The Breast Center Introduces the APEX Advancement
Dr. Dellacroce (00:15):
Breast cancer care and breast reconstruction is what we do. And today I’m very pleased to announce the publication of our latest advancement that helps it all work better for you. Hi, I’m Dr. D and I’m about to share something with you that we’ve been working on for a very long time, Perhaps more important than ever. With recent headlines about breast implant safety, we set out to do some serious myth busting and along the way reinvented a 25 year old operation called The DIEP Flap. Our purpose was to dive into the little known flaws of older procedures, raise the bar and establish a long overdue standard for work in this area. The result of all this produce a new innovation that helps us better deliver the quality patients expect when they choose breast reconstruction with natural living fat. Hot off the presses, we call it the APEX flap.
This advancement builds on a well known breast reconstruction operation called the DIEP Flap. It’s been around for a quarter century and was supposed to help us recreate new living breasts from extra belly fat without damaging stomach muscle Along the way. The premise was good that a new breast could be made out of soft living fat without hurting the six pack muscles. But in the real world, the DIEP flap often failed to live up to its promise. It’s flawed in its purest form. It can’t always give us enough blood flow to keep the new breast soft. And when surgeons try to add more blood flow power, they end up cutting up the muscle and nerves in the stomach defeating the whole purpose. And so over time, as we begin to see more and more women referred in from all over the place with problems, it became clear that something was wrong.
So we made it our mission to open up the dialogue and look for ways to fix the flaws. The issues start here. Sometimes the little blood vessels are lined up nicely. We can collect things by simply spreading the muscle fibers apart. No cutting. The operation is straightforward and pure. Other times things aren’t lined up so well and one of two things can happen. Either one of the extra blood vessels is cut and we risk having part of the fat wither and turn hard, or the surgeon cuts across the muscle patching between to join vessels together, creating a whole new set of problems, cut enough of the muscle and you’ll leave loose ends that can spasm and cause pain. Cut more and you’ll be weakened. Cut more still, and you may suffer a hernia. It’s a conundrum. Either way, your surgeon’s not really to blame. It’s just the way the good Lord made us, but the implications are significant nonetheless.
So those are the problems. The DIEP flap by itself fails to consistently deliver what patients may think they are getting when they sign up for it. And that is where our latest work comes in. The apex flap picks up where the DIEP flap falls short in our practice. We’ve been doing this for about 10 years, but didn’t write about it until now because we didn’t want to get ahead of our skis with what we thought we were seeing, and we wanted enough experience to say something meaningful. Now the paper goes into great detail on this, but the takeaways are that this decision tree governs the whole complex of operations and is anchored centrally by the apex conversion. This allows us to branch away from the flaws of the DIEP flat when the need arises, and by doing so, gives us a significant reduction in fat necrosis while at the same time consistently maintains the promise and premise of maximum structure protection.
It’s done with high level microsurgery, but the goals are simple, better blood flow to avoid hard spots and perfect attention to preservation of muscle nerves and strength. Now listen closely. One of the most important parts of all of this is our suggestion that work of this type be supported with documentation of the surgical field, both for your reassurance and for the sake of furthering study. In this case, that means an image of the muscle work is always taken and placed in the medical record, which of course a patient may request copy of if she’s so desires. This is nothing exotic or out of the ordinary is very routine in other specialties like orthopedics and laparoscopic work. It helps us audit our technique and monitor quality. Ultimately, the point is to exchange hard spots in the new breasts for healthy, soft, permanent results. Our dependence on high blood vessels around the belly button for freedom to lower incisions so that we avoid high unsightly scars and the tummy look is more in line with what she expects.
And we exchange damage, pain, and weakness left behind by dated procedures for precision, faster recoveries and lasting strength. Remember, the only way you can have assurance that your operation, whether a DIEP flap, an apex flap or other was done according to a standard of some sort, is to add a picture of the muscle work to your medical record. Ask your doc about it. Hey, doc, do you or will you put a pick of the work you did for me in my record? It’s your right to know how your work was done. If they can’t want or don’t, let’s rubbish find another doctor. Doesn’t have to be here. There are plenty of docs out there who are very interested in doing the best work possible and are very open to your questions about quality. Do yourself a favor and look for them. Insider tip. I can assure you, if it was my wife, I would accept nothing less. The photo would be in the chart, and that’s all I have to say about that.
So don’t settle. Ask hard questions. Take your team to task. We are here to serve you. It’s your right to know how your work will be done and how it was done. The point at the end of the day is to make breast reconstruction work better for you. None of this is rocket science. These concepts are all basic and are now out in the open for you so that you can be a better decision maker when it counts. Before I leave you, remember, no operation is perfect, No surgeon is perfect. All surgery carries risk as a trade off for benefits. So consult with your doctor before making any decision for surgical care. Our final exchange is this, As of today, rather than uncertainty, smoke mirrors our fancy doctor talk. You are given the benefit of clear information and a new advancement developed in the interest of your health and wellbeing. Until next time, I’m Dr. D, be well. Be empowered and be encouraged.
Dr. DellaCroce introduces a new method of breast reconstruction for women affected by breast cancer. Published in the Journal of Plastic and Reconstructive Surgery, it is called the APEX FlapSM and it helps breast reconstruction work better for women facing mastectomy.