Abstract P1-17-16: Deconstructing breast cancer reconstruction

Abstract

Abstract Background: The American Cancer Society currently invests more in breast cancer research than any other cancer type. However surgical treatments for breast cancer have been studied as far back as 3,000 BCE. Until the mid 19th century, the surgical treatment of breast cancer was limited either by sociocultural and religious views or technology. The advent of anesthesia and sterile practice in the late 1800s and early 1900s paved the way for innovation and precision. Synopsis: Despite being completely against breast reconstruction, Dr. William Halsted completely reconstructed breast cancer surgery. At the turn of the 20th century, Halsted’s new mastectomy procedure demonstrated to the world how technological advancements showed promise for a cure for breast cancer. The “Halsted Radical Mastectomy” recommended the removal of all diseased tissue including the pectoralis major muscle. Halsted later recommended further dissection of rectus abdominis, serratus anterior, subscapularis, latissimus dorsi and the teres major muscle without any breast reconstruction. With a local recurrence rate of 7% - an unheard of figure among the surgeons of the time- the “Halsted Radical Mastectomy” dominated the field for almost a century. With Halsted’s domination of technique came domination of thought. Halsted’s strong opinion against breast reconstruction influenced the American standard of care for breast cancer surgery for decades to follow. His treatment plan of mastectomy without reconstruction was the standard, so much so that other procedures for reconstruction, such as the latissimus dorsi pedicle flap (the first myocutaneous flap for breast reconstruction) were forgotten about for almost 70 years. Despite Halsted’s tight grasp on surgical thought, later 20th century innovations in breast reconstruction showed aesthetic results. Gradually, immediate breast reconstruction began to be advocated for all patients who were eligible. Breast cancer surgery and treatments continued to evolve and improve to ultimately lead to personalized medicine plans which have greatly improved patient outcomes. The shift in American surgical culture around breast reconstruction after mastectomies provide a lesson on how the power of cultural context shapes modern medical treatments. Significance: The medical recognition and treatment of breast cancer long outdated the modern day anesthetized, sterile, evidence-based procedures. Today, most women with early stage breast cancer will have some type of surgery. Therefore, it is important to appreciate the advancements and improvements in technology that have led us to the personalized medicine plans that have greatly improved outcomes. Citation Format: Cecelia Allison, David Fear. Deconstructing breast cancer reconstruction [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-17-16.