As part of her breast cancer treatment, Jane Culbreath of Debach, Louisiana underwent a mastectomy and lost her breast in 1998. After two failed attempts with breast implants , Jane's doctor considered a TRAM muscle flap procedure which involves using the patient's own abdominal fat and muscle to rebuild the breast . At 101 pounds, Jane did not have enough fat for doctors to safely perform the procedure, though. However, Jane's identical twin sister, Joan Liddell of Memphis, Tennessee was 20 pounds heavier than Jane. In an unusual, new reconstructive technique, a plastic surgeon performed a "tummy tuck" (abdominoplasty) on Joan, removing portions of her waistline fat (but no muscle), and used the tissue to rebuild her sister's breast.
Dr. Robert Allen, MD, chief plastic surgeon at Louisiana State University, performed the twins surgeries and is one of the few doctors in the United States who will transplant skin and fat to the breast area, leaving the abdominal muscle intact. To perform the surgery, Dr. Allen dissected one artery and vein from Joan's abdominal muscle along with skin and fat. The artery and vein helped provide a temporary blood supply for Jane's rebuilt breast until new blood vessels began to grow a few days after the surgery.
Dr. Stephen Kroll, MD of the M.D. Anderson Cancer Center says the new "fat only" breast reconstructive technique leaves the patient with a more natural feel to her new breast. However, the procedure does take longer than a traditional TRAM muscle flap operation and is more invasive. The additional surgical methods also have the potential to cause more complications, especially if the tissue is taken from a donor. Nevertheless, Dr. Kroll now uses the new procedure taking only fat and skin from the patient's abdomen, leaving the muscle intact on 70% of his patients.
The two main methods of breast reconstruction available to breast cancer patients who have their breasts removed by mastectomy are:
- the insertion of saline-filled breast implants
- or a muscle flap operation (usually TRAM flap)
Breast implant insertion is the most popular breast reconstruction technique. However, implants may cause a variety of complications, including capsular contracture (hardening of scar tissue around the implant) and infections around the implant. Approximately 50% of saline implants need some type of modification or replacement after five to 10 years.
A TRAM flap procedure involves using the patient's own muscle, skin, and fat to rebuild the contour of the breast. Tissue is usually taken from the abdominal region but can be taken from the back, stomach, or buttocks. A TRAM flap procedure does not usually require additional surgeries (as with implants). However, cutting the abdominal muscle may cause hernias and abdominal weakness in some patients. Usually, women who are athletic notice the differences more than other women, said Dr. Allen. A variation of the TRAM flap procedure, called a free TRAM, involves severing a smaller portion of the abdominal muscle and fat and moving it to the chest.
Dr. Allen and the twins decided to try the tissue transfer after Joan jokingly suggested a "fat transplant." Her sister Jane had attempted to have breast implants inserted twice after her mastectomy in 1998 but infections and previous skin damage from radiation therapy caused complications. Since Jane and Joan are identical twins (with the exception of their 20 pound difference in weight), Dr. Allen was able to use Joan's abdominal fat and skin from her tummy tuck to rebuild Jane's breast without the fear of tissue rejection (from blood type or cell characteristics). Because no muscles were cut during Joan's tummy tuck, she was able to walk without pain a few hours after the surgery.
The 46-year old twins hope the attention their unusual operation has generated will help inform more breast cancer patients of the new, gentler "fat only" reconstructive technique and prompt them to ask their plastic surgeons for additional information. Currently, the "fat only" procedure is only performed by a handful of surgeons across the United States.
- The March 6, 2000 Associated Press report, "New Breast Reconstruction Procedure," is available http://dailynews.yahoo.com/htx/ap/20000306/hl/a_new_breast_1.asp
- For additional information on breast reconstruction after mastectomy, including implant insertion and TRAM flap procedures, please visit http://www.imaginis.com/breasthealth/reconstruction.asp
