“Concealed” Scar Technique for Breast Surgery Promotes Emotional Healing

Approximately one in eight women will develop breast cancer during the course of her lifetime. Although genetic testing can identify individuals who have inherited a harmful gene (BRCA1 or BRCA2) that increases breast cancer risk, other factors, such as a woman’s reproductive history or a family history of some cancers, can also increase the risk of developing the disease.

The challenges that accompany a breast cancer diagnosis are both physical and emotional. Surgery to remove a cancerous tumor is the standard of care, but can cause patients distress at the thought of scarring or disfigurement. Highly skilled breast surgeons who are focused both on removing the cancer and optimizing the appearance of the breast can alleviate such concerns.

Ted A. James, MD, MS, FACS, chief of Breast Surgical Oncology and co-director of the BreastCare Center at Beth Israel Deaconess Medical Center is one such surgeon. He and his BIDMC colleagues regularly employ a special breast cancer surgery technique – which combine their breast surgery skills with plastic surgery techniques – to minimize noticeable scarring. Although some situations do not allow for this type of breast cancer surgery, data has shown that women whose surgeries are performed with these techniques are at no greater risk of cancer recurrence.

“It is truly a win-win,” says Dr. James. “Not having an incision that is a visible, daily reminder of the experience you went through has tremendous benefit in terms of well-being, quality of life, and getting back to your normal routine.”

Breast cancer surgeries include lumpectomy, during which a tumor and some of the surrounding tissue is removed, and mastectomy, during which all of the breast tissue is removed. This “concealed” scar technique for breast cancer surgery for lumpectomy involves placing the incision underneath the breast line, around the areola, or in the fold of the armpit, depending on the location of the tumor. When skin-sparing or nipple-sparing mastectomy followed by reconstruction by a plastic surgeon is performed, the breast surgeon makes the incision around the areola or under the breast. This preserves the skin and does not create the typical large scar across the chest. “After reconstruction, sometimes it’s very difficult to tell which breast was removed,” Dr. James says.

The Beth Israel Deaconess Medical Center BreastCare Center team includes breast oncology surgeons, plastic and reconstructive surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, nurse practitioners, nurse/patient navigators, genetic counselors, and social workers who work collaboratively to develop an individualized treatment plan for every patient. For example, realizing that a lumpectomy to remove a large tumor will result in loss of volume in that breast, the breast surgeon and plastic surgeon can decide to be in the operating room together, using their combined expertise to remove the cancer and preserve the symmetry of the breasts at the same time. Or the surgeon may have information the radiation oncologist needs to know prior to planning post-surgical treatment.

“The broad experience of our multidisciplinary group allows us to develop a comprehensive plan from start to finish,” Dr. James says. “Sharing knowledge and having the entire team on the same page is essential to keeping our commitment to meet patients’ physical and emotional needs.”