Читать книгу A Lighter Side to Cancer: From Wake-up Call to Radiant Wellness - Sandra Miniere - Страница 12

November and December 2000

The morning I entered the hospital to have a left modified radical mastectomy with reconstruction, I was plummeted into a stunning reality. Nothing and no one could rescue me from this assault to my body and wellbeing. Once again, I had to endure a traumatic experience that left me feeling vulnerable. There was no escape. Surviving two divorces and repressed memories of sexual abuse prepared me to face life’s challenges courageously. Over time, I learned to trust that everything would work out OK.

Paul drove me to the hospital on November 29, 2000. My other support people were thousands of miles away, which did not seem to matter because I felt alone in what was about to happen. People offered to be there, but I thought I would need them when I got out of the hospital. Wrong!

As I entered the large bathroom off the surgery waiting room with its eight curtained stalls, I was stunned that I could be so calm. Observing myself, I thought, “Would I be this calm if my life were in serious danger?” I only had stage I breast cancer and had to cope with having a mastectomy with reconstruction, about a four-hour procedure. The surgeon would remove the breast tissue from the left breast, including the nipple and place an implant under the chest wall muscles. On the right side she would insert an implant so the two breasts looked symmetrical. She would remove the nipple and take a piece of skin from my abdomen to place over that opening. I would come back six months later so she could take another piece of skin on the other side of my abdomen to build a nipple.

What the Expert Says...

Oncoplastic Surgery: A Creative Surgical Approach

for Breast Cancer Patients

by Gail S. Lebovic, MA, MD, FACS

For Additional Information visit: www.ASBD.org

The term Oncoplastic Surgery describes an evolution within the field of breast surgery that was started in the late 1980s by a few pioneering surgeons. Concerned with the disfiguring surgeries commonly associated with breast cancer removal, these individuals sought a more creative surgical solution. Basically, the idea behind Oncoplastic Surgery is to combine the principles of surgical oncology (cancer removal) with techniques from plastic and reconstructive surgery. In this way, the surgeon plans the cancer-removing portion of the operation while keeping in mind the aesthetic outcome, and utilizing techniques to improve the appearance of the breast(s) afterwards. Oncoplastic Surgery does not describe a particular surgical procedure; it represents a comprehensive approach to surgical planning intended to achieve:

1.Wide surgical margins free of tumor

2.Reduced risk for local recurrence

3.Optimized cosmetic outcome by preserving more skin

4.Breast volume reduction for patients with large breasts and breast cancer

5.In general, fewer surgical procedures overall

6.Prophylactic removal of the breast tissue with reconstruction for patients at high/serious risk of breast cancer (i.e., genetic)

Studies have demonstrated that the Oncoplastic approach adds to the oncologic safety of breast-conserving treatment, and ultimately better cosmetic outcomes following breast cancer surgery. This occurs because a larger volume of breast tissue can be excised and wider surgical margins free of tumor can be obtained. Oncoplastic techniques can be utilized routinely, and they are especially useful in specific cases such as removal of large tumors, when standard breast-conserving approaches have a high probability of leaving positive margins behind. By obtaining a “cleaner” margin, the associated risk of local recurrence can be diminished without creating an unacceptable deformity of the breast.

A preoperative assessment includes a discussion regarding the cancer, but will also include the details of methods of breast reconstruction and whether surgery is needed on the opposite breast such as reduction, lift, or augmentation in order to achieve breast symmetry.

Over the past several decades, techniques for breast reconstruction have undergone dramatic improvements. With the advent and integration of breast implants, tissue expanders and new methods for natural tissue flap reconstructions, there have been dramatic improvements in the appearance of reconstructed breasts. However, even though plastic and reconstructive surgery has seen and achieved great success, recent studies reveal that most women undergoing mastectomy (as many as 80%) are not having breast reconstruction. Unfortunately, fewer and fewer surgeons are committed to this highly specialized area leaving far too many women with little or no option for reconstruction.

This phenomenon has stimulated a tremendous interest in the field of Oncoplastic Surgery, with many breast surgeons seeking additional training in order to offer full and comprehensive management to their patients. Since there are many various clinical practice settings within the United States, sometimes surgeons will work as a team, and in other situations, a single surgeon may have the skills to perform both the cancer surgery and the reconstruction as well.

As mentioned, in some cases the primary surgeon may not take on the additional responsibility of performing the breast reconstruction; however, if the surgeon has an intimate knowledge of the various techniques, the risks, benefits, and timing of each type of reconstruction, this can help the patient take a more active role in planning the overall surgical approach. This allows for integration of all aspects of the surgery. In many cases, immediate breast reconstruction can at least be started at the time of mastectomy with placement of an implant, expander, or flap. This ultimately helps the patient emotionally through the loss of the breast, and in most cases, decreases the number of surgical procedures the patient ultimately needs to undergo.

In this manner, the field of Oncoplastic Surgery will help surgeons learn and apply creative surgical solutions that simultaneously improve oncologic outcome and surgical cosmesis. These techniques are broadly applicable to all patients undergoing breast surgery, and it is most likely that university training programs will soon offer specialty training for surgeons in Oncoplastic Surgery. The American Society of Breast Disease has dedicated significant resources to teach surgeons these unique skills in a unique annual program called the “School of Oncoplastic Surgery.”

Dr. Lebovic is Past President of the ASBD, and founder of the School of Oncoplastic Surgery.

Once inside the bathroom, I had to strip naked and put on the white elasticized stockings and a gown that opened at the back. I placed my underwear, jeans, sweater, socks, and shoes in a paper bag with my name on it. I walked to my gurney with the bag in my hands and gave it to Paul for safekeeping. Reality set in. At that point, I told myself, “You just have to do this. You'll cry about it later. Now, you must stay positive and visualize a positive outcome.” I had to do this to save my life. And, it felt like I was doing it rather well. Grace carried me.