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

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