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KNOW YOUR BREAST CANCER SURGERY OPTIONS

Sources:1 American Cancer Society2 Cancer, February, 2008, Amy Alderman, MD

BREAST CANCER FACTS Breast cancer is the second most common cancer among American women. About 1 in 8 (12%) women in the U.S. will develop invasive breast cancer during her lifetime.1 The majority of these cancers will be surgically treated.

BREASTCANCERSURGERY.COM IS DESIGNED TO EDUCATE YOU ON YOUR BREAST CANCER SURGICAL OPTIONS IN A COMPREHENSIVE AND UNDERSTANDABLE FORMAT.

7 out of 10 newly diagnosed breast cancer patients are never told their breast reconstruction options2

WHAT ARE MY SURGICAL OPTIONS?Take action and learn about the surgical options you have available from breast conserving surgery to mastectomy including Hidden Scar™ Breast Conserving Surgery and Hidden Scar™ Nipple Sparing Mastectomy.

BREASTCANCERSURGERY.COM IS DESIGNED TO EDUCATE YOU ON YOUR BREAST CANCER SURGICAL OPTIONS IN A COMPREHENSIVE AND UNDERSTANDABLE FORMAT.

HIDDEN SCAR™ NIPPLE SPARING MASTECTOMYAn advanced surgical approach using an inframammary fold incision (the natural crease beneath the breast) that removes the underlying breast tissue while preserving the nipple-areolar complex and breast skin.

HIDDEN SCAR™ BREAST CONSERVING SURGERY (LUMPECTOMY)An advanced approach that removes the tumor along with a small portion of the surrounding healthy tissue (margin), while preserving the majority of the breast, through a single incision hidden in one of three places.

NIPPLE SPARING MASTECTOMYA technique for mastectomy that removes the entire contents of the breast through a single incision on the outer side of the breast or in the inframammary fold (the natural crease beneath the breast), while preserving all of the breast skin in addition to the nipple-areolar complex.

SKIN SPARING MASTECTOMYA technique for mastectomy that removes the entire contents of the breast through a single incision around the areola while preserving all of the breast skin except the nipple-areolar complex.

WHAT ARE MY SURGICAL OPTIONS?

BREAST CONSERVING SURGERY (LUMPECTOMY)A breast conserving surgery (often referred to as a lumpectomy or partial mastectomy) removes only the tumor and a small area of surrounding healthy breast tissue but saves the majority of the breast, including the nipple area.

MASTECTOMY A simple mastectomy (or referred to as a total mastectomy) removes the breast tissue along with the majority of the breast skin and the nipple areola complex.

BREAST RECONSTRUCTIVE SURGERYBreast reconstruction surgery is typically performed after a mastectomy – either at the time of the cancer surgery or at a later date. Typically performed by a plastic surgeon, breast reconstruction may utilize either implants or autologous (uses your own body fat and/or muscle from the back or abdomen) reconstruction to achieve optimal aesthetic results.

black dashed lines = incision location

red shaded area within red dashed lines = tissue removed

Hidden Scar Breast Cancer Surgery is an advanced approach in which breast surgeons remove cancerous tissue through a single incision made in inconspicuous areas to minimize visible scarring. By utilizing this approach, surgeons are able to preserve a natural-looking breast by sparing the nipple, areola and surrounding tissue. The Hidden Scar approach may also ease the emotional impact of breast cancer surgery, in that patients have little to no visible reminder of the surgery, and experience a more natural looking breast reconstruction. Patients who undergo this approach are also at no higher risk of recurrence than patients who undergo any other type of technique.

Hidden Scar Breast Cancer Surgery may be appropriate for a wide range of breast cancer patients undergoing nipple sparing mastectomy or breast conserving (lumpectomy) procedures. Qualification depends on a patient’s tumor size and location, breast shape and size, and your surgeon’s training. Ask your surgeon if you are candidate for one of the below surgical options.

Hidden Scar™ Nipple Sparing Mastectomy Clinical Incision

Hidden Scar™ Breast Conserving Surgery (Lumpectomy)

Clinical Incision

Hidden Scar™ Surgery

HIDDEN SCAR™ NIPPLE SPARING MASTECTOMYHidden Scar Nipple Sparing Mastectomy is an advanced surgical approach that removes the underlying breast tissue while preserving the nipple-areolar complex and breast skin. The inframammary fold incision (the natural crease beneath the breast) is the preferred incision location for breast and plastic surgeons due to its ability to hide any scar. This safe approach can be utilized in patients seeking prophylactic mastectomy (prevention because of a strong family history or carriers of the BRCA gene), in women with DCIS (non-invasive cancer), or small tumors that do not lie directly beneath the nipple. These patients normally have relatively small to medium-sized breasts (A to C cups) without significant excess skin or ptosis (breast sagging).

