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                                         Options after a MASTECTOMY
       When was
        your last                                                                                          By Mary Ross
      mammogram?                               More than 200,000 women will be
                                     diagnosed with breast cancer this year in the
                                                                                       women don't want more surgery or have health
                                                                                       issues that put them at risk for more operations.
                                     United States. More than half of them will have
                                     mastectomies. But                                 Implant Reconstruction Procedure
                                     fortunately, options for reconstruction after a   Patients who do want reconstruction have
                                     mastectomy have improved tremendously in          several options. Saline or silicone implants are
                                     the past 30 years. Prior to the 1970s, breast     still the No.1 choice for 90 percent of women
                                     cancer patients didn't have many options for      because this procedure does not require surgery
                                     either treatment or reconstruction.               on another donor site of the patient's body, like
                                               For many breast cancer patients, the    the newer TRAM flap and DIEP flap proce-
                                     reconstruction option is a life-renewing          dures do, and the recovery time is much less.
     The 'Women's                    experience."There's no question breast cancer     Plus, the implant reconstruction process can be
                                     is touching everyAmerican. But it's a very        started at the same time as the mastectomy or
    Imaging Center                   treatable form of cancer," says Dr. Jeremy        at a later date, depending on the wishes of the
                                     Williams at The Rocky Mountain Center for         patient and the advice of the cancer surgeon.
      Your center for complete       Breast Surgery at Park Meadows Cosmetic                      With implant reconstruction, a
            breast care.             Surgery"The bar needed to be raised in            silicone tissue expander is put into the patient's
                                     reconstruction."                                  chest and slowly inflated to stretch the skin and
                                               Dr. Linda Huang, a Denver plastic       muscle to accommodate the implant and help
      Digital Mammography            surgeon, has performed breast cancer recon-       shape the breast skin and pocket. The implants
        Breast Ultrasound            structions for over 20 years and has seen         are inserted after this process is completed and
    Non-surgical Breast Biopsy       tremendous progress."Treatment now is more        the expander is removed. Later, after the
       Bone Density Exams            customized," she says."The scars of the past      implants are in place, the patient's nipple is
                                     from a mastectomy were like a shark bite.The      replaced using a skin graft from another area of
        Second Opinions
                                     doctors didn't have the tools we now              the bodyThe area is then tattooed to give it a
       Thyroid Ultrasound            have.Almost everyone got a radical mastec-        nipple-like color.
      Abdominal Ultrasound           tomy, and all of the lymph nodes were
                                     removed."                                         TRAM Flap Procedure
      Radiologists and Staff                                                                      Women who want to use their own
                                               In a radical mastectomy the breast,     muscle or fat instead of implants for recon-
    Dedicated to Breast Imaging      nipple, areola and all the pectoral chest         struction can opt for the TRAM flap procedure,
                                     muscles were removed, leaving a long, ugly        which has been around for 30 years, or the
                                     scar and weakening the arm.This aggressive        newer DIEP flap procedure, which was
      303-321-2273                   surgery was the common treatment for breast
                                     cancer patients from the time of its invention in
                                                                                       developed within the past 10 years.
                                                                                                  In the TRAM (transverse rectus
                                     1882 until the 1970s.And reconstruction           abdominus myocutaneous) flap procedure, the
    3ConvenientLocations             options either weren't offered or weren't         surgeon takes the vertical abdominal muscle,
                                     available to many women. "In fact, the            more commonly known as "the six pack;' and
    3773 Cherry Creek N. Dr. # 101   majority of women today are now offered           shifts it up to the breast area, where it is then
          Denver, CO 80209           reconstruction options," says Porter Hospital     attached horizontally to the mastectomy site.
                                     surgeon Colleen Murphy. "Most patients can        Muscle from the back in the shoulder blade
                                     begin the reconstruction procedure immedi-        area, a latissimus flap, can also be used.
