Hidden Scar surgery hides marks, reminders of breast cancer

 In Health
When Tami Weeks was diagnosed with breast cancer, survival was the only thing that mattered to the Westminster resident.

“I’m 59 years old, so if she had said we’re doing a bilateral mastectomy, it would have been fine,” Weeks said of her doctor. Looks “seemed like something that would be important to younger girls. I just wanted to get it over with.”

But her surgeon at Carroll Hospital’s Center for Breast Health insisted on doing a procedure that hides the incision in the armpit, breast crease or edge of the areola. Such surgeries are the latest frontier in breast cancer surgery aimed at eliminating evidence of the dreaded disease that is diagnosed in one in eight women and can cause lasting body image issues.

While surgeons can remove tumors without removing a whole breast, spare nipples and skin, and begin reconstruction immediately after surgery using an implant or fat from a women’s own belly, the scars remain. They are often big, jagged lines women can see every time they look in the mirror.

“They are nothing but a daily reminder to a cancer patient,” said Dr. Dona Hobart, a breast surgeon and medical director of the Carroll breast center who has been working to hide the surgical scars from breast cancer for years.

Most of the more than 230,000 women diagnosed with the cancer each year require surgery. It’s unclear how many surgeons are working to hide scars, which remains a relatively new approach, Hobart said.

She doesn’t think many doctors outside of university affiliated hospitals or specific breast cancer centers like Carroll’s likely have learned specific procedures for masking the telltale lines that some women consider a permanent defacement of their physical attractiveness — and their femininity.

That means many women probably don’t know it’s an option, or like Weeks, don’t initially realize that minimizing a scar is important to them, Hobart said.

There is more than one method and tool to hide a scar, but she said the surgery was made far easier when manufacturers began attaching lights to retractors used to separate tissue. The lighting allows doctors to see as they tunnel under the skin from an arm pit through a breast to the site of a tumor.

She uses an instrument from Invuity, which dubbed the related procedure “Hidden Scar surgery” when it launched its tool in 2015. The company reports that eight doctors at seven Maryland hospitals and surgeons in about 40 other states have been trained on the tool.

The Hidden Scar surgery takes a bit longer and is more involved than cutting directly at the point of the tumor. It’s not advised for some women, such as older patients with other health issues who shouldn’t remain under anesthesia any longer than necessary.

Weeks agreed to the procedure because she trusted Hobart, whom she called after receiving a suspicious mammogram but before she was officially diagnosed. Hobart, who was away on vacation at the time, talked Weeks through options on the phone.

Follow-up imaging and a biopsy confirmed treatment was necessary. Weeks had invasive lobular cancer, which begins in the breast’s milk-producing glands and has the potential to spread. There was also a second tumor, an invasive ductal cancer. Weeks had surgery in July, then radiation that was recently completed and hormone therapy that continues.

The physical remnants of the surgery already are diminishing. Week’s scar, a semi-circle at the edge of her nipple, looks like a faint pencil line, and she expects it to continue fading.

Hobart has been so pleased with the results of such procedures that she recently began using it to place chemotherapy ports. Typically located in the middle of the chest, such ports deliver chemotherapy drugs to a vein.

Studies going back years say women can develop negative perceptions of themselves because of their altered appearance, including scars, and even become reluctant to look at their own bodies.

The actress Angelina Jolie’s widely read 2013 essay in the New York Times about her own breast surgery was credited with not only prompting more women to get tested for what she called “faulty” cancer genes, but also for helping women understand that there were surgical options that would leave them less scarred. The essay describes her decision to have her breast removed and the “beautiful results” of surgery.

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