Dr. DellaCroce on Mastectomy and Why Details Matter
Dr. Dellacroce (00:19):
Basic truths that seem obvious, but it’s surprising how easy it is to get lost in the sea of information and conflicting opinions when it comes to making decisions about our health.
But some truths are constant. Details do matter, and the first steps in your care journey are often the most important and most impactful medical professionals know this, and our friends and families have the special advantage of direct access to this kind of insider information starting now. So do you. Hi, I’m Dr. D, and I wanna share with you the number one thing that I would change today about breast cancer treatment across the board and the things we’re doing to march towards better outcomes for you. So what is it? What is it that makes everything harder when it comes to post mastectomy breast reconstruction? Well, it goes all the way back to 1894 when Dr. Halstead revolutionized the treatment of breast cancer with the first mastectomy. His approach was called radical, but he did push for progress in the field. Since then, breast cancer treatment has evolved in nearly every way from genetic testing to dramatic leaps forward in plastic and reconstructive surgery. Nothing is the same as it was 100 years ago, except for one thing, The football shaped side to side transverse across the breast, parallel to the floor incision design that removes the breast in a wedge
Bad because it takes away the tip of the breast and flattens it into a permanent and irreversible dome. This leaves an empty space in your bra and complicates clothing options for all the obvious reasons. But the good news is it’s completely avoidable. I really don’t. Maybe folks just get used to doing things a certain way. Maybe it’s a lapse of logic or a failure to apply art to the science of the treatment plan. I don’t know. But what I do know is that you can’t afford to allow yourself to be overwhelmed in the moment that matters most, and you mustn’t let yourself get swept away by it all. If you feel that happening, stop, breathe, and take one step at a time because knowledge is power and it’s simpler than you might think. So listen closely and let’s break it down with my rule of threes.
First, we start with the three situations where the transverse ellipse parallel to the floor across the breast. Flattening incision design may be reasonable to consider, number one, when you have made a personal decision not to have breast reconstruction at all. Number two, if you have very advanced disease and reconstruction isn’t advised early on. And number three, if after doing all your homework, you’re still unsure about having reconstruction and wanna put that decision off till later, understanding that you will lose the advantages of look and touch sensation that are enhanced when we carefully preserve your outer breast skin.
The second part of my rule of threes is how the art of modern mastectomy incision planning overcomes the 100 year old problem. Here they are in no particular order. These designs can be used for all breast sizes, all breast shapes, and they can be applied to all situations. Whether we are treating active disease or performing preventive mastectomies for our high risk patients, they work for implant placement and when we’re rebuilding the breast with natural living tissue all on the same day of your mastectomy, otherwise known as immediate reconstruction, let’s look at them one by one. First is the side incision. It can be used for compact breasts. Breasts that aren’t saggy nice because it’s hidden away from the midline and can’t be seen in even the lowest cut garments. It can be used for nipple sparing as well as non nipple sparing procedures. Number two, the vertical or lift incision. I use this one for women with large breasts and those with a sag shape. It allows me to lift the nipple position and reshape the overall breast, and it also works for nipple sparring and non nipple sparing plans. Side note, this design can do some incredible things for women with even the largest breasts. I wrote a paper about it a while back, and you can check that out here later if you like.
Finally, the underneath or fold incision used for women with moderate size and is particularly appealing because we can hide the incision completely. It’s generally only for women who are having nipple preserving surgery, and it can leave the breast with an untouched look.
So that’s it. Our goals are to hide, incisions, reduce or eliminate scarring, preserve, and even enhance shape. Yes, you can usually keep your own nipple, and we don’t cut away skin unnecessarily to place islands, patches, or paddles as they’re called when doing natural tissue reconstruction. I see this all the time in women who come to see me from outside and it detracts from the result. The only exception to that is when tumors are close to the skin requiring substantial excisions to deliver safe margins, which fortunately isn’t too common anymore with early detection. Remember my rule of threes and that your final outcome begins at the beginning with the first brush stroke. I want you to be encouraged. You’re now armed with knowledge, so be your own advocate. Seek a second opinion if you need to. There’s no reason to live 100 years in the past and early decisions are important. When all things come together and the best of modern techniques are combined with an experienced team, your opportunity for a quality outcome increases greatly. The sun will come up. Don’t forget that. The goal ultimately is to choose best care first. I’ll say that again. Best care first, so that you enjoy a result that mirrors progress and you get back to being you.
My hope is that this gives you a strong foundation of understanding. Remember, not every situation is the same, and the skillset and experience of every team is different. Consult with your personal physician for individual advice and care planning. Until next time, I’m Dr. D. Take care.
Dr. DellaCroce, a founding surgeon of the Center for Restorative Breast Surgery and St. Charles Surgical Hospital, introduces his “Mastectomy Rule of 3’s” and explains what you should know about mastectomy before making decisions. You’ll learn how those important early decisions in your breast cancer journey impact your ultimate outcome. The Center for Restorative Breast Surgery was established as a dedicated center for women seeking the most advanced methods of breast reconstruction and is committed to educating women on all of their options before making surgical decisions.