Dr. Julie Vasile is an ABPS board certified plastic and reconstructive surgeon practicing in Westchester County, New York, Fairfield County, Connecticut, and New York City. Dr. Vasile has a special interest in restoring the form and self-confidence of patients with breast cancer. She believes her patients deserve to be informed of their options to enable them to make educated decisions. Dr. Vasile will listen compassionately to you and guide you.
Perforator Flap Microsurgical Breast Reconstruction (NO MUSCLE used)
Dr. Julie Vasile specializes in perforator flap breast reconstruction, a technique that uses your own fat and skin tissue to create a breast, without harming the muscle. The tissue can be transferred from many donor sites on the body, but the abdomen is the most common source of tissue.
When the abdomen is the source of tissue, the procedure is commonly referred to as a DIEP (deep inferior epigastric artery perforator) flap or SIEA (superficial inferior epigastric artery perforator) flap.
Other donor sites of tissue that can be used are the upper and lower buttock (SGAP, IGAP, DFAP) flaps, upper thigh (TUT, PAP) flaps, upper outer thigh (LTP flap) and outer (lateral) chest tissue (TDAP, ICAP) flaps.
There are continuous advancements in knowledge resulting in more areas of fatty tissue that a breast can be reconstructed from. Dr. Vasile continues to keep abreast of surgical advancements so that patients have reconstructive options.
Dr. Julie Vasile performs this surgery as a team with another microsurgeon, who has also done additional extensive fellowship training with perforator flap breast reconstruction. We have treated many patients that thought they had no further options.
Research and InnovationDr. Julie Vasile is considered a world authority on using MRA imaging for perforator flap breast reconstruction. Dr. Vasile's research created protocols for using magnetic resonance angiography (MRA) to accurately map out the small vessels in the tissue (abdomen, buttock, thigh, and lateral thorax), thus identifying the best vessel and site to use for microsurgical breast reconstruction.
She started the first MRA perforator flap program that accurately and simultaneously mapped out non-abdominal and abdominal tissue with radiologist Dr. Prince in 2008.
Advance knowledge of the best vessel to use can help the surgeon identify suitable patients for perforator flap breast reconstruction and can shorten the operating time. In contrast with other imaging modalities, MRA does not expose patients to radiation. This continuing research collaboration is an effort to improve efficiency and safety for the procedure.
The most useful recent advance in perforator flap reconstruction is stacked flaps, also called double flaps, to make one breast. Dr. Vasile has tremendous and successful experience with stacked DIEP flaps for reconstruction of one breast to match the other breast. The newest advance in stacked flaps is using double flaps to make two breasts or four flap breast reconstruction.
An extended DIEP flap 4 flap procedure uses the standard DIEP flap along with the fat on the sides of the abdomen (DCIP flap). It allows the creation of two breasts using the abdominal tissue and sides of the abdomen to meet reconstruction volume and tissue requirements. This is a technically more complicated procedure, but can reliably provide adequate volume in one stage.
Double flaps can be a powerful reconstruction tool in the right patient. Double flaps simultaneously from the abdomen and thigh donor site or from two thighs are potential options that have yielded tissue in our breast reconstruction patients who thought they had no further options.
Preoperative MRA information, attention to details, minimizing risk with a thorough preoperative consultation, nursing team dedicated to breast flap reconstruction, two surgeon team of which each surgeon is fellowship trained specifically in perforator flap breast reconstruction are some of the factors that has led to her excellent patient outcomes.
Successful OutcomesDr. Julie Vasile started the perforator flap breast reconstruction program at Northern Westchester Hospital, Mt. Kisco, NY in 2011. From 2011 to 2016, she has a 0% flap fail rate in Westchester, NY.
This success rate included breast flap reconstruction done at the same time of mastectomy, as well as breast flap reconstruction done over 20 years after a patient's mastectomy. This success rate included "complicated" patients with history of multiple surgeries to the chest and abdomen, radiation therapy to the chest, mantle ray radiation, failed implants, hypercoaguable blood disorders (Factor V Leiden, prothrombin gene, low protein S, MTHFR gene), diabetes, hypertension, elevated weight BMI, low weight BMI, previous smokers, congenital tuberous breast disorder, multiple allergies, frequent PVCs, neoadjuvant chemotherapy with immunosuprression, stacked double flaps to one breast, stacked double flaps to both breasts (4 flaps), flaps that required radiation therapy after reconstruction. This success rate also included prophylactic mastectomies in patients at elevated risk for breast cancer, like BRCA+.
Prior to Northern Westchester Hospital, Dr. Vasile was in the breast program at Stamford Hospital. Dr. Vasile had a 0% flap failure rate in Stamford, CT, from 2009 to 2010.
An interest of Dr Vasile’s is in lymph node transfer for the possible improvement in lymphedema (arm swelling after axillary node dissection or congenital leg swelling). The lymph node transfer can be done in conjunction with a deep inferior epigastric artery perforator (DIEP) or superficial inferior epigastric artery (SIEA) flap procedure for breast reconstruction. A lymph node flap can also be transferred microsurgically on its own blood supply to the site of lymphedema.