BioZorb® Implant Side Effects

The BioZorb® is a 3D implanted tumor bed marker created for patients with breast cancer to mark the breast cancer surgical excision site accurately. It consists of a spiral three-dimensional bioabsorbable framework embedded with six permanent titanium surgical clips. The BioZorb® offers 3-dimensional breast radiation treatment targeting and is available in various sizes from 2-5cm, including Lower Profile, and is intended to enhance results in breast-conserving surgery (BCS) when used in early breast cancer stages. Low Profile (LP) is an ideal option for smaller, flatter surgical cavities.

Dr. Gorman is one of the leading breast surgeons that has successfully used the BioZorb® implant in hundreds of Stereotactic Body Radiation Therapy (SBRT) breast cancer surgeries. She has seen firsthand how they improve outcomes with breast-conserving therapy post-surgically.

The BioZorb® implant has many benefits for patients, including excellent cosmetic outcomes, improved accuracy in radiation therapy, and minimal scarring after breast conservation therapy. Many breast cancer patients who have received breast-conserving surgery have experienced the benefits of the BioZorb® implant, though there have been a few reported side effects. This article will discuss some of the side effects reported by patients who have had the BioZorb® marker implanted and how the benefits still outweigh any potential risks.

BioZorb® Reported Side Effects

  • Some patients with BioZorb® implants have reported hard, uncomfortable lumps in the area of their implants.
  • Patients have reported skin deformation and scarring of the skin around the devices.
  • Patients have reported skin reddening, irritation, and itching in the vicinity of their BioZorb® implants.
  • Patients have reported that the devices have not been absorbed in the expected time frame but instead have stayed intact for over 2.5 years.
  • Some individuals also claim that the implant is so unpleasant that they want it removed or decide to undergo partial breast reconstruction or a mastectomy to remove the entire breast.
  • Some patients report that the BioZorb® implant causes the affected breast to become noticeably bigger than the unaffected breast.

Do the benefits of the BioZorb® implant outweigh the side effects?

About 60% of the more than 200,000 American women with early-stage breast cancer had a lumpectomy with whole breast irradiation. Since it can be challenging to identify the specific region of the breast where the tumor came from, radiation is often applied to the entire breast. BioZorb® was developed to improve the accuracy of such radiation therapies, and it has done just that.

Six titanium clips on the device show radiation oncologists precisely where to point the radiation beam. Radiation is thus applied to the tissue that needs it the most. The “lumpectomy bed” will then benefit from the boost of radiation. And even though sometimes the whole breast must still undergo radiation treatment, BioZorb® guarantees that the correct location gets the optimal boost dosage. With BioZorb®, Dr. Gorman also has been able to use partial breast radiation with SBRT (BioZorb® as the target). This shortens the course of radiation to five days and has improved cosmetic outcomes.

According to a study in the World Journal of Surgery, of 110 patients using the BioZorb® implant, the marker enabled more precise targeting for radiation planning and treatments in 95.7% of the cases.

Over the course of around two years, BioZorb® is naturally absorbed by the body, but the metal clips are left in place. As a result, during routine mammography, it is easier for your doctor to precisely analyze the former tumor spot.

Breast surgeons are utilizing an extra advantage of BioZorb® implantation. After surgery, the BioZorb® prosthetic implant aids in preserving the breast’s natural form by supporting the breast tissue. As part of your lumpectomy, the 3-D spiral design of the marker is proving to help reshape the breast, which enhances the breast’s contour and, ultimately, its aesthetic appeal.

Dr. Gorman and BioZorb®

BioZorb® provides breast cancer surgeons with another cutting-edge method to enhance therapeutic and cosmetic results and improve overall patient outcomes. Dr. Gorman believes that for many patients, the benefits of the BioZorb® device outweigh any potential side effects. She continues to perform surgeries with the BioZorb® implant to help more women heal and recover.

If you have questions about the BioZorb® device or breast cancer treatment, please call our office to schedule an appointment. At your consultation, Dr. Gorman will be happy to personally answer all of your questions. Texas Breast Center is committed to providing its patients with a personal, individualized, and targeted approach to breast surgery and breast cancer treatment.


Habits that May Lead to Breast Cancer

Around the globe, breast cancer affects millions of women. One in eight women is predicted to have breast cancer during their lifetime in the United States alone. While there are several risk factors that you can’t control, such as a family history of breast cancer or dense breast tissue, there are certain behaviors and lifestyle choices that may have a significant impact on lessening your risk. Eliminating the habits that you can control can help decrease your risk of developing breast cancer.

Poor Diet

About 30 to 40 percent of all malignancies are considered to have some connection to diet. You cannot avoid developing breast cancer with diet or food alone. However, certain meals may improve your body’s health, strengthen your immune system, and lower your chance of breast cancer. According to research, eating a range of foods that are high in nutrients, including fruits, vegetables, legumes, and whole grains, may help you feel your best and provide your body with the energy it needs. Animal studies suggest eating food cultivated without pesticides may help prevent the unfavorable cell alterations linked to pesticide usage.

In nations where the traditional diet is plant-based and low in total fat, breast cancer is less prevalent. However, studies on American adult women haven’t shown a link between dietary fat consumption and a woman developing breast cancer. A high-fat diet throughout adolescence, however, may increase a girl’s risk of developing breast cancer later in life, even if she doesn’t go on to gain weight or become obese.

Further study is required to fully comprehend how nutrition affects the risk of breast cancer. However, it is undeniable that calories do matter, and fat is a significant source of calories. Being overweight or obese, which are breast cancer risk factors, may be brought on by high-fat diets. Because excess fat cells produce estrogen, which may promote the development of extra breast cells, overweight women are considered to have a greater chance of developing breast cancer. Breast cancer risk is increased by this additional growth.

Lack of Exercise

Regular exercise benefits your health in a variety of ways, one of which is a decreased risk of breast cancer. Over the last 20 years, several studies have consistently shown a relationship between increased physical activity and a decreased risk of breast cancer.

It is unclear exactly how exercise reduces the chance of developing breast cancer. It is believed that exercise controls estrogen and insulin, two substances that may promote the development of breast cancer. Regular exercise also aids women in maintaining a healthy weight, which supports hormone regulation and immune system health.

Unfortunately, there is no magic number of hours a woman should exercise each week to prevent breast cancer. We do know that more is preferable to less, and that some is better than none. Additionally, more intense exercise is more productive than less intense exercise. All people should exercise for at least 150 minutes per week of moderate effort or 75 minutes per week of vigorous intensity, ideally spaced out over the course of the week, according to the American Cancer Society.

Brisk strolling, dancing, leisurely biking, yoga, golfing, softball, doubles tennis, and routine yard and garden upkeep are some examples of moderate-intensity exercises. Jogging, running, rapid cycling, swimming, aerobic dancing, soccer, singles tennis, and basketball are some examples of high-intensity exercises. Along with your regular daily activities at home and at work, all of these extracurricular activities include stair climbing and walking from your vehicle to the garage.

Exercise has the additional benefit that it keeps you from merely sitting around. The probability of acquiring breast cancer and several other forms of cancer, as well as obesity, type 2 diabetes, and heart disease rises with sitting time, regardless of how much exercise you receive when you’re not sitting, according to an increasing body of research. Many of us spend most of our workdays seated at a desk. Because of this, it’s even more crucial to include activity throughout your day.

Certain Types of Birth Control

There is a small increase in the risk of breast cancer associated with the current or recent usage of oral contraceptives. According to studies, women’s breast cancer risk is 20–30% greater while using birth control pills (and immediately after) than the risk for women who have never used the pill. However, since the absolute risk of breast cancer for the majority of young women is low, this additional risk has only a little effect.

Women’s chances of developing breast cancer start to decrease after they quit using oral contraceptives. The risk eventually drops to the same amount as women who have never used the pill. Despite the increased risk of breast cancer , birth control pills also lower the risk of uterine and ovarian cancer in addition to preventing pregnancy. Just like with previous, higher-dose versions of the drug, modern, lower-dose tablets have been associated with an increased risk of breast cancer.

Some alternative contraceptives contain (or release) hormones, just like birth control pills do. Depo Provera users who have been using it for extended periods of time may be at a higher risk for breast cancer than women who have never used it.

Research on IUDs that release hormones and breast cancer research have conflicting results. IUDs don’t increase the risk of breast cancer, according to some research. According to other studies, women who use hormone-releasing IUDs may have a 20% greater chance of developing breast cancer (similar to birth control pills). According to other research, women who previously used hormone-releasing IUDs may be more likely to develop breast cancer after menopause.

