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AAMC's new implant method speeds up breast cancer recovery
Capital - 10/5/2018
With the combination of an old routine and new technology, surgeons at Anne Arundel Medical Center say their patients are recovering from breast cancer faster.
To improve mastectomy reconstruction after breast cancer, AAMC chief of plastic surgery Devinder Singh is using the prepectoral method.
In the 1960s, doctors would remove the breast and put implants under the skin during mastectomies. This usually resulted in scarring, infection and painful disability, Singh said, so the modern method became burying implants under the chest muscles.
"It looked horrible, was incredibly disabling and was a bloody mess," Singh said.
With new technology, Singh says the old method can be done while preserving the skin and speeding up recovery. It is especially notable in October, which is Breast Cancer Awareness Month.
Singh calls patient Michelle Hutchison a living success story.
Hutchison, of Bowie, was diagnosed with stage two breast cancer at 25 years old in October 2016. To help her recover from a double mastectomy, Singh used the prepectoral method combined with three new technologies: the SPY Elite, Alloderm and Prevena.
"It's really hard to be so young with such debilitating cancer," Hutchison said. "You hear plastic surgery and think you're going to come out like a Barbie or fake. I look the same post-cancer as I did pre-cancer."
To see how well the skin around the breast will hold up, Singh uses the SPY Elite, a fluorescence imaging system that shows microvascular blood flow and perfusion in tissue. In other words, it's a camera that highlights where there is good blood flow so doctors can determine whether tissue will survive with an implant under it.
"Breast surgeons have a really hard job. They have to remove the breast and keep the skin. That remaining skin's behavior is critically important," Singh said.
Singh says SPY has helped him develop the 10:80:10 ratio for his surgeries. Ten percent of the time, Singh says SPY tells him the skin won't be good for an implant at all. Eighty percent of the time, it will look okay but he'll put in an expander instead of an implant. The last 10 percent of the time, skin is perfect and the implant goes straight in.
Since SPY is less than a decade old, Singh says it isn't being utilized at every hospital.
"It's a very unique thing going on here," he said. "We throw the kitchen sink at every breast reconstruction."
To support the implant, Singh also uses a biological mesh, called Alloderm. This is cadaver skin with the epidermis and all cells removed that is made into a sterile collagen framework. When placed in the patient to support the breast implant, it's regenerated from new blood vessels in the patient.
The mesh cuts down pain, so Singh said he ends up prescribing fewer opioids and no muscle spasm medication.
Prevena, a high-tech incision dressing, is the last piece that modernizes the prepectoral method.
"Pervena was the coolest part of recovery for me," Hutchison said. "It was there for a reason."
In lieu of simple bandages or wraps, Prevena is a dressing that protects against infection by sealing the incision up with vacuum pressure. The dressing removes fluid from the incision site through a tube and is connected to a remote control.
"I thought 'I'm literally charging my boobs right now,' but if that's the worst after a double mastectomy I'll take it," Hutchison said. "It's like Christmas in a boob."
The dressing also helps reduce pain and scarring. Hutchison said she has almost no scars after surgery and was able to go back to work just 20 days later.
"This is the marriage of technique and technology," Singh said. "It's much less painful, and we get a better-looking reconstruction. We're doing what we did 60 years ago, but with better tech."
Credit: By Selene San Felice - email@example.com - twitter.com/selenecapgaz
Caption: Doctor Devinder Singh, right, a plastic surgeon at Anne Arundel Medical Group, discusses a new way to insert breast implants in breast cancer patients over the pectoral muscle instead of under it. Cancer survivor Michelle Hutchison had the procedure.
/Paul W. Gillespie / Staff