Skip Navigation
request an appointment my chart notification lp musc-logo-white-01 facebook twitter youtube blog find a provider circle arrow
MUSC mobile menu

STAT

An MUSC blog
Keyword: oncology

A new approach to breast reconstruction offers better results for more women. According to MUSC plastic surgeon Kevin O. Delaney, M.D., pre-pectoral breast reconstruction can benefit women who:

  • Are seeking reconstruction for the first time
  • Underwent reconstruction surgery years or decades ago but aren’t happy with the results or suffer side effects

If women aren’t satisfied with how their breasts look or feel after reconstruction—or have lingering pain from the procedure—this new technique may help them.

Pre-Pectoral Breast Reconstruction: What Is It?

MUSC Health provides a range of treatment options for women seeking breast reconstruction after a mastectomy. Whether a mastectomy was performed to treat or prevent breast cancer, Dr. Delaney works closely with MUSC Health’s Hollings Cancer Center team to guide women toward the best available options.

MUSC Health offers 2 main types of breast reconstruction today. Free-flap DIEP (deep inferior epigastric perforator) breast reconstruction relies on a patient’s own skin and fat tissue to rebuild breast tissue, whereas other procedures use breast implants.

As Dr. Delaney explains, pre-pectoral breast reconstruction is a new way of performing implant-based procedures, an approach MUSC Health has been offering for close to 2 years.

“We're one of the first centers in the region to perform this pre-pectoral, or subcutaneous, breast reconstruction,” says Dr. Delaney. “In this procedure, we place a breast implant just beneath the breast skin, which means we don't need to cut a patient’s pec muscles.”

Previously, surgeons would need to cut a patient’s pec (or pectoralis major) muscles in order to set the implant underneath these muscles. That’s how implant-based breast reconstruction has traditionally been performed for the past 20 to 30 years.

Breast Reconstruction Technique Offers Many Benefits

According to Dr. Delaney, the new pre-pectoral approach offers many pros and few cons. Two significant benefits to patients: a better cosmetic outcome and less pain.

“One main benefit to this approach is that the cosmetic outcome of the reconstructed breast looks a lot better,” Dr. Delaney explains. “Pre-pectoral breast reconstruction avoids what is commonly known as an animation deformity, which happens to most women who’ve had implant reconstruction under the muscle, to varying degrees.”

This animation deformity occurs when a woman moves her arms or flexes her muscles. The implant, as well as the overlying breast skin, flattens and moves towards the armpit, which many women consider undesirable, says Dr. Delaney.

Because the pre-pectoral technique eliminates the need for cutting the pec muscle, women experience significantly less pain in the short and long term. This equates to a much faster and easier recovery following the surgery. Women also don't lose any functionality of their pec muscle, which is a possibility with the traditional approach.

Dr. Delaney says this new technique is now the preferred route of implant-based breast reconstruction at MUSC. He says it’s slowly catching on nationwide but that as of now, it’s largely offered only through academic centers.

Pre-Pectoral Breast Reconstruction: The Right Candidates

Dr. Delaney assesses the best reconstruction approach on a case-by-case basis, but he says there are only a few reasons why he would recommend against the pre-pectoral approach for implant-based reconstruction.

The main caveat is if a woman has previously undergone radiation therapy to the breast. “Since the breast skin typically doesn't heal as well after it's been exposed to radiation, it makes the pre-pectoral breast reconstruction more risky from a healing and ultimately infection standpoint,” says Dr. Delaney.

However, the majority of women seeking breast reconstruction can benefit from this approach. In addition to offering current patients a better treatment option, this procedure could also benefit a wide swath of women who received breast reconstruction previously but aren’t happy with the results.

“Many women who have undergone sub-pectoral implant-based breast reconstruction in the past, whether it was 3 years ago or 20 years ago, have significant complaints,” says Dr. Delaney. “Patients come to us with tightness in their chest or up into their arm, chronic pain in that area, as well as complaints about the animation deformity and how they don't like the look of their reconstructed breasts. Those are all real complaints that we hear every day.”

