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Breast cancer strikes fear in women. Not only is there concern of loss of life but for women, the loss of one's breast affects their view of being complete. Depending on what type of cancer has been diagnosed and how much it has spread to surrounding tissue different surgeries will be recommended by a breast surgeon. In certain cases, women may be candidates for skin sparing mastectomy which can greatly assist in an improved appearance of their breast reconstruction.
What is Skin-Sparing Mastectomy?
During a simple or total mastectomy, the breast surgeon removes the entire breast and skin but leaves the lymph nodes and muscle tissue intact under the breast. With skin sparing mastectomy, the surgeon removes the cancerous breast tissue through a keyhole incision made around the nipple and areola. The nipple and areola are removed.
The surrounding skin remains mostly intact creating a pocket that will allow reconstruction to take place inside. Breast reconstruction takes place either by using an artificial breast implant or by inserting tissue and muscle located close by that is nourished by its own blood supply for healing.
Candidates for Skin-Sparing Mastectomy are:
1. If breast cancer has not spread into the surrounding skin.
2. If radiation treatments have not damaged skin on the breast.
3. If in the early stages of breast cancer.
4. If a lumpectomy is suggested, can be an alternative
5. For those who have a high risk of breast cancer and want preventive mastectomies performed, i.e. test positive for Brca gene changes, strong family history or already had cancer removed in the other breast.
6. If the specific type of breast cancer is non invasive and still only in the cells it began.
Reconstruction of the breast can be done either at the same time as the mastectomy surgery or can be done later as long as the skin is free of cancer involvement. However, it is most important for the skin sparing mastectomies to be performed by surgeons experienced with this technique and should be discussed with your doctor beforehand.
Skin sparing mastectomies are not believed to increase the risk of cancer recurrence though many doctors are still slow to endorse this technique. At University of Texas at the MD Anderson Cancer Center, 1,810 patients with primary breast cancer were followed from January 2000 to December 2005 to compare the incidence of local recurrence, regional reoccurrence or systemic reoccurrence of their cancer.
Sixty percent of the patients had standard mastectomies and 40 percent had skin sparing ones. More of the standard mastectomy patients had radiation and lymph node involvement. After statistically correcting for the stage of the tumors found, the researchers did not find a significant difference in the disease free survival rates of the two groups.
Women who are faced with the stress of learning they have cancer and are wondering how they will physically and emotionally put their lives back together need to obtain as much information they can. Not all breast cancer treatment will result in a mastectomy but if that is what the doctors feel is best, the breast preservation foundation has created a list of questions to ask the doctors involved in your care. Click on: www.breastpreservationfoundation.org/what-to-ask-your-surgeon
sources:
www.breastpreservationfoundation.org/faqs/
www.facs.org/surgerynews/0409onlineonly.pdf
Local-regional and distant recurrence rates after standard versus skin-sparing mastectomy
Min Yi1, Funda Meric-Bernstam1, Steven J Kronowitz2, Khazi M Nayeemuddin1, Barry W. Feig1, Rosa F. Hwang1,W. Fraser Symmans 3, Merrick I. Ross 1, Anthony Lucci1, Frederick C Ames 1, Isabelle Bedrosian1, Eva Singletary1, Henry M. Kuerer 1, Kelly K. Hunt 1. Departments of Surgical Oncology, 2Plastic Surgery, and 3Pathology, The University of Texas M. D. Anderson Cancer Center accessed at
www.posters2view.com/sabcs08/viewp.php?nu=4138
Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues. Other articles by Michele can be read at http://www.helium.com/users/487540/show_articles
Add a Comment1 Comments
Michelle - Thanks for including the link to the list of questions to ask your physician and medical team. The decision on whether or not to have a mastectomy, and everything that surrounds it, can be very emotional. Having fact-based resources available, such as your article and the questions check list, is very helpful. Take care, Pat
February 8, 2010 - 6:00pmThis Comment