Empowering Breast Surgeons: A Call for Collective Action

David Weintritt, MD, FACS

Almost everyone knows about breast cancer. They’re familiar with the big foundations, the pink ribbons, the focused attention every October. Lots of money goes into researching it, trying to find a cure, spreading awareness, and more.

The overall survival (OS) rate is also increasing. Patients who are diagnosed today have a higher chance of survival than those who were diagnosed just a few years before them. The five-year OS rate is at 91%, with the 10-year rate following closely behind at 84%.

However, amid all this progress, we, as breast surgeons, have become complacent instead of clamoring for the latest technologies and techniques to advance our care.

Having a mindset that taking on something new is too much work, that we’re already stretched thin, or that the advancements aren’t proven enough—although potentially legitimate—can quickly become too much of a barrier to personal and professional development.

The ecosystem of all involved—from researchers to patients—needs us on the frontline of care to be brave to be part of the innovations.

We can do more and do it in a way that positively pushes us outside our comfort zones without adding too much more to our plates. Taking measured steps when we aren’t ready to go all in on something new can still make a difference.

One area I’m passionate about is post-mastectomy chest numbness, an adverse effect of mastectomy that patients were long told to just accept. However, that no longer has to be the case. We can improve sensory outcomes by collaborating with plastic and reconstructive surgeons to perform a surgical technique called breast neurotization. Athough it isn’t something to dabble in, we already have the right skills and tools, giving us a solid foundation to learn more about the technique and take measured steps toward implementing it.

About Breast Neurotization

Long considered to be unavoidable and irreparable, chest numbness leaves many patients feeling disconnected from themselves and the world around them. It’s not only an issue of emotional health—patients can lose the ability to feel hugs or a loved one’s head on their chest—but a safety issue too, being at a higher risk of burns, pinched and raw skin from rubbing clothing, and other everyday injuries.

It happens when nothing is done to repair the nerves that are cut during a mastectomy. The nerves lose their ability to send touch, temperature, and pain signals to the brain, often resulting in permanent numbness.

Fortunately, this no longer needs to be the case. Breast neurotization is a surgical technique that helps restore the nerve connection. It requires a breast surgeon and a plastic reconstructive surgeon, both trained in the technique, to complete.

The potential for breast neurotization starts during the mastectomy. The breast surgeon identifies nerves that may be good candidates for neurotization without compromising oncologic safety, and then the plastic surgeon reconnects the identified nerves using an allograft during the reconstruction. Overall, the technique adds negligible time in the operating room (OR).

When I first learned about the technique, I wondered how interested patients would be. Since I’ve started discussing and offering it to them with my plastic surgeon counterparts, we rarely hear a “no,” and patients seem excited about the possibility of regaining some sensation in their chests. We talk about this at the same time as we discuss the mastectomy, and the plastic surgeon usually takes the time to talk about it again with reconstruction options. We explain that sensory nerves will be cut and removed with the breast tissue—and how that generally results in chest numbness—and that with breast neurotization, some level of sensation can be restored after reconstruction. Even when patients know it can take time for sensation to return since nerves are slow to grow and that their sensation won’t be exactly as it was pre-mastectomy, they’re eager and willing to try. With life after cancer, patients deserve to feel like themselves.

Ways to Learn More About Breast Neurotization

If you’re interested in learning more about breast neurotization, here are two places to start.

Talk with your patients

Ask your patients about sensation loss and its effect on them. Whether they’re living with a numb chest or are faced with that potential reality, they’ll be able to share a perspective I and other surgeons cannot. You’ll have the opportunity to gain a better understanding of your patient population and what’s important to them to fuel decisions for your practice.

Talk with other surgeons

Consider talking with the plastic surgeons you refer to about chest numbness. What do they think about it? Do they already offer breast neurotization? Are they interested in learning more about it together? You could also discuss it with peers at society meetings and conferences to gauge where others are at and how they think.

Advancing Care and Our Careers

Breast neurotization is potentially a life-changing advancement in breast cancer care. It offers a chance to improve how someone feels and their safety with a small amount of time in the OR. Why would we pre-judge the outcome? The most accurate way to judge the outcome is if we do it, do it consistently, and have a program to monitor patients’ results. If you’re ready to incorporate it into your practice, look into training options.

Breast neurotization also represents a single advancement. There are many out there worth learning about and getting trained on. Advancing the standard and quality of care, as well as progressing our own careers, can be done in measured, meaningful steps. Imagine what could happen if we all took steps together.

David Weintritt, MD, FACS, is the founder of the National Breast Center and Foundation and a board-certified breast surgeon with Virginia Cancer Specialists.

Reference

Breast cancer facts & figures 2019-2020. American Cancer Society. 2020. Accessed October 10, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf