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Plastic surgeons offer microsurgery technique for breast reconstruction, tummy tuck after mastectomy
November 06, 2009Since her teens, Jennifer Jablon had watched family members deal with breast cancer during their 40s, 50s, and 60s. She wondered whether it would be her fate too.
In her mid-50s, Jennifer's mother was diagnosed with breast cancer and tested positive for the recently identified BRCA1 gene, indicating a genetic predisposition to breast cancer.
"I spent about six months in denial after my mom tested positive. When I finally tested myself, I tested positive for the gene," she recalled. During subsequent MRIs, doctors twice found benign cysts, prompting her to seek a prophylactic bilateral mastectomy - a precautionary procedure in which both breasts are removed to minimize the risk of malignancy.
The choice also set her thinking about breast reconstruction options.
The 36-year-old mother of a 7-year-old opted for a relatively new and rare microsurgery by plastic surgeons at
UT Southwestern Medical Center called the Deep Inferior Epigastric Perforator (DIEP) flap procedure.
"The DIEP flap procedure can offer women seeking breast reconstruction after a mastectomy some of the advantages of a more natural breast with the effects of a tummy tuck. Although it is more complex surgery, it preserves muscles for quicker recovery and less postoperative pain," explained Dr. Michel Saint-Cyr, assistant professor of plastic surgery and one of the few surgeons in the nation trained to perform the procedure.
In the DIEP flap procedure, surgeons reconstruct the breast with skin and fat taken from the abdomen. They then individually reattach blood vessels to the relocated tissue under a microscope in a technically challenging procedure.
The procedure can be done immediately after a mastectomy, so patients can have breast tissue removed yet awaken with reconstructed breasts, Dr. Saint-Cyr said.
"The goal was to go to sleep with two and wake up with two," said Ms. Jablon, who underwent the procedure this past spring.
In addition, for many women, the reconstructed breast is firmer, has a more youthful appearance than prior to reconstructive surgery and ages similarly to a natural breast, said Dr. Saint-Cyr, who specializes in breast reconstruction surgery.
To determine whether DIEP flap or other reconstruction options are suitable, Dr. Saint-Cyr recommends that women consult with a board-certified plastic surgeon who has experience with all the available procedures.
"This is a critical life decision, so all options should be on the table. That may not necessarily happen if the physician doesn't have experience in all these procedures," said Dr. Saint-Cyr, who has written numerous papers on the DIEP flap and similar procedures for peer-reviewed journals.
"Due to the complexity of the microsurgery, only about 40 surgeons nationwide routinely perform these types of procedures, so travel may be required for some women to find a surgeon with the needed experience," Dr. Saint-Cyr said.
Procedures such as those used for Ms. Jablon will be discussed Dec. 5 at a seminar hosted by UT Southwestern on "What's New in Breast Reconstruction: Optimizing Results Using a Multidisciplinary Approach." at the Excellence in Education Auditorium in the Simmons Biomedical Research Building, 6000 Harry Hines Blvd., Dallas. Topics at the event, which is open to the public, will include options in breast reconstruction, breast conservation therapy and nipple-sparing mastectomy, and a husband and wife's perspective after breast reconstruction. For more information or to register for the "What's New In Breast Reconstruction seminar, call 214-648-3138, visit www.utsouthwestern.edu/courses or e-mail cmeregistration@utsouthwestern.edu.
Visit www.utsouthwestern.org/plasticsurgery to learn more about UT Southwestern's clinical services in plastic surgery.
The University of Texas Southwestern Medical Center at Dallas
The choice also set her thinking about breast reconstruction options.
The 36-year-old mother of a 7-year-old opted for a relatively new and rare microsurgery by plastic surgeons at
UT Southwestern Medical Center called the Deep Inferior Epigastric Perforator (DIEP) flap procedure.
"The DIEP flap procedure can offer women seeking breast reconstruction after a mastectomy some of the advantages of a more natural breast with the effects of a tummy tuck. Although it is more complex surgery, it preserves muscles for quicker recovery and less postoperative pain," explained Dr. Michel Saint-Cyr, assistant professor of plastic surgery and one of the few surgeons in the nation trained to perform the procedure.
In the DIEP flap procedure, surgeons reconstruct the breast with skin and fat taken from the abdomen. They then individually reattach blood vessels to the relocated tissue under a microscope in a technically challenging procedure.
