New Technique Helps Avoid Mastectomies

New treatments are being developed every day for cancer. For years, many women with breast cancer have required mastectomies (the surgical removal of the entire breast) to rid their breast of disease. Many women subsequently undergo breast reconstruction to cosmetically restore the breast. Reconstruction often means moving muscle and skin from other parts of the body--extensive surgery that is physically and emotionally challenging.

Oncoplastic Surgery
By combining oncology surgery and plastic surgery together in one procedure, UW surgeons now offer many women an alternative to mastectomy called oncoplastic surgery.

"This technique achieves a superior cosmetic result compared to a standard lumpectomy for carefully selected patients," says Dr. Benjamin Anderson, UW associate professor of surgery, and clinical medical director of the UW Breast Care and Cancer Research Program.

Cancers tend to develop in segments of the breast along the milk ducts. Removing large regions with a lumpectomy would be esthetically unacceptable, forcing the surgeon to recommend mastectomy.

Generally, plastic surgeons have a different goal than cancer surgeons. They reduce, augment, and reshape the breast to improve its cosmetic appearance using incisions that are designed to be hidden.

Oncoplastic surgeons use the best of both surgeries. A patient receives a customized operation to remove the cancer and restore the breasts natural shape and appearance, even with large tumors.

Donut mastopexy
"The donut mastopexy lumpectomy, originally used for breast reductions, allows us to remove an entire segment of the breast through an incision at the edge of the areola," says Dr. Anderson. "The final scar circles the areola and is virtually hidden."

The "donut" refers to the shape of skin removed from around the areola. The surgeon separates the overlying skin from the healthy breast tissue to fully expose the breast gland. The cancerous segments are then excised (removed). The surgeon then shifts the remaining healthy tissue on the chest wall to "remold" the breast and the ring of skin around the nipple is pulled together with a purse-string suture (similar to what a drawstring does), leaving a tiny scar that is deftly hidden around the nipple.

"We have performed this new procedure on 15 women thus far with cosmetically excellent results," says Dr. Anderson. If necessary, a breast reduction on the other side can restore symmetry.

Donut mastopexy lumpectomies are not often performed in the U.S., but are being increasingly looked at as a good potential alternative to mastectomy. (This operation is not useful for all breast cancer surgeries.) To see this story on the Web, please go to www.uwbreastcare.com/mastopexy.shtml.

If you have questions about breast health, please contact: The Breast Health Clinic, (206) 598-5500.
The Breast Cancer Specialty Center(part of the new Seattle Cancer Care Alliance), (206) 288-2166 or www.uwbreastcare.org.

Women's Cancer Genetics & Risk Reduction Clinic, 206-288-2166.