First, let’s consider the anatomy of the breast. The breast consists of a skin envelope filled with breast tissue, which is intermixed with the normal fat of the front of the chest, the side of the chest, and the underarm. The breast skin, which gives shape to the breast, is not usually involved in cases of breast cancer. Therefore, the skin incisions used to biopsy and remove breast tissue can be designed using principles developed by plastic surgeons to minimize scarring and produce the best cosmetic results, (results similar to a breast lift or breast reduction). Scientific evidence and common sense tell us that we can use plastic surgery-designed incisions to effectively treat breast cancer while preserving and sometimes improving the shape of the breast.
A skin-sparing mastectomy, also known as breast-conserving surgery, is a way to treat cancer, yet preserve the breast skin, causing less scarring than a traditional mastectomy. The skin-sparing procedure removes cancerous breast tissue through a small circular incision usually around the nipple area. The surgeon leaves most of the overlying breast skin, which creates a natural skin envelope, or pocket, that can be filled with an implant or with a patient’s own tissue from another part of the body. The skin-sparing technique significantly improves the cosmetic outcome and presents the best option for reconstruction.
Approximately one in every ten women will develop breast cancer at some point in their lives. Candidates include women requiring surgery for the removal of all breast tissue (mastectomy), or part of the breast tissue (lumpectomy), in cases in which the cancer does not involve the skin of the breast. This technique is also commonly used for propholactic mastectomies, a procedure performed for women who are at high risk for breast cancer, but don’t yet have breast cancer, such as women with a strong family history, and women whom test positive for the BRACA gene.
Breast cancer usually involves only breast tissue, not the skin covering the breast. Studies have been conducted, and the research published in medical literature shows that a skin-sparing mastectomy does not affect the risk of disease recurrence. The skin-sparing mastectomy not only causes less scarring, it is also effective cancer treatment.
The skin-sparing procedure borrows techniques developed from the field of plastic surgery. It causes less scarring and provides the best option for immediate breast reconstruction, or future reconstruction. This is because with properly placed incisions, scarring is reduced and irreplaceable skin is preserved. With this method, the surgeon who reconstructs the breast can achieve the most natural looking breast possible because the appearance of the skin envelope of the breast is preserved, and scars are placed according to plastic surgery practices. The risk of disease recurrence is not affected by a skin-sparing mastectomy.
Many women with breast cancer report feeling that their femininity has been compromised. A skin-sparing mastectomy and breast reconstruction gives women with breast cancer the best opportunity to return to the life they knew prior to their diagnosis and treatment. This includes an aesthetic looking breast(s), properly fitting clothes and the feeling that their womanhood and sexuality are still intact. The use of plastic surgery techniques to remove the diseased breast tissue may allow for improvement in breast shape and enhancement of breast size if desired. For example, this technique allows the surgeon to lift a droopy breast, or increase breast size by the use of a larger implant. Many women see this as a silver lining to the otherwise negative experience.
There are really no disadvantages. The only downside is that women with advanced stage breast cancer are not candidates, because in such cases, the cancer may involve breast skin.
Yes, immediate reconstruction is one of the advantages, but you can also have future reconstruction or no reconstruction. Either way, if the breast cancer does not involve the skin, it is typically the best option for women deciding to have a breast reconstruction.
Possibly. It depends on how the incisions are made and how much skin is left intact. The incisions that are made without breast preservation in mind will make it difficult to achieve a natural looking breast.
If you are adequately insured, you will be covered for a traditional mastectomy. A skin-sparing operation usually takes longer than a traditional mastectomy, due to the extra care the surgeon must take in making minimal incisions and preserving the skin. Surgeons only get reimbursed for a traditional mastectomy, but many are willing to perform the skin-sparing operation for the patient’s benefit.
Oncoplasty refers to the combination of oncological, or cancer, surgery with techniques of plastic surgery. It is a new term for an emerging field in which cancer surgeons are being trained in cosmetic techniques.
No, as long as he or she is properly trained in the procedure. It could be a general surgeon, a cancer surgeon, a breast surgeon, or an oncoplastic surgeon.
Yes, only an oncoplastic surgeon or a plastic surgeon have the training to complete the reconstruction. If you choose to have a mastectomy with a surgeon who does not perform reconstruction, that surgeon ideally should work with a plastic surgeon for the best cosmetic result.
Unfortunately, not all doctors or the public are up-to-date on the latest advances in surgical techniques for mastectomy. Women need to advocate for the best care available, not only for treating their cancer, but also for preserving the appearance of their breasts.
See the Ask Your Surgeon section on our web site.
|
Q & A
