Hollings surgeons offer cutting-edge reconstructive options to breast cancer patients

From flat chest closures to sensation sparing reconstructions, MUSC Hollings Cancer Center offers breast cancer patients more reconstructive options thanks to breakthroughs in technology and advanced surgical techniques.

Kevin Delaney, M.D., an MUSC Health plastic surgeon who works with breast cancer patients at Hollings, said giving patients a seat at the table is important for overall care and quality of life. Providing options to patients is a core part of Hollings’ Advanced Breast Reconstruction Program.

“We make the reconstructive process and decision-making patient focused,” Delaney said. “A patient’s type of breast cancer, current health status and age can all play a role in the options we may recommend. At the end of the day, we want to give our patients options.”

 

Delaney said one of the biggest decisions that breast cancer patients have to make is whether they want implants, which can be placed easily but have a limited lifetime, or have reconstruction using their own tissue, known as autologous perforator flap or flap reconstruction.

While implants offer patients a quicker procedure and recovery time, they likely will need to be replaced over time. Delaney said flap reconstruction is a more intensive surgery and requires a hospital stay but reduces the risk of complications from implants and future surgeries.

“The most common type of flap reconstruction that we do at Hollings is where we remove the lower abdominal tissue, skin and fat and disconnect that from the belly area, leaving important blood vessels attached,” Delaney said. “We then move the tissue, skin and fat up to the breast and hook those blood vessels up to blood vessels under the rib to ensure that that tissue stays alive.”

Another option Hollings’ patients have is to do no reconstruction at all and opt for a flat chest closure. “This tends to be more popular in the older cohort of patients. In the last two years, however, I’ve seen more younger and healthy patients opt not to go through reconstruction and choose a flat chest closure,” he said. “There isn’t a rhyme or reason for this that I know of. Every few years, we see an uptick in younger patients opting for this procedure.” 

“To provide full treatment, we must support patients both physically and mentally. Involving patients in their care and giving them options, guidance and support is a major focus that we are proud of at Hollings.”
— Dr. Isis Scomacao

Giving patients improved options for reconstructive surgery is in the spotlight after a new study found surgery choice correlated with long-term quality of life for breast cancer patients under 40 who were polled. For instance, researchers found that unilateral or bilateral mastectomy patients who underwent radiotherapy had lower satisfaction rates than those patients who underwent breast-conserving therapy.

Preserving function and sensation in the breast is a prime focus for Isis Raulino Scomacao, M.D., an MUSC Health plastic surgeon who specializes in sensation and nipple-sparing reconstructive procedures. “By increasing sensation, we really improve the life of that patient,” Scomacao said. “This improves patient satisfaction and is another way of improving the reconstructive options we can offer.”

 

Scomacao says one of the biggest areas of dissatisfaction comes from patients who lose sensation in their nipples. Despite options for nipple-sparing surgeries, patients reported loss of sensation following the procedure, which resulted in a lower quality of life.

Scomacao said Hollings is one of the few cancer centers in the country to offer a nerve-preserving nipple reconstruction for patients who have opted to have implants. With this option, surgeons do a nerve graft on the side of the breast where it meets the chest wall. Surgeons then connect the nerve to the undersurface of the nipple, with the goal of improving sensation of both the nipple complex and breast skin.

“The end goal is to provide patients options and the best quality of life,” Scomacao said. “Hollings offers breast cancer patients specialists in every facet of their care, under one roof. By having providers in one system, we can communicate quicker, review each patient’s case and bounce ideas off each other to come up with the best treatment plan possible for that individual patient.”

Delaney said the multidisciplinary team at Hollings ensures that patients receive the most comprehensive and best treatment plan available. On top of taking care of the physical needs, Hollings also offers patients mental health support and survivorship groups.

“We understand that there is so much more to patient care than the diagnosis and the physical treatment,” Delaney said. “To provide full treatment, we must support patients both physically and mentally. Involving patients in their care and giving them options, guidance and support is a major focus that we are proud of at Hollings.”

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