Walking near her home in Twin Lakes on an autumn afternoon, Cheryl Casper takes time to absorb the scene, savoring every second.
Cheryl Casper: There's usually this big blue heron that hangs out down the street. It's really neat to see.
It seems like a simple thing - taking the time for a little bird-watching - but it's priority for Casper. A priority driven by fact that her breast cancer returned earlier this year. A mastectomy was recommended. And even though only one breast had cancer, she decided to have both removed. Adjusting to her decision didn't come easy.
Cheryl Casper: I don't feel that I'm hung up on having large breasts, but I've always thought of myself as having some breast, just for appearance sake.
Her decision might keep her safe from cancer, but it didn't necessarily mean the end of her struggles. Breast reconstruction came with a whole new set of risks.
Cheryl Casper: It was a big decision to make. I kept wishing that I didn't have to make that decision. There were really no good options.
Breast reconstruction is considered an important part of recovery, so much so that in 1998, legislation was passed to require health insurance companies to cover the cost. Most patients choose implant surgery, performed by plastic surgeons like Dr. Johan at the Cleveland Clinic.
Dr. Johan: Implants, the majority of them are doing very well, but occasionally you do have some complications as well. You can have (an) implant deflate, or (an) implant can rupture, or get infected or harden, too.
That's why some women prefer other methods. So-called flap techniques use the body's own tissue to form a more natural feeling breast than silicone or saline. But surgeons cut the needed tissue from the abdomen or back. It means you sacrifice some of your muscle. That may lead to loss of abdominal strength or the risk of a hernia, and further surgeries - a difficult reality for breast cancer patients like Darcy Houseman.
Darcy Houseman: I remember my plastic surgeon made the comment, you'll probably never be able to do another sit up.
For Houseman, that was just the beginning. When she had another surgery on her abdomen due to gall bladder problems, the loss of muscle from her breast reconstruction caused complications.
Darcy Houseman: The only thing holding the abdomen in there, holding my organs in, you know my intestines, is the tissue because the muscles broke apart. They just slid over to the side, the muscles that were left.
But recently doctors at the Cleveland Clinic, following the lead of a few other hospitals nationwide, have realized that in tissue reconstruction, muscle isn't essential. What is essential is blood flow. As the tissue is lifted from the belly up to the chest, it must have good blood circulation, or it won't survive. Again, Dr. Johan.
Dr. Johan: Think of yourself of having a big lawn and you're trying to irrigate this lawn, and if you have good water pressure, this irrigation system will reach all the whole square of your lawn. But if you have a very low system, water pressure not very good, then that means you won't reach that corner over there.
This newer technique for breast reconstruction is called the DIEP Flap procedure. The surgeon meticulously dissects the blood vessels from the muscle in the abdomen, then uses microsurgery to reattach the blood vessels in the chest. The blood flow is maintained and the stomach muscle is saved. It's tedious work and requires a highly specialized surgeon. A limited number of U.S. surgeons perform the procedure but hospitals indicate the demand for DIEP Flap is growing.
Dr. Johan: They really like about the preservation of the muscles. So that is why now more and more and more people are requesting about this technique and very interested in this technique.
The Cleveland Clinic says interest has grown so much over the last year, that in the past few months, they've hired four more surgeons who can perform the DIEP Flap procedure. Women like Cheryl Casper say that with all they've lost, they're relieved to be able to save their muscle. Oh, and DIEP Flap does offer something else women like...
Cheryl Casper: I guess i didn't mention the positive side effect, that you get a tummy tuck with it. (laughs)
For 90.3 News, I'm Elaine Falk.