Skin Sparing Mastectomy
A better understanding of the biology of breast
cancer, has led to the development of this technique. Seminal
work by the team at MD Anderson Cancer Center in the U.S., has
shown quite conclusively, that in selected patients with early
stage breast cancer, the breast can be removed through limited
incisions, leaving most, if not all, of the breast skin for reconstructive
purposes. In other words, the breast tissue can be "shelled
out" of the skin envelope through small incisions.
The advantage of this, is that the reconstructive surgeon can
fill this empty breast envelope at the same time as the mastectomy,
with either a prosthesis, or the body's own tissue, typically
the excess tummy fat. The cosmetic implications are obvious: retaining
the breast skin, allows for a better match of the opposite breast,
better positioning of the scars, better return of sensation, and
better preservation of the breast crease. The nipple and areola,
however, are routinely removed with the mastectomy specimen, but
can be reconstructed - usually at a later date. What is important
to note is that this procedure does not, in any way, negatively
effect the prognosis. The former belief that radical procedures
are neccessary to prevent recurrence has been shown to be untrue.
Immediate Reconstruction
Traditionally, patients with breast cancer have the mastectomy
soon after diagnosis. When all has settled, those who want reconstruction
are referred to a plastic surgeon - usually several months after
the mastectomy. Whilst this is a perfectly acceptable way of doing
things, it does mean another operation, with all the trauma this
entails.
We can now offer patients the choice of breast reconstrcution
at the same time as the mastectectomy. This too has been shown
to be quite safe in patients with early stage breast cancer, and
does not affect the prognosis either positively, or negatively.
Immediate reconstruction is usually done in combination with a
skin sparing mastectomy for the best results. The breast, along
with the nipple and areola are removed, and the glands in the
armpit are also resected as part of the cancer treatment. The
breast envelope can now be filled with either a silicone prosthesis,
or a TRAM flap - using the extra tummy fat to make a new breast.
So the patient is put under anaesthetic with two breasts, has
one removed, and wakes with 2 breasts, and a flat, tight tummy!
Psychologically, financially, and cosmetically superior to the
conventional 2 stage approach.
Breast reconstruction is covered by most medical aids, although
it may occassionally require motivation.
If you have any questions about this, feel free to email
me
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