Breast Cancer Surgery
ALL THE OPTIONS,
ALL THE SPECIALISTS,
ALL IN ONE PLACE
Breast cancer surgery—mastectomy in particular—was once assumed to be permanently disfiguring. Not anymore. Through recent advances in reconstructive surgery, that fear is now largely unfounded. In fact, many women undergoing breast reconstruction today achieve results that are on par with elective cosmetic surgery. Those same patients also have more choices at Virginia Hospital Center, which offers every available form of breast reconstruction surgery through its Reinsch Pierce Family Center for Breast Health. “Breast reconstruction has changed dramatically in recent years,” says dedicated breast surgeon Stephanie Akbari, MD, FACS. “Many women still associate disfigurement with breast cancer, recalling the radical mastectomies of 35 years ago, but it no longer has to end with a debilitating deformity. Once patients see pictures of the latest procedures and realize the sophistication of today’s approaches, they feel better. We can do lifts for symmetry. We can do augmentation. And if a mastectomy is required, we can often save the skin and sometimes even the nipple. Obviously the priority is to eradicate the cancer, but the bar is now set much higher for cosmetic outcomes.” Upon receiving a cancer diagnosis, a woman’s first step is to discuss treatment options, which usually starts with her breast surgeon and plastic surgeon. Choosing the right approach will depend on breast size, the size and location of the tumor, body type, and other mitigating health risks.
LUMPECTOMY AND RADIATION
Patients whose cancers are small may opt for lumpectomy, a breast conserving surgical approach that removes only the tumor and a margin of tissue around it. This option is usually coupled with post-operative radiation therapy. In some cases, the cosmetic outcome can be enhanced by oncoplastic breast surgery, a procedure in which breast tissue is redistributed following lumpectomy to avoid creating a cavity. The major benefit in this scenario is that much of the patient’s natural breast tissue is preserved. Although it’s a fairly common practice in Europe, Dr. Akbari is the only breast surgeon in the greater Washington, DC region with advanced training in this specialized approach.
MASTECTOMY AND RECONSTRUCTION
Some patients may require a mastectomy followed by breast reconstruction. Virginia Hospital Center offers a variety of plastic surgery options for mastectomy patients that fall into two categories. One approach uses the patient’s own tissue to create a new breast. The other recreates breasts with either silicone or saline implants. “Today, women have many options when it comes to breast reconstruction. We spend a great deal of time educating our patients about all of their possible options and then facilitate the one that is best for them,” notes plastic surgeon Mazen Bedri, MD. Dr. Bedri received his medical degree and advanced training in plastic surgery from The Johns Hopkins University School of Medicine, followed by an advanced fellowship in breast reconstruction and aesthetic surgery at Mercy Medical Center in Baltimore.
This procedure uses the patient’s own tissue to create a new breast and can sometimes be done at the same time as the mastectomy. Flap options include the DIEP (deep inferior epigastric perforator) or SEIA (superficial epigastric inferior artery) which uses abdominal tissue to create a new breast. Other flap options include using tissue from the back, buttocks or inner thigh, or the TRAM (transverse rectus abdominus myocutaneous) flap.
Implant-based reconstruction poses another option for mastectomy patients. Both silicone and saline implants offer patients a safe alternative for breast reconstruction. Discussions with a plastic surgeon will help the breast cancer patient reach a tailored and individualized approach that is best for her.
WEIGHING PROS AND CONS
Every breast cancer scenario is unique and personal, and not all options are appropriate for all patients. Factors in the decision making process include details of the cancer, the potential need for radiation therapy, a patient's body composition, medical problems and recovery time. A woman who is very thin may not be a candidate for flap reconstruction because there is no tissue to move. Some patients need to return to work and can’t afford a six week recuperation time. Individuals with other mitigating health risks may not be able to tolerate lengthy surgeries. “Breast cancer treatment is not one size fits all,” says Dr. Akbari. “Everyone has a different tumor location, breast size and body type, and these must be taken into consideration. We spend a lot of time educating patients so they can make the best choices for themselves.”
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