A Notable New Approach To Mastectomy

                Elodie

After Elodie Trouche learned that she carried the BRCA2 mutation gene, and had a 50 to 70 percent chance of getting breast cancer, she became “sick to her stomach worrying” while she waited for her six-month MRI and xray results.  Wishing to ease her mind, Elodie was ready to have a mastectomy, but she didn’t want to be “mutilated,” she recounted. Her sister, who also had carried the BRCA gene, underwent a mastectomy in France a few years earlier, when she was diagnosed with breast cancer.  Eloide didn’t want her breasts to look like her sister’s. “I’d be devastated to have what my sister has in terms of surgery,” she said.

My surgeries were going to be prophylactic. I did them as a healthy patient,” said Eloide, who had a hysterectomy first. “I wasn’t sick, and I didn’t want to be treated as someone with cancer,” she emphasized. “At 45, I wasn’t planning to have other children (she has a 4-year-old son), so I had my ovaries removed and began hormone replacement therapy. There are too many risks associated with entering menopause that early,” she explained.

When it came to her breasts, Eloide woke up one morning and it was “in my head to have [far less invasive] robotic surgery,” but people looked at her like she was “crazy,” she recalled. Learning from a friend with cancer about a doctor on Long Island who was looking for a patient on whom he could perform his first robotic breast surgery, Eloide jumped at the opportunity.

ENTER DR. TANNA

Dr. Neil Tanna, a double board-certified plastic surgeon specializing in cosmetic and reconstructive plastic surgery of the face and breast, had long questioned why patients with and without breast cancer have similar surgeries.  Always thinking of ways “to do things better to maintain a woman’s femininity, and keep her spirits as high as possible and her recovery as low as possible,” Dr. Tanna started researching literature on the most minimally invasive ways to do surgery and breast reconstruction.

From the left: Dr. Gary Deutsch, Dr. Alan Kadison (lead surgical oncologist), Dr. Armen Kasabian, and Dr. Neil Tanna (lead plastic surgeon) with the robot

Learning about the robotic mastectomy, first done in Europe in 2015, Dr. Tanna and Dr. Alan Kadison, a surgical oncologist, traveled to Milan and Paris to spend a few days each with the doctors who had performed the operation. “We were blown away by the procedure, which involves making only a small, 3-to-4 centimeter incision, totally off the breast; instead in line with the bra line a few centimeters below the armpit,” Dr. Tanna explained. “The robot allows us to have the visualization and to use small instruments.  We were impressed with the technique, the doctors’ data and their experiences,” he said.

As fate would have it, Drs. Tanna and Kadison and Eloide found each other! “We told Eloide we had never done the surgery, but she wanted to move ahead,” Dr. Tanna recounted. After getting approval from an Institutional Review Board,as well as training on a cadaver model, he and Dr. Kadison planned Eloide’s surgery for March of this year. “We were happy to start with Eloide because she was a BRCA patient, and there was no question that a nipple-sparing mastectomy (form of mastectomy where the nipple is saved) was indicated,” Dr. Tanna said. And, Eloide’s breasts weren’t sagging, so excess skin didn’t have to be removed. “Robotic surgery can’t be used to remove extra skin,” he added.

ELOIDE AFTER ROBOTIC BREAST SURGERY

The robotic removal of tissue from Eloide’s breasts, and the insertion of implants, lasted about eight hours. Patient and doctors were delighted with the outcome. “I took painkillers the next day, but otherwise had no pain. I drove again after 10 days, and returned to work after two weeks.  I bike and run, and there is zero change in the way I swim. All my mobility has returned,”Eloide reported.

Eloide after her robotic mastectomy and implant surgery

A B cup before the surgery, Eloide opted to have small D implants.  “I breastfed my son for two years, which stretched my skin, so I didn’t have to have it stretched for the larger implants. My old skin is holding them. They feel comfortable and look natural,” Eloide added. “The robot also makes breast reconstruction easier, because it gives us good visualization once the breast tissue is removed,” Dr. Tanna said.

“Eloide had no complications and a quick recovery. This is no longer your grandmother’s mastectomy,” commented Dr.Tanna. “Some women with the BRCA gene, or other genes that predispose them to breast cancer, are afraid to get surgery, but they don’t have to be as afraid today since there are options to restore the breast so it looks as natural as possible.” Besides the aesthetic advantages, robotic breast surgery helps a patient’s overall psychological well being, Dr. Tanna said. “It’s in a woman’s interest to have this surgery if she has a high risk of getting breast cancer.”

By keeping incisions off the breasts, robotic surgery also doesn’t compromise the blood supply to the breasts or “insult” the tissue as does a traditional mastectomy, which involves major cuts to the skin, muscle and often to the nipples, Dr. Tanna explained. “We think we’re minimizing the risk for some of the potential complications related to blood flow after a traditional mastectomy and reconstruction.”

THE NEXT STEP: BREAST CANCER PATIENTS

Believing that robotic surgery also can have successful outcomes for cancer patients, Dr. Kadison aims to lead a clinical trial that will track the outcomes of the surgery on a meaningful group of patients with breast cancer. Hoping to get regulatory approval for the trial by the last quarter of this year, Drs. Kadison and Tanna say they have a “responsibility to patients and to the scientific community at large to determine the safety and success of the robotic technique.”

It’s important to know, however, that robotic surgery only can be performed on women who are candidates for “nipple preservation,” because if cancer is located in tissue near the nipple, it must be accessed by removing the nipple through a traditional mastectomy.

Eloide, in the meantime, has created Robotic Prophylactic Mastectomy, a Facebook group where women can share their experiences about enjoying life after mastectomy.

If you’re interested in contacting Dr. Tanna, you can email him at ntanna@northwell.edu or call him at 516-497-7900.  His practice is located in New Hyde Park, NY.