PARTIAL BREAST RECONSTRUCTION
Each year, close to 94,000 women are candidates for a lumpectomy to remove the small cancerous masses in their breast. While the procedure is less severe than a mastectomy, women could be left with a defect. Reconstruction has long been a very involved procedure because implants didn't fit the shape of the breast. Now, doctors have a better option.
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Two years ago, Penny Pavlica thought she was having surgery to remove a cyst.
Penny Pavlica
Had breast cancer
"Well, when they went in to remove the cyst, they found cancer underneath it."
Doctors performed a lumpectomy. It's considered a breast-conserving procedure, but shrinkage and tightness from radiation can cause significant deformity.
Aldona Spiegel, M.D.
Plastic Surgeon
Baylor College of Medicine
Houston, TX
"I find that women that have a significant deformity after breast conservation are equal to women that have had a complete mastectomy in the way they feel about themselves."
The unusual shape of the missing area and skin make an implant impractical, so Doctor Spiegel offers women another option.
Aldona Spiegel, M.D.
"We're essentially using the skin and the fat from the abdominal area and matching it to whatever is required to reconstruct the area where the tumor was taken from."
Doctor Spiegel says, unlike other reconstruction procedures, this procedure leaves the abdomen muscles intact.
Aldona Spiegel, M.D.
"We're climbing and trying to strive for a minimally-invasive surgery with the best benefit and the least loss of function."
Less cutting also means faster recovery. Most patients are back to regular activities in four weeks. Penny went back to running in just five weeks, and today, only has one regret.
Penny Pavlica
"I wish that I would not have waited a year to have it done."
Doctor Spiegel says, because this is such a delicate procedure, it takes longer than other reconstruction surgeries. Also, women need enough excess tissue in the abdomen for the procedure to be performed. Doctor Spiegel says about 70 percent of her patients are candidates.
BACKGROUND: Any form of surgery that removes only part of the breast is considered "breast-
conserving" or "breast preservation" surgery. One type of breast conserving surgery is a lumpectomy. Each year, close to 94,000 women are candidates for a lumpectomy. Technically, a lumpectomy is a partial mastectomy, because part of the breast is removed. But how much of the breast is removed can vary greatly. The surgeon removes only the part of the breast containing the tumor and some of the normal tissue that surrounds it. All the tissue removed from the breast is examined carefully to see if cancer cells are present in the normal tissue surrounding the tumor. Most women receive five to seven weeks of radiation therapy after lumpectomy, in order to eliminate any cancer cells that may be present in the remaining breast tissue. While a lumpectomy is less severe than a mastectomy, a woman can be left disfigured, which can affect her psychologically. Additionally, the way the procedure is done, including the follow up radiation, can cause skin to shrink and make the arm lose some function.
RECONSTRUCTION IN THE PAST: For a long time, reconstruction after a lumpectomy was hard to do.Reconstructive surgeon, Aldona Spiegel, M.D., from Baylor College of Medicine, says, "Essentially, if you can imagine a third of the breast being gone, and in order to replace that after radiation, you are missing two things. You are missing volume and you are missing some of the skin that has shrunk with the radiation. There is the possibility of using an implant, but that's difficult because you would have to have a custom-made implant to fit exactly what the defect is, and that is not possible." Now, doctors have developed ways to use the patient's own tissue to reconstruct the breast.
DIEP FLAP: One type of surgery is called the DIEP flap, or the Deep Inferior Epigastric Perforator Flap. It uses excess abdominal skin and fat from the lower part of the abdomen. The vessels that supply blood flow to the flap are separated from the abdominal muscles, which are left completely preserved. The benefits of the procedure include: soft reconstruction, complete preservation of abdominal muscles, minimally invasive, and it has the potential for restoration of normal sensation.
SIEA: Another type of partial reconstruction that uses the patient's own tissues is known as the SIEA flap, or the Superficial Inferior Epigastric Artery flap. It uses small vessels for blood supply that go through the fatty layer just below the skin of the abdomen. In some women, these vessels are adequate for use in reconstruction, and therefore the surgical dissection is even shallower than the DIEP flap. In this procedure, as in the DIEP flap, the muscle is completely preserved. This procedure also offers the potential for restoration of normal sensation.
Anissa Orr
Communications Specialist
Baylor College of Medicine
anissaa@bcm.tmc.edu
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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