With consummate skill and innovative surgical techniques, Drs. Christopher Pellegrino and Vincent Perrotta of Peninsula Plastic Surgery offer renewed hope and restore self-esteem to women who have had to contend with the ravages of breast cancer
When 39-year-old Julie Webster of Salisbury was diagnosed with stage-2b invasive lobular carcinoma last year, her first thoughts were of her children.
To Julie, it seemed as if history were morbidly repeating itself. Julie’s grandmother had died of breast cancer at age 36, leaving her then-4-year-old daughter, Julie’s mother, with a sense of loss that would accompany her throughout her life. Now that it was Julie’s turn to battle what was at the very least a three-generation-old legacy (Julie’s mother was diagnosed with breast cancer at age 55), she was determined not to subject her daughters, Avery and Reese, to the same tragic fate.
Although Julie’s mammogram showed that the four-centimeter “density” was contained in one breast, she decided to have a double mastectomy, to maximize the chances that the cancer inside her would not spread. As difficult as the decision may have been, to Julie it was a sensible one. In fact, actress Angelina Jolie, who is about the same age as Julie, had recently undergone the same procedure.
To know Julie even a little is to know she is one who places as much value on the quality of life as on life itself. So, when the time came for her procedure, she assembled what she felt was the best possible surgical team in Dr. David Sechler of Peninsula Surgical Group and Dr. Christopher Pellegrino of Peninsula Plastic Surgery, to not only save her life but also to reassemble the shattered pieces of it.
“I already had experience with Dr. Pellegrino from a previous breast-augmentation procedure and had come to like and trust him very much,” offered Julie as she got ready to pick up her girls from school on a rainy Tuesday afternoon. “My feelings were reinforced when Dr. Sechler, whom I also trust, said that he’s worked very successfully with Dr. Pellegrino in the past and that he thought I made the right choice.”
Restoring the pride of womanhood that Julie had come to know meant that Dr. Pellegrino had to redo his own work, in that Julie’s prior augmentation procedure was performed on a foundation of mammary tissue and muscle tissue that no longer existed.
“Dr. Pellegrino and Dr. Sechler really worked together like a well-oiled machine,” praised Julie, who was just about to celebrate her 15th wedding anniversary with husband Chris at the time of this interview. “It was as if they were a surgical partnership that had been working as a team for years. After Dr. Sechler performed the double mastectomy, Dr. Pellegrino removed the old implants and replaced them with a new tear-drop-style implant that we agreed would look more natural. He also used a transverse vertical incision that was also designed to maximize a natural aesthetic.”
Julie went on to emphasize that Dr. Pellegrino and his staff at PPS were just as amazing after the procedure as they were in the OR.
“I love Dr. Pellegrino! He’s so kind, gentle and caring yet so skilled,” said Julie, “and his assistant Robin, too! They were absolutely just as amazing to me after the procedure. I’ve seen them every few weeks since, and I actually look forward to it. They are so nice, and they take such a sincere interest in my condition and welfare. I feel like I picked the best possible surgical team I could have, and I am totally thrilled with my results. In a way, I feel like Dr. Sechler gave my children back their mother and Dr. Pellegrino gave my husband back his wife!”
In recent years, Peninsula Plastic Surgery has evolved into an elite surgical practice in the field of breast reconstruction. At this point, they routinely and expertly perform such procedures as delayed and immediate unilateral (one side) and bilateral (both sides) implant reconstructions, immediate reconstruction following lumpectomies, TRAM-flap reconstructions (transferring skin and muscle from the body), areola tattooing and areola reconstruction. They also regularly remodel breasts to create symmetry of size, shape, hang, balance and even pigmentation. This proficiency comes in especially handy for women who have had radiation therapy following lumpectomy, which, according to recent clinical studies, eventually produces deformity and/or asymmetry in 20% to 40% of patients.
“We are working hand-in-hand with Dr. Thomas DeMarco and local hospitals to improve breast-cancer care on the Delmarva Peninsula,” stated Dr. Vincent Perrotta, Dr. Pellegrino’s partner at PPS. “In fact, we expect that within a year or so, the quality of care here will be com-parable or superior to that offered in Baltimore.”
