— -- When breast cancer patient Kim Jordan arrived at the Torrance Memorial Medical Center in Torrance, California, earlier this month, it was so early that it was still pitch black out. She was heading into the hospital for a complicated surgery expected to last all day and well into the evening.
“I’m just worried,” she said. “I just want to wake up.”
The 50-year-old Los Angeles Metro conductor was at the hospital for a double mastectomy and reconstructive surgery. Unlike 80 percent of women who undergo breast reconstruction, Jordan had decided against implants and instead chose a complex transplant surgery that creates natural breasts from one’s own flesh and blood.
“Kim has large breasts and she also has a lot of abdominal tissue that she doesn’t want,” said Dr. Michael Newman, her plastic surgeon, just before he headed into the operating room. “Instead of giving her a tummy tuck, and throwing that tissue away, we’re going to use that tissue to give her new breasts.”
It may sound a bit like science fiction, but the surgery has been around for two decades. It is called the DIEP flap -- an acronym for the type of blood vessels involved in the procedure. It is a far longer surgery than implant surgery, with a lengthier initial recovery period, but there are also advantages.
“With the flap, it’s your own tissue,” said Dr. Lisa Jewell, a plastic surgeon who works alongside Dr. Newman. “So it’s going to look and change and age with you for the rest of your life.”
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The surgery has a higher success rate than implant surgery, with a lower percentage requiring repeat operations. And if all goes well, the results are permanent, whereas implants need to be replaced every one to two decades.
“I make the analogy of an implant being like a tire in your car,” said Dr. Whitney Burrell, another plastic surgeon in the practice. “It's great. It’s not meant to last forever... DIEP flap, you're done.”
Because tissue is removed from the abdomen, DIEP flap patients also get the appearance of a tummy tuck.
“A lot of patients are hesitant because we tell them it’s a long surgery,” Dr. Jewell said. “But then we kind of present them with the silver lining, which is getting rid of something they’ve always wanted to get rid of and putting it to better use.”
By 7:30 a.m., Jordan was ready for surgery, and she hugged her friend, Mandy, before the anesthesiologist put her under. Following a morning mastectomy performed by a different surgeon, Dr. Newman and Dr. Jewell did the painstaking work of removing her stomach tissue and forming new connections between blood vessels in the chest and abdomen tissue.
“This is an organ transplant like a kidney transplant or a lung transplant,” said Dr. Jewell on one of her scarce breaks during the 15-hour surgery. “You have to connect it to a reliable and steady blood supply, Otherwise the tissue dies and we don’t have it available to make a breast. So once we do that, then we can all take a deep breath.”
Depending on the amount of stomach tissue available, patients have some say in deciding the size of their new breasts, and can opt to go larger or smaller. In Jordan’s case, Dr. Newman and Dr. Jewell worked to correct unevenness in her breasts that was a byproduct of earlier surgery.
Just before nine o’clock, Dr. Newman put the finishing touches on Jordan’s new breasts.
“As far as volume goes, I think they’re much more similar,” he said.
The cost for this type of labor-intensive and long surgery is many tens of thousands of dollars. Fortunately for Jordan, her insurance will cover it. Though the surgery could also be performed as an elective cosmetic procedure, it would be prohibitively expensive. Dr. Jewell said she does not expect to do the surgery for purely cosmetic reasons in the future.
“It is a very extreme surgery to do for cosmetic purposes,” she said.
The surgery finally wrapped up close to 11 p.m., and Jordan was wheeled off to the ICU for the first phase her recovery.
Jennifer Fisher, a 44-year-old mother who works in special education, has been in that recovery room as one of Dr. Jewell’s patients. Fisher got the surgery in July. Her breast cancer diagnosis had come 10 years earlier, when she was busy raising a toddler.
“At that moment, you become the warrior, you change,” she said. “You no longer are a mom and this and that, you become a person fighting this for everyone else and yourself.”
She initially got an implant, but she never liked the way that it looked or felt. After an implant check two years ago revealed recurring cancer, she decided that she was ready for the DIEP flap. She also prepared herself for the surgery by renewing her commitment to exercise and losing 30 pounds. These days, she could not be more pleased with her transformation.
“Dr. Jewell really kind of liberated me a little bit to say, ‘You deserve to have the body you see yourself having, and be grateful for that body,’" she said.As for Jordan, nine days after her surgery, she arrived at South Bay Plastic Surgeons for her first post-op appointment. Despite some lingering discomfort, she was all smiles.
“I got nice knockers,” she said, “and no stomach.”
For her doctors, this is what it is all about.
“It is a huge quality of life issue,” Dr. Jewell said. “Breast cancer is a terrifying diagnosis, and most of the reason why is because women imagine themselves without breasts, with horrible scars on their bodies, without that outward symbol of femininity. And our job is to take that out of the equation.”