Local surgeons use new tech to hide scars from breast cancer surgeries

PROVIDENCE – Women who’ve had breast cancer surgery often live out their lives with highly visible scars reminding them of their diagnosis and surgery. However, experienced breast cancer surgeons trained in a relatively new system, Hidden Scar Breast Cancer Surgery, are able to perform many nipple-sparing mastectomies and lumpectomies without leaving visible scars, Dr. Jennifer Gass, co-director of the Breast Health Center at Women & Infants, a Care New England hospital, and the hospital’s surgeon-in-chief, told Providence Business News.

“With the National Cancer Institute reporting a five-year survival rate for localized breast cancer of 98 percent, women are dying with a history of breast cancer, but not because of it,” said Gass. “The more we can make [breast cancer and surgery] something in their past and not a daily reminder … [the better]. That’s a leap from decades ago, [when the typical response was]: ‘It’s cancer; get it out. It doesn’t matter what it looks like.’ ”

Gass has been certified in the use of the Hidden Scar Breast Cancer Surgery’s Intelligent Photonics technology, which is manufactured by Invuity Inc. (Gass is compensated by the company for her teaching and lecturing on its use.)
Even before the new technology was introduced, she had performed many lumpectomies and nipple-sparing mastectomies to hide the surgical scar in the peri-areola margin. However, Invuity’s retractors come with lights that are designed to fit into breast incisions for lumpectomies and mastectomies. “It gives the patient such a boost to see that [she] is not defined by her breast cancer history,” said Gass.

In addition to Gass, Dr. David Edmonson has been certified in the technology; Kent Hospital Breast Health Center’s Dr. Candace Dyer, Women & Infants’ Dr. Hannah Bansil and Dr. Sonali Pandya and Dr. Ashley Stuckey, who see patients at both Women & Infants and Kent hospitals, are seeking certification. No other surgeons have been certified yet in Rhode Island, and only two surgeons have been certified in Massachusetts, said Bob Gerberich, vice president of sales at Invuity.

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In explaining Invuity’s Intelligent Photonics technology, Gerberich said, “It’s not a scalpel. It’s an advanced … technology that illuminates the surgical cavity from within. … It does not do the cutting [but] it is integrated into … retractors [that hold] the breast pocket open.” By illuminating the surgical cavity from within, the technology, which Women & Infants Hospital began using in 2015, provides surgeons with visual access to make incisions that can be hidden post-surgery.

Specifically, the technology allows surgeons, Gass explained, to remove the cancer and leave incision scars in these areas: the inframammary fold (under the breast, where a bra’s underwire sits), the peri-areola margin (in the interface between the areola’s pigmented skin around the nipple and the normally pigmented skin) or the axillary crease (in the hollow of the armpit). Calling the nipple-sparing mastectomy “a game changer for breast cancers,” Gass noted that surgeons initially put the such surgical incisions on the side of the breast, from the nipple area to the armpit. But, as surgeons began to query whether cutting at the inframammary fold was feasible, Gass said, “It’s these retractors that give you space and light to do so.”

While retractors with lights are not novel, this approach, which is unique for breast cancer surgeries, offers a different quality of light by refracting the light, which is then diffused into the surgical cavity, Gass said. Another benefit is that the cool light both avoids burning the patient and causing an operating room fire.

Asked how often she uses Invuity’s technology, Gass said, “It’s my default approach. I offer it to 90 percent of my patients.” Breast cancer patients with very large breasts who choose to have a breast cancer reduction surgery with cancer surgery are not eligible for the Hidden Scar Breast Cancer surgery, nor are patients with cancer presenting with nipple discharge, inflammatory breast cancer or cancer that has infected the skin, she said.

Women & Infants Hospital diagnoses and treats some 450 to 500 women with breast cancer each year, said Gass. While the retractor’s disposable light increases a surgery’s costs by about $200 or $300, Gass said, “It becomes inconsequential [when compared to the] cost of caring for a cancer survivor and avoiding revisional surgeries.”

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