Scars become lifelike breasts for cancer patients
- on November 30, 2012
By Lisa Gutierrez, The Kansas City Star
KANSAS CITY, Kan. — Inside the University of Kansas cancer center, halls bustling with medical staff in scrubs and patients with wispy chemo hair, stands the oasis called Missy's Boutique. Purses and jewelry and other shopping eye candy share space with the depressing accessories of breast cancer — prostheses, wigs, mastectomy garments.
Sometimes, the customers need more than what's there. And that's when the staff refers them to a petite, elegant, grandmother of six named Nancy Klug.
Last week, Klug talked by phone with a woman facing a mastectomy and breast reconstruction in January.
The woman had lots of questions. But Klug had one, too.
"Do you know what your new breasts will look like?"
No, the woman said.
"Would you like to see mine?"
The woman was stunned. "You would do that for me?"
"Absolutely." Klug cheerfully suggested they do lunch.
Anytime, anywhere, in airport bathrooms, out shopping, on vacation, the 63-year-old Klug will happily discuss the breasts that KU plastic surgeon Teresa Buescher created for her nearly three years ago in a state-of-the-art procedure known as the DIEP flap.
Klug will share details of her 14.5-hour surgery — a double mastectomy followed by reconstruction — the painful recovery and the follow-up surgery. Sometimes, very discretely, she'll allow someone a peek at Buescher's handiwork.
How many times has she heard: "Never in a million years would I know those aren't your breasts!"
With such passion, Klug should be drawing a salary from the American Society of Plastic Surgeons. The group representing more than 7,000 board-certified plastic surgeons in the United States recently launched the first national BRA Day — Breast Reconstruction Awareness Day. The campaign's motivation: Seven out of 10 women eligible for breast reconstruction after cancer surgery are not told about their options.
And women want to know. According to an ASPS survey released last month, 90 percent of breast cancer patients want to see what the results of reconstruction would look like before they choose a cancer treatment.
Groups that work with breast cancer patients find time and again that women want to see more than before-and-after photos. They want to see real breasts and talk to women like Klug who've had the surgery. flap
At a BRA Day show-and-tell in New Orleans last month, reconstruction patients opened their blouses to reveal their new breasts to other cancer patients.
Ideally, a breast cancer patient would learn about reconstruction options while deciding her cancer treatment, said Malcolm Z. Roth, chief of plastic surgery at Albany Medical Center in New York.
Women also need to know, he said, that since 1998 federal law requires health insurance providers that cover mastectomies to also cover reconstruction.
"I think it's a lot of things, and some of it may be unintentional," said Roth. "Oftentimes, there is the discussion with the doctor who may be doing the breast cancer surgery or maybe the family doctor saying, 'Well, breast reconstruction is something we can talk about, you don't need it ... you can worry about it later on.'
"Or it may be a loved one, the woman's children, parents, best friends, saying 'Susie, just take care of the cancer. Don't do more surgery than you need.'?"
No one method fits every woman, nor is reconstruction the right choice for every patient, Roth said. The majority of American women who have mastectomies don't have breast reconstruction.
"It's never something I would tell her she should do," he said. "Certainly, it is up to the woman."
Klug's new breasts make her feel more normal, the way she did before the words "breast cancer" entered her life. "I look in the mirror and feel complete," said Klug, a retired occupational therapist living in western Shawnee.
"For a woman to know that she is faced with losing a part of her very intimate feminine identity is very degrading. It is a painful thing."
Before her surgery she held a funeral for the breasts she was born with. A sexy blouse. Dinner at home with her husband. And later in the evening, boxing up the bras she would never wear again.
Cancer has been a pox on Klug's family. Her mother died of colon cancer, then her husband lost a kidney to cancer in November 2006. They had talked about moving back to Hawaii, but then she was diagnosed with breast cancer in November 2009.
Her breasts had long been a health concern. She'd always had dense tissue and "was always getting these scary mammograms."
