Clancy performs breast reconstruction immediately following a mastectomy as a single-stage operation, greatly reducing the physical and emotional pain many women endure between the loss of a breast and later reconstruction.
“It makes a huge difference for people,” Clancy said. “They can quickly get back to living their normal lives and feeling good about themselves.”
“Making somebody whole again”
Having any kind of cancer can be a major life crisis, but for a woman breast cancer means not only dealing with the disease, but also with a visible change that can deeply affect her sense of identity and lead to a period of grief.
“Women see their breasts every day, and many times they associate who they are and their womanhood with their breasts. That’s a big deal with breast cancer.”
The reconstruction that Clancy performs right after a mastectomy can greatly ease and even eliminate this overwhelming sense of loss.
“Making somebody whole again is one reason I love my work,” she said.
Another reason traditional reconstruction with implants can be difficult for women is the need for “expanders,” devices that are inserted under the muscle and skin to hold a space for later implants. They’re hard and inflexible and can be quite painful.
“If you’ve known people who have gone through reconstruction with expanders, they’ll tell you that it’s miserable,” Clancy said.
Immediate reconstruction at the time of the mastectomy completely eliminates the need for expanders.
“Breast In a Day” and “Goldilocks”
There are two types of reconstruction that Clancy can perform immediately after a mastectomy — one that uses implants or tissue from another part of the body, and one that uses the patient’s own breast skin.
The first procedure, which at City of Hope is called “direct-to-implant” or “one-stage” reconstruction, sometimes goes by the flashier name, “Breast in a Day.”
As soon as the breast surgeon has removed the breast tissue, Clancy begins her work. She’s quick to point out that it’s a true team effort, because the surgeon who removes the breast tissue must also be skillful in creating skin flaps that will work well with reconstruction.
It’s a combination of not just what we the plastic surgeons can do, but what the breast surgeons do. And at City of Hope we’re blessed with excellent mastectomy surgeons.”
The other type of same-day reconstruction, known as the “Goldilocks” procedure, uses the mastectomy skin flaps instead of implants to create a new, natural-looking breast, which is sculpted from the patient’s remaining breast tissue.
This procedure is an option for women with very large or full breasts, because there must be ample skin and tissue remaining after the malignancy has been removed. It may also be used with some obese patients, who face a higher risk of complications with traditional reconstruction techniques.
So why was this surgery named for Goldilocks, the girl who tasted the three bears’ porridge, looking for one that was not too hot and not too cold?
“Well,” said Clancy, “it isn’t not having any reconstruction, but it’s also not a full complete breast reconstruction. It’s somewhere in the middle.”
Who’s a candidate for immediate reconstruction?
Recently, a headline about an exciting new breast reconstruction procedure — one that only one in 10 women were candidates for — grabbed Clancy’s attention. Excited to hear of something new in her profession, she read the article, only to learn it was nothing new at all.
“We’ve been doing it for the last four or five years routinely — and we can do it with a broad range of people,” Clancy said.
There are, of course, a few patients who are not good candidates for these procedures.
“When people have very advanced tumors and must, immediately afterward, continue chemotherapy or have radiation, then we don’t want to do anything that may delay the treatment.”
Passion meets talent and skill
Breast reconstruction demands a combination of surgical and aesthetic skills that perfectly match Clancy’s passions and talents — a lifelong love of medicine and art.
In medical school, the first time she observed plastic surgeons in action, she knew that was the career she wanted. And from very early on her interest was focused not on cosmetic surgery but on breast reconstruction.
“I wanted to use my skills to do good for people,” Clancy said, “and City of Hope is such a great place to practice, because we’re able to treat so many different people.”
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