HIDDEN SCAR™ BREAST CONSERVING SURGERY (LUMPECTOMY)Hidden Scar Breast Conserving Surgery or Lumpectomy is an advanced approach that removes the tumor along with a small portion of the surrounding healthy tissue (margin), while preserving the majority of the breast, through a single incision hidden in one of three places:

• inframammary fold (the natural crease beneath the breast)• along the areola border• axilla (armpit)

Hidden Scar Lumpectomy uses oncoplastic techniques to fill the void created at the site of tumor and margin removal, while leaving the patient with a more natural shape and contour of the breast.

You may be considered for a Hidden Scar Lumpectomy if the size of the cancer is small enough relative to the size of the breast, and if the cancer is confined to one specific area in the breast. The most important criteria for this approach is that the size of the tumor will allow for its complete removal with some margin of normal tissue all the way around the tumor.

Skin and Nipple Sparing Mastectomy

Skin Sparing and Nipple Sparing Mastectomy procedures are performed through small incisions to achieve optimal aesthetic results. A Nipple Sparing Mastectomy allows for complete removal of the breast tissue while keeping both the skin and the nipple-areolar complex intact. Alternatively, a Skin Sparing Mastectomy allows the surgeon to remove all of the breast tissue and the nipple-areolar complex while keeping the skin intact. Preservation of the nipple and areola depends upon your diagnosis and the size and location of the tumor. Breast reconstruction surgery is typically performed after any type of mastectomy for an optimal aesthetic outcome.

As newer, more advanced surgical approaches are now being performed that provide effective oncologic results along with optimal breast aesthetics, more women are opting for a mastectomy instead of breast conserving surgery as the primary surgical treatment for breast cancer. Ask your surgeon if you are a candidate for one of these surgical options that can result in a more natural looking aesthetic outcome.

Nipple Sparing Mastectomy Clinical Incision

NIPPLE SPARING MASTECTOMYNipple Sparing Mastectomy is an advanced technique for mastectomy that removes the entire contents of the breast through a single incision on the outer side of the breast or in the inframammary fold (the natural crease beneath the breast), while preserving all of the breast skin in addition to the nipple-areolar complex. By preserving both the skin and nipple-areolar complex, this approach can provide patients with a more natural looking outcome.

Nipple Sparing Mastectomy is typically performed on women with tumors that are not near the nipple-areola complex.

SKIN SPARING MASTECTOMYSkin Sparing Mastectomy is a technique for mastectomy that removes the entire contents of the breast through a single incision around the areola while preserving all of the breast skin except the nipple-areolar complex. The skin is preserved for reconstruction of the breasts with either an implant or autologous tissue (taken from another location on the body). A nipple can either be reconstructed or tattooed later to achieve a more natural looking outcome.

Skin Sparing Mastectomy Clinical Incision

Breast Conserving Surgery (Lumpectomy)

A breast conserving surgery (often referred to as a lumpectomy or partial mastectomy) removes only the tumor and a small area of surrounding healthy breast tissue but saves the majority of the breast, including the nipple area.

A woman may be considered for a lumpectomy if the size of the cancer is small enough relative to the size of the breast and if the cancer is confined to one specific area in the breast. The most important criteria for a lumpectomy is that the size of the tumor will allow its complete removal with some margin of normal tissue all the way around the tumor, while leaving the patient with a cosmetically acceptable breast. With newer techniques, referred to as oncoplastic procedures, the surgical team may be able to improve the aesthetic appearance of the breast after a lumpectomy by choosing the incision size and location that makes it easier to mobilize breast tissue in such a way that remaining normal breast tissue fills the void created at the site of the lumpectomy.

In addition, when a lumpectomy is performed for invasive cancers, some form of axillary lymph node surgery is almost always appropriate. For less invasive cancers, lymph nodes may or may not be sampled.

Breast Conserving Surgery (Lumpectomy) Clinical Incision

RADIATION TREATMENTSAs the standard of care, for a woman choosing a lumpectomy, radiation treatments to the breast will almost always be required. In some older patients radiation, at times, can be avoided. When radiation is required, it is usually given daily as a whole breast radiation, and requires a treatment plan that will last approximately six weeks. For some women, newer radiation techniques will allow her to undergo partial breast radiation, which can shorten the radiation time to five days. At select centers, a single radiation treatment may be offered at the time of the lumpectomy. Thus, it is important for a woman to ask their surgeons about these choices and determine the options available and that best suits her clinical situation.

CONSIDERATIONS FOR LUMPECTOMYBetween 10 and 40 percent of the time, when the pathologist looks at the lumpectomy specimen, there will be an area where cancer cells are seen at the edge of the lumpectomy, raising the possibility that cancer cells may still be left in the breast. In this case, a repeat surgery will be offered to the patient in order to remove more tissue and get the required clean margins. This piece of information is crucial for the patient to understand before she makes a choice of a lumpectomy instead of a mastectomy as this re-operation rate may, for some women, cause her to choose mastectomy.