Discuss the advantages and disadvantages of any contraceptive pill with your doctor before using it (or if you already are and haven’t done so).

Not Getting Routine Mammograms

Low-dose x-rays of the breast are called mammograms and can help doctors identify a breast cancer diagnosis. Regular mammograms are one of the best breast cancer screenings that may assist in detecting early stage breast cancer, when treatment has the best chance of being effective. Years before physical breast cancer symptoms appear, a mammogram may often detect breast abnormalities that might be cancer. Results from decades of research definitively demonstrate that women who receive routine mammograms are more likely to have breast cancer discovered earlier, are less likely to require an invasive breast cancer treatment like chemotherapy and surgery to remove the entire breast (mastectomy), and are more likely to recover from the disease.

Mammography is not flawless at detecting breast cancer cells. Dense breast tissue can make it harder for radiologists to see breast cancer on mammograms. Although most breast cancers will be detected, some will be missed. A woman will probably need more testing (such as additional mammograms or a breast ultrasound) in order to determine if anything seen on a screening mammogram is cancer. Additionally, there is a slight possibility of receiving a cancer diagnosis that, if not discovered during screening, would never have given rise to any issues.  It’s crucial that women undergoing mammograms be aware of what to anticipate and the advantages and limitations of screening. As you age, your risk of developing breast cancer increases. Breast cancer screening through mammography is vital for women over age 40.

Use of Tobacco Products

According to research, smoking may significantly increase the chance of developing breast cancer, particularly in women who began smoking as adolescents or who had a family history of breast cancer. Smoking might increase one’s chance of developing breast cancer because specific chemicals in tobacco products may cause out-of-control cell proliferation in the body. Smoking is associated with an increased risk of breast cancer in certain women, despite the fact that it is not thought to be a direct cause. In addition, smoking may make treating breast cancer more difficult and lead to complications from breast cancer surgery. Avoiding tobacco products is an important factor in breast cancer prevention.

Excessive Use of Alcohol

Many studies reveal women who consume alcohol have an increased risk of breast cancer. According to research, the relative risk of breast cancer rose by roughly 7% for every alcoholic beverage taken daily. Compared to women who didn’t consume alcohol, women who had 2-3 alcoholic drinks per day had a 20% increased chance of developing breast cancer.

Alcohol may alter how a woman’s body processes estrogen. Blood estrogen levels may increase as a result of this. Women who drink alcohol have greater amounts of estrogen than non-drinkers do. As a consequence, higher estrogen levels are related to a higher risk of breast cancer. Alcohol and cancer risk can be controlled by limiting the amount you consume.

Hormone Replacement Therapy

Breast cancer risk is elevated by the majority of hormone replacement therapy (HRT) types. However, individuals who take combination hormone replacement therapy (HRT), which combines both estrogen and progesterone, are at a greater risk.

Breast cancer risk is only modestly elevated when HRT is used for less than a year. However, the hazards become more severe and continue longer the longer you use HRT.

HRT-related breast cancer risk varies from individual to individual. The risk may vary depending on your age when you start HRT, any medications you may be on, and overall health.

Breast cancer risk factors are greater for people who take HRT before or shortly after menopause as compared to those who start it later.

Even though there are several potential causes of breast cancer, some behaviors and lifestyle choices may have a big impact. These lifestyle choices, including smoking, drinking alcohol, and eating poorly may all raise your risk. Regular physical activity and maintaining a healthy weight are effective methods to lower your risk. This disease may also arise as a result of certain birth control methods and hormone replacement therapy. If you have any of these risk factors, it’s important to speak to your doctor about them.


The Cost of Breast Cancer Treatment: What are the Contributing Factors?

In a recent survey of patients diagnosed with early-stage breast cancer, 38% said they were worried about finances due to their treatment. 14% said that their breast cancer cost them at least 10% of their household income. 17% said that they had spent even more than that 10% on out-of-pocket medical expenses.

When doctors, surgeons, and radiation oncologists were asked about how their offices handle financial discussions with their patients, 50% of medical oncologists reported that someone in their practice “often or always discusses financial burden” with their patients. 43% of radiation oncologists said they did as well. Only 16% of surgeons reported the same.

Furthermore, no one seems to know, going in, just how far a diagnosis of breast cancer is going to set them back financially. It is difficult to find answers about the cost of treatment, whether for surgery, radiation, or other medications. We are taking this chance to clear the air between doctors and patients; we can give the answers that so many have been looking for and help to start the conversation so you can be prepared should this diagnosis ever come your way.

Total Costs

In 2010, breast cancer was the highest-costing cancer in the United States. Nationwide, it cost a total of $16.5 billion. By 2020, this is expected to increase to $20.5 billion. The American Cancer Society estimates that over $180 billion is spent on health care expenses and lost productivity every year due to cancer.

Of course, each person’s case is unique. Their access to insurance must be taken into consideration. Different stages of cancer are harder to treat than others, which can affect overall treatment costs. Not to mention that disease takes root differently in each person, so it must be treated differently. And with no one-size-fits-all treatment, there is no one-size-fits-all price tag. All of these factors must be considered.

Stages

The stage at which a patient’s breast cancer is discovered significantly affects how difficult it is to treat. A study was done recently and published in The American Health and Drug Benefits1 on the cost and frequency of some treatments based on the cancer stage and how long it had been since the diagnosis.

It was not much of a surprise to find that those patients with more advanced stages of breast cancer spent more on treatments. For those with stage 0 cancer, the average cost of treatment at twelve months after diagnosis was $60, 637. After twenty-four months, the price had jumped to $71, 909 per patient overall.

For those whose cancer had advanced to stages I-II, their medical costs were approximately $82,121 in the first twelve months of treatment. In the second twelve months, each patient still in the study brought the total average to $97, 066.

With breast cancer in stage III, the average cost in the first twelve months continued to rise to $129,387. After a full twenty-four months, the study reported that patients spent an average of $159,442.

At stage IV, the most difficult to treat, the average treatment costs were $134,682 at twelve months and $182,655 at twenty-four.

According to the study, patients were paying an average of $85,772 within the first twelve months of being diagnosed with breast cancer, despite their cancer stage. And within the first two years of their diagnosis, the study reported their treatment costs averaging $103,735.

Treatments

Another major factor that will contribute to the overall cost of breast cancer treatment is the kind of treatment a patient is receiving. Which treatment you receive depends on the location, cancer stage, and extent to which the disease has spread. Sometimes the procedures are combined to get the best results and return you to health quicker and more effectively. The same study mentioned above also explored the average amount spent on categories of treatments, and how common these kinds of treatments were within the given periods.

Surgery

Surgery is a standard treatment for a breast cancer diagnosis. If applicable, it is a way to remove cancer physically from where it has taken root. Altogether, surgical treatment accounts for an average of 20% of the cost of breast cancer care treatments within the first year after diagnosis, and 4% in the second year.

  • Inpatient breast cancer surgery accounts for 6% of the cost treatment in the first year, and 2% in the second year. In the first year of treatment, the cost of breast cancer surgery is, on average, $4,762, while in the second year after diagnosis, the cost is approximately $347.
  • Outpatient breast cancer surgery accounts for approximately 14% of the price of breast cancer treatment in the first twelve months, and 2% in the second. The cost of outpatient surgery in the first and second years were found to be, on average, $11,691 and $389 respectively.

Chemotherapy

Chemotherapy is another well-known treatment of cancer. It accounts for approximately 19% of breast cancer treatment in both the first and second year after diagnosis.

  • For general chemotherapy, the average cost (including all costs on the day of the treatment) in the first year is $15,113. As this accounts for 18% of the payment for treatment for breast cancer, this is particularly significant. In the second year post-diagnosis, the average cost for this treatment is $3,625. This makes up 16% of all breast cancer treatment costs.
  • Oral chemotherapy is far less conventional. It only accounts for approximately 1% of the costs of first-year treatment, and 3% in the second year. Patients are usually paying $432 in their first year and $636 in their second year for this treatment.

Radiation

Radiation is used to kill the tumors by damaging cancer cells’ DNA. It is often used in combination with surgery. It makes up 18% of diagnosis treatment costs in the first year and 3% in the second year. In the first year, it costs an average of $15,455, while in the second year, patients pay $638.

Medication

Hand in hand with these major treatments come medications. Medications make up for 3% of the first year’s medical payments, and 7% of the second year. That equates to approximately $2,258 and $1,510 respectively.

