Loss & Recovery

As a teacher, Felicia Whisenhunt usually schedules her routine medical checkups for summer break. In 2015, however, she didn’t. The mother of two and wife had been caring for her father with Alzheimer’s disease and had forgotten. That September, after school had started, she realized she needed to schedule her well-woman exam.

She’s lucky she remembered. Two days before her appointment, Mrs. Whisenhunt thought she felt a lump while in the shower, but she dismissed it, not even thinking to tell her doctor in the exam room that day.

“He noticed it,” she says. “I saw his face, and it was concerning.”

Her doctor wanted her to get an ultrasound. Mrs. Whisenhunt scheduled it immediately.

“I could tell by everyone’s expressions that it was bad,” she recalls.

The next day, a breast biopsy confirmed her worst fears: advanced-stage breast cancer. She was 40.

After getting multiple opinions, she chose UT Southwestern Medical Center for her care, confident she was in the right hands. From bedside manner – her surgical oncologist, Rachel Wooldridge, M.D., was holding her hand when she woke up from a surgery – to advanced care and innovative techniques to reconstruct her breast tissue, the team at UT Southwestern saved Mrs. Whisenhunt’s life.

A Long Road

Shortly after her diagnosis, Mrs. Whisenhunt started chemotherapy, which involves drugs designed to stop the cancer’s growth and shrink the tumor. About five months later, in February 2016, she had a double mastectomy – surgery to remove both breasts. She didn’t want to take the risk of the cancer coming back in the second breast.

“Then, when I was healed from that, I started radiation through the end of the school year,” she recalls. The purpose of the radiation on her right side was to make sure no cancer remained.

Throughout all of this, she continued to teach kindergarten, and the teachers and parents at her school provided a loving support network.

“My youngest had just turned 4. My oldest was going into first grade,” she says, adding that the year was a blur. “I survived because I had amazing friends and family.”

Innovative Approach to Breast Reconstruction

After successful cancer treatment, Mrs. Whisenhunt was ready to consider breast reconstruction. For patients who have had partial or total mastectomies, breast reconstruction is a process to help women regain the shape and appearance of their breasts – and for many, their confidence.
Mrs. Whisenhunt’s team included Sumeet Teotia, M.D., Director of the Breast Reconstruction Program and Associate Professor of Plastic Surgery at UT Southwestern, and Nicholas Haddock, M.D., Associate Professor of Plastic Surgery and Orthopaedic Surgery.

Drs. Teotia and Haddock focus their plastic surgery practice 100 percent on breast reconstruction. They are also two of the most experienced surgeons in the world at an innovative technique called a four-flap breast reconstruction. This technique involves taking fat and skin from the back of each thigh and from two areas on the stomach (four spots total) to reconstruct the breast.

Some surgeons use only the stomach tissue, called the DIEP flap. While that’s the first choice, some women, like Mrs. Whisenhunt, don’t have enough tissue there; other women have had abdominal surgeries in the past that make it difficult to use. When taking tissue from the thigh area alone, it’s known as the profunda artery perforator (PAP) flap procedure.

Very few surgeons have mastered using both areas in the same procedure. And of the post-mastectomy breast reconstruction surgeries done in the U.S., Dr. Teotia says 70 to 80 percent are implant-based; the rest are flap-based. Due to their expertise and unique practice, for Drs. Teotia and Haddock it’s 50-50.

The flap, or microsurgical, procedures offer great aesthetic benefits and softness as well as less skin tightness than implants, particularly in patients who’ve had radiation, the surgeons say. But, they note, every woman’s situation is different, so they work with their patients and their oncologists to make sure they select the right procedure for each individual.

The four-flap procedure is typically best for younger women who otherwise have no significant medical problems, Dr. Teotia says, and for women who’ve had radiation.

If a young patient has an implant-based procedure, there’s a higher likelihood of having to do a follow-up reconstruction surgery, Dr. Teotia says. There are risks for leak, rupture, or intolerance to implants long term, and they don’t age the way the body does, so they can stretch the skin and feel heavy.

“We tend to believe a younger, healthier patient would do better implant-free,” he adds. “Felicia will never have to have another breast reconstruction in her life. And her breasts will age and mature the way her body normally would.”
Over the past six years of working together, Drs. Teotia and Haddock estimate they’ve completed about 1,200 microsurgery/flap breast reconstruction surgeries.

