Novel breast cancer surgical technique now available in New England

Jennifer Gass, MD, chief of surgery at Women & Infants Hospital of Rhode Island and a breast surgeon with the Breast Health Center in the hospital's Program in Women's Oncology, recently completed a one-month sabbatical in Paris with the world-renowned breast surgeon Krishna B. Clough, MD, medical director of the Paris Breast Center.

The sabbatical is key to making the novel surgical technique available to breast cancer patients through Women & Infants, which is the first facility in New England using this new approach to breast and cosmetic preservation.

Dr. Gass traveled to Paris to gain hands-on experience with Dr. Clough, who has been a pioneer in the field of oncoplastic surgery, a surgical approach that combines the best techniques from plastic surgery with oncologic surgery to remove breast cancer. The oncoplastic approach helps the breast surgeon reshape the remaining breast, either by redistributing the volume lost when the cancer is removed through the remaining breast, or by using other tissue to refill the space. The end result is a cancer-free breast that looks natural.

Dr. Clough, who trained in the United States and France, was chief of the Department of General and Breast Surgery at the Curie Institute when he resigned in 2005 to found the Paris Breast Center, the first facility in France dedicated to breast surgery and breast cancer.

Continuing his research, Dr. Clough and a small group of European surgeons created the concept of oncoplastic surgery. At the Paris Breast Center, oncoplastic surgery was fully integrated as a multidisciplinary treatment and is now considered one of the main recent advances in breast cancer surgery.

"Many women with breast cancer know they need to have surgery to remove the disease but they are afraid of looking disfigured after surgery," explained Dr. Gass, who is also who is also director of the Breast Fellowship at Women & Infants and an assistant professor of surgery at The Warren Alpert Medical School of Brown University. "Oncoplastic surgery includes tailoring the excision to minimize distortion, ultimately yielding a breast of optimal size and shape."

Furthermore, the oncoplastic approach considers pre-existing breast diagnoses, as the surgeons plan to remove the cancer. A woman, therefore, may have ptosis (sagging breasts), macromastia (very large breasts) or asymmetry (breasts that are uneven in size) before her breast cancer diagnosis. The underlying condition, along with the cancer diagnosis, are addressed in surgery.

"The patient, at completion of therapy, has not only had treatment for her cancer but the underlying condition as well," Dr. Gass noted. "She can be more confident in her self-image."

The oncoplastic approach to breast surgery has greatly advanced the field from the traditional mastectomy to nipple sparing mastectomy. While mastectomy has been paired with immediate reconstruction in the past, women had to undergo additional surgery to achieve the final result. Now, with the preservation of the nipple areola complex, a truly one-staged immediate reconstruction is a reality. Oncoplastic surgeons use breast reduction techniques to contour the breast to have a smaller but rounder, more uplifted appearance. The unaffected breast is often exposed during the procedure to ensure the results are visually symmetrical. The unaffected breast may also undergo a procedure to create symmetry in some cases.

"Overall, the goal of oncoplastic surgery is to improve the patient's journey through survivorship," Gass said. "We want women to look at themselves with the pride they deserve, rather than looking at a scar as if it were a badge of courage."

In addition to bringing these new procedures to Women & Infants, Dr. Gass will also be teaching them to the breast cancer fellows who study at the hospital, the only facility in New England to offer such a prestigious educational opportunity.