University of California San Francisco
Helen Diller Family Comprehensive Cancer Center

New Method Of Breast Reconstruction May Reduce Pain For Some Cancer Survivors

By Kathleen Masterson | UCSF.edu | November 20, 2018

New Method Of Breast Reconstruction May Reduce Pain For Some Cancer Survivors

Hani Sbitany, MD, a plastic and reconstructive surgeon at UCSF Health, performs a breast reconstruction surgery. Sbitany is one of a few surgeons using a procedure that is less invasive and has a less painful recovery. Photo by Susan Merrell

For nearly four decades, the main option for breast reconstruction for women who had to undergo a mastectomy was to place implants under the main chest muscle – a procedure that often results in chronic pain and muscle weakness in the chest and arms.

Hani Sbitany portrait
Hani Sbitany, MD

It also creates a strange unsightly contraction of the breasts and chest whenever the main muscle – the pectoralis major – contracts, called animation.

“Whether it’s loss of strength, whether its chronic pain or whether animation deformity – there are drawbacks to putting these implants under the muscle,” said Hani Sbitany, MD, a plastic and reconstructive surgeon at UCSF Health.

Now, Sbitany is one of a handful of surgeons who are pioneering and studying the outcomes of a new approach that is less invasive, has a less painful recovery and results in more natural looking breasts.

Significant Improvement for Patients

The procedure is called a prepectoral reconstruction, and involves placing the implants on top of the pectoralis muscle, just under the skin where breast tissue naturally resides.

For women, the difference is significant. Just ask Deborah Cohan, MD, MPH.

Cohan was diagnosed with breast cancer in 2013. Within a few months she had a complete mastectomy, followed by chemotherapy and later breast reconstruction. At the time the prevailing method was still to place the implants under the pectoral muscles.

“After the reconstruction I was having tingling symptoms in my hands and arms … when I would raise my arms, my hands would go white,” said Cohan, a physician at UC San Francisco. She also developed left shoulder pain and felt substantial pain in her chest.

Whether it’s loss of strength, whether its chronic pain or whether animation deformity – there are drawbacks to putting these implants under the muscle.

Hani Sbitany, MD

Plastic and Reconstructive Surgeon at UCSF Health

“It was hard to work at the computer, I couldn’t open doors or jars without feeling chest wall pain,” said Cohan. Cohan says she tried all kinds of things to address the pain: physical therapy, chiropractic adjustments, acupuncture, conscious dance and meditation – but she chose not to use opiate medicines for the pain. “I learned to live with chronic pain but not cover it up.”

The surgery also left Cohan with animation: “Whenever I would flex my pectoralis muscle, the implants would move up my chest, so I had to wear shirts with a super high collar or my breasts would fall out, basically.”
 

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