Other Treatments

There are, of course, other treatments. Smaller subcategories that don’t quite fit these above, including hormone therapy, additional inpatient or outpatient care, or professional or specialist care. They make up about 42% of potential treatment costs in the first year and 67% of costs in the second year. That equates to $35,762 in the first twelve months and $14,980 in the second.

Health Insurance

Another factor that contributes to the overall cost of breast cancer treatment is health insurance. Healthcare, the amount of coverage you have, and the type of coverage you have, are all essential to discuss with your doctor, oncologist, and surgical team to make sure you understand where you stand.

Researchers in North Carolina found that patients who received a cancer diagnosis and did not have insurance or Medicare paid $6,711 for medication, while those with insurance paid $3,616 and those with Medicare paid $3,090 simply because they do not have the means to negotiate for a lower price.

Often, clinical appointments are more costly, as well. Where an insured patient might pay approximately $65-246, a patient without insurance coverage would pay around $129-391.

Ask Questions/Dr. Gorman

Getting a diagnosis of breast cancer is near impossible to imagine, and even harder to plan for. But if you ever find yourself in that place, you have a little more knowledge about what to expect. One should always be prepared for the unexpected, and it never hurts to have a little money saved up for emergencies. But breast cancer treatment costs will require more than just a bit of your savings. However, with communication with your team and laying out your healthcare terms and concerns as you discuss your health plan, everyone can be on the same page and do what they can to work within your needs.

Dr. Valerie Gorman knows about the financial burden that comes with breast cancer. She is dedicated to offering her patients a personalized approach to breast surgery and the treatment of breast cancer. She and her team will help to create a treatment plan that best meets your needs, and most fits your lifestyle. Because of the experience and breadth of our specialists, a multitude of treatment options exists which can be tailored to your situation.

There is no need to panic when you hear the word cancer. We have walked alongside many people who have been diagnosed and understand your fears and concerns. It is our privilege to walk with you and help you through this difficult process.

 

 

 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/#idm139828318640480title

 

 


What is Hidden Scar Breast Cancer Surgery?

When someone is first diagnosed with breast cancer, their first concern is not often about their appearance. They might first consider prognosis. Can the surgeons get the cancer out? What are the treatment options? But if surgery is necessary, the cosmetic applications are a consideration. Your breast cancer team wants you to have the best results possible, including minimal scarring.

Breast Cancer Surgery

There is more than one way to remove tumors and cancerous cells surgically. Surgery options for the more extreme cases are the simple or total mastectomy, the radical mastectomy, and the double mastectomy. For the less severe cases are the lumpectomy or partial mastectomy, the nipple-sparing mastectomy, and the skin-sparing mastectomy. While these are still serious surgeries, these procedures can allow the patient to keep more of their natural breast shape with less dramatic scarring. While the type of procedure can certainly depend on how big the tumor or cancerous area is, treatment ultimately comes down to you, the patient, and your needs.

Breast Cancer Scars

The different variations of surgical procedures lead to different appearances, sizes, and locations for scars. With a total mastectomy, where all of the breast tissue, skin, and the nipple are removed, there will be a noticeable change in appearance. That area of the chest will be flat, and there will be a visibly large scar where the breast was.

With a skin-sparing mastectomy, the skin remains, but the nipple and breast tissue are removed. There is some room for reconstruction here under the skin, but there will still be a medium- to large-sized and prominent scar across the front of the breast.

A nipple-sparing mastectomy, however, leaves the skin and nipple and takes only the breast tissue and tumor. The scar traditionally branches off from the areola towards the armpit. It is still on the medium to large side of the scale and quite noticeable.

A lumpectomy only removes a portion of the breast tissue–that closes to the tumor–to ensure that none of the tumor is missed. This, too, can leave a large scar, which is quite visible depending on the location of the tumor and the surgeon’s approach.

All of these treatment options and their variations can be very effective with a skilled surgeon and oncology centers you are comfortable with. But they can leave a noticeable scar that many patients find a disheartening reminder:

  • 72% of women did not realize how uncomfortable their breast cancer surgery scars would make them feel when undressed
  • 72% of women are not displeased with the location of their scar
  • 76% of women did not realize how uncomfortable their surgery scars would make them feel when someone else sees them undressed
  • 82% of women have not worn a particular item of clothing because it reveals their breast cancer surgery scars
  • 87% of women are self-conscious due to their scars

Hidden ScarTM Breast Cancer Surgery

In 2015, Invuity launched a new surgical approach to assist with just this issue. The Hidden ScarTM Breast Cancer surgery program was created to help surgeons and patients by offering less invasive methods of performing the surgery.

The Hidden Scar procedure allows for a smaller incision while still providing light in the surgical site, permitting the surgeons to treat the cancer and remove the tumor while still preserving as much of the breast’s natural shape as possible. More than that, this hidden scar process offers better cosmetic results by, as the name suggests, hiding the scars in the body’s natural folds.

Hidden Scar Mastectomy

For a nipple-sparing mastectomy, the Hidden Scar Breast Cancer Surgery scar will dramatically decrease. There can be no evidence of any cancer within the nipple for Hidden Scar Surgery, and this surgery is best suited to patients who have non-invasive cancer.

The Hidden Scar mastectomy is performed by making an incision in the inframammary fold, or the natural fold under your breast. It will naturally be hidden by the fall your breast and its small size.

Hidden Scar Lumpectomy

A Hidden Scar Lumpectomy offers options for where the incision will go, depending on where the cancer is located in the breast.

  • The Axilla, or under the armpit. The scar is usually hidden in a natural fold.
  • Around the edges of the areola. Many patients prefer this option, as the scaring is minimal and hidden even when wearing a petite bikini top.
  • The Inframammary fold – like the mastectomy.

Dr. Gorman and Hidden Scar

Dr. Valerie Gorman and her team have experience with the Hidden Scar approach. They have performed Hidden Scar Breast Cancer Surgery and understand the differences and options that come from each approach to oncological surgery. Dr. Gorman knows that it is important to discuss all of your options when it comes to your health and will answer any questions you may have until you can come to a conclusion with which you are happy. Contact the Texas Breast Center in Waxahachie to make an appointment and have any questions answered.

 


The BioZorb Marker Could Help Post-Surgical Breast Cancer Results and Clinical Imaging

What is BioZorb?

The BioZorb marker is a medical device meant to be implanted in the surgical site. Thanks to its open structure, it can be stitched into place by breast surgeons to avoid movement and allow the surrounding tissue to grow around the device after the procedure. The marker has six titanium clips that are used for future clinical imaging.

What is BioZorb Made of?

The structure itself is made of a material that is bioabsorbable, or able to be absorbed by the body. Therefore, as the tissue grows and reforms, the BioZorb can be absorbed, leaving behind only the titanium clips as tissue markers for imaging if necessary. This process takes approximately a year.

How Does BioZorb Help?

Using a BioZorb implant in breast cancer treatment can be helpful surgically, cosmetically, and with radiation treatment. Surgically, the implant–or the titanium clips if the implant has already been absorbed–can provide a perfect reference point for any future imaging for where the previous breast surgery and radiation procedures took place.

It can also assist with the structure of healing, which lends itself to improved breast cosmesis. Often with tumor removal, the breast can appear concave where the tissue grew in to fill the void the tumor left. However, BioZorb offers structure for the surrounding tissue to grow around to prevent any potential divots. This can sometimes help with oncoplastic surgery or post-lumpectomy cosmetic surgery. As for radiation therapy, the implant can provide a target for the beam to minimize the radiation damaging any surrounding tissue unnecessarily.

What are some facts about BioZorb?

Your doctor is placing an implant into your breast during this surgery. The implant is firm, but not painful and can usually be felt in the breast for 12 to 18 months, even once the surgical scars have healed. It will eventually be absorbed by the body.

When should BioZorb be used?

It is not uncommon for a patient to react strongly when they hear a diagnosis of breast cancer. They may want to avoid any risk and go straight for the total mastectomy, removing the full breast and therefore the cancer.

However, with a breast cancer team working with you on your treatment, there is more room for a personalized approach. The cancer can be treated with surgery, radiation, or a combination of the two, and when it is caught at an early stage, a total mastectomy is not needed. A lumpectomy can remove a tumor while leaving most of the breast intact.

It is in these cases that BioZorb is useful. When a patient is able to receive breast-conserving surgery, the cancerous tissue is removed by the breast surgeon, and then the skin is closed. From there, radiation may be administered by a radiation oncologist to reduce the risk of recurrence without damaging the surrounding tissue. This can be difficult without something in the breast to mark where the surgery took place. Sometimes, the empty space of the surgical site where the tumor was will fill with a liquid, forming a seroma, and this can be an indication of where to radiate.

However, if BioZorb is placed in the breast during surgery, the metal marker clips work like a road sign pointing the way for the radiologist to follow. Even after the body absorbs the coils, the clips remain in case they are needed again for imaging purposes.

Dr. Gorman and BioZorb

Dr. Valerie Gorman uses BioZorb in applicable cases to help her patients recover with less pain, less cosmetic adjustment, and more accurate imaging. But she did not take this step lightly. Before jumping all in with BioZorb, she was involved with a study testing accelerated partial breast irradiation (APBI) using her preferred intensity modulated radiation therapy (IMRT). The IMRT was directed in each of the 57 cases by a BioZorb device to keep the radiation localized.

They found that, in the follow-up visits, the cosmetic results were excellent on all accounts. Only one patient experienced pain in the area, at it was easily treated. Patients were pleased with the results.

Dr. Gorman has worked with BioZorb before, and she and her team know the benefits it can bring. She will answer any questions you have. She always wants you to be comfortable and knowledgeable about your treatment, which is why she has done her own research into BioZorb. She wants you to receive the best treatment and best results long term.


An Overview of Invasive Ductal Carcinoma

What is Invasive Ductal Carcinoma?

If you have received a cancer diagnosis of invasive ductal carcinoma, you may not understand what that means. You may, like any of us would be, be scared. As one of the most common types of breast cancer, invasive ductal carcinoma–IDC–accounts for about 80% of all breast cancers. Also called infiltrating ductal carcinoma, cancer infiltrates and invades the breast tissue after bursting free of the milk ducts. A carcinoma is a cancer that begins in organ-lining tissue or skin. Therefore, the name–invasive ductal carcinoma–is no more than a definition of the thing it names.

What Causes Invasive Ductal Carcinoma?

Cancer can form anywhere when cells in a given area start to multiply after a change of shape or makeup. They multiply rapidly and don’t die when they should. In this case, the cells are increasing inside the milk ducts. There are several risk factors that could contribute to these changes in the cells (though sometimes the changes happen in people who do not have these risk factors and others have the risk factors and never get IDC). Some of the factors are being female, smoking, alcohol intake, previous radiation therapy, poor nutrition, family history of breast cancers, or potentially having mutations to some genes. The most commonly known breast cancer genes are BRCA1 and BRCA2 gene, which have been linked to IDC in some cases.

Is Invasive Ductal Carcinoma Dangerous?

In the early stages, IDC can be difficult to notice, as it causes few symptoms, which can make it dangerous. However, if you are doing regular self-breast checks and screening mammograms, it is likely to be caught sooner rather than later. Some signs of breast cancer to keep an eye out for during your breast checks are breast pain, nipple pain, inverted nipple, swelling of the breast (all or just a part), dimpling, irritation, redness, scaliness, or thickening of the nipple/breast skin or breast tissue, a lump in the underarm, or discharge from the nipple that is not milk.

What are the stages of Invasive Ductal Carcinoma?

Like many cancers, invasive ductal carcinoma is broken down into five stages, and each stage is measured in terms of the size of the tumor, how the lymph nodes are affected, and metastasis–where the cancer has moved throughout the body. All of these points are considered and taken into account, along with genetics, surgical results, and other considerations to assist in giving the patient their prognosis. The first stage is called stage 0, or ductal carcinoma in situ (DCIS), then Stage I is at when the cancer is starting to leave the milk ducts, and stage IV is when the cancer has spread outside the breast or auxiliary lymph nodes. For IDC specifically, this means:

Stage 0 — The disease is primarily in the ducts, though it may have spread to the lobules of the breast but no further. It is considered noninvasive at this point.

In the early part of Stage I (Stage IA), the tumor is small but has become invasive, though it still has not reached the lymph nodes. The cancerous area is between .2 mm and 20 mm.

Stage II can vary from person to person. Early Stage II  (Stage IIA) can either have no tumor, but the cancer has spread to up to three lymph nodes under the arm, a 20 mm or small tumor AND have spread to the lymph nodes or have a tumor that is between 20-50 mm without any spread to the lymph nodes. Later Stage II (Stage IIB), either has a tumor between 20-50 mm and has spread to the under-the-arm lymph nodes, or it must be over 50 mm without spreading to the nodes.

Fittingly, there are three phases to Stage III. In the first (Stage IIIA), the cancer (any size) has spread to 4-9 lymph nodes–under the arm or mammary. However, it has not spread anywhere else. If this is not the case, it could be a cancerous area of over 50 mm that has spread to 1-3 axillary lymph nodes. For the second phase of Stage III (Stage IIIB), the cancer may have been diagnosed as Inflammatory Breast Cancer due to its spread to the chest wall, swelling, and ulceration of the breast. Sometimes it will have spread to 9 or more lymph nodes–again, mammary or axillary–but most likely nowhere else. In Stage IIIC, any tumor will have spread to 10 or more lymph nodes. These could be mammary lymph nodes, axillary lymph nodes, or the lymph nodes under the collarbone. However, the cancer still has not spread throughout the body.

Stage IV is also known as Metastatic cancer. Metastasis is when the cancer has spread to other parts of the body such as distant lymph nodes, bones, other organs, or the chest wall. The tumor can be any size. Cancer is first diagnosed as metastatic about 5-6% of the time and is most commonly found after previous diagnoses of early breast cancer.

Survival Rate of Invasive Ductal Carcinoma

As of 2017, the survival rates for people treated for breast cancers have been increasingly favorable. For those in stages zero and one, the survival rate–measured as the five-year survival rate–is nearly one hundred percent. For those with stage two breast cancer, the survival rate is 93 percent, an increase from the 86 percent survival rate of 2014. For stage three, the five-year survival rate is 72 percent, a dramatic increase from 2014’s 57 percent. Finally, stage four is currently holding at a 22 percent survival rate, a jump from 2014’s 20 percent.

Is Invasive Ductal Carcinoma Curable?

Just as every patient’s experience with cancer is unique, so is their treatment. There may be a form of drug therapy, such as chemotherapy, a hormone therapy, HER2 targeted drug, or some combination. There could be surgery such as a breast-conserving surgery (lumpectomies, partial mastectomies) or a mastectomy, which can involve breast reconstruction. The patient may need radiation therapy to prevent a recurrence of the cancer. Your treatment route is determined by many factors. Family history can come into play, as can the size of the cancer, the type of tumor, maybe genetics, and how far this invasive breast cancer has spread. However, just as important is you and where you stand in all the chaos. Make sure you understand what your treatments are. Ask your doctors questions. They are there to assist you through your process and make sure you are receiving the right treatment.

Dr. Valerie Gorman

Dr. Gorman and everyone with her at the Texas Breast Center are there to help you with your questions about invasive ductal carcinoma and its treatment. She will walk with you through the whole process, and she knows how important it is for you to be informed. She and her team will cater your treatment to your needs and walk with you on your journey through this process.


Valerie Gorman, MD Presents With Hologic at 20th Annual Meeting of the American Society of Breast Surgeons

Hologic, Inc. (Nasdaq: HOLX) will showcase its growing breast surgery franchise, which includes products such as the new Trident® HD specimen radiography system, LOCalizer ™ wire-free guidance system and the BioZorb ® marker, in Booth #103 at the 20th Annual Meeting of The American Society of Breast Surgeons (ASBS) in Dallas from April 30 to May 5.

The pioneer behind the Genius™ 3D Mammography™ exam, Hologic has recently expanded its product portfolio significantly through insight-driven innovation and strategic acquisitions to address the entire clinical continuum of breast cancer diagnosis and care. From digital specimen radiography and stereotactic breast biopsy systems to breast biopsy markers and surgical guidance systems – Hologic’s comprehensive suite of products is designed to meet the unmet and changing needs of radiologists, pathologists and breast surgeons.

“ASBS marks an exciting milestone this year as we debut our newly expanded portfolio of breast-conserving surgery solutions,” said Pete Valenti, Hologic’s Division President, Breast and Skeletal Health Solutions. “We look forward to building upon our relationships with this community of leading breast surgeons and showcasing our growing suite of products designed to improve cancer detection, patient satisfaction and comfort, and facility workflow.”

