Breast Cancer Recurrence Rates Low with Nipple-Sparing Mastectomy
A recent study published in Plastic and Reconstructive Surgery confirms that nipple-sparing mastectomy (NSM) is a very safe procedure when performed in appropriate patients. Preserving the nipple-areola complex at the time of a mastectomy is associated with a very low risk of recurrence, just over 3%.
“Nipple-sparing mastectomy remains a viable option in the appropriately indicated patient with regards to long-term cancer recurrence,” state the researchers.
What is a Nipple Sparing Mastectomy?
A nipple-sparing mastectomy (NSM) preserves the nipple and areola along with the entire skin envelope. Only the underlying breast glandular tissue is removed. Nipple-sparing mastectomy significantly improves cosmetic results when combined with immediate breast reconstruction and is oncologically safe when performed in appropriate candidates. It can also improve the return of sensation in some patients.
The Research Behind the Study
120 patients undergoing nipple-sparing mastectomy for breast cancer treatment were evaluated for breast cancer outcomes. The analysis included a total of 126 therapeutic NSM procedures. Prophylactic (preventive) NSM procedures to reduce the risk of breast cancer in women at high genetic risk were excluded.
At a median follow-up of 10 years after NSM, the analysis showed a very low risk of recurrent cancer: 3.33% per patient and 3.17% per reconstructed breast. Of the four patients who developed a recurrence, two had local recurrences (breast-only) and two had cancer spread beyo0nd their breast (locoregional recurrence).
The recurrence risk was higher in women who’s initial cancer involved the lymph nodes. However, there were no demographic, surgical, or tumor-related variables that predicted the risk of recurrent breast cancer.
Reassuring Findings but Surveillance Still Important
The confirmation of favorable long-term cancer control is crucial because of the increased use of NSM and immediate reconstruction in women with breast cancer. “Patients with nipple-sparing mastectomies have had low locoregional recurrence rates in a retrospective review of patients with a median follow-up of 10 years,” researchers conclude. “Despite low rates of recurrence, close surveillance remains important to continually assess for long-term safety of nipple-sparing mastectomy.”
To learn more about Nipple-Sparing Mastectomy, download the FREE Breast Advocate App today!
Why All Breast Cancer Patients Should Be Offered Rapid Genetic Testing at Time of Diagnosis
A breast cancer diagnosis brings with it a need for many different treatment decisions. One of the first decisions to consider, is which operation to have to remove the tumor. Surgical options include a lumpectomy, oncoplastic surgery, a mastectomy, or even a bilateral mastectomy (removal of bth the cancer breast and healthy breast). Many women, particularly in the US, often find themselves trying to decide between the least invasive approach, a lumpectomy, or the most aggressive, a bilateral mastectomy with or without breast reconstruction.
Factors such as tumor size, breast size, the location of the tumor, and the type of breast cancer can greatly impact which surgery is recommended. Patients should be given all options and discuss the pros and cons of each procedure with their healthcare team to determine which treatment plan best serves their individual needs.
Bilateral Mastectomy Recommended for Patients at High Risk Due to Genetic Mutation
For patients with a genetic mutation (such as a BRCA1 or BRCA2 mutation), who have a much higher risk for developing cancer in the future, the removal of both breasts is usually recommended as it significantly reduces the risk of another breast cancer in the future. Patients can of course opt to save their healthy breast and instead have close follow up including 6-monthly MRIs, and can also take risk-reducing medication like Tamoxifen.
However, not all patients undergo genetic testing prior to breast cancer surgery to even know they are at higher risk of developing another breast cancer in the future.
Rapid Genetic Testing Offers Patients More Insight When Planning Breast Cancer Surgery
A study published in Annals of Surgical Oncology found that women with a recent breast cancer diagnosis who are offered a rapid genetic test, and who received their results prior to their initial breast surgery, oftentimes chose to have a bilateral mastectomy. In the study, more than 1,000 women were offered a rapid genetic test following a breast cancer diagnosis. Of those who tested positive for a BRCA mutation, over 70% chose to have a bilateral mastectomy, with or without reconstruction.
These test results demonstrate the need for further evaluation of the current model of breast cancer care. Currently, not all women with a breast cancer diagnosis are routinely offered genetic testing. Only those who also have a family history of breast cancer, or are very young at the time of diagnosis are typically referred to a genetic counselor for gene testing.
By offering all women the option of a rapid genetic test at the time of diagnosis, patients would be better informed when making surgical treatment planning decisions.
