Breast Cancer: Is Natural Breast Reconstruction Right for You?

Breast cancer patients who undergo mastectomies are often faced with the decision of how best to reconstruct their breasts. Currently, implant reconstruction is the most common way of rebuilding the shape of their breasts after surgery. However, one drawback of implants is that they typically need to be replaced every 10 to 15 years.

An alternative to implant reconstruction that's growing in popularity is known as natural breast reconstruction, or breast reconstruction using natural tissue. This method uses skin and fat from certain body parts to create a natural-feeling breast.

But what exactly does natural breast reconstruction entail, and is it the right choice for you?

What Is Natural Breast Reconstruction?

The human breast consists mainly of fat, especially after a woman's child-bearing age. At its core, natural breast reconstruction involves transplanting fat from one area of the body — such as thighs, buttocks and back — to another.

Natural breast reconstruction is also known as DIEP flap, or deep inferior epigastric artery perforator flap. This procedure removes extra skin and fat from the lower abdominal area, where many women carry surplus tissue. However, the muscle and function of the abdominal area will still be maintained after the surgery.

Once this tissue is removed, blood vessels from the tissue are attached to blood vessels in the breast area. The arteries and veins from the removed tissue are sewn to arteries and veins in the chest area using a microscope to restore blood flow to the tissue and make the transplant a success.

Natural Breast Reconstruction Myths vs. Facts

Because synthetic implants are still the prevailing choice for breast reconstruction, several myths have propagated throughout the medical community regarding the downsides of natural breast reconstruction. Many patients worry that the surgery will be too long, that the recovery will be too difficult, or that there will be a significant chance of failure.

However, these concerns are usually unfounded. Typically, the surgery lasts about five hours when in the hands of an experienced physician. Patients usually recover in the hospital for two to three days, with nonopioid medications that mitigate the pain well.

A full recovery typically occurs within two to six weeks, with an average recovery time of four weeks. This is only slightly longer than implant breast reconstruction, which has an average recovery time of three weeks.

In addition, the risks of failure and complications are minimal. The failure rate of natural breast reconstruction is very low, at around 0.7 percent, and can be lowered with the right surgical team. The hernia rate from this type of operation is less than 2 percent.

By dispelling these myths around natural breast reconstruction, an operation that once seemed scary becomes something realistic and tolerable, and perhaps preferable for certain situations.

Making the Right Choice for You

The benefits of a successful natural breast reconstruction are invaluable. Rebuilding breasts with their own body tissue provides patients significant improvements in their mental attitude and bodily sensation.

Of course, there are real downsides to natural breast reconstruction surgery, including the risk of infection or serious bleeding, and not every patient is a good candidate for the surgery.

However, if you are curious about natural breast reconstruction, schedule a consultation with an experienced breast reconstruction surgeon. They can help by answering questions and empowering you with the knowledge you need to make the best decision.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Improving Breast Reconstruction Patient Outcomes with SPY Elite and Hyperbaric Oxygen Therapy

Sarah Bessin, a 47-year-old breast cancer survivor, received her diagnosis in July 2015. In October, Bessin opted to begin breast reconstruction at the same time as her mastectomy. The team at MedStar Georgetown University Hospital was able to save Bessin’s breast tissue and improve her breast reconstruction outcome through the unique combination of the following two tissue-saving technologies to diagnose and avoid serious complications:

  • The SPY Elite fluorescent imaging system that gives breast surgeons and plastic surgeons the ability to assess the quality of blood flow in the breast tissue in order to make the critical decision on whether to insert implants immediately or wait.
  • Hyperbaric oxygen therapy to facilitate the healing process.

“My surgeon told me he would decide during surgery whether or not I could undergo breast reconstruction immediately, but I’m so glad he decided to wait before proceeding with implants. It gave me a chance to heal, and the results of my reconstruction are just remarkable,” Bessin shared.  

