Robins woman chooses UI surgeons for specialized breast reconstruction

In February 2014, Denise Brown of Robins, Iowa, had a routine mammogram in Cedar Rapids. When the results for her right breast came back abnormal, she underwent a biopsy and two lumpectomies.

The lumpectomies and a subsequent MRI showed that Denise had multifocal ductal carcinoma in situ (DCIS)—a common type of breast cancer found in the milk ducts of the breast. For some women, a small amount of DCIS may never turn into invasive cancer that can spread throughout the body. But since Denise’s DCIS was multifocal (in multiple spots) and high-grade, her risk of developing invasive cancer later was high.

“Although DCIS is considered pre-invasive cancer, if you want to remove it all and it is in multiple spots throughout the breast, you can’t really take it out with a lumpectomy,” says University of Iowa breast surgeon Ingrid Lizarraga, MBBS. “You have to remove the whole breast to take it [the cancer cells] out.”

Before her appointment with a local plastic surgeon, Denise had done her research. In addition to a skin-sparing mastectomy—which involves removing all breast tissue while leaving as much skin as possible—Denise wanted to have a DIEP (deep inferior epigastric perforator) flap reconstruction.

“I knew that was the procedure I wanted,” remembers Denise. “I wanted it to be more natural, and I didn’t want them messing with my muscle—I’m too active for that.”

In a DIEP flap procedure, tissue is taken from the patient’s abdomen to form a new breast. A more common procedure requires taking some of the abdominal muscle and its blood supply, as well, but a DIEP flap procedure requires meticulously separating the vessels supplying blood to the skin and fat in the abdomen and connecting them to the blood vessels in the chest, eliminating the need to remove abdominal muscle.

“The advantages of the DIEP flap procedure are that you don’t have to take any muscle, you aren’t left with an unsightly bulge on the upper abdomen from tunneling the flap to the breast, and you don’t have the risk of a hernia,” says Lizarraga.

The plastic surgeons at Denise’s Cedar Rapids hospital, however, were not able to offer the procedure Denise wanted, so she was referred to University of Iowa Hospitals & Clinics, where surgeons have the highest number of DIEP flap patients in the state.

“When a patient wishes to use their own tissue for reconstruction, we prefer to do that operation, but it requires more expertise on the part of the plastic surgeon and the team,” says Lizarraga.

Denise underwent her first-ever inpatient surgery in June 2014. The mastectomy procedure, led by Lizarraga, and the DIEP flap reconstruction, performed by UI plastic surgeon Jerrod Keith, MD, went smoothly. Denise now returns to UI Hospitals & Clinics for yearly follow-up mammograms.

Dubbed a “rock star” by her doctors for her determination and fast recovery, Denise is thankful for the specialized care she received.

“The team approach meant a lot to me. I felt like they were very prepared when I got there,” says Denise. “I would tell anyone, ‘Go there and get on their team.’”

— Catie Malooly
Fall 2015