Personalized Treatment Recommendations in the Palm of Your Hand
The Breast Advocate® app is another great resource for patients weighing their options for breast cancer surgery or breast reconstruction.
Co-created by leading specialists and patient advocates, Breast Advocate® is a free breast cancer surgery app that provides ALL your surgical options along with evidence-based recommendations, personalized for you.
Download the free app HERE.
Advances in Breast Reconstruction Are Changing How Women “Feel” After Mastectomy
Many patients undergo a mastectomy as part of their breast cancer treatment. A mastectomy is a procedure that removes the breast tissue and, in some cases, the breast skin and nipple-areola. During mastectomy surgery, nerves that allow patients to feel (known as ‘sensory’ nerves) are often cut, leaving the patient numb.
Unfortunately, many patients are not told they could end up with a numb chest after their mastectomy, so this often comes as a shock to patients following surgery. This statement was recently echoed by NBC’s Kristen Dahlgren in an article published on Today.com who “…never realized that women who have mastectomies lose feeling in their chests.”
There is some good news though… Thanks to advances in surgical techniques, patients can now maintain or restore feeling following breast cancer surgery.
Sensory Nerve Preservation
The first step in preserving feeling is identifying and protecting the sensory nerves at the time of mastectomy, if the patient’s anatomy and diagnosis allows. During a mastectomy, surgeons must prioritize removing all tissue that looks and feels like breast tissue, otherwise the patient will not get the maximum benefit from the mastectomy in the first place. However, there are steps surgeons can take during the surgery to identify and preserve some of the nerves that provide feeling. However, sometimes this is not possible because of the patients’ anatomy, or because of the location of the breast cancer.
Sensory Nerve Reconstruction
Sensory nerve reconstruction (microneurorrhaphy) is a microsurgical technique designed to reconnect sensory nerves that were cut during the mastectomy. This can be performed with or without a nerve graft.
Most commonly, sensory nerve reconstruction is performed in conjunction with autologous (‘flap’) breast reconstruction procedures like the DIEP flap. However, nerve reconstruction is also possible with implant-based breast reconstruction.
Although the sensation that returns is not usually as good as that provided by Mother Nature before the mastectomy, for most patients, regaining some feeling is far preferable to the alternative of a numb breast.
Unfortunately, at this time, sensory nerve reconstruction is only performed at the time of breast reconstruction and is not offered routinely by all plastic surgeons. Patients must do their research to find a surgeon who offers and regularly performs this procedure.
5 Things You Should Know Before Having Breast Reconstruction Surgery
Breast implants are NOT the only option
The most commonly performed method of breast reconstruction performed today uses tissue expanders and implants. Although this approach is a good option for many, it’s not the only option. Likewise, implants may not be the best option for some patients. Reconstruction options using your own tissue (referred to as autologous or “flap” reconstruction) is also an option. In particular, after radiation treatment flap procedures are associated with fewer complications than implant-based reconstructions.
Sensory nerve reconstruction may be an option
Following a mastectomy, many patients experience permanent numbness to the chest area and reconstructed breast. This is because the sensory nerves that provide feeling are usually cut during the mastectomy. There is some good news though! Advances in breast reconstruction techniques have made sensory nerve reconstruction possible: reconnecting the sensory nerves in the chest can significantly improve the return of feeling to the reconstructed breast.
Enhanced Recovery After Surgery (ERAS) protocols are making recovery easier
Many surgeons are now implementing ERAS protocols to ensure their patients experience an easier recovery following breast cancer surgery, with or without reconstruction. Regardless of the type of reconstruction performed, ERAS protocols are reducing hospital stays, shortening recovery, and reducing the need for narcotics to control discomfort after surgery.
Shared decision-making matters
Breast reconstruction is not a one-size-fits-all procedure. Ensuring you discuss all your options and how they align with your lifestyle, preferences, and goals is critical in planning the best reconstructive option for you.
You can choose NOT to have breast reconstruction
It is important for patients to remember choosing NOT to undergo breast reconstruction and instead opting to “go flat” is an acceptable choice. Going flat (aesthetic flat closure) gives patients seeking no reconstruction the ability to maintain balance and symmetry without reconstructing the breast(s). Women can also choose to go flat after breast reconstruction if they are unhappy with their reconstruction results or have experienced complications after breast reconstruction.
To learn more about ALL your options, download the Breast Advocate App today!
