Myra DiGange, BSN, RN, hospital administrator at St. Charles Surgical Hospital in New Orleans, Louisiana, never imagined she would one day become a patient in her own hospital. Yet after a diagnosis of breast cancer this past June, DiGange underwent a bilateral mastectomy and breast reconstruction under the care of a Center for Restorative Breast Surgery physician.
DiGange chose to undergo an advanced microsurgical technique called deep inferior epigastric perforator (DIEP) flap surgery immediately after her mastectomy. In this procedure, surgeons use the patient’s own abdominal tissue to reconstruct natural looking breasts. As in DiGange’s case, many patients are able to have DIEP surgery at the same time as the mastectomy, eliminating the need for separate procedures.
DIEP breast reconstruction surgery has replaced older breast reconstruction techniques, such as transverse rectus abdominis (TRAM) and Latissimus flaps. It improves on prior techniques by using fat from below a patient’s belly button and avoiding cutting muscles from the abdominal wall.
“With DIEP, patients don’t need implants and the procedure preserves a patient’s abdominal muscle function and strength,” said Penny Banks, MSN, BSN, RN, clinic director at The Center for Restorative Breast Surgery. In the long term, DIEP flap surgery can decrease risk for hernias and abdominal weakness.
There is also what many women would consider an additional benefit. When surgeons relocate the living tissue from below a patient’s belly button, they effectively give patients a “tummy tuck,” Banks says.
In recent decades, the field of breast reconstruction following mastectomy has rapidly evolved, along with the role nurses play in caring for patients. Although they are more common now, reconstructive surgeries are not simple and require careful follow-up both by the clinical team and caregivers, who help the patients at home.
Recovery can take weeks, and patients must be prepared for that. After her DIEP flap surgery, for example, DiGange’s care team recommended caregiver support for a week to 10 days after surgery and they advised her to avoid strenuous activity for 4 to 6 weeks.
DiGange appreciated how nurses involved her family in the care experience and discussed ways that her husband could help during her recovery at home. “They showed my husband how to look for signs of infection and to help care for my surgical drains, which were placed to prevent blood and lymphatic fluid from building up at the surgical site,” says DiGange. She also appreciated one nurse’s special sensitivity. “My elderly mom gets anxious at the sight of bruises, so my nurse made sure everything was covered and out of sight when my mom came to visit,” she says.
DiGange who is now cancer free, is looking into nipple reconstruction as a next possible step. This would require further surgery. Alternatively, she is considering working with a tattoo artist who comes to the Center and inks areolas and nipples that are realistic and 3-dimensional. She is grateful for the support she has had so far along the journey, especially from her nurses.