We have become accustomed to attending online webinars. One I have watched from inception is the iBreastBook webinars. It was designed by oncoplastic breast surgeon Yazan Masannat. He is located in Aberdeen, Scotland. I continually learn from these webinars and appreciate the global presence of presenters and attendees. Yazan is driving change in breast surgery by exploring the latest surgical techniques in breast surgery in these online learning opportunities. The most recent one I attended I ask myself; can we drive change in breast sensation through webinar attendance?”
Why is Driving Change in Breast Sensation Important to Me?
The title of the webinar I am commenting on is, Mastectomy: What is New. The presenters were an impressive group of international surgeons in breast surgery. They are as follows:
- Nicola Rocco, Italy, on the safety of skin and nipple sparing mastectomy.
- Mahmoud El-Hossiny, Egypt, on the Goldilocks mastectomy.
- Anne Peled, San Francisco, USA, on sensation preserving mastectomy with implant reconstruction.
- Minas Chrysopoulo, San Antonio, USA on sensation restoring mastectomy with free flaps.
I am a patient who has experienced successful return of sensation to my breasts after DIEP flap breast reconstruction. It is equally important for me to emphasize what I learned and was inspired by in the webinar today as a patient advocate on behalf of the breast cancer community I serve. They are asking about these techniques.
I had left breast radiation in 2002 after a lumpectomy to excise my early-stage breast cancer. In 2014, I had a recurrence and new primary breast cancer. I then had a double mastectomy and delayed DIEP flap seven months later. Minas Chrysopoulo, one of the presenters for the iBreast webinar, performed my DIEP flap. In the months following the surgery I began to regain sensation in my breasts after being left numb by my double mastectomy, even on the previously radiated left side. This is why driving change is important to me. I want others to have this experience after being affected by breast cancer. To me, it is not happening enough, but I have hope! It’s a big deal to me, too, Dr. C!
Techniques in Nerve Preservation Discussed
Dr. Anne Peled, a pioneer in breast preservation with her husband, Ziv Peled, a peripheral nerve and plastic surgeon, utilize their combined skills on behalf of patients. Their work in preserving and grafting nerves is known worldwide. However, it is not practiced worldwide. This is why these webinars drive change. The technique Anne spoke of is preserving nerves at the time of mastectomy.
A breast cancer survivor herself, Anne knows first-hand this nerve preserving procedure not only is an issue of safety but also one of quality of life for patients. There have been reports of thermal burns because of numbness in the breast. This is a safety issue and is one that is difficult for me when I hear patients are experiencing this. We can do better. The erogenous sensations lost when nerves are cut leaving a patient numb impact a breast cancer patient’s quality of life after surgery. Preserving the nerves can maintain this sexual health function.
Techniques in Nerve Reconstruction Discussed in Webinars
Dr. Minas Chrysopoulo, a sought-after expert in nerve reconstruction with free flaps, talked about the procedure performed on me during my delayed DIEP flap. My surgery was in 2014 and he has been collaborating with his colleagues at PRMA for a number of years doing this procedure with remarkable success. He followed Dr. Peled’s presentation and stated, “Preserving nerves is always a choice over reconstructing nerve.” The reality is it is not always the case for a number of reasons.
Dr. C pointed out how crucial a collaborative team effort is. Working with breast surgeons to maximize nerves at the time of mastectomy is imperative. However, many patients travel to their practice that have their mastectomy elsewhere. They come to Dr. C experiencing numbness and this is where his surgical prowess benefits patients when he reconstructs these nerves restoring sensation to the breasts.
What I found absolutely fascinating is hearing him speak about portions of blood vessels they trim during surgery, necessary to access other perforators, and reuse them as a nerve conduit when they sew the nerves together. This is a cost-effective measure when an expensive nerve graft does not have to be used as the nerve conduit. It cannot always be the case but when they can, they utilize these trimmed, saved portions of blood vessels. He even showed the technique in the webinar in a video. Talk about the ultimate recycling! Fascinating!
Witnessing Change in Breast Sensation Through Webinar Attendance
When comrades unite in settings like this and you see the excitement build, you witness the change. Yazan suggested bringing Dr. Peled and Dr. Chrysopoulo over to Europe to begin to train surgeons there teaching them these techniques in nerve preservation and reconstruction. I smiled as I watched the exchange and the magic happen. It was welcomed by the moderators, presenters, and this patient advocate.
I know these changes will happen. I have witnessed it on a global scale and will stop at nothing to be part of this change in any small way I can. If you are a patient, ask your breast surgeon if they know about nerve preservation. Ask if it is oncologically safe in the setting of your tumor and where it is located in your breast. If they do not do it, ask if they can refer you to a breast surgeon who does do it. But be prepared it may involve travel on your part. If your nerves have been cut already during a mastectomy, ask the plastic surgeon you have a consult with for breast reconstruction if they perform nerve reconstruction. If they do not, ask if they can refer you to a microsurgeon who does do it.
When Patients Help Drive Change
I know I have repeated myself but this bears repeating. We cannot drive change as patients if we do not ask for and insist on finding surgeons who preserve and reconstruct nerves to give patients breast sensation who are affected by breast cancer and face loss of breasts. Surgeons who are not performing these procedures, please consider adding it to your armamentarium of skills. Patients are asking! I recently spoke to one patient seeking a surgeon who restored or preserved sensation. Her statement to me, “I thought they all did this!” This is a big deal to us.
This Webinar Will Drive Change in Breast Sensation
I leave you with some powerful quotes from presenters and moderators of the webinar.
If we do not get the basics right, then it doesn’t matter how wonderful and how brilliant we’re doing all of this neurotization… if we don’t get the mastectomy right then everything goes wrong, and you just repent and then the patient has tears.
Dr. Iain Brown
This is something people can start incorporating into their practice, just looking for nerves, not injuring them, and really trying to find them. That in and of itself will be a great start. Once you do this it is pretty remarkable. Once you start seeing nerves you can’t unsee them.
Dr. Anne Peled
As human beings we find reasons not to change and not to add complexity to our routines. We are status quo beings. But it is always good to validate your status quo choices. Patients see the difference. They really, really do. Thank you, Terri. I know you’re listening based on your comment. Thank you for chiming in. It’s a big deal guys and thank you for recognizing that.
Dr. Minas Chrysopoulo
Yes, I am listening and YES, it is a big deal!