Hologic Products

A sampling of the products on display in the Hologic booth includes:

The Trident®HD specimen radiography system, a next-generation solution that delivers enhanced image quality, improved workflow, and instant sample verification during breast-conserving surgeries and stereotactic breast biopsies. 1 The system, which recently received FDA clearance in the U.S. and a CE Mark in Europe, uses amorphous selenium direct capture imaging – the same detector technology used in Hologic’s 3Dimensions™ mammography system – to generate crisp, clear, high-resolution images. The system also features a bigger detector that allows for complete imaging of larger breast surgical specimens, along with a wide range of surgical and biopsy samples. 2

The LOCalizer™wire-free guidance system, which is designed to enable precision and ease of use for breast surgery guidance. The LOCalizer tag is designed to replace traditional wire-guided methods, helping provide increased comfort and convenience for patients and their healthcare teams. Additionally, the Tag is designed to be implanted into the breast any time prior to the surgery, providing increased flexibility for patients and providers. A recent study has shown that the LOCalizer tag may be able to reduce positive margin rates with lumpectomy due to the unique feature of reading distance from the tag. 3

The BioZorb®3D bioabsorbable marker, an implantable three-dimensional marker that potentially enables a more targeted radiation therapy and helps clinicians overcome challenges in breast-conserving surgery or lumpectomy. When used to mark the surgical site, BioZorb has been shown to yield good to excellent cosmetic outcomes for at least two years post-surgery and result in minimal scarring on mammography after breast-conserving surgery. 4,5 Additionally, the marker has been shown to improve accuracy in setup and boost targeting as reported by 96 percent of radiation oncologists. 6

The TruNode®wireless gamma probe, a sterile, single-use device for common, radio-guided surgical procedures that senses hotspots using an innovative detector and heuristic audio feedback technology. The TruNode probe is designed to perform less invasively and may reduce infection risk from reprocessing due to its sterile, single-use performance.

Dr. Gorman’s Presentation on 5-day Radiation Therapy

Hologic will also host a breakfast symposium, BioZorb® and a New Way to 5-day radiation, featuring Cary Kaufman, MD, FACS and Valerie Gorman, MD, FACS on Saturday, May 4 from 6:30 – 7:45 am. Additional hands-on workshops hosted by Hologic will cover topics such as stereotactic breast biopsy, oncoplastic skills, and portable breast ultrasound.

The Genius ™ 3D Mammography ™ exam (also known as the Genius ™ exam) is only available on a Hologic® 3D Mammography™ system. It consists of a 2D and 3D ™ image set, where the 2D image can be either an acquired 2D image or a 2D image generated from the 3D ™ image set. There are more than 6,000 Hologic 3D Mammography ™ systems in use in the U.S. alone, so women have convenient access to the Genius exam. To learn more about the Genius exam, visit http://www.Genius3DNearMe.com.

About Hologic, Inc.

Hologic, Inc. is an innovative medical technology company primarily focused on improving women’s health and well-being through early detection and treatment. For more information on Hologic, visit www.hologic.com.

Hologic, 3D, 3D Mammography, 3Dimensions, BioZorb, Genius, The Science of Sure, Trident and TruNode are trademarks and/or registered trademarks of Hologic, Inc., and/or its subsidiaries in the United States and/or other countries. Hologic is an exclusive distributor and licensee of the LOCalizer product and trademark, which is manufactured by Health Beacons.

Forward-Looking Statements

This news release may contain forward-looking information that involves risks and uncertainties, including statements about the use of Hologic products. There can be no assurance these products will achieve the benefits described herein or that such benefits will be replicated in any particular manner with respect to an individual patient, as the actual effect of the use of the products can only be determined on a case-by-case basis. In addition, there can be no assurance that these products will be commercially successful or achieve any expected level of sales. Hologic expressly disclaims any obligation or undertaking to release publicly any updates or revisions to any such statements presented herein to reflect any change in expectations or any change in events, conditions or circumstances on which any such data or statements are based.

This information is not intended as a product solicitation or promotion where such activities are prohibited. For specific information on what products are available for sale in a particular country, please contact a local Hologic sales representative or write to [email protected]

SOURCE: Hologic, Inc., used by permission.

1 Wilson A. Trident 2.0 QUAL Qualitative Findings. Explore and identify the ideal breast biopsy verification system from the OR. Kadence International. July 2016.

2 Compared to original Trident system

3 N = 50 patient, single arm pilot study. DiNome M et al. Microchipping the breast: an effective new technology for localizing non-palpable breast lesions for surgery. Poster presentation, Society of Surgical Oncology annual meeting, Mar 27-30, 2019.

4 Kaufman, et al. Oncoplastic Surgery with the 3-D Tissue Implant Maintains Post-Lumpectomy Breast Contour. Poster presented at the American Society of Breast Surgeons 18th Annual Meeting, May 2-5, 2018.

5 Kaufman CS, et al. Registry Study of 337 Bio-Absorbable 3-D Implants Marking Lumpectomy Cavity Benefit Cosmesis While Targeting Radiation. Poster presented at the Society of Surgical Oncology Annual Cancer Conference March 15-17, 2017.

6 Harms S, et al. Mammographic imaging after partial breast reconstruction: Impact of a bioabsorbable breast implant. J Clin Oncol 33, 2015 (suppl 28S; abstr 111)

View source version on businesswire.com:https://www.businesswire.com/news/home/20190430005179/en/


FAQs About Mastectomy

What are the types of mastectomy?

 

  • Simple/Total Mastectomy–The entire breast is removed; lymph nodes and muscle are not removed.
  • Radical Mastectomy–The entire breast is removed, this time including the pectoral muscles and lymph nodes extending under the arm. This is rarely done today.
  • Modified Radical Mastectomy–Removes the entire breast including the lymph nodes;
  • Double Mastectomy–Both breasts are removed.
  • Lumpectomy/Partial Mastectomy–Part of the breast is removed, namely abnormal tissue or cancer, rather than the whole breast, just removing the lump.
  • Nipple-Sparing Mastectomy–The breast tissue is removed, but the nipple and skin are left unscathed.
  • Skin-Sparing Mastectomy–The skin is left intact while the breast tissue, areola, and nipple are removed.

 

Mastectomies are recommended for those who have large tumors or tumors that affect multiple areas of the breast. They can also be used as a preventative measure for those who carry the BRCA1 or BRCA2 gene or other genetic mutations that increase your risk of breast cancer. The skin- and nipple-sparing mastectomies are newer surgeries. These are optimal for minimal scarring and reconstruction.

What is recovery like for a mastectomy?

Your stay in the hospital after a mastectomy will vary depending on the kind of mastectomy you had, your reactions to the anesthesia, and whether or not you had reconstruction done at the time. However, it can be guaranteed that after surgery, you will be taken to a recovery room until the nurses are sure you are stable and (mostly) alert. At this point, you will be wheeled along to your hospital room where you will stay approximately 1-2 days.

Then, once you are home, you must keep the incisions clean. Your surgeon will give you instructions on how to do so, as well as how to care for your drainage tube, which you will only have with you until your follow up exam.

Your doctor should prescribe you medication for your pain, though the levels vary depending on the location, type of mastectomy, and amount of tissue taken. Follow your doctor’s instructions for approved medication intake.

It usually only takes a few weeks to be back to normal activities, though anything that uses your arms a lot or seems strenuous to your body should be approached cautiously for a while. If you’re ever unsure, you can always check with your doctor. It’s better to be safe than sorry. But soon enough you’ll be back on your feet and facing the world again.

What are mastectomy recovery tools?

While you are recovering, there will be many things you will have directly on your mind. There will be drains to empty and keep untangled, pain medications and antibiotics to keep track of, what will be waiting at home after your stay in the hospital, and your life at large to consider. But there are some tools to help you stay comfortable while you heal. And some people have been patients before you. They have tips to recommend based on their experience.

Some tools that many find helpful are drain belts or robes and mastectomy pillows. There are variations on both of these tools, but both offer support and work to simplify your recovery.

After the mastectomy, drains are left in the area to allow any access fluid to leave the body rather than pooling. The fluid follows a tube to a bulb that you empty regularly and record the amount in them. However, the tubes can quickly become an inconvenience with a risk of snagging. The easiest solution is to attach the drains to your clothes with the velcro attachment or clip them onto a lanyard. But other people have come up with more comfortable and convenient solutions. There are now drain belts, which are comfortable belts with holster-like pockets in which the bulbs can sit. There are drain robes that have pockets to keep the drains out of your way. And some companies produce adhesive pockets that will attach to whatever clothes you wear, making your pajamas into drain holders. Dr. Gorman’s surgical team will provide a bra for you post-operatively that includes rings to which you can attach your drains.