     11 W. Dry Creek Circle, #101
                                     ately following the mastectomy."                             The disadvantages to this procedure
         Littleton, CO 80120                   Many women also are opting for a        are that muscle taken from these areas leaves
                                     bilateral mastectomy, thanks to better            a scar and the donor area is permanently
       215 Union Blvd., #375         reconstruction options, since the chances of      weakened, since muscle has been removed.
        Lakewood, CO 80228           getting cancer in the second breast for women This surgery also takes more time than
                                     who inherited the BRAC gene mutation is 40        the implant option due to the delicacy of
                                     percent after having it in one breast.            moving muscle from one location to another       Today, despite these advances, more than half     and saving the arteries and veins that supply
                                     of women who have mastectomies don't have         blood to the tissue.Additionally, the hospital
                                     any reconstruction, often because they don't      stay is longer than it is for implant surgery.
                                     know their options,Williams says.They also        This procedure is chosen when an implant fails
                                     may not have access to reconstruction surgery or when a patient has had rediation for a
                                     or feel the need for reconstruction. Plus, many
lumpectomy and the cancer returns, requiring a   surgery," says the 38-year-old Williams, who                Another advantage to the DIEP
mastectomy. Often, the previous radiation        trained in microsurgery and the DIEP flap          procedure is that the new breast feels natural
changes the stretchability of the chest tissues, procedure at Johns Hopkins.                        and it will grow or shrink like normal breast
leading to thinning and breakdown of the skin              This intricate surgery requires one      tissue when the woman gains or loses weight.
over an implant, especially during the expan-    general surgeon and two plastic surgeons           Another side benefit is the "tummy tuck" the
sion procedure. Using a woman's own tissue       extensively trained in microsurgery. The DIEP      patient gets in the process of harvesting the flap
avoids this problem.                             procedure uses the same abdominal skin and fat     from the lower abdominal region and the
                                                 used in the TRAM procedure, which is the           liposuction of a fatty area for shaping the
DIEP Flap Procedure                              same tissue removed in a "tummy tuck."The          breast.
          The newest option is the DIEP (deep    difference is that the DIEP procedure leaves in
inferior epigastric perforator) flap procedure,  place all the abdominal muscle that the TRAM       TUG and SGAP flap Procedures
which, until lately, had been performed more     procedure removes. The skin and fat around the               Inner thigh or buttocks tissue can also
frequently on the East and West coasts than in belly button are relocated onto the chest to         be used in the most recent techniques.The TUG
Denver. Only 50 doctors throughout the United reconstruct the breast.This microsurgical             (transverse upper gracillis) flap and SGAP
States are experienced with this procedure. In   reconstruction takes up to eight hours because     (superior gluteal artery perforator) flap are used
the Denver area, Dr. Joyce Aycock at the         the surgeon has to dissect the blood vessel        in cases where the women don't have enough
University of Colorado Hospital and Dr.          through the muscle to provide a blood supply       donor fat in the abdomen.This surgery is less
Jeremy Williams and Dr. Christopher Williams to the newly relocated skin and fat while saving       frequent, and fewer surgeons are familiar with it.
(no relation) perform the DIEP flap procedure the muscle at the donor site.                                   Huang,Williams and Murphy agree
at Sky Ridge Medical Center.                               The advantage to this surgery is a       that performing reconstructions for breast
          Jeremy Williams was particularly       faster recovery than with theTRAM procedure        cancer patients is highly rewarding. These
interested in expanding the use of the DIEP      because there is no weakening of the abdomi-       patients have survived a life-and-death struggle
procedure in Denver because he is a Colorado nal or back areas.A subsequent procedure is            and often have a different perspective than their
native and watched his mother endure breast      usually done to help shape the breast with fat     regular patients do. They are grateful for their
cancer and the discomfort and expense of         acquired by liposuction from a fatty area of the   renewed health and are happy to feel good
having to leave the state to have this procedure patient. Like the implant procedure, reconstruc-   again about how they look. Reconstruction
performed. "My mother spent over $20,000         tion of the nipple and the tattooing process are   helps them move on to the new phases of their
traveling back and forth to the East Coast for   done in a subsequent surgery.                      lives, cancer-free.