Previously, Dr. Delaney says he couldn’t offer those patients many solutions. But now, with this pre-pectoral technique, he says he can significantly improve many patients’ symptoms or complaints in a straightforward outpatient surgery that takes just a few hours.

“We can remove their old implant, put their muscle back down to where it belongs anatomically, and then put a newer, better implant in below the skin,” he says. “Their pain significantly improves. Their animation deformity goes away. And they're incredibly pleased with how much better their reconstructed breasts look and feel as opposed to when they were below the muscle.”

A Better Breast Reconstruction Option Now Available

Dr. Delaney wants to spread the message that there’s a new option available for women who may fall into this category—and that their health insurance would likely cover it because it’s a part of breast reconstruction care.

“As plastic surgeons, if patients have had breast cancer treated but they're displeased with their reconstruction, we want to help,” he says. “If they’re not local, we can often talk to patients via telehealth and let them know whether this procedure might benefit them.”

For more information, contact Dr. Delaney at delaneyk@musc.edu.
 

Screen Shot of New Medical Video Center

The MUSC Health Medical Video Center is now available online at MUSCHealth.org/medical-video. It profiles cutting-edge surgical procedures and innovative treatments available at MUSC Health and is intended for a health care audience. Its initial areas of focus are cardiology, oncology, neuroscience, and pediatrics. The site contains educational (and explicit) surgical video and photography.

Dr. Robert StuartDr. Azizul Haque

The body’s own immune system could be a potent weapon in the war on cancer if the cloaking mechanisms tumor cells use to elude it could be deactivated. In an article published in the February 15 issue of the Journal of Immunology, one of those cloaking mechanisms was identified in B cell tumors by a team of MUSC immunologists led by Azizul Haque, PhD (above right), MUSC Health hematologist/oncologist Robert Stuart, M.D. (above left), and their colleagues at the University of Indiana and German Research Center for Environmental Health. They reported that overexpression of the c-MYC protein, one of the most commonly activated genes in human cancers that is implicated in the cancer-related deaths of about 100,000 people worldwide, is linked to the ability of B cell tumors to “hide” from the immune system.1 Specifically, they showed for the first time that overexpression of the c-MYC protein in Burkitt’s lymphoma interferes with human leucocyte antigen (HLA) class II antigen presentation. T cells can mount an immune response against antigens only if they can “see” them; they “see” them when TCRs (T cell receptors) on their surface recognize antigen fragments bound to HLA class II molecules on the surface of antigen-presenting cells. When tumor antigen is not presented properly due to c-MYC overexpression, it remains invisible to the T cells. The article also provided evidence that treatment of c-MYC-overexpressing cells with a c-MYC inhibitor decreased c-MYC expression and partially restored HLA class II-mediated antigen presentation. These results suggest that c-MYC inhibitors could help “unmask” B cell lymphomas and promote a more robust immune response. According to Haque, “This study uncovers a mechanism by which c-MYC impairs immune detection of malignant tumors, which could be targeted in future treatments for B cell lymphomas and other malignancies.” The article by Haque and colleagues was highlighted in the “In This Issue” section of the Journal of Immunology, reserved for the top 10% of articles published in the journal.

References

1 God JM, Cameron, C, Figueroa J, Amria S, Hossain A, Kempkes B, Bornkamm GW, Stuart RK, Blum JS, Haque A. Elevation of c-MYC Disrupts HLA Class II–Mediated Immune Recognition of Human B Cell Tumors. The Journal of Immunology 2015;194:1434–1445.

Subscribe to Progressnotes

Submit a Story Idea


Current Issue of Progressnotes

Digital EditionPDF | Home

Progressnotes - Spring 2017 cover thumb

Back Issues of Progressnotes

past issues of progressnotes