Autologous breast reconstruction — using a patient’s own skin and fat instead of implants — is now an option for breast cancer patients seeking care in Wichita.
Plastic and reconstructive surgeon Mitchell Flurry, MD, joined Via Christi Plastic Surgery & Aesthetics in mid-2015, bringing with him the ability to perform the newest and most advanced type of breast reconstruction: autologous tissue transfer from the abdomen or the thighs to create new breasts.
The most common procedure is the deep inferior epigastric perforator (DIEP) flap, which takes tissue from the abdomen to reconstruct a breast. Other procedures — the profunda artery perforator (PAP) flap and transverse upper gracilis (TUG) flap — take excess skin and fat from the medial thighs. After the tissue is harvested from the donor site, it is placed within the breast pocket created after mastectomy, blood vessels are connected under a microscope, and the tissue is molded into the shape of a breast.
The result is a new breast made of living tissue that looks and feels like a natural breast. As living tissue, the breast adapts naturally as the patient ages and gains or loses weight as the patient does.
Mitchell Flurry, MD, plastic and reconstructive surgeon with Via Christi Plastic Surgery & Aesthetics, speaks with a patient.
Dr. Flurry, who completed a plastic surgery residency at Pennsylvania State University and a breast and microsurgery fellowship at the University of Texas Southwestern Medical Center, has performed more than 150 DIEP flap procedures.
“Microsurgery is only 50 years old and the goal previously was simply to make the tissue live,” Dr. Flurry says. “Techniques have evolved to the point that our success rates are very high, and I can concentrate more on the aesthetic aspects of the reconstruction.”
Early breast reconstruction procedures involved using a patient’s entire rectus muscle, along with surrounding tissue, to craft a new breast in a procedure known as the pedicled transverse rectus abdominis myocutaneous, or TRAM, flap. Because the rectus muscle is removed, patients receiving the TRAM flap are at higher risk for abdominal weakness and hernias.
Through the decades, different autologous procedures have been developed, from a muscle-sparing TRAM procedure that sacrificed just part of the rectus muscle to perforator flaps, where no muscle is taken and vessels are delicately teased out from the surrounding tissue used to supply blood to the flap.
“We can dissect one to five very small vessels of less than 1 millimeter from the rectus abdominis muscle and leave the remainder of the muscle intact,” Dr. Flurry explains. “You won’t have a fascial or a muscle defect.”
With DIEP, women now have a more “elegant, optimal solution with better aesthetic results and fewer donor site complications,” according to breastreconstruction.org.
A Viable Option
In addition to creating a more natural breast made of living tissue, there are other reasons a DIEP procedure may be a more feasible option, Dr. Flurry says, including:
- The procedure can be performed on both breasts. Increasingly, women with cancer in one breast are opting for preventive mastectomies in the other.
- It can be used to create larger breasts than traditional breast reconstruction surgeries, providing naturally larger-chested women with more proportional results.
- The reconstructed breast can more closely mimic the shape of the remaining breast in a unilateral reconstruction.
- It provides younger breast cancer patients with an option that doesn’t require the long-term maintenance of silicone or saline implants.
- It can be a solution for a woman whose prior breast reconstruction has failed, perhaps because of radiation or infection; or for a woman who chose to delay or not pursue reconstruction initially after a mastectomy.
A side benefit to the DIEP, PAP and TUG flaps is that the removal of the tissue from the belly or thighs provides results similar to a tummy tuck or thigh lift.
Achieving successful DIEP outcomes requires a dedicated commitment from the surgeon, hospital and patient and an investment in medical staff, training, equipment and recovery time.
Since arriving at Via Christi following his breast and microsurgery fellowship, Dr. Flurry has provided nursing education about the latest protocols in advanced microsurgery techniques and patient care. He spent significant time and effort to obtain all the instruments, monitoring devices, and staff necessary to have routine success for his patients.
Following a DIEP procedure, the patient spends 72 hours in Via Christi’s ICU, where a ViOptix monitor provides real-time measurement of the oxygen saturation and tissue viability of the flap. The monitor can detect problems well before symptoms are visible to medical staff and notify Dr. Flurry of any flap failure.
“The sooner I can react to the problem, the higher the chance of salvaging the flap,” Dr. Flurry says of the 24/7 monitoring. “I’m notified immediately.”
A ViOptix monitor provides real-time measurement of oxygen saturation and tissue viability of a reconstructed breast.
Because it is an intricate surgery, the DIEP flap procedure is about a 10- to 12-hour surgery, nearly twice as long as a traditional TRAM procedure. Following a three-day ICU stay, the patient spends one to two days in the surgical unit. Patients must stay in a stooped, slumped position for one to two weeks following the DIEP flap because there will be considerable tension in the abdominal area due to the amount of tissue removed. A patient will progress with fewer restrictions until about week six after the procedure.
“By six weeks, the risk for failure is very, very low because the blood supply is stable and happy,” Dr. Flurry says. “In essence, the women have new breasts from their own tissue that won’t need to be removed or changed.”
For more information about breast reconstruction and other plastic surgery options, contact Via Christi Plastic Surgery & Aesthetics, located at 1947 N. Founders Circle in Wichita, at 316-609-4440.