THE HOUSTON CHRONICLE – AUGUST 27, 2008
HOSPITAL OFFERS RECONSTRUCTIVE SURGERY FOR CANCER PATIENTS
The DIEP flap, or Deep Inferior Epigastric Perforator, is a reconstructive breast surgery for cancer patients who have undergone a mastectomy or lumpectomy. The procedure, covered by insurance, removes the extra skin and flesh from the lower abdomen and transplants it to the chest cavity, creating a new breast. Instead of implants, which may have to be replaced and can become hard over time, the DIEP flap surgery gives patients a new breast made from their own flesh, meaning it will be soft and supple.
Before Janet Gail Mills of The Woodlands had a mastectomy that removed a cancerous tumor and her right breast, she knew it was only a matter of time before doctors could build her a new one. Diagnosed with lobular cancer in March 2007 after finding a lump in her breast, Mills said the disease took her by surprise. “I didn’t have a family history,” she said. “But I actually had two tumors.” Once she began treatment Mills learned surgeons would need to take so much of the breast tissue to remove the cancer that a mastectomy was unavoidable.
After four and half months of chemotherapy, the cancerous breast was removed and Dr. Bob Basu, a plastic surgeon, placed an expander, an implant, inside the remaining tissue to keep the breast shape and elasticity while she underwent weeks of radiation treatment. “The expander saves the skin tissue because otherwise the skin just shrivels up,” Mills said. Basu practices breast reconstruction, a small field dedicated to rebuilding the breasts of cancer survivors using their own tissue. Known as a DIEP flap, or Deep Inferior Epigastric Perforator, the six to eight hour surgery removes extra skin and flesh from the lower abdomen and transplants it to create a new, supple breast that results in a combination breast reconstruction and modified tummy tuck. The procedure is covered by insurance.
“Most people think plastic surgery is just cosmetics,” Basu said. “That’s part of it, but there are a lot of things about plastic surgery, especially reconstruction, that help in integrated care programs.” Trained at Baylor University, Basu began performing the complicated surgery at the Texas Medical Center and only recently branched out to offer the procedure at Memorial Hermann The Woodlands Hospital, where he has a large patient base. “Patients have the medical center option, but didn’t want to make the drive,” he said. “It made sense to move the program to The Woodlands Hospital. If you can get MD Anderson level of care close to home, then patients can make good decisions for themselves.”
While Basu still advocates implants for some patients, women like Mills who have radiation as part of their cancer treatment can develop hard tissue around the implant, causing the breast to become hard and painful. “Implants, although safe, our philosophy is implants and radiation don’t mix. It can trigger a lot of scarring,” Basu said. “The belly is a great transplant site with soft, supple flesh. Because Ms. Mill’s implant was radiated, it started becoming hard and needed to come out.” The DIEP flap surgery, introduced in the late 1990s, has become more well-known in the last years.
The first version, a TRAM procedure, or transverse rectus abdominis myocutaneous, removed not only the extra fatty tissue and skin from the abdomen, but also part of the abdominal muscle, which would leave patients with weakened abdominal walls and an increased risk of hernias or bulging. The DIEP flap surgery leaves the muscles intact. Most of Basu’s breast cancer patients are in their 40s. “It’s not a 60-plus disease anymore. We’re seeing patients from 30 to 55, with the youngest at 23,” he said. Mills, Basu’s first patient to undergo the surgery at Memorial Hermann The Woodlands Hospital, spent eight-and-a-half hours under the knife while Basu and his surgery partner, Dr. Sugene Kim, performed microvascular surgery under a high-powered microscope to connect the chest cavity blood vessels with the transplanted flesh.
“It wasn’t easy, not having a choice. I think all of it has been a hard road at times. I’ve been through chemo, gone through mastectomy, it’s almost just another step in the process. Nothing is easy about cancer, the word itself is kind of disturbing.” The outcome is more than Mills hoped for. “It’s a big deal for me to just be able to say I was the first, and it’s so nice to drive 10 minutes and be home from the hospital,” Mills said. “It’s amazing that they can do that. To be able to take a breast that’s been removed and have something hard in there and now be back to soft tissue. It’s given me back a breast of my own.”
Mills said she’s looking at the surgery as the positive side of cancer with a new breast and a flat stomach after three children. While in the hospital, nurses checked the blood flow to her new breast with a monitor on a regular basis. “Whenever they hooked it up to hear the heartbeat, that was as exciting as when I had my kids, hearing that blood flow and knowing there was new life there,” she said. Part of Basu’s practice is educating patients about their options.
Basu said according to a medical study, one third of women were never told reconstruction was available and it covered by insurance. “Even five, ten years later you can say, I’m ready now,” Basu said. “Even patients who had a mastectomy a decade ago. This is not something the average plastic surgeon does,” he said. It’s a lot of work with long cases and surgeries. You have to want to do it. And you can’t just set this up in any hospital. I don’t think this will ever be commonly performed because of the complexity and training, but hopefully we can improve awareness. This is an option.”