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What is conservative mastectomy – la Repubblica

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What is conservative mastectomy – la Repubblica

Even mastectomy, that is, the removal of a breast due to cancer, can be conservative. He explains what this term means and how breast cancer surgery has changed Viviana GalimbertiDirector of the Surgical Breast Division at the European Institute of Oncology (IEO) in Milan and member of the promoting committee of the DonnaxDonna project.

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Dr. Galimberti, what is meant by conservative mastectomy?
“Mastectomy underwent a first change in the early 2000s, becoming increasingly conservative. At one time, in fact, there was a tendency to remove a large part of the skin and the nipple. Over the years more and more skin has begun to be saved, up to skin sparing surgery, in which only part of the nipple was removed. A big change was then the nipple sparing surgery, possible where there is no infiltration of the tumor in the nipple-areola area or microcalcifications in the underlying part”.

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Is sensitivity also preserved?

“Unfortunately, only about 20% of patients partially retain sensitivity, because the whole gland is denervated, but we still see a greater psycho-social well-being”.

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What are the contraindications to nipple sparing mastectomy?

“Obviously this technique cannot be used when the tumors involve the retroareolar tissue, or in the case of inflammatory tumors, pathological secretions from the nipple itself, or in those with Paget’s disease. Other relative contraindications are previous radiotherapy, being a heavy smoker or having very large breasts, because in these cases the risk of the nipple necrosis increases. It has to be evaluated on a case-by-case basis. In some patients it is possible to remove it and then re-graft it with plastic surgery techniques”.

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But is it possible to reconstruct the nipple, in patients in which it has to be removed?
“Where it cannot be preserved, it is possible to recreate it with a skin flap and using dermopigmentation, but the aesthetic result is not always satisfactory, because it tends to flatten out over time and the pigment can lose its colour. In some cases it is possible to take a small part of the contralateral nipple and dermopigment the areola. Another possibility is the so-called 3D tattoo, in which the areola-nipple complex is drawn and colored with dermopigmentation, like a trompe-l’oeil”.

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A recent study shows that about a quarter of women in the US experience some sort of burnout and stop breast reconstruction. Does it also happen in Italy?

“It is true that when it is not possible to reconstruct the areola and the nipple, many women give up or interrupt reconstructive oncoplastic surgery. It’s a psychological issue: having to go back to the hospital and facing a new operation represent insurmountable obstacles for some patients. This is also why it is essential that psychological support is provided in the Breast Units: when women are supported, they hardly abandon the course”.

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Would it be ideal to be able to do an immediate reconstruction?

“Yes, that is, a reconstruction contextual to the mastectomy, in a single operation. Unfortunately this onco-plastic technique is not in the Lea and is therefore not reimbursed by the health system, while reimbursement is foreseen for deferred reconstruction, although it varies greatly from region to region. In my view, this is a very serious problem that will have to be overcome. Despite this, however, in the Breast Units each patient is guaranteed the most suitable technique for her specific case”.

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