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Abramson Family Cancer Research Institute



"Confronting Cancer Through Art" is an exhibition by people whose lives have been touched by cancer.


This week we are featuring artwork by:
Jacqueline Kniewasser
Pontypool, Ontario


Visit the Children's Art Gallery

This week's artwork was donated by a pediatric cancer patient who received treatment for cancer at The Children's Hospital of Philadelphia.

A Mastectomy that Spares the Skin

   Author:  Rosann Giordano Thompson
   Affiliation: University of Pennsylvania Medical Center
   Posted Date: October 20, 1997
   Reprinted with permission from Penn Health Magazine, September 1997
Last Revision Date: Sunday, 14-Feb-1999 13:54:27 EST
Copyright © 1994-1999, The Trustees of the University of Pennsylvania

Cancer surgeons and plastic surgeons have joined forces at Penn's Medical Center to perform "skin-sparing mastectomies" -- a technique that permits removal of the cancerous tumor in the breast while retaining much of the breast's natural shape and peripheral sensation. The procedure involves excising the breast tissue through an opening made by removing only the nipple and surrounding areola. This leaves the breast "skin envelope" and eliminates the need for totally removing the breast.

The procedure requires the involvement of both the surgical oncologist and the plastic surgeon from the onset. Prior to surgery, the plastic surgeon marks the patient's breast where the incisions should be made for the best cosmetic outcome; the oncologic surgeon then modifies these incision guidelines-if necessary-to provide for a successful cancer surgery. To begin the surgery, an incision is made right around the nipple area, starting with an entry about the size of a half-dollar. As the surgery proceeds, the skin around the opening stretches and allows the surgeon enough room to remove the breast tissue. After the successful removal of the cancerous tissue, the plastic surgeon reconstructs the breast-by filling the breast envelope with tissue and muscle from the patient's abdomen and/or back-then closing the incision in a cosmetically pleasing manner. According to Louis P. Bucky, M.D., skin-sparing mastectomy is a progression from radical mastectomy and modified radical mastectomy to a level more in keeping with "breast conservation," a goal of reconstructive surgery. "Through careful research we've learned that you don't have to always perform radical mastectomies to maintain appropriate survival to cure a cancer," explains Bucky, assistant professor of surgery and a plastic surgeon at Penn's Center for Human Appearance. "Recurrence with this type of surgery is extremely low because all the breast tissue has been removed, even though the skin flap is left." As he puts it, "If you can perform this surgery, not compromising your cancer cure, I think it emerges as the best of both worlds for the patient."

Yet not all patients who present with breast cancer are candidates for skin-sparing mastectomy, which is performed in about 15 percent of all mastectomies across the nation. Douglas Fraker, MD, associate professor of surgery and chief of the division of surgical oncology, explains that the selection depends on the size and location of the tumor and on the needs of the individual patient. Some may prefer mastectomy rather than lumpectomy and radiation. And women with ductal carcinoma, a noninvasive cancer localized in the breast, cannot be treated by lumpectomy surgery. Other candidates for skin-sparing mastectomy are those with larger lesions and smaller breasts, as well as those whom Fraker describes as fearful of or unable to be subjected to the radiation treatments that traditionally follow lumpectomy surgery. Most patients of Fraker and Bucky are between the ages of 40 and 60, but they would perform skin-sparing mastectomy on an older patient in good health.

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