“Dance is one of those things that it doesn't matter how good you are,” said Louise Kelter. “You never stop learning. There's always more. This is what I love to do. I want to enjoy the use of this body until I can't use this body any longer, so that's what pushes me.”
Louise, now 63 years old, was diagnosed with invasive tubulolobular carcinoma in October 2009, after a routine mammogram. She had a double mastectomy followed by reconstruction with expanders placed for implants. After that, she had chemotherapy because her doctors found a positive lymph node after surgery. Ten days after her first chemo appointment, Louise became septic, and one of the expanders became infected. At that point, she was referred to Constance Chen, MD, at the New York Center for the Advancement of Breast Reconstruction, who told her about natural tissue breast reconstruction.
“I'm very fortunate,” Louise said. “I have a wonderful marriage and two children and six grandchildren. But I'm also a very high-energy person, and dance is my happy place. I underwent the DIEP flap surgery and it was the smartest thing I ever did. I still go dancing four or five times a week.”
Why did you decide to have natural breast tissue reconstruction?
Even after my infection, I knew that I still wanted reconstruction. At that point, one of my breasts was completely mangled. And the other one, the expander, it wasn’t even where it was supposed to be; it was in my armpit. So when I finished the chemo and my breast surgeon said now you can go back and go to the plastic surgeon and we can fix everything, I was told that implants were no longer an option for me. I was referred to Dr. Chen because she was one of the few surgeons who was doing DIEP flap reconstruction on very thin women. I went to see her and she looked at me and she said no problem. I can make breasts for you.
I knew it was the right choice for me. Now I can actually close the book on this chapter in my life. These are the breasts that I’ll always have. They're perfectly fine and I will never have to have anything done again. I don't have to worry about any kind of contracture or rupture. I don't have to replace them.
How was your experience with DIEP flap surgery and your recovery?
The first two weeks are hard. But by the third week, you’re able to function on your own. Yes, it hurts. There are surgical drains. There is the surgical bra. There are compression garments. There's all the stuff to deal with, but you can handle it. By the third week it’s much better, and then every week is a huge difference. You wake up on week four and you feel so much better.
How is your life different now, after the natural breast tissue reconstruction surgery?
It’s a big surgery but within six weeks, I was dancing again. Maybe I wasn't dancing full speed, but I was dancing and moving and I've never had a problem with movement of my arms or using my abdominal muscles. I'm very pleased that that's the route that I ended up choosing. Most important, I know I will never have surgery ever again. This is it. And what's amazing to me is that I think my figure is far better now than it was before I ever had cancer.
Will most people’s insurance plans cover the surgery?
Frankly, the reconstruction surgery is quite costly. However, there's a law that was passed in 1998 that protects women. It is a federal law that whatever type of breast reconstruction a woman may choose must be covered by their insurance.
I'm very passionate about making sure that people know that every insurance company has to cover this type of reconstruction. Everybody's specific benefits are different, but I do advise patients who are faced with this to ask lots of questions and fight for their rights. Ask about the in-network gap exception, for example. If there isn’t a doctor within your network who’s capable of doing this type of surgery, the woman has the legal right to have the surgery elsewhere and it must be covered. One should never take no from an insurance company on anything when it comes to health care.
What advice can you offer to other women who may be newly diagnosed with breast cancer?
Know your options if you're faced with breast cancer. My own oncologist was not that familiar with natural breast tissue reconstruction. He'd heard about it, but really never had patients with it. So sometimes you have to do your own research. Ask about flap surgery. Knowledge is the key to everything.