Breakthroughs Help Breast Cancer Patients with Reconstruction and Side Effects
From plastic surgery to lymphedema and hair loss, Sylvester’s researchers are finding new ways to help improve outcomes.
The American Cancer Society estimates that 310,720 new cases of invasive breast cancer will be diagnosed in the United States in 2024.
Treating breast cancer goes beyond treating the cancer itself. Innovations in reconstruction and side effect prevention are helping patients at the Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.
Devinder Singh, M.D., chief and program director of plastic surgery at Sylvester and a professor of clinical surgery in the Miller School’s Division of Plastic Surgery, said the cancer center’s collaborative spirit encourages breakthroughs. Clinicians with varied expertise work well as a team, with support from Sylvester leadership.
“They help us bring these super-advanced, really complicated techniques and technologies into the center,” Singh said. “We’re able to not only acquire them, but also deploy them and utilize them, and then research them and see if they’re working.”
New Breast Reconstruction Options
Over the past few decades, more patients have come to expect reconstruction post-mastectomy — and for many, it’s lifesaving care, Dr. Singh said. Sylvester surgeons are continually learning and testing advanced reconstruction techniques.
Juan Mella-Catinchi, M.D., M.P.H., a plastic surgeon at Sylvester and an assistant professor of surgery in the Miller School’s Division of Plastic Surgery, focuses on breast reconstruction using a patient’s own tissue, including fat, skin and blood vessels, known as autologous tissue. The most common location for breast reconstruction tissue is the abdominal wall, or DIEP flap. When this isn’t an option, surgeons can take tissue from the thighs.
These options have changed the way Sylvester surgeons approach breast reconstruction and provide patients with options beyond implant-based reconstruction.
“The main benefit of autologous breast reconstruction is a natural appearing reconstructed breast with your own tissue that will provide a long-lasting outcome,” Dr. Mella-Catinchi said.
The techniques require refined skills. Dr. Mella-Catinchi and other microsurgeons at Sylvester use specialized microscopes and sutures finer than a hair to sew the tiny blood vessels together during reconstruction.
Dr. Mella-Catinchi and Dr. Singh also are using new techniques to restore nipple and areola sensation for patients who undergo nipple-sparing mastectomies.
Using nerve autografts (from a patient’s own nerve) or allografts (from a cadaveric nerve), the surgeons reconnect the nerve that’s cut in the patient’s chest during mastectomy. Dr. Singh said they are currently performing the surgeries and studying how well they work, with results expected in one or two years due to the time it takes for nerves to grow through the graft.
Healing With Less Risk
Reconstructive surgeons must work with a patient’s “traumatized, devascularized, paper-thin skin,” which creates new risks, Dr. Singh said. One in seven post-mastectomy cancer patients with immediate reconstruction can suffer an infection, he said — a rate much higher than people who have elective breast implants. There is also a risk of seroma, hematoma, skin death and incision separation.
Vacuum dressings called negative-pressure therapy dressings are one option for reducing risk and improving healing. Dr. Singh has been conducting clinical outcomes research to test how well they work — with excellent results so far.
One recent study “demonstrated these dressings worked extremely well and reduced infection rates near to nearly zero,” he said.
Lymphedema Prevention
Breast cancer frequently metastasizes to lymph nodes in the armpit, or axilla. Cancer surgeons then must remove some or all of a patient’s lymph nodes. When this happens, the fluid that is normally drained by the lymph vessels in the arm is disrupted. There’s about a 30% risk of this occurring, resulting in lymphedema, Dr. Mella-Catinchi said. Symptoms of lymphedema include limb heaviness, swelling and skin tightness, and increase the chance of infections or cellulitis.
Sylvester surgeons now offer prophylactic or immediate reconstruction of the lymphatic system with a lymphedema bypass: sewing together lymphatic vessels with a vein in the armpit to restore drainage.
Dr. Mella-Catinchi, who is studying the effectiveness of this comprehensive lymphedema treatment program, said he’s already seen lymphedema rates decrease to 10 to 12%. For this and other work, Sylvester is recognized as a center of excellence by the Lymphatic and Education Research Network (LERN).
Chemotherapy Side Effect Prevention
Hair loss, or alopecia, is another common problem for breast cancer patients. Fifty to 90% of patients who undergo chemotherapy with common drugs called taxanes experience this side effect. Most recover, but about 10 to 20% have a permanent loss, said Xiangxi “Mike” Xu, Ph.D., a radiation oncologist at Sylvester and assistant professor of radiation oncology at the Miller School.
Taxanes stiffen cellular microtubules in cancer cells, which causes cell death by preventing cell division. But these drugs also prevent division in non-cancerous cells — especially those that divide quickly, such as hair and blood.
Dr. Xu has developed techniques for using non-invasive ultrasound to break apart the drug-affected microtubules and restore division in these non-cancerous cells.
With Ralf Paus, M.D., and Tongyu Wikramanayake, Ph.D., from the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, he’s demonstrated the effectiveness of his technique to prevent hair loss in preclinical studies and using human hair follicles in the lab. He’s now preparing to clinically test the procedure with Matthew Schlumbrecht, M.D., M.P.H., a Sylvester researcher and associate professor of gynecological oncology at the Miller School, who studies gynecologic cancer disparities.
“We have really high confidence this is going to work in humans,” Dr. Xu said.
Dr. Xu and Fan Liu, Ph.D., a Sylvester member and research assistant professor of biochemistry and molecular biology at the Miller School, also discovered they can use a similar technique to “rescue” blood progenitor cells inside bone marrow by adapting an ultrasound machine already commonly found in oncology clinics. They are planning a clinical study of this procedure with Dr. Schlumbrecht.
These and other advances illustrate the breadth of breast cancer care at Sylvester and the options available to patients.
“When you step back and you think about what we’re doing for our breast cancer patients at Sylvester, it’s on the absolute most leading-edge that a patient could have anywhere around the world,” Dr. Singh said.
Tags: breast cancer, breast cancer risk, breast reconstruction, cancer research, chemotherapy, Dr. Devinder Singh, Dr. Fan Liu, Dr. Juan Mella Catinchi, Dr. Matthew Schlumbrecht, Dr. Ralf Paus, Dr. Tongyu Wikramanayake, Dr. Xiangxi Xu, lymphedema, plastic surgery, Sylvester Comprehensive Cancer Center