Breast cancer: 'The plastic surgeon needs to be part of the cancer team'

Breast cancer: 'The plastic surgeon needs to be part of the cancer team'
Plastic surgeon Dr. Kiya Movassaghi thinks women facing a masectomy need to consult with a plastic surgeon before they have the cancer - and their breasts - surgically removed.

EUGENE, Ore. - The Pacifc Northwest has one of the highest rates of breast cancer in the country: one in seven women will be diagnosed with the disease.

When the disease requires a surgeon to remove a woman's breasts in a procedure known as a masectomy, however, nothing requires the surgeon to talk to the patient about breast reconstruction.

Plastic surgeon Dr. Kiya Movassaghi thinks women facing a masectomy need to consult with a plastic surgeon before they have the cancer - and their breasts - surgically removed.

"It allows me to assess the patient's anatomy beforehand so I know what they look like beforehand and therefore I can give the patient the best advice for reconstructive options," Movassaghi said. "There is nothing like the skin of the breast that you can replace it with so if you can preserve it, ideally, you can come up with the best cosmetic reconstructive options for the woman."

Movassaghi favors a law like on in New York state that requires suregons performing masectomies to suggest patients consult with a plastic surgeon prior to the operation.

"It is not about enforcing the reconstructive options for the patients," Movassaghi said. "Patients don't have to see a plastic surgeon if they don't want to, but at least they were told that they have an option."

"I think the plastic surgeon needs to be part of the cancer team," Mossavaghi said.

Dr. Kristian Ferry, a surgical oncologist - the technical name for a doctor who performs surgeries as part of cancer treatment - recommends that more women consult with plastic surgeons before a masectomy.

Ferry does not favor forcing doctors to make that recommendation, however.

"I think in most cases it is entirely appropriate and is part of my practice," Ferry said. "And in some cases it's clearly not appropriate."

For example, when a woman will be going on to chemotherapy or when a women faces another more radical surgery, Ferry might not advise plastic surgery as an option.

But the doctor agress that plastic surgeons should be involved before the masectomy when women want to consider reconstructive surgery

"In most cases it is best to get a plastic surgeon involved from the beginning because they can tell the patient a lot about what their options are and also have them think about things they normally wouldn't think about and widen their scope of the overall outcomes they could have," Ferry said. "In the past we sort of thought about younger patients only seeing the plastic surgeon for immediate reconstruction. That probably is false preconceptions. Now we have patients that are quite elderly seeing the plastic surgeon."

Ferry thinks a physician has a responsibility to discuss the subject with a breast cancer patient.

"I think if you don't offer, if those options aren't on the table, they don't think about those things," Ferry said. "You have to get past your preconceptions as a doctor and a surgeon and think more about what the patient would want."

Ferry said surgeons have been hesitant to leave breast and nipple skin behind in "complete envelope sparing procedures" because of the risk the cancer could come back.

That might not be necessary however, and leaving that skin intact helps plastic surgeons better reconstruct the breast.

"There has been no data," Ferry said. "In fact there has been data to the opposite that there is not reoccurrence in that skin that you leave behind. In fact when you do a partial mastectomy or do a mastectomy, a traditional procedure, you leave skin behind and our local reoccurrences are vanishingly low."

Ferry agrees that not as many women as choosing reconstruction as could be.

"Overall in the United States about 20 percent of mastectomies are reconstructed," Ferry said, "and probably that should be higher."

But Ferry doesn't think a law is the way to achieve that goal.

"It may introduce more confusion than benefit," Ferry said. "For the patients that are not appropriate for consultation or really don't want that, it burdens them with more information that's really not useful and time and expense."

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