Preserving body image and self-confidence
For women diagnosed with breast cancer, the overarching goal has always been a cure. Now, for women facing breast surgery, the emphasis has become twofold: Treat the cancer and leave the patient looking as natural and complete as possible. “In guiding patients from diagnosis through surgery, we have to make oncologically sound decisions, and we are able to achieve really beautiful cosmetic outcomes, whether preserving a breast or removing a breast with immediate reconstruction,” says Leah Gendler, MD, medical director of breast surgery for Morristown Medical Center.
Adds Rebecca Yang, MD, medical director of breast surgery for Overlook Medical Center, “Years ago, the thought was that we should remove the cancer and be thankful that the cancer is out. We take a multidisciplinary approach and work closely with oncologists and plastic surgeons to provide coordinated care so patients achieve the best possible outcomes.”
Dana Holwitt, MD, breast surgeon for Morristown Medical Center, a breast cancer survivor herself who was diagnosed in 2009 and had reconstructive surgery, explains, “It is so important for women who are facing a diagnosis of breast cancer to be able to look in the mirror and feel whole after they have finished active treatment. Restoring feminine identity can be a huge stumbling block in the survivorship process, so it is vital, as breast surgeons, to have that discussion at diagnosis. It is a huge part of the healing process. Our role as breast surgeons is to explore all surgical options available to our patients, including reconstruction. We have to think about survivorship and reclaiming feminine identity because newly diagnosed patients typically are not able to process beyond their diagnosis initially.”
With oncoplastic surgery, form meets function; doctors take a cosmetic approach to deliver the most beautiful result in conjunction with the best outcome. There are many ways to achieve this, and many factors to consider. Among them: Where is the cancer located? What is the size and stage of the cancer? Is the patient at increased risk for a future breast cancer? How much surgery does she want? “It’s like piecing together a puzzle that is unique to every patient,” says Dr. Gendler. “We get to know each woman and understand her relationship with her body. Each patient ends up with a personalized plan tailored to her unique situation.”
Whether that plan calls for a mastectomy or, as in most cases, a lumpectomy, there are ways to preserve or even improve the appearance of the breast. Scars can be hidden in “secretive” places, like the inframammary fold (where the breast naturally meets the chest wall), the crease of the armpit or the circumference of the areola. With “hidden scar surgery,” surgeons use special retractors – long, lighted instruments – that provide appropriate visualization and enable surgeons to remove the cancer with an improved rate of clean margins. “Surgery is then safer for the patient, with fewer complications,” says Dr. Gendler. “With mastectomy, we’re able to leave behind healthy, well-vascularized skin flaps, ready to cover the reconstructed breasts and heal with fewer complications.” Also available is BioZorbTM, a special spiral implant that dissolves over time but helps to support the breast while it heals, providing a scaffold for scar tissue, and prevents the skin from collapsing into the lumpectomy bed.
Although cancer is usually confined to one breast, a matching surgery can be done on the opposite side to enhance cosmetic outcomes, explains Margaret Sacco, MD, medical director of breast surgery for Chilton Medical Center. For example, a lumpectomy may be combined with a bilateral reduction (especially for women who have larger breasts and have always wanted a reduction), or a plastic surgeon may insert implants to achieve a symmetrical result. “There are so many different ways to approach breast surgery,” says Dr. Sacco.
“Women need to pursue all options, and all options should be explained.” Adds Dr. Gendler, “As we better understand the biology of cancer, our expectation is that most of our patients are going to be living long, healthy lives. We want them to feel good about their bodies – proud and confident, and ready to embrace life after breast cancer.”
Atlantic Breast Associates is part of Atlantic Medical Group and Atlantic Health System Cancer Care. The physicians of the Atlantic Breast Associates medical team – Marcella Fornari, DO; Leah Gendler, MD; Dana Holwitt, MD; Margaret Sacco, MD; and Rebecca Yang, MD – are fellowship-trained, board-certified surgeons who specialize exclusively in breast surgery.