“We’re passionate about supporting a patient’s choices.” JOHN HIJJAWI, MD


“So now my son had cancer and no donor, and mom,


who’s supposed to be the caregiver, has cancer,” Mary said. “If I wasn’t a bike rider through all of this, I think I’d be somewhere curled up in a ball.” Mary said. “I would go out on my bike and scream and cry and pray. I would do my best thinking on my bike.”


Another donor was eventually found for David, a man


living in Florida, and he had a bone marrow transplant at Children’s Hospital of Wisconsin.


For Mary, she sought


treatment from Froedtert & The Medical College of Wisconsin’s Breast Cancer Program “because it’s a state- of-the-art academic medical center.”


Two years later, Mary


chose Froedtert again after making a personal decision to undergo a double mastectomy (both breasts removed). She was focused on helping her son fight his cancer and breast reconstruction wasn’t immediately on her radar.


But after meeting with


need to take that muscle, we can shape the breast more creatively and it has, in many ways, a better blood supply than the old techniques.” It’s also an option for women who had mastectomies or lumpectomies years, even decades, ago.


advanced training haS advantageS


The DIEP Flap requires more advanced training and so fewer surgeons are qualified to perform it, despite its many advantages. In fact, said Dr. Hijjawi, “The Medical College of Wisconsin is a training site for this operation. There’s no other microvascular DIEP Flap training program in the state of Wisconsin.”


The DIEP Flap can have


advantages over implants as well.


“There are fewer additional


n john logiudice, Md, and john hijjawi, Md, FacS


John Hijjawi, MD, FACS, Medical College of Wisconsin plastic surgeon and director of the Reconstructive Breast Surgery Program, and doing her own research, she began considering it. Dr. Hijjawi completed a fellowship in Belgium with one of the originators of a technique for microvascular breast reconstruction called the DIEP Flap procedure.


Better reconStruction optionS


There are generally two kinds of breast reconstruction procedures, according to Dr. Hijjawi. One uses breast implants and the other uses the patient’s own tissue. The DIEP Flap procedure transfers skin, fat and blood vessels from a patient’s abdomen to create a breast. It improves upon an earlier technique that also involved cutting core muscles.


“Leaving the core muscles intact leads to fewer


complications, less pain and a quicker recovery overall,” Dr. Hijjawi said.


Dr. Hijjawi performed Mary’s DIEP Flap procedure


with John LoGiudice, MD, Medical College of Wisconsin plastic surgeon. Both are board-certified plastic surgeons who have also completed fellowships in microvascular surgery. The two are among the relatively few surgeons in the country who perform the DIEP Flap routinely.


“Essentially, DIEP Flap is the gold standard of breast reconstruction,” Dr. Hijjawi said. “Not only do we not


8 Froedtert Today May 2011 froedtert.com


procedures. If you use an implant, you need at least two procedures and implants, like anything man-made, can wear out,” Dr. Hijjawi explained. “While it is not life threatening, that situation usually requires another operation.”


Dr. Hijjawi emphasized that breast implants are


extremely safe, but that some women prefer to use their own natural tissue.


“We’re passionate about supporting a patient’s choices.


My practice is pretty evenly split between the DIEP Flap and implants. We want to offer options so that the operation fits that individual woman.”


Although not every procedure is right for every patient,


Dr. Hijjawi said that almost every woman can have some form of reconstruction.


“We can usually find something that will provide that


patient with breast reconstruction without putting them at any significant risk.” he said.


In Mary’s case, her double mastectomy and breast


reconstruction were done at the same time, so she would have one fewer surgical procedure. First, the breast cancer surgeon and his team removed both of her breasts, then Dr. Hijjawi and Dr. LoGiudice performed the DIEP Flap to reconstruct her breasts using her abdominal tissue.


“A patient falls asleep with breasts and she wakes up


with breasts made out of her extra tummy tissue,” said Dr. Hijjawi. “An offshoot is that you get a tummy tuck at the same time. Not to make light of it, but cancer is hard, and it’s nice to have a silver lining. And the tummy tuck is a normal part of this type of breast reconstruction.”


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