More natural, cosmetic mastectomy option

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SARASOTA, Fla. -- A skin-sparing procedure helping women who undergo mastectomy offers a more natural option for women with a high risk of cancer.

What compels a woman to undergo a mastectomy?

“I had a biopsy and two surgeries, the second surgery had two lumpectomies and I felt like I was going to lose my breast anyway, a piece at a time,” said Janet Cosby.

“I had DCIS, which is ductile carcinoma in situ, and I had three lumpectomies without clear margins.”

Janet was told to wait and see what happens, but her doctors were proactive, and she fit the criteria for a nipple and skin sparing procedure.

The ideal woman for the procedure, says Dr. Russell Novak of Sarasota Memorial Hospital, is a woman who doesn’t have cancer. “A woman who has a premalignant condition or a genetic risk factor, those people we worry a lot less about margins around tumors and things like that. We're actually doing this operation to lower their risk for breast cancer and leave them with a good cosmetic result.”

The surgery is a collaboration between the patient, the oncologic general surgeon, the oncologist and plastic surgeon.

“As far as the actual surgery, I’m in there with the general surgeon from the minute go. I’m there as his expert retractor until it's time for me to start the reconstruction immediately, at the same time.”

The surgery approach is underneath the fold of the breast, which hides the scar. “So, no one is really seeing it, and that's the biggest influence for the patient to be able to look at herself from her point of view and not see a scar. Not only not see a scar, but not see a flattened breast, to see a breast with her nipple and her natural shape.”

Lynn Zook also had the procedure. “There's some relief that the cancer's gone, I don’t have to worry about it, it was stage zero.”

The procedure, which involved two surgeries and expanding the skin, takes about five to six months from beginning to end.

“When they remove the breast, they put the expander in, so every week, two weeks I would come to Dr. Shulman and she would put the saline solution in and it would expand a little bit, making skin.”

The aesthetic results are good, says Dr. Shulman of Sarasota Memorial.

“They will look actually very real, because the silicone implants are now very soft and nice, and natural. And if they want the same size, the same shape, we can do that. If they'd like a little fuller or a little bit smaller, we can do that.”

Janet Cosby’s double mastectomy unexpectedly revealed something, as well. “They found that I had invasive cancer in the left breast, which nobody had seen before. So I would have ended up where I am anyway.”

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