In October 2019, while watching a television interview about breast cancer awareness, Annette Whalen made a mental note to schedule a
mammogram. That moment may have saved her life. The mammogram revealed ductal carcinoma in situ or DCIS, an early form of breast cancer that affects the milk ducts.
“I was fortunate that it had not spread into the breast tissue,” said Whalen.
While breast cancer may be found after symptoms appear, many women experience no symptoms, which makes screening a lifesaving tool.
“Mammography can find some cancers that may otherwise elude detection for years,” said
Anne Wallace, MD, director of the
Comprehensive Breast Health Center at UC San Diego Health. “If left alone, tumors confined in the duct can eventually break through and become invasive. Early treatment prevents the spread of the tumor and makes treatment more successful.”
Whalen discussed her diagnosis and treatment plan options with a multidisciplinary team at UC San Diego Health. Whalen underwent a mastectomy of her left breast where cancer was present and immediate reconstruction.
Following a mastectomy — the surgical removal of all breast tissue either in one breast or both — a patient may elect to undergo breast reconstruction with implants or with their own body tissue. Whalen chose to reconstruct her left breast with the latter, called a
free flap procedure.
“In the United States, implants are used in breast reconstruction very often,” said
Christopher Reid, MD, an expert in breast reconstruction with advanced training in the free flap procedure. “Implants may be an appropriate option, but I want people to know there is another option using their own tissue to recreate breasts that does not require foreign material.
“Because free flaps utilize the patient’s own tissue they offer more benefits. At the end of day, I encourage patients to decide for themselves which option is right for them. The right choice is different for everyone, based upon what they want and how they view the options. I underwent advanced training to be able to provide patients every option.”
The free flap procedure utilizes skin and fat from the patient, usually from the abdomen or upper thigh, to form the shape of a breast.
Whalen understood that the free flap procedure requires more extensive surgery initially, but it eliminates future surgeries that implants require, said Reid. Implants may require follow up surgeries to correct failures or aesthetic abnormalities or may need replacement if the implants rupture, scar or change position.
The free flap procedure creates a breast that feels and looks like a natural breast. In addition, because it is their own tissue the reconstructed breast will change normally with the person. If a person gains or loses weight the reconstructed breast changes with them and it does not deteriorate, like implants can, said Reid.
“Patients who undergo breast reconstruction have been shown to live longer, report greater quality of life and satisfaction as well as better psychosocial and sexual well-being,” said Reid. “Reconstruction is not for everyone, but if a patient is thinking about it they should consult with a plastic surgeon to discuss what option is right for them.”
Reid and two of his plastic surgery colleagues,
Frederic Kolb, MD, and
Ahmed Suliman, MD, perform multiple free flap procedures weekly at Jacobs Medical Center at UC San Diego Health. The multidisciplinary free flap group includes a dedicated anesthesia team that specializes in pain control and enhanced recovery for this particular surgery. There are also dedicated nurses in the microsurgery unit who are trained to care for patients post procedure. This reduces the need for recovering in an intensive care unit and shortens patients’ hospital stay. Most patients go home after just three days.
Whalen was hospitalized for three nights after the reconstruction. Two weeks later, she said she felt back to normal.
“I thought recovery would be complicated and painful. It was uncomfortable at times, but the process was straightforward and the outcome was fantastic,” she said. “I made changes to what I eat and am in the best shape of my life. I feel better about myself and I'm grateful for my surgeon. After going through this procedure, I wouldn’t change a thing.”
All reconstruction can have risks and complications, but in skilled hands a good outcome can usually be achieved. Speak to your health care team to find out what is right for you.
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