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

Q: I had a lumpectomy followed by chemo and radiation treatment. The tumor was on the inner edge of my left breast — basically skin and bone. My plastic surgeon (whom I respect and appreciate) used an implant and Neulasta. He formed a sling and sewed in to my sternum and ribs. I’ve had this procedure done twice. Each time the sutures were absorbed, the skin lifted and resulted in symmastia. I am wondering if non-dissolvable stitches along with sewing the neulasta to the area behind my breast which wasn’t super blasted  — forming a sort of “sail” would be an option. I would be interested in what you think and what solution you might have.

Thank you for your time!

A: We primarily do flap, not implant reconstruction, but I can still offer some insight.

Permanent sutures could possibly help, but if there is long-term significant force on them (which it sounds like there may be), they can work their way through soft tissue and still come loose (just like an orthodontist can move teeth through bone over long time periods). Nonetheless, it’s probably worth a try, especially if you liked the way your breast looked before the sutures dissolved.

There are also some potential options using your own tissue. Unfortunately, replacing the defect with free fat grafts, while technically straightforward, is a little controversial, as there is some concern that this could increase the risk of local recurrence (but this is far from definitively established). There are centers (one in Boston comes to mind) who are doing this as part of a controlled study. Also, depending on the size of the defect and the location of your scars, reconstruction with a small microsurgical flap might be a reasonable (although significantly more complicated) option.

It sounds like you have a good relationship with your surgeon, which is great. Please continue to share your thoughts with him, and I’m confident things will work out for you one way or another.

Dr. Richard Kline

Center for Natural Breast Reconstruction

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