Breast cancer breakthrough? NJ surgeon performs two mastectomies with robotics

Michael L. Diamond | Asbury Park Press

Show Caption Hide Caption Local doctor first to use robotics for breast surgery Dr. Stephen Chagares of Tinton Falls is the first to use robotics for breast reconstruction surgery.

TINTON FALLS - A surgeon here has performed two mastectomies using robotics in a procedure that he said left no scars on his patients' breasts.

Dr. Stephen Chagares said he performed the surgeries through an incision on the side. The breast tissue was replaced with an implant in the same procedure.

"I don’t even look like I had anything done," said Yvonne Zucco, 56, who was treated by Chagares for breast cancer. "And to know the cancer is gone. That was the main thing.”

The procedure appears to be one of the first done in the U.S. It would mark an advance in the use of robotics and raise a new series of questions about how to pay for it.

But it could be a groundbreaking option for women who choose mastectomies, a physically and emotionally painful surgery in which the entire breast is removed.

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Breast cancer affects 1 in 8 women and is the second-leading cause of cancer death, trailing only lung cancer.

Some women can be treated with lumpectomies, which conserve the breast. But more women are turning to mastectomies, not only to treat breast cancer, but also to prevent it; the rate of mastectomies increased 36 percent from 2005 to 2013, according to the U.S. Department of Health and Human Services.

From science fiction to the OR

Chagares lives in Shrewsbury with his wife, Marianne, and 11-year-old daughter, Isabella. See him discuss the procedure in the video above.

He performs general surgery — breast and skin cancer, hernias and gall bladders — and took an interest in robotic-assisted technology that has become part of operating rooms in recent years. And he has privileges at Monmouth Medical Center in Long Branch and Riverview Medical Center in Red Bank.

He likened it to a science fiction movie from his childhood, "Fantastic Voyage," where a tiny submarine and its even more tiny crew are injected into a scientist who was nearly assassinated and try to save him.

"It’s basically the same mastectomy we’ve always done, but just (can) reach in further through a smaller hole on the side,” Chagares said.

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The robots use the same tools as surgeons, but they can get to places inside the body with far more dexterity, beaming magnified images onto a screen.

Hospitals are touting the technology as a chance for surgeons to perform less invasive surgeries for often complicated procedures.

Hackensack Meridian Health recently said it bought the da Vinci single port robotic system for its Hackensack University Medical Center hospital for urology procedures like prostate and kidney cancer.

Weighing the benefit versus the cost

It isn't cheap. Intuitive Surgical, based in Sunnyvale, California, sells its da Vinci robotic systems for between $500,000 and $2.5 million.

And it isn't yet clear if robots would deliver a better, less expensive outcome for mastectomies than traditional methods, setting up a dilemma. Would hospitals be reimbursed enough by insurers for the procedure?

One Stanford University School of Medicine study released last year found robot-assisted laparoscopic surgery to remove a patient’s kidney was more expensive than traditional laparoscopic surgery. But the two approaches had a comparable outcome.

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Chagares, however, said it is difficult to compare removal of kidneys to the cosmetic damage mastectomies can cause. And he uses the same robot that surgeons use for other procedures. So when he saw doctors in Italy were using robotics for mastectomies, he decided to visit.

The doctors there treated 24 women between June 2014 and July 2016, eventually reducing the length of the operation from seven hours to three hours. The patients had similar outcomes to the traditional method, their study found.

Chagares brought the technique back home. In addition to Zucco, Chagares performed the surgery on Brian Thomson, 34, of Middletown, who grew breast tissue and was worried it would become cancerous.

"There’s so many positives to this," he said. "That’s why when I saw it, I said, 'I have to go to Italy and bring this back.'”

The American Cancer Society in New Jersey declined to comment on this story.

'I still look like myself'

Not everyone needing a mastectomy is a candidate. For example, a patient whose breast cancer has spread to the nipple would need a traditional surgery, Chagares said.

But Zucco decided it was worth a try. She was diagnosed with breast cancer last March and quickly became concerned; her sister died from the disease.

She braced for what was to come, scars and all, knowing the most important thing was to wind up cancer-free. But her physician put her in touch with Chagares, who said he could perform a mastectomy with robotics, and she was convinced it was worth a shot.

Chagares did the surgery at Monmouth Medical Center in September. When Zucco awoke, she could scarcely tell the difference in her breast. She went home two days later. And she could lift her arm above her head within a week.

"The cancer is gone and I still look like myself," she said.

Michael L. Diamond; @mdiamondapp; 732-643-4038; mdiamond@gannettnj.com