Breast reconstruction restores sense of femininity

BREAST RECONSTRUCTI RESTORI

“Besides helping patients choose their most viable option for reconstruction, we must work closely with their oncologists to determine when reconstruction is best for each individual.”

NG Self-esteem toBreast Cancer Survivors

BY AMI FELKER

Each year, physicians and scientists reach significant milestones in the treatments and causes of breast cancer. At The Methodist Hospital, patients are undergoing state-of-the-art diagnoses and cutting-edge treatments that beat the cancer and reconstructive procedures that restore their sense of femininity and self-esteem.

“With new techniques and a better understanding of breast cancer, there is a gamut of ways to reconstruct breasts after mastectomies,” said Dr. Robert Weimer, reconstructive surgeon at Methodist. “Surgeons and patients now have options when choosing what is best for the patient.”

Weimer, and his partner Dr. David Lee, typically perform three types of traditional breast restorations — skin expansion, latissimus dorsi flap and the flap from the abdominal area.

In some women, a simple skin expansion is used, in which the surgeons insert a skin expander for a short period of time, replaced by a breast implant later. “This outpatient procedure is a very safe alternative and requires much less recovery time,” Lee said.

For many patients, surgeons prefer to use flaps, in which the muscle and tissue on a woman’s upper back or abdominal area is transferred to her chest in order to build a breast mound. “Our goal, as far as restoration is concerned, is get a nice breast mound to work with. The rest —

Dr. David Lee

perfect symmetry, nipple restoration — is icing on the cake,” Weimer said.

“Besides helping patients choose their most viable option for reconstruction, we must work closely with their oncologists to determine when reconstruction is best for each individual,” Lee said. “Radiation can be detrimental to the restoration process, so we want our patients to beat the cancer before we begin reconstruction.”

“Lynette Jupp was completely shaken when doctors found a lump in her left breast in 2004. Not long after her mother, niece and cousin’s diagnoses, Jupp was diagnosed with breast cancer at 54. Tragically, after a lumpectomy and radiation treatments, a followup mammogram at Methodist in August 2005 still showed three suspicious spots in Jupp’s left breast and two in her right. “I could see the mass on the films because it was magnified,” she said. “All I could think was ‘get this out of me.’”

Three months later, Jupp underwent bilateral mastectomies at Methodist, and at the same time, began a three-step restoration process that is only offered at a handful of specialized centers around the country.

“We are essentially rebuilding the patient’s breast with her own tissue, and giving her a tummy tuck at the same time,” said Dr. Aldona Spiegel, who specializes in microsurgical muscle-preserving procedures for breast restoration. “The results have been phenomenal.” Spiegel, who is director of the Center for Breast Restoration at The Methodist Hospital, said it is also possible to restore sensation.

Spiegel usually performs breast reconstruction in a three-stage process. The first step is a tissue transfer that can be performed at the same time as a mastectomy, or in patients who already had a mastectomy. A general surgeon removes the nipple and the cancerous tissue from the breast, leaving only the breast skin.

Coinciding with this, Spiegel uses microsurgical techniques to carefully separate the fatty tissue and blood vessels from the abdominal area, while preserving the muscular integrity of the abdominal wall.

Once the general surgeon has removed the cancerous tissue from the breast, Spiegel transfers the abdominal tissue to the breast area, where the small blood vessels and nerves are microsurgically connected. The abdominal tissue is used to restore the volume of the breast and the abdominal skin is used to restore the areola (area around the nipple).

After three to four months of healing, Spiegel performs a second outpatient surgery, in which she sculpts the tissue to establish more symmetry — assuring that both breasts are equal in size, shape and appearance.

Three months later, in an officebased procedure, she reconstructs the nipple using skin from the original surgery. To complete the reconstruction, the patient’s nipples are tattooed a natural color, and within just one year of being diagnosed with breast cancer, her breasts are fully restored.

“I wouldn’t trade my surgery for the world,” said Jupp, who will soon undergo the second step of the reconstructive process. “Amazingly, I still have some of the same sensation in my breasts that I felt before the breast cancer.” With the cancer behind her, she has taken an active role in assuring that all women are educated about the dangers of breast cancer and the options for screening. As a mother and grandmother, she currently is researching genetic counseling to assure her daughter and granddaughters are well cared for in the future.

Genetic counseling can help determine the likelihood that a patient could have familial breast cancer. Further genetic testing determines if the patient has a specific mutation in her DNA, which could mean up to an 80 percent chance of developing breast cancer.

“I promised my kids that I will provide them with all the education and screening I can find,” she said. “I want them to have every opportunity to find anything suspicious and take care of it before it becomes a problem.”