State-Of-The-Art Breast Reconstruction

July 8, 2014 Jeffrey Scott

This article features Jeffrey Scott, MD, and James Edwards, MD, Plastic and Reconstructive Surgeons at Providence Medical Group's Plastic and Reconstructive Surgery Clinic, located in Mill Creek.

A cancer diagnosis is terrifying on its own, but in the case of breast cancer, the possibility of breast disfigurement adds another unsettling detail.Reconstruction_Scott

Pam Gardner, a 59-year-old operating room nurse from Marysville, says the months after her diagnosis were a strain. “I was terrified,” Pam says. “A cancer diagnosis is just scary, even for those of us who work in health care. I was always an exerciser, but during that time I worked out even more, just to tire myself so I could sleep at night.”

Pam had a small ductal cancer with no lump. Her worries focused on survival, of course, but she was also very concerned about the prospect of losing her breasts. “The cosmetic aspect was important for me. My breasts have been a big part of my identity,” Pam says. “My relationship with my husband, working in the public eye, being seen in the shower at the gym—I did care about that part of it.”

The impact

Each year more than 296,000 American women face breast cancer. The emotional and physical impact has evolved through the years, as knowledge about the disease, treatment, and reconstructive options have advanced.

Depending on a woman’s individual circumstances, breast reconstruction may be done in conjunction with mastectomy or delayed until after treatment is complete. Options include implant-based procedures, or autologous flap procedures (using a woman’s own tissue from another part of her body).

Women in Snohomish County now have access to one of the most advanced autologous alternatives available today, known as DIEP (deep inferior epigastric perforators) flap surgery. Plastic and reconstructive surgeons James Edwards, MD, and Jeffrey Scott, MD, both practicing at Providence Medical Group, offer the two-surgeon DIEP procedure locally.

Leading-edge reconstruction

Dr. Scott says that the DIEP procedure takes advantage of excess tissue in the abdomen, including skin, fat and blood vessels, to reconstruct a new, living breast at the mastectomy site. DIEP provides significant benefits, including a natural-looking breast. It also preserves the core muscles’ strength and even offers an abdominal contouring, tummy-tuck effect.

“DIEP is an important piece in the spectrum of breast reconstruction procedures,” Dr. Scott says. “Providence Regional is one of only a few sites in the state that offer the option, in part because of its complexity.” DIEP requires two surgeons, trained in microvascular surgery, working together during the procedure.

Dr. Edwards says the procedure is a true example of multidisciplinary cooperation, as he and Dr. Scott work closely with general surgeons, medical and radiation oncologists to ensure the best possible result for each patient. “Also, due to the complexity, having stellar, specialtytrained support staff in the operating room and post-operatively is essential, and we have that here at Providence.”

Pam opted to have both breasts removed and reconstructed with DIEP. Now a year and a half post-diagnosis, Pam says she did require significant recovery time, with follow-up procedures. Still, it was the best choice for her.

“I never had to go without breasts, and that was important to me,” she says. “The added benefit of the tummy tuck was nice too—just a small positive angle to go with the negative of a breast cancer diagnosis.”

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