When you have cancer, hospital gowns feel like curtains at a theater in the Twilight Zone. The drama when the curtains parted this time was not about amputating my breasts. It was about considering that another part of my body could be used to replace them.
The medical director of the Baptist Health Breast Center, Dr. Robert DerHagopian, looked at my abdomen and said, lets see if there is enough. He then grabbed the excess fat that I am most ashamed of and my abdomen muscle with both hands.
There is not enough, said Derhagopian, also known as Dr. D. Check again. I can assure you can find plenty of fat there, I said jokingly. He remained serious and said, They can also remove ...
I couldnt hear the rest. His voice slowed down, and all I saw was his hand pointing to my behind. I panicked.
He was referring to the use of a flap tissue from elsewhere in the body for breast reconstruction.
There are many different types of procedures of this kind. The TRAM (Transverse Rectus Abdominus Myocutaneous) flap procedure uses tissue from the abdomen. The DIEP (Deep Inferior Epigastric Perforator) flap uses tissue from the abdomen but preserves the muscle. The SGAP (Gluteal Artery Perforator) flap uses tissue from the buttock area. And I decided no surgeon was going to touch that.
Fear boiled into anger. I love my body. I would usually run for my life or fight if any one dared to come at me with a knife, but there was an enemy inside me, and fighting it required Derhagopians ability to cut and slice. It is no wonder so many breast cancer survivors in Miami love him.
Weeks after that visit, while I recovered from chemo in bed, I turned to YouTube to try make sense of the situation. Dr. Gordon Lee, director of microsurgery at Stanford Hospital, explained the procedures during a lecture earlier this year.
He described the TRAM flap procedure as being very similar to what is done in a tummy tuck, but in a tummy tuck where the tissue is not discarded. This tissue is saved with its blood supply and transferred to the chest region to make a breast. it does rely on circulating vessels to allow this tissue to be living tissue.
Patients who have insufficient amount of tissue in the abdomen, prior abdominal liposuction, or prior abdominal operations with excessive scars are not good candidates for the TRAM Flap. A risk with the TRAM flap is that once the muscle is gone, it never grows back. That can lead to weakness of the abdominal wall, hernias and bulges, Lee said.
Patients who have had abdominal surgery are candidates for the DIEP flap, but only if they have abdominal fat to spare, and they are not smokers. A good candidate must also have adequate sized blood vessels, which cannot be determined accurately before the operation. The DIEP flap procedure, which Lee referred to as the Cadillac of all surgeries, requires that a doctor use a microscope to hook up the blood vessels from the belly tissue to the chest.
Out of all of the other options for reconstruction, a flap has the greatest longevity, said Lee. If you gain weight and you tend to gain weight in the abdomen region you will actually gain weight in your breast tissue.
At the Miami Breast Center, Dr. Roger K. Khouri also likes the way transferred fat works on the breast. He has performed hundreds of flap procedures, but said he no longer recommends them.