Oncoplastic Surgery Success Story at Tufts Medical Center
While there are thousands of difficulties that surround breast cancer, one of the largest for many women is losing their breasts in surgery. While it is a necessary evil due to the cancer, it can be very difficult on confidence and self-image. If they wish to reconstruct their breasts, there are typically two separate surgeries. One, of course, to remove the cancer and the second to reconstruct.
A local surgeon has recently decided that it may be a better idea to combine the two into one surgery.
Pat's story
Approximately a year ago, Pat Palonen went in for an entirely routine mammogram. She was entirely shocked when she was told that the results showed she had breast cancer. She later described the experience, saying, "it was like hitting a brick wall."
Unfortunately, the cancer was large. Patients similar to Palonen are typically encouraged to first have a mastectomy and then proceed to reconstruction with implants, usually at a significantly later date. However, this was distressing to Palonen. She did not have any desire to have to wait to begin reconstruction. She would much rather have one large surgery, and recover from both, than spend double the amount of time in the operating room and dealing with recoveries.
Luckily for her, Dr. Abhishek Chatterjee at Tufts Medical Center is perfecting just that. He has been trained as both a breast cancer surgeon and a plastic surgeon, so he offered to remove all of Palonen's cancer and, at the same time, fix her breasts.
He explains the procedure, "oncoplastic surgery allows the woman to preserve her breasts. It's taking a large section of tissue from her breast that has the breast cancer and then rearranging the breast tissue that is left behind in a form of a breast lift." To many who have to go through a mastectomy, this alternative is very appealing.
Some might wonder whether the procedure is equally effective as an entire removal of the breast, but it has actually shown to be even more effective. Unlike the standard lumpectomy, Dr. Chatterjee is able to remove even more tissue, which means that it is more likely that the cancer will be removed.
Dr. Chatterjee continues, "you're done with regards to the cancer 90% of the time and the woman wakes up in one surgery with her own breast, with her own nipple, with her own sensation that tissue with a breast lift looking many times quite good."
When Pat heard of the wonders Dr. Chatterjee was able to work, she knew she had found her doctor. She told him, "hey if I can do it in one shot, one and done, I'm there."
She certainly was there. The procedure went well and now, over nine months after the surgery, she reports that she is doing well. She says, "it's your own skin. You still remain you." This is an important facet of what Dr. Chatterjee is working on, because some women feel that reconstruction surgery will make them "fake" or "plastic", but his procedure enables survivors to hold onto some of their old self, making them feel more comfortable with the procedures.
He is proud of what he could do for Palonen and explains, "she feels whole and most importantly, she is free of cancer."
Palonen continues to gush about how thankful she is that she found Dr. Chatterjee and she performed the surgery that changed her life. She refers to his hands as "miracle hands", and says to him, "I love you. I love you and thank you so much for everything you've done for me. I will forever be so thankful to that man for his talent."
While it is likely that many would opt to have oncoplastic surgery instead of doing two separate procedures, Dr. Chatterjee mentions that there are fewer than 20 doctors in the country with his particular expertise who would be able to complete the procedure to the same effect.
What exactly is oncoplastic surgery?
We have briefly referenced Dr. Chatterjee's explanations of oncoplastic surgery, but via his review "Oncoplastic Surgery: Keeping It Simple With 5 Essential Volume Displacement Techniques for Breast Conservation in a Patient With Moderate- to Large-Sized Breasts" we can learn more about this life changing procedure.
As we have learned, oncoplastic surgery is a relatively new field that is constantly evolving that combines the relative strengths of breast surgical oncology and plastic surgery. It has both immediate health and aesthetic values. Not only does it remove the cancer as a typical lumpectomy would, but it has actually been shown to be more effective. The aesthetic value for the patient is that they will not have to undergo the shock of seeing their body as drastically altered, and are sometimes even pleased with the lifted appearance of their breasts. However, the aesthetic value is not simply cosmetic. It can save the patient a significant amount of worry, anxiety, stress, and sometimes depression associated with the change in appearance.
This is all possible because oncoplastic surgery enables the surgeon to remove sizable portions of the breast in the oncologic resection without compromising, and sometimes improving the appearance.
In his review, he lists the ways in which a breast surgeon could remove breast cancers in most areas of the breast by utilizing 5 oncoplastic techniques. The choice of which technique to use comes from where the cancer is located in the breast and the size of the tumor to be removed.
The first technique is able to address small to medium cancers centrally located in any quadrant and is able to be used for grade 1 ptosis, especially when patients have enlarged nipple areola complexes. The second technique is specifically for small, moderate, large inferior pole or lower quadrant cancers, and is able to be utilized for grade II to III psosis. For this technique, a plastic surgeon should usually be involved, or a surgeon who has been sufficiently trained in plastic surgery techniques. For technique three, wise incision pattern inferior pedicles are best for small, moderate, large superior pole or upper quadrant lesions, which once again can be used for grade II or III ptosis. The third technique is wise or circumvental incision pattern, superomedial pedicle for small, moderate, large inferior pole, superior pole, lower outer quandrant, upper outer quadrant lesions. However, this is different from the superior pedicle technique because cancers that are slightly superior to the nipple areola complex are able to be removed with precise keyhole excisions. This technique should not be used for inner, medical cancers (because the pedicle arises from this point) but can be used for grade II or III ptosis. The final (fifth) technique is hemi-wing pedicle for large to very large upper outer quadrant defects that has very similar steps to technique 4. While this has been a brief reference to his guidelines of five techniques, for more information feel free to read his review "Oncoplastic Surgery: Keeping It Simple With 5 Essential Volume Displacement Techniques for Breast Conservation in a Patient With Moderate- to Large-Sized Breasts."
Due to Dr. Chatterjee's tremendous work, more women like Pat Palonen will be able to have a more seamless transition through their breast cancer operations.
Reference
http://boston.cbslocal.com/2017/08/25/breast-cancer-oncoplastic-surgery-tufts-medical-center/
