[5 min read]
In this article:
- Every patient's recovery from breast cancer is different, and comes with it's own unique challenges.
- Patinets who choose reconstruction are often surprised by the numbness and loss of sensation that can affect many facets of life, including body image, intimacy and sexual health and emotional well-being.
- Providence Swedish's expert surgeons offer an advanced procedure that may help restore some sensation lost with traditional post-mastectomy breast reconstruction. Learn more.
Life changes forever with a breast cancer diagnosis. There are sometimes-wrenching decisions about treatment and surgery, and conversations about who to tell and when. And then there are the realities of living in a new body.
At Providence Swedish, patients have access to some of the country’s most advanced breast surgery procedures, including sensation-preserving mastectomy (SPM), which repairs nerves that need to be cut during mastectomy and may help restore some sensation lost with traditional post-mastectomy breast reconstruction.
To learn more, we spoke with Carolyn Menendez, M.D., who has been recognized as one of the country’s leading breast surgeons, and Suzette Miranda, M.D., division chief of plastic surgery at Swedish Medical Center and medical director of Swedish Plastic and Aesthetics. In 2019, Dr. Miranda trained with surgeons who were early adopters of SPM. She was the first Washington state surgeon to perform a nerve graft associated with a direct to implant breast reconstruction procedure.
Why does breast sensation matter?
During a mastectomy, surgeons remove breast tissue to treat or prevent breast cancer. Many of the sensory nerves running through the tissue are cut during surgery, resulting in numbness in the breast, nipple area and chest wall. Patients are left with an inability to feel touch, temperature or pressure. This can affect everything from daily activities to intimacy and body image. For many patients, the goal of SPM isn't simply rebuilding a breast. It's restoring a connection to their bodies which may be lost during cancer treatment.
“What’s revolutionary is that we finally have something for women that can really satisfy their idea of breast reconstruction,” says Dr. Miranda. “Until now, there has never been a time when we preserve breast sensation after mastectomy. With nipple-preserving mastectomies we get to keep the outside, but now we are keeping some of the inside.”
What is nerve-sparing breast reconstruction?
Nerve-sparing breast reconstruction is a specialized surgical technique designed to preserve important sensory nerves or reconnect them during reconstruction. The goal is to give those nerves a chance to heal and regenerate, potentially restoring sensation over time. Depending on the patient's anatomy and treatment plan, surgeons may use several approaches:
- Nerve preservation: During a nipple-sparing mastectomy, surgeons carefully identify and protect nerves whenever it is safe to do so.
- Nerve grafting: If nerves must be cut during surgery, surgeons may use a nerve graft to bridge the gap and create a pathway for nerve fibers to regrow.
- Reinnervation: Surgeons connect chest-wall nerves to nerves in the reconstructed breast or nipple area, helping restore sensory pathways. Most patients do not regain sensation immediately, and outcomes vary. However, many women experience meaningful improvements in touch sensation as the nerves recover following surgery.
Who are the best candidates?
Not every patient is eligible, and cancer treatment goals always come first. A care team that includes a breast surgeon and reconstructive plastic surgeon can help determine whether nerve preservation or nerve reconstruction is appropriate. Good candidates include:
- Patients undergoing nipple-sparing mastectomy
- Patients having immediate reconstruction at the time of mastectomy
- Women choosing implant-based reconstruction
- Patients without extensive scar tissue who have moderate-to-small sized breasts
- Individuals undergoing risk-reducing mastectomy because, of a BRCA mutation or other inherited cancer risk
Collaborative, understanding experts
The procedure is unique in its blending of leading edge techniques in plastic and cancer surgery, as well as collaboration between surgeons and their teams, says Dr. Menendez.
“Of course, the oncologic outcome is paramount in every procedure. But speaking as a cancer doctor, I can now tell patients that they get more control over the reconstruction piece. It changes their journey,” Dr. Menendez says. “It used to be ‘make them look good in a bra’ and now we have gotten to ‘look good, feel good’ and we have to ask ourselves why it’s taken so long. The answer is that you have to have motivated people like Dr. Miranda who did this huge thing and brought the procedure [to Providence Swedish].”
“This is about you being you and feeling like this is your tissue. Before this procedure, we weren’t able to do this for patients,” Dr. Miranda continues. “The very idea that we offer this kind of innovation lets patients know that we care about what’s important to them. We are also women, so we know what it means to lose a breast and what reconstruction is trying to regain. All of this, in addition to the facts that we have surgeons in our oncology and plastics and aesthetics practices that do these procedures and no one in our region has done as many of these procedures as we have — this is what really distinguishes us from any other practice in the Pacific Northwest.”
Learn more and find a physician or advanced practice clinician (APC)
If you or a loved one have questions about cancer diagnosis, treatment or care, the experts at the Providence Swedish Cancer Institute are here for you. We can accommodate both in-person and virtual visits. To talk to someone or make an appointment, call 1-855-XCANCER.
You can also learn more about available clinical trials. Our physician investigators and researchers are involved in hundreds of ongoing trials involving most types of cancer.
Visit swedishspa.org to learn more about our MedSPA and how the experts at Swedish Plastics and Aesthetics can help you live more comfortably in your own skin, or call 206-215-6211 today to make your appointment for a consultation.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.
Additional resources
Life is for living to thrive, not just living to survive
When menopause and breast cancer treatment overlap, supportive, experienced care teams help patients
Our new MedSPA offers exceptional care with natural results
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
The Providence app offers world-class health care with human connection
Follow us on Facebook, Instagram and X.
About the Author
More Content by Swedish Cancer Team
