Natural option for breast cancer patients

After having a cancerous tumor removed from her right breast, Mindy Lytle didn’t want anything foreign in her body.

A mastectomy left the Vancouver woman with uneven breasts — the right side no longer had breast tissue, the left was untouched — but she didn’t like the idea of a breast implant and didn’t want to use a prosthesis.

So Lytle, 55, was relieved to learn she had another option — one that used her own tissue to reconstruct her breast.

“I liked the idea of it being my tissue, aging with me,” Lytle said. “I just wanted it to be me again.”

In February, Lytle underwent deep inferior epigastric perforator, or DIEP, flap breast reconstruction. The procedure takes the DIEP blood vessels, as well as the connected fat and skin, from the abdomen and moves it to the chest to reconstruct the breast.

“I like to say this breast is now full of Blue Star Donuts,” Lytle said.

Meticulous surgery

In the operating room last month, Dr. Manish Champaneria, a plastic surgeon at PeaceHealth Plastic Surgery, performed another DIEP reconstruction. He began the somewhat tedious reconstruction surgery at 8 a.m.

The patient previously had undergone reconstruction surgery with an implant. But the side with the implant was tight and restricted compared with her native breast, so she opted for a DIEP flap procedure.

Champaneria first removed the implant and some of the surrounding tissue, as well as the unhealthy, radiated skin on the woman’s breast. Then, he went to work dissecting the vessels from the woman’s abdomen.

Champaneria made a triangular incision on her belly and, over the course of several hours, worked to detach the skin and fat from the muscle beneath it. Using a felt pen, Champaneria marked the locations of viable vessels on the woman’s skin and, following those markers, carefully disconnected the vessels. He needs at least two large vessels in order to give the transplanted tissue the best chance to survive and remain healthy.

Champaneria then used a microscope to guide him as he connected the vessels in the transplanted tissue to arteries in the chest. After that, he stitched the flap into place. The reconstructed breast was smaller than the native breast, but Champaneria will later liposuction fat from the abdomen into the breast to make them more symmetrical.

Longer recovery

While patients appreciate having an option that uses their own tissue, the reconstruction procedure does come with some drawbacks, Champaneria said. The surgery takes longer than breast reconstruction with an implant, and the recovery is slower.

Reconstructing one breast using the DIEP flap procedure can take eight to 12 hours, and some patients aren’t comfortable with the idea of being under anesthesia that long, Champaneria said. After the surgery, the patient is in the hospital for three to four days and has one-on-one nurse monitoring. The extra time in the hospital is necessary because the blood flow to the transplanted tissue could be damaged — if there’s a kinked or twisted artery, for example — and cause the tissue to die, he said.

“It’s not an easy recovery,” Champaneria said.

Still, patients opt for the DIEP flap procedure for several reasons.

Many times, patients choose it because, like Lytle, they don’t want an implant or the follow-up surgeries and monitoring that comes with breast implants, Champaneria said. And, because the surgery uses tissue and not an implant, the reconstructed breast looks natural, aging with the body and changing size if the patient gains or loses weight, he said.

Another consideration is radiation. The expanders required for implants may not do as well with tight, radiated skin, whereas the DIEP flap procedure replaces the damaged, radiated skin with healthy skin from the abdomen, Champaneria said.

Finally, patients appreciate the aesthetic benefits to their belly; the procedure gives the appearance of a tummy tuck, Champaneria said.

“It’s kind of demoralizing,” she said. “So when I woke up and had a breast — I didn’t cry the whole time — I cried then.”

The reconstruction has helped her to heal, particularly because her new breast was made from her own tissue.

“I’m me again,” she said.