After a mastectomy, she had breast reconstruction without implants

May 3rd, 2019

Lydia Friese, like other women who have had breast cancer, had tough decisions to make about breast reconstruction.

After she discovered lumps in her right breast and doctors confirmed she had breast cancer, Lydia went through five months of chemotherapy and then had a mastectomy. What followed was another tough decision. She wanted breast reconstruction to restore her breast to near normal size and appearance, but before she made a decision, there was so much to learn about the options.

A photo of Lydia Friese in the water with her husband and grandchildren
After a mastectomy, Lydia Friese had breast reconstruction surgery. She is pictured in the water with her husband, Kurt Friese, and their grandchildren. Photos courtesy of Lydia Friese.

Would she choose breast reconstruction with an implant? Select a procedure called a pedicled TRAM flap? Or opt for a free flap, a painstakingly complex surgery in which tissue from her abdominal area would be removed and used to rebuild her breast.

Lydia, a lifelong Colorado resident, had extraordinary help from her husband, Kurt. He’s been a chiropractor since 1985 and dedicates himself to helping others become healthier. Now, his No. 1 patient was his wife. Kurt delved into the medical research and journals about the ups and downs of each option. When it came time to ask questions of UCHealth doctors, Kurt had a long, sophisticated list of them.

Lydia, having spent a lifetime working along her husband, had one guiding principle: “I wanted to go all natural,’’ she said.

Silicone implants

With that, the option of having an implant made of silicone gel was off the table. That led them to Dr. Frederic Deleyiannis, a plastic surgeon at the UCHealth Plastic and Reconstructive Surgery Clinic in Colorado Springs. Dr. Deleyiannis, a renowned surgeon who has returned smiles to patients with facial paralysis and rebuilt ears from rib bones, explained to Lydia and Kurt two other options:

  • A Pedicled TRAM (Transverse Rectus Abdominis Myocutaneous) flap surgery involves using the abdominal skin, fat and rectus abdominis muscle and rotating it to the mastectomy site. The blood vessels of the transferred tissue remain attached as the flap is tunneled under the skin of the upper abdomen into the breast pocket
  • A Free DIEP (Deep Inferior Epigastric Artery Perforator) flap is an alternative to a pedicled TRAM flap. To decrease the risk of abdominal wall weakness and to increase the blood flow to the transferred tissue, the DIEP flap was developed. This flap also uses the skin and fat of the lower abdomen (similar to a tummy tuck), but it does not use any of the abdominal wall muscles.  The tissue is removed from its blood supply and brought up to the breast pocket, where blood flow is restored by reconnecting the artery and vein using microsurgery. The flap is connected to the blood vessels under the third rib.

After careful consideration, Lydia and Kurt asked Dr. Deleyiannis to perform a free DIEP flap. It seemed like the best option for them. Lydia believed it would provide her with a natural-looking breast, along with other reasons: “First, it would be my own tissue. Second, because it was my own tissue, I wouldn’t need regular MRIs as follow-ups to check the integrity of an implant over the future decades. … Finally, as a side benefit, I had a tummy tuck,’’ she said.

Lydia Friese with her family.
Lydia Friese, (far left), with her family.

The hurdle: Lydia would be in surgery for nearly a full day, a long time for anyone to be under anesthesia. She believed, however, that she was strong and healthy and would do well.

Trust in her doctor

She put her full faith in Dr. Deleyiannis and his team, the only surgeons in southern Colorado who do free DIEP reconstructive surgery, a highly complex and advanced surgery.

“The advantage is that it is not an implant-based reconstruction which, over time, can have problems of infection, scar tissue, and asymmetry,’’ Dr. Deleyiannis said. “But there is risk; You don’t want to underplay the risk.’’

Finding the lump

In 1989, scar tissue developed on Lydia’s right breast after she experienced blunt force trauma to her right upper chest. In January 2017, the couple came home from Florida after visiting their grandkids. Lydia noticed that her breast “just didn’t feel right.’’

And it seemed that whenever a low-pressure weather system swept in, Lydia’s right breast hurt. She asked her husband, who has developed almost a sixth sense when it comes to touch, to exam her.

“When I felt it, there were four little nodules on top of the scar ball, and they were probably like the half size of a pea,’’ Kurt Friese said.

Confirmation

Lydia had a mammogram, an MRI and an appointment with Dr. Ingrid Sharon, one of southern Colorado’s preeminent breast surgeons. The MRI confirmed the mammography findings of the car ball’s nodules, but added the unfortunate surprise of multiple additional tumors father down in the milk ducts. Dr. Sharon confirmed breast cancer.

Next, the oncology team, led by oncologist Dr. Vishal Rana, met and a decision was made to undergo two rounds of chemotherapy, lasting about five months. After Dr. Sharon surgically installed a chemo port, which was connected to a deep vein leading to her heart, the chemo sessions began about two weeks after the Valentine’s Day confirmation of cancer.

