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ABQ Journal Feature Health Story

After having a mastectomy for breast cancer, Roberta Crawford opted for a breast reconstructive surgery that’s new to New Mexico. Called DIEP flap, the surgery preserves a patient’s muscle function. (Marla Brose/Albuquerque Journal)

Though she lost a part of herself when she had to undergo a mastectomy, Roberta Crawford says it could have been worse – she might not have been able to pick up her grandchildren.

Thanks to a breast reconstructive surgery that’s new to New Mexico women, Crawford’s recovery was less painful and speedier than other options. The surgery is called deep inferior epigastric perforator, or DIEP flap for short.

The DIEP flap surgery became available in New Mexico in November by Drs. Jennifer Chan at Sandia Plastic Surgery and Gladys S. Tsao-Wu at New Mexico Plastic Surgeons. The surgeries are performed at Lovelace Women’s Hospital in Albuquerque.
    
Breast reconstruction is covered through health insurance plans, and the portion that is covered varies depending on the type of surgery and the type of insurance plan, says Laurie Volkin, communications manager for Lovelace Health System.

While other breast reconstructive surgeries involve implants and/or the patient’s tissue and muscle, the DIEP flap uses only the patient’s fat and skin from the abdominal area, making for a shorter recovery time, and a smaller chance of having health problems associated with the surgery down the road.

The main benefit of this particular surgery is that it preserves the patient’s muscle function.
“By making DIEP flap available to patients, we can do a breast reconstruction and leave the muscle intact,” Tsao-Wu says.

And that was really important to Crawford, 62, who leads an active life of traveling with her husband to visit family and friends around the country. She also is an avid walker, enjoys gardening and looks forward to picking up her small grandchildren – activities that require having proper muscle function.

Women who have the transverse rectus abdominus musculocutaneous (TRAM flap) reconstruction, which uses muscle, fat and skin tissue from the abdomen, are at risk of having trouble sitting up or of getting a hernia, the doctors said in an interview.

Before Chan and Tsao-Wu began offering the DIEP flap, women had to travel out of the state to have that particular surgery performed. Chan says keeping families close to home makes the recovery process easier on everyone.

Since November, the team has done three DIEP flap surgeries and has many more lined up. But patients for this particular surgery must be screened carefully due to the possibility of complications.
The DIEP flap surgery requires a particular skill set on the surgeon’s part. Two surgeons working together on one breast can take about nine hours to complete in the operating room.

The after-care also is intense, the doctors say. Tsao-Wu and Chan share the workload of the DIEP flap surgeries so that it’s feasible for their practices and personal lives.

Considerations

Until the surgery is under way, surgeons can’t be sure whether the procedure can be completed without using the patient’s abdominal muscle.

“We may or may not take muscle,” Chan says. “We find out in surgery.”

Another complication can involve the patient’s blood circulation.

The recovery time for DIEP flap is less than, or about the same as, other breast reconstructive surgeries, they say. It’s less painful and fewer long-term risks are associated with the procedure because muscle isn’t being disturbed. Hospitalization is longer – up to a week – after this particular surgery. The recovery is the same as other breast reconstructions, Chan says.

Tsao-Wu adds that the surgery isn’t for everyone. For example, a super-skinny woman who wants a D-cup won’t have enough fat on her body to form a D-cup breast.

“We’re not going to offer it to her,” Tsao-Wu says.

But if she started with a small breast and is OK with that, then the surgery is a possibility.

Women who are overweight or have diabetes or other health problems are likely to encounter complications, so they are not good candidates for the surgery. Anyone who’s had a tummy tuck in the past isn’t a candidate at all, Tsao-Wu says.

The women “need a little muffin top but not too much muffin top,” Chan says.

A breast reconstruction is a process, and it can take several months to complete. If the patient is going through cancer therapy, the process can be even longer, Tsao-Wu says.

“We have to time the surgery and spread things out,” she says.

Crawford’s story

Crawford, 62, says that breast cancer doesn’t run in her family, and that after years of going in for mammograms and having negative results, she stopped going in for the exam for about four years. When she went in for a mammogram about three years ago, she found out she had cancer in her right breast. And it had traveled to her lymph nodes.

In December 2012, she had what she’s hoping is her last surgery.

“When you’re healthy, you don’t think about it,” she says of scheduling a mammogram. After moving to Albuquerque seven years ago she didn’t immediately find a primary physician.

“Regular doctors remind you” to get in for an exam, says Bob Crawford, her husband.

Her breasts were removed in one surgery, and the one breast that was cancer-free was immediately reconstructed using an implant. She had reconstructive surgery on the other breast several months later after the tissue healed.

Roberta Crawford says that tissue was removed from her stomach area without disturbing the abdominal muscles. There is a scar but aside from that, the area has healed, she says.

“I feel real positive about it,” Crawford says. “Everything seems to feel OK.”

A couple of surprises also came out of the surgery: a flatter stomach and a new belly button.
The Crawfords have grandchildren living in Maryland and they try to visit as often as they can.

“When you have grandkids you want to pick them up,” Bob Crawford says.

“I feel I’m pretty well back to normal,” Roberta Crawford says, adding that she can clean the house, and she’s looking forward to working in the garden when the weather warms up.

Crawford is “in awe” of the work that the doctors performed on her body. And, she’s not planning on undergoing any more surgeries.

She’s thankful for those who helped her through the ordeal and is glad that it’s over.

“You’re losing a part of yourself but it’s not as bad as it could have been,” Roberta Crawford says.

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