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.

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.