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Updated: March 2009

Lumpectomy Defect and Radiation, DIEP Flap

Photo of Grace Ann's Procedure
Photo of Grace Ann's Procedure
Before
After

A lumpectomy and radiation resulted in deformity of this patient’s left breast, marked by retraction of her nipple. She desired corrective surgery in order to return her left breast to its’ original shape without altering her right breast. She is seen here before and after undergoing a DIEP flap procedure to correct her left breast contour.

Grace-Ann's Breast Reconstruction Story:

 

I underwent gastric bypass surgery in 2003. I had spent my entire life overweight, and at 278 pounds, it was a matter of life, death, and happiness. For the first time, I was doing something for me. My doctor made me promise that if I had the bypass surgery, I would make an appointment to get a mammogram. Although I was reluctant to schedule the appointment, I was never one to back out of a promise.

It was Labor Day weekend, and the looks on the technicians’ faces as they directed me from the mammography room to have my breast ultrasound, told me they didn't want to leave early to celebrate the holiday. Something was very wrong.

Within a few days, I had an excisional left breast biopsy, which revealed the cancer. The surgeon was very kind, and carefully explained all of my options. Lumpectomy or mastectomy, the choice would be left to me. I felt like I was dreaming. It all seemed so surreal. Because the tumor was small, I opted for a lumpectomy. I don't remember if the risks of lumpectomy when the tumor is located directly behind the nipple were discussed with me. Everything was happening so fast, but it felt like slow motion. Auto-pilot took over.

I woke up from the lumpectomy bandaged and sore, as I expected. I took time off from work, and prepared for the long road of chemotherapy and radiation. My friends came over, saw me, and cried. “Why are you crying?” I would ask. I actually loved being bald and having no hair on my body. Cancer was this horrible, disgusting thing, yet knowing that the surgeon got clear margins and that it was all out of my body, gave me a sense of peace. It was like a cleansing experience for me; out with the toxins, in with my new life. I never once questioned, “why me?” I thought, “who better than me?”

I won an award during treatment, for patient-of-the-month. I was treated to a spa day, and felt like a princess. My relationship with my husband, which prior to my diagnosis was in jeopardy, had a renewed sense of purpose. He even won the husband-of-the-month award at my treatment center, and got a bottle of champagne. When I was done with active treatment, I looked in the mirror, and didn't like what I saw. I felt like half of a woman. Although radiation had not damaged my skin, my nipple had inverted, and my breast was very deformed. I was also in a great deal of pain. I decided something had to be done. Even though breast reconstruction is for women who have had mastectomies, I decided to consult with a plastic.

My oncologist said there was a procedure that took skin from my own body to correct the breast defect. I had plenty of extra skin to take. It had been two years since my gastric bypass surgery, and my weight dropped from 278 pounds to 175 pounds. I called my primary care physician for a recommendation. The woman that answered the phone must have been my guardian angel. She disappeared after speaking to me, but not before giving me the recommendation for the plastic surgeon who would change my life.

When I met my plastic surgeon, I immediately felt at ease. It's never been easy for me to take my clothes of in front of anyone, but he had such a relaxed demeanor, and right away I knew he would be the one to fix me. Because I had excess abdominal skin and fat from losing 100 pounds, I was a perfect candidate for the DIEP flap reconstruction. He would take the extra skin and fat from my belly, and recreate the breast, while preserving my original nipple. The added benefit would be a newly tightened abdominal area, which I desperately needed after my weight loss. “What a bonus!” I thought.

I left my plastic surgeon’s office feeling eager about my upcoming surgery, and I thought my journey had run its course. Then, the insurance battle began. I saw my plastic surgeon in November, and with the support from his office staff, I was finally approved for surgery in April. I don't know that I could have handled the insurance battle if I hadn't already finished my chemotherapy and radiation treatments. It amazed me that after going through so much, I had to fight so hard for something that I knew I was entitled to. There were moments that I truly felt I was not going to be able to have the surgery, but I was determined, and my spirits and efforts prevailed.

In April of 2007, I had surgery to fix my deformed left breast with a DIEP flap. This surgery was the best thing I ever did for myself. My husband was a saint when it came to taking care of me and helping with the drains. Two weeks later, we were off to Florida, and I felt great. Because we were able to save my original nipple, my reconstruction was a one-stage process. I don't have enough words to describe how great I feel right now. I'm ecstatic about life. Every aspect of my life improved because I got better. I got better! And everyone around me is better for it. I feel complete, as every woman should. I look in the mirror, and I can't believe it's me!

Although I have lingering effects from chemotherapy, such as neuropathy, and I have to live with the same fear of recurrence that other survivors share, I am so grateful for everything that has happened to me. I have a new lease on life, and I plan on living it to the fullest. Every day is a chance for a new beginning.

 

Photos and Doctor Commentary

 

Photo of Grace Ann's Procedure  Photo of Grace Ann's Procedure

Defect After Lumpectomy and Radiation

 

Defect Pulls Nipple into Breast

 

Photo of Grace Ann's Procedure  Photo of Grace Ann's Procedure

Plan to Correct Defect on Breast

 

DIEP Flap Design on Abdomen

 

Photo of Grace Ann's Procedure  Photo of Grace Ann's Procedure

Correction After DIEP Flap

Correction  Restores Nipple

The patient has a pronounced indentation of the left breast after lumpectomy and radiation that draws the nipple and areola inward. The plan involves removing scar from the breast, and design of a DIEP flap that adds new skin and fat to restore the breast form. After correction, the breast has a round shape with restoration of a visible nipple and areola, quite similar to the other breast. Because no muscle was taken from this patient’s abdomen, she underwent abdominal contour improvement similar to a traditional abdominoplasty as well.