Minimally Invasive Breast Surgery

Many of my patients come to me years after their mastectomy. Of course, I prefer to rebuild their breast during the mastectomy operation. But the result is the same.

With our BRAVA + AFT (autologous fat transfer) procedure you will not be cut open again. As compared to the traditional methods, this involves no incisions, no new scars, no foreign objects and it recreates a natural feeling breast with the benefit of liposuction.

Plus, you will keep as close to normal sensation in your breasts and nipples. The procedure is covered by insurance for breast cancer patients.

BRAVA is placed over the breast area. The bra is worn while you sleep for average of 30 days before surgery. External expansion of the breast occurs via a comfortable vacuum pressure created by BRAVA. Tissue, and blood vessels begin to expand and generate a scaffold for fat to be injected. Your fat is harvested from several areas of your body through liposuction and is strategically injected into your breasts. No cuts or incisions are made.
Many of my patients come to me years after their mastectomy. Of course, I prefer to rebuild their breast during the mastectomy operation. But the result is the same.

With our BRAVA + AFT (autologous fat transfer) procedure you will not be cut open again. As compared to the traditional methods, this involves no incisions, no new scars, no foreign objects and it recreates a natural feeling breast with the benefit of liposuction.

Plus, you will keep as close to normal sensation in your breasts and nipples. The procedure is covered by insurance for breast cancer patients.

BRAVA is placed over the breast area. The bra is worn while you sleep for average of 30 days before surgery. External expansion of the breast occurs via a comfortable vacuum pressure created by BRAVA. Tissue, and blood vessels begin to expand and generate a scaffold for fat to be injected. Your fat is harvested from several areas of your body through liposuction and is strategically injected into your breasts. No cuts or incisions are made.

The minimum amount of breast cancer that can be detected depends on what type of cancer you are dealing with. In terms of a lump or mass (usually representing an invasive ductal cancer), a tumor as small as 3-4 millimeters (25 millimeters = one inch, so 3-4 millimeters is well under 1/4 of an inch) can sometimes be seen on mammogram, ultrasound or MRI, depending on the density of the breast tissue. DCIS, or in-situ (or noninvasive) cancer often does not form a mass, and typically is detected when microcalcifications are seen on mammogram - again the amount of disease can range from just a few millimeters to a much larger area. Unfortunately both non-invasive and invasive cancers can be present without microcalcifications or a mass on imaging, so sometimes it is very difficult to get a true idea of the extent of disease before surgery. Once the tissue is removed, the pathologist will measure the size of the cancer - it may be larger or smaller than what was anticipated based on the imaging studies.

As far as the minimum amount of breast tissue removed at lumpectomy - it really varies tremendously - there is no standard. The goal of a lumpectomy is to remove the tumor and a "margin" - a rim of normal breast tissue - and still preserve as best possible the cosmetic appearance of the breast. There remains considerable debate on what an adequate margin is - some will be comfortable with no cancer cells right at the edge of the specimen, and some like to go for a wide margin, as large as one centimeter (10 millimeters) or greater. As in many areas, the truth is probably somewhere in between - usually 2-5 millimeters is generally acceptable for invasive cancer and 5 millimeters or greater for DCIS. But as I mentioned in the paragraph above, it can sometimes be difficult to estimate the true extent of the cancer, which makes it very difficult to give a good estimate prior to surgery of just how much tissue will be removed. In addition, at the time of surgery sometimes areas of adjacent tissue look or feel abnormal - it's sometimes a judgement call how much to remove. We try to balance between not having to return to the operating room due to positive margins, versus the poor cosmetic results of removing too much normal breast tissue.

There are some devices being evaluated that are looking at intraoperative margin assessment - being able to tell during the surgery if breast tissue at the edge of the tumor has cancer cells or not. These devices are under investigation, but do seem promising for providing the surgeon more information during the procedure regarding how much tissue to remove. The minimum amount of breast cancer that can be detected depends on what type of cancer you are dealing with. In terms of a lump or mass (usually representing an invasive ductal cancer), a tumor as small as 3-4 millimeters (25 millimeters = one inch, so 3-4 millimeters is well under 1/4 of an inch) can sometimes be seen on mammogram, ultrasound or MRI, depending on the density of the breast tissue. DCIS, or in-situ (or noninvasive) cancer often does not form a mass, and typically is detected when microcalcifications are seen on mammogram - again the amount of disease can range from just a few millimeters to a much larger area. Unfortunately both non-invasive and invasive cancers can be present without microcalcifications or a mass on imaging, so sometimes it is very difficult to get a true idea of the extent of disease before surgery. Once the tissue is removed, the pathologist will measure the size of the cancer - it may be larger or smaller than what was anticipated based on the imaging studies.

