A New Dimension in Breast Imaging and Reconstruction

University of Kansas Hospital’s breast imaging services are benefiting more patients than ever before with a higher degree of personal satisfaction.

The field of breast cancer is a constantly evolving one with improved methods of delivering radiation or detecting cancer sooner. Now medications are even offered based on a patient’s genetics and breast reconstruction is more natural looking and less painful. Two leading services are available in the Kansas City area through the University of Kansas Hospital: 3-D imaging and DIEP breast reconstruction.

Since March 2012, the hospital has been performing 3-D mammography. Using 3-D images of the breast increases the likelihood of detecting cancers by about 10 percent to 15 percent over 2-D images, says Dr. Marc Inciardi, a radiation oncologist at the hospital.

But an even larger benefit is that 3-D technology reduces the rate of false-positive results from mammograms, he says.

“Generally, 10 percent of patients are brought back for extra views,” he says. “Research has shown this reduces the recall rate by 30 to 50 percent. It cuts back on patient anxiety, time and cost to come back for other procedures.”

Instead of using a flat model in breast imaging, 3-D mammography provides slices of images that are put together to create a better picture. For instance, if someone has a 40-millimeter breast when it compressed, then 40 slices, or images, are taken.

Inciardi says the new mammography doesn’t necessarily work better than traditional for all patients. There are four main types of breasts—very fat, mostly fat, more dense than fat and very dense. Patients who will benefit most from 3-D mammography are those in the middle. 2-D works well with patients with very fatty breasts and the results aren’t as good with 3-D for patients with very dense breasts.

One challenge with new breast imaging technology is cost. Because it is so new, most insurance doesn’t pay for the procedure, Inciardi says. They charge an upfront fee and bill the insurers, but most deny it and the remainder is left to the patient. Even though patients have to pay for the procedures, Inciardi says there is about a 70 percent uptake, which is a high number for hospitals that charge for the mammogram.

Another radiological procedure offered at the University of Kansas Hospital is 3-D ultrasound, known as ABUS. It, too, provides better resolution and has been shown to increase detection rates by 60 percent. It is approved for all patients.

The hospital is the first in the region to have both of these breast imaging procedures. But their advancements go beyond detection.

In the area of breast reconstruction, there are two types of surgery: patients can receive breast implants or use their own tissue to create new breasts after a mastectomy. Many women prefer their own tissue for a handful of reasons, says Dr. Julie Holding, a breast reconstruction specialist at the hospital.

First, patients receiving implants will be more likely to have scar tissue build up in the area, meaning they will require another surgery in about 10 years to replace the implant. Many women who have gone through cancer don’t want to have other surgeries if they don’t have to. Implants have a much higher complication rate and more discomfort when a patient has had radiation, Holding says. And finally, there is a more natural drape to the breast and it is softer than an implant.

With this surgery, the tissue that fills the breast cavity comes from the abdominal area. The surgery used to be performed by taking the whole rectus muscle and tunneling it into the breast pocket left over after the mastectomy. This had the extreme disadvantage of losing the abdominal muscles. Holding says women undergoing this procedure had problems with weakness in the abdomen and bulging in the stomach.

The next generation of these surgeries was a procedure that spared some of the muscle. Now, Holding and just a few other physicians in the nation are able to preserve all of the muscles in the abdomen.

The procedure takes more time and commitment than an implant reconstruction, Holding says. The surgery can take up to 10 hours because Holding uses a microscope to go through the stomach muscles and dissect skin, arteries and veins. This tissue is used to fill the breast along with skin from the stomach that covers the opening. As much muscle as possible is saved and the result is a more “natural looking” breast, she says. Holding also says that a lot of women like the secondary side effects of the surgery, which is a tummy tuck.

This surgery is a good option for most patients. The only times patients aren’t eligible is if she doesn’t have enough excess fat in her stomach; she wants very large breasts and doesn’t have enough stomach fat to fill them; or if a patient is too overweight or has heart of artery problems. The surgery is long and complicated and the patient has to be healthy enough to tolerate it.