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New technique at Houston Methodist - The Woodlands aims to restore sensation for women with reconstructed breasts

October 4, 2018

After undergoing a procedure like a mastectomy, not only can the physical changes to a woman’s body be overwhelming, but feeling and sensation may be lost in their breast area — which could be an invisible yet devastating side effect.

At the Institute for Reconstructive Surgery at Houston Methodist - The Woodlands Hospital, two doctors are pioneering the use of a surgical technique to restore breast sensation for women who have needed breast reconstruction.

The technique, which is approved by the Food and Drug Administration for reconnecting nerves in a reconstructed hand, is only in the clinical trial phase for use with breast reconstruction.

Yet, Dr. S. Benjamin Albright and Dr. Steven Gordon, both plastic and reconstructive surgeons, have already had a few patients who have opted for this technique.

Evelyn Laryea, was the first patient that Albright worked with in this regard.

When Lareya found out her younger sister was diagnosed with breast cancer, Laryea had genetic testing done and discovered that she had a Breast Cancer 2, also known as BRCA 2, gene mutation.

This puts her at a higher risk for breast and ovarian cancer, leading her to decide to have a hysterectomy and double prophylactic mastectomy a few months ago.

When it came time to decide on a breast reconstruction technique, Laryea said she didn’t initially consider that she would lose sensation and feeling with her reconstructed breasts.

“I was more trying to protect myself from having any health issues. My main thing was healing and not having any infections,” Laryea said.

After talking with Albright about her options, she decided to pursue this new technique as an incentive to regain feeling.

Albright explained that this procedure starts with what is called DIEP flap reconstruction surgery, during which the doctor removes the existing breast tissue and replaces its volume with fat tissue from the woman’s lower abdominal area.

Then, the doctor takes it a step further by implementing a surgical technique to restore the sensation of the breast in addition to the shape. They intentionally bring the nerves of the breast skin and new tissue together, connecting the two by using a nerve graft that acts like a tunnel.

In a typical mastectomy, Albright said all the nerves in the breast skin area are cut, leaving a numb feeling in the entire breast. In this procedure, the doctor helps the nerves regenerate instead.

“The ultimate outcome for the patient would be to not only have a breast that looks aesthetically natural and feels texturally natural, but also has the sensation of her brain interpreting (the reconstructed breast) as her own breast,” Albright said.

While this option takes six to eight months to see if it is successful and is a longer surgery and recovery time, Albright said that it is a low-maintenance, long-term option. This is compared to an implant-based reconstruction.

Laryea has just one more surgery to complete the process. She said she is hopeful, and even thinks she is starting to get the sensation back at times.

Albright said that this surgery is similar to a “tummy tuck” because it takes tissue away from the abdomen. So, Laryea not only gets to look toward regaining feeling, but also gets to go shopping for some new clothes.

“That’s the best part,” Laryea said with a laugh.

Gordon said that the early results from this procedure look promising.

“We know that this has worked before in extremity (hand) cases, so it’s a big step going forward to see if we can have the same success in the breast field,” Gordon said.

If it doesn’t work, Gordon said the only drawback is that the doctors have added extra time to the patient’s surgery and recovery time.

Another patient, Stephanie Hudson, underwent the same surgeries. After finding out earlier this year that her sister had ovarian cancer, she had genetic testing done: it revealed that she had a BRCA 1 gene mutation, which also puts her at a higher risk for the female cancers.

Like Laryea, she had hysterectomy and a double prophylactic mastectomy. But, Hudson said she was considering having breast implants placed. That changed when she sat down with Albright for the first time.

“It was incredible. (Albright) spent a long time going over my options. I told him I had some reservations, but he walked me through the options and recommended (the flap) reconstruction,” Hudson said.

Though she knows it will take time to regain sensation in her breasts, Hudson said she is extremely hopeful.

“It’s a tough blow to hear that all of the parts that make you a woman need to be removed as quickly as possible. The fact that (Albright) was able to restore me back to how I was…you can imagine how that makes me feel,” Hudson said.

jane.stueckemann@chron.com

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