Mastectomy and Plastic Surgery Leave Patient Looking Good
Guilliana Rancic’s brave and very public decision to treat her early stage breast cancer with a double mastectomy at first seems like an over reaction. After all, aren’t we living in the age of treating small breast cancers with the triple whammy of lumpectomy, radiation and often chemotherapy? The reality is that most women submit to this advice. A significant portion of the breast tissue is surgically removed and the remainder is treated with radiation. A conserved breast but distorted to some degree by surgery and radiation remains as does the risk of developing another cancer.
The reality of living under the threat of another breast cancer drives many women, like Ms. Rancic, to insist on another option. Mastectomy removes almost all the breast tissue and therefore almost all of the risk of another cancer. At first this seems like quite an over reaction. Why would a woman choose to undergo mastectomy; removal of the entire breast, to treat a cancer when much less invasive options are offered. But new advances in breast cancer surgery make the choice of mastectomy an attractive option not only for treatment of breast cancer but even prophylactically for women at high risk to develop breast cancer.
Traditional mastectomy methods result in loss of the entire breast and leave a disfiguring scar horizontally across the chest. Even Plastic SBut new surgery techniques are rapidly putting an end to disfiguring mastectomy. These operations are a natural fusion of effective breast cancer surgery with plastic surgery techniques long known to improve breast appearance. The emerging field, known as Oncoplastic Surgery, is named for the combination of Oncologic or cancer surgery and Plastic Surgery. The new methods affect all areas of breast cancer surgery from biopsy to lumpectomy, and even mastectomy.
For example, breast biopsies were formerly performed, routinely, through a fairly long incision placed on the breast directly over the lump. Frequently this results in a very obvious, red, raised scar in upper part of the breast. Now most biopsies are done under local anesthesia with a device that can even completely remove some lesions. The biopsies that must be done with surgery can now be accomplished with hidden scars using newer Oncoplastic incisions.
The real paradigm shift, though, is happening in the way mastectomy can now be done. The application of Plastic Surgery methods now allows breast surgeons to perform mastectomies and leave the patient looking as good or even better after surgery. How is this possible?
In smaller breasts, for example, rather than removing the entire breast, properly trained breast surgeons use Skin Sparing techniques to remove all the breast tissue while preserving the nipple-areola complex as well as all of the original skin. This method effectively preserves the exterior appearance of the breast, the skin envelope. Then either an implant or a patient’s own fat can be inserted to replace the interior volume. Many times this surgical switch-out is performed in a single stage.
For women with larger breasts, Oncoplastic surgery offers a breast reduction type mastectomy. In this operation the surgeon uses the principles of breast reduction surgery to remove the breast tissue while sparing the skin and tailoring the shape into a lifted more perky breast at the same time. The inside volume of the breast is then replaced with an implant or fat tissue from the abdomen or hips.
Why do many women opt for the seemingly extreme choice of mastectomy when lumpectomy and radiation offers satisfactory treatment? Perhaps it’s because new Skin Sparing and Nipple Sparing Oncoplastic Surgery isn’t really extreme. The Breast Preservation Foundation (breastpreservation.org) offers valuable information, including links, FAQ’s and pictures that explain how skin sparing mastectomy, breast reduction mastectomy and other Oncoplastic Surgery works.
Written by Joel A. Aronowitz, MD - Clinical Professor Plastic Surgery
USC Keck School of Medicine
Cedars Sinai Medical Center
University Stem Cell Center
Disclosure: Dr. Aronowitz has never treated Guilliana Rancic
Image source of plastic surgery: Wikipedia