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Health Matters: Providence Mission Hospital | 7 A New, Better Mastectomy Result Breast surgeon Dr. Marla Anderson and reconstructive surgeon Dr. Michael Lee have teamed up to offer patients an exciting new option in post-mastectomy breast reconstruction. M arla Anderson, MD, medical director of surgical breast oncology at Providence Mission Hospital, "is always pushing the envelope to offer cutting-edge care for patients," says Michael Lee, MD, a plastic and reconstructive surgeon who partners with her to perform a new sensation-sparing mastectomy with breast reconstruction. "I think it's great we've been able to bring this to Mission and all of Orange County," Dr. Lee says. The procedure is relatively new, and the Mission team was the first to perform it in Orange County. The two surgeons have just begun offering the procedure, which restores sensation to the nipple, areola and surrounding area. In a traditional mastectomy, the nerves that give the nipple and nearby surfaces their ability to feel heat, cold, pain and touch are destroyed when the breast tissue is removed. In some cases, the nipple itself is taken off, meaning that even if the breast is built back up with an implant and a reconstructed nipple (usually with skin from elsewhere on the patient's body), the patient will never have any feeling in the new breast. That loss of sensation can have serious consequences, both emotional and physical. The patient may feel less whole or less feminine, while the inability to feel heat, cold or pressure on the breast skin can be dangerous, resulting in injury to the reconstructed breast. "This surgery is about improving the patient's well-being and how she feels about her body following mastectomy and breast reconstruction," says Dr. Anderson. WHO IS A CANDIDATE? Women who are having a nipple-sparing mastectomy (NSM), whether for breast cancer treatment or risk reduction, are potential candidates for the sensation-sparing technique. (NSM is also known as a subcutaneous mastectomy or nipple-areola-sparing mastectomy.) Although the procedure's track record isn't lengthy, data show that the procedure works best in women with smaller cup sizes who don't smoke and who are not overweight. During the mastectomy Dr. Anderson identifies the appropriate nerve roots and preserves them. Then, during the breast reconstruction, Dr. Lee uses a nerve graft to connect those nerves to the nipple. Dr. Lee's role in grafting the nerves involves microsurgery done at high magnification, a technique in which he has special training. "It takes six to 12 months for the nerves to recover" and for feeling to return to the nipple, he says. Because the breast tissue that is removed includes the mammary glands and the network of ducts that connect them to the nipple, the reconstructed breast can't produce milk. However, given the significant improvement in breast reconstruction after mastectomy, the reconstructed breast can look, and now feel, very much like the patient's original breast. In the case of a double mastectomy, the two breasts will match each other and look natural. "Now that breast cancer treatment is so good," says Dr. Lee, "we want to restore the breast as much as possible." Adds Dr. Anderson, "We are excited to offer this cutting-edge approach to help empower women to maintain a high quality of life and to live fully after undergoing surgery." HOW OFTEN SHOULD YOU GET A MAMMOGRAM? The American Cancer Society, the American Society of Breast Surgeons and the American College of Radiology suggest that women of average breast cancer risk start annual mammograms at age 40. Earlier this year, the U.S. Preventive Services Task Force also lowered the recommended age at which women should start mammograms to 40 but recommends screenings every other year rather than annually. It's important to be aware that all recommendations are for women of "average risk." So your first step in making decisions about the timing, frequency and type of screenings you want is figuring out your individual cancer risk by talking with your primary care doctor or gynecologist. Higher-risk women may want to consider additional screening technologies such as ultrasound and MRI. You can schedule your mammogram by calling 949-364-6900 or visiting providence.org/treatments/ mammography. Dr. Marla Anderson Dr. Michael Lee

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