Mastectomy pillows are pillows that are shaped or placed in a way to help support you after your surgery. This can be anything from a regular pillow that is placed under your knees to raise your legs and increase blood flow to the armpit pillow–a rectangular pillow that lays over your chest with notches cut out for your arms. Some provide support for both breasts, while others go between the breast tissue of one breast and the other. Find the pillow that minimizes pain and discomfort and offers the support and comfort you will need. Volunteers in our community sew rectangular post-op pillows for Dr. Gorman’s patients. Each of Dr. Gorman’s patients receives one of these pillows in recovery immediately after surgery.

Previous breast cancer patients have made suggestions to make your recovery as easy as possible. First, stock up on food—at least two weeks’ worth–before your surgery. You will not want to go shopping while you are healing. And while you may not want to eat right away, you should try to find something light on the stomach so you can take it with your pain medication, such as yogurt or pudding.

When you take your first shower about two days after your surgery—or when Dr. Gorman clears you to do so—it’s generally best to do so sitting in a shower chair. You have been off of your feet and on medication since your mastectomy. It’s safest to sit while you clean yourself off.

Avoid housework. Think of this as an excuse to avoid your chores for as long as you can. You need to heal before you start expending that kind of effort. Similarly, don’t try to rush back to work. Many women recommend waiting at least three weeks before returning to your job. Returning too quickly could not only tire you out but could potentially cause complications. This advice is especially relevant to those who have reconstruction surgery, as well.

Dr. Gorman’s team provides a one-on-one education time for each patient that covers all of this information and more prior to a mastectomy.

What will my mastectomy scars look like?

The type or amount of scarring will differ based on the type of mastectomy you are having done. The total, radical, and modified radical mastectomies will leave a visibly large scar as a large amount of tissue/skin is removed. However, with partial/lumpectomies, skin-sparing, and nipple-sparing mastectomies, the scars are less noticeable. Skin-sparing mastectomies tend to leave behind a scar that is usually where the nipple was previously. The scar of the lumpectomy is small and linear and tends to be hidden away in the crease or around the nipple to avoid detection. Lastly, the nipple-sparing mastectomy generally leaves a scar under the breast, where it can be tucked away in the bra-line to avoid visibility.

The Texas Breast Center utilizes Hidden Scar™ Breast Cancer Surgery to help minimalize scarring in patients. Dr. Gorman works with each patient to make the right decision for them on the right kind of mastectomy, and from there to ensure the scarring will be minimal and where it will as minimally intrusive as possible.

How does breast reconstruction work?

Not everyone has breast reconstruction after a mastectomy. For example, those having lumpectomies do not necessarily need one, because a majority of the breast tissue is left alone in the breast. With a mastectomy, reconstruction is more likely as all the tissue was removed. However, it really is up to the patient. Talk to your surgeon about your preferences so that they can be informed when discussing your options with you

What are the risks of a mastectomy?

A mastectomy, like any other surgery, has its risks. There will be swelling in the area, as well as bruising for a while after the surgery. The breast will be sore and scar tissue will form and likely harden. Some patients experience phantom pain in removed breasts. More seriously, however, the incisions could bleed or become infected, or, more rarely, skin necrosis. There is a risk of lymphedema or swelling in the arm where lymph nodes were removed. Seromas (fluid filling the now-empty breast) can form. And not the least of the risks can be a change in self-confidence.

Dr. Gorman is aware of these risks and is there to help prevent them. If they can’t be avoided, she will support you through them and work with you on a plan to improve, step by step.

Should I have radiation or chemo with my mastectomy?

Chemotherapy is not used in all cases of breast cancer. And, if it is used, it is not always used in the same way. There are two primary ways it is used concerning surgery.

Some kinds of chemotherapy–neoadjuvant chemotherapy–is used before surgery as an attempt to shrink the tumor to a more manageable size that requires less extensive surgery. Adjuvant chemotherapy is given after surgery to kill any possible remaining circulating cells that may have been left behind to prevent more tumor growth.

Radiation is often recommended after a mastectomy as a tool to prevent the recurrence of cancerous growth. Traditionally, radiation is administered for five to six weeks, up to five days a week. However, Dr. Gorman has experience with a method that only takes five days, with less waiting period between surgery and the radiation beginning for post-lumpectomy patients.

Can men get a mastectomy?

Breast cancer in men may be rare, but it is still very possible. Only 1% of breast cancer diagnoses are in men, but that still accounts for 1 in every 1,000 men. Invasive Ductal Carcinoma is the most common form of breast cancer found in men. Like in women, black men have a higher risk of getting breast cancer than those of other races. Take precautions and familiarize yourself with the breast area by firmly feeling over the breast tissue in the area for anything unusual.

If a man receives a diagnosis for breast cancer, there is a high chance surgery will be involved in treatment. The operation could be used to establish how far into the lymph nodes the cancer has spread (a sentinel lymph node biopsy, for example), to relieve symptoms of advanced cancer, or to remove as much of the tumor itself as possible (a mastectomy).

All of these and a few more can be performed on a man to help treat him for breast cancer. It is not just women who get this disease, and today’s treatments reflect that.

How do I take blood pressure after a mastectomy?

There is some question about where to have blood pressure taken and blood drawn from post-mastectomy; more specifically, patients ask whether it is safe to do these things on the same side of the body as the mastectomy. While you can have your blood pressure tested from either arm without causing any trouble to your healing process, there could be a (minimal) risk when it comes to drawing blood after breast cancer surgery.

After certain types of mastectomies–radical mastectomy, modified radical mastectomy, sentinel lymph biopsy, or any procedure when the lymph nodes are removed–there is a risk of lymphedema. Lymphedema is a swelling of the arm and usually stems from an infection of the arm. Because having blood drawn in a medical facility is done in a clinical environment with sterile equipment, the already small risk of infection becomes minimal. However, it is still recommended to take the ‘better safe than sorry’ route and instead have your blood drawn from the arm opposite your operation.

The same goes for vaccines and other injections. While the medication won’t cause any complications, it’s best to reduce the chances of introducing possible infections to the area soon after your breast surgery or years later.

What do I ask my surgeon?

You should always prepare a few questions when going into a procedure like this. Likely, a number of them will get answered simply through the surgeon’s explanation of the process, but it never hurts to be prepared. Here a few to get you started:

 

  • What are the risks of my type of mastectomy?
  • Will I need reconstruction? Can it be done in the same procedure?
  • How can I prepare my home for my recovery before the procedure?
  • How can I emotionally prepare for this?
  • What medicines/foods should I or shouldn’t I take on the day of the procedure?
  • Who will perform my breast reconstruction surgery?
  • How much breast tissue will be removed in my mastectomy?
  • Will I need radiation therapy?
  • How long will I stay in the hospital?
  • Will I need to return for additional surgery?

And remember, there really are no stupid questions. None. This is your surgery, you deserve to know about it, and Dr. Gorman is here to help you understand. Ask away and she will do her best to answer. She will help with your before questions, your after questions, and your it’s-been-a-while-but-this-just-occurred-to-me questions. Being informed is something she wants for all of her patients, and something she will do her best to ensure as she walks with you every step of the way.

Who performs a mastectomy?

A breast cancer surgeon will perform your mastectomy, and a plastic surgeon will perform your breast reconstruction should you have that done. When choosing your surgeon, Johns Hopkins recommends a surgeon who:

  • Specializes in breast cancer
  • Is recognized as a breast surgical oncologist
  • Performs many breast cancer surgeries each year

 

Looking at these qualifications, Dr. Valerie Gorman at the Texas Breast Center can be your breast cancer surgeon, and of course, is always ready to help. Her specialty is breast cancer surgery and its related topics. Her residency was in general surgery, though with a focus on detecting and treating breast cancer. She is also currently serving as the Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center, as well as board-certified by the American Board of Surgery.

At the Texas Breast Center, mastectomies and other breast cancer surgeries are what Dr. Gorman is known for, and she performs them year-round.


FDA Warns Against Robotic Surgery for Breast Cancer, Updated

FDA General Warning

The FDA released a warning about using robots in surgeries. Since then, the da Vinci surgical robot has been brought to the forefront by many news networks. Over its history, it has had many successes, but more notable are its failings. While it has only been in use for twenty years, the da Vinci has had over twenty thousand adverse events filed with the FDA. Of these twenty thousand, seventeen thousand were classified as device malfunctions such as pieces falling off into the patients’ bodies or the arms freezing or going in the wrong direction. At least 274 of the events have been categorized as deaths.

