Breast Reconstruction Starts with Your Mastectomy

Currently, there are several types of mastectomies / lumpectomies offered to women with breast cancer in the United States:

Radical Mastectomy: Excision of the breast mound, nipple, areola, extensive overlying skin and pectoralis major muscle with the need for a skin graft for closure;

This method of mastectomy is of historical interest only as this approach has been largely abandoned unless a tumor has invaded the pectoral major muscle itself.

Modified Radical Mastectomy: Excision of the breast mound, nipple, areola, overlying skin and axillary lymph nodes through one chest wall incision;

Skin-Sparing Mastectomy: Excision of the breast mound, nipple and areola typically through a circular incision around the areola;

This method of reconstruction is commonly performed in the setting of a staged sentinel lymph node procedure through a separate axillary incision.

Total Nipple and Areolar, Skin-Sparing Mastectomy: Excision of the breast mound through a single incision on the breast either in a transverse, vertical or periareolar location;

This method of mastectomy is more commonly associated with a diagnosis of DCIS or a low-grade invasive tumor with margins 2 cm away from the nipple-areolar complex (NAC). Women electing this method of mastectomy are screened with MRI in our center and undergo frozen section of the mastectomy specimen at the level of the NAC. Sentinel Lymph Node procedures are preformed via a separate incision in the axilla as are full axillary lymph node dissections, if required.

Breast Conservation (Lumpectomy and Axillary Lymph Node Dissection followed by Irradiation): Excision of the breast tumor and a minimum of several mm of tissue surrounding it through an incision overlying the mass or via a periareolar incision;

This method of treatment is commonly combined with a Sentinel Lymph Node procedure and possible axillary lymph node dissection via a separate incision and is followed by total breast irradiation, a radiation protocol distinctly different from irradiation delivered to patients with large tumors and evidence of axillary lymph node involvement of tumor. Total breast conserving irradiation is typically given after the completion of chemotherapy if required. Breast conserving lumpectomy can be facilitated by needle-localization if the lesion can not be felt on physical examination, i.e. solely a mammographic or ultrasound abnormality.

At times, patients have a less than acceptable cosmetic outcome from Breast Conservation and elect to proceed with Breast Reconstruction. Others may develop a second cancer in the same breast at a later date that will require additional surgery. Dr. Marga is committed to continuing a relationship with you should you require care later in you journey should these events occur.

The type of mastectomy/lumpectomy performed will affect how your final reconstruction will be performed, and it can affect your final cosmetic outcome.

Dr. Marga is pleased to work with your cancer care team to maximize your cosmetic outcome without compromising your health and safety.

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