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October 2008 Issue

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Radical Breast Surgery Gives Patient New Outlook

By Amanda Harper
Published October 2008

Sally Heidelberg had always thought self breast exams were “hokey”—and, admittedly, never did them.

That instantly changed the day the then 39-year-old Hyde Park resident found a lump in her right breast. Heidelberg says she’ll never forget that day.

She was at the YMCA taking a shower after her regular exercise routine when she overheard a woman talking about the wigs she wore after her breast cancer treatment.

The woman, as Heidelberg puts it, “was the picture of health.”

It convinced her to do a self-breast exam right then—and she found a lump in her right breast. The lump was only 1.2 centimeters in diameter. Most tumors that small are not detectable with a manual exam.

“Recent studies on the benefits of self-breast exams have left some women confused about what makes sense for them,” says Elizabeth Shaughnessy, MD, PhD, an oncologic surgeon and breast cancer researcher at the UC Barrett Cancer Center at University Hospital.

“I still urge patients to become familiar with the contours and feel of their breasts. What’s most important is noticing a change in one’s self-breast examination, not so much detecting abnormalities because most people are not certain what is abnormal.”

Heidelberg was diagnosed with an early-stage, slow-growing form of estrogen-receptor positive breast cancer on Jan. 6, 2005. Wasting no time, she scheduled a lumpectomy to remove the tumor within two weeks.

“I asked my surgeon if I was going to die and she said, ‘No— you’re going to beat this,’” Heidelberg recalls.

“I couldn’t help thinking: How could this have happened to me? I’m young, I’m healthy—I’ve got my whole life ahead of me.”

Having already been blessed with two children, she decided to have a hysterectomy in September 2005 as a preventative measure. In the back of her mind, she always thought she may get breast reconstruction, too, but decided “to try to live with it first.”

In February 2008, though, she reached her breaking point when a regular mammogram revealed a potential problem in the other breast.

“I didn’t realize how much space the fear of recurrence was taking up inmind. I knew I wouldn’t find peace until I had done everything I could to prevent the cancer from coming back,” she recalls.

She consulted UC plastic surgeon Jesse Taylor, MD, about a preventative double mastectomy with reconstruction. Taylor specializes in a microsurgical reconstruction procedure known as the DIEP (deep inferior epigastric perforator) where he creates a new breast using the patient’s own tissue and fat.

During the procedure, he surgically reattaches tiny blood vessels from the transplanted tissue to the chest wall.

Traditional breast reconstruction uses TRAM (transverse rectus abdominis muscle) flaps where entire pieces ofmuscle, skin and fat aremoved up from the lower stomach into the chest cavity to form a breast.

The procedure can lead to abdominal hernias, loss of abdominal muscle control and fat necrosis, a condition where the skin continues to live but the underlying fat dies and forms a firm mass. The masses, in turn, lead to cancer scares and more biopsies.

The DIEP flap procedure spares the muscle, reducing the risk for complications associated with TRAM flap surgery, improving the tissue’s blood supply and retaining abdominal muscles. The result is a more natural breast, both in feeling and appearance.

“Many patients—especially young survivors—are frustrated by the appearance of their breasts after cancer surgery but find the idea of a permanent prosthesis (implants) unappealing,” explains Taylor, who sees patients at University Hospital and University Pointe.

“Accepting implants can be psychologically challenging because you’re introducing a foreign element, something that your body will naturally resist.”

Then 42 years old and in good health, Heidelberg was an ideal candidate for microsurgical reconstruction. She had her final surgery in September 2008.

“I’m looking forward to the rest of my life,” she says. “I feel good about the future.”

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