LEADING MEDICINE SP R I NG /SUM M ER 2022
Fighting Cancer with Your Fork
Defend Yourself Against Colorectal Cancer When Is the Right Time for
JOINT
REPLACEMENT?
YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN EAST HOUSTON/BAYTOWN
IN THIS ISSUE - SPRING-SUMMER 2022
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Wound Care A range of specialized wound care treatments can help heal chronic wounds and prevent serious complications. Fighting Cancer with Your Fork Learn how plant-based and antioxidant-rich foods can provide some protection against cancer. When Is the Right Time for Joint Replacement? Discover your path to treatment for joint pain. Defend Yourself Against Colorectal Cancer Take steps in your daily life to prevent colorectal cancer, from eating a healthy diet and exercising regularly to quitting smoking and controlling your weight.
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Could It Be Gallstones? A gallbladder attack can happen when you're least expecting it. Know what to watch for and how to prevent gallstones. Living with Valve Disease: Protect Your Heart Working closely with your doctor to manage valve disease can help you feel better and reduce the risks to your heart. Exploring Reconstructive Surgery Options After Mastectomy Learn about the timing of breast reconstructive surgery and new techniques that allow surgeons to transplant tissue from another part of the body to the mastectomy site.
NEWS & EVENTS
NEW PATIENT TOWER BRINGS MORE ADVANCED MEDICAL CARE TO THE COMMUNITY
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comprehensive $250 million facilities master plan is underway at Houston Methodist Baytown Hospital to build technologically advanced facilities, renovate existing ones and ensure the hospital continues its mission to provide the most advanced medical care and services to the residents of Baytown and surrounding areas. The five-story patient tower currently under construction is the largest project initiated so far under the plan. This facility will expand capacity and services to the community and will include: New expansive private patient rooms An intensive care unit featuring cutting-edge medical technologies An entire floor dedicated to childbirth and obstetrics services “This new, state-of-the-art facility will further expand Houston Methodist Baytown Hospital’s ability to serve our community and meet the growing demands of Baytown, east Harris, Liberty and Chambers counties,” said Houston Methodist Baytown CEO David Bernard. The tower was preceded by other recent projects, including: A two-story parking garage that created over 700 free spaces for patients, visitors and staff An expanded emergency room project, which added 42 private treatment rooms and numerous technological and infrastructure improvements, the 2 North medical-surgical patient unit, as well as a new level II neonatal intensive care unit (NICU) The Outpatient Center includes the Ambulatory Surgical Center, Houston Methodist Orthopedics & Sports Medicine at Baytown, the Houston Methodist Breast Care Center at Baytown, the Houston Methodist Primary Care Group and Imaging Services
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The renovated Houston Methodist Neal Cancer Center at Baytown offers enhanced cancer care and treatment services, including the addition of 12 private and semiprivate infusion suites A new observation unit that provides patient care, including diagnostics, treatment and monitoring following an emergency department visit “Houston Methodist Baytown always grows with the needs of our community,” Bernard said. “These new facilities allow us to expand our services and continue providing unparalleled safety, quality, service and innovation to our community.”
Learn More For more information on the full range services offered at Houston Methodist Baytown and to schedule an appointment, visit houstonmethodist.org/baytown or call 281.420.2273.
Wound Care Seek Care Now to Avoid Problems Later
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wound, such as a cut, bedsore or surgical incision, can be troublesome for anyone. It may keep you from activities you enjoy for a time or require you to Dr. Jacobo seek help with things Nurko you normally do by yourself. Taking care of any wound is key to healing and getting back to your normal life. But for people with diabetes or other conditions that make healing difficult, proper treatment of a wound can mean the difference between life as they know it and gangrene, amputation or even death.
LOOK FOR THE SIGNS
When a wound has become infected, there may be: Redness, warmth and tenderness around the wound Pus (a yellowish-white fluid coming from the wound, sometimes with a foul odor) Fever If you have any of these symptoms, make an appointment to see your health care provider right away. Other possible complications include infections in your bloodstream and septic shock, a critical illness that can cause organ failure and death.
