OHSU Surgeon Performs New Breast Reconstruction Technique In Oregon

04/03/11  Portland, Ore.

The microsurgical technique produces a natural breast with less recovery time.

Wesley Schooler, M.D., has nimble fingers.

They’re long and slender. When the plastic surgeon speaks to you, his fingers echo his statements with syncopated, expressive gestures. But it is at work where his fingers truly come to life, painstakingly unweaving delicate blood vessels from layers of muscle in an attempt to help women who have lost one or both of their breasts.

Schooler, Oregon Health & Science University associate professor of plastic surgery, is one of the few surgeons in the country performing a precise and time-consuming form of breast reconstruction surgery, a technique know as the DIEP flap procedure. During the surgery, Schooler carefully transplants recovered abdominal fat, skin and blood vessels to the breast site. The total reconstruction takes four to six hours – for each breast.

The result is a reconstructed breast more similar to the natural breast than saline or silicone implants. But unlike its similar and more common predecessor, the TRAM flap, the DIEP flap does not require a debilitating loss of abdominal muscle mass and also calls for less recovery time. These two features make the technique a lifestyle-affirming option for many women, including those with active lifestyles who do not wish to give up abdominal strength and those whose health problems may make them ineligible for the TRAM flap.

As with the TRAM flap, the tissue for the new breast in a DIEP flap procedure is harvested from the abdomen. But while the TRAM flap technique transplants abdominal muscle to the breast site in addition to skin and fat, the DIEP flap technique leaves the muscle behind, taking only skin, fat and the blood vessels necessary to supply blood to the reconstructed breast. Microsurgery is then used to connect those blood vessels to a new blood source in the chest. The procedure is named for those blood vessels (Deep Inferior Epigastric Perforator) which are transferred along with the skin and fat flap.

Tamara Phelps knew she wanted to have her breast reconstructed when she learned she needed a mastectomy. Diagnosed with breast cancer five years before many women schedule their first mammogram, Phelps at age 35 found herself in the midst of a whirlwind of cancer treatment and recovery options. When it became clear that Phelps needed a mastectomy, she began to look at her choices for breast reconstruction.

Through the recommendation of her oncologist, Phelps met with Schooler, who outlined several types of reconstruction. As a young woman, whose work at an airline requires physical exertion, Phelps decided that the DIEP flap technique would best fit her needs.

“I basically looked at all the options,” she said. “I didn’t want to go with the implant, because it didn't seem natural. Anything that had to move muscle was not an option for me. I already had cancer – I didn’t want to mess with a part of my body that is healthy.”

Phelps underwent the procedure in December 2006, two months after her initial breast cancer diagnosis. Six weeks after surgery, Phelps was able to return to work and resume a mostly “normal’ life, even as she works to manage her breast health.

She continues to be enthusiastic about her new breast. “It makes me feel like I haven’t lost anything, even though I have,” she said. “I can feel me. Like I’m still me.”