Dr. Ordoyne: When my patients come to me, some of their biggest concerns are, “When am I going to develop cancer, or has it developed in me already?” 

Kerry: Between 31 and 32, my anxiety just really started to increase as I was going to the doctor because I knew I was getting closer to the time that my mom had been diagnosed. So, I remember at one point I was waiting for the results of a mammogram, and I mean my I’m sitting there waiting, and the anxiety was just like, and the, the nurse came back in, and everything was fine, but she said, “You know, have you ever thought about getting genetic testing? You know, I can just see your anxiety with this.” 

Dr. Stolier: I can truthfully say that when we began to do genetic testing, it changed everything, We have empowered women to make decisions about their own health, and we’ve empowered them with information.

Lorell: It’s an awful thing to have to face, but here I am, given information. You’ve got a pretty good cancer risk. Well, let me do something about it.

Dr. Stolier: Well, it all comes down to risk. There’s a risk of developing breast cancer, and there’s actually a risk of dying from breast cancer. And I think that any woman who has tested positive for one of the gene mutations is concerned about these; both of them. 

Dr. Ordoyne: The biggest reason for talking to your physician about having a prophylactic mastectomy is it’s better to treat your disease prior to getting it rather than to wait till you have cancer and then treating it at that time. 

Dr. Stolier: Prevention is everything; it’s everything. So, if we look at all the options that we have in front of us, risk reduction surgery reduces a woman’s risk of developing breast cancer and subsequently dying potentially from that breast cancer by 90%, and that’s probably as good as we have at the moment.

Dr. DellaCroce: To deliver the highest quality at the end of the day, it requires, it demands a team of experts who collaborate and work together because the outcome, both in terms of the risk reduction and the ultimate result in terms of the restoration of wholeness, comes with that first incision. 

Dr. Ordoyne: By working with the plastic surgeons, we can have a more customized approach in developing techniques of restoring the breasts to its natural state. And that way, I can do my mastectomies through incisions that will be more pleasing cosmetically. 

Dr. Stolier: What we try to do is to try to help women feel better about themselves, feel better about their body image, and overall have a better quality of life.

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.

(00:32):
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

(02:04):
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.

(03:15):
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.

(04:04):
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.

(05:37):
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.

(05:57):
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.

(07:30):
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.