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. Dr. Vasile believes her patients deserve to be informed of their options to enable them to make educated decisions. She will listen compassionately to you and guide you.
Perforator Flap Microsurgical Breast ReconstructionDr. 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 (TUG, 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. Vasile performs this surgery as a team with another microsurgeon, who has also done additional extensive training with perforator flap breast reconstruction. We have treated many patients that thought they had no further options.
Research and InnovationDr. Vasile started a research collaboration in New York City with Weill Cornell radiologists, Dr. Martin Prince and Dr. Tiffany Newman. Dr. Vasile’s research entails using magnetic resonance angiography (MRA) to visualize the small blood vessels in the donor site tissue (abdomen, buttock, thigh, and lateral thorax), thus identifying the best vessel on which to do the microsurgical breast reconstruction. 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.
The most useful recent advance in perforator flap reconstruction is stacked flaps, also called double flaps, to make one breast. Dr. Vasile has 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. This involves using 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 other potential options that have yielded tissue in our breast reconstruction patients who thought they had no further options.
Another 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.