“And we’ve done close to 50 procedures with the four-flap technique,” Dr. Teotia says. “It’s a very creative and powerful tool when used in selected patients appropriately.”

A Team Focus

Both accomplished surgeons, Drs. Teotia and Haddock believe that a big part of their success comes from their ability to work as a cohesive team.

Their team approach, Dr. Haddock says, helps both inside and outside the operating room. In the clinic, they have their own patients but consult with each other regularly on the same day.

“Inside the OR, there’s no question there’s a benefit – we’ve shown this with science. Having both of us in there reduces surgery time. We both can do the procedure very well, but put both of us together and it’s compounded.”

Getting out of surgery in four to six hours versus eight to 10 hours, Dr. Haddock notes, translates into real benefits for their patients – less anesthesia and less swelling, and they go home sooner and get back to their normal activities more quickly.

And while there are rarely issues during surgery, Dr. Haddock says, having another surgeon in the room is a huge benefit in troubleshooting, especially in complex microsurgical decisions.

“Having an equally minded, focused, and creative colleague in the OR is essential for the success of these flaps and allows flexibility in innovation,” adds Dr. Teotia.

And it’s not just the surgeons. “Our entire team plays a role,” he adds. That includes nurses, anesthesiologists, residents, and fellow assistants. “We physically could not do this at most places. It requires a well-oiled and efficient machine.”

A Complex Case

For Mrs. Whisenhunt, breast reconstruction surgery wasn’t simple. After her diagnosis, she learned she had the BRCA2 gene mutation, which increases a woman’s risk of both breast cancer and ovarian cancer, as well as other cancers.

Because of that mutation and the risk of ovarian cancer, she and her doctors agreed that a hysterectomy – to remove the ovaries, fallopian tubes, and uterus – was advisable.

Complicating matters, she had a very large omental hernia (where the fatty covering of the stomach and intestines pushes through an abdominal defect, an opening in the layer of abdomen that keeps intestines inside) that needed repair.

However, surgeons faced a dilemma: The hernia repair would involve mesh, which could cause challenges for a future hysterectomy. And abdominal surgeries would damage a key area where Drs. Teotia and Haddock needed to pull tissue for the reconstruction. Hence, the hernia repair had to be done after the flap procedure. Together, Drs. Teotia and Haddock worked with gynecologic and general surgeons and an entire operating room team to stage the surgery, allowing experts in each specialty to do their work effectively and efficiently in a coordinated fashion.

As Drs. Teotia and Haddock worked on the breast reconstruction, the hysterectomy was completed, followed by the hernia repair, in an approximately 12-hour procedure.

Whether it’s a rare, intricate case like Mrs. Whisenhunt’s or another, comparably more straightforward flap procedure, microsurgery requires deep skill and expertise, with the surgeons working on 1- to 2-millimeter-wide blood vessels and regularly making complex decisions.

“These are very safe procedures, and our success rate is in the 99 percent range,” Dr. Teotia says. “The four-flap procedure is an uncommon option, but fortunately, we have a high level of expertise, experience, and success.”

The Road to Recovery

After Mrs. Whisenhunt’s big surgery, she spent a few days in the ICU. Her friends worried about her home recovery.

“I had some take-control mom friends who helped,” she says. Those friends set her up at a rental house for two weeks where she could recover. “People came to take care of me, and my husband brought the kids to see me.”

The reconstruction process has involved additional follow-up surgeries. But today, she’s back to enjoying life with her husband and her two sons, who are now 9 and 7.

She’s also educating herself on cancer and engaging in any activities that might help prevent it in the future. She’s even participating in a clinical trial about the effects of exercise.

The experience has changed her life and her perspective. “You don’t take life for granted, and you try to not let little things bother you,” she says. “Stress is terrible for cancer patients, and my husband has been a huge advocate of me avoiding stress.” Mrs. Whisenhunt adds she’s grateful for her team at UT Southwestern.

“Every doctor has been just what I needed,” she says. “I’ve been really lucky.”

She encourages women to do self-checks and get their well-woman exams and mammograms.

“Statistically, every woman needs to be checking,” she says. “I tell my girlfriends that it is 1 in 8 of us, so feel your boobies and take care of yourself!”