WHEN IT JUST WON’T HEAL
“Chronic wounds require medical attention,” said Dr. Jacobo Nurko, vascular surgeon and medical director of the Houston Methodist Wound Care and Hyperbaric Medicine Program at Baytown. “It’s important to identify why wounds aren’t healing and treat them effectively. That requires close monitoring and a personalized care plan.” Any open sore needs to be cleaned, and debris, dirt or splinters removed. But if the wound is infected, or just won’t heal, your health care provider may also recommend one or more of the following treatments:
BRUISE CONTROL As you age, your skin thins out and capillaries become more fragile, making bruises more common. Some medicines, such as blood thinners, can also cause you to bruise easily. Most bruises have a predictable pattern: The blemish starts out as a black and blue or purple blob, then turns greenish and fades away in about two weeks. But if you have bruises that won’t heal, develop for no reason, or are unusually large or painful, you could have a blood-clotting disorder or a blood disease. See your health care provider immediately.
Get the Treatment You Need
To learn more about wound care, visit houstonmethodist.org/ wound-care or call 281.425.2160 to schedule an appointment with a wound care specialist with the Houston Methodist Wound Care and Hyperbaric Medicine Program at Baytown.
Dressings. Made of gauze, foam or other materials, special dressings contain antibacterial or antiviral substances. They prevent further injury, protect against germs and infection, and give a wound enough moisture to help it heal. Skin substitutes. People with diabetes may get help for slow-healing wounds from a material made from dissolvable mesh and human cells. It’s placed over the wound, and as it’s slowly absorbed into the body, the human cells replace the damaged tissue in the wound. Hyperbaric therapy. Spending time inside a special chamber, where the oxygen level and air pressure are much higher than you’re used to, helps your blood deliver more oxygen to the wound site. This can speed wound healing. Off-loading. This means keeping pressure off the affected area. If you have diabetes, you may need special footwear or require crutches to stay off a foot wound.
Super-charging your diet. When the body is healing, it needs more protein and vitamins A and C. Get them from lean beef, fish, poultry, low-fat dairy, dark-green leafy vegetables, orange or yellow vegetables, citrus fruits and spinach. Discuss your diet with your health care provider, especially if you have diabetes. Surgery. To remove dead tissue from the wound, your health care provider may perform a procedure called surgical debridement. They'll use a scalpel or other tool to remove damaged, dead or infected tissue. Some patients may need flap reconstruction. In this procedure, a pad of skin or other tissue (usually taken from a patient’s own body) is used to cover the wound. “When a chronic wound gets the treatment it needs, we can get you back to your normal life, free of the worry of serious complications,” said Nurko.
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FIGHTING CANCER WITH YOUR FORK D oes what you eat really make a difference in your risk for cancer? Many experts agree that making better choices about what you put on your plate is one way to protect against the cell changes, or mutations, that can lead to cancer. Although some risks for cancer are out of your control, choosing a healthy diet is one way to take action. Dr. Ugochukwu “A diet rich in fruits and vegetables may help A. Odo protect against some types of cancer,” said Dr. Ugochukwu A. Odo, an oncologist at Houston Methodist Neal Cancer Center at Baytown. “Plant-based foods contain vitamins, minerals and antioxidants that can provide some cancer protection as part of an overall healthy diet.”
