The Sant Pau hospital, in Barcelona, ??is the only center in Europe that performs immediate reconstruction of the breast and lymphatic system in breast cancer surgeries. Jaume Masià (Amposta, 1967) has implemented this pioneering procedure, which allows the incidence of lymphedema after the intervention to be reduced from 32% to 3%. Masià has once again brought together the world leaders in breast reconstruction at the 20th edition of the Barcelona Breast Meeting.
What does your technique solve?
It is to solve lymphedema, that is, when there is an interruption of the lymphatic drainage of the arm because we remove the lymph nodes and many times we also irradiate. It is a very disabling pathology since it not only affects the volume and functional capacity of the arm, but also the patient’s immune system, having a high risk of infections in the lymphatic system, most of which are important and serious.
How do they do that?
After the oncological axillary emptying that must be done due to the tumor, before removing the nodes we isolate the tubes that transport the lymph [lymphatic vessels] to the body and connect them to residual veins that remain in the armpit so that the lymph goes to the venous system , which is where it has to go. We 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 armpit emptying has a 32% risk of having lymphedema. With this surgery, which does not take much more time than conventional surgery, you only have a 3% risk. The risk of having a pathology that, once established, is lifelong and is very difficult to solve, is reduced tenfold.
To what extent are you pioneers?
We are the only tertiary hospital in Europe that performs this type of surgery in a regulated manner on all patients undergoing armpit emptying. Thanks to our experience in developing these techniques and demonstrating that they are safe and effective for patients, we have now achieved that many people in the world want to apply what we do here.
What depends on whether your method becomes universal?
Of two things. One, that the surgical teams learn this supermicrosurgery technique, which requires extensive training. Afterwards, the hospitals provide technological resources that the majority still lack: high-power microscopes, green and indocyanine scanners, supermicrosurgery material, 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 thing that can happen to you is that you are left as you would be without it having been done. It is this 3% that, honestly, are very special cases due to anatomical variations of the patient, something that can never be avoided. This type of technique has very high reliability and a minimal risk of complications. The patient cannot lose anything, she can only gain.
Is breast cancer the one that has the greatest impact on society?
Definitely. Firstly, because it has a very high prevalence, it continues to increase and will affect practically one in eight women, a segment of the population that is professionally and socially active. 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 men have an important role in education and in the family, the basic pillar here, in Germany or in Finland, is still women. If we count the indirect expenses in the form of sick leave, loss of talent, depression, family problems… the cost of these techniques is ridiculous 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 raise awareness, in all aspects, of the breast that we reconstruct. Now we can achieve tactile sensitivity, pain sensitivity, temperature sensitivity… the last step is to maintain the erogenous sensitivity of the nipple.
What role do breast implants have?
There are two main types of reconstruction: with implants and with your own tissue. Most hospitals make 70% implants and 30% their own tissue. Sant Pau has practically 60% autologous tissue.
Do implants evolve?
They improve and their safety increases, but they are still a foreign 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 that is inherent to the fact that they are foreign bodies, which is that they 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 the patient forgets about everything.
Are women who do not have surgery in Sant Pau at a disadvantage?
We must seek equity from those of us who set the tone. Sant Pau has been the school of breast reconstruction in Spain and half 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 the rest is secondary?
This is a totally wrong, old and outdated concept of health. According to the WHO, health is not the absence of disease. We do not treat a breast tumor, we treat a woman and we must ensure that once she has undergone 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 a full reintegration if they feel one hundred percent the same as before.