that recliner and I slept in it most nights. It helped to keep my feet elevated.  Every day, at least one time, I took a short, slow walk up and down the hall for exercise. I saw Dr. Kline 3 times during the next 10 days and he assured me everything was fine and my breasts looked “beautiful”—although at that time I didn’t think they looked so beautiful. Now, 5 weeks later, I can see how nicely everything is shaping up and I don’t think I will require a lot of revision at the Stage 2 procedure. I am glad I chose the DIEP procedure. The recovery is long, but it is worth it.

Did I ever seriously consider implants? The answer is yes, because implants represented the path of least resistance. I could have had the surgery done locally and I wouldn’t have had the additional expense of the trip from Indiana to South Carolina. Also, I would have had my entire support system around me. In making my decision I talked to many women who had implants and it seemed to me that they either loved them or hated them. Those that loved them seemed to love them only after 2-3 additional procedures due to complications. Everyone complained about the fills being painful and some found the implants to be cold or uncomfortable. Also there was the risk of capsular contracture and the necessity of replacing the implants every 10-15 years. I also talked with many women I met through F.O.R.C.E. who had flap procedures. I saw their results and they were fabulous. Short of a few fading scars, you could not tell that their breasts were not original. All of them seemed quite pleased with their new breasts.

Yes, recovery is a bit prolonged with DIEP. You definitely need someone very devoted to you to help out those first few weeks. I needed help getting up and down, showering, dressing, and emptying my surgical drains. My husband helped me with everything, dispensed my medications and gave me a blood thinning shot daily. I could do very little without his assistance the first 10 days following surgery, and I slept much of the time. Still, I was able to get around slowly and even went out to local restaurants my two weeks in Charleston. I also had pain medication, which made life bearable.

As the weeks have progressed, I feel my strength slowly returning. I am not yet 100% but I am planning to return to my job part-time on January 9th, with hopes of returning fulltime the following week. For anyone considering a flap procedure but fearful of the recovery, I would advise them that it is doable. It’s not as bad as you think. A certain amount of fear is normal if, like me, you have never had a major surgery. But for me, everything went fine, even though I am 59 years of age, older than any one I have met who had DIEP. So, I think if I can do it, anyone can.

My only regret is that I didn’t come to my decision for prophylactic surgery before I got cancer. Time ran out to make that decision but I am thankful my cancer was found early and I am thankful for my husband of 29 years, Larry, was by my side supporting me every step of the way. I would advise anyone facing cancer to not panic, do your homework, and be very proactive in your treatment. Learn everything about breast cancer that you can so you can understand your options. Choose your doctors carefully. Get second opinions and do what YOU think is best for you. You have many options; don’t let anyone take any of them away from you. Make your own decisions.

Having cancer has changed my view of life. It seems much more precious and much more vulnerable than before. I am thankful for a second chance and thankful that I had so many options that my mother and grandmother did not have. My mother had radical mastectomies, which are very disfiguring. I am glad that I still look much like I did before. I had nipple-sparing surgery and when I look at my breasts I still see me in there. I can’t wait to see the results following my final revisions. I am very grateful for Dr. Kline, Chris Murakami, RN and Clinical Coordinator, and all the staff at The Center for Natural Breast Reconstruction for a very positive reconstructive experience.

About Linda Burkholder

My name is Linda Burkholder and I have lived in Kokomo, Indiana the past 22 years. I am the proud mother of two adult children, a daughter 23 years-old and a son age 21. I have been married to my husband, Larry, for 29 years. I work fulltime at Indiana University as an Administrative Secretary to the Dean of the School of Public and Environmental Affairs. I love animals and have two Pembroke Welsh Corgis and four cats. In my spare time I enjoy reading and knitting.

Do you have a question for one of our doctors? Ask us!

Improving Your Self-Esteem after Mastectomy

breast reconstructionA mastectomy affects you not only physically, but also mentally and emotionally. Many women feel like a vital part of them has been taken away, and their self-esteem suffers as a result. If these feelings aren’t resolved, they can lead to depression and other issues. It’s important that if they surface, you recognize them and know you can find help.

Focus on the positive.

While the surgery itself may not be a positive thing, focusing on being optimistic helps your self-esteem. You may decide on breast reconstruction and feel excited about having new breasts, or you may be heartened by the fact that you’re now a breast cancer survivor and can move forward with your life. Often, mastectomy patients find that the smallest things, such as a drive in the mountains or a sunrise, bring them joy.

Allow yourself to grieve.

