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t m c » p u l s e | o c t o b e r 2 0 1 8 31 2 to 3 millimeters in width—to the new site. "In recent years, in the field of breast cancer, we've come up with a number of new techniques … primarily in the sense of improved outcomes with implants and new flap techniques to reconstruct," said Matthew Hanasono, M.D., professor and director of the Reconstructive Microsurgery Fellowship Program in the department of Plastic Surgery at MD Anderson. "Today, the gold standard is to use tissue from the abdomen (the so-called DIEP flap) or the older version of the flap, called the TRAM flap," Hanasono said. The DIEP (deep inferior epigas- tric perforators) flap contains blood vessels, skin and fat from the lower abdomen to use for breast recon- struction. The TRAM (transverse rectus abdominus) flap uses muscle, skin and fat from the abdomen for breast reconstruction. With the advent of new tech- nologies, including more powerful microscopes and finer tools, plastic surgeons are entering a new frontier of microsurgery that is revolution- izing soft tissue reconstruction. Supermicrosurgery is a technique of dissection and anastomosis of small vessels ranging from 0.3 to 0.8 millimeters using suture needles 30 to 80 microns thick—finer than the average human eyelash. In addition, surgeons are able to use other parts of the body—beyond the abdomen—to form a breast. "The newest evolution of this is to take it either from the thighs or the buttocks or the hip—places we didn't think were options before," Roubaud said. "Women carry a lot of extra weight in those areas, and they are usually more than happy to let us take it and turn it into a breast." Under federal law, breast recon- struction is covered by insurance. Prior to the Women's Health and Cancer Rights Act of 1998 (WHCRA), which protects breast cancer patients who have chosen to undergo mastectomies and requires insurance to cover reconstructive surgery, breast reconstruction was considered a cosmetic proce- dure and, therefore, not medically necessary. Many insurance carriers claimed that a breast did not serve a bodily function and, therefore, did not affect a woman's health. "I consider a mastectomy an amputation," Roubaud said. "At no other place in the body would we cut off a body part and not offer some- one rehabilitation—a prosthetic leg, a prosthetic arm, etc. The fact that, for years, we cut off women's breasts and didn't offer them anything seems to be a little archaic." (continued) Until women are reconstructed, we haven't finished their treatment. We haven't finished restoring them. We know more now than ever in the medical community that you can't cut people's bodies and ignore their soul. — MARGARET S. ROUBAUD, M.D. Margaret S. Roubaud, M.D., is an assistant professor in the department of plastic surgery at The University of Texas MD Anderson Cancer Center.