Heart Saving Breast Reconstruction

Breast reconstruction surgery preserves mammary artery

(RxWiki News) When a woman has breast cancer in her left breast, radiation therapy in the area can increase her risks for heart disease. A new surgical technique proactively manages this risk.

A breast-reconstruction surgery that's growing in popularity has been improved to protect and preserve the mammary artery should it be needed for future cardiac surgery.

"Ask your doctor if the DIEP flap can be used for your breast reconstruction."

Having cardiac bypass surgery is a relatively unlikely event for a woman. However, if she's had radiation on the left side following a mastectomy, she's has a two-fold greater risk of having potentially fatal heart disease.

While radiation is more commonly performed after a breast-conserving lumpectomy, "Approximately 20-30% of women who undergo mastectomy meet the criteria for 'high risk of recurrence' and are candidates for post-mastectomy radiation," lead researcher, Gedge D. Rosson, M.D., associate professor of plastic and reconstructive surgery at the Johns Hopkins School of Medicine, tells dailyRx.

Because of the increased risk post-mastectomy radiation poses, Dr. Rosson says it's better to have the mammary artery available should it be needed for future by-pass surgery.

An increasingly popular surgical technique following mastectomy uses a flap of abdominal skin and fat to reconstruct the breast, without involving any muscle tissue. This new procedure is called DIEP (deep inferior epigastric perforator).

Ordinarily, the internal mammary artery is used to connect blood supplies, cutting it off as an active heart vessel. But this artery is usually the first one heart surgeons use to by-pass diseased and damaged arteries.

Dr. Rosson has discovered and perfected a new breast reconstruction technique called “end-to-side anastomosis," which preserves the mammary artery should it be needed in the future.

He tested the safety of this technique by reviewing records of 30 patients who had received either the conventional or new type of DIEP.

For women who are undergoing breast cancer reconstruction, Dr. Rosson offers these suggestions. "Patients should first ask if the DIEP flap is available at their center, and then, if it is, ask if the reconstruction surgeons use the Internal Mammary artery," Dr. Rosson said.

"If a patient with high risk for future cardiac surgery is concerned about the use of her internal mammary artery, she can ask if the reconstructive surgeon would consider an end-to-side anastomosis technique," he said.

According to the American Society of Plastic Surgeons, 93,000 breast reconstructions were performed  in 2010. Most of these surgeries involved the use of implants, but 20 percent used the patient's own tissue.

The DIEP flaps are essentially a "tummy tuck" that uses the removed tissue to recreate the breast which has good shape and feels natural, according to Dr. Rosson. About 5,000 of these surgeries were performed in 2010.

Findings from this study were reported in the October, 2011 issue of the journal, Plastic and Reconstructive Surgery.

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Review Date: 
October 14, 2011