Mastectomy Patients Offered Total Skin-Sparing Procedure
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Cristiano Boneti, M.D., is excited that he can give UAMS breast cancer patients improved reconstruction results.
Jan. 4, 2011 | Cristiano Boneti, M.D., is excited that breast cancer patients at the University of Arkansas for Medical Sciences (UAMS) now have a surgical option that wasn’t available as recently as seven years ago. The procedure is called the total skin-sparing mastectomy, and it can give improved reconstruction results to breast cancer patients who undergo mastectomy procedures.
“Some of the first mastectomy procedures involved removing the entire breast, the underlying muscles and most of the skin from the chest wall,” said Boneti, who is an assistant professor in the UAMS College of
Medicine’s Department of Surgery, Division of
Breast Surgical Oncology. “The procedure was very
disfiguring and devastating for the patient.”
After decades of using the very aggressive procedure, surgeons wanted to develop a less-invasive option to give patients an improved cosmetic result. Surgeons modified the original procedure and began to remove only the actual breast, leaving the underlying muscles intact.
“From the initial modification, many others were developed that gave patients improved cosmetic results, but none of those modifications were able to successfully preserve the nipple,” said Boneti, who sees patients in the Breast Cancer Clinic at the UAMS Winthrop P. Rockefeller Cancer Institute. “Because the nipple contains most tubules and glandules that may turn into breast cancer, people were afraid to save the tissue out of fear the cancer would come back.”
In 2004, researchers discovered that the top seven millimeters of the nipple did not contain any tubules or glandules. With that discovery, the total skin-sparing mastectomy was developed. The procedure removes all the breast tissue and leaves only the skin of the breast, including the skin of the nipple. By saving all the skin of the breast, the reconstruction process can now take place at the same time as the mastectomy procedure.
“The total skin-sparing mastectomy allows our patients to undergo the mastectomy and reconstruction procedures at one time,” said Boneti. “Before this procedure, patients would have to undergo at least two or three surgeries in order to have the breast removed and reconstructed; now it can all be done at once.”
“A lot of patients I speak with say that having to lose their breasts on top of being diagnosed with cancer is too much, because they feel that their womanhood is associated with their breasts,” said Boneti. “By offering this type of procedure we are allowing patients to focus primarily on cancer and not the cosmetic implications of having a mastectomy, and that provides a great benefit to our patients.”
Boneti along with V. Suzanne Klimberg, M.D., chief of the Division of Breast Surgical Oncology and professor on the Departments of Surgery and Pathology in the UAMS College of Medicine, presented their findings on the total skin-sparing mastectomy procedure in December 2010 at the Southern Surgical Association’s annual meeting in Palm Springs, Fla.
“UAMS took on a leadership role in regard to practicing the procedure, and since we presented our findings at the Southern Surgical Association meeting, Dr. Klimberg has received calls from surgeons throughout the nation who want to learn how to perform the procedure,” said Boneti.
Klimberg also directs the Breast Fellowship in Diseases of the Breast at UAMS and holds the Muriel Balsam Kohn Chair in Breast Surgical Oncology at UAMS. Boneti completed his fellowship in the breast program under the direction and guidance of Klimberg.