A revolutionary procedure has been developed that is an alternative to radical mastectomy. This procedure is an above the muscle, single-stage procedure that preserves the nipple, areola, and surrounding skin.
The procedure was developed by Elizabeth Hopkins, an aspiring physician and premedical student at Florida Atlanta University in Boca Raton, who has spent more than 640 hours shadowing Hilton Becker, MD, a local plastic and reconstructive surgeon. Along with Jeffrey Lind II, MD, they described their procedure in Plastic and Reconstructive Surgery (2015; 3(6):e412).
Hopkins, 32, who has been on both sides of the operating table, underwent a double mastectomy in 2014 as a preventive measure. She tested positive for the genetic mutation in the BRCA2 gene on chromosome 13, and hereditary cancer has plagued generations of her paternal lineage.
“This blessing in disguise introduced me to a brilliant surgeon whose unique procedure enabled me to have a skin and nipple sparing mastectomy free from animation deformity, which happens when implants are placed beneath the pectoral muscle; mine were placed over the muscle,” said Hopkins. “Being his patient and working side-by-side with Dr. Becker has changed my life and will hopefully change the lives of many others.”
The majority of breast reconstructions performed today are done as a two-stage procedure where an expander is placed in the submuscular position followed by exchange for an implant several months later after the tissue has expanded. Sometimes, in the appropriate patients, a single-stage reconstruction can be performed where an implant is placed in the submuscular position at the time of the mastectomy.
The new, above the muscle, single-stage procedure developed and studied by Becker preserves the nipple, areola, and surrounding skin. Becker uses a vertical mastectomy incision, a dermal flap for coverage, and a definitive adjustable smooth saline implant.
“This technique, when combined with an adjustable implant, addresses the complications related to subpectoral implants and traditional expanders currently used in mastectomies,” said Becker. “There are numerous advantages to using a vertical incision over a horizontal incision. From the surgical perspective, it allows for ease of access, and from an aesthetic perspective this incision leads to a better cosmetic result with a scar that resembles that of a breast lift procedure. The procedure is minimally invasive as no new tissue planes are opened after the general surgeon has completed the mastectomy.”
Thirty-one patients, median age 51 years, underwent this single-stage breast reconstruction in the preliminary study and were followed over the course of 4.5 years. Results from this study have shown a low complication rate and implant loss. Benefits of this new procedure include the elimination of animation deformities or movement of the implants, elimination of asymmetry, less postoperative pain and discomfort, and a faster recovery. In addition, the natural position of the implant above the muscle leads to a more natural feel.
“Procedures that spare the nipple and skin have been shown to be oncologically safe and allow for much more flexibility in implant-based breast reconstruction,” said Becker. “Single-stage breast reconstruction will become more important as there continues to be increasing financial strains on our health care system.”
Reconstructive breast procedures continue to be a common operation for plastic and reconstructive surgeons. In 2013, 95,589 breast reconstruction procedures were performed, with the large majority of those being implant-based.