Advancing Nipple-Sparing Mastectomy and Immediate Breast Reconstruction

Submitted by Stony Brook Surgery on Wed, 08/13/2014 - 07:54

<strong><font color="#990000">New Study Expands Role of Patient-Centered Treatment Option for Women with Breast Cancer</font></strong>

<P><STRONG>By <A href="/surgery/people/faculty/dr-tara-l-huston">Tara L. Huston, MD</A>, of the Stony Brook <a href="/surgery/divisions/plastic-reconstructive-surgery">Plastic and Reconstructive Surgery Division</a></STRONG></P>

<p><div class="photobox2">
<a href="/surgery/people/faculty/dr-tara-l-huston">
<img src="/sdmpubfiles/dr-tara-huston.jpg" width="150" height="211" alt="Dr. Tara L. Huston | Stony Brook Plastic Surgeon" title="Dr. Tara L. Huston | Stony Brook Plastic Surgeon" /></a>
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<div class="caption">Dr. Tara L. Huston</div></div>

<P><I>The surgical treatment of breast disease is rapidly evolving. The desire to develop treatments that are less invasive and afford a higher level of cosmesis for patients is strong. </P>

<P>One of our faculty, <a href="/surgery/people/faculty/dr-tara-l-huston">Tara L. Huston, MD</a>, assistant professor of surgery and a member of our plastic and reconstructive surgery team, just published a scientific paper detailing her study of patients who had undergone prior breast surgery to see if it was safe and feasible to perform nipple-sparing mastectomy in this group.</P>

<P>The peer-reviewed article appears online in <a href="http://journals.lww.com/annalsplasticsurgery/pages/default.aspx&quot; target="_blank">Annals of Plastic Surgery</a>, the only independent journal devoted to general plastic and reconstructive surgery. This journal serves as a forum for current scientific and clinical advances in plastic surgery.</P>

<P>Dr. Huston's work shows that patients who have scarring from prior breast surgery can successfully undergo nipple-sparing mastectomy with immediate reconstruction. Here, she explains how her findings may benefit patients who come to our <a href="http://cancer.stonybrookmedicine.edu/breast-cancer-team/">Carol M. Baldwin Breast Care Center</a>.</I><BR clear=left><BR>
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<P><B>On Long Island, one in nine women</B> will be faced with the diagnosis of breast cancer in her lifetime. The number of women undergoing <A href="http://stonybrookphysicians.staywellsolutionsonline.com/Search/92,S,P07…; target=_blank>mastectomy</a> is increasing. Fortunately, the field of plastic and reconstructive surgery has evolved dramatically over the past thirty years to keep up.</P>

<P>The trend for immediate breast reconstruction after mastectomy has grown from 10% in the 1980s to about 90% today here at Stony Brook. Most recently, our breast surgeons have adopted the technique of <a href="/surgery/blog/faqs-about-nipple-sparing-mastectomy-what-women-need-to-know">nipple-sparing mastectomy</a>, preserving the nipple-areola complex as well as all of the breast skin.</P>

<P>This is a method that we employ when both the oncologic and reconstructive surgeon believe it is safe and feasible.</P>

<P>As we have begun performing more and more nipple-sparing mastectomies with immediate reconstruction, our empowered patients here at Stony Brook continue to encourage us to expand the indications for this surgery.</P>

<P>At this time, the ideal patients for this procedure from an oncologic perspective are those undergoing risk-reducing mastectomies or those with small, well-differentiated tumors located far from the nipple.</P>

<div class="callout"><P><B>Patients with scarring from prior lumpectomy do not have a higher rate of compromised blood flow <BR> in the nipple-areolar complex, and may be considered for nipple-sparing mastectomy.</B></P></div>

<P>From a reconstructive standpoint, we find that smaller cup sizes, with minimal ptosis (drooping) and breasts which have not yet undergone radiation or surgery are the best candidates. However, with each passing year, we expand the scope of the nipple-sparing mastectomy procedure, and are able to offer this procedure to more and more women.</P>

<P>For many years, we have known that nipple-sparing mastectomy can provide superior cosmesis with a high level of patient satisfaction. Because of concerns for nipple-areolar complex survival using this technique, selection criteria can be limited.</P>

<P>In my study reported in <I>Annals of Plastic Surgery</I>, we evaluated the impact of scarring from prior <a href="http://stonybrookphysicians.staywellsolutionsonline.com/Search/92,P0778…; target="_blank">lumpectomy</a> on nipple-areolar complex viability.</P>

<P>A total of 318 nipple-sparing mastectomies were performed over a six-year period. We compared 122 breasts with prior lumpectomy incisions/scars to 196 breasts without prior surgery. All nipple-sparing mastectomies in this study were followed by implant-based reconstruction.</P>

<P>Factors analyzed included reasons for surgery, technical details of the operation, co-existing medical conditions, and whether or not additional radiation or chemotherapy was needed.</P>

<P>In this study, approximately 20% of the nipples studied had some degree of compromised blood flow. However, there was no statistically significant difference in the rates between the two groups.</P>

<P>Of all of these patients in the study, only two actually required return to the operating room for debridement; that is, removal of damaged tissue to improve the healing potential of the remaining healthy tissue. The great majority healed with conservative management consisting of dressing changes. </P>

<P>At an average follow-up of one and a half years, patient satisfaction was very high. The take-home message is that patients with scarring from prior lumpectomy do not have a higher rate of nipple-areolar complex ischemia, and may be considered for this procedure.</P>

<p><table border=1 bordercolor="#990000" cellpadding=7><tr><td>
"In carefully selected patients, [nipple-sparing mastectomy] may significantly improve the cosmetic result by allowing the breast to maintain its virtual appearance," says Dr. Huston. "Preservation of the nipple-areolar complex has important implications for the well-being of our female patients." &#182; Research has demonstrated improved psychosocial well-being, sexual function, and overall satisfaction with aesthetic outcome.
— "<a href="/surgery/blog/nipple-sparing-mastectomy-is-improving-the-care-of-patients-with-breast-cancer">Nipple-Sparing Mastectomy Is Improving the Care of Patients with Breast Cancer</a>"
</td></tr></table></p>

<P><span class="pointer"><B><a href="http://www.ncbi.nlm.nih.gov/pubmed/25003464&quot; target="_blank">Read the abstract</a> of Dr. Huston's study of
nipple-sparing mastectomy in patients with scarring from prior lumpectomy. For consultations/appointments with her, please call 631-444-4666.</B></span></P>