YOUR DIET AND CANCER RISK
Antioxidants are important nutrients, such as beta-carotene, lycopene, lutein, and vitamins A, C and E. These healthy nutrients are abundant in fruits, vegetables, nuts and grains. Antioxidants help protect body cells from damage caused by
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LEADING MEDICINE IN EAST HOUSTON/BAYTOWN
unstable molecules, called free radicals. “Free radicals can damage DNA and may play a role in the development of cancer, so we’re looking at how antioxidants may help work against free radicals,” Odo explained. More research is needed to understand the links between diet and cancer, but there’s some evidence to suggest that antioxidants and other nutrients in foods may fight cancer by: Destroying free radicals that damage DNA, which can lead to cancer Helping to eliminate carcinogens (cancer-causing substances) Blocking the activation of carcinogens
SOURCES OF ANTIOXIDANTS
Here’s where you can find antioxidants in foods: Vitamin A: liver, dairy products, eggs and fish liver oil. It’s also converted from carotenoids, found in dark-red, green and yellow vegetables Vitamin C: citrus fruits, tomatoes, peppers, broccoli, leafy vegetables, strawberries and potatoes Vitamin D: milk, cold-water fish, egg yolks and liver
Vitamin E: avocado, coconut or olive oils; sweet potatoes; avocados; nuts; sunflower seeds; and soybeans Allyl sulfides: garlic, onions, shallots, leeks, chives and scallions Carotenoids: apricots, papaya, sweet potatoes, tomatoes, mangoes, carrots, pumpkin, red peppers, spinach, corn and cantaloupe Catechins: green tea and berries Flavonoids: parsley, carrots, citrus fruits, broccoli, cabbage, cucumbers, squash, tomatoes, eggplant, peppers, soybeans and berries Folate: avocados, bananas, orange juice, cold cereal, asparagus, green leafy vegetables, dried beans, peas and yeast Lycopene: cooked tomato products, watermelon and pink grapefruit
CANCER-FIGHTING GROCERY LIST Here’s a list of superfoods for your next grocery trip. Apples
Flaxseed
Peas
Blueberries
Garlic
Squash
Broccoli
Grapefruit
Strawberries
Cherries
Grapes
Tomatoes
Coffee
Green Tea
Walnuts
Cranberries
Kale
Whole Grains
Dry Beans
Lentils
FOODS TO KNOW
Odo recommends eating at least five servings of fruit and vegetables each day. “Try to fill two-thirds of your plate with plant-based foods, and choose a variety of colorful fruits and vegetables,” Odo added. Here are some cancer-fighting foods you may want to add to your shopping cart: Berries — Fruits like strawberries and blueberries are loaded with antioxidants, which have cancer-fighting properties. Tomatoes — Tomatoes are rich in lycopene, a powerful plant compound that may protect against prostate cancer. Whole grains — Whole grains can help reduce your risk of colon cancer. Be sure to check ingredient labels on breads and other grains and look for the words “100% whole grain.” Red-orange fruits and vegetables — Foods, such as butternut squash and sweet potatoes, are rich in beta-carotene which acts as an antioxidant to help protect cells from damage. Coffee — Your morning cup of java contains a variety of plant compounds that may be protective for some cancers. Dark-green leafy vegetables — Kale, spinach, romaine lettuce and other green, leafy vegetables are excellent sources of fiber, lutein and flavonoids. These substances may help protect against mouth, pharynx and larynx cancers. Green tea — Laboratory studies have suggested that green tea may help slow the development of colon, liver, breast and prostate cancers.
FOODS TO LIMIT
Grilled and red meats — Red meat has been linked to colorectal and other cancers. Grilling meat over high heat can additionally form cancer-causing agents. Instead, opt for grilled vegetables, which do not create carcinogens when exposed to high heat.
Focus on Prevention
To schedule a cancer screening appointment and discuss any concerns with a doctor at Houston Methodist Primary Care Group, visit houstonmethodist.org/pcg/baytown or call 832.556.6670. If you or a loved one is diagnosed with cancer, we will assist you in scheduling an appointment with an oncologist at the Houston Methodist Neal Cancer Center at Baytown for next steps and a treatment plan.
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When Is the Right Time for
Joint Replacement? J
oint pain from arthritis can interfere with your everyday activities and limit your ability to work, play and enjoy life. Arthritis is a common problem, and you’ll find a Dr. David Sun multitude of medications and treatments designed to provide relief and improve mobility. But how do you know if the timing is right to get a hip or knee replacement? “It’s time to take action when pain keeps you from the activities you enjoy, whether that’s playing golf, going to a ballgame or walking around the block,” said Dr. David Sun, a board-certified orthopedic surgeon with Houston Methodist Orthopedics & Sports Medicine at Baytown. When knee or hip pain bothers you every day, keeps you awake at night and affects your quality of life, it’s time to see a doctor. Although the decisions and the time frames are different for everyone, the path to treatment usually starts with talking to your primary care doctor or an orthopedic specialist. They can evaluate your joint pain and develop a treatment plan that’s customized for you.
