Breast Reconstruction Option Saves Muscle

Two doctors at Froedtert & the Medical College have become experts in a microsurgical breast reconstruction procedure that uses the patient's own abdominal tissue and skin to form the new breast, saving valuable muscle function. DIEP flap surgery refers to the Deep Inferior Epigastric Perforator, the blood vessel that supplies the reconstructed breast.

An Exceptional Team
Each DIEP flap surgery is performed jointly by John B. Hijjawi, MD and Robert M. Whitfield, MD, Assistant Professors of Plastic and Reconstructive Surgery at the Medical College of Wisconsin. They currently perform about nine DIEP flap surgeries per month, mainly for patients who have had a mastectomy.

Both Dr. Hijjawi and Dr. Whitfield are experienced in microsurgery, with particular expertise in DIEP flap procedures. "We've spent a lot of time developing our comfort level with the surgery and the technique," says Dr. Whitfield.

Dr. Hijjawi recently completed a Kroll Fellowship at University Hospital in Ghent, Belgium, where he continued his studies of complex microsurgery techniques.

"My Fellowship was also in microsurgery," Dr. Whitfield says, "and I've been doing it since the outset when I came to the Medical College. We both share an interest, a passion, really, in providing this service."

There are three phases to the procedure. In the first, physicians find the blood vessels that will supply the new breast tissue and attach them to other blood vessels in the breast area. In the second, the breast mound is created with abdominal fat, and in the third, the nipple is reconstructed. The series takes several months.

Dr. Whitfield says that many hospitals in the US do not offer the DIEP flap surgery. "It's harder, it takes more time, more concentration, more effort than other reconstruction methods. It requires the microsurgical technique, and not everybody has that experience."

In addition, he said, there is a time factor involved: The DIEP flap procedure is very labor intensive. "When Dr. Hijjawi and I do a bilateral case (both breasts), it usually takes several hours. In many instances, that might not be cost-effective, but we do what's best for the patient, not what's best for the insurance company."

Raising Awareness
Drs. Hijjawi and Whitfield are actively raising awareness of the procedure within the medical community. "John and I are in the specialty, and we want to be good role models for the younger people just starting out in medicine - a lot of it has to do with the enthusiasm with which it's approached by people who are already doing it."

The two physicians also present at national-level medical conferences to help communicate their knowledge about the DIEP flap surgery. "We're trying to do what we can to help other plastic surgeons become comfortable with the techniques," says Dr. Whitfield.

In addition to physician interest, public education is an ongoing goal. To that end, Drs. Whitfield and Hijjawi turned to the Internet. "The Internet is helping us spread the word to patients," says Dr. Whitfield.

Dr. Hijjawi and Dr. Whitfield also introduce new patients to those who have already had the DIEP flap procedure. "I never, ever 'sell' the operation," says Dr. Whitfield. "In every patient's initial consultation, I recommend that they talk to another patient who has had the operation done. I look at what they have and what they need, and I try to match them up with someone in a similar situation."

Providing Help for Every Woman
To better serve the needs of those not located in Wisconsin, Dr. Hijjawi and Dr. Whitfield would like to facilitate regional knowledge about DIEP flap surgery at Froedtert & the Medical College. "Our goal is to let people know that every woman should have the opportunity to have all options for breast reconstruction." The ultimate goal of the breast reconstruction team at Froedtert & the Medical College is to provide women with the procedure with which they are the most comfortable.

To many women, the DIEP flap surgery is a logical choice, and one which they feel with best meet their physical and emotional needs. Dr. Whitfield says, "They don't want implants, and they don't want any more muscular damage or tissue damage done than necessary. Dr. Hijjawi and I are striving to provide that for as many people as we can."

"As we look to the future, more and more people will become aware of all of the options, and we can truly be of service to those who want this procedure."

P. J. Early
HealthLink Contributing Writer

To read more about the edu/article/1031002690.html>DIEP Flap for Breast Reconstruction: The New Gold Standard.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.