Although her breast cancer diagnosis initially left her stunned, Heidi Grisé wasn’t about to let it hijack the rest of her life.
“You are just overwhelmed,” Grisé, now 51, said in describing the emotional wave that swept over her when a doctor told her three years ago that she had invasive breast cancer. “It is almost like an out-of-body experience.”
After the initial shock, Grisé said she settled into learning as much as she could as fast as she could about the disease, the latest treatments and, if necessary, breast replacement surgery. What she quickly discovered is that when it comes to breast cancer and its treatment, no one size fits all.
In addition to surgery, breast cancer treatments currently available include systemic chemotherapy, radiation, hormonal therapy and targeted therapies that go after specific genes and proteins that allow cancer to grow and survive.
Grisé of West Simsbury is not alone when it comes to facing the challenges of breast cancer. According to the National Cancer Institute, 231,840 women in the United States will hear for the first time in 2015 that they have breast cancer. In addition, roughly one in eight will develop the disease during their lifetime.
By the time doctors discovered Grisé’s cancer, it had spread throughout one of her breasts. From what she had read and what her doctors confirmed, Grisé knew that a mastectomy, the surgical removal of the diseased breast tissue, would be the best way to stop the cancer from spreading further and ultimately killing her.
Although the decision to undergo a mastectomy was relatively straightforward, Grisé said, choices were more difficult when it came to how to rebuild her body and spirit afterward and feel whole again. For personal reasons, Grisé did not want silicone implants.
She instead chose to have both breasts removed by a cancer surgeon and the replacements fashioned by a plastic surgeon using fat, skin and blood vessel tissues harvested from her own body. She wanted both the cancer and plastic surgeries done one right after the other and finished before the anesthesia wore off.
Her choice of surgical options led her to the office of Dr. Leo Otake, chief of plastic surgery at St. Francis Hospital and Medical Center in Hartford. Otake’s surgical expertise, she learned through her own research and discussions with her oncologist and cancer surgeon, included a reconstructive technique that she believed was best for her.
The technique involves harvesting a section, or flap, of tissue that the surgeon disconnects from its blood supply in the lower abdomen, and moving it to the chest, where it is reconnected to a new blood supply and fashioned into breast mounds that take the place of a woman’s breast or breasts that have been surgically removed.
“Every woman’s situation is unique,” Grisé said. Surgical options are not only dictated by the type of cancer involved and its stage of progression, but also by the training and skill of the surgeon a woman chooses for the surgery.
“You have to decide the result you want to achieve,” Grisé said. “It is just so personal.”
A Variety Of Options
Some women prefer silicone implants, even though they are subject to wearing out after about 10 years and needing to be replaced.
Those choosing reconstruction using their own tissues will undergo longer surgical procedures and must deal with the aftereffects of moving otherwise happy tissue from one place on the body to another.
Post-mastectomy breast reconstruction has come a long way since being first described in 1895 by Vincenz Czerny, a professor of surgery at Heidelberg University in Germany. During an operation, Czerny, who is considered a pioneer in the field of plastic surgery, replaced a woman’s diseased breast with a benign, fist-sized fatty tumor known as a lipoma that he’d found in her flank.
Breast reconstruction using silicone breast implants came along in the 1960s and is still used today.
“Autologous reconstruction,” which relocates tissue from another site on a woman’s body to her chest, where it’s used to build replacement breasts, came along in the late 1970s.
By 1982, a group of plastic surgeons had developed the so-called TRAM (transverse rectus abdominis myocutaneous) flap procedure, in which skin, fat, blood vessels and muscle, either left attached or free floating, are cut from the lower abdomen and moved up into the chest and used to build breast mounds. The attached TRAM flap procedure, which involves tunneling the flap from its point of attachment in the abdomen up into the chest, was described as “the workhorse” of autologous breast reconstruction.
Today, however, many surgeons have backed away from the procedure because of the post-surgical risks for developing abdominal hernias or bulging caused by the muscle’s being cut. It is no longer recommended or performed at the John Hopkins Breast Center in Baltimore.
Within the past 10 years, microvascular surgeons have been using detached islands of skin, fat and blood vessels, and little or no muscle, from the lower abdomen or buttocks and moving them to the chest, where they are reattached to a blood supply and fashioned into the breast replacement.
Unlike silicone implants, tissue flaps require a blood supply to keep them alive. It was initially easier and produced better outcomes to leave the flap attached to a blood supply from the underlying muscle. Moving the muscle with the flap, however, led to more abdominal ruptures and greater weakness.
With advances in microsurgical techniques, however, plastic surgeons like Otake who are trained in microvascular free flap procedures can bring an area of the abdomen and the deep inferior epigastric perforator blood vessels that serve it (also known as a DIEP flap) up into the chest and leave behind the intact muscles.
“Leaving the abdominal wall intact means there’s less risk of abdominal wall bulging” after the surgery, Otake said.
‘A Very Personal Decision’
For Grisé, whose husband, Dr. David Grisé, is a pulmonologist at St. Francis, it was important that she have a hand in deciding not only the course of her cancer treatment, but also in shaping her recovery.
Although Grisé accepted that surgery was her best option, she did not want to be disfigured for the rest of her life.
“I liked using my own tissues,” Grisé said. Using an implant would have meant less surgery initially but probably not in the long run because they wear out.
“I didn’t want to have to go through another [implant] surgery,” Grise said, “and I didn’t want to compromise the muscles in my abdomen.”
“What I liked was that he [Otake] said this is a very personal decision and that he wanted me to understand all the pluses and minuses in each … and that he understood that every woman is different about what they want in the end.”
Otake sees a large part of what he does as helping breast cancer patients to “get through the rest of their lives after the cancer is cured.”
“Psychologically and spiritually, it is a daunting voyage,” Otake said.
“There’s always that specter” before them, Otake said, and troubling thoughts “bubbling in their mind.”
Otake said it has been his experience that women who have breast replacements made from their own tissue are generally more satisfied with the results.
“They also get a tummy tuck out of the deal,” Otake said.
But, he said, “The No. 1 goal is to ensure your cancer is beaten,” adding that he is just part of a team of medical specialists working together toward the same end.
For Otake, “the great feel-good proposition” of his life as a doctor is being able to tell a patient: “You are cancer free.”
He also likes to leave patients “with a sense of wholeness.”
Grisé said she’s thankful that Otake’s and her paths crossed.
“I needed someone who is compassionate and who would take the time … a doctor who is reassuring and caring,” Grisé said. “That makes all the difference in the world.”