EVALUATING JOINT PAIN
First, you may go through an assessment of pain and discuss your ability to function in everyday activities. Your doctor will order X-rays, do a physical exam and ask questions about your joint pain. Next, they may ask the following questions to evaluate the severity of your condition and determine the next steps: Do you have frequent or intense joint pain with activity? Do you have difficulty walking, standing up or bending over?
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DON’T LET JOINT PAIN SLOW YOU DOWN Are you dealing with joint pain in your daily routine? You don’t have to accept joint pain as part of your life. You have the power to overcome the obstacles standing in your way so you can focus on the benefits of treatment. Break free from limitations and common misconceptions, such as: I’m too young to have joint problems. Reality: It’s not uncommon to have arthritis in your 40s and 50s. Early diagnosis can help provide relief and prevent worse problems from developing in the future. Joint pain is part of aging. Reality: Joint pain is very common, especially as you age, but it doesn’t have to prevent you from doing the things you love. I don’t have time for a long recovery. Reality: Advanced treatment techniques and targeted physical therapy make it possible to recover quickly and return to light activities within a few weeks. Having joint replacement surgery is a decision that can change your life. Choosing the right treatment path can result in decreased pain, better mobility and improved quality of life.
Are you experiencing stiffness and a limited range of motion? Do you have inflammation, stiffness and swelling in the joint? Do you suffer pain while at rest, or does pain keep you up at night? Have you been experiencing symptoms for a long time? Are your symptoms getting worse? Does your pain persist even after taking over-the-counter pain medications? Are you suffering side effects from pain medications?
Is joint pain wearing you down mentally and emotionally?
EXPLORING TREATMENT OPTIONS As a next step, your doctor may recommend conservative and nonsurgical treatments to relieve your joint pain. Medications and steroid injections may help reduce pain. Using a brace or doing physical therapy can help provide stability, build strength and maintain range of motion. Losing extra weight is also very helpful by taking the pressure off your joints. “It’s wise to start with a conservative approach to management of hip and
Make an Appointment knee arthritis, which means trying other treatments before considering surgery,” Sun said. Nonsurgical treatment options are intended to help you stay active and function better with joint pain. However, sometimes they don’t provide enough relief, or they may stop working after a while. Seeing an orthopedic specialist can help you understand all your options, including when to consider joint replacement surgery.
PLANNING YOUR JOINT REPLACEMENT SURGERY
If you’re a candidate for joint replacement surgery, you’ll discuss with your doctor
the next steps involved in planning your surgery. Taking a proactive approach in the weeks and months before surgery can help set you up for a speedy recovery. “When preparing for joint replacement surgery, we focus on education, nutrition, physical therapy, mindfulness training and discussing expectations about pain,” Sun added. Recovery times are different for every patient, but most people go home the same day of surgery and are back to work in six to eight weeks. The bulk of the recovery happens in the first two months after surgery, but it’s common to continue
Take the next step and schedule an evaluation with an orthopedic specialist. Visit houstonmethodist.org/orthopedics or call 281.427.7400 to schedule an appointment.
making progress with strength and mobility up to 12 months after surgery. “We are doing many joint replacements now as same-day discharge, depending on your overall health. This means after surgery, you will be up and walking with physical therapy and back home the same day,” Sun said.
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DEFEND YOURSELF AGAINST
COLORECTAL CANCER
C
ancer of the colon or rectum — commonly called colorectal cancer — is the second-leading cause of cancer-related death. “But, if colorectal cancer is detected early, it has a very high survival rate,” noted Dr. Samir Nath, a gastroenterologist with the Houston Dr. Samir Nath Methodist Gastroenterology Associates at Baytown. “The rate of people being diagnosed with colorectal cancer and death rates for people in the 65-plus age range have been dropping in recent years. However, the number of cases and deaths in younger people is rising.” The American Cancer Society estimates that more than 106,000 cases of colon cancer and almost 45,000 cases of rectal cancer will be diagnosed in 2022. Combined, colon and rectum cancers are expected to cause more than 52,000 fatalities in 2022.
