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DONALD J. CAPUANO, MD
Plastic Surgeon

AN OPERATION THAT CAN DECREASE THE RISK
OF BREAST CANCER
FROM ABOUT 9% (ONE IN ELEVEN)
OR
25%, 50%, 75%, 95%

TO 7% and LESS

DEPENDING ON RISK FACTORS


THIS IS A CONTROVERSIAL OPERATION


Information Regarding

Subcutaneous Mastectomy
or skin sparing mastectomy

You are reading information regarding the surgical procedure for removal of breast tissue. Sometimes known as subcutaneous mastectomy, more recently known as skin sparing mastectomy.

The surgery involves removal of most (98% plus) of the breast tissue which lies beneath the skin. Incisions are used to try to minimize scars. The skin shell is filled by a prosthesis or implant similar to that used for breast enlargement OR by tissue from other areas of the body such as a tram flap or free tram flap, (see explanation further in this description).

THIS IS A CONTROVERSIAL ISSUE. . . . . . In most cases this surgery is performed on breasts that are FREE of cancer or have MINIMAL OR NONINVASIVE cancer.

Some would wondered why a woman would choose to have her breasts removed if there is no cancer.

I have wondered why a woman, at high to very high risk, is told that she has to wait until cancer actually appears before her breasts or at least most of the internal breast tissue is removed.

Further, why should she be made to wait until there is a significant chance that her disease is no longer confined to the breast(s)?

As a Physician who does advise women about breast removal because of high risk, I attempt to present facts as I see them. It is imperative that there be no 'pressure' to go ahead with such surgery.

Each woman must have ample time to reflect and decide, without pressure, as to what should be done. It has been my observation that women who come to see me have thought about removal of their breasts for some time and in some cases for many years.

What is important is that the woman reflect as to how important her current breast configuration is to her. She must consider whether long term survival is more important than the physical and psychological value of the breast configuration.

For most women who consult me, long term survival is of the essence. They want to live to see their children grow, and to see their grandchildren grow.

Whether or not an individual is a candidate for surgery partially depends on risk factors. These risk factors have been statistically analyzed and help give an idea of the probability that cancer will occur.

WHAT DETERMINES 'AT RISK' FOR BREAST CANCER

The statistical chances of developing cancer can be calculated. While calculated connotes an exactness, certainly any such calculation is not exact, but it gives a woman enough of a 'ball park' figure as to the risk.

The following are associated with increased incidence of breast cancer.
- The presence of 'pre-malignant' changes.
- The presence of 'minimal' cancer in a breast.
- The presence of invasive cancer in the opposite breast.
- Pre-menopausal breast cancer in one's mother, maternal grandmother, sisters, or maternal aunts.
- The presence of a genetic marker for breast cancer.
Inability to examine the breast clinically or by mammography.

More than one of the above compounds or increases the risk. IF THE RISK FACTORS ARE NUMEROUS one might reasonably state that the development of cancer approaches inevitability.

Removal of the inner portions of the breast(s) with preservation of the skin and nipple areolar complex if possible and with reconstruction, is THE LOGICAL THING TO DO - TO SAVE LIVES AND TO ATTEMPT TO PRESERVE A SEMBLANCE OF A PLEASING BREAST.

What are considered pre-malignant conditions ?
It is not necessary to feel or see a lump to have pre-cancerous conditions. There may be merely a slight thickening or firmness. If tissue is removed for analysis, it may show precursors to cancer or 'pre-malignant disease'. Diagnoses such as ductal hyperplasia, intraductal papillomatosis or lobular carcinoma-in-situ are associated with increased chances of cancer. If a woman has had cancer in the opposite breast, there is an increased chance of developing cancer in the remaining breast.

The Genetic Marker There are several markers associated with an increased incidence of cancer. This is not a 100% correlation but indeed the presence of the gene marker does carry an increased risk. The cost of testing originally was two to four thousand dollars. For example, a woman without known additional risk factors, may have about a nine percent chance of cancer (about one in eleven will get cancer of the breast over their lifetime estimated at 80 plus years). As the risk factors compound, this percentage may 'add up' over one's lifetime to a fifty to seventy-five percent chance of cancer.

Besides having a calculated increased chance of breast cancer, another reason for undergoing a reconstruction after subcutaneous mastectomy or skin sparing mastectomy as mentioned, is that doctors may be unable to adequately 'follow' breast masses. Cancer, in its early stages may be present, but undetected in the breast.

Other reasons to decide to go ahead with surgery is because of chronic pain, infections, or the need for repeated biopsies associated with deformity of the breast.

While this operation is controversial, only a few physicians would not recommend this operation for a woman whose mother and maternal grandmother had pre-menopausal carcinoma of the breast, and who has had one breast already removed for cancer of the breast or who has lumps in the opposite breast that are difficult to 'follow', or whose mammograms shows suspicious microcalcification. If a genetic marker is detected then indications for surgery are great.

Before going ahead with surgery, IT IS THE INDIVIDUAL'S JOB to have it perfectly clear why removal of breast tissue is indicated.

All risks and complications must be considered. This is an operation that has been done many times and successfully so. In most cases this type of surgery is done on breasts that are FREE of cancer or have MINIMAL OR NONINVASIVE cancer.

CIRCUMSTANCES THAT INCREASE THE RISK FOR BREAST CANCER

All percentages are estimates and may be revised from time to time

.Pre-menopausal breast cancer in % increase risk
..mother----------------------------------------15-25%
..maternal grandmother----------------10-25%
..sisters-----------------------------------------15-25%
..maternal aunts-----------------------------05-15%
..genetic cancer marker------------------65-95%
..carcinoma in situ--------------------------25-50%
..intraductal papillomatosis---------------1-10%
..with atypia-------------------------------------10-25%
..cancer in one breast----------------------20-25%
..other "pre-cancerous" conditions-------5-15%

IN THE EVENT A DECISION IS MADE TO GO AHEAD WITH SURGERY
click here
Information - Consultation


SUBCUTANEOUS MASTECTOMY requires understanding before surgery. If you have questions, you must ask them. Do not request and consent to surgery unless you understand the benefits versus the risks of surgery.

This information is provided for your general information. How such information exactly applies to an individual would depend on a face to face history, examination, perhaps laboratory exams and individual treatment plan. Further, because of the nature of electronic media and information - there is no doctor-patient relationship but merely a general information display - THANK YOU.

Skin-Sparing Mastectomy ~ Subcutaneous Mastectomy
Breast Surgery To Prevent Cancer

SAVING THE NIPPLE AND SKIN OF THE BREAST

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