Plastic Surgeons Transplant Tissue between Identical Twins

November 22, 2017 Volleyball Injuries

Louisville, KY USA - Cheryl Adair has alot to be thankful for this holiday season – a new breast donated from her twin sister Cherona Craig’s abdomen and the early arrival of her first grandchild. In a combined surgery at Jewish Hospital lasting over 14 hours, plastic surgeons from Kleinert Kutz and Associates, the Christine M Kleinert Institute, and the University of Louisville transplanted abdominal skin and fat from Craig’s abdomen to create a new breast for Adair 3 weeks ago on October 31, 2017.

Adair, 47, was first diagnosed with breast cancer in 2009 at age 39. She had the cancer lump surgically removed from her right breast, followed by 6 weeks of radiation. Three years later, in 2012, she developed another tumor in her right breast and this time underwent a double mastectomy with reconstruction, followed by more radiation. With her twin sister by her side throughout her journey, Adair thought she had breast cancer behind her. But unfortunately, yet another tumor appeared in the skin of her right chest last year. She had to have more skin removed and this time, chemotherapy. She battled infections and wound problems and was ultimately left with the right half of her chest significantly deformed from scars and radiation. Once recovered from all of her cancer treatments, Adair hoped one day to have her right breast rebuilt.

In June 2017, lead surgeon, Dr. Michelle Palazzo offered the twins a unique option to reconstruct Adair’s chest and make a new breast out of her twin sister’s abdomen. The surgery is performed by carefully removing tissue (called a Deep Inferior Epigastric Perforator or DIEP flap) from the front of the abdomen, reconnecting it to the chest vessels with a microscope, and shaping it into the form of a breast. This is the same tissue removed and discarded after a tummy tuck. This microsurgical technique has become an increasingly common way to reconstruct a breast from a patient’s own abdomen. But using a twin sister’s abdomen to create a breast has only been described five times in the world. In this case, Craig’s abdominal tissue was of much better quality than Adairs and would make a better breast. This procedure, compared to other reconstructive options, would also allow for removal of much more of the diseased skin of Adair’s right chest, where the tumor had recurred in 2016. In the end, if successful, Adair would get a new right breast and Craig would have nearly the equivalent of a tummy tuck. Craig was thrilled to provide her sister with a way to recover both physically and emotionally from the trauma of losing a breast. Adair’s only request was to recover in time to help care for her first grandchild due in December.

To begin the process, the twins had to be tested to make sure they were identical. The results came back that they were 99.99% likely to be genetically identical and therefore, Adair’s body should not reject her sisters donated tissue and she should never need rejection medicines. Getting insurance coverage for such a unique case was a bigger challenge. After months of phone calls and letters, the insurance coverage was finally approved only 5 days before the scheduled surgery. The surgical team (Drs. Michelle Palazzo and Donald Graham of Kleinert Kutz and Associates and Terry McCurry of the University of Louisville) planned the double surgery carefully, meeting with each other and the twins on multiple occasions.

The twins left their homes in Bedford, KY early in the morning on Halloween and arrived at Jewish Hospital to be prepared for surgery. Craig was brought into the double operating room first around 8:30 am and surgery started to carefully harvest her abdominal flaps. Adair was brought into the other side of the operating room and surgery started around 11 am to prepare her chest to receive a flap from her sister. Drs. Palazzo, Graham, and McCurry worked in teams of two, additionally utilizing the skills of microsurgery fellows Laxminarayan Bhandari, Katherine Fu, and Uzair Qazi of the Christine M. Kleinert Institute and plastic surgery fellow Nitin Engineer from the University of Louisville.

In the operating room, images of blood flow to the abdominal tissue were visualized using a LUNA Fluorescence Angiography System both before disconnecting the flaps from Craig and after connecting the flaps to Adair. The right side of the abdominal flap flowed well, so it was connected first to Adair’s right chest. Using a double-head microscope and tiny instruments and needles, the surgeons sewed together blood vessels the size of spaghetti noodles with stitches the size of hairs. Once the right abdominal flap was successfully transplanted to Adair’s right chest, surgeons confidently cut away the damaged skin. The left abdominal flap did not flow well through its tiny network of vessels even before being disconnected from Craig, but an attempt was made to connect it to Adair’s left chest. The left flap still did not flow well, so it was discarded and a breast implant was returned to Adair’s left chest.

Craig left the operating room around 6 pm and Adair before midnight. The sisters recovered together in a double room at Jewish Hospital and were discharged within 3 days. They both continue to do well at home and have been seen in the office weekly.

Adair is thankful that this was one of the easiest surgical recoveries she’s been through. Three days after being discharged from the hospital, Cheryl Adair became a grandmother to a healthy baby girl, Harper Lee, who arrived 6 weeks early.

Story by
Michelle D. Palazzo, MD

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