This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions. Q: I had a lumpectomy and radiation in 2004. The defect in my breast is increasingly more noticeable (clothed) than in the past. Now, I'm interested in reconstruction to improve shape & size of my breast. Do you have any advice? A: Lumpectomy defects can be challenging, for several reasons. Firstly, the tissue is radiated, which of course makes ANYTHING less likely to work. Secondly, there is no really satisfactory way to reliably replace the volume that was lost, precisely where you want it. Sometimes a small implant can be helpful, but not always. If the defect is large enough, a microvascular flap of the type we do can be used, but often this seems like overkill for the size of the defect. Free fat grafting (sucking fat from elsewhere and injecting it into the breast) might be as close to an ideal solution as possible, and some surgeons do it currently, but it has not been established with certainty that this does not increase the chance of cancer recurrence, so we are holding off on that procedure until more evidence is in. In many lumpectomy / radiation breasts the entire breast envelope, including the skin, has shrunken significantly. This often presents the option of re-arranging (with surgery) the remaining breast tissue to improve the shape, then subsequently lifting or reducing the other side to match as closely as possible. Hope this helps. If you’d like to send pictures, I can possibly give you more specific suggestions. If you’d to speak with our nurse Chris or PA Kim to give them more information, they’d be happy to give you a call. Dr. Richard Kline Center for Natural Breast ReconstructionHave a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!