As she'll tell you herself, Teresa Buescher enjoys the work of reconstruction surgery. Buescher, a plastic surgeon at Kansas University Hospital, likes being able to give women good news all the time. To say, "We can do that." To her, it's a far less gloomy world than oncology.
For many women who undergo mastectomies, losing part or all of one or both breasts comes with the same fraught emotions of any other kind of amputation.
Their old clothes don't fit, because they were designed with breasts in mind. When the women look in the mirror, they see indentations that Buescher describes as a "bootprint" on their chest where the breast was. Even women who decided not to get reconstruction surgery often come back to Buescher's office saying, "I really can't live like this. I look in the mirror and cry," she said.
The "superior" reconstruction type at the moment, in Buescher's opinion, is the one she specializes in, Deep Inferior Epigastric Artery Perforator, or the DIEP flap. The DIEP flap takes skin and tissue from the abdomen to fashion a replacement breast out of a woman's own tissue while sparing abdominal muscles.
The DIEP flap represents an advance over another, similar procedure. The Transverse Rectus Abdominis Myocutaneous, or TRAM flap, also takes tissue from the abdomen but takes with it muscles critical for abdominal strength. The procedure can leave women with a higher risk for a hernia as well as orders not to lift anything heavier than 20 pounds after getting the surgery.
That's why Buescher recommends DIEP flap, though the procedure itself is grueling, complicated and can't be performed on all women. Buescher joined KU hospital in 2009, bringing knowledge of how to do the surgery with her. She is one of two surgeons there who perform the surgery and one of relatively few across the country who do it. She has performed the operation on more than 350 women.
It's only through a painstaking and precise process, which involves separating blood vessels from muscles, that surgeons are able to leave abdominal strength intact when conducting a DIEP procedure. The surgery can last eight to 10 hours, and women must have good blood circulation to undergo it, meaning they have to be in relatively good shape.
"I won't do a couch potato," Buescher said. Smokers have to quit. And if they don't already, Buescher makes them start exercising several times a week in the time leading up to the surgery.
For the woman who can undergo the surgery, the payoff is looking and feeling more like who they were before getting a mastectomy.
"You don't need reconstruction to live, but it really helps somebody to feel better," Buescher said.