One of the most difficult decisions a breast cancer patient will ever face is choosing who will perform her mastectomy. For women in our area, that choice just got a lot easier. Texas Health Presbyterian Hospital Flower Mound now offers patients advanced breast surgery, where the mastectomy and reconstruction of the breast (or breasts) is performed during the same procedure and uses the patient’s own tissue instead of an implant.
Deep inferior epigastric artery (DIEP) flap breast reconstruction represents an evolution in technique from TRAM flap reconstruction. Originally, in a pedicled TRAM flap, the skin, fat, and muscle from the abdomen was transferred to the mastectomy site to recreate the breast. The second generation of this procedure, the free TRAM flap, was developed to preserve the dominant blood supply and increase the survival of this tissue. Unfortunately, it continues to harvest the lower rectus muscle which causes significant morbidity to the abdominal wall.
The latest evolution of this procedure, the DIEP flap breast reconstruction, allows the rectus muscle to remain in place. An incision is made to free the lower abdominal skin, fat, and blood vessels from the muscle. This tissue is then disconnected from the abdomen and transferred to the chest where the DIEP flap blood vessels and the recipient blood vessels in the chest are repaired using an operating microscope.
Kerri Perry, MD, an experienced board-certified surgeon, has been performing mastectomies alongside plastic surgeons for years. Only recently has the DIEP flap option for reconstructive surgery become available for patients at Texas Health Flower Mound. “The hospital is really supportive and excited to now offer this as an option for breast cancer patients,” said Dr. Perry. “Previously women had to travel outside their hometown to have this procedure, which made it hard for them to have a network of support nearby. It’s always easier for the patient to receive care close to home, and it’s nice to have people who are well-trained and willing to provide excellent care here in Flower Mound.”
Dr. Perry performs the mastectomy and then a plastic surgeon completes the breast reconstruction. “It’s a fairly advanced vascular procedure but, because we’re using a woman’s natural tissue, she has less restrictions and more natural results as compared to using a breast implant,” Dr. Perry said.
Board-certified plastic surgeon Brice McKane, MD, and his associate, Frederick Duffy, MD, team up to perform the DIEP flap at Texas Health Flower Mound. “Since the reconstruction utilizes a woman’s own tissues, the risks associated with implant reconstruction are avoided,” Dr. McKane said. “Furthermore, if only one breast is operated on, it is usually easier to match the remaining breast with tissue compared with implant reconstruction.”
Over time, breast implants can shift or rupture, and some women experience internal scar tissue growth around the implant known as capsular contracture, which can cause hardening and distortion of the breast. When capsular contracture occurs, the implant usually needs to be replaced. “For women who think long term, the DIEP flap is a good option,” said Dr. McKane.
”The DIEP flap procedure uses both skin and tissue taken from the patient’s lower belly but leaves the muscle mostly undisturbed to reduce the risk of any future weakness in that area,” said Dr. McKane. If she’s previously had abdominal surgery, fat and skin can be taken from her back or inner thighs.
While the breast surgeon is removing the affected breast tissue, the plastic surgeon is making the incision in the tummy and lifting fat tissue away from the muscles along with the blood vessels. “When I complete the mastectomy, the plastic surgeon uses a microscope to attach the vessels,” said Dr. Perry.
The plastic surgeon will monitor the patient during her recovery. “Then we follow patients with an exam and ultrasound each year,” Dr. Perry said. Patients will not require mammograms as the breast tissue has been removed. Recovery time following the surgery is typically several weeks.
The DIEP flap procedure is not widely available as the technique requires advanced microsurgical training and is therefore only performed by a relatively small number of plastic surgeons around the country. To provide the DIEP flap at Texas Health Flower Mound, the hospital had to find experienced surgeons, acquire the microscope used during the microsurgical technique, and train its nursing staff on the nuances of taking exceptional care of these patients.
Also convenient for women is Texas Health Flower Mound’s Women’s Imaging Center. Located on the hospital’s campus, the center offers some of the latest technology and all-digital mammography along with a computer-aided detection system, which improves the early detection of breast cancer. An onsite board-certified radiologist interprets the images and can perform ultrasound examinations when indicated. The Women’s Imaging Center also offers 3D tomosynthesis of the breast, ultrasound and stereotactic needle biopsies, ductograms, aspirations, and breast ultrasound.
Texas Health Flower Mound has achieved many accolades in six short years and has become well-regarded in the community as a trusted health resource with a staff committed to improving the overall well-being of its neighbors. Throughout the year, educational classes, health fairs, and community outreach programs abound. It’s no wonder the hospital has been recognized as the Best Place to Have a Baby by North Texas Child magazine’s readers. And, for four years in a row, Modern Healthcare has ranked the hospital among the top 100 Best Places to Work in Healthcare nationwide.
In addition to Emergency Services and other hospital services, Texas Health Presbyterian Hospital Flower Mound offers:
- Advanced Joint Replacement
- Epilepsy and Seizure
- Robotic Surgery
- Sleep Diagnostics[/one_half]
- Women’s Imaging
- Bariatric Surgery
- Neck and Spine[/one_half_last]
4400 Long Prairie Road
Flower Mound, Texas 75028
Text: Pamela Hammonds
Photo: Guy T
Texas Health Presbyterian Hospital Flower Mound is a joint venture owned by Texas Health Resources and physicians dedicated to the community and meets the definition under federal law of a physician-owned hospital. Doctors on the medical staff practice independently and are not employees or agents of the hospital.