'Look at me': Windham woman's modest wish fulfilled with help of alternative breast reconstruction procedure

By Suzanne Laurent
Staff writer

May 09, 2008 12:34 pm

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Donna Bramante InDelicato faced breast cancer — twice. She had surgeries and radiation, and lost her hair to chemotherapy. Both of her breasts were removed.

Through it all, InDelicato of Windham, N.H., remained strong and felt grateful to be alive.

Then last summer, something inside her broke.

"I went bathing suit shopping with my mom," the petite 43-year-old woman said. "I took the suit home — a girl's size — and it just hung on me."

She went back to the store, and the sales clerk wouldn't take it back because the tag was missing.

"I lost it," InDelicato said. "I just broke down sobbing and had to leave the store."

Around the same time, InDelicato met a young mother in the waiting room while her daughter took a ballet lesson.

"She told me that she had a bilateral mastectomy because she tested positive for the breast cancer gene," InDelicato said. "She also told me about her reconstruction done by a plastic surgeon (Karl Breuing) in Boston and gave me his card."

Breuing practices at Brigham and Women's Plastic Surgery at Faulkner Hospital. For the past six years, he has been pioneering a product called AlloDerm for use on some of his breast reconstruction patients.

AlloDerm is donated human tissue from cadavers that goes through a cell removal process that eliminates DNA but retains other important portions of the tissue.

The tissue is processed at a company called LifeCell Corp., based in Branchburg, N.J., which has been around since 1986 and first used the application for burns. It then began using the tissue for hernia repair.

Breuing said he has done this type of reconstruction on more than 160 women over six years and that he's followed them since their surgeries. So far, he reports, they are all doing very well.

"The conventional way of breast reconstruction was to use a patient's own tissue from the abdomen, back or buttocks," Breuing said. "But some patients don't have enough tissue in these areas or are very young and don't want to sacrifice strength if tissue is taken from the back, for example."

In the fall of 2007, InDelicato decided to give Breuing a call.

"I was not only flat-chested, but actually concave," she said.

"One day my mother had brought over some things to my house in an Abercrombie & Fitch bag," she said. "I looked at the photo of the girl on the bag, and she had 'just a bump' for breasts. I thought, 'That's all I want.'"

She actually brought the bag to Breuing for her consultation.

"The more we talked and he learned a little more about me and what I wanted, he thought I'd be the perfect candidate for the AlloDerm reconstruction procedure," InDelicato said.

A long journey

InDelicato was diagnosed in 1999 at the age of 34 with non-invasive breast cancer and had a lumpectomy. After her surgery, she and her husband, John, who had a 3-year-old son, Vallen, wanted another child. Their daughter, Victoria, was born Nov. 6, 2001.

Then late in 2002, InDelicato discovered another lump. She was still breast feeding Victoria and had to stop abruptly. Her biopsy delivered bad news: This time, the cancer was invasive and it had spread to her lymph nodes.

"It was the most aggressive type you can have," she said.

InDelicato underwent chemotherapy and radiation and decided in the summer of 2003 to have bilateral mastectomies with reconstructive surgery at the same time. When she woke from the procedure, however, she found out all had not gone as planned.

"They discovered a raging infection in one of my breasts," she said. "I woke up with no breasts."

InDelicato had revisited the idea of reconstructive surgery over the four years since her double mastectomy, but because of her small frame, scars and skin damaged by radiation, her doctors decided she was not a good candidate for reconstructive surgery.

"I tried prostheses, but it just wasn't me," InDelicato said. "So, I just accepted who I was and embraced life."

But since she found Breuing, she said she is thrilled to be pioneering the AlloDerm tissue.

"I want women to know about this option because a lot of them are afraid to even get a mammogram for fear of losing their breasts," she said. "This might make it less scary."

While InDelicato had her reconstruction done during one surgery last November with the AlloDerm and silicone implants put in place, most patients have two surgeries for reconstruction.

During the first, a surgeon places an expander into an AlloDerm hammock to create a space underneath the skin large enough to allow for the silicone implant during a second surgery.

"In the past with the patient's own tissue, we would have to put a saline-filled expander under the chest muscle and squeeze fluid into the pocket," Breuing said. "This is uncomfortable, time consuming and initiates a lot of scar tissue."

With AlloDerm, the surgeon does not need to get under the chest muscles (if needed, an expander is placed under the AlloDerm pocket and adjusted to how much or how little skin the patient has left at the site of reconstruction).

"With Donna, we were able to use enough of her own skin during the first surgery," Breuing said.

"Of course, I didn't want much," InDelicato said. "Just a 'bump.'"

The silicone implants that sit in the AlloDerm pocket are made of a new material that won't leak into the body.

"They call it 'gummy bear' silicone," InDelicato said. "The gel stays in place even if there is a small rupture, unlike the saline implants."

Another option for women

Breuing said that the most important thing he has found about using AlloDerm is that it gives a woman another option for reconstruction.

"It also gives her a little breathing time after getting the diagnosis of cancer," he said. "A woman thinks, 'I need to get that cancer out of me.' It doesn't force her to make decisions to commit to taking tissue from another part of the body at the same time."

Breuing compares the tissue to a coral reef; it's flexible and porous, and actually grows with the patients' own cells.

He said the AlloDerm begins revascularization (re-establishment of blood supply) with the patient's own cells around two weeks after surgery and that after three to four months, the tissue has become part of the patient's body. The body doesn't recognize AlloDerm as a foreign body and therefore doesn't reject it.

A true crusader, InDelicato has talked to LifeCell and suggested that the company talk to general surgeons about the product because that is who the patient first goes to for surgery and then the plastic surgeon is called in for consultation.

"Right away, a woman would know about this option if her general surgeon told her about it," Indelicato said.

"Breuing is one of the pioneers who brought the application of using AlloDerm for breast reconstruction to us," said Rich Egan, a senior marketing manager at LifeCell.

While Egan said the thought of using donated tissue may be a little unsettling to some patients, InDelicato said she finds comfort in knowing that "somehow someone gave of themselves."

"It's the same as going to an organ bank for a cornea or bone or cartilage," said Breuing, who gives seminars around the country on the use of AlloDerm and is just beginning to introduce it to Europe.

InDelicato said she didn't realize it, but that looking back she must have been mildly depressed during the four years before her reconstruction.

"I wake up every day, now, and I'm so happy," she said. "I put on my clothes and run downstairs and say to my family, 'Look at me.'"

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