Breast Reconstruction Surgery: A Team Approach

Dr. Valerie Gorman, MD, FACS, is a breast cancer surgeon, board-certified by the American Board of Surgery. She specializes in surgical diseases of the breast and surgical oncology, serving as the Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center in Waxahachie, Texas.

As she helps her patients through the process of learning their best options for cancer treatment and the most effective type of surgery to help, her staff works with her. But she also knows that she is not the last step in the healing process. It is common for breast surgery for cancer to require reconstruction. So Dr. Gorman has an established partnership with Dr. Potter that has now lasted more than 15 years.

Dr. Jason Potter, MD, DDS, is a plastic surgeon who serves the greater Dallas area and has affiliations with multiple hospitals and hospital systems. He is double board-certified, with his advanced surgical