11/30/2016 12:00:00 AM
Kassandra Garrett, now 26, was overwhelmed when she was diagnosed last year with an unusual type of breast cancer called Paget’s disease.
It started with an itchy red patch on her left breast. A biopsy eventually revealed cancer.
Surgery was the recommended treatment, and doctors suggested reconstruction afterward. The idea of implants, however, just didn’t feel right.
“I’m the type of person ‘If it’s not in your body to start with, it doesn’t belong there,’ ” Garrett said.
So after she considered her options, Garrett underwent a double mastectomy in mid-August and, at the same time, a procedure called a DIEP flap.
Now cancer-free, Garrett is back at work as a restaurant manager and caring for her three children. And she’s happy with the results.
Breast cancer is the most commonly diagnosed cancer in women, with more than 246,600 new diagnoses expected this year, according to the American Cancer Society. While more women are having reconstruction after breast cancer treatment — 106,000 in 2015, up 35 percent from 2000, according to the American Society of Plastic Surgeons — studies suggest 70 percent aren’t made aware of their options for reconstruction.
The Women’s Health and Cancer Rights Act of 1998 required health plans that offer breast cancer coverage to provide coverage for breast reconstruction and prostheses. But because so few knew about their options, Reddy said, the Breast Cancer Patient Education Act followed in 2015 with a call for more education.
Implants (mostly silicon, some saline) still are by far the most commonly used option. The DIEP flap procedure — DIEP stands for “deep inferior epigastric perforator” artery — which has been available for some time, is an advance on an older surgery called a TRAM flap. That procedure involved transferring some muscle from the abdomen, Reddy said, which could result in abdominal wall weakness, bulges or hernias.
The DIEP flap, which does not use muscle, is the most common procedure using a patient’s own tissue, with about 8,400 procedures performed last year. Surgeons also can use tissue from the inside of the thigh, buttocks or back.
The procedure is technically difficult. Surgeons use an operating microscope to reattach the blood vessels using sutures thinner than a strand of hair, with a needle the size of an eyelash. Another relatively new option — called oncoplastic surgery — combines a traditional lumpectomy, in which just the tumor is removed, with plastic surgery techniques.The approach has been used for more than 20 years in Europe, where studies indicate it’s as safe cancer-wise as a traditional lumpectomy. The approach has started to gain in the United States over the past five years, though it’s not yet widespread or well-known. In general, the technique works best in women with moderate to large breasts or those with smaller breasts and a small tumor.
Many women diagnosed with breast cancer, however, seek mastectomies. Most women who get screening mammograms have small tumors that can be treated with lumpectomy followed by radiation. Those who do need mastectomies, are those with large tumors or genetic conditions that predispose them to breast cancer.