“Everything that we do in plastic surgery involves blood flow. If blood flow is disrupted, the overlying skin can die. This is the reason we need to be able to anticipate these problems intraoperatively so we can act quickly,” said Troy Pittman, MD, Bessin’s breast reconstruction surgeon. 

SPY Elite: A New Valuable Player in the Operating Room

After a mastectomy, the plastic surgery team enters the operating room with a fluorescent imaging system called SPY Elite. SPY Elite has a long arm that connects to an infrared lamp device, which is used for scanning over a patient’s body. A special contrast is injected through the patient’s IV line, and a TV monitor shows the scans of breast tissue and blood vessels in real time.

A breast reconstruction surgeon will move the SPY Elite lamp over different areas of the breast to detect the quality of blood flow in breast tissue before proceeding with the surgery. The system’s monitoring of the blood flow helps surgeons determine if the patient’s tissue is in a safe state to move forward with surgery and place an implant.

If blood flow is limited, surgeons will add hyperbaric oxygen therapy after surgery to promote healing in the tissue.

“SPY Elite lets me look at the blood supply of the breast tissue and the nipple in real time,” Dr. Pittman said. “This helps us diagnose a problem early on and initiate hyperbaric oxygen therapy within 24 hours, if we need to.”

SPYing a Problem During Bessin’s Procedure

During Bessin’s procedure, the SPY Elite imaging system informed Dr. Pittman’s team that there were worrisome vascular changes in her breast skin following the mastectomy. To avoid compromising the vascular health of the skin, Dr. Pittman decided on a different plan.

The new breast reconstruction approach for Bessin meant waiting on the implants and placing tissue expanders, a type of deflated temporary implant, in the surgery site. This plan allows for healing time in the hyperbaric oxygen therapy chamber. 

“Our goal is to get patients in for treatment as soon as possible. We are aggressively treating the patient to save their breast tissue and augment their healing,” said Kelly Johnson-Arbor, MD, medical director of Hyperbaric Medicine in the Department of Plastic Surgery. “Our dedicated team of physicians, nurses and technicians work to ensure that patients remain safe and comfortable during their treatment regimen.”

Healing Tissue Within Days with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy exposes patients to pure oxygen in a pressurized space. Sending patients to the hyperbaric oxygen chamber treats the initial blood flow issue and can help the patient avoid future healing problems. Treatment begins within  24 hours after surgery and does not require patients to stay in the hospital. 

Bessin’s tissue healed in only 13 hyperbaric oxygen therapy treatments. Her hyperbaric oxygen therapy schedule began with two visits to the hospital per day, which later decreased to one visit per day near the end of her treatment.  

“I bounced back quite quickly. I’m already working my normal schedule, and my energy level is back to normal,” Bessin shared. “I’m so grateful to my doctors for providing this therapy!”

Hyperbaric Oxygen Therapy: Rest and Relaxation Time

Bessin recalled that she spent most of her time relaxing in the hyperbaric oxygen therapy chamber, which is a large glass tube. In the chamber, patients cannot wear makeup, lotion, nail polish or outside clothing, nor can they bring in a cellphone, books or paper. A glass of water and a cotton gown are permitted inside the chamber. During treatment, a nurse or technician stays in the room the whole time to administer the hyperbaric oxygen therapy, answer questions or assist with movie selections.

“Georgetown has a great movie selection,” Bessin pointed out.

Access for Every Breast Reconstruction Patient at MedStar Georgetown

Dr. Pittman has used SPY Elite with hyperbaric oxygen therapy at MedStar Georgetown for five years. For breast reconstruction, Dr. Pittman’s team uses SPY Elite on almost every patient, but particularly in those who want to begin breast reconstruction with an implant immediately after a mastectomy.

“SPY Elite and hyperbaric oxygen therapy allow us to aggressively treat patients safely and predictably,” said. Dr. Pittman. “This approach gives our patients the best chance for success.”

To date, MedStar Georgetown University Hospital is the only center in the greater Washington, D.C., region to offer both SPY Elite and hyperbaric oxygen therapy for patients with breast cancer.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.