When Jill Shuttner was faced with making a decision about reconstructive surgery after a mastectomy for breast cancer, she consulted multiple doctors about her options.
She knew plenty of breast cancer survivors, including her own sister, who had made full recoveries from reconstruction procedures with artificial implants, but when she learned of an alternative that could use her own tissue instead of silicone or saline breast implants, she was intrigued.
“When I found out I didn’t have to have a foreign body in my body and I could use my own tissue, I liked that idea,” Shuttner said. “I’m very happy with how it turned out.”
Shuttner, 54, underwent a procedure called the deep inferior epigastric perforator flap (DIEP) or free flap procedure, which was performed by Evan Katzel, MD, at Penn Medicine Princeton Health.
During a free-flap procedure for breast reconstruction, a flap of tissue is removed from the abdomen similar to the area removed during a tummy tuck, and the flap is shaped to recreate the breast. The flap contains skin, fat, and blood vessels that bring healthy tissue and blood supply to the affected area.
Little or no muscle is taken from the abdomen, and by using the patient’s own tissue, the reconstructed breast incorporates naturally with surrounding tissue.
“While a longer and more complex surgery than alternatives, the results of the free flap procedure for breast reconstruction are a natural feeling and looking breast and a flatter belly,” said Katzel, a fellowship trained microvascular plastic surgeon. “Patients can have the free flap procedure at the same time as their mastectomy or as a delayed procedure any time after a mastectomy.”
Penn Medicine is now the highest-volume center for free flap breast reconstruction in the world — performing over 700 tissue-based breast reconstructions every year. The availability of the procedure at Penn Medicine Princeton Health means that patients like Shuttner can have breast reconstruction surgery and their follow up exams close to home, where they can heal with the support of their loved ones. The procedure is part of Princeton Health’s comprehensive breast care program, which offers breast cancer patients a range of treatment and reconstruction options.
Shuttner discussed her options with Katzel and with her surgical oncologist at Princeton Health, Margaret Crivello, MD, and chose to have her procedure at the same time as her mastectomy.
Afterward, she spent three days recovering at Penn Medicine Princeton Medical Center where she was constantly monitored to ensure that the reconstructed tissue was getting enough blood supply.
“Everything went really well,” Shuttner said. “Having the option to have the free flap procedure at the same time as my mastectomy was really nice because I always felt like myself. When I came out of the procedure I was myself.”
Techniques Continue to Advance
Having completed an estimated 7,000 free flap procedures to date, Penn Medicine’s Division of Plastic Surgery is at the forefront of breast reconstruction volume, research and innovation.
Additionally, the reconstructive microsurgery team at Penn Medicine continues to advance and expand the options for breast reconstructive surgery for patients across the region.
Penn Medicine has recently been involved in clinical trials for a procedure that reconnects the nerves that supply sensation in the breast.
The procedure, known as Resensation, is offered at Princeton Medical Center, the Hospital of the University of Pennsylvania, and Pennsylvania Hospital and was the topic of a Philadelphia magazine article last year that featured Penn Medicine plastic surgeon Suhail Kanchwala, MD, the first physician in the region to offer the treatment.
Kanchwala called the procedure a boon for breast cancer patients, almost all of whom experience some degree of numbness after a mastectomy.
The technique, a nerve graft, reconnects one of the nerves that supply sensation to the chest to one of the sensory nerves in the free flap tissue. Once the nerve has regenerated, which typically takes between nine months and a year, patients may experience the return of some degree of sensation in the new breast.
“Empirical data is definitely showing that some patients are getting sensation back and that’s a great thing,” said Katzel, who performs the procedure at Princeton Health. “It was just a given in the past that you weren’t going to have sensation, and now at least we have an option to give you back some sensation.”
Additionally, doctors at Penn Medicine are also performing minimally invasive free flap procedures that result in reduced pain, quicker recovery to normal function, superior cosmetic results and the virtual elimination of the need for perioperative opioid medications.
“Almost every patient who has breast cancer is a candidate for breast reconstruction,” said Joseph M. Serletti, MD, chief of Plastic and Reconstructive Surgery at the Perelman School of Medicine. “We are pleased to be able to offer a full spectrum of breast reconstruction procedures so that patients throughout our region can work with their doctors to find an approach that is right for them.”
Keep Moving Forward
Shuttner is approaching the two-year anniversary of her mastectomy and free-flap procedure. Reflecting back on the day she received her cancer diagnosis, she remembered her thoughts going immediately to her two sons.
Her older son, Jamie, was set to graduate from West Virginia University in less than two months, and her younger son, Daniel, was kicking off his freshman year at Montclair State University.
“I just started thinking, ‘Oh my God I’m going to miss everything,’” said Shuttner, who had chemotherapy prior to her surgery as well as radiation afterward. “It was very, very upsetting.”
However, the team at Princeton Health worked with her to develop a treatment plan that enabled her to celebrate her family’s milestones and enjoy the activities they had planned — including seeing “Hamilton” on Broadway.
“There were certain things I wanted to do, and the team at Princeton Health made sure I did them, “ Shuttner said. “I thought I was going to have to give up my Hamilton tickets, but they scheduled my surgery around the show.”
Shuttner said she feels good today, and like most people, wants to get back out in the world after staying home for the past year because of the COVID-19 pandemic.
“I feel very, very good and everything has gone well,” Shuttner said. “Hopefully it’s going to stay that way. That’s the plan — to keep moving forward.”