Dawn Johanson of Hunting Creek, Va. would certainly agree. Five years ago, Dawn underwent a right-breast lumpectomy and post-operative radiation. She was devastated 12 months ago when Dr. Perrotta biopsied a mass on the same breast and discovered that her cancer had returned.
Dr. Perrotta directed Dawn to see Dr. John Reilly, who like Dr. Sechler, is an excellent breast surgeon based in Salisbury. Dr. Reilly recommended a mastectomy, which Dawn refused, insisting that she wanted to continue to preserve her natural breast even if it meant accepting an increased risk of another recurrence and metastasis. She would accept only another lumpectomy.
But getting Dawn back to the operating room proved difficult, as her recurrence propelled her into a deep depression. “I was actually ready to give up,” confessed Dawn, who is a former Accomack County sheriff’s deputy. “I was tired of the disappointment and debilitation of both the disease and the treatment, which, in trying to save my life, kind of deformed me and what I used to be.”
Having decided to postpone additional surgery indefinitely, it took several weeks of phone calls by Dr. Perrotta and his medical assistant, Jenifer Rose, before Dawn finally consented to move forward with another procedure.
“Dr. Perrotta and Jen Rose never gave up on me and wouldn’t let me go,” Dawn said. “They called me all the time and kept asking me not to give up and encouraged me to undergo treatment.”
“Dawn's case was very complicated,” Dr. Perrotta said. “Her recurrent cancer had progressed enough to invade the pectoralis major muscle, located under the breast, which meant that for Dr. Reilly to be successful in removing all of the cancer, he would have to resect a very large segment of tissue, containing skin, breast tissue and muscle.”
Dr. Perrotta proposed using a “muscle-sparing latissimus dorsi” flap, one not yet seen on the Delmarva Peninsula. Through this approach, Dr. Perrotta would harvest from Dawn’s back some skin, fat and a piece of the latissimus dorsi muscle just large enough to replace the piece of muscle Dr. Reilly was planning on removing. The great majority of the latissimus dorsi muscle would be left intact and therefore remain functional, which was very important to Dawn, who is a competitive amateur athlete and an avid weight trainer.
The great news is, Doctor Reilly was able to successfully remove all of the recurrent cancer, and Dr. Perrotta reconstructed the breast with the muscle-sparing latissimus dorsi flap.
A year later, Dawn is doing well. Dawn's fitness trainer states that her right latissimus dorsi muscle is as strong as her left one. And according to Dawn, her breasts have near-perfect symmetry.
The latissimus dorsi muscle-sparing flap is just one example of state-of-the-art reconstructive surgery now available on the Delmarva Peninsula. But there is more to come. Doctors Perrotta and Pellegrino plan on soon introducing the DIEP flap to the region. With a DIEP flap, one of these surgeons will be able to reconstruct a breast with skin and fat harvested from the belly, leaving the belly appearing as if it has undergone a tummy tuck. Unlike the TRAM flap, which also uses skin and fat from the belly, the DIEP flap leaves all of the muscles of the belly intact.
“We urge patients stricken with breast cancer to seek a consultation from a plastic surgeon for breast reconstruction,” Dr. Perrotta said. “Nothing can eliminate the hardship and trauma of cancer, but preserving or restoring the aesthetics of one’s womanhood makes it just a bit more bearable.”
The other good news for the women of the Eastern Shore is that thanks to The Women’s Health and Cancer Rights Act of 1998, health plans that cover mastectomy must also offer post-mastectomy and breast-reconstruction benefits. This usually includes procedures on the unaffected breast for the purposes of symmetry.
Editor’s note: Drs. Perrotta and Pellegrino were recently accepted as members of the prestigious American Society for Aesthetic Plastic Surgery (ASAPS). For more information on the range of services and procedures that Peninsula Plastic Surgery offers — featuring before-and-after photos of actual patients, including Dawn and Julie — visit their website.
PENINSULA PLASTIC SURGERY
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