SCREENING IS VITAL
“For cancers such as colorectal cancer that can be detected by screening, getting tested can be lifesaving,” Nath noted. Unfortunately, about 1 in 3 people who should get tested for colorectal cancer have never been screened. “That’s troubling because the risk of developing colorectal cancer increases with age,” said Nath. “In addition, having a family history of the disease, colorectal polyps or inflammatory bowel disease makes the risk of colorectal cancer significant.” Cancer of some other organs may also increase the possibility of colorectal cancer.
OTHER STEPS TO PROTECT YOURSELF
The following lifestyle changes can help prevent the disease: Control weight. Quit smoking. Limit alcohol to one drink daily for women and two for men. Exercise. Eat low-fat meals rich in fruits and vegetables. And don’t overlook dietary fiber. Although the medical consensus on fiber’s ability to fight colorectal cancer has seesawed due to some contradictory findings, the largest study ever undertaken maintains that fiber is indeed a powerful cancer fighter. The 15-year study, ending in 2000, involved nine European countries and 400,000 people. It suggests a high-fiber diet can reduce colorectal cancer risk by 40%.
HOW IT DEVELOPS
Colorectal cancer attacks the large intestine — the long digestive organ that removes solid waste from the body. The majority of colorectal cancers start as polyps. Polyps are visualized as irregularity on the lining of the colon and rectum. Whether a polyp will turn into cancer depends on its type and size. Simply removing them before they become cancerous usually prevents the disease.
FAMILY TIES
With a blood test, doctors can find genes that cause the two inherited colorectal cancers that so far have been identified: Familial adenomatous polyposis, a very rare defect marked by hundreds of rectal polyps that appear in the teenage years. Left untreated, cancer develops in nearly every patient by age 45. Hereditary nonpolyposis colorectal cancer accounts for 10% of colorectal cancer. It’s marked by handfuls of polyps. About 80% of flawed gene carriers develop cancer.
SCREENING FOR CANCER
Schedule Your Screening Today Make an appointment for colorectal cancer screening now. To find a doctor, visit houstonmethodist.org/ spg/gastroenterology/baytown or call 281.422.7970.
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The American Cancer Society recommends one of these screening schedules for most people ages 45 and older (up to age 75): A yearly fecal occult blood test or fecal immunochemical test A stool DNA test as recommended by your doctor A sigmoidoscopy every five years A barium enema every five years A colonoscopy every 10 years A CT colonography (virtual colonoscopy) every five years In addition, you should report any of these symptoms to your doctor: Changes in bowel habits Bright-red or black stool Abdominal pain and cramps Unexplained weight loss Exhaustion
Could It Be GALLSTONES? G
allstones — crystalline structures that vary in size from a grain of sand to a golf ball — generally cause no symptoms. But, if you’ve experienced nausea, Dr. Yassir vomiting, and pain on Ashraf the right side of your abdomen, it could be a gallbladder attack. Your gallbladder is a small pear-shaped organ located under the liver. It stores bile, a substance made by the liver that helps the body digest fat.
WHAT CAUSES GALLSTONES?
“Gallstones may form if digestive fluids, or bile, contain too much cholesterol or too much bilirubin and harden, or when the gallbladder doesn’t empty bile properly or often enough,” explained Dr. Yassir Ashraf, a gastroenterologist-hepatology specialist with Houston Methodist Gastroenterology Associates at Baytown. In many cases, gallstones can remain in the gallbladder undetected. You might learn you have gallstones during an unrelated imaging test. If your gallstones aren’t causing any symptoms, your doctor may recommend leaving them alone.
WHEN TO SEEK TREATMENT
Problems occur when a stone travels from the gallbladder to a nearby bile duct. A stone that blocks the duct can trigger an attack. “A gallbladder attack most likely occurs in the evening after eating a heavy meal and can continue for several hours,” Ashraf added.
It’s important to contact your health care provider once you start having symptoms to avoid complications. You may be referred to a gastroenterologist or surgeon to treat your condition. Surgery to remove the gallbladder, called cholecystectomy, is one of the most common procedures to treat gallstones. Fortunately, people can live normally without their gallbladder. Surgeons perform two types of cholecystectomy: Laparoscopic cholecystectomy is a minimally invasive procedure that requires only one or several small incisions in the abdomen to remove the gallbladder. Surgeons may perform robotic-assisted surgery using the da Vinci® Surgical System. “These instruments give the surgeon greater control and precision. They also offer an enhanced 3D view inside the body,” Ashraf noted. “A patient can often go home the same day.” Open cholecystectomy is performed using one large incision. Your surgeon will use this approach if your gallbladder is extremely irritated, infected or damaged from previous operations. You may need to stay in the hospital for several days or up to a week.