You’ve had a loss, and it’s likely to provoke the same feelings of grief as losing a loved one. You may feel denial or anger, which is perfectly normal. Allow yourself to experience those feelings instead of minimizing them or holding them inside. If you feel the need for a grief counselor, ask your doctor or religious professional for a referral. A hospice bereavement counselor may also be a good choice.

Talk it out before, during, and after.

Whether you feel relief that the cancer is gone, grief over losing a part of your body, or hesitation in allowing your partner to see you right after your mastectomy, talk it out with someone you trust. Many women confide in their partners first, while others may turn to a family member, fellow breast cancer survivor, or therapist.

Find someone you feel comfortable with, and don’t be afraid to express yourself. The more you bring out in the open, the better you’ll feel.

Consider breast reconstruction as soon as possible.

Many patients look at natural breast reconstruction as their chance to finally have the breasts they’ve always wanted. They become very involved in learning what the surgery entails and what their options are. In fact, reconstruction often improves our patients’ self-esteem because their new breasts signal a new beginning, which is exciting and empowering.

In fact, our happiest patients are those who choose to have reconstruction at the same time as mastectomy, which reduces self-esteem issues.

Treat yourself.

This is the time to celebrate the amazing, unique woman you are. Be kind to yourself, and treat yourself to what you desire as often as you can. Travel, go shopping, and pursue those dreams.

If you’re a survivor, what advice can you give?

Breast’s Anatomy: What Makes Up a Breast?

Image to the left taken from

Breasts are milk-producing (mammary) glands surrounded by fat and are attached to the front of the chest by ligaments. The breast rests on the pectoralis major chest muscle, but has no muscle tissue itself. The fat in the breasts determines their shape and size, which varies among women even though the size of the mammary gland system is relatively standard. In addition, women commonly have one breast that is larger than the other.

Breasts begin developing between the ages of 9 and 14 for most girls, and signal the start of puberty. Breast tissue is highly sensitive to the hormones estrogen, progesterone, and prolactin throughout the menstrual cycle. While breastfeeding, prolactin triggers milk production within the breast, and its anatomy is simple yet complex.

Lobules, Alveoli, and Ducts

Breasts have 15 to 20 sections known as lobes or lobules that converge at the nipple. Each lobule consists of hollow sacs called alveoli, and the lobules are connected through ducts. The final collection area for milk is known as the main duct.

During breastfeeding, prolactin stimulates the alveoli to pull nutrients from the woman’s blood to produce breast milk, and oxytocin causes the alveoli to release the milk through the mammary ducts to the nipple.


Also known as the mammary papilla, the nipple is the outlet for the mammary ducts and where milk is secreted.


Often included when referring to the nipple, the areola is the round pigmented area surrounding the nipple. During breastfeeding, small bumps on the areola known as Montgomery glands produce an oily substance that cleans and lubricates the nipple.

Lymph Nodes and Ducts

The lymphatic system helps fight infection by capturing and excreting pathogens and toxins through lymph nodes and ducts. These nodes are found near the breast, in the armpit, and behind the breastbone. Often, axillary (armpit) lymph nodes are removed during mastectomy.

Cooper’s Ligament

This ligament is often called “nature’s bra” because it lifts the breast and prevents it from sagging.

For a slideshow on breast anatomy, visit

Have questions about breast cancer? Visit our blog’s Ask the Doctor section.

Do You Know Your Breast Reconstruction Options?

breast reconstruction optionsWe’re thrilled to share some exciting news with you, today! Dr. Richard Kline, Charleston breast surgeon, and the lovely Leslie Haywood, owner of Grill Charms™ and breast cancer survivor, were recently interviewed on one of our local Charleston news channels. During this interview, Leslie shares her inspirational story of breast cancer survival and how she chose to have the breast surgeons of The Center for Natural Breast Reconstruction perform her natural breast reconstruction.

Dr. Richard Kline of The Center for Natural Breast Reconstruction spoke about breast reconstruction options for women who are currently undergoing treatment for breast cancer or who have had a mastectomy.

See below for the interview:

If you want to learn even more about Leslie Haywood’s story (and get a chuckle from her hilarious narrative), click here to view one of our recent blog interviews with her.

For those of you who aren’t aware of The Center for Natural Breast Reconstruction and what we do, here’s a brief description:

Charleston plastic surgeons Dr. James Craigie and Dr. Richard Kline specialize in breast reconstruction for women who have undergone mastectomy and those who are considering risk reducing prophylactic surgery. Some of the procedures performed by these Charleston breast surgeons include DIEP, SIEA, and GAP free flap breast reconstruction, which utilize your own tissue with no implants and no muscle sacrifice.

