Posts in Hereditary Breast Cancer
You've heard of breast RECONSTRUCTION, but do you know about PRE-CONSTRUCTION?

Today I truly realized that my approach to breast surgery is quite different than the average surgeon in the Seattle & Bellevue metro areas. I have been told by numerous plastic surgeons, that my approach is unique and that my outcomes from a cosmetic standpoint are excellent. I had always assumed that these comments were a bit “inflated” and were the standard collegial niceties volleyed amongst surgeons. However, after being asked to explain my surgical approach numerous times, by physicians, surgeons, nurses, and operating room staff - I have finally come to the realization that I am truly offering women a unique approach to their breast cancer surgery. Whether my surgery is intended to cure a patient with breast cancer or to prevent breast cancer by risk reduction surgery (e.g. BRCA1 gene mutation carriers), I find that my approach and techniques often provide women with more choices and better outcomes.

One such example is PRE-CONSTRUCTION.

PRE-CONSTRUCTION is not a defined or standard breast surgery term, but it seems like the best word to describe the following scenario(s)…

Women who want to have a mastectomy (to treat breast cancer OR for risk reduction surgery) understandably hope that their cosmetic outcome will be good. For women with small to medium breast volume with little to no ptosis (medical jargon for what gravity + time does to our breasts!) nipple sparing mastectomy with reconstruction is a relatively simple solution. Most often these women wish to retain the same size and shape of their current breast(s). Because there are highly cohesive silicone breast implants (e.g. Gummy Bear Implants) available in their “size” these women are considered “excellent" candidates for this surgery.

Unfortunately, breast implants are NOT designed for reconstruction…they are designed for cosmetic breast augmentation. Therefore the size, volume, and shape of available breasts implants cannot address the needs of every mastectomy patient. This is when PRE-CONSTRUCTION is needed.

Some women have large to very large breasts and would like to be a smaller size. Some women with ptosis would like a breast form that places their nipple at a more desirable level. Some women need the volume and weight of their breast tissue lifted so that is correctly “sits” on their chest muscles; which will alleviate chronic neck/back/shoulder pain and posture strain.

What these women need is a breast lift or breast reduction (mastopexy and mammoplasty respectively). However performing a mastopexy/mammoplasty at the same time as the total nipple skin sparing mastectomy is NOT recommended. Once the underlying breast tissue is removed (i.e. mastectomy) the blood supply to the skin and nipple areolar complex of the breast is severely compromised. To then proceed with additional full thickness surgical incisions that divide and then suture back together the skin of the breast, to achieve the breast “reduction” or “lift” would result in eventual wound breakdown, wound infection, skin necrosis/skin loss, necrosis of the nipple/loss of the nipple, removal of the implant due to infection, and delayed reconstruction, interference with potential adjuvant breast cancer treatments…the list goes on and on. Most surgeons simply tell these women that nipple sparing mastectomy with reconstruction is NOT an option for them.

I do not agree with that. These women can become excellent candidates for nipple sparing mastectomy and reconstruction by first doing PRE-CONSTRUCTION.

For women who have a current diagnosis of breast cancer, I will perform a partial mastectomy (i.e. lumpectomy) and lymph node biopsy if indicated AND at the same time, perform a breast reduction or breast lift. The contralateral breast (i.e. other side) will also be lifted or reduced in size to achieve symmetry and balance. Once the wounds are sufficiently healed (~3 months later), we then go back to the OR and perform the total nipple skin sparing mastectomy with immediate reconstruction on the affected breast with or without a contralateral prophylactic mastectomy.

For women who need risk reduction surgery (i.e. prophylactic mastectomy) the lumpectomy and lymph node surgery is omitted but we still do the multi-step procedural approach; pre-construction, then mastectomy and reconstruction.

My approach is absolutely safe from a cancer treatment standpoint and is great for any women who needs/wants prophylactic mastectomy and reconstruction AND wants to have a smaller breast size.

Silicone breast implants are heavy, much heavier than natural breast tissue and therefore many women would like to be a “smaller” size to minimize the implant size/weight. Saline implants are not as heavy as silicone implants but saline implants are NOT a good option for reconstruction. This is because saline cannot hold its form and the implant will be very noticeable when used for reconstruction. Saline implants are great for cosmetic breast augmentation when women have a healthy layer of breast tissue and skin that will “drape over” the implant and thus make the implant undetectable.

Remember: Its Your Body, Its Your Choice

For more information about PRE-CONSTRUCTION or if you would like a consultation with Dr. Mikki Seagren, please click here.

Hereditary Breast Cancer Risk

Today, one of my dearest friends, Dr. Meghan Nadeau, was honored by the Puget Sound Business Journal as a 40 under 40 award recipient. She was selected for her dedication to caring for women with hereditary breast cancer. Exemplified by her contribution, as one of the co-founders, to Jane.

What is Jane?

Well as the other co-founder, I can fill you in on some of the details…After I completed my fellowship at UCSF, I began practicing in Seattle, WA as a breast surgical oncologist. I quickly noticed a very concerning pattern. I was caring for numerous young woman with breast cancer. Some in their early 20s. Often with advanced and aggressive forms of breast cancer. Sadly, this is not that uncommon. I cared for many young breast cancer patients in San Francisco. Although breast cancer is truly a disease that most commonly occurs in older women, it CAN affect women in their 20s and 30s, well before the typical age when women begin annual screening mammograms. So what was so concerning? Well…nearly EVERY young women I cared for had multiple “red flags” that should have been identified prior to her breast cancer diagnosis. I was counseling these young women about genetic risk, submitting a sample for genetic testing, and identifying a genetic mutation (such as BRCA1) after they had already been diagnosed with breast cancer. The healthcare system had failed these young women. If these “red flags” had been identified prior to their breast cancer diagnosis, perhaps these women could have made an informed choice about their healthcare. Specifically, about their breast health. I could not continue caring for these young breast cancer patients without doing something about this blindspot in the healthcare system.

Breast cancer remains the most common cancer diagnosed in women and as I have already mentioned, it is most commonly diagnosed in older women. That is why for years and years the recommendation for breast cancer screening was to begin annual screening mammograms at age 40. But what about the uncommon diagnosis of breast cancer in young women? Well, we (the collective medical community) are supposed to notice the occasional “red flag” in a young woman’s family history and then appropriately refer her for genetic testing. Seems reasonable.

I assumed (as I’m sure most of you do too) that young women with an increased risk of breast cancer are being appropriately screened and offered genetic testing when indicated. I trusted the “system” just like all of my young patients had.

The system is broken.

I could go on and on about all the various reasons the system isn’t working, suffice to say, trust me, it is broken. I have tried to fix it, but I assure you, it doesn’t want to be fixed. At least not anytime soon.

Jane is our solution to this problem.

Rather than fix a broken system we are abandoning the system. We are on a mission to put the knowledge and tools in the hands of those who stand to benefit the most, you! We want to empower every women to take control of her breast health. We want every woman to have access to understanding her own unique, personalized breast cancer risk. Every women should have the option to be tested for genetic risk.

This is just the beginning but our little start-up, Jane, has BIG plans!

To learn more, please check out our website.