TUPELO • Tupelo surgeons have expanded their tool box to help women who need mastectomies.

Three years after bringing the nipple sparing mastectomy, Tupelo surgeon Dr. Danny Sanders and Dr. Bob Buckley performed their first buttonhole mastectomy this summer.

“I’m stealing plastic surgery techniques to treat cancer,” said Sanders, who works closely with plastic surgeon Buckley.

Both techniques aim to remove the tumor and give women a very natural reconstruction.

“The No. 1 goal is to cure cancer,” Buckley said. “My part is more about getting them back to as close to normal as possible.”

Looking better can really lead to feeling better with breast cancer recovery.

“If you look at cancer patients and how they cope,” Sanders said, “a big part is how they feel about themselves.”

The more sophisticated techniques are important as women will likely live with the results for a long time.

“We’re seeing a lot of young patients,” Buckley said.

Some patients have breast cancer and need a mastectomy. Others have tested positive for BRCA genes and have elected to have preventive bi-lateral mastectomy.

Introducing new techniques

In 2016, Sanders and Buckley began offering a nipple sparing mastectomy after receiving training. The procedure allows the skin and nipple to be preserved as the surgeon removes all of the breast tissue. The plastic surgeon places tissue expanders and lays the groundwork for implants that will be inserted later. The incision is hidden under the breasts.

In the past three years, they’ve done about 40 of the nipple sparing surgeries. However, the technique worked best for women with relatively small breasts.

The buttonhole technique allows surgeons to offer a reconstruction technique to women with larger breasts.

The surgeon still removes the breast tissue creating a skin flap on the top of the breast. On the lower part of the breast, the top layer of skin is removed, but the surgeons keep the blood supply in place to feed the nipple area. Once the tissue expander is in place, the bottom of the breast and nipple slide under the top flap. Using guides placed before the surgery began, a hole is created for the nipple to come through.

As with the nipple sparing technique, the incisions are largely hidden under the fold of the breast.

The patient who was the first to take advantage of the buttonhole technique has done well, Sanders said.

Not every breast cancer patient who needs a mastectomy is a candidate for these techniques. Sometimes the cancer is too close to the nipple.

“Tumor location sometimes dictates what we can do,” Buckley said.

Because good circulation is so important for the outcomes with the procedure, patients are preferably non-smokers.

The procedures do not create problems if the patients need radiation or chemotherapy after surgery based on the pathology of the tumor and neighboring lymph nodes. The final insert is usually placed after radiation is completed.

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