Nonsurgical treatments are only used in situations when surgery is not an option. These include: Oral medications can dissolve certain types of gallstones. Endoscopic retrograde cholangiopancreatography (ERCP) uses X-rays and a thin, tube-like device, called an endoscope, to locate and remove a stone that’s stuck in a bile duct. Lithotripsy uses shock waves to break up stones.
PREVENT GALLSTONES
Making the following lifestyle changes can help you avoid gallstones: Eat a healthy diet consisting of whole grains, fruits and vegetables, and healthy fats, such as olive oil. Pass up refined grains, such as white bread, foods that are high in sugar, and unhealthy fats such as cholesterol and transfat, which are often found in prepared foods. Lose weight slowly if you are overweight or obese. Aim for 1 or 2 pounds a week. Losing weight too quickly can lead to gallstones. Get regular physical activity. Aim for at least 30 minutes of moderate-intensity exercise, like brisk walking or bike riding, on most days of the week.
Help for Digestive Problems The gastroenterologists at Houston Methodist Gastroenterology Associates at Baytown specialize in diagnosing and treating gallstones and other digestive disorders. Call 281.422.7970 for more information or to schedule an appointment.
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Living With Valve Disease:
PROTECT YOUR HEART
E
very day, your good health depends on your heart valves opening and closing successfully about 100,000 times. Your heart’s four valves work together to ensure adequate blood flow through the heart and throughout the body. If you have a heart condition that prevents one or more of those valves from functioning properly, this can put Dr. Walter a strain on your heart and cause problems O'Hara with circulation. A narrowing or stiffening of a heart valve can make it harder for the heart to pump blood. Having a leaky valve that doesn’t open and close properly can cause a backward flow of blood called regurgitation. As these problems worsen, the heart may have to work harder to make up for the reduced blood flow. Valve repair or valve replacement surgery may be needed to treat the condition and restore function.
MANAGING HEART VALVE DISEASE
“Valve disease can be caused by infections, heart attacks and other conditions linked to heart disease. Or you can be born with it,” explained Dr. Walter O’Hara, a cardiovascular surgeon at Houston Methodist Heart & Vascular Center at Baytown. “For some people, the condition stays the same throughout their lives and doesn’t cause problems. But for others, heart valve disease slowly worsens. It can put you at an increased risk of developing infective endocarditis, a serious infection that can damage or destroy heart valves.” Fortunately, working closely with your doctor to manage valve disease can help you feel better and reduce the risks to your heart. Here are some key steps to take: Prevent infection. Preventing infection is essential in protecting your heart valves from further damage. Tell your doctor and dentist that you have valve disease, and take antibiotics before any dental procedures, surgeries or invasive tests. Also, be vigilant about taking care of your teeth and gums to prevent infection. Watch for signs of infection. See your doctor if you have any signs or symptoms of an infection, especially if you have a fever, increased heart rate, fatigue, body aches, or a persistent cough or swelling in the feet, legs or abdomen. Take your medications as directed. Your doctor may prescribe medication to treat your valve disease or manage symptoms. It’s important to keep track of your medications and take them as directed by your doctor. Consider having surgery. Your doctor may recommend surgery to fix a valve problem. Surgical options vary based on the type of problem, and may include:
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Keep Your Heart Strong The interventional cardiologists with the Valve Clinic at Houston Methodist DeBakey Heart & Vascular Center at Baytown can help treat and manage your valve disease. Together you can review the actions you can take to reduce complications and live your best life. Call 346.292.1416 or visit houstonmethodist.org/valve-clinic to schedule an appointment with a heart valve disease specialist today.
