If you are newly-diagnosed with breast cancer, and this post is one of your first reads on the subject of reconstruction, you may be surprised to know that keeping the nipple is not standard in breast reconstruction. I know I was shocked to learn that the nipple has always been removed as a matter of course, even with a 'skin-sparing' mastectomy. I had always imagined that the breast would just be scooped out like a melon, and new 'filling', whatever it may be, put in. Learning that I would probably lose my nipple came as devastating news to me, I don't mind saying. That was the point at which I became pretty depressed about my situation.
Indeed, for many of us who face mastectomy, losing the nipple seems to be the most disfiguring part of the surgery. This fact is finally starting to percolate among surgeons who have been taking a harder look at the true risks associated with keeping the nipple. For a long time since breast conservation surgery became standard, it was thought that the nipple area would always be at higher risk for harboring cancer cells, since all the ducts in the breast lead to the nipple. But as surgeons actually began listening to their patients who wanted to keep their nipple, they looked harder at the data to see if this was really true, and it was found that for most women who don't have cancer near the nipple, or Paget's disease, the nipple could often be kept with little risk of cancer recurrence in that area. Some surgeons, in fact, completely hollow out the nipple area, leaving a hollow cone that can be refilled with other tissue.
Many surgeons are learning just how much keeping the nipple improves the quality of life for a woman, and may greatly improve her morale post-op, especially if she ends up facing an ongoing battle with cancer . Sometimes the small things really do matter. I remember sitting in one reconstructive surgeon's office and he said to me, "Mastectomy is such a harsh term. We prefer to say, "Gland Replacement Therapy". I appreciated that statement, because when all of the breast skin, including the nipple, is kept, then it really is just a matter of replacing the mammary tissue and fat in the breast with something else. You still have your breast, although there may be little to no feeling. This is, indeed, a far cry from classic mastectomy, where a woman is left with no breast, and only a scar running across the flattened area. As far as I'm concerned, anything that brings one closer to having the breast they used to (or in some cases an even better breast) is a blessing!
Nipple sparing mastectomy (NSM) is newer, but it is slowly becoming the gold standard for reconstructive care, and will continue to be. More and more practices around the country are offering this option, so seek them out. Below is a short list of those bigger names that offer NSM. There is certainly nothing to lose if your surgeon feels you are a candidate, and the worst that will happen is what happened to me -- the nipple will not do well, and you'll end up having some reconstruction. Personally, I comfort myself, knowing that I tried.
A simple search for any of these names, along with the terms 'nipple sparing' will probably take you where you need to go.
Cleveland Clinic (I believe the procedure was pioneered here)
University Hospitals, Cleveland (I find Cleveland to be a hub for many advanced medical procedures. You lucky Ohioans!)
Sloan-Kettering, NYC
Robert Allen practice, NYC
Mayo Clinic
Paoli Hospital, Paoli, PA
And here is a wonderful thread on breastcancer.org with many names from all around the country, along with personal recommendations.
http://community.breastcancer.org/forum/44/topic/750056?page=1
Good Luck!
No comments:
Post a Comment