Many Patients Are Not Receiving Advanced Breast Conserving Surgical Techniques

Ruzanna Harutyunyan's picture
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New surgical techniques have dramatically improved the aesthetic results of mastectomy without sacrificing outcomes. Properly placed incisions and skin-sparing, or breast skin conserving, surgical approaches provide women undergoing biopsy and surgical treatment for breast cancer with the best option for appropriate cancer eradication while still permitting reconstruction of a more natural looking breast. Yet, according to a recent study, one third of California board-certified breast surgeons surveyed still regularly use the archaic practice of cutting across the whole breast when performing a mastectomy, resulting in unnecessarily disfiguring scars.

A skin-sparing operation removes cancerous breast tissue by using the same minimal and judiciously placed incisions used by plastic surgeons for elective breast surgery. The most common approach is to use a simple, small, circular incision around the edge of the nipple area. The surgeon leaves all or most of the overlying breast skin, preserving the natural skin envelope that can be filled with an implant or with a patient's own fat tissue from another part of the body. This skin-sparing technique is appropriate for women whose breast cancer does not invade the skin of the breast.

In the study, recently presented at the American College of Surgeons meeting and published in the October 2008 issue of The American Surgeon, the researchers surveyed California board-certified general surgeons who perform breast cancer surgery. The majority of the 414 surgeons who responded to the study agreed that a skin-sparing mastectomy does not result in a higher risk of cancer recurrence, and three-quarters recognized that the cosmetic results of a skin-sparing operation were better than a standard mastectomy. Despite this, fewer than two-thirds said they perform a skin-sparing mastectomy in most cases when immediate breast reconstruction is planned.

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"This finding is important because it shows that women with breast cancer are treated appropriately for the cancer, but many woman are unnecessarily left with highly visible scars and poor breast shape after surgery," said Joel Aronowitz, M.D., senior author of the study and the Clinical Chief of the Plastic Surgery Division at Cedars-Sinai Medical Center in Los Angeles. "We have a well developed body of literature demonstrating uncompromised, highly effective treatment of the malignancy over the long-term, and more aesthetically pleasing results with skin-sparing mastectomy, yet there remains significant variation in practice patterns among general surgeons treating breast cancer.

"Part of the problem is that amidst the shock and anxiety of a breast cancer diagnosis, many women and some physicians consider the appearance of the breasts of secondary importance and not worthy of serious consideration compared to the treatment of cancer. Natural looking breasts help restore a women's sense of wholeness and aid in the healing process."

Aronowitz and his co-authors concluded that additional education regarding skin-sparing mastectomy is needed among the general surgery community to increase utilization of breast skin conserving approaches and use of plastic surgery principles for placement of incisions for biopsy and mastectomy procedures. Their hope is that increased use of these modern, reconstructive surgery concepts will result in a decreased use of standard, centuries old "cut across the chest" incisions.

"Breast cancer patients should be assertive with their doctors to ensure that the most modern aesthetic techniques and principles are applied with the same rigor as is given to the treatment of their cancer," Aronowitz said.

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