Vision of the Future

New technology helps predict success of breast implant healing.

Marlene Wynarczuk was religious about getting her mammograms. The test results were always negative until August 2018, when the exam showed something lurking deep within Marlene’s left breast. The New York native was taken by surprise.

Photos by Jordan Pysz.

Marlene was a perfect candidate for the new technology available at Lakewood Ranch Medical Center.

“There were absolutely no symptoms,” Marlene reports. “I didn’t feel a lump, I didn’t have pain, and my breast didn’t look different. It was actually a very tiny growth, so it’s likely nobody would have felt it on a breast exam. I was given the three-dimensional mammogram, so that’s how they found it.

“I decided that instead of a biopsy, I’d have a lumpectomy, thinking I was going to cut to the chase. After I went through that, it was determined that I had triple-negative breast cancer and the best thing for me going forward was to have bilateral mastectomy and reconstruction.”

Upon her diagnosis, Marlene was matched with a breast care navigator at The Breast Health Center at Lakewood Ranch Medical Center in Bradenton. Among the helpful services the navigator provided was a recommendation for a plastic surgeon for Marlene’s reconstruction. The navigator suggested Anna Maria Widmyer, MD.

“We lived in the Lehigh Valley in Pennsylvania while my children were growing up, and that’s where Dr. Widmyer did her residency,” Marlene recounts. “When I looked up her background, I said, She’s my homegirl. There was an instant connection.

“Later, when I met Dr. Widmyer, I thought she was wonderful, and I trusted her immediately. I put my needs in her hands and felt very comfortable about it.”

“Marlene is high risk for wound healing complications, so she was a perfect candidate for new technology we have at Lakewood Ranch Medical Center,” Dr. Widmyer describes. “The technology is a tissue perfusion monitoring system.

“It tells me if there’s adequate blood flow to the skin to successfully place breast implants for reconstruction at the time of mastectomy. With this information, I get a better idea if the breast tissue flaps will heal properly. If I’m not convinced, I insert tissue expanders and place the implants later.”

Dr. Widmyer used the new technology with Marlene. Marlene’s tissue flaps didn’t appear capable of healing with implants placed immediately, so the doctor used tissue expanders instead.

Marlene returned to Dr. Widmyer’s office to have the expanders filled with fluid until they reached an acceptable volume. Finally, in January of 2019, Dr. Widmyer switched out the expanders for implants.

Green Means Flow

Lakewood Ranch Medical Center acquired the tissue perfusion monitoring system at the end of 2018, but Dr. Widmyer worked with the technology for five years during her surgical training, so she is experienced with it. She likes the technology because it’s a more objective tool for decision-making in the OR.

“Without this technology, reconstructive surgeons make decisions about implant placement using our clinical judgment,” Dr. Widmyer notes. “We consider factors such as the thickness of the tissue flap and the appearance of the skin in the operating room. Does it appear to have good blood flow? Is it mottled, warm and soft?

“Sometimes, however, we can be fooled by our own perceptions or our desire to complete the reconstruction in one step. The new technology provides quantitative data about blood flow so we can make more informed decisions about placing implants and performing reconstructions after mastectomy.”

The tissue perfusion monitoring system is used in the OR after the surgeon completes the mastectomy. First, Dr. Widmyer places a temporary implant, then she injects the patient with a fluorescent dye. The dye travels through the patient’s blood vessels, and those in the tissue flap are highlighted on a computer monitor.

“The blood vessels with good flow light up in green, and the vessels that are not getting good blood flow are dark,” Dr. Widmyer explains. “Once identified, I can cut out tissue with poor blood flow. At the same time, I place pressure on the patient’s skin to determine if it can tolerate implants. Using that information, I decide whether or not to proceed with reconstruction.”

“Everybody at Lakewood Ranch Medical Center was wonderful. They were very compassionate, kind and caring.” – Marlene

The data gathered using the new technology helps reconstructive surgeons make more informed decisions regarding their patients’ care. Dr. Widmyer suggests that there are additional advantages to using the technology.

“It’s been shown to decrease complications for one,” she asserts. “The technology shows me which areas of the tissue flap lack adequate blood supply, and I can resect them while still in the operating room. Removing the substandard tissue can improve wound healing and decrease flap and implant loss.”

Due to the high rate of complications, the need for revision surgery is common with breast reconstruction. The rate of revision surgery hovers in the 30 to 40 percent range.

“Using the new technology at Lakewood Ranch Medical Center, I’ve decreased that significantly,” Dr. Widmyer observes. “This technology may save the patient a trip back to the operating room for revision surgery.

“With its benefits, this technology greatly increases patient satisfaction with their breast reconstructions and overall experiences.”

Angelic Intervention

Lakewood Ranch Medical Center’s new technology suggested that Marlene would have healing difficulties if Dr. Widmyer placed implants immediately after her mastectomies. Instead, Dr. Widmyer waited, and Marlene received her implants three months later. Now, Marlene marks her recovery by celebrating small triumphs.*

Equipment photo courtesy of Lakewood Ranch Medical Center.

Tissue perfusion monitoring system

“My strength is returning, and I can do more, including little things that people take for granted every day,” she relates. “Last week, I was finally able to stretch enough to put the sheets on my bed by myself. I was a very happy girl. And every day, I get stronger.

“Today, I feel fine. I’m very comfortable with the implants. There’s no pain, and I wear clothes and look like everybody else, so I’m good with them.”
Marlene is good with her experience as well.

“Dr. Widmyer is the most passionate, knowledgeable person, and she was with me every step of the way,” she enthuses. “I can’t imagine she would treat her mother better than she treated me. She’s an angel.

“Everybody at Lakewood Ranch Medical Center was wonderful. They were very compassionate, kind and caring. I recommend Lakewood Ranch Medical Center, their new technology and Dr. Widmyer to anyone with breast cancer.”

* Individual results may vary. There are risks associated with any surgical procedure. Patients should talk with their doctors about these risks.
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