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Expanding Options Available for Breast Cancer Survivors

September 11, 2012

Plastic Surgeon Brings New Reconstruction Technique to Washington Township

A lot has changed in the medical field. Stories from previous generations of invasive surgeries have been replaced with huge advancements in laparoscopic and minimally invasive options. Likewise, during the past 20 years when it comes to breast cancer reconstruction surgery, the progress made has been profound.

Recently, Washington Hospital added yet another tool in the arsenal of reconstruction options available to patients in Washington Township Health Care District.

Washington Hospital plastic and reconstructive surgeon Dr. Prasad Kilaru sought out an advanced training course offered by Duke University, an opportunity he says offered the benefit of hands-on training to learn the new technique, which he says is an important alternative for certain breast cancer reconstruction patients.

"The procedure is called the DIEP (deep inferior epigastric perforator) flap," explains Dr. Kilaru. "The advantage is using abdominal tissue to reconstruct the breast. In the old days - and what I used to do - involved taking abdominal tissue and the associated muscle for reconstruction. With the new procedure, we leave the muscle in place, which allows us to avoid the morbidity of taking muscle."

In other words, because the procedure doesn't sacrifice muscle tissues, there is less chance for developing weakness or hernia after surgery, unlike other procedures that impact the muscle.

"It's a slightly longer procedure, but recovery is a little bit faster," he says. "One of the reasons I wanted to do this is because the procedure is offered at Stanford and UCSF, and I think people - no matter where they are - should have access to the same level of care without having to travel out of the area."

Dr. Kilaru says his goal in offering this option to breast reconstruction patients is simple: to improve their overall experience. He gives a little bit of history on breast reconstruction, and how many advances have been made.

"In plastic surgery we want to replace like with like, and skin and fat is what the breast is made up of," he says. "The first type of reconstruction that evolved was done with implants, and even now the most common breast reconstructive procedure done across the country involves using implants.

"The evolution from there was using tissue from the back, which offers better skin coverage and softer skin, but usually there is not enough skin or soft tissue to reconstruct a full breast and an implant is needed to complete the reconstruction. It was like making an A or B cup and then using an implant to make the breast bigger. You didn't get the same natural appearance that you get using abdominal tissue."

Dr. Kilaru explains that it was during the 1980s that surgeons began to employ abdominal tissue for breast reconstruction by using a single abdominal muscle and skin from the lower abdomen, leaving the muscle attached, and moving it to the breast site, which provided adequate blood supply, skin, and fat for the breast.

"Subsequently, they found another blood vessel that supplies the muscle with better blood supply. Then, in 'free flaps,' as they are called, the surgeon completely disconnects and auto-transplants, or reconnects, the artery and vein at the new site."

This works in the same way, he says, as an organ transplant, only without the risk of tissue rejection because the tissue is coming from the patient's own body.

"So, historically, we went from using implants to back tissue to TRAM (Transverse Rectus Abdominis Myocutaneous) flaps, which uses one of the muscles that make up the "six-pack" over the abdominal wall."

The TRAM procedure, according to Dr. Kilaru, can either involve a pedicle flap (attached and tunneled) in which the muscle is left attached and moved to the breast site, or a free flap, in which the muscle is disconnected and reconnected.

"The next question was: can we do it without taking the muscle, allowing for less morbidity to the abdomen, which resulted in the DIEP flap."

Another benefit of the DIEP flap procedure, he says, is that it's like getting a tummy tuck. By reconnecting the tissue further up the chest to make the breast, it simultaneously improves the contour and shape of the abdomen.

"Again, another thing we're seeing in my practice is cancer affecting women at a younger age, including many women in their 30s," he says. "And when patients are younger, they're more active, they want to do things like pick up their kids and work out. If you can preserve the muscle, they can do that faster, so there are definite advantages to this procedure.

"Back in the day, they use to say it's not a big deal to lose one muscle - because you can still do a sit up, but with younger patients, that's not always good enough."

Even though the procedure takes an extra hour or two, it gives a better result to the patient, which is the important part, according to Dr. Kilaru.

"My point is that there are always things you can do to improve the care of your patients. When there's an option that's medically valid, accepted, and available, we're doing a disservice if we don't offer it in the community. At the end of the day, I wanted our hospital to be able to offer the same options as Stanford and UCSF offer. We have world-class orthopedics and neurosurgery programs; there's no reason not to offer world-class plastic surgery options to our community."

To learn more about the full array of women's health services - including diagnostics, treatment, education, and genetic counseling for heritable cancers - available through Washington Hospital Healthcare System, visit www.whhs.com/womens-health/.

To find a doctor in the specialty you are looking for, visit www.whhs.com and click on "Find My Physician."

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