Skin-Sparing Mastectomy and Immediate Breast Reconstruction

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Many women would agree—in no instance is it more important to become an informed self-advocate than in the case of a breast cancer diagnosis. First, there’s a confusing array of choices in dealing with the cancer, adding up to a steep learning curve at a time of great distress. Then, when it comes to reconstruction, there’s another set of options to understand. Unfortunately, according to information published by the American Society of Plastic Surgeons (ASPS) just last year, almost 70 percent of women who could be candidates for reconstruction aren’t informed of their choices by their primary physician (American Society of Plastic Surgeons 1).

Is this problem related to health care “silos”? Yes, partially. Hence the ASPS’s urge for a team approach to breast cancer so women can learn about their choices prior to cancer surgery. Is it related to the fact that there are still many more male surgeons than female (Freishlag 1)? Perhaps. Whatever the reasons, immediate reconstruction following a skin-sparing mastectomy is an option that should be discussed more often.

Immediate breast reconstruction—reconstruction performed directly after mastectomy surgery —isn’t new. Traditionally, however, surgical options have primarily been:

• Implant placement, if enough tissue remains to cover the implant
• Tissue expander, if tight skin needs to stretch prior to implant placement
• Tissue flaps relocated from the abdomen, back, buttocks or thighs
(American Cancer Society 1)

A study published by Dr. Christopher Crisera and colleagues from the University of California, Los Angeles in April of this year may help to spread the word. The UCLA researchers studied the results of 35 women who had received a silicone gel implant (or implants) immediately following their cancer surgery. The surgeons rated the aesthetic results as “good to excellent” (American Society of Plastic Surgeons 2).

The key to the procedure is the skin-sparing mastectomy (SSM) technique. According to the Breast Preservation Foundation, the approach uses a small incision near the areola, through which the cancerous tissue is removed. The cancer surgeon creates a natural envelope for an implant by leaving most of the breast skin intact. Not only does a breast reconstructed this way look more natural, the Breast Preservation Foundation said that women who opt for SSM have the same risk of recurrence as women choosing traditional mastectomy (Breast Preservation Foundation 1).

A more aesthetically pleasing result isn’t the only benefit of SSM and immediate implant placement, according to Dr. Crisera. Obviously, it can be psychologically advantageous for a breast cancer patient to emerge from surgery never having to experience life without one or both breasts. In addition, when opting for immediate reconstruction, a woman can avoid the additional cost and risk associated with further surgery.

If someone you know is facing a breast cancer diagnosis, you owe it to her to make sure she knows about one surgical option that may be available—immediate breast reconstruction following a skin-sparing mastectomy.

Resources:

American Society of Plastic Surgeons. Plastic Surgeons, Breast Surgeons Urge Team Approach, Breast Cancer Survivors, Physicians, Advocacy Groups, Medical Societies, Manufacturers, Press Cite Vastly Improved Quality of Life for Patients. Thousands of Member Surgeons, One High Standard. May 20, 2010, Web. June 1, 2011. http://www.plasticsurgery.org/News-and-Resources/Press-Release-Archives/2010-Press-Release-Archives/Plastic-Surgeons-Breast-Surgeons-Urge-Team-Approach.html

Freishlag, Julie A. M.D. “Women Surgeons, Still in a Male-Dominated World.” Yale Journal of Biology and Medicine. December, 2008. Web. June 1, 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605307/

American Cancer Society. Breast Reconstruction After Mastectomy, Types of Breast Reconstruction. American Cancer Society. Web. June 1, 2011. http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastReconstructionAfterMastectomy/breast-reconstruction-after-mastectomy-types-of-br-recon

American Society of Plastic Surgeons. Immediate Implant Replacement Provides New Option for Reconstruction After Mastectomy. Thousands of Member Surgeons, One High Standard. April 11, 2011. Web. June 1, 2011.
http://www.plasticsurgery.org/News-and-Resources/Press-Release-Archives/2011-Press-Release-Archives/Immediate-Implant-Replacement-Provides-New-Option-for-Reconstruction-After-Mastectomy.html

Breast Preservation Foundation. Skin-Sparing Mastectomy, What is Skin-Sparing Mastectomy (SSM)? Breast Preservation Foundation. Web. June 1, 2011. http://www.breastpreservationfoundation.org/skin-sparing-mastectomy/

Reviewed June 13, 2011
Edited by Kate Kunkel

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.