“It doesn’t look like I had anything done”
When Marilyn Cahill showed up for her routine mammogram at Falmouth Hospital, she got the news no woman wants to hear. Using the hospital’s 3-D tomosynthesis breast screening technology, the radiologist had found a suspicious spot in her right breast.
That set off a chain of events that led Cahill, 54, through a cancer diagnosis, a double mastectomy and reconstructive surgery. But, while the overall experience was challenging, she is happy with the end result. Her breast reconstruction was done using a technique that not only hid any reconstruction scars but spared her natural nipples.
“I love the way I look; it doesn’t look like I had anything done,” she said recently. “I’m really happy with the way I look and feel.”
Nipple-sparing reconstruction is a Hidden Scar technique, according to Cape Cod Healthcare surgeon Kathryn Dalton, DO, who did Cahill’s surgeries in conjunction with plastic surgeon Michael A. Loffredo, MD, at Cape Cod Hospital. The breast surgeon makes the incision under the fold of the breast, leaves the skin and nipple intact and removes the interior tissue. The plastic surgeon then inserts tissue expanders and, about three months later, an implant, Dr. Loffredo said.
The nipple-sparing technique received a lot of publicity when Angelina Jolie chose it for her prophylactic double mastectomy in 2013. The goal is to have a more natural looking and feeling nipple than is possible when the entire breast is removed, and the nipple has to be created by a plastic surgeon.
“The old school surgery was where we did radical mastectomies and they were so disfiguring,” said Dr. Dalton. “We’ve just learned over time that we have the same survival rates when we do less-invasive surgery.”
Cahill, who is married with two grown children and one grandchild, had the mastectomy in January 2017 and reconstructive surgery the following May. She did not need chemotherapy or radiation.
“It’s tough to get through, I’m not going to lie,” Cahill said. “But with that being said, it’s peace of mind to have had it done.”
Just As Safe
Studies have shown nipple-sparing surgery to be as safe as more radical mastectomies for qualifying women with cancer, according to data reported by the American Society of Breast Surgeons [pdf].
And, the latest research says the technique is safe for high-risk women who have a genetic mutation that increases the risk of breast cancer. Dr. James Jakub, a breast surgeon at the Mayo Clinic in Rochester, Minn. and others, analyzed 551 prophylactic mastectomies in 348 patients from nine medical institutions between 1968 and 2013. Of these, 145 patients had a single breast removed after breast cancer was discovered in the other breast, while 203 had both breasts removed as a precaution. No double mastectomy patients developed breast cancer at any other site in the body, according to the data published in April in Current Surgery Reports. The seven patients who died had a prior or an existing cancer at the time of their surgery in the opposite breast.
“There’s a nipple-sparing database that’s ongoing,” said Dr. Dalton. “The database shows that it’s safe and that there’s no difference in survival.”
Not every patient, however, qualifies for nipple-sparing surgery. It’s not appropriate for women who have very large breasts or for those with cancer in the areola and nipple or inflammatory breast cancer. Nor, should it be done on those who smoke or are diabetic and may have prolonged healing issues, said Dr. Dalton. The size of the tumor, however does not seem to matter, she said. And the surgery can be used on women with multiple tumors, lymph-node involvement or those who will need radiation treatment, she said.
“Assuming the patient is a good candidate, the risks of the surgery are more or less the same as the risks of the more traditional mastectomy reconstruction,” said Dr. Loffredo. “The results, however, can be dramatically superior. Mastectomy can be a very traumatizing experience for a woman and when we are able to save the patient’s nipple and areola and then deliver her a natural-appearing breast, she tends to recover from the experience better overall.”
Women diagnosed with breast cancer at Cape Cod Hospital or Falmouth Hospital, who are interested in learning more about the nipple-spare and Hidden Scar technique, can have a consultation with Dr. Dalton to see if they are eligible for the surgery.
Patients are advised that although the breast may appear more natural, they may lose sensation in the nipple and areola. Cahill said she has numbness on her right side and sensitivity on her left.
“But that’s OK, I’m cancer free,” she said.
And now Cahill is working to help other cancer patients. She’s started a “shabby chic” business painting and selling furniture and is donating 50 percent of all proceeds to the Cape Wellness Collaborative, which offers integrative treatments to cancer patients.
“I’m in a good place right now and very fortunate to have great surgeons and great caregivers,” she said. “Cape Cod Hospital was amazing.”