Her gynecologist sent her to the Breast Cancer Prevention Center at the University of Kansas Hospital where she participated in a study of women taking hormone replacement therapy. Months of drug regimens, fine-needle aspirations, ultrasounds and mammograms ensued.
Then came that fateful day, as happens for so many women, when she heard these words: We need to look at your breasts again.
The cancer in her right breast was a type fed by hormones and unresponsive to conventional chemotherapy treatments.
"My response was, 'I just want this out of me, like right now,'?" she said. The size and location of her tumor pointed to a mastectomy. She chose a prophylactic mastectomy in her healthy left breast to avoid more cancer down the road.
Klug asked her oncologist, "and where do I go from there?"
You meet with a plastic surgeon, was the answer.
That turned out to be Teresa Buescher, who is upfront with all her patients from the get-go: "Surgery is stress. It's like getting hit by a car, but you planned it."
She's blunt that way. Buescher's soldier-like posture, unwavering eye contact and rapid-fire speech tell of her military past — 15 years in the Army, seven in the Navy, time served in Iraq. As a military surgeon she operated on burn victims and rebuilt blown-apart arms and legs. She moved into plastic surgery in 1993 after seeing how it changed the lives of patients.
For her bio on the KU hospital website, she explained her new mission: "Helping ladies regain their self-esteem and feeling of wholeness after cancer amputations is a really big deal to me, more like a crusade. Nobody has to walk around feeling mutilated."
Buescher first showed Klug implants, still the most common form of breast reconstruction in the United States.
After a brief fantasy about Victoria's Secret-size breasts, Klug said no to silicone. "I couldn't picture myself on the beach in Maui when everything else is heading south and I have these perky boobs," she said.
Instead, on April 6, 2010, she had a procedure called a DIEP (deep inferior epigastric perforators) flap in which Buescher constructed two new breasts from tissue and blood vessels removed from Klug's abdomen. It's a two-fer: Tummy tuck and new breasts.
"It's you. No foreign bodies, no big infection worries," Buescher said. "And people are more comfortable with that. You can lay on them. They bounce, they flop, they hang. They do the things your breasts normally do."
Only a handful of hospitals in the country have surgeons who perform DIEP flaps; according to breast cancer resource websites the University of Kansas Hospital is the only place within several hundred miles that does.
Until a few weeks ago when KU hired another plastic surgeon with the training, Buescher was the only surgeon in Kansas City doing DIEP flaps. More popular on the coasts, the surgery has been around for more than a decade and has gained a following among young patients choosing prophylactic mastectomies.
A similar approach is the pedicled TRAM flap. In that procedure, the surgeon harvests lower abdominal fat and skin along with one of the rectus abdominis muscles — an ab, or part of the six-pack and the blood vessels therein — for the new breasts.
Because the abs are involved, patients post-surgery must sometimes find new ways of doing ordinary things, like getting out of chairs, to compensate for the loss of muscle strength.
Buescher prefers the DIEP flap because it leaves the abs intact. It's a longer surgery than the TRAM procedure, though, up to five hours for one breast, eight for both, with all the delicate snipping, moving and stitching of blood vessels involved. In rare cases, tissue can die from blood starvation, and the tissue within the flap is removed.
Klug went home with five drains hanging from her breasts and hips that collected post-surgery fluids. For weeks she couldn't lift anything heavier than a gallon of milk, though she's since regained that strength. Driving was off-limits. Then a short follow-up surgery was needed so Buescher could perfect the breasts.
Some DIEP flap patients have sensation in their new breasts, but others don't. Details are created with surgery and tattoos.
The scar on Klug's abdomen stretches hip to hip, but she has no regrets.
"Women who get reconstruction are more likely to go back into the workforce. There have been studies about that," Buescher said. "They're less likely to be reclusive and more likely to go back out and do what they used to do. It's all about trying to be normal."