May 2003

Current Issue
Past Issues
About Us

Public Affairs
Baylor Home

Public Affairs
Baylor College
of Medicine
One Baylor Plaza,
Room 176B
Houston, TX 77030
Telephone:
  (713) 798-4712
Fax
   (713) 798-3692
Email: pa@bcm.tmc.edu

Comments, Suggestions?

Sensory nerve preservation allows sensation in reconstructed breast

By Anissa Anderson Orr

Dr. Aldona Spiegel explains the options for breast reconstruction with her patient.

As principal of South Houston Elementary, Karen Holt built a career on her love of learning.

When doctors diagnosed her with breast cancer for the second time and recommended a mastectomy, Holt decided to educate herself about her options. Facts she learned more than 1,300 miles from home would guide her ultimate decision.

“When my sister had surgery in Ohio, I met a patient on her floor who was having a mastectomy,” Holt said. “Her doctor said he knew of a new surgery where the muscle was spared. After I returned, I had only two days before my own mastectomy. I went back to my doctor and asked one more time, ‘Is there anything else I can do? I was very concerned because I snow ski and windsurf and was very active.’”

Commonly used breast reconstruction procedures transfer skin, fat and muscle. The recovery time can be a week or longer and certain movements are limited because the stomach muscle has been cut. Holt was not ready to sacrifice her quality of life and level of activity if an alternative was available.

“I went back to Houston and cancelled my surgery right away,” Holt said. “I didn’t know where to go, who to go to and what to do.”

Holt’s gynecologist referred her to doctors at the Breast Center at Baylor College of Medicine and The Methodist Hospital. She learned from her team of doctors that Aldona Spiegel, MD, an assistant professor of plastic and reconstructive surgery in the Michael E. DeBakey department of surgery at Baylor and a plastic surgeon at The Methodist Hospital, performed the muscle-sparring procedure. Holt met with her and had the surgery.

A student cracks a confetti egg on Karen Holt 's head at the school's Easter celebration this year.

Now, eight months later, she is cancer free. She works out several times a week, takes dance lessons, and skis. She is pleased with the reconstruction and says she, “looks great, and can wear low-cut tops like before the surgery.” Better yet, she feels great. She can even feel sensation in her breast, something she never expected.

“I had no idea that the surgery would result in me feeling anything,” Holt said. “My main concern was my safety and well-being. I was also concerned that I would have the ability to be physically active. Dr. Spiegel told me that there was a possibility that she would be able to reattach the nerve, and then it would be four to six months to see if it would work. But I didn’t really think about it.”

Using microsurgical techniques, surgeons at Baylor can attach the sensory nerve left in the chest wall to a nerve contained in the abdominal tissue used to reconstruct the breast. Traditional surgery to remove cancerous breast tissue, such as a lumpectomy or mastectomy, severs the nerve that supplies sensation to the breast.

Holt had a single mastectomy, which allowed Spiegel to compare the sensation in the reconstructed breast with the natural breast.

“When they regain sensation, patients consider the reconstructed breast to be more natural and accept reconstruction more easily,” said Spiegel.

Spiegel has performed the procedure in collaboration with Baylor microsurgeons Saleh Shenaq, MD, professor and chief of the division of plastic surgery and chief of the plastic surgery service at The Methodist Hospital, and Michael J. A. Klebuc, MD, an assistant professor of plastic surgery.

Patients begin to feel sensation about three to six months after the nerve connection procedure, she said. The procedure was developed at the Breast Restoration Center, a joint effort of Baylor’s department of plastic surgery and the Breast Care Center at Baylor and The Methodist Hospital.

“The reason why there is such a lag time is that the nerve has to grow through the flap into the skin layers, and the growth rate is about an inch per month,” Spiegel said.

She performs the nerve connection surgery in conjunction with one of two breast reconstruction techniques that use a woman's own abdominal skin and tissue but spare the underlying muscle. The deep inferior epigastric perforator or DIEP flap, transfers the skin and fat, with the blood supply coming from tiny vessels. The abdominal muscle, not needed for the reconstruction, is left in place.

Dr. Aldona Spiegel

In a similar, less-invasive procedure called the superficial epigastric artery or SIEA flap, the blood supply comes from just the fat of the abdominal area. The SIEA flap uses a more shallow incision, however, only 70 percent of patients have blood vessels in the superficial area of the abdomen. Both procedures ease recovery time and allow women to resume an active lifestyle about four weeks after surgery, while creating a natural-looking and feeling breast.

“The abdominal scar can also be well hidden, so most patients will be able to wear a bikini without any scars being visible,” Spiegel said.

Not every breast cancer patient facing reconstruction qualifies for the procedure. Some women are too thin and lack tissue for the reconstruction. In others, the nerves are damaged and cannot be reattached. The procedure is not available everywhere. It takes a longer time to perform, and it requires specially trained microsurgeons to connect the nerves.

“It is devastating to hear a physician say you have cancer,” Holt said. “It is even more devastating to hear a surgeon tell you that you will have to have surgery. I think it is great that you can have a mastectomy and still be pretty, sexy and feel good about yourself. I think this surgery does it for you.”

© Copyright 2002 - 2003 Baylor College of Medicine. All Rights Reserved.