New Cleveland Clinic Technique Improves Mastectomy Outcomes

A mastectomy technique developed at Cleveland Clinic preserves the nipple to give the breast a more natural appearance. But not all women have been eligible for it.

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A new advance by Cleveland Clinic surgeons promises to make “nipple-sparing mastectomy” available to more women while improving its results.

“Many patients prefer to save the skin and nipple of the breast to help preserve the breast’s appearance following mastectomy,” says Stephen R. Grobmyer, MD, co-leader of Cleveland Clinic’s Comprehensive Breast Cancer Program.

Procedure widely embraced

Joseph Crowe, MD, developed nipple-sparing mastectomy at Cleveland Clinic in 2001 for patients who opted for prophylactic surgery because of a high risk of breast cancer.

Over the years, the technique gained widespread use. Soon, nipple-sparing mastectomy was adopted for certain patients who already had breast cancer. But their tumors had to be smaller, situated far from the areola and accessible through certain approaches.

Ultrasound-guided incisions

In 2013, Dr. Grobmyer and plastic surgeon Risal S. Djohan, MD, began to use what they called tumor ultrasound-guided incisions, or TUGI, during mastectomy. Using ultrasound in the operating room, the breast surgeon can locate the incision exactly where the cancer is found on the breast.

This allowed them to offer the procedure to more patients and to improve outcomes.

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Cleveland Clinic results

From 2013 to 2016, Drs. Grobmyer and Djohan performed 94 mastectomies. Thirty-one women had 31 nipple-sparing procedures, and 13 of those were performed using TUGI.

Those chosen for TUGI mastectomies had tumors that were either very close to the skin, in breast regions unsuited to traditional incisions, or both. Ordinarily, they would have faced skin-sparing or traditional mastectomies.

“Clear tissue margins are a major factor in the success of cancer procedures,” explains Dr. Grobmyer. “With TUGI, we can make incisions close to the cancer and carefully remove all malignant tissue with good cosmetic results.”

Afterward, no cancer was found in tissue margins removed from TUGI patients, and 17 months after mastectomy, none of their cancers had recurred.

“Cleveland Clinic breast and plastic surgeons work as a team to achieve the best possible outcome for patients,” notes Dr. Djohan.

No problem with reconstruction

Using TUGI did not make immediate or delayed breast reconstruction more difficult. The surgeons inserted tissue expanders immediately after mastectomy to gradually stretch the skin and make room for the final breast implant.

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“And by preserving more of the breast’s anatomical structures, TUGI avoids the need for another surgery to reconstruct the nipple,” notes Dr. Djohan.

Research will continue at Cleveland Clinic to further refine the new technique.

Meanwhile, “TUGI can be considered one of the options producing the best outcomes for breast cancer patients,” says Dr. Grobmyer.


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