Nina Hildebrand (left) donated tissue to her twin Naomi Whinnie. The sisters were recovering Wednesday in a room at the East Cooper Regional Medical Center.

MOUNT PLEASANT - Woman shares a part of herself in twin sister's reconstructive surgery

Twin sisters Naomi Whinnie and Nina Hildebrand could not sleep Tuesday night. The sisters talked and held hands, side by side in hospital beds, amazed that it was over.

A team of surgeons led by Dr. Robert J. Allen reconstructed Whinnie's breasts using tissue donated from her sister. The seven-hour procedure Tuesday at East Cooper Regional Medical Center is believed to be the first of its kind using tissue donated from a twin to reconstruct both breasts of the other.

Twin-to-twin surgeries were performed in 2000 and 2001 to reconstruct one breast. Those surgeries were also performed by Allen and his team. The painstaking procedure rebuilds breasts from live tissue, attaching microscopic blood vessels to nourish the transplanted skin and fat.

The 44-year-old twins, who live within walking distance of each other in Johnstown, Pa., stayed close when Whinnie fell apart after her breast cancer diagnosis four years ago.

Whinnie discovered the growth when she felt a thickening in her mammary glands. A mastectomy followed in 2005. Another preventive mastectomy of her healthy breast came the following year.

"I'm from a small town. People looked at me funny" after the second mastectomy, she said. "But more are getting this done."

Then came the chemotherapy. When the time came for reconstruction, Whinnie suffered complications from the expanders used to stretch her skin.

Radiated skin does not expand well, Allen said, and Whinnie's skin broke where her breasts had received radiation treatment and became infected. The healthy breast implant became encapsulated in scar tissue.

Hildebrand said she joked with Whinnie that she wished she could give her sister the fat from her belly. When Whinnie discovered through Internet research that her sister's joke could be a reality, the pair did not hesitate to make it happen.

First the twins underwent genetic testing to confirm they were identical. They also were tested for the breast cancer gene, and both tested negative. Whinnie is part of the 85 percent of women who develop breast cancer with no family history of the disease, Allen said.

Allen pioneered the microsurgical procedure to offer women an alternative to implant reconstruction. Using live tissue provides several advantages, he said. The frequency of complications is reduced, and the tissue feels more natural.

"This is not a vanity procedure," he said. "It's not vanity to reconstruct a body part lost to cancer."

Dr. James E. Craigie participated in the procedure, called a deep inferior epigastric perforator, or DIEP. The process is named after the artery and vein removed with the tissue. Craigie and Dr. Joshua L. Levine, based in New York, were trained by Allen at Louisiana State University School of Medicine.

Allen and his team routinely perform microsurgical breast reconstruction using a patient's own fat, but because Whinnie had a tummy tuck, or abdominoplasty, and weighed only 105 pounds, she had little body fat to spare. Her ace in the hole: an identical twin.

But Hildebrand is a petite woman, too, weighing only about 115 pounds. Allen managed to harvest 2 pounds of tissue, and in the process, gave her a tummy tuck too.

Following major surgeries and a restless night, the women looked like the weight of the world had been lifted from them.

Husbands, doctors, nurses came and went as the sisters sat in matching pajamas, hands clasped.

"I was excited that I was put back together again," Whinnie said.

The Post & Courier
Reach Jill Coley at 937-5719 or jcoley@postandcourier.com
Photo by: Melissa Haneline/staff

Breast reconstruction surgery has come a long way over the last few decades. In the past, breast cancer survivors had few options after a mastectomy.

Now, a new technique promises to help thousands of women feel whole again.

Naomi Whinnie, of Cambria County, was diagnosed with breast cancer which resulted in radiation plus a double mastectomy.

Her identical twin sister, Nina Hilderbrand, said, "Anything that happens to her affects me. I tried to help her but I felt, 'What else can I do?'"

Most breast reconstructive surgeries involve muscle tissue, but the new technique involves "epigastric perforator flap reconstruction" and only uses living tissue. The muscle function is preserved and no artificial implants are needed.

Many women use their own stomach tissue, but Whinnie had undergone a tummy tuck, so her sister offered to donate her tissue. The procedure was the first twin-to-twin reconstructive breast surgery in the world.

Whinnie said, "You owe it to yourself to know what your options are - what's available. This microsurgery (is) just amazing. You get immediate results and you're up and moving around."

She added, "I'm whole again, I look better than I did before."

Because the twins are identical, there is no chance for tissue rejection. The procedure, which took place at East Cooper Medical Center in South Carolina, took seven hours.

DIEP flap only accounts for about 5 percent of breast reconstruction surgeries. At present, only a few dozen doctors in the country are trained to dissect and connect the blood vessels.

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POSTED: 5:21 pm EDT October 19, 2006
UPDATED: 8:24 am EDT October 20, 2006

Naomi Whinnie counted on support from her identical twin, Nina Hildebrand, through two mastectomies and chemotherapy for breast cancer.

A first-of-its-kind surgery Tuesday brought the 44-year-old sisters from Vinco even closer.

Whinnie had both surgically damaged breasts reconstructed with tissue taken from her twin. The operations took place in Mount Pleasant, S.C.

“I can’t thank her enough for doing this for me,” Whinnie said from East Cooper Regional Medical Center in Mount Pleasant. “What a gift to make me feel good.”

Surgeons Robert J. Allen and James E. Craigie of the Center for Microsurgical Breast Reconstruction in Charlestown, S.C., performed the seven-hour operation using a technique pioneered by Allen.

Unlike the more-popular surgical implants or reconstruction with muscle tissue, Allen’s technique transplants skin and fat from the lower abdomen to reconstruct the breast.

“The big advantage is that it ends up with a more natural reconstruction that’s permanent,” Craigie said. “It doesn’t deteriorate over time, and it doesn’t sacrifice a muscle.”

Normally, surgeons transplant the patient’s own skin and fat, but Whinnie had undergone a tummy-tuck after the births of her children, Kala and Mason.

Because that left Whinnie ineligible for the normal option, Hildebrand asked if she could help.

“It just made sense to me,” Hildebrand said. “One option she couldn’t do, but I knew I could help her through this.”

Allen had twice used the procedure with identical twins, but only rebuilt one breast. They contacted the Center for Microsurgical Breast Reconstruction and were approved after additional tests to confirm they are identical twins.

“It was a win-win,” Whinnie said. “She gets to look good, and I was put back together again. She benefited because she had a tummy tuck.”

Hildebrand said it was not about self-improvement, but only concern for her sister.

“We are very close,” Hilde-brand said. “We only live about 500 yards apart. We talk on the phone every day. We go on vacations together.”

Whinnie said she learned about the deep inferior epigastric perforator flap – DIEP flap – reconstruction through her research on the Internet after her double mastectomy in Johnstown.

Only about 50 surgeons in the country have been trained in the advanced microsurgical techniques to dissect and connect tiny blood vessels under the operating microscope, Allen said.

He estimates that DIEP flap accounts for about 5 percent of breast reconstruction, while most use artificial implants, muscle tissue or both. That leads to concern about muscle loss.

“Muscle is created to do work. It has a function,” Allen said. “With DIEP flap, you don’t have to give up what the muscle does. You are replacing like with like.”

The first-ever double breast reconstruction with donated tissue drew media attention, Whinnie said Wednesday, after a full day of interviews. She praised the surgeon’s work saying she felt completely recovered, despite the attention.

Both sisters were getting a little tired, Whinnie admitted – but not from interviews or surgery.

“I kept my sister up all night, because I am whole again,” Whinnie said.