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Cleveland Clinic physicians have developed a new mastectomy technique that
leaves the nipple intact, allowing for a more natural-looking breast
reconstruction.
"The response that we are getting from patients to this surgery is the
most overwhelming I have seen in 25 years," says Clinic breast surgeon
Joseph Crowe, M.D., who developed the new technique.
Since January 2002, Dr. Crowe and colleague Julian Kim, M.D., in
collaboration with plastic surgeons Jillian Banbury, M.D., and Randall Yetman,
M.D., have performed nipple-sparing mastectomy in nearly 50 women.
"The nipple-sparing procedure is not for every woman with breast
cancer," Dr. Crowe is careful to qualify. The cancer must be a small tumor,
confined to one location and at least 3 to 4 centimeters away from the nipple,
he explains.
Only a small percentage of all the women who are eligible for the
nipple-sparing procedure elect mastectomy, he adds. Many women with small tumors
still prefer lumpectomy and radiation for their treatment.
Various approaches to preserving the nipple have been evaluated over the
years, but the concern has always been the risk of cancer recurrence due to the
concentration of milk ducts beneath the nipple, a site where many breast cancers
develop.
Dr. Crowe overcomes this concern by "skeletonizing" the breast, as
he describes it. "Essentially, the surgeon removes all of the breast tissue
under the nipple and areola, leaving only a thin envelope of skin," he
says.
During surgery, tissue samples are sent to pathology to be tested for cancer.
If there is any hint of disease in the area under the nipple, the nipple is
removed. If the samples are negative, the nipple and areola are left intact for
reconstruction.
The team will be presenting early results for the first series of patients to
undergo the nipple-sparing procedure at The Cleveland Clinic. Dr. Crowe notes
that the data are very encouraging, showing excellent cosmetic results with a
high rate of patient satisfaction.
To maximize the cosmetic outcome, Dr. Crowe and Dr. Kim work closely with Dr.
Yetman and Dr. Banbury in planning for reconstruction. "The mastectomy
incisions must be placed to preserve the blood supply to the nipple and areola.
Yet, the breast surgeon has to be able to remove the cancer and leave enough
skin for reconstruction," explains Dr. Banbury.
Patients can choose from several reconstruction options, including the TRAM
flap and implants. After reconstruction is complete and the breast is completely
healed, several tiny surgical scars are the only indication that the woman has
had a mastectomy.
Molly Fisher, 45, had a nipple-sparing double mastectomy at the Clinic in
January, and the cosmetic results, she says, are nothing less than remarkable.
"I wish I could tell – and show – every woman what it’s like,"
she says. "I looked in the mirror after my surgery and I couldn’t believe
what I saw. I looked normal."
Mrs. Fischer’s local doctor, who diagnosed the cancer in her right breast,
had recommended lumpectomy and radiation because the tumor was small. "But
I had always said if I ever got breast cancer, I wanted both my breasts
removed," says Mrs. Fischer.
At the urging of her father, a retired surgeon, Mr. and Mrs. Fischer made the
120-mile round trip from their home to the Cleveland Clinic to meet with Dr.
Crowe for a second opinion about her treatment.
"Dr. Crowe never tried to talk me out of my decision for a double
mastectomy," says Mrs. Fischer. "Then, when he told me about the
nipple-sparing procedure, it was a bonus. Knowing that I am both cancer-free and
look normal—I thank God for that every day."
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