Tom Charlier

During Toni Pittman's first bout with breast cancer, two surgeries weren't enough.

She first had to undergo a mastectomy and allow some time to heal. Then she endured two breast reconstruction procedures.

That was more than 20 years ago.

This year, during a second fight with the disease, things were different for Pittman. Thanks to new technology added at Baptist Memorial Hospital for Women, the 70-year-old workers' compensation nurse case manager had her breast reconstruction work begin immediately after the mastectomy, with only one follow-up procedure needed later.

One less operation meant a savings not only in time, but in cost.

"I see it as a big benefit," Pittman said.

Baptist Women's is the first Memphis-area hospital to be equipped with the SPY Elite Fluorescence Imaging System, which provides surgeons something of a glow-in-the-dark road map as they perform reconstructive operations.

Just as colors can be used to depict storm severity on radar images, the SPY system uses different hues to distinguish healthy tissue from dying tissue. That way, it dramatically reduces the likelihood of post-operative complications, such as infection, which inflate medical costs an average of nearly $23,000 per patient, according to one study.

"The more surgeries, the more it costs," said Dr. Lou Adams, a member of The Plastic Surgery Group of Memphis who often operates at Baptist Women's.

Although it could be used in a variety of operations, the SPY system is especially beneficial in the field of breast construction surgery, Adams said. It's a field that has become increasingly important over the past 40 years as breast cancer surgeries improved in precision and technique, allowing more women to undergo reconstruction rather than use external prosthesis.

One of the main challenges of reconstructive surgeries involves necrosis — the death of tissue — underlying the skin that's saved during mastectomies. Necrosis often occurs where blood flow has been impaired as a result of the trauma caused by the removal of the breast gland.

The trick for surgeons is to identify which tissue has sufficient blood flow and therefore can be used during reconstruction.

"The old technique was to scratch and see if it bleeds, or cut it and see if it bleeds ... ," Adams said. "This technique takes it to the 21st century."

The color-coded images tell surgeons how much, percentage-wise, of the original, preoperative blood flow is still coursing through tissue after the mastectomy.

"Black is bad — there's no blood flow there," Adams said.

Experience has shown that where blood flow levels are below 35 percent, the tissue probably won't survive, he said.

By removing the guesswork, surgeons can know which tissue can be used during the reconstruction. In many cases, that means the patient can get a breast implant minutes after the mastectomy is completed and "wake up with a new breast," Adams said.

"The SPY camera allows me to be assured that I can go straight to the implant ... and have healthy tissue," he said.

"If I build the breast with unhealthy skin, I'll lose the implant because it will become infected."

In Pittman's case, the SPY camera showed that her skin needed time to rest and heal. It also identified some skin edges that needed to be trimmed because of insufficient blood flow. But by having that knowledge, Adams was able to insert and sew up a temporary inflatable tissue expander immediately after Pittman's mastectomy. She'll get a permanent implant later.

Adams said it's important that cancer patients have access to safe breast reconstruction options.

"It (reconstruction) brings them out of that depth of despair," he said. "Dammit, if they've gone through cancer, they should come out of it with something they want."

Reach Tom Charlier at thomas.charlier@commercialappeal.com or 901-529-2572 and on Twitter at @thomasrcharlier.