Our Charleston breast surgeons also perform nipple sparing mastectomy, reconstruction after lumpectomy, microsurgical breast reconstruction, and breast restoration. Visit The Center for Natural Breast Reconstruction website at

Your Questions About Breast Reconstruction Answered

nipple sparing mastectomyThe questions below are answered by the breast reconstruction surgeons of The Center for Natural Breast Reconstruction, Dr. James Craigie and Dr. Richard Kline:

If a woman has flap reconstruction, are the nipples reconstructed at the same time or at a later date?

While it is sometimes possible to reconstruct the nipples at the same time, usually for various reasons it is preferable to delay the nipple reconstruction until a later time. Nipples must be positioned very carefully to look their best, and that means the final shape of the breast mound must be stable prior to choosing the nipple position. Tissue flaps must be carefully monitored for several days following the initial reconstruction to assure early detection of any problems, and temporarily leaving extra flap skin on the breast mound helps greatly with this. Additionally, FWIW, the skin that the nipples are reconstructed from, whether flap skin or native breast skin, frequently has no sensation, making it even easier to reconstruct the nipples as a small procedure in the office.

If a woman is a candidate for a nipple-sparing mastectomy, can she have flap reconstruction and retain her nipples?

Yes, in many cases. Problems arise when the breasts are very “ptotic” (droopy), especially if the flaps cannot be made as large as the breast tissue that was removed. The nipples can often be saved even in this situation with special techniques (examples include performing a delayed breast lift some months after flap reconstruction with the flap nourishing the nipple, or, in the case of a prophylactic mastectomy, having a breast lift or reduction some months before the mastectomy), but the overall reconstruction is more complicated and prolonged.

Can you explain what you mean by a muscle-sparing free flap breast reconstruction?

“Muscle-sparing” simply means that NO MUSCLE TISSUE at all is removed. This does not necessarily mean that the muscle suffers no injury, as the blood vessels which nourish the flap usually must be removed from the muscle, but the amount of damage is commonly small enough that the muscle ultimately recovers its function.

What are some criteria that may disqualify a patient for breast reconstruction?

Any serious medical conditions which would prevent a patient from tolerating 4-8 hours of general anesthesia would prevent her from having flap reconstruction. Some medical conditions, such as diabetes, increase various risks (in particular, risks of wound healing problems), but do not disqualify the patient from having reconstruction. We do not perform reconstruction on patients who are currently cigarette smokers (or use nicotine in any form) because nicotine’s effects on wound healing after flap surgery is frequently catastrophic. However, most patients will clear all nicotine form their system after a month’s abstinence. Some very slender patients do not have enough donor tissue anywhere on their bodies for flap reconstruction, but this is quite uncommon.

For more information on breast reconstruction, visit our website.

How One Cancer Survivor Embraces Life After Cancer

Debbie Woodbury

Debbie Woodbury

We are not only delighted, but we are also extremely honored to introduce our In Her Words guest blogger for today, Debbie Woodbury. As a cancer survivor, blogger, speaker, and advocate, Debbie has become an inspiration to all women—no matter their age or health history. In our interview with Debbie, she talks about her amazing blog, Where We Go Now, and discusses the benefits she, as well as her loyal readers, receive from reading her blog.

See below for our exclusive interview with Debbie:

1. Where We Go Now is a completely unique blog that acts like a community and resource for women. Who is Where We Go Now for and what benefits do you hope readers get from visiting your blog?

Thank you so much for inviting me to lend my voice to In Her was created for cancer survivors exploring the gifts and losses of life beyond cancer. The idea for the site came from my own journey. About nine months after my mastectomy, I startled to realize I was keeping a tally in my head of the changes cancer was bringing me. Although I was excruciatingly aware of the losses, I was begrudgingly recognizing gifts. When I could ignore the gifts no longer, I decided to write them down side by side with the losses.

The losses were obvious, but there were a surprising number of gifts. Introspection, closer relationships, discovering yoga and meditation, making new friends, becoming aware of the present moment, learning to say “yes” to myself, and writing—just to name a few.

That list is now the heart of We’ve all taken major, earth-shattering losses, but I hope readers visiting are inspired to recognize cancer’s gifts in their own lives. The most beautiful entries readers have posted are found at the Community Gifts and Losses List page. My Gifts and Losses List helped me find emotional healing and balance after cancer and I hope readers visiting receive the same benefit.

