Identical adult twins undergo first-of-its-kind procedure performed by UofL physician

A woman who survived a rare childhood cancer successfully underwent a first-of-its-kind procedure with University of Louisville Physicians to help restore her appearance.

Jarrod Little, M.D., a plastic and reconstructive surgeon with UofL Physicians, used fat grafted from Janna Coleman’s identical twin, Jessie, to reshape Janna’s face from the damaging effects of radiation and chemotherapy. While fat grafting has been done for years, there are no instances in medical literature of it taking place from one person to another, and never before on identical twins. While tissue from twins has been used for organ transplants, soft tissue procedures between twins are rare, Little said.

The surgery took place at University of Louisville Hospital, part of KentuckyOne Health, over about three hours on Thursday, Nov. 19, and was a success.

“It will make a huge difference for her,” Little said. “She looks like a new person. I’m very happy with the results.”

Janna, 28, was diagnosed with an aggressive rhabdomyosarcoma at the age of 7. Childhood rhabdomyosarcoma is a disease in which malignant cells form in muscle tissue, and Janna’s formed behind her jaw. She was successfully treated, but the surgery, radiation and chemotherapy to her head and neck left lasting effects, damaging her pituitary gland, which disrupted her growth, most noticeably around her face. He jawbone never grew to an adult size.

While Janna is an identical twin, her sister, Jessie, did not have the same condition. Though they once looked so much alike even their father had trouble telling them apart, after her treatment Janna no longer looked as much like her sister.

“The cancer was the easy part; the aftermath is what’s been hard,” Janna said.

Janna went through more than 10 reconstructive surgeries over the years to help, but without much success. After moving to Louisville and working as an oncology nurse, she heard of Little and went to him to see if there was anything else that could be done.

With the jawbone in Janna's face damaged and stunted from radiation, Little determined reconstruction of her jaw was not an option. Fat grafting to help re-shape her face was, but Janna did not have enough fat, and was unable to gain weight because of her development issues.

But when Little learned Janna was an identical twin, he came up with the idea to take fat from Jessie and transplant it into Janna’s face. The procedure also was unique in that many people with Janna’s condition and location of her tumor do not survive to adulthood.

By increasing volume to the face and repairing some of the damaged tissues, the goal of the procedure was to give Janna’s face a more natural volume and contour so the size of the jaw bone will not be as noticeable, Little said.

Fat also was a good option for Janna because it has a high concentration of stem cells, which are beneficial because they can form into new types of cells. When they are introduced to a new area, they can regenerate surrounding soft tissue. And with the twins having a nearly 100 percent genetic match, the probability of success was high.

“I just want to look like my sister and more like a twin,” Janna said. "It is hard being her twin. She's gorgeous.”

To donate fat, Jessie had to make an effort to gain weight. For months, the normally health-conscious Jessie ate high-calorie foods – including ice cream, pizza and fast food – to develop enough fat that could be removed by liposuction for Janna.

“She’s my sister, my twin,” Jessie said before the surgery. “Of course I’m going to do anything I can to help.”

“I want her to be more confident in herself and be proud to say we're twins and not be shy about it because we're exactly alike.”

It will take several months to assess the full effects of the procedure. One or two more sessions may be needed before the reconstruction is complete.

While Janna’s portion of the procedure was covered by insurance, Jessie’s was not, so UofL Hospital donated her costs.