Breast cancer surgery often can be accomplished through a lumpectomy or segmental mastectomy (removal of only the affected tissue), allowing breast conservation. For patients who require a mastectomy (removal of the entire breast), there are new techniques in reconstructive surgery to restore the breast’s appearance. Surgery can reconstruct a breast, including the size, shape, nipple and areola (shaded skin surrounding the nipple). The surgery often can be performed immediately following the mastectomy, while you are still sedated, and is performed by a qualified plastic surgeon.
Types of Breast Reconstruction
Some breast reconstruction is accomplished by employing a breast implant and some of the latest techniques use your own skin, fat and muscle from other areas of your body such as the back, tummy, buttocks or area close to the chest. Contralateral symmetry surgery is performed on the unaffected breast, when needed, to assure a uniform appearance in shape and size.
“In terms of breast cancer and reconstruction surgery, the field has really exploded with reconstructive options that were not available 10 years ago,” according to James Chao, M.D., FACS, who specializes in breast reconstruction in cancer patients.
Pioneering Better Options
Among the recent developments, Dr. Chao cited newly approved silicon gel implants that are completely different from those used 15 years ago, now with a sort of memory gel, although he noted that they have long been available to cancer patients at UCSD, which helped pioneer them for mass-market approval.
Some women opt to have a second surgery after three or four months of healing to also reconstruct the nipple and areola. This procedure often can be done on an outpatient basis.
Surgical Collaboration Improves Outcomes
At UCSD, surgeons collaborate closely to coordinate cancer and reconstructive surgeries, interfacing for best outcomes. Patients of Breast Cancer Unit Director Anne Wallace, M.D., FACS, have a surgical oncologist and a reconstructive surgeon in one person, and she often is able to perform the surgeries simultaneously. This also is the case for the surgical team of Dr. Chao and surgical oncologist Sarah Blair, M.D., who partner to work with patients and to plan and perform surgeries together.
“As plastic surgeons, we help with the planning stages and get involved early, which provides the same level of safety in terms of the ability to resect the tumor and at the same time get an aesthetically pleasing outcome,” said Dr. Chao. “Even with lumpectomies, we work with the surgeon to help with markings so that the incisions fall into the natural reconstructive planes. All the necessary tissue is removed, but we are still able to preserve a good portion of the breast, and usually able to preserve nipple sensation and prevent the nipple from being crooked.”
Chao said research shows that a concurrent surgery is preferred, with better patient outcomes in terms of the quality of the reconstruction and the breast appearance, as well as hastening healing and minimizing the patient’s down time.
“It’s another testament to what can be achieved with better communication and the team concept that a center of excellence can provide, with all the experts under one roof,” said Dr. Chao.
New Developments for Faster Healing, Less Scarring
One of the exciting new advances in breast cancer surgery is the development of stronger sutures that allow a smoother closing with fewer sutures, resulting in faster healing and less scarring. UCSD is the West Coast center for this clinical trial and this is available only to patients at Moores UCSD Cancer Center.
Another major development has been the refinement of microsurgical flaps, including perforator flaps that enable the surgeon to use only skin and subcutaneous fat for the reconstruction, preserving musculature, especially in the abdomen. Dr. Chao said that once patients heal, the breast will “jiggle and move and age like your other breast.” This is particularly beneficial, he says, because implants have a limit on longevity and may need to be replaced after as few as 10 to 12 years. UCSD is at the leading edge of these approaches, employing techniques that are years away from being offered elsewhere in the San Diego region.
The Moores UCSD Cancer Center is pioneering a novel rehabilitation protocol especially geared toward restoring upper body range of motion in patients who undergo bilateral mastectomy (removal of both breasts). During recovery from this surgery, patients work with a team of upper extremity specialists – plastic and hand surgeons, a certified hand and occupational therapist, and specialists in lymphedema (swelling of tissue after removal or radiation of lymph nodes) -- in a regimented program to gain faster recovery in both arms.
Dr. Chao said he spends a lot of time with patients to review their options and preferences and to explain the risks, benefits and projected outcomes of various procedures. Yet because he knows patients have some questions they are uncomfortable discussing with their doctor, he tries to pair new patients with former patients who meet roughly the same profile or who had the same procedure.
Former patients agree to mentor new patients, providing a listening ear and sharing “war stories,” as Dr. Chao called it, assuring them and telling them what to expect.
“I want them to have a free interchange to talk about me,” he said, “So they get the true, unabashed version. They might have some questions they are uncomfortable asking me, so they get those answers. And the former patients tell them things I might forget, like, "Bring your own slippers with you.’”