Incredible Stories

Pat Kosharek

When Pat Kosharek turns on her computer at work each day, a little pink teddy bear smiles back at her. Propped up on the hard drive, the bear is a gift from Pat’s colleagues at Alverno College in Milwaukee. Donning a pink ribbon, the bear symbolizes Pat’s journey to becoming a breast cancer survivor — not once, but twice.

Pat, 56, received the bear upon returning to her job as an admissions counselor in January 2006 — just six weeks after undergoing a mastectomy and breast reconstruction surgery at Froedtert & the Medical College of Wisconsin.

The First Diagnosis

Pat was first diagnosed with cancer in her right breast in August 2002 following a routine mammogram. She underwent a lumpectomy (surgical removal of the tumor) at an area healthcare facility. Radiation therapy also was planned, but Pat chose to look elsewhere to continue her treatment.

She researched various healthcare providers and selected Julia White, MD, radiation oncologist, and Janet Hosenpud, MD, medical oncologist, at Froedtert & the Medical College of Wisconsin. “They were absolutely wonderful to me,” Pat said.

In late 2002, Pat received six weeks of radiation therapy with Dr. White. Follow-up tests showed no remaining cancer. Dr. Hosenpud prescribed tamoxifen, a drug that slows or stops the growth of cancer cells that are present, and helps to prevent new cancers from developing in women who have been treated for breast cancer. Pat took tamoxifen, but needed to stop after having a bad reaction.

Because of her cancer diagnosis, Pat continued to have a mammogram every six months (compared to annually for routine screenings). If she was free of cancer after three years, she could return to annual mammograms.

The Second Diagnosis

At the three-year mark in the fall of 2005, Pat was in high spirits. “I was excited thinking it would be a whole year until I needed another mammogram,” she said. But the news wasn’t good; the film showed microcalcifications, again in her right breast.

Microcalcifications are tiny calcium deposits in the breast that appear singly or in clusters. They indicate changes within the breast that may be caused by cancer or by benign breast conditions. A biopsy was needed to provide more information.

“I was totally devastated,” Pat said. “I was not expecting that news. Based on my first experience with Froedtert & the Medical College of Wisconsin, I knew that I wanted to go there again for care — no hesitation.”

Pat arranged to meet with Tina Yen, MD, surgical oncologist at Froedtert & the Medical College of Wisconsin, for the biopsy. The cancer had, indeed, returned. “Dr. Yen was very comforting and very forthright — nothing was hidden,” Pat said. “She recommended a mastectomy because additional radiation therapy could not be done on my breast.”

“About 5 percent to 6 percent of breast cancer patients will suffer a recurrence in the breast after a successful lumpectomy and breast radiation,” Dr. White said. “That is about the same rate of recurrence on the chest wall after complete removal of the breast (mastectomy).”

Breast Reconstruction

Knowing that Pat would lose her breast, Dr. Yen told Pat about John Hijjawi, MD, who performs the DIEP flap breast reconstruction procedure. Dr. Hijjawi and his partner, Robert Whitfield, MD, plastic and reconstructive surgeons at Froedtert & the Medical College of Wisconsin, are among only a few surgeons in the United States who perform DIEP (Deep Inferior Epigastric Perforator) flap surgery.

This complex microsurgery involves removing tissue from the abdomen — preserving the abdominal muscles — and transferring it to the chest where it is shaped to look and feel like a natural breast. This type of reconstruction allows women to have a new breast made entirely of their own tissue while preserving the abdominal muscle. Women experience less post-operative pain and recovery time with the DIEP flap procedure compared to other breast reconstruction methods that remove abdominal muscle.

“I couldn’t come to grips with the thought of losing a breast,” Pat said. “I talked to my cousin who had had a mastectomy as well as the DIEP flap procedure. I didn’t have a clue about the DIEP flap, but after talking to her, I thought that there really was an answer for me.”

Pat then met with Dr. Hijjawi. “Dr. Hijjawi explained everything,” she said. “He gave me Web sites to look at and was always available for questions. I researched as much as I could about it.”

During her research, Pat learned about the Women’s Health and Cancer Rights Act of 1998, a federal law which states that most health insurance plans that provide coverage for medical and surgical benefits in connection with a mastectomy are required to provide reconstructive surgery benefits.

In November 2005, Pat underwent the mastectomy, performed by Dr. Yen, and the DIEP flap breast reconstruction, performed by Dr. Hijjawi, in one 11-hour procedure at Froedtert & the Medical College of Wisconsin.

“I couldn’t fathom not having a breast,” Pat said. “Waking up with a new breast was a big factor in my recovery. I also got a tummy tuck, which I’m very happy with.” (The “tummy tuck” was the result of removing abdominal tissue to construct the new breast.)

Life After Surgery

After her surgery, Pat spent five days in Froedtert Hospital. “The nursing staff was outstanding,” she said. “I had the same nurses the whole time. They get to know you, and they were very compassionate and respectful.” With 7/70 scheduling at Froedtert, nurses work seven 10-hour days, and then are off for seven days. This means patients are more likely to have the same nurses during much of their stay.

One week after surgery, Pat was able to slowly return to a few normal activities, such as buying groceries. To aid her recovery, she did stretching exercises at home. A few weeks later, she saw Dr. Hosenpud for a follow-up visit, and did not require any further treatment.

Pat returned to work in six weeks, encouraging women to return to college so they could seek a new direction in lives. In her spare time, she enjoys writing poetry and other forms of creative prose. Some of her works have been published in literary magazines.

“It was a totally positive experience,” Pat said. “It went from a worst-case scenario to a best-case scenario. While it was a huge thing to take on, I was very pleased and have been talking to other women about Froedtert and the DIEP flap procedure.”

And the little pink bear continues to smile at Pat each day.

The Women's Health and Cancer Rights Act of 1998

The Women's Health and Cancer Rights Act of 1998 (WHCRA) was signed into law on October 21, 1998. This federal law includes protections for individuals who elect breast reconstruction in connection with a mastectomy.

Under WHCRA, if you have coverage under a group health plan, or under an individual health insurance policy that covers medical and surgical benefits in connection with a mastectomy, the group health plan or issuer (an insurance company or HMO) must also provide coverage for reconstructive surgery in a manner determined in consultation with you and your attending physician. Coverage includes reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.

Most plans and issuers that provide coverage for medical and surgical benefits in connection with a mastectomy are required to provide reconstructive surgery benefits.

Author: Marla Fraunfelder