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June 2012
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Lourdes surgeons marry cancer treatment with aesthetics

BY KAT RUSSELL krussell@paducahsun.com

Cancer treatments have primarily focused on getting the cancer by any means possible, with little concern for aesthetics or the resulting scarring and impact that may have on the patients' psyche.

But at Lourdes hospital, breast surgeons Drs. Rebecca Gill and Daniel Howard are offering their breast cancer patients another option: onco-plastic surgery techniques that marry surgical cancer procedures with plastic surgery techniques.

"The standard approach for the last 50 or 100 years or so has been who gives a rip what it looks like, we got that cancer," Howard said. "It really wasn't about making it look nice, it was about getting the cancer."

While getting the cancer is important, Howard said the traditional approach can leave patients feeling disfigured and unattractive, adding to the already-stressful nature of their conditions.

Howard, a surgeon more than 30 years, said he was of the "get the cancer and (never mind) the aesthetics" generation, until he realized there was a different way to do things.

"Traditionally, we would cut the whole breast off, sew things up tight and in six months or a year or two, the plastic surgeon would try to go back and rebuild the breast," he said.

"The concept of the hidden scar techniques is that you put the scars in places that are hidden so that you can get the cancer out and the patient can't find the scar, and they really like that," he said.

Incisions are typically made along the underside of the breast, along the line of the areola or in the armpit, to better hide the scar, he said.

Typically, there are two main approaches when it comes to breast cancer surgeries -- mastectomy and lumpectomy, said Gill. A mastectomy removes the whole breast, while a lumpectomy removes the tumor and some of the surrounding tissue.

But Gill and Howard take it one step further, offering skin- and nipple-sparring mastectomies and lumpectomies whenever possible.

In a skin- and nipple-sparing mastectomy, an incision is typically made along the underside of the breast and the breast tissue is scooped out, leaving the breast skin and nipple intact.

"That way the incision is going to be hidden somewhere the patient can't see, so when they look at their breast after reconstruction, the breast is going to look normal."

As for the lumpectomy, "we try to hide the scar in places where the patient can't see it afterwards," Gill said. "We also rearrange the tissue that we left in the breast in order to make that breast mound look as normal as possible."

Though not necessarily new procedures, the use of hidden scar techniques for breast cancer patients is not widely spread, Gill said, and only recently has a certification program been created.

"Less than 2 percent of the breast cancer operations that are done in the United States are of this type, so this is not commonplace," Howard said. "So that's a big number of breast cancer survivors who are potentially scarred or unhappy with their appearances. And that's not what we want."

About a year ago, Invuity Inc., an advanced medical technology company, announced the launch of its Hidden Scar Surgery program. The program is designed to certify surgeons and establish "centers of excellence" at major cancer centers and hospitals across the country. This innovative program will train surgeons on advanced minimally invasive and minimal access surgical approaches that deliver optimal clinical and aesthetic outcomes for patients.

"The beautiful thing for us is that the medical community, fairly recently, said 'hey this is important, this is something that we think should be done for breast cancer patients,' and it just so happens to be what we've been doing for many years," Gill said.

Lourdes also offers intraoperative ultrasounds, meaning an ultrasound is performed while operating, which enables surgeons to get better margins and take less tissue.

Howard said in recent years, the marrying of cancer and plastic surgery techniques has allowed for patients to have several options that weren't available before, such as the combination of a lumpectomy and a breast reduction or breast lift.

"Those are things that dramatically alter women's cosmetic result and that makes them very happy," he said. "We've got 3 million breast cancer survivors out there. We want then enjoying life, feeling happy and confident about themselves."

Though the cancer always comes first, the doctors said minimalizing the scarring and seeking ways to better cosmetic results for their patients can dramatically reduce the lasting emotional scars.

"Physically patients are going to heal from the surgery and they're going to get over it much more quickly than they are mentally," Gill said. "And not having that constant reminder, not having to look at that big scar every day, helps them get back to feeling like themselves and helps them get back to their lives much more quickly."

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