Sant Pau Hospital (Barcelona) is the only center in Europe that performs immediate reconstruction of the breast and the lymphatic system in breast cancer surgeries. Jaume Masià (Amposta, 1967) has implemented this pioneering procedure, which allows the incidence of lymphoedema to be reduced from 32% to 3% after the intervention. Masià has once again brought together the world leaders in breast reconstruction in the 20th edition of the Barcelona Breast Meeting.
What does your technique solve?
It is to solve lymphoedema, that is, when there is an interruption of the lymphatic drainage of the arm because we remove the lymph nodes and often also radiate. It is a very disabling pathology, as it not only affects the volume and functional capacity of the arm, but also the patient’s immune system, and has a high risk of infections in the lymphatic system, most of them important and serious.
How do they do it?
After the oncological axillary drainage that has to be done because of the tumor, before removing the nodes, we isolate the tubes that carry the lymph [lymphatic vessels] in the body and connect them to residual veins that remain in the axilla · it so that the lymph goes to the venous system, which is where it should go. Let’s advance a little what already happens physiologically, which is that the lymphatic system always goes to the venous system through the thoracic duct.
What does the patient gain?
A patient undergoing axillary drainage has a 32% risk of developing lymphoedema. With this surgery, which does not take much longer than conventional surgery, you only have a 3% risk. The risk of having a pathology that, once established, is for life and is very difficult to solve is reduced tenfold.
To what extent are you pioneers?
We are the only third-level hospital in Europe that regularly performs this type of surgery on all patients undergoing axillary drainage. Thanks to our experience in developing these techniques and proving that they are safe and effective for patients, we have now managed to get many people in the world to want to apply what we do here.
What depends on his method being universalized?
Of two things. One, for the surgical teams to learn this supermicrosurgery technique, which requires a high level of training. Then, for the hospitals to put in some technological resources that the majority still lack: microscopes of high bonus, green and indocyanine scanner, supermicrosurgery equipment, and the ideal would be, as we have in Sant Pau, the Symani, which is the first supermicrosurgery robot. This technique will take a minimum of three to five years to deploy.
What are the risks?
The worst that can happen to you is that you remain as you would be if it had not been done. It is this 3% which, honestly, are very special cases, due to an issue of anatomical variations of the patient, which can never be avoided. This type of technique has very high reliability and a minimal risk of complications. The patient has nothing to lose, only to gain.
Is breast cancer the one that has the most impact on society?
Certainly. First, because it has a very high prevalence, it continues to increase and will affect almost one in eight women, a segment of the population that is active at work and socially. The patients are mostly between 30 and 60 years old, women who are not only professionals, but also mothers. As much as we want to say that the man has an important role in education and in the family, the basic pillar here, in Germany or in Finland, remains the woman. If we count the indirect costs in the form of layoffs, loss of talent, depression, family problems… the cost of these techniques is negligible compared to the consequences of breast cancer in our society.
What is the next step?
We have one last step left, which is to be able to achieve awareness, in all aspects, of the breast we are reconstructing. Now we can achieve tactile, pain, temperature sensitivity… the last step is to maintain the erogenous sensitivity of the nipple.
What role do breast implants play?
There are two main types of reconstruction: with implants and with own tissue. Most hospitals make 70% implants and 30% own tissue. Sant Pau has practically 60% autologous tissue.
Do implants evolve?
They improve and increase their security, but they are still a strange body, an inert material. The body evolves, we gain or lose weight, we age, gravity acts on the tissues, which fall… Therefore, implants have a limitation, which is inherent in the fact that they are foreign bodies, which do not evolve. They neither gain weight nor lose weight. The current trend is, as long as it does not have a negative impact, to use own tissue and for the patient to forget everything.
Are women who do not have surgery at Sant Pau at a disadvantage?
We must try to achieve equity from those who set the standard. Sant Pau has been the school of breast reconstruction in Spain and in the middle of Europe. Maybe we are more restless, we have more ambition, we are innovating, but it does not mean that other hospitals cannot have this soon.
Isn’t the important thing to cure cancer and other things are secondary?
This is a completely wrong, old and outdated concept of health. According to the WHO, health is not the absence of disease. We don’t treat a breast tumor, we treat a woman, and we have to make sure that once she has gone through the procedure she is the same as before, with full quality of life. The concept that we treat tumors is unacceptable: we treat people, and these people only have full reintegration if they feel one hundred percent the same as before.
