Hyperbaric Oxygen Therapy

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The envelope of a healthy breast (the skin surrounding the breast tissue) receives most of its blood flow through the breast tissue underneath it, with a much smaller amount traveling through the skin. A mastectomy cuts off all of the blood supply from the tissue, leaving only the blood supply from the skin. This supply can be inadequate, and when it is, the skin dies. The goal of a skin-sparing/nipple-sparing mastectomy is to keep the breast envelope, including the nipple, alive and healthy - but skin necrosis is one of the risks. The nipple delay procedure that I had is one of the ways that the risk can be mitigated; another is hyperbaric oxygen therapy, or HBOT.

"Hyperbaric" means "increased pressure"; in HBOT, the patient is enclosed inside a pressurized clear acrylic chamber, breathing 100 percent pure oxygen. The air pressure in the chamber is twice the normal atmospheric pressure at sea level. In addition, the air we normally breathe contains only 21 percent oxygen, as opposed to the 100 percent oxygen in the hyperbaric chamber.

"Hyperbaric oxygen therapy is a new tool in our ability to provide the best possible wound care when it is used in conjunction with other treatments," says plastic surgeon Prasad Kilaru, M.D., Medical Director of the Washington Center for Wound Healing & Hyperbaric Medicine. "The blood’s hemoglobin and plasma cells carry oxygen throughout the body. The body’s tissues need an adequate supply of oxygen to function, and injured body tissues need even more oxygen to heal. Oxygen stimulates the immune system to kill bacteria and releases the body’s own ‘growth factors’ that promote healing. Oxygen also stimulates the development of new blood vessels into the wound area. The amount of oxygen the blood carries can be increased dramatically – up to ten times as much – by using hyperbaric oxygen therapy."

Dr. Funk and Dr. Trott both prescribe HBOT routinely for mastectomy patients, although Dr. Funk typically reserves it for higher-risk patients, such as smokers, who have compromised blood supplies. Dr. Trott, however, recommends it even for low-risk patients like me - one 90-minute session before surgery, and one per day for the first three days after surgery. Based on the limited amount of information available online, it seems that prophylactic use of HBOT is quite rare - it is more commonly used to try to turn things around when healing is not going well. But despite the expense ($250/session, not covered by insurance) and the inconvenience, I would much rather do it before there's a problem than after. At least that way, if there is a problem, I'll know that I did everything I could to prevent it.

I had my first session this afternoon at the Hyberbaric Oxygen Clinic of Santa Monica (I think there is no city in the world with a higher density of alternative and complementary medicine offerings than Santa Monica!). It was much as I expected - they slid me into a clear plastic tube and I lay there for an hour and a half. My ears popped while the tube was pressurized at the beginning, and again at the end when it was decompressed, but other than that I really wasn't aware of either the air pressure or the oxygen level. I wasn't allowed to take my iPad or iPhone in with me, sadly, but I was able to watch a DVD on the TV that was mounted just above my tube. It was actually quite relaxing. It may not be as nice after my surgery, since I will probably be in pain and missing my pain pump. But I'm in favor of anything that will speed my recovery - and I am truly grateful to have treatments like this at my disposal.

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