As far as the minimum amount of breast tissue removed at lumpectomy - it really varies tremendously - there is no standard. The goal of a lumpectomy is to remove the tumor and a "margin" - a rim of normal breast tissue - and still preserve as best possible the cosmetic appearance of the breast. There remains considerable debate on what an adequate margin is - some will be comfortable with no cancer cells right at the edge of the specimen, and some like to go for a wide margin, as large as one centimeter (10 millimeters) or greater. As in many areas, the truth is probably somewhere in between - usually 2-5 millimeters is generally acceptable for invasive cancer and 5 millimeters or greater for DCIS. But as I mentioned in the paragraph above, it can sometimes be difficult to estimate the true extent of the cancer, which makes it very difficult to give a good estimate prior to surgery of just how much tissue will be removed. In addition, at the time of surgery sometimes areas of adjacent tissue look or feel abnormal - it's sometimes a judgement call how much to remove. We try to balance between not having to return to the operating room due to positive margins, versus the poor cosmetic results of removing too much normal breast tissue.

There are some devices being evaluated that are looking at intraoperative margin assessment - being able to tell during the surgery if breast tissue at the edge of the tumor has cancer cells or not. These devices are under investigation, but do seem promising for providing the surgeon more information during the procedure regarding how much tissue to remove.

There are many state of the art less invasive procedures available to women undergoing breast cancer treatment. These procedures range from nipple sparing mastectomy, new reconstructive materials, new anesthetic options and partial breast radiation.

From the surgical standpoint, many women undergoing mastectomy are candidates for nipple sparing mastectomy. This procedure entails performing the mastectomy via a bra line incision which is barely visible. The entire skin and nipple/areola are left intact while removing the underlying breast tissue. A reconstructive surgeon can reconstruct the breast at the same time. The cosmetic result of this type of mastectomy as compared to a traditional mastectomy is far superior. It is important that the surgeon selects the patient for this type of surgery very carefully ensuring that the cancer is not located near the nipple and the margins are all clear. Data so far have shown that the risk of local recurrence with this type of mastectomy is the same as the traditional mastectomy.

In the reconstructive field, there has been the development of many new implant shapes and materials that achieve superior cosmetic results while necessitating less surgery. These new materials allow the reconstructive surgeon to adequately cover the implant after mastectomy. In some cases this allows the patient to have a one stage reconstruction thereby avoiding future reconstructive surgeries.

In the anesthetic field, many patients undergoing mastectomy in my practice are opting to undergo epidural anesthesia or spinal blocks prior to general anesthesia. This causes numbness of the chest area after the surgery. By having less pain after surgery, there is less need for pain medication and thus less risk of nausea and vomitting. This in turn shortens the time in the recovery room as well as shortens the hospital stay.

In the radiation oncology field, many surgeons are offering partial breast radiation to select patients with small tumors. This is a balloon catheter that is placed in the lumpectomy bed at the time of lumpectomy. Instead of the traditional 6 weeks of whole breast radiation, patients are receiving a 5 day course of radiation to the lumpectomy bed only. Thus far, the data has been promising showing equal local recurrence rates compared to the traditional 6 week course.

Breast cancer surgery and treatment has changed dramatically in the last decade toward the more minimally invasive with superior cosmesis, less pain while maintaining similar local recurrence and survival. There are many state of the art less invasive procedures available to women undergoing breast cancer treatment. These procedures range from nipple sparing mastectomy, new reconstructive materials, new anesthetic options and partial breast radiation.

From the surgical standpoint, many women undergoing mastectomy are candidates for nipple sparing mastectomy. This procedure entails performing the mastectomy via a bra line incision which is barely visible. The entire skin and nipple/areola are left intact while removing the underlying breast tissue. A reconstructive surgeon can reconstruct the breast at the same time. The cosmetic result of this type of mastectomy as compared to a traditional mastectomy is far superior. It is important that the surgeon selects the patient for this type of surgery very carefully ensuring that the cancer is not located near the nipple and the margins are all clear. Data so far have shown that the risk of local recurrence with this type of mastectomy is the same as the traditional mastectomy.

In the reconstructive field, there has been the development of many new implant shapes and materials that achieve superior cosmetic results while necessitating less surgery. These new materials allow the reconstructive surgeon to adequately cover the implant after mastectomy. In some cases this allows the patient to have a one stage reconstruction thereby avoiding future reconstructive surgeries.

In the anesthetic field, many patients undergoing mastectomy in my practice are opting to undergo epidural anesthesia or spinal blocks prior to general anesthesia. This causes numbness of the chest area after the surgery. By having less pain after surgery, there is less need for pain medication and thus less risk of nausea and vomitting. This in turn shortens the time in the recovery room as well as shortens the hospital stay.

In the radiation oncology field, many surgeons are offering partial breast radiation to select patients with small tumors. This is a balloon catheter that is placed in the lumpectomy bed at the time of lumpectomy. Instead of the traditional 6 weeks of whole breast radiation, patients are receiving a 5 day course of radiation to the lumpectomy bed only. Thus far, the data has been promising showing equal local recurrence rates compared to the traditional 6 week course.

Breast cancer surgery and treatment has changed dramatically in the last decade toward the more minimally invasive with superior cosmesis, less pain while maintaining similar local recurrence and survival.