After a lumpectomy, recurrences of the cancer occur in the first one to five years at the lumpectomy site in approximately three to five percent of patients. Occurrences elsewhere in the breast, not at the site of the original cancer, usually occurs approximately eight or more years after the surgery and are believed to be new cancers and not recurrences. In almost all instances of breast cancer recurrence, particularly for those patients who have had radiation treatments to the breast, mastectomy will be required.

Mastectomy

Mastectomy is defined as surgical removal of the breast tissue. A simple mastectomy (or referred to as a total mastectomy) removes the breast tissue along with the majority of the breast skin and the nipple areola complex. When the breast cancer is more extensive or the tumor size is out of proportion to the breast size, a mastectomy may be a better surgical option compared to breast conserving surgery (lumpectomy).

Mastectomy Clinical Incision

MASTECTOMY VS. BREAST CONSERVING SURGERYIt may also be a personal choice to select mastectomy over breast conserving surgery. Even if the tumor size and location makes the patient a candidate for breast conserving surgery, other factors may cause you to choose mastectomy over breast conserving surgery. All cancers can be treated with mastectomy. The question is whether the patient can consider breast conserving surgery or for other reasons, chooses to have a mastectomy.

Additionally, many patients do not want to go through the potentially stressful time each year when they have mammograms. Worrying about that is often a legitimate reason for any patient to opt for mastectomy over breast conserving surgery. In fact, many patients will also choose to have a prophylactic mastectomy on the non-cancer side for the same reasons.

Patients who are known to carry one of the BRCA mutations may have a higher risk of local breast recurrences after breast conserving surgery, and have an increased incidence of a second cancer in the other breast during their lifetime; therefore these patients may choose mastectomy.

AESTHETIC ALTERNATIVES TO SIMPLE (TOTAL) MASTECTOMYWhen mastectomy is the required treatment for breast cancer, or chosen by the patient who has the option of either breast conserving surgery or mastectomy, the patient may be a candidate for what is called a Skin Sparing Mastectomy, Nipple Sparing Mastectomy, or even a Hidden Scar™ Nipple Sparing Mastectomy. If a patient is a candidate, these less invasive operations can be performed without sacrificing recurrence or survival rates. Ask your surgeon if you are a candidate for one of these surgical options that can result in a more natural looking aesthetic outcome.

BREAST RECONSTRUCTION SURGERY MAY UTILIZE EITHER IMPLANTS OR AUTOLOGOUS TISSUE.Breast reconstruction surgery is typically performed after a mastectomy – either at the time of the cancer surgery or at a later date. Typically performed by a plastic surgeon, breast reconstruction may utilize either implants or autologous (uses your own body fat and/or muscle from the back or abdomen) reconstruction to achieve optimal aesthetic results.

IMPLANTS SALINEThese implants are filled with sterile saline (salt water) therefore causing no side effects to the body if a leak occurs. However, if the implant ruptures it will deflate within a few hours. Replacement is necessary.

SILICONEThese implants are filled with a thick silicone substance that feels very similar to natural breast tissue. If a rupture occurs, it may go undetected for several years. Once detected, replacement is necessary.

TISSUE EXPANDERA common breast reconstruction technique is tissue expansion, which involves expansion of the breast skin and muscle using a temporary tissue expander to make room for the permanent breast implant. At the same time the mastectomy is done by your breast surgeon, the plastic and reconstructive surgeon will insert a tissue expander beneath your skin and chest muscle. The expander will gradually be filled over several weeks or months to obtain the desired size. A few months later, the expander is removed and the patient receives a permanent breast implant. This type of breast reconstruction requires two separate procedures and the permanent implant can be placed during an outpatient procedure.

TISSUE EXPANDER

DIEP (deep inferior epigastric perforator)

SIEA(superficial inferior epigastric artery)

AUTOLOGOUS BREAST RECONSTRUCTION OPTIONS

ABDOMENDIEP (DEEP INFERIOR EPIGASTRIC PERFORATOR) SIEA (SUPERFICIAL INFERIOR EPIGASTRIC ARTERY)This procedure uses abdominal tissue but no muscle. The fat, with local blood supply, is used. It is also possible to include nerves with the tissue to restore the sensation to the breast when it is reattached. Because there is no transfer of muscle, the structural integrity of the abdomen is maintained.

LD(latissimus dorsi)

BACKLD (LATISSIMUS DORSI)This is the back muscle which is used with an eye-shaped piece of skin and fat. The blood supply is left in place (pedicle flap), and the skin, fat and muscle are tunneled to the breast and attached. In most cases an implant may also be required for the desired results.

Not only do I not have to look at scars that make me feel embarrassed, but my husband can look at me and not even notice that I had surgery.

ALYSSA MCCREA WASHINGTON, DC

HIDDEN SCAR NIPPLE SPARING MASTECTOMY

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