2. What benefits do you receive from blogging about your life after cancer? (i.e. clarity, joy in helping others, etc.)

With each blog post I write, I still manage to surprise myself by writing down a thought I didn’t know I had until it hit the screen. Blogging brings me a deeper understanding of what I went through, and continue to experience, because of cancer.

Blogging also taught me that survivorship is a multi-faceted, life-long journey. I’ve blogged about my “beautiful,” eloquent cancer scars; yoga; how giving back to others helped me heal from cancer depression; awful summers and moving beyond them; my first survivors’ walk, the best thing anyone ever said to me about my cancer, and so much more.

Of all the posts I’ve written so far, however, I probably learned the most from the one I wrote about gratitude. I learned in writing that post, which I also gave as a speech, that I never would have recognized cancer’s gifts without gratitude, cancer’s first and most important gift to me.

The most wonderful part of blogging is getting comments back from my readers. It’s so gratifying to know my experiences have struck a chord with other survivors and perhaps made a difference in how they approach their survivorship. I will never say that cancer itself is a gift, because it is not. But recognizing the gifts it brought and continues to bring into my life is very healing for me.

Stay tuned for Part II of our interview with Debbie, which will publish this Wednesday, August 10!

About Debbie Woodbury:

Debbie Woodbury is a cancer survivor, blogger, speaker, and advocate. She entered the diagnostic and treatment phases of breast cancer in 2008. When she completed treatment in 2009, she was left to deal with cancer’s emotional impact. With the support of family, friends, and wonderful oncology therapists, she was able to create her Gifts and Losses List and eventually realize that “Survival > Existence.” The Gifts and Losses List became the heart of, a community of survivors sharing the gifts and losses of lives lived beyond cancer.

Connect with Debbie on Twitter and Facebook.

4 Must-Try Outdoor Activities

outdoor fitnessExercise can be a dirty word, so we prefer to talk about being active. When you’re active, you’re doing things you enjoy, so it doesn’t feel like a chore. During the summer, you have a wide range of outdoor options to have fun, keep your weight down, elevate your mood, and get some fresh air. We’ve discovered a few outdoor activities you might like to try . . .


A highly enjoyable water sport, kayaking is similar to canoeing, but a kayak typically has a closed deck. The kayaker sits with legs in front and uses a double-bladed paddle. Any body of water, from a river to an ocean, is suitable for kayaking. If you like excitement, kayaking down swift-moving rivers, waterfalls, and rapids—also known as whitewater kayaking—is for you.

Kayaking works most of the muscles of the body, especially the torso and arms. You can certainly purchase everything you need to kayak, but kayaking companies will also outfit you on a rental basis.


Another water sport, surfing has always been synonymous with ocean waves, but it can be done anywhere waves occur, such as lakes or rivers. The surfer rides a surfboard, a 5-foot or longer flat platform, and maneuvers the board toward a wave hoping it will carry him or her forward, called catching the wave. Once the surfer has caught the wave, he or she stands up on the board to ride the wave. Surfing takes patience and practice.

Surfing works all the major muscle groups, especially the muscles of your upper body while catching the wave, and the muscles of your core, legs, and buttocks while riding the wave. The only equipment you need is a surfboard, which may be purchased or rented.


Similar to surfing, paddleboarders ride a board, but instead of catching waves far from shore, the rider stays nearer to shore, sits or kneels on the board, and uses a swimming motion or an oar to move the board. Variations including paddle surfing and doing yoga on the paddleboard make this sport fun and accessible for almost anyone.

Like kayaking and surfing, paddleboarding is a full-body workout and is an excellent cardiovascular activity. Paddleboards tend to be longer than most surfboards, up to 15 feet or more, and can be purchased or rented.


For those who prefer dry land or exploring, hiking offers a fun way to stay active and see the outdoors. Most serious hikers are environmentally conscious, and they walk trails in mountainous or hilly areas. Hikers receive a double benefit: exhilarating activity and incredible views. Many people get away from the hustle and bustle of their lives by hiking, and they enjoy the peace of being one with nature.

Hiking works most major muscle groups, and the higher hikers climb, the better workout they get. Equipment is simple: good hiking boots, thick socks, protective clothing, and a backpack stocked with food, water, a compass, and a map of the area. If the hike is going to be longer than a few hours or in areas without trails, the hikers should have other essentials such as a knife, fire starter, flashlight, and GPS device.

Have you tried any of these activities, and did you enjoy them? Any tips for the rest of us?