When breast cancer is detected and the recommendation is a mastectomy—more than 100,000 women in the U.S. undergo some form of this surgery each year— women have a few different options for reconstruction if they prefer to go that route. According to the Dana-Farber Cancer Institute, recent statistics show that 40 to 50 percent of women who undergo mastectomies have some form of breast reconstruction.
After choosing to have a preventive double mastectomy, Rose says finding comprehensive information on breast reconstruction was the most challenging part of the process. “I felt like I needed a PhD in Google to find all of my available options, and that was unacceptable to me,” she explains. After recovering from surgery, Rose threw herself into research and ultimately created her nonprofit, The Previvor Foundation, which, like AiRS, provides resources to women in need.
Nowadays, thanks to brilliant surgical minds and modern technological advancements, there are many options for breast reconstruction, including implants placed directly after mastectomy, fat grafting and free flaps. However, San Jose, CA plastic surgeon Kirk A. Churukian, MD says the greatest innovation so far has to be the nipple-sparing mastectomy (cancerous tissue can be removed from the breasts while leaving the nipples intact).
“Typically, the most challenging aspect of a reconstruction surgery is trying to recreate the nipple-areolar segment of the breast, or the ‘top of the cone,’” he explains. “With this newer technique, we are able to preserve the contour and shape of the breast without having to expand the breast significantly, though it’s not a fit for everyone.”
Cutting-Edge Approach
Beverly Hills, CA plastic surgeon Lisa Cassileth, MD has made it her mission to make breast reconstruction after a nipple-sparing mastectomy even better. “Despite the fact that more people are doing nipple-sparing, direct-to-implant reconstruction, there’s still a big population of patients who aren’t good candidates for this surgery,” she says. “They may be high-risk due to health issues and can’t withstand a long procedure, or they may just not want implants.”
Earlier this year, Dr. Cassileth published an innovative technique called SWIM (skin-sparing wise-pattern internal mammary perforator) in the Journal of American College of Surgeons. The surgery combines a wise-pattern breast reduction with a nipple-sparing mastectomy. “We fold the post-mastectomy skin and subcutaneous fat into itself to create new breasts—generally an A or B cup, depending on how much usable skin there is; not everyone is a candidate—while maintaining blood flow to the nipples,” she explains. “Many patients want more options, but they don’t know SWIM exists because it’s a relatively new idea.”
Although many of Dr. Cassileth’s patients are high-risk BRCA-positive (in the 80th percentile for getting breast cancer) and have the time to research how they want their reconstruction done, she also works with non-BRCA patients who want new breasts without implants or a flap. “This is a great opportunity for those who otherwise may not have had a reconstruction at all,” she says, noting that the recovery is very similar to that of a mastectomy. Patients can expect to feel sore for about a week, and can return to full activity over the next couple of weeks.
