Dr. Manish Champaneria performs breast reconstruction surgery, which can be seen in the reflection of his glasses, on a patient Sept. 12 at PeaceHealth Southwest Medical Center in Vancouver. The microsurgical reconstruction procedure, called deep inferior epigastric perforator flap, uses tissue from the abdomen to reconstruct the breast after a mastectomy. (Natalie Behring for the Columbian)Photo Gallery
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.”
Breast Cancer Awareness
Each year, more than 200,000 women in the U.S. are diagnosed with breast cancer, including thousands of women in Washington. In honor of their fight — and as part of National Breast Cancer Awareness Month — The Columbian published a collection of stories about the women who have received breast cancer diagnoses, the science and technological advances for treating them, and the community that supports them. The rest of the stories are here at Columbian.com and in a special section, Confronting Breast Cancer, that can be found in today's print edition.
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 Cadillac breast reconstruction,” Champaneria said.
But not everyone is a good candidate for the procedure.
People who have had a previous tummy tuck or other extensive abdominal surgery cannot have the surgery because their blood vessels are typically damaged. People who are medically unhealthy, morbidly obese or who have clotting or bleeding disorders are also not good candidates, Champaneria said.
The procedure has evolved since it was first introduced in the early- to mid-1990s, Champaneria said. But until two years ago, when Champaneria joined the PeaceHealth practice, the procedure wasn’t available in Clark County.
Follow-up procedures
After Lytle’s reconstruction surgery in February, she returned in April for a matching procedure. During that surgery, Champaneria reduced the size of Lytle’s left breast. He took some of the fat removed from the left breast and put it in her reconstructed right breast to give it more volume and shape. In July, Lytle underwent the final stage of the reconstruction process, nipple reconstruction.
“I’m so happy,” Lytle said.
After the cancer diagnosis and subsequent mastectomy, Lytle had struggled with looking in the mirror and seeing a missing breast.
“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.
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