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New Technique in Breast Cancer Surgery Helps Hide Scars


Korey Karnes Huyler for GBMC

October 15, 2019
More than 300,000 women in the United States are diagnosed with breast cancer each year — and because of that staggering number, it’s a disease than gets a lot of attention from doctors and researchers. So it’s not surprising that new treatments, medications and surgical techniques are constantly being introduced.

While almost everyone diagnosed with breast cancer eventually undergoes some type of surgery — lumpectomy, mastectomy, with or without reconstruction — a newer method of performing these surgeries with a more cosmetically favorable result has joined the mix: Hidden Scar Surgery.

“The standard of care for most early stage breast cancer is breast-conserving surgery, which is lumpectomy followed by radiation therapy,” says Dr. Sara Fogarty, a breast surgeon at The Sandra and Malcolm Berman Comprehensive Breast Care Center at Greater Baltimore Medical Center (GBMC). “And recently, there has been a big push to also do more cosmetically favorable incisions — these are called Hidden Scar surgeries, which use small incisions that are hidden.”

So, what does that really mean?

“We try to make our incisions underneath the breast or around the areola (the colored part around the nipple), or even in the armpit, so that there is no actual scar on the front of the breast,” explain Dr. Fogarty. “Often women don’t see these scars, which is great.”

Several decades ago, women with breast cancer underwent a mastectomy potentially followed by a second reconstructive surgery. Now the trend in breast cancer surgery is to offer less invasive procedures with similar or better outcomes.

“We’re really moving away from bigger surgery and numerous surgeries,” Dr. Fogarty explains. “A lot of things that used to be surgical aren’t anymore because our other treatments are so much better. For example, nowadays we rarely perform axillary dissection, a procedure for invasive breast cancer where many of the lymph nodes are removed. The data shows it does not affect survival outcomes."

Instead, she regularly performs sentinel node biopsies, where she removes a single node or nodes from the armpit. “If there is disease in these nodes, instead of returning to the OR for more surgery, we will extend the radiation fields to include the patient's armpit," she explains.

Dr. Fogarty says most of the surgeries she currently performs are lumpectomies and attempts to hide these scars whenever possible, meaning that only the tumor and some surrounding normal tissue is removed — and the scarring is minimal. This means survivors won't have the constant reminder of their breast cancer by seeing a scar for the rest of their lives.

Rapid improvements in medicine are also changing the breast cancer surgery landscape.

“With chemotherapy, newer immunotherapies and hormone therapy, larger surgeries are not required as in the past, and even less surgery will be done in the future,” explains Dr. Fogarty. “It’s changing so fast. There are always new drugs, and new research is ongoing."

The GBMC breast cancer team works together to create a unified treatment plan.

“The surgeons, radiologists, pathologists, medical oncologist and radiation oncologists here at GBMC all work together very closely to treat our patients, remove the cancer and help prevent recurrence.”
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