And while many of these issues have been solved in any of the 175 recalls the da Vinci has been through in the past decade (in the past two years alone these have consisted of everything from general software updates as well as failing surgical arms), there are 3,000 of these robots in use in surgery today.

Some Benefits of Surgery via Robotic Aids

However, when used properly, using robotics in surgery can bring benefits to the operating table. They allow for more precision, minimizing scarring, blood loss, and pain, and can minimize the risk of infection. Because of all this, it even lessens recovery time, which is why many people would opt for robotic surgery in the first place, especially as the technical glitches are being weeded out.

Long-Term Survival Concerns for Breast Cancer Patients Having Robotic Surgery

This new FDA warning, however, might put a damper on those benefits. Even if the surgery goes off without a hitch and you recover faster than average because you used a robot surgeon, you now have a new worry. In a study done primarily on cancer surgeries (especially cervical and breast surgeries such as mastectomies),

it has been discovered that there may be long term survival effects from using a robotic surgeon.

The warning cited a clinical trial run by The New England Journal of Medicine comparing the patients with early-stage cervical cancer by the type of surgery they had performed and their results four and a half years later. They were randomly assigned open surgery (using a large incision), minimally invasive surgery using a laparoscope (small incision using a small camera to assist the surgeon), or minimally invasive using a robotic surgeon (that is, a surgeon operating via a robot). Approximately half the patients were operated on via open surgery, and half were via minimally invasive, and of the minimally invasive, 15.6% were robot-assisted.

When the four and a half years were up, 96.5% of those who received open surgery were alive and cancer-free, while only 86% of those who underwent minimally invasive surgery were in the same condition. That’s over ten percent more. The FDA cited this study as evidence against robotic surgeons. Alongside that, assistant director for the health of women in the FDA’s Center for Devices and Radiological Health, Dr. Terri Cornelison stated the FDA is aware that “surgeons have been using the device for uses not granted marketing authorization by the FDA,” putting the patient, you, at risk.

2021 Update

In August of 2021, the FDA released a new safety communication about robotically assisted mastectomies, reminding physicians and patients alike that conclusive results on the safety and effectiveness of robot use in surgery has not been established beyond short-term follow-up.

A Hands-On Approach

Dr.  Valerie Gorman has always believed in a hands-on approach with her patients. She chooses not to perform robotic surgeries. Dr. Gorman takes the time from your first step into her office to your last checkup (which is when you decide it is) to answer your questions, so you always know the risks. She knows her tools and what now to bring into the operating room with her. Moreover, she will make sure you are comfortable with her space too.

If you have had a mastectomy done using a robot assist and have concerns, contact your surgeon, or Dr. Gorman would be happy to take a look for you and answer your questions.


Mastitis and Inflammatory Breast Cancer: Things You Should Know

What is Mastitis?

Mastitis (commonly known as ‘Lactation or Puerperal Mastitis,’ terms related to post childbirth) is an infection that occurs in the breast tissue. This condition is often caused by tears around the nipple, obstructed milk ducts, or improperly drained milk; this is a common occurrence with breastfeeding mothers and new mothers who have had a baby within the last 6 to 12 months, but can also occur at other times in life. When cases of bacteria appear within the breast due to a tear or obstruction, the body combats the infection with white blood cells. This results in symptoms include swelling, pain, redness, a fever accompanied with chills, and warmth of skin in (typically) one breast. Rest assured, Lactating Mastitis is unrelated to breast cancer and will not increase your risk for breast cancer.

In the case of rare conditions such as Non-Lactational Mastitis, which is a occurs in women with diabetes, women with depressed immune systems, and women who have lumpectomies following radiation therapy. New symptoms similar to Lactation Mastitis and women experiencing Non-Lactational Mastitis should consult their medical professional to discuss their overall health and how to support their breast health better.

Are the symptoms of Mastitis and breast cancer similar?

Yes, in the case of Inflammatory Breast Cancer, often the symptoms present in a similar way as does Mastitis. It is crucial to see your doctor to examine the area to positively identify cases of Mastitis. If you are experiencing symptoms such as itching, a rash, an inward nipple, swelling, rapid increase in breast size, nipple discharge, discoloration of a breast that starts off pink progressively turns purple, and ridged, thick skin (comparable to an orange peel), you may have Inflammatory Breast Cancer (IBC). Due to the common symptoms caused by Mastitis and Inflammatory Breast Cancer, it is crucial to pay attention to the affected area and consult a medical professional. Inflammatory Breast Cancer does not show symptoms like the standard breast cancer disease because Inflammatory Breast Cancer does not cause a breast lump and may not show up in a mammogram, making it more difficult to diagnose the disease. Infection or injury to breasts do not cause breast cancer because breast cancer is caused by cancer cells blocking lymph vessels within the body. Although less common than non-inflammatory breast cancer, Inflammatory Breast Cancer is aggressive and needs immediate treatment. Generally, within 1-3 months symptoms appear and rapidly spread to nearby lymph nodes. Inflammatory Breast Cancer is often treatable. Patients who seek earlier treatment have higher success rates after Inflammatory Breast Cancer is diagnosed.

What Should I Do If I Have Mastitis?

If you have conditions of Mastitis, it is best to see your medical professional to begin early diagnosis and treatment. Anticipate tests such as a mammogram or biopsy of breast tissue to determine Mastitis or breast cancer. If tests results show Mastitis, antibiotics are administered to eliminate the infection from the breast tissue, and women usually feel relief in 48 to 72 hours. If there are complications, such as a breast abscess, expect to have the fluid drained from the breast either through surgery or a needle aspiration. Despite the ease of clearing Mastitis through prescribed antibiotics, ignoring symptoms can be serious as infection could affect the bloodstream.

Although it might be uncomfortable, it is okay to continue nursing while experiencing Mastitis. Mastitis will not affect the health of the baby or milk produced from breasts. To prevent Mastitis while breastfeeding, try to receive proper amounts of sleep and eating balanced meals to maintain a healthy body to fight infections. Make sure to breastfeed often as well emptying the breast of milk after nursing by using a breast pump, or by massaging breasts to remove any excess milk to keep the milk ducts open and free from obstructions. Note to also alternate breasts in which the baby latches onto for feeding, and support the baby to latch onto the nipple properly. Mastitis can occur when the mother suddenly stops breastfeeding the baby, as her breasts continue to produce milk causing the milk in the breasts to become stagnant and a hub for bacteria. Try weaning the baby off of breastfeeding over a period of time instead of suddenly stopping. This allows for the breasts to slow milk production. Another method of prevention is to take care of the nipple skin to avoid irritation or cracking by using a 100% pure lanolin ointment. This is safe for breastfeeding and is hypoallergenic.

What Should I Do If I Have Inflammatory Breast Cancer?

Dr. Gorman will review your diagnosis carefully and recommend treatment options. Often, treatment begins with chemotherapy. Breast surgery may then be needed to remove the breast (mastectomy), or part of the breast (lumpectomy) and to possibly remove lymph nodes that have been affected by Inflammatory Breast Cancer. Surgery can also support cosmetic enhancements to the breasts when the cancer is removed.

Dr. Gorman will then discuss whether radiation is needed, clearly communicating its risks and added benefits.

If you are concerned that you may have cancer and not mastitis, do not hesitate to contact us. We want you to be proactive in seeking answers. Valerie Gorman, MD is a breast surgeon who specializes in personalized treatments for breast cancer. Should you have breast cancer, you are in good hands at Texas Breast Center. Dr. Gorman will walk alongside the patient, from the first mammograms, through surgery and any additional treatments, to follow visits in the future, all for your peace of mind. Her efforts to ensure you have a caring medical professional at every stage of cancer treatment allows for patients and families feel assured that she genuinely cares about their recovery. Dr. Gorman always attempts to accelerate the process with her hands-on approach and clear communication, so there is not the anxious waiting that patients often experience at other breast cancer centers.


How Can I Improve My Self-Image After Breast Cancer?

body image after breast cancer pinkBody image issues are real concerns for women cancer patients that can impact self-esteem and mental health. You may view your body and yourself differently after breast cancer. Give yourself time to adjust. It takes time to adapt, so remember to treat yourself with compassion and kindness. Talking with others who have been in similar situations either in one on one conversations or support groups may help. This can be instrumental in providing understanding and hope. Keep your network of family and friends close and let them give you comfort. It’s okay to ask for and accept help.

If you struggled with your body image before the cancer diagnosis, then you may have an even harder time coping with changes in your appearance after. The reaction of people close to you and others can affect the way a person adjusts to the changes, as well. Counseling can be helpful if body image is a significant issue for you, particularly if it negatively impacts your return to work and/or other normal activities before cancer.

