On the Forefront of Breast Reconstruction
The department’s breast reconstruction program has taken on multiple initiatives. There’s patient safety, where groups of nurses, physicians, allied health professionals, epidemiology and infection specialists, patient safety specialists, and administrators make up a CUSP team (Comprehensive Unit-based Safety Program) to generate ideas to improve patient care and bring down patient infection rates and lengths of stay. There’s clinical research into the effects of radiation treatment on various breast reconstruction procedures and its impact on patient quality of life at various points along the process. There are advanced and technically demanding procedures like DIEP (deep inferior epigastric perforators) flap and fat grafting, also known as lipo-filling and fat-transfer, which help to rebuild the breast and surrounding areas following mastectomy and which are available widely only in select institutions.
“It’s important for us to be leaders in making the patient experience and patient care world-class,” says Gedge Rosson, director of breast reconstruction and the microsurgery fellowship program.
Amid all this innovation, what remains perhaps most unique is the department’s ongoing commitment to personalizing the experience for patients. It’s not just about the ability to provide the most advanced techniques, but about getting to know every patient and matching each with the reconstruction that best fits his or her own life circumstances and recovery expectations, says Michele Manahan, the department’s director of patient safety.
“Our role is to rebuild to what a patient wants to be,” Manahan says. “It’s like fashion: what one person thinks is pretty, another doesn’t. We find out a patient’s wants and goals and apply our technology and skills to that.”
Restoring Form and Function: Oncologic Reconstruction
Oncologic reconstruction is the epitome of a team effort. Plastic surgeons collaborate with a multitude of other specialists, supporting the most appropriate oncologic treatment with cutting-edge reconstructive techniques. The goal is patient outcomes that maximize both form and function.
As any surgeon knows, when resecting a tumor, it’s often impossible to avoid nerves, bone and muscle. In some cases, the tumor could not be removed unless surgical oncologists can count on reconstructive surgeons to rebuild what they must destroy. So with plastic surgeons at the table from the start, each procedure is planned and executed to ensure that patients with cancer leave not just free of the disease, but also at their highest possible level of physical functioning.
Plastic surgery team members at Johns Hopkins attend regular tumor board and multidisciplinary clinic meetings to discuss cases with their interdepartmental colleagues. For example, when a patient presents with a sarcoma that’s invading the spinal cord, the physicians plan the resection that will best address removal of the tumor and simultaneously devise the reconstruction of the affected bone, muscle, tissue and blood vessels. The reconstructive team regularly collaborates with colleagues in urology, vascular surgery, surgical oncology, orthopaedic oncology, neurology, radiation oncology, gynecology, and physical medicine and rehabilitation, combining the highest level of cancer treatment with the most advanced surgical and microsurgical techniques.
This approach treats the disease while preserving, or even enhancing, the patient’s wholeness, says oncological reconstruction director Justin Sacks.
The department has made interdepartmental collaboration a centerpiece of its oncologic reconstruction efforts, and some faculty members consider it the essence of their work.
“You’re getting the most sophisticated cancer surgery known to man,” Sacks says.