Houston Breast Reconstruction Surgeon Advances New Method for Sensation Recovery for Breast Cancer Patients
In her continuous efforts to improve upon breast reconstruction outcomes, Houston breast reconstruction surgeon, Dr. Aldona Spiegel's most recent work (set to be published later this year) will unveil an innovative and effective technique that increases sensation recovery for breast reconstruction patients.
One person who understands the unique issues faced by breast cancer survivors is Dr. Aldona J. Spiegel, a Houston plastic surgeon specializing in reconstructive surgery for breast cancer survivors. As Director and Founder of the Center for Breast Restoration at the Institute for Reconstructive Surgery at The Methodist Hospital in Houston, TX, Dr. Spiegel has spent years helping women complete successful rehabilitation from breast cancer and other breast related problems.
Dr. Spiegel specializes in microsurgery and advanced breast reconstruction techniques that not only enhance aesthetic results, but optimize patient quality of life post-reconstruction as well. Her chief focus has been on the most advanced form of breast reconstruction, the muscle-preserving DIEP Flap surgery, which unlike the more common TRAM Flap, completely preserves the abdominal muscle and uses only skin and fat for the new breast mound. This results in less post-surgical pain and faster recovery for her patients, but more importantly, it preserves the strength and function of the patient’s muscle, allowing them to resume a fully active lifestyle after recovery. This dedication to continually improving upon existing techniques to optimize results for patient satisfaction has led Dr. Spiegel to her most recent endeavor: Sensation Recovery.
In traditional surgery that removes cancerous breast tissue, the nerve that supplies sensation to the breast is severed, leaving the patient with significant or complete loss of sensation in the skin of the patient’s breast. For women who undergo autologous reconstruction (using her own tissue) sensory nerves have been shown to grow into the transplanted tissue over time from surrounding mastectomy skin, restoring some sensation to the newly constructed breast. However, this process is very slow as nerve growth progresses gradually, and is only observed in about 50% of patients.
Unfortunately, due to the fact that sensory re-innervation can be a lengthy process with variable results, most reconstructive surgeons do not consider it a priority. Yet, studies have repeatedly shown that the presence of sensation in a reconstructed breast can improve the patient-rated quality of life post-mastectomy and reconstruction.
In recent years, the DIEP Flap has become the flap of choice, due to its preservation of the abdominal muscle and superior aesthetics, and is the primary technique used in Dr. Spiegel’s practice. Therefore, to improve upon this preferred breast reconstruction technique, Dr. Spiegel turned her attention to finding new techniques to restore lost protective sensation in the breast following mastectomy.
Dr. Spiegel and her team recently completed a clinical study that explored the use of a new method of DIEP Flap neurotization (nerve regeneration) that utilized the anterior cutaneous 3rd intercostal nerve using two different neurotization methods (a PGA conduit tube versus direct nerve coaptation) to compare effects on sensation recovery. Traditionally, the lateral cutaneous branch of the 4th intercostal nerve is the recipient of choice for flap neurotization. However, this nerve is frequently damaged during breast cancer surgery and lies in a separate microsurgical field, thereby increasing flap inset complexity. This novel approach offers the possibility of routine DIEP and SIEA Flap innervation with an undamaged donor nerve that is reliably found in the recipient vessel microsurgical field.
Patients were evaluated 2 years post-reconstructive surgery and exemplified a significant increase in sensation recovery when DIEP Flap neurotization was employed using a PGA conduit tube. Therefore, Dr. Spiegel’s research revealed that DIEP Flap neurotization using the 3rd intercostal nerve with a PGA conduit tube is an effective technique that provides significantly increased sensation recovery. Moreover, this method can be carried out without adding considerable surgical time (an average of 15 minutes).
Dr. Spiegel’s pioneering research and breakthrough findings on DIEP Flap neurotization were presented at the annual meeting for the European Association of Plastic Surgery and are set to be published later this year, which will enable other surgeons to utilize these techniques in an effort to continue to improve breast reconstruction outcomes.