The procedure can be done immediately after a mastectomy, so patients can have breast tissue removed yet awaken with reconstructed breasts, Dr. Saint-Cyr said.
"The goal was to go to sleep with two and wake up with two," said Ms. Jablon, who underwent the procedure this past spring.
In addition, for many women, the reconstructed breast is firmer, has a more youthful appearance than prior to reconstructive surgery and ages similarly to a natural breast, said Dr. Saint-Cyr, who specializes in breast reconstruction surgery.
To determine whether DIEP flap or other reconstruction options are suitable, Dr. Saint-Cyr recommends that women consult with a board-certified plastic surgeon who has experience with all the available procedures.
"This is a critical life decision, so all options should be on the table. That may not necessarily happen if the physician doesn't have experience in all these procedures," said Dr. Saint-Cyr, who has written numerous papers on the DIEP flap and similar procedures for peer-reviewed journals.
"Due to the complexity of the microsurgery, only about 40 surgeons nationwide routinely perform these types of procedures, so travel may be required for some women to find a surgeon with the needed experience," Dr. Saint-Cyr said.
Procedures such as those used for Ms. Jablon will be discussed Dec. 5 at a seminar hosted by UT Southwestern on "What's New in Breast Reconstruction: Optimizing Results Using a Multidisciplinary Approach." at the Excellence in Education Auditorium in the Simmons Biomedical Research Building, 6000 Harry Hines Blvd., Dallas. Topics at the event, which is open to the public, will include options in breast reconstruction, breast conservation therapy and nipple-sparing mastectomy, and a husband and wife's perspective after breast reconstruction. For more information or to register for the "What's New In Breast Reconstruction seminar, call 214-648-3138, visit www.utsouthwestern.edu/courses or e-mail cmeregistration@utsouthwestern.edu.
Visit www.utsouthwestern.org/plasticsurgery to learn more about UT Southwestern's clinical services in plastic surgery.
The University of Texas Southwestern Medical Center at Dallas
Breast Reconstruction Current Events and Breast Reconstruction News RSSFat injections can improve breast reconstruction -- jury's out on augmentation
Injecting fat after breast reconstruction to correct implant wrinkling or dimpling may be safe and effective to improve breast shape.
98 percent of elective mastectomy patients would have reconstruction again, says ASPS study
Women who have breast reconstruction after an elective mastectomy are satisfied with their decision, have low complication rates and 98 percent would do it again.
Mastectomies on the rise and MRI use may explain part of the trend, say Mayo researchers
The number of women undergoing mastectomy (total breast removal) for early-stage breast cancer has increased in the last three years at Mayo Clinic in Rochester. The increase follows a steady decline during the prior seven years.
Breast Reconstruction Advances Fix Distortions Left by Lumpectomy
Lumpectomy or breast conservation surgery is the most common type of breast cancer surgery currently performed. A benefit of the surgery is that only part of the breast is removed, but a drawback can be the resulting physical appearance of the breast, which may be disfigured, dented or uneven.
Lack of patient-provider discussion contributes to disparities in use of breast reconstruction
In a new study examining disparities in postmastectomy breast reconstruction, researchers at Brigham and Women's Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) in Boston, Mass., concluded that lack of patient-provider discussion may contribute to socioeconomic, age and race-related inconsistencies in the use of breast reconstruction after mastectomy.
Surgical site infections more common than expected following breast procedures
Infections at the incision site occurred in more than 5 percent of patients following breast surgery and cost them more than $4,000 each in hospital-related expenses, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
More Women Are Choosing Double Mastectomy Even When Breast Cancer Is Confined to a Single Breast
Researchers are reporting a 150 percent increase between 1998 and 2003 in American women opting to have both breasts removed when cancer has been found in only one breast-a procedure called contralateral prophylactic mastectomy (CPM).
Fat stem cells being studied as option for breast reconstruction
Breast cancer survivors might one day avoid the prospect of invasive breast reconstruction surgery, opting instead for an approach that would involve using stem cells derived from their own fat.
Breast reconstruction not as safe for obese patients
Significantly obese women may wish to consider delaying breast reconstruction following mastectomy until they achieve a healthier body weight.
One-third of breast cancer patients unhappy with cosmetic outcome of lumpectomy
Women with breast cancer often undergo a lumpectomy and radiation to save their breasts and avoid the need for additional reconstructive surgery.
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