Inspire 2017 FALL

Pali Momi: Breast Reconstruction: Rebuilding Lives

"Breast cancer care is very important but if you don’t give patients reconstruction options, you’re not finishing what you started,” Dr. Helen Hui-Chou said.  As a highly skilled, board certified plastic and reconstructive surgeon at Pali Momi Medical Center and the daughter of a breast cancer survivor, Dr. Hui-Chou is extremely passionate about breast reconstruction.

Dr. Hui-Chou’s sentiments echo the message of the national Breast Reconstruction Awareness campaign and its October BRA Day celebrations, which also promote a breast cancer ribbon image with its loop closed. The American Society of Plastic Surgeons is working to make reconstruction an essential part of the treatment process for breast cancer patients so they are aware of all of the options through their journey to recovery and survivorship. It is crucial for a medical center to provide those connections between plastic surgeons and general surgeons by having a multi-disciplinary team work together to provide comprehensive care for each patient. Dr. Hui-Chou collaborates with various surgical oncologists at Hawaii Pacific Health to determine the best treatment plan for each individual patient.

However, many patients often don’t know that health insurance covers breast reconstruction for both breasts, even if only one is diagnosed with cancer. There’s also no time limit. Patients can undergo breast reconstruction when they feel ready, whether that’s months or years later.

The big part of this new insight for women is sometimes overcoming the perception of plastic surgery. Gone are the days of procedures being about surgically enhancing yourself, it’s more about a healing process in different areas.

“The majority of plastic surgeons are rebuilding something that has become abnormal,” Dr. Hui-Chou said. “Whether it’s a dog bite, car accident or cancer, it’s just trying to help patients rebuild their lives.”

Luana Scanlan-Himalaya feels as if her life was dramatically improved by breast reconstruction.

“It made me whole again,” Luana said. “I feel like a new woman.”

A cancer diagnosis in 2013 caught Luana by surprise after a regular mammogram discovered a mass in her right breast.

“It was hard to hear,” Luana said. “I’m like ‘No, you must have someone else’s test results. It can’t be me.’”

From that point, the Kapolei mother of four went through test after test, a biopsy and several operations. Besides her breast, doctors found cancer in her lymph nodes under her arm. Luana chose to get a lumpectomy and undergo intense chemotherapy and radiation.

After her treatment, Luana was cleared of cancer and in remission. Shortly after that, her right breast started to get engorged, red and hot on a regular basis. She worried that the cancer was back, but tests showed no cancer. The painful symptoms continued for two years along with fevers and flu symptoms.

Luana went to visit Dr. Hui-Chou at a time when her right breast was hurting again. Dr. Hui-Chou explained that the symptoms she experienced were similar to others with side effects from radiation treatment.

After reviewing her breast reconstruction options, Luana chose DIEP flap surgery. This is a reconstructive procedure in which blood vessels, called deep inferior epigastric perforators (DIEP), as well as the skin and fat connected to them, are harvested from the lower abdomen and transferred to the chest to reconstruct a breast after a mastectomy. This procedure also does not sacrifice any of the abdominal muscles. It’s like having a tummy tuck and breast reconstruction at the same time.

In Luana’s case, her tissue was very damaged from radiation therapy so she chose to have a mastectomy, followed by a DIEP flap procedure to rebuild her breast shape.

“The thought of using your own tissue to heal the broken parts of your body is amazing,” Luana said. “Since I’ve had the DIEP flap, I’ve experienced no pain. It’s such a relief, mentally and physically. I’m not worrying anymore.”

Dr. Hui-Chou performed the surgeries for Luana’s breast reconstruction. Dr. Hui-Chou came to Pali Momi specifically to provide the DIEP flap procedure in the islands.

“I had met surgeons in Texas and California who would say ‘The Hawaii health systems send us surgeries for DIEP flap because no one in Hawaii is doing it,’” Dr. Hui-Chou said. “I thought to myself, it’s not fair that patients who want this have to fly away from home and their family for such a big surgery elsewhere.” So she moved to Hawaii for a chance to deliver the specialized surgery.

While introducing a new advancement in care for local patients was a feat in itself, Dr. Hui-Chou found herself equally as proud of the yearlong process required to make the service available.

“Setting it up in a place that never had it, leading a staff who had never done it or seen it, training nurses who never monitored it, and taken care of it—the challenge of that was more of the accomplishment,” she said.

A vital part of delivering this type of reconstructive procedure is having the best medical tools and resources to ensure surgical success. Donors who gave in support of the Pali Momi Women’s Center would help by funding a Spy Elite, one of the most advanced fluorescence imaging systems.

The Spy Elite enables surgeons to visualize microvascular blood flow and the delivery of blood in tissues during surgery.

“If I didn’t have this, I wouldn’t do the surgery,” Dr. Hui-Chou said. 

She uses the Spy Elite to visualize how the dye moves through the blood vessel into the flap. When the flap lights up, it confirms that the tissues are viable with good blood flow. This is impactful if you consider Dr. Hui-Chou is dealing with blood vessels that are so small that the sutures used to put them together are finer than a human hair.

“A lot of hospitals can’t afford the most advanced or innovative care,” she said. “If you don’t have donors, you wouldn’t be able to offer patients some of the things that come with top of the line care.”

Luana certainly feels like she received the best possible outcome.

“Coming out of this, I feel much stronger, like my future is endless,” Luana said.

The sense of satisfaction is mutual for Dr. Hui-Chou.

“For me it’s kind of an ingenious technique to take something we don’t normally want and make something they really want and need to have back,” she said. “I think that’s why it’s such a good option for some women and I want to be able to do it.”