Dr. Sharon worked with Dr. Greg Liebscher, a plastic surgeon, and the two performed a 4.5-hour surgery that included a mastectomy. The removed mastectomy tissues had clear, well-defined margins, indicating the surgery had successfully removed all the tumors. There were also three lymph nodes removed, and all appeared clear of cancer – for seven days. Unfortunately, small specs of cancer cells became evident in the lymph node closest to the tumors. This led to a decision for follow-up radiation treatment.

The questions

A photo of Lydia and Kurt Friese backpacking.
Lydia Friese and her husband, Kurt Friese, enjoy the outdoors.

Lydia and Kurt Friese then met with Dr. Jane Ridings, a distinguished radiation oncologist at UCHealth, to talk about what would come next. This was in September, 2017.

“She said, ‘sit down, you can ask whatever questions you want for however long that you want,’ ‘’ Kurt said. “I’ve got more than 1,200 post-graduate classroom hours and about half of those are in radiology. I’m not a radiologist but I have some radiology for normal anatomy for the things that I do. I had seven pages of questions, and I sat down with her and we went through every one of them.

“We started at 1 o’clock. She was great and she tolerated my questions. I’m sure she is not used to people coming in and asking questions on a technical basis, but she handled it great.’’

Kurt joked that he was a graduate of Michigan State University, and she was a graduate of the University of Michigan – a Wolverine and not a Spartan.

“I kidded her, and said, ‘We knew this was going to be a problem.’ ’’

The options for treatment

One of the options was getting Lydia into a clinical study that would be a shorter time frame and shorter with higher radiation dosages to certain areas. Lydia started a 19-day trial two weeks before Thanksgiving, and completed it Dec. 12, 2017.

“The whole process of going there was maybe 20 minutes each daily session,’’ Lydia said of radiation therapy. “I can’t express enough how the nurses, the techs, everyone was just so fantastic. ‘’

Lydia didn’t get sick from the radiation, but the radiation therapy made Lydia look as though she had a bad sunburn on the right side of her chest.

During a follow-up with Dr. Ridings, she mentioned that UCHealth had a new plastic surgeon, Dr. Deleyiannis, who could do the surgery in Colorado Springs. They met with him in April 2018.

“He was great. I told him what I wanted was the flap and what my husband had explained to me is that it’s a tough surgery but it is an easier process of healing more quickly. He said, ‘You’re pretty much right.’ ’’

Dr. Fred Deleyiannis

A talk with the doctor

Kurt had a long talk with Dr. Deleyiannis.

“In any situation that we’re in, no matter what expert we’re dealing with, I always have technical questions, ‘’ Kurt Friese said. “He gave his educational presentation, and I only had two questions. He answered almost everything that I was going to ask him.’’

Lydia spent weeks preparing to be as strong as possible for the surgery, scheduled for Aug. 25, 2018.

A photo of Lydia Friese ice fishing.
Lydia Friese enjoys the outdoors, including ice fishing.

“Due to the length of time microscopic surgery requires, I wanted to be prepared as much as possible for the procedure,’’ Lydia said. “I exercised within my limits to be in the best physical condition possible. I made sure I had a great diet and I really believed this was the best thing for me so I had a very positive attitude going into that day.’’

The day arrived

Lydia was the first patient in the operating room that day. She checked in about 5:30 a.m. and Kurt was at her side until 7:30 a.m., when Lydia was wheeled into the operating room.

In the operating room, Dr. Deleyiannis went to work on the reconstructive surgery that is available to patients who have excess abdominal tissue that can be removed and used to form a natural-looking breast.

“It’s a hard surgery, and it’s a big operation,’’ Dr. Deleyiannis said. “Some people may not be good candidates for the surgery and others say, ‘No, I don’t want a big operation, give me the implants even if they are not natural’.”

What’s involved

For Breast Microsurgical Reconstruction the Plastic Surgery Team includes Dr. Deleyiannis and Dr. Nancy Wong. “One surgeon prepares the vessels by removing a small section of rib to expose the vessels on top of the chest, while the other harvests the DIEP flap from the abdomen.  Then we transfer the DIEP flap to the chest and sew the vessels from the DIEP flap into the vessels of the chest.” Dr. Deleyiannis said.

Kurt waited for hours in the waiting room at Memorial Hospital Central.

“I brought materials so I could do work,’’ he said, recalling the day. “But on that day, I just didn’t care to. I was watching that monitor all day. Five o’clock, the place empties out, and she’s still in there.’’

It was about 6:30 p.m. by the time he was able to see Lydia in the recovery room. A few hours later, she was taken to the ICU, where she said her nurse was “simply wonderful.’’

A photo of Dr. Nancy Wong
Dr. Nancy Wong

“Regarding Dr. Deleyiannis, he has been awesome. I sought three opinions from surgeons before deciding what to do. He has been great,’’ she said. “He is just so friendly, and he listens to you and he explains everything so clearly.’’

Lydia was released from Memorial four days later.

She went back to work helping Kurt in the chiropractic practice soon after her surgery. These days, she’s hiking and walking, enjoying her grandchildren, enjoying life.

 

 

About the author

Erin Emery is a writer for UCHealth and is based in Colorado Springs.