August 26, 2013
New breast shaped from abdominal fat and skin looks and feels natural
Lewis Andres, MD, and Inessa Ricci share a light moment at a Phoenix pool. It was during a dip in her Tucson pool two months after her mastectomy when Inessa decided it was time for DIEP free flap breast reconstruction surgery.
Physically, Inessa Ricci healed just fine from a mastectomy performed in Tucson in March 2012. Emotionally, she faltered.
"I knew I had to put my big girl face on for my kids," said the 47-year-old Tucson mother of three, ages 12, 17 and 24. "And I did. But at my lowest points, I had to turn my back on the mirror — and I knew it was just a mirror — when I got out of the shower." Facing the disfigurement was just too hard.
Her surgeon had informed her of reconstruction options for her right breast, but Inessa wasn't ready for it when she had the mastectomy. "I knew I didn't want a foreign object — no implants — in my body," she said.
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This article appears in the September - October 2013 edition of HealthBeat, John C. Lincoln's free health newsletter.
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Two months later, still dodging the mirror, she got in the pool and couldn't swim. "It might have been that my arm was weak from the mastectomy, but my body felt unbalanced.
That's when I knew I couldn't live like this for the rest of my life," she said.
Her Internet research uncovered a procedure called a DIEP free flap. DIEP stands Deep Inferior Epigastric Perforator. The surgery leaves your abdominal muscle intact while using only fat from the lower abdomen to form a new breast. The procedure can be done at the time of a mastectomy or afterward.
The DIEP free flap surgery uses a woman's belly fat to create a breast with the softest and most realistic look and feel.
Only a few plastic surgeons in the U.S. perform the complex microsurgical procedure, and Lewis Andres, MD, a plastic and reconstructive surgeon with John C. Lincoln Hospitals in Phoenix, is one of them. He's fellowship trained in advanced aesthetic and microsurgical/reconstructive surgery.
"I dissect skin, fat and a blood vessel from the muscle in the lower abdomen, leaving the muscle behind," said Dr. Andres. "Taking that muscle can lead to hernias and can make it difficult for a woman to flex and bend.
"The blood vessels that need to be reattached to the chest are less than one millimeter in diameter," he continued. "Because there are two surgery sites, the recovery time, three to four weeks, is longer than with implants, but the results tend to look very natural.
"If you gain or lose weight, the breast looks more natural, and there's no chance of rupture like there is with an implant. A lot of women like the fact that it's a tummy tuck, too," he said.
Although every woman is a candidate for the procedure, precautions are needed for diabetics, smokers and women who have had previous abdominal surgery, such as a hysterectomy.
Preparing for DIEP Free Flap Breast Reconstruction Surgery
Dr. Andres formed a new right breast for Inessa by using her abdominal fat and skin. He connected the chest's blood supply to what used to be in Inessa's abdomen.
Inessa talked to a woman who had undergone the procedure and conversed online with another. In May 2012, she and her husband, Ben, traveled to Phoenix to consult with Dr. Andres.
"I was nervous," Inessa said. "I'm petite — five feet, one inch, and 108 pounds — and I wasn't sure I had enough abdominal fat. After examining me, Dr. Andres thought I did. On the way back to Tucson, I knew this surgery was for me. I felt really assured with Dr. Andres. He took the time to check out everything ahead of time."
He ordered an angiogram to ensure that the abdominal blood vessels essential to the surgery's success would work, along with a CT scan to evaluate abdominal blood flow. The surgery was a go.
On Sept. 14, 2012, Dr. Andres performed the meticulous microvascular surgery at John C. Lincoln North Mountain Hospital.
He formed a new right breast with only the abdominal fat and skin, and connected the chest's blood supply to what used to be in Inessa's abdomen. The surgery took close to five hours.
Inessa spent four days in the hospital recovering. "I was a big baby," she admitted later with a laugh. "I'm very nervous in hospitals due to past experiences, but the care at North Mountain was amazing. I felt like I was in a hotel. Everyone was very responsive and encouraging.
Dr. Andres made me look at my new breast while I was in the hospital. I started crying. I thought it was the most beautiful thing in my life. I was afraid I'd look like Frankenstein, but I didn't. The symmetry was very good."
In a subsequent procedure in December at John C. Lincoln Deer Valley Hospital, Dr. Andres reconstructed a nipple and in January tattooed an areola.
"I'm so pleased with the results. It looks natural," Inessa said. "I'd do all over again."
For more information, please visit JCL.com/breastreconstruction.
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