Dr. Frank Dellacroce (00:10):
Hello, I’m Dr. Frank Dellacroce, founding partner at the Center for Restorative Breast Surgery. Today I’m gonna share with you an important discovery we’ve just published that concerns an advancement that allows us to produce results that were once thought impossible. In the world of reconstructive microsurgery for mastectomy, this discovery concerns nipple sparing mastectomy and the evolution of breast cancer care. Nipple sparing mastectomy and breast reconstruction is fairly straightforward when the breasts are near perfect shape to begin with. But what about women with imperfect breasts? Breasts that sag drew or have shapes that don’t lend themselves well to nipple sparing mastectomy. In the case of the well shaped breast, the mastectomy surgeon simply makes an access incision and removes the breast tissue from beneath the skin, preserving the properly positioned nipple and the surrounding skin envelope. The plastic surgeon simply places the implant in the preserved pocket with a spared nipple and closes the skin over it.

(01:14):
But breast cancer isn’t just a disease of women with well shaped breast and proper proportions. Women with breasts that drew are our oversize historically have been excluded from the benefits of nipple sparing mastectomy. That is up until now. Today we’re very excited to present our discovery recently published in the Journal of Plastic and Reconstructive Surgery. In it, we describe a technique that allows us to include these women, and it further describes why implant reconstruction is not always the best method for someone who’s seeking the benefits of a nipple sparing mastectomy. So let’s look at these women who are excluded in the first place and find out what we did to include them. It starts with the fact that mastectomy not only removes breast tissue, but it also removes the blood supply that that breast tissue brings to the overlying skin and nipple. And so without that blood supply, surgeons have had no way to reposition the nipple without losing the last remaining source of blood flow from the surrounding skin.

(02:27):
Since breast implants add no support of the nipples blood supply needs, tightening the skin or reducing the breast size has typically required cutting the nipple away and tightening the remaining skin around the implant. So that means that implants are not always the best way to rebuild a breast, particularly when you want to have a nipple sparing mastectomy. The breast issue is still removed from beneath the skin. A nipple just as was shown a few moments ago, but instead of using an implant to rebuild the breast, we use living tissue that is transplanted from excess in the tummy or hip region. And over the years, with careful study, we realized that these procedures bring an unexpected, surprising and almost magical benefit to nipple sparing mastectomy that implants cannot deliver. And up until now, no one was aware of this. Living tissue creates new blood vessels that grow into the breast skin and nourish the preserved nipple just as the breast tissue did before it was removed.

(03:33):
So these sophisticated microsurgical procedures create a fully living breast that we can then reshape and remodel just like a natural breast. This means we found a way to combine nipple sparing mastectomy and breast reconstruction in a way that allows us to fully lift and reshape the breast to produce results that were once thought unachievable. So let’s consider a patient with right breast cancer and a drooping breast shape. With this breakthrough, we are now able to offer her the benefit of nipple sparing mastectomy and rebuild her breasts for her with micro surgically transplanted living fat, all while preserving her nipple and producing a transformative result. A second young lady with bilateral mastectomy with large sagging breasts. With this discovery, we’re able to offer her nipple sparing mastectomy. Now she’s thin, so we transplant a bit of tissue from her hip and micro surgically rebuild her breast, allowing the production of a result that is otherwise unachievable.

(04:45):
I cannot overstate the importance of this discovery. So I’m gonna leave you with three takeaway points that I hope will help you are that you’ll share with someone who might benefit from this breakthrough. First, long incisions across the chest no longer have a place in modern breast cancer care, and many if not most women are candidates for nipple sparing mastectomy, whether it be for preventive reasons or to treat active breast cancer. Secondly, implants are not always the best choice to rebuild a breast loss to cancer, particularly if you want to have a nipple sparing mastectomy. In the United States, implant reconstructions are performed on more than five times the number of women who have reconstruction with their own living tissue. This is largely because we don’t do a good enough job explaining the benefits that living tissue can bring to a reconstructed breast and the magical impact it has for a woman seeking nipple sparing mastectomy. Third and last is the good news that women with sagging or drooping breast shapes are a large size are now to be included as candidates for nipple sparing mastectomy. It’s been a pleasure sharing this information with you today. For more detail, look for us on the web at www.breastcenter.com. I’m Dr. Frank Dellacroce, and in the spirit of health, wellbeing and progress, I wish you well.