Annuloplasty — surgical placement of a ring around the valve to make it close tight Balloon valvuloplasty — widening the opening of the valve using a balloon through a catheter Transcatheter aortic valve replacement (TAVR) — replacement of a narrowed or damaged aortic valve See your doctor regularly. Heart valve disease is something you may have to manage for the rest of your life, even after having surgery for valve repair or replacement. “It’s important to have a doctor monitor the progress of your valve disease,” O’Hara said. “You may need regular echocardiography or other tests to keep tabs on it.” Be sure to keep up with your follow-up visits as scheduled.
Exploring Reconstructive Surgery OPTIONS AFTER MASTECTOMY
F
or some women who’ve had (or will have) a mastectomy, reconstructive surgery can help them feel and look better. And that doesn’t necessarily mean Dr. Richard Siy breast implants. Today’s techniques allow surgeons to transplant tissue from another part of the body to the mastectomy site.
THE TRAM AND DIEP FLAP APPROACH
One popular approach uses the abdominal tissue as a transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flap. “During abdominal flap surgery, we take excess skin, fat and sometimes muscle from the abdomen together as a unit, or flap, and transplant it to the chest,” explained Dr. Richard W. Siy, plastic surgeon with Houston Methodist Baytown Hospital. “We reposition it in the mastectomy wound, reconnect its blood supply if needed, and suture it to the edges of the breast incision.” Abdominal-based reconstruction can involve a free flap, in which the the tissue is completely taken off the body and then its blood supply reconnected to blood vessels in the chest. Or, the surgeon can leave one or two stalks of tissue, called pedicles, connected to the original abdominal site to supply blood. In cases when women have too little abdominal fat or too many abdominal scars, doctors may recommend using different flaps from the buttocks, back or thigh tissue. Additional surgeries may be necessary to create a nipple or to refine the results.
When is the right time for reconstructive surgery? Flap surgery can be performed during mastectomy surgery or many years later. It also may be appropriate after a lumpectomy in which the surgeon has removed a large amount of breast tissue. Since the goal is to create a balanced look, a breast lift or a reduction of the healthy breast may also be helpful. Women who have breast reconstruction at the time of the mastectomy may have longer operations and higher risk of woundhealing problems. On the other hand, immediate reconstruction may soften the emotional impact of the mastectomy, limit the total number of surgeries and reduce medical expenses. If you are unsure about reconstructive surgery, it may be better to wait. Additionally, you may need to postpone final reconstructive surgery if you plan to undergo radiation or chemotherapy. Be sure to let your surgeon know if you’re considering future reconstructive surgery. What can I expect? The operation may last from six to eight hours. Hospital stays of up to a week are not uncommon. As with any surgery, swelling, infection or blood clots may occur. Because some abdominal muscle is removed during TRAM flap surgery, weakened abdominal walls may bulge or lead to back pain. For these reasons, some surgeons strengthen the abdominal wall with synthetic mesh during the surgery. How will I look and feel? Your new breast will appear normal under clothing. Often the surgeon can sculpt the tissue to closely match the opposite breast. Outwardly, the new breast may feel natural,
but it will not have the same sensation as your original breast. “Some women recover some feeling, usually beginning about six months after surgery,” Siy said. “Today’s microsurgical tools and techniques allow us to reestablish nerve function in many cases.” Until then, doctors advise extra caution, particularly when sunbathing. Some women have been severely sunburned on the breast and/ or abdomen. What else should I know? Ask your doctor to connect you with the American Cancer Society’s Reach to Recovery program. Through this program, you may talk to someone who had the operation you’re considering. Also, obtain a second surgical opinion if desired and check your insurance coverage. Armed with the facts, you’ll be able to make the best decision for your physical and emotional health.
Explore Your Options To discuss options for reconstructive surgery after a mastectomy or lumpectomy, visit a plastic surgeon with Houston Methodist Baytown Hospital. To make an appointment, call 346.292.1895.
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At Houston Methodist Orthopedics & Sports Medicine at Baytown, we know that joint pain affects every part of your life. With treatment plans customized for you, our specialists offer a full range of advanced nonsurgical and surgical techniques. Our expert joint care includes:
BY CEDAR
GAR
Live life without joint pain.
• Innovative pain control methods • Physical therapy to improve mobility and range of motion • The latest technology, including minimally invasive surgical techniques that help reduce recovery time
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