Along with the emotional stress that cancer and its treatment can cause, it may also change how you look. Many women with breast cancer feel self-conscious about changes to their bodies. Some physical changes may only last a short time while others are permanent.

Possible Changes in Physical Appearance Due to Breast Cancer Include:

  • Scars from surgery (Scarring After Breast Cancer Surgery);
  • Hair loss as a result of chemotherapy or radiation therapy;
  • Surgical modification of body parts;
  • Weight gain/loss;
  • Skin changes such as redness, itching, more sensitivity, or pain in the area that was treated;
  • Loss of muscle mass or muscle weakness;
  • Lymphedema; and
  • Changes in sexual functioning.

Hair Loss and Breast Cancer

One of the possible changes listed above is hair loss from radiation therapy or chemotherapy treatments. Hair loss can be especially stressful. Ask Dr. Gorman about possible ways to retain your hair with the use of cooling caps or scalp cooling systems. If hair loss is going to happen, it most often starts within two weeks of treatment and gets worse one to two months after starting therapy. Your scalp may feel very sensitive to washing, combing, or brushing. It’s important to note that hair often begins to grow back even before treatment ends.

You’ve got choices even if you do lose all of your hair. There are many cover-ups to choose from, or you can go bald. However, many women want to find some way to conceal their bald head and keep warm. Then it’s a matter of what you’re most comfortable with whether it’s a wig, a scarf, or a hat. Be creative.

Lymphedema As Result of Cancer Treatment

Another physical change that you may not be familiar with is lymphedema, and it refers to swelling that generally occurs in one of your arms or legs and sometimes both. It’s most commonly caused by the removal of or damage to your lymph nodes as part of your cancer treatment. This happens because there is a blockage in your lymphatic system, which is part of your immune system. This blockage prevents lymph fluid from draining, and the fluid buildup leads to swelling.

Lymphedema Signs and Symptoms:

  • Swelling occurring in part or all of your arm or leg, including fingers and toes;
  • A feeling of heaviness or tightness;
  • Restricted range of motion;
  • Aching or discomfort;
  • Recurring infections; and
  • Hardening and thickening of the skin (fibrosis).

While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb.

Changes in Your Sex Life Due to Breast Cancer

Talking about your sex life and relationships can be extremely uncomfortable especially after dealing with changes from your illness. You’re not sure exactly what’s wrong or how to treat it, but you know things are different. Many women report having less sex after their illness and here are a few reasons why:

  • A common issue that many women bring up is not feeling “sexy” anymore. This is so understandable because breast cancer is such a physically and emotionally taxing experience that changes so many aspects of a woman’s life.
  • Having breast cancer slows down your body and can result in taking longer to do lots of things, including getting interested in and starting and finishing sexual intercourse.
  • For the woman that has been thrown into sudden-onset menopause, sex can be not just uncomfortable, but even painful. So, not surprising that you may have less sex, for now. Many women report having had little or no sex from the time of diagnosis through treatment.

How breast cancer affects your sexuality is different for every woman. You may find the support you need from your healthcare team, partner, family, friends or other survivors. A support group or close friend may be the key to you reconnecting with your own sexuality. Many online groups host discussion boards where you can “talk” about concerns with someone who has been there.

Finding Help and Support During and After a Breast Cancer Diagnosis

Learning to be comfortable with your body and self-image during and after breast cancer treatment is different for every woman. The right information and support can help you manage these changes over time. It’s essential for you to know that regardless of your experience with breast cancer, there is advice and support to help you cope. Talking with Dr. Gorman and your healthcare team at Texas Breast Center is a great place to start.

Resources:

If you’re interested in visiting a Breast Cancer Support Group, contact Texas Breast Center for more information.


Is Chemotherapy Necessary Before or After Breast Cancer Surgery, or At All?

Is Chemo necessary for breast cancerChemotherapy is an effective way to treat and prevent the spread of breast cancer, but new research suggests it is not always necessary.

A recent study found that breast cancer has been highly over treated with chemotherapy and doctors can now confidently provide an alternative treatment known as Endocrine Therapy.

However, each patient is different with a unique set of circumstances. Chemotherapy is necessary in advanced stages, as well as early stages when specific characteristics are present, such as spreading to the lymph nodes or other body parts.

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What To Say To Someone With Breast Cancer

what to say to someone with breast cancerWhen someone gets diagnosed with breast cancer, the world can seem a very lonely place; there is no right or wrong way to react, everyone is an individual and will cope with challenges differently. An issue that many patients have talked about is the reactions of their friends and family, once they do summon up the courage to break the news.

Very few partners, family members or friends are likely to be trained counselors, and even if they were, it is much more difficult saying the right thing to someone who means the world to you personally. Most people it seems, feel obligated to say something, and it is a fair assumption, that a pregnant pause or an extended period of silence is not what your friend or relative is looking for, but the question is what is the right thing to say in this situation? After all none of us are trained in these matters, and we all want to help, so let’s examine some potential ideas so that if you ever find yourself in this situation, you won’t be left speechless.

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Sentinel Lymph Node Biopsy Procedure: Key Facts You Need To Know

Cancer is perhaps the scariest word in the dictionary, capable of striking fear into the heart of anyone who hears it inside of a second. Part of the problem is that the minute a doctor says that word, anything that he or she says subsequently becomes a total blur. It is like the patient is trying to listen to the doctor while being underwater. That’s the reason we have a resource section on our site. This article answers questions about the procedure for a biopsy of the sentinel lymph node.

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Scarring After Breast Cancer Surgery

scarring after breast cancer surgeryThe public conception of breast cancer treatment is quite positive; people are confident that medical science has achieved a reasonable degree of success at dealing with breast cancer, and so ironically many women express more concern about how their body will look postoperative.

Although her priorities will always be focused on defeating the cancer, Dr. Gorman is passionate about delivering the best possible treatment to all of her patients, which is why, when possible, she advocates the use of hidden scar treatment.

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Fluid Collection After Breast Surgery – Seroma

Fluid Collection After Breast Cancer Surgery – SeromaSurgery of any kind always involves some degree of risk, and Breast Cancer surgery is no different in that regard. The good news is that the vast majority of breast cancer surgeries across the world are completed successfully without any complications. Generally speaking, when any complications do arise, they tend to be minor and easy to deal with from a medical standpoint.

Fluid collection following breast surgery is one of the more common side effects, and the purpose of this article is to explain what causes it, what to expect, and how it is treated. Although breast surgery can be understandably daunting, fluid collection is not something that should cause any huge concerns or worries. In most cases, the problem resolves itself.

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What Is Invasive Lobular Breast Cancer?

what is invasive lobular breast cancerBreast Cancer consists of many different types, so if you have been diagnosed with Breast Cancer, then it is important that you understand which specific kind of Breast Cancer you have. The treatment, prognosis, and outlook vary depending on the different type.

Invasive Lobular Breast Cancer takes its name from the origin of this type of breast cancer. It begins and develops within the milk-producing glands of the breast. These are known as the lobules, which is where the name of this particular cancer originates. The Invasive part of the name differentiates between cancer and pre-cancer.

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Lumpectomy Surgery Recovery – What To Expect

lumpectomy surgery recoveryHumans by their very nature do not like the unknown, which might explain why one of the most frequent questions we are asked at the Texas Breast Center is what to expect regarding your lumpectomy surgery recovery.

This is something that Dr. Gorman always explains in great detail, before the operation as it is essential that our patients have the proper care and support systems in place so that they can recover quickly.

The good news is that due to advances in technology, for most women having a lumpectomy procedure there is no need for an overnight stay. Nobody likes the thought of spending time in a hospital bed, so this normally brings a great deal of relief to our patients, being able to go home to your bed, and be surrounded by your family is an excellent way to start the recovery process.
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How Developments In Breast Cancer Research Have Improved Treatment In The Last Thirty Years

breast cancer treatmentWe want to feature a recent study by Rufus Mark, MD, Gail Lebovic, MD, Valerie Gorman, MD, Oscar Calvo, PhD. on recent developments in Breast Cancer Treatment.

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Birth Control and Breast Cancer: What’s the Connection?

contraception and breast cancerLate in 2017, the media picked up on a study published in the New England Journal of Medicine that linked hormonal contraceptives, like the pill and some intrauterine devices (IUDs), with a higher risk of breast cancer.

After hearing this news, you might be concerned about whether your family planning choices might increase your cancer risk. Here’s what I explain to my patients.

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