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SUMMER 1995 ISSUE
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SINAI HOSPITAL
Sinai Surgeons Can Create a Lifelike Breast After Cancer
44
I
t's bad enough for a woman to go
enormous support Sinai offered them. The
ence, where breast surgeons, radiologists,
through breast cancer and an op- TRAM procedure is extremely delicate, involv-
chemotherapists, social workers, nurses, and
eration," says Daniel Sherbert,
ing suturing of tiny blood vessels and other physical therapists plan the treatment strate-
M.D., of Sinai Hospital, "but then
structures. It is done under high-powered sur-
gy together and coordinate the steps. The ca-
to have to worry about being dis-
gical microscopes. "Sinai was willing to invest pability of offering TRAM flap reconstruction
figured or risking more health problems with in the very best state-of-the-art, high technolo-
is a tremendous asset to complete the services
implants is asking too much."
gy equipment," say Alani and Sherbert. "They
offered to breast cancer patients at Sinai.
That's why Dr. Sherbert, a plastic surgeon,
gave us everything we needed and wanted to
While breast cancer is still a terrible disease,
and his colleague Hashim Alani, M.D., chief make this operation successful."
the options for treatment have increased great-
of Plastic Surgery at Sinai, have brought a rev-
Sinai's reputation in breast cancer surgery ly over the past 15 years. These include taking
olutionary new breast reconstruction procedure and breast reconstruction is recognized through-
out only part of the breast or even just the can-
to the Detroit area. It's called
cerous lump, along with radia-
the TRAM (transverse rectus ab-
tion or chemotherapy. And, if
dominis myocutaneous) flap.
the entire breast has to come
The surgeons cut out a wedge of
off, the procedure is not as dras-
skin-covered tissue from the out-
tic, explains Dr. Alani. "The
side of the lower abdomen, move
cancer surgeons will now leave
it up to the breast area, and care-
skin and chest muscles, which
fully sew it into the spot where
makes it easier for us to do our
a cancerous breast was removed.
work," he says. "Plus, they no
Drs. Sherbert and Alani can
longer feel you have to wait sev-
even create a lifelike nipple by
eral years to see if the cancer is
cutting and twisting the skin of
really gone. If you want to have
the implanted tissue so it puck-
breast reconstruction right
ers. Later, after the woman has
away, we can begin the proce-
recovered from surgery, they tat-
dure during the same operation
too the puckered area to match
as the breast removal — pro-
the woman's own nipple color.
vided you are a good candidate
"Our patients are extremely
for surgery."
happy with the results," says Dr.
To have a successful TRAM
Sherbert. "The skin is soft,
reconstruction, you need good
warm, and pliable. It feels very
veins and arteries. The im-
much like the real breast did.
plant won't take unless the
After TRAM flap breast reconstruction.
There's a bonus too — an auto- Before breast reconstruction.
blood vessels that the surgeons
matic tummy tuck, which comes
connect work well and bring
with the removal of skin, fat, and
lots of blood to the area to keep
muscle from the lower abdomi-
REPIACING BREAgn
ARE YOUR ONIONS? it alive. Women with heart dis-
nal area!"
ease, blood vessel disease, high
RAM flaps from the lower abdomen
publicity about silicone sac ruptures and sub-
The breast feels real because
blood pressure, diabetes, or
are certainly the gold standard in re-
sequent health problems — after all, Jenny
it is real. It is composed of a
who are substantially over-
construction
for
women
who
have
lost
Jones
had hers removed! — has forced com-
woman's own tissue nourished
weight are not good candidates
their breast to cancer. But what if you don't
panies to take them off the market. However,
by her own blood. The skin, fat,
for TRAM operations. All of
want to go through the procedure or you can't
it is worth noting that the sac in which the salt
and muscle from the lower ab-
these
problems affect the qual-
have a TRAM for medical reasons?
water breast implant is contained is made of
domen is very similar to breast
ity
of
blood vessels. Smokers
Right now, a good second choice for breast
silicone, as are pacemakers, heart valves, and
tissue composition. The TRAM
may
not
be eligible either, be-
replacement is called a saline implant. A
other devices approved for use in the human
flap breast cannot be rejected
cause smoking damages the
saline implant is a bag that is fixed into the
body. This latter type of silicone is hard (as
like an organ transplant from
blood vessels. The good news
area where the breast was removed and cov-
opposed to the liquid type used in breast im-
another person, so it's not nec-
ered with skin. This bag can be gradually
plants) and does not seem to create negative
is that, if you quit smoking for
filled with salt water through a small open-
reactions in the body.
essary to take strong anti-rejec-
a period of time, your blood
ing that is left at the site of placement. The re-
Many women liked the silicone implants.
tion drugs after the operation.
vessels can recover, and you
sulting breast provides shape and resiliency
However, use of these implants has been re-
The scarring is minimal, and
might be able to have a TRAM
to
the
area.
Salt
water
is
very
compatible
with
stricted to reconstructive use only and will no
fades with time to the point of
breast construction eventual-
the body, since a good portion of what we are
longer be available for breast augmentation.
being almost undetectable. Ac-
ly. In addition to women who
made of already is salt water.
cording to Dr. Sherbert, "When
have had breast removals for
Silicone implants, small sacs filled with
you're done, you're done for a
cancer, Drs. Sherbert and Alani
liquid silicone, are rarely used anymore. Bad
lifetime. It's part of you."
have performed TRAMs on
The TRAM operation was in-
women who have what are
vented 15 years ago by Dr. Carl Hartrampf of out the area. In addition to superior equipment
called precancerous lesions. The changes in
Atlanta, Georgia. Dr. Sherbert, a native Michi- and talented surgeons, Sinai favors a team ap- their breast tissue have a high likelihood of be-
gander, recently completed a fellowship in proach, which eases the difficulty of going coming cancerous, and so the women undergo
Atlanta and worked with Dr. Hartrampf. More through breast cancer treatment. Instead of preventive breast removal. TRAM flaps have
than 6,000 women a year undergo TRAM pro- having many appointments on separate days,
also been placed in women who underwent
Sinai offers their breast cancer patients a com- breast reconstructive operations with silicone
cedures and the numbers are growing.
What lured Dr. Sherbert back to Michigan? prehensive program at Sinai's Women's Breast implants and had to have the implants removed
Other than his roots, he says, it was the oppor- Center in West Bloomfield. Every woman's because of problems.
tunity to work with Dr. Alani at Sinai and the medical history is reviewed at a team confer-
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