http://curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1636

New reconstruction procedures allow women to conserve their own nipples. Is there a downside?

At 59, Andrea Ziltzer’s mother was diagnosed with breast cancer. A year later, she died. Of course, there are no words to describe the agony of losing a mother, but in Ziltzer’s case, it also forced her to make several decisions regarding her own health.

The Westchester, New York, mother of two didn’t know whether her mother carried either of the two genetic mutations for breast cancer, BRCA1 or BRCA2, but she decided to be tested. She learned at age 45 that she carried the BRCA2 mutation.

Then she made another decision: to have a preemptive prophylactic mastectomy. “Getting tested was a much harder decision to make than deciding whether to get a mastectomy,” Ziltzer says. “I was much more scared of cancer than any operation.”

Andrea Ziltzer chose nipple-sparing prophylactic mastectomy after learning she was positive for the BRCA2 mutation. Photo by Susan Farley.

Surgical Decisions

After extensive research, Ziltzer picked a one-step, nipple-sparing mastectomy in which the breast tissue is removed and replaced with an implant. In traditional reconstruction, the nipple and areolar are removed and recreated.

The nipple-sparing surgery is still uncommon and lacks consensus among breast surgeons, but it is becoming increasingly popular among health consumers as they look for less invasive options.

The main concern of opponents revolves around the fact that the nipple complex is rich in breast ducts from which most breast cancers arise. What health professionals agree on is that the pool of candidates for nipple-sparing surgery is small and falls into three major groups:

> Cancer-free women who are considering a mastectomy as a preventive measure.

> Women with small breast cancer tumors that are not located in danger zones near the nipple.

> Women whose doctors have biopsied the breast tissue and determined that the locations of tumors do not pose risks for the nipple-sparing procedure.

Typically, the nipple and areola are removed along with the breast tissue for reconstruction because traditionalists worry about them harboring cancer cells. One study showed tumor cells in about 20 percent of mastectomy specimens done for breast cancer, but no tumor cells were found in cases of prophylactic removal. But in recent years, researchers have revisited the danger of cancer cells lurking in the nipples or nearby tissue—and whether the risk is low enough to leave them.

Get the Facts

The results have been mixed. One study by the Cleveland Clinic found very low rates of recurrence in 149 nipple-sparing mastectomies it performed between 2001 and 2007. Another by the Memorial Sloan-Kettering Cancer Center had similar results, with doctors concluding that the procedure could lead to excellent results with the right candidates.

The two- to three-hour operation, with the official name of “total nipple areolar sparing with direct-to-implant reconstruction,” is a process where implants are immediately inserted after the mastectomy, according to C. Andrew Salzberg, MD, a pioneer of the surgery and chief of plastic surgery at Dobbs Ferry Hospital in New York.

“This has revolutionized reconstructive surgery,” says Salzberg, who has done 800 procedures in the past nine years. “And it has made the decision of having a mastectomy much easier for some patients because they will know they’ll look just as good—or better—almost immediately.”

However, some physicians fret that the study groups have not been large or controlled enough to give the procedure a green light.

Sally Knox, MD, a breast surgeon at Baylor University Medical Center in Dallas, says she hasn’t adopted the procedure primarily because she hasn’t seen the need.

“We are doing areola sparing, and we can save the pigment, and the plastic surgeons build a nipple that looks great,” she says. “Why save the tip of the nipple where all the ducts converge if you are getting a good cosmetic result?”

Knox says that no sensation is saved in the nipple-sparing procedure, which means the only difference is that the woman is saving the nipple and has all her own skin for the possibility of an improved cosmetic appearance.

“Some surgeons will love it, and others won’t,” she adds. “The ladies should talk over the benefit and risk with their surgeons.”

Ziltzer says the initial recovery “was not a piece of cake.” But as the healing began, “it was absolutely manageable.” And even though the immediate post-surgery look is “really unattractive,” Ziltzer says it’s a process.

Eventually, she felt she looked better than before the mastectomy.

This article appeared in www.curetoday.com at http://curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1636

C. Andrew Salzberg, M.D.
Thomas McNemar, M.D.
Steven P. Seidel, M.D.

Addicus Books
ISBN: #1-886039-74-07

Available at The New York Group for Plastic Surgery and Barnes and Noble.

Want to improve your appearance and boost your self-confidence? If you are one of the many women who feel their breasts are too small, perhaps you’re considering breast augmentation. It is one of the most popular cosmetic procedures performed today, and women having the procedure report high rates of satisfaction. The surgery gives them greater confidence, affecting how they feel about themselves and how they interact with others.

The authors of Breast Augmentation and Body Contouring are board-certified plastic surgeons who have consulted with many women like you and have performed thousands of cosmetic procedures. They will answer many of your questions, including:

• What types of implants are used – saline or silicone?
• What size implant is appropriate for me?
• Where are incisions made? Where will scars be?
• Is nipple sensitivity affected by the surgery?
• What type of anesthesia used?
• What kind of recovery can I expect?
• What are the risks and complications associated with this surgery?

The authors also cover common body contouring procedures, including tummy tucks, and liposuctionof the stomach, hips, buttocks, thighs, and knees. Dozens of before and after photos help you further envision the results of cosmetic surgery.

The book contains 88 color illustrations and photos, including dozens of “before and after” photos of women who have had breast augmentation and other procedures.

Please be aware that this video contains graphic surgery footage.

www.youtube.com/watch?v=sEBCPL8U6i4

Warning: This video contains very graphic surgical video.

www.youtube.com/watch?v=W1hYU6RUsXo

Please be aware that Dr. Salzberg’s One Stage Operative Procedure contains graphic surgery footage.

One Stage Operative Procedure

Tarrytown, New York – April 13, 2007. Despite a federal law requiring insurance companies to pay for breast reconstruction, only 16% of U.S. women have their breasts surgically reconstructed after mastectomy. A recent study may have identified a large part of the problem: mastectomy patients are frequently unaware of their reconstructive options, because many general surgeons never provide referrals to a plastic surgeon.

The study of 456 general surgeons found that 44 percent referred fewer than one in four of their mastectomy patients to a plastic surgeon for a reconstructive consultation. “Each and every woman who faces mastectomy should have the option to choose or refuse breast reconstruction,” says Dr. C. Andrew Salzberg, co-founder of New York Group for Plastic Surgery, LLP and pioneer of One-Stage Implant Reconstruction with AlloDerm®. Salzberg encourages women to learn about their reconstructive options and make their own decisions about which procedure, if any, is right for them.

“Breast reconstruction can make an enormous difference to a woman who loses her breasts, by improving both her physical appearance and emotional outlook,” says Salzberg. “It’s an incredibly personal decision-one that a woman should make for herself, based on her knowledge of reconstructive options and which, if any, is right for her.”

Salzberg’s new website, http://www.mybreastreconstruction.com/, objectively explains various reconstructive methods, what recovery is like, and what women can expect in the way of results. The site includes before-and-after photos of reconstruction, pages of patient information and resources, and information regarding the FDA’s recent approval of silicone implants. The website also provides information for women who are considering preventative mastectomy due to an increased hereditary risk of breast cancer. “We want women to know what’s available,” says Salzberg, “so they can make informed decisions about what’s really best for them.”

Dr. Salzberg has been listed as a “Best Doctor for Women” by Ladies Home Journal and since 1990 has been listed as a “Best Doctor in the New York Metro area.” His One-Stage Breast Reconstruction with Implant and AlloDerm^® eliminates much of the time and discomfort associated with the traditional procedure of rebuilding breasts with implants.

For more information, contact Dr. Salzberg at 800-433-741.

Procedure at Conference for High-risk Women

Surgeon’s innovative technique streamlines reconstruction

Tarrytown, New York – July 1, 2007. Dr. C. Andrew Salzberg, an internationally-renowned plastic surgeon who was named as a “Best Doctor for Women” by Ladies Home Journal, and since 1990 has been listed as a “Best Doctor in the New York Metro area,” addressed the Joining Forces Against Hereditary Cancer conference in May.

Salzberg’s area of expertise-breast reconstruction after mastectomy-is of particular interest to high-risk women who face mastectomy either to treat breast cancer or to reduce their risk of developing the disease. For many, breast reconstruction recreates their physical profile and restores their sense of self after losing their breasts. Salzberg described his One-Stage Breast Reconstruction with Implant and AlloDerm^®, a single-surgery procedure that streamlines traditional implant reconstruction. “The One-Stage technique produces excellent results for almost any woman after mastectomy, and particularly for those who pursue prophylactic mastectomy to reduce their cancer risk,” Salzberg said.

FORCE Executive Director Sue Friedman said Salberg’s input is highly-regarded. “FORCE helps members make informed decisions about their healthcare by providing credible information about cutting-edge procedures. Reconstruction is of particular interest to our community; for many of our members, Dr. Salzberg’s One-Stage technique represents a viable post-mastectomy option,” she said.

The annual symposium is a collaboration between Facing Our Risk of Cancer Empowered (FORCE-http://www.facingourrisk.org), the only international nonprofit group devoted to improving the lives of those affected by hereditary breast and ovarian cancer, and the H. Lee Moffitt Cancer Center and Research Institute. The international gathering provides the latest developments in surveillance, research, treatment, survivorship and advocacy-all issues of interest to individuals and families concerned with hereditary breast and ovarian cancer syndrome.

Dr. C. Andrew Salzberg is co-founder of New York Group for Plastic Surgery, LLP. His website, www.mybreastreconstruction.com, explains various reconstructive methods. Contact him at 800-433-7410 or info@nygplasticsurgery.com. Learn more about breast reconstruction and One-Stage Breast Reconstruction with Implant and AlloDerm^® at http://www.mybreastreconstruction.com/.

Breast cancer is the most common malignant tumor among females in the USA, with one out of eight American females developing breast cancer in their lifetimes. The latest studies [1] show that 212,920 new cases of invasive cancer developed in 2006, which is 2.5 times more common than the incidence of lung cancer, and that 40,970 females will die from this disease each year.

Therefore, awareness of this cancer is an important health issue, with more women beginning to assess their risk of breast cancer, either informally or with instruments such as the GAIL model [2]. The availability of genetic testing for BRCA-1 and BRCA-2 has revealed many women who are at significantly increased risk. Many aggressive surveillance programs have been developed using advanced MRI and ultrasound, and reductions in breast cancer risk of 50% or more have been proven using chemoprevention strategies with tamoxifen and raloxifene. However, many women are starting to seriously consider prophylactic mastectomy for near-total reduction of breast cancer risk. At our institution, we have developed a procedure for prophylactic subcutaneous mastectomy via an inframammary incision that spares the nipple and is combined with immediate silicone implant reconstruction with the assistance of Alloderm. In this article we will describe the procedure and some of the important issues surrounding its implementation from our experience.

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PubMed is a service of the U.S. National Library of Medicine that includes over 18 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.

From the: U.S. National Library of Medicine and the National Institutes of Health
http://www.ncbi.nlm.nih.gov/pubmed/18575951?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Ashikari RH, Ashikari AY, Kelemen PR, Salzberg CA.
Ashikari Breast Center, 128 Ashford Avenue, Dobbs Ferry, NY 10522, USA.