Medical center surgeons take new approach with breast reconstruction

Breast cancer survivor Sunny Reicks talks with reconstructive surgeon Dr. Fredrick Durden

When breast cancer attacked again, Sunny Reicks was unsure if she could go through the recovery process again.

She knew it would be just as hard – if not harder – on her 9-year-old son. This time, he was old enough to understand and ask those gut-wrenching questions no parent wants to answer. She turned to the oncology and plastic surgery teams at The Nebraska Medical Center who controlled and removed the cancer and used an advanced breast reconstruction technique to create new, natural breasts using tissue from other parts of her body. 

Reicks’ journey began in 2005. Just 24 years old, she noticed her left breast felt a little bigger than her right. No big deal, she thought – but better get it checked.

“My mom had breast cancer at 32,” Reicks said. “She advocated self-exams often. She pounded it into my mind.” 

A mammogram and biopsy found cancerous cells that hadn’t spread. Her doctors at the time encouraged her to have both breasts removed (double mastectomy), hoping the cancer wouldn’t return. 

Then in 2011, Reicks noticed a lump on her left breast just six months after having a revision done to her original breast reconstruction with implants. Diagnosed with Stage III breast cancer, she came to the medical center.

First, surgical oncologist James Edney, MD, performed the mastectomy, removing her reconstructed breasts. 

“Seventy percent of my patients opt for a reconstruction the same day as the mastectomy,” Dr. Edney said. “But in Sunny’s case, the extent of the tumor meant we needed to continue with radiation and delay reconstruction.”

That meant Reicks’ next step was radiation and chemotherapy directed by oncologist Elizabeth Reed, MD. 

Plastic surgeon Perry Johnson, MD, advised that the radiation treatments, coupled with the lack of tissue around her implants, made her a poor candidate for breast reconstruction using implants. 

Reicks’ options were limited, but one of them included a different type of reconstruction procedure done by plastic surgeon Frederick Durden Jr., MD.

“Dr. Johnson told me that flap surgery with Dr. Durden was my best option,” Reicks said. “So I researched it and I felt comfortable with what I read about the procedure online and what Dr. Durden showed me.” 

Dr. Durden believes in educating his patients on all the options for breast reconstruction. Theses include prostheses, implants and tissue transfers including rational flaps, free flaps and various microsurgical perforator flap techniques – his specialty. He showed Reicks pictures for each step of surgery. 

“Some women don’t like seeing the pictures, but it’s important to have a serious conversation about the variables involved,” Dr. Durden said. “This isn’t a minor procedure. Patients must be prepared to make a substantial investment of their time and health.” 

Dr. Durden removed tissue from her stomach area in order to reconstruct the new breasts. Almost a full month into recovery, Reicks said the results of the surgery exceeded her expectations. She has dealt with some pain, but she said cancer pain specialist Madhuri Are, MD, has helped her tremendously. She said her new breasts feel a lot different than the reconstructed implants she had previously. 

“They don’t move the same – they don’t sit the same. They’re just more natural – that’s what I like the best so far,” she said. “It also doesn’t hurt to have a skinnier tummy.” 

Nationally, only 25 to 30 percent of women who have a mastectomy undergo reconstruction. Dr. Durden hopes to raise that number not only by providing another surgical option, but by doing a better job of educating women at the right time. 

“We should be introducing women as early as possible, which is as soon as they are advised to undergo a mastectomy,” Dr. Durden said. 

Most women who undergo mastectomies are candidates for microsurgical flap or perforator flap breast reconstruction when natural tissue reconstruction is preferred over implant reconstruction. Many times, the surgery can be done the same day as the mastectomy. Dr. Durden says he’s just excited to give women like Reicks another option for rebuilding what cancer has taken away. 

“I felt this was a place I could really have an impact,” Dr. Durden said. 

“There is no one else nearby who does it,” Reicks said of the procedure. “I’m a single mother. I couldn’t drag my son to New Orleans or somewhere else in order to have this done and recover. If Dr. Durden wasn’t here in Nebraska, I wouldn’t have been able to get the surgery. I wouldn’t trade any of my breast care team: Drs. Durden, Reed, Edney, Johnson and Are. I don’t think there’s a better team anywhere.”

“I will not waste my time switching doctors again, because I have already done that too many times. I guess this is my last cry for help.”

 
That’s how Maggie Cannon ended a long email to the Deepak Madhavan, M.D., assistant professor of neurological sciences and medical director of The Nebraska Medical Center Epilepsy Program.
She did not know Dr. Madhavan, but after eight years of seizures and repeated appointments with neurologists all over Omaha, Cannon felt like she was out of options.
Watch the video to see how Dr. Madhavan helped find Cannon answers, treatment and a refreshed outlook on life.

U.S.News and World Report surveyed the nation’s roughly 5,000 hospitals to come up with this year’s list of Best Hospitals. Fewer than 150 of those hospitals are nationally ranked.

UNMC faculty members helped The Nebraska Medical Center rank as the state’s best hospital according to the U.S.News and World Report.

The Nebraska Medical Center is ranked in five different specialties:

Cancer (No. 40)
Gastroenterology (No. 25)
Nephrology (No. 41)
Neurology and Neurosurgery (No. 40)
Orthopaedics (No. 36)

The publication also rated the medical center as “high performing” in the following specialties:

Cardiology & Heart Surgery
Diabetes & Endocrinology
Ear, Nose & Throat
Geriatrics
Gynecology
Pulmonology
Urology

In addition to these rankings, U.S.News and World Report ranked The Nebraska Medical Center as the top hospital in the state. Of the 16 specialties studied by U.S.News and World Report, The Nebraska Medical Center was ranked in 12.
“This is wonderful recognition of the outstanding work of our faculty, which is now being recognized across the country,” said UNMC Chancellor Harold M. Maurer, M.D. “It’s in keeping with the emergence of UNMC as a ranking academic medical center in the United States.”

“These rankings are proof of the tremendous amount of work our physicians and staff have done to care for our patients; many of whom have come here from all over with very serious and rare conditions,” said Glenn Fosdick, president and CEO of The Nebraska Medical Center.

The medical center’s cancer and neurology/neurosurgery programs have been ranked on the Top Hospitals list before. It’s a first for gastroenterology, nephrology and orthopaedics.
The hospital rankings, said U.S.News Health Rankings Editor Avery Comarow, are like a GPS-type aid to help steer patients to hospitals with strong skills in the procedures and medical conditions that present the biggest challenges. “All of these hospitals are the kinds of medical centers that should be on your list when you need the best care,” Comarow said. “They are where other hospitals send the toughest cases.”

The Nebraska Medical Center and UNMC celebrated a significant milestone June 2, by pulling together patients, physicians and medical staff to mark the 100th heart transplant performed since the program was re-established in 2005.

Jorge Parodi, executive director of Cardiovascular and Pulmonary Services, noted that as a hospital we often measure the success of a program in “survival rates or quality of life measurements,” but in looking around at the event he said, “It is evident the success of this program is measured in moments and receiving the opportunity to spend more time with your loved ones, your family and your friends.”

The night was filled with unscripted speeches from patients as many took to the microphone to recognize the physicians and staff who had done so much to help them through their transplant journey. One patient in particular, acknowledged that it is very rare in life that you meet a physician who will go above and beyond for your care, but that every physician he met at The Nebraska Medical Center did just that for him. In turn, Ioana Dumitru, MD, medical director of the Advanced Heart Failure and Cardiac Transplantation Program, emphasized the strength of patients who place their faith in the team of physicians and staff to help heal and treat them.

The milestone serves as proof of the extraordinary care patients receive from the outstanding team of physicians, nurses and their support staff at the medical center. Many patients identified one of the most critical aspects to their health recovery as the opportunity to be at home with family and friends. All were relieved to find out they would be in the hands of expert medical staff trained in advanced cardiac failure with the stability of being in a comfortable and familiar setting.

While the 100th heart transplant is significant, the team is not slowing down. “Six months ago when we starting planning this celebration we were at 90 heart transplants and I was a little concerned we wouldn’t make it to 100,” said Parodi. “But I am happy to announce that as of today we have performed 109 heart transplants at The Nebraska Medical Center,” said Parodi.

With the continued growth and expansion of the cardiac failure team and the Heart Transplantation Program it is not hard to imagine the celebration for the 200th heart transplant will be here before we know it.

When you see Eulish Moore walking the halls of the Cardiac Progressive Care Unit on the 7th floor of Clarkson Tower, it is hard to believe that little more than a year ago, he had accepted that he was dying.

“I had accepted my fate,” he recalled. “ I said, ‘if death is this peaceful, I’m okay with it. I’m ready to go.’”

Moore was in intensive care in another Omaha hospital where he was being treated for congestive heart failure. His wife was not willing to let him go.

“She did some research on the internet,” Moore said. “She found out the med center had this device, an LVAD (left ventricular assist device).”

Moore’s wife arranged a transfer. The next day he arrived at The Nebraska Medical Center. Though he was too weak to remember any of it now, he and his family met with the heart failure team, led by Ioana Dumitru, MD. They had new hope.

“My heart got new life on Valentine’s Day 2011,” Moore said. He now had an LVAD helping his heart. The device helped his weakened heart by taking over much of the heart’s function. His journey was not over. Moore was listed for a heart transplant.

His new heart came to him in August. With a new heart came a new outlook for Moore. The man who had once resigned himself to dying was more intent than ever on living.

“I want to do everything I can to make sure this young heart will function the way it’s meant to,” said Moore. “At some point, the daughter of my donor, who was born two weeks after he passed away, will get to touch this heart and know that her father was a really generous man.”

His desire to give back does not just extend to his donor’s family. Three months after transplant, Moore made a commitment to help others going through the same process he did. Three days each week, Moore is back on the CPCU; not as a patient but as a hospital volunteer. He talks with patients who are considering an LVAD or a transplant; or who have just had those surgeries.

“Life is really meaningful,” he said. “Tomorrow isn’t promised to us so we need to make the best of what we have today. And I am loving it.”

Moore is living those words every day. He was recently named volunteer of the year for the city of Bellevue Mayor’s Commission on Alcohol and Drug Education. He plans to return to work as a drug and alcohol counselor soon.

Kathryn Slattery knew a heart transplant was a possibility at some point in her life. She never imagined she would get a new liver as well. On January 10, Slattery, then 17 years old, became the first person in Nebraska to ever receive a combination heart and liver transplant.

She recalled the moment when she received the news that a heart and liver were available for transplant.

“I was nervous and excited,” she said. “I started texting my friends right away.”

The transplant surgery began late in the afternoon on January 10. It lasted 14 hours. Cardiac surgeons John Um, MD and Jim Hammel, MD performed the heart transplant first. When Slattery’s new heart began beating, the liver transplant team began their portion of the operation. Transplant surgeons Jean Botha, MD, Wendy Grant, MD and David Mercer, MD, PhD worked through the early hours of January 11 to complete the procedure.

“It really was a great surgery all around,” Dr. Mercer said. “The heart surgery was just fantastic; the cardiac transplant team did such a great job.”

Heart and liver transplant recipient Kathryn Slattery describes her recovery as transplant surgeon Dr. David Mercer looks on.

The transplant was Slattery’s fourth open heart surgery. She was born with a condition called hypoplastic left heart syndrome, which causes incomplete development on parts of the left side of the heart.

“Kathryn had pancreatitis in 2008,” her father Jim Slattery said. “That was our first indication there might be a problem with her liver as well.”

On December 1, she called home from school in Lincoln saying she did not feel well. Four days later she was admitted to Children’s Hospital and Medical Center. After spending two weeks at Children’s, she was transferred to The Nebraska Medical Center to be put on the transplant list.

Heart/liver transplants are rare. According to the Organ Procurement and Transplant Network, just 28 such surgeries were done in 2010 and 2011. Of those 28, only three were children.

“We have done so many of the individual organ transplants (heart and liver) here, we felt confident in our ability to do both for Kathryn,” said Dr. Mercer.

Slattery turned 18 during her recovery in the hospital.

“We had a party in one of the conference rooms,” she recalled. “Cake, pizza and opening presents; it was great.”

Slattery said her best present will be to go home and sleep in her own bed for the first time in two months.

The family shared their sincere thanks for the donor, the donor’s family and their sacrifice. They also expressed thanks to everyone at the medical center.

“It was always our choice of where to have this surgery done,” said Marilyn Slattery, Kathryn’s mother. “The confidence we had after meeting the surgical team, and their willingness to do it – that made the decision. I couldn’t imagine having it done anywhere else.”

LaShannon Bland knew heart trouble ran in his family. But at age 27, he did not think his heart would start giving out.

“I started feeling tired, short of breath, and felt my heart rhythm was bad,” Bland, now 32 said. “I came to the emergency room thinking I was having an asthma attack. They told me it was heart failure.”

Bland began working closely with heart failure specialist Ioana Dumitru, MD.

“We started him on heart failure medicine,” Dr. Dumitru said. “Unfortunately, his heart didn’t respond. The next step was to implant a left ventricular assist device (LVAD).”

Even with the help of the LVAD, a mechanical device that does much of the heart’s work, Bland’s heart was still failing. Transplant was the only other option.

“I went on the transplant list in January,” he recalled. “A week later, I got the call. February 3rd, 3:00 AM.”

Bland was the 100th heart transplant recipient at the medical center.

“LaShannon did very well in surgery,” said John Um, MD, heart transplant surgeon at The Nebraska Medical Center. “He had a strong recovery and is doing very well now that he’s out of the hospital.”

Bland is deeply grateful for his donor.

“It’s really more than words can express. I really want to thank them, their family, and everyone who had a part in keeping me going,” he said. “It’s my second chance. I feel sad that someone had to leave this earth to keep me on it. My love and my heart goes out to them and their family.”

Bland doesn’t spend much time thinking about being the 100th heart transplant recipient. He’s looking forward to being the father to his three kids he could not be when he was sick. He looks forward to simple things like running with his daughter or playing basketball with his son.

“This milestone, 102 transplants in six years is a great credit to The Nebraska Medical Center and UNMC staff members who work so closely with the patients,” said Jorge Parodi, executive director of cardiovascular services.

Bland feels a special connection to the medical center. Not just for the cardiology and transplant teams, but for the institution as a whole.

“I was born here,” he said. “My first life started here, and my second life started here too.”

New center would elevate Nebraska’s role in cancer care and research

Leaders from the University of Nebraska Medical Center and its hospital partner, The Nebraska Medical Center, announced today preliminary plans for a new cancer center at the medical center’s Omaha campus. The cancer center would house research facilities, a multidisciplinary outpatient treatment center and clinic, and a new hospital tower. Medical center leaders call it the largest project ever proposed here.

“We have some of the leading cancer experts in the world right here at this medical center,” said Glenn A. Fosdick, president and CEO of The Nebraska Medical Center. “This project takes that commitment to the next level. Having all of our experts, patient care areas and research in one location is more convenient for patients and will allow medical teams to collaborate on patient care and the development of new treatment options.”

“This is a transformational project for all Nebraskans,” said UNMC Chancellor Harold M. Maurer, M.D. “These facilities will elevate our cancer services, enhance our educational programs and provide a central location and synergy that not only will benefit our clinicians and researchers but most importantly, patients.”

The new cancer center would be built on the west side of the medical center campus. While details of the project are still being reviewed, plans call for three facilities – a multidisciplinary outpatient clinic, a 98-lab research tower, and a hospital tower with 108 beds dedicated to oncology patients.

In addition to the cancer center, project plans also call for construction of a fourth building – an ambulatory care clinic – to be built near 42nd and Farnam streets. This building would provide outpatient clinic space for the medical center’s various programs outside of cancer.

The new cancer center does not have an official name yet. Medical center officials refer to it as the Cancer Center Project. The best layout of the three structures in the Cancer Center Project is still being studied and will be announced as more details come into focus.

Building the new project will require the demolition of Swanson Hall and the parking structure to its south. New parking structures are part of the design for the new cancer center. The project does not call for any expansion west of Saddle Creek Road. Swanson Hall was built in 1948 (as Children’s hospital) and currently houses offices for UNMC physicians, staff and researchers. No patient care is provided there.

Comprehensive Cancer Care

The National Cancer Institute has given just 40 cancer centers in the United States the comprehensive designation. This new facility would be built with the goal of including UNMC and The Nebraska Medical Center in that prestigious group by the year 2020.

“This kind of single-site facility is the future of cancer care and research,” said Ken Cowan, M.D., Ph.D., medical director of the UNMC Eppley Cancer Center and oncologist at The Nebraska Medical Center. “Very few academic medical centers are positioned this well geographically and programmatically. We can provide an all-encompassing cancer center with great access, and more importantly, outstanding care and expertise.”

Economic Impact

An economic impact study is being done as part of the proposal for the cancer center project. Medical center leaders expect the impact on the local economy to be profound with the project creating an estimated 1,200 new jobs by 2020 with an infusion of $100 million annually to Nebraska’s economy.

“This is a very collaborative effort to bring a sizable amount of economic development to our community and state,” said Michael Yanney, local businessman and chairman of the UNMC committee for Campaign for Nebraska, the University of Nebraska Foundation’s comprehensive fundraising campaign. “It will make the city and region a major player in cancer treatment and research.” More than 85 percent of the project’s costs are expected to come from private funds.

Cost and Construction

A project of this size and scope will require a significant amount of time and money. The exact cost of the project has not yet been determined. Estimates at this early stage in the proposal indicate the project would cost around $370 million. No construction date has been set. Funding sources are still being sought, including $50 million from the state of Nebraska to support the construction of the cancer research tower.

“Nebraska has an opportunity to make an investment now that will serve the people of the state well into the future,” said James B. Milliken, president of the University of Nebraska. “Education and job creation are high priorities for Nebraska, and our proposal advances both. We are delighted that our partners in the Legislature are joining us to help build a stronger, more competitive Nebraska – which is a central part of our mission as the state’s only public university. This is an excellent example of how the public, education and private sectors can work together for the betterment of the state.”

“This is an investment in the future,” Fosdick said. “This proposed project would ensure we maintain our current standing as a nationally recognized cancer care provider and allow us to organize ourselves in a new way that would ensure our cancer care is second to none nationally.”

“These new facilities will elevate Nebraska’s status as an international leader in health science and health care,” Dr. Maurer said. “Most of the current comprehensive cancer centers are on the east or west coast. There is a real need for a complex like this here.”

“The concept of seizure freedom has become the expectation instead of a hopeless dream.” – Deepak Madhavan, M.D.

People often ask Dr. Deepak Madhavan, Director of the Comprehensive Epilepsy Program at the Nebraska Medical Center why he became an epileptologist, or what it is that makes him so very passionate about his work. “I think that the answers to these questions are similar. I feel that in doing my job, I can help make people better. Epilepsy is a disease that can be so crippling to a person’s life, leading to loss of driving privileges, missed work and school days, and just overall difficulties with some of the life activities that most people take for granted.”

It is estimated that seizures and epilepsy affect approximately 1% of the world’s population, making it one of the most common neurological disorders.  This means that in the Middle East and North African countries, with a population of about 381 million people, over 3.8 million people could suffer from seizures and epilepsy. With limited number of institutions offering the latest treatment options to their patients in some of these countries, many millions of patients are denied epilepsy treatment and seizure-free lives.

Advances in modern epilepsy treatment, both medical and surgical, have come a long way over the last several years. The concept of seizure-freedom has become the norm rather than a hopeless dream. “It is incredibly rewarding for me to see a person achieve seizure-freedom, and return to school, work or society with newfound confidence and security that their seizures are under control, “says Dr. Madhavan.

The Nebraska Medical Center (TNMC) in Omaha, Nebraska provides advanced treatment for patients and offers specialized training programs for international healthcare professionals to combat this serious ailment. At its Level- 4 epilepsy center, it offers the most advanced medical and surgical treatments and diagnostic measures for epilepsy, for both adults and children. Its well trained and dedicated team offers comprehensive epilepsy care for people with even the toughest seizure disorders. With advanced tools and technology such as Magnetoencephalography (MEG), they are able to noninvasively diagnose and localize many types of epilepsy that eluded treatment in previous eras.

TNMC provides epilepsy therapies to patients that were not available in the region even as recently as two years ago, with a large number of those involving multiple-stage approaches, where intracranial EEG electrodes are placed for the most precise localization and resection of epileptic tissue. They also provide other surgical services, including Vagus Nerve Stimulator (VNS) implantation, and more traditional epilepsy surgeries such as Temporal Lobectomy.  Availability of implantable brain stimulators and drug delivery devices are on the horizon.

In addition to the advanced medical and surgical treatments for epilepsy, the experts at TNMC specifically focus on the effects of general wellness on seizure control. It may be surprising, but factors like diet, stress management and getting a good night’s sleep can be effective added therapies for the control of seizures.  Dr. Madhavan explains, “Our patients enjoy a comprehensive approach to their epilepsy, where their mood, sleep, and social situation are seen as critical factors in their overall well-being.  In essence, it is not enough for us to stop seizures, but we make it our mission to enhance a patient’s   self-worth in the society”.

“The Nebraska Medical Center treats patients from many countries and has a successful history of being an international resource for cancer-care and transplantation. For international patients with epilepsy, we prioritize the diagnostic and treatment methods to make their visits as effective and comprehensive as possible. We offer personalized care for patients and their families, with on-going accessibility to epilepsy center staff and personnel, as well as full-time Arabic-speaking staff to assist patients around the clock”, says Nizar Mamdani, Executive Director of the International Healthcare at TNMC.

TNMC has affiliations with 121 healthcare facilities in 44 countries and is well known for its personalized healthcare training programs for its international partners. “We offer outstanding customized training programs in epilepsy and seizures; cancer-care and transplantation; pathology and pharmacy and healthcare management programs for international healthcare professionals, so that they may in-turn, offer outstanding treatment options to their patients at their own hospitals. These training programs are offered both at our institution in Nebraska as well as at our international partner’s facilities”, explains Mamdani.  For additional information contact, nmamdani@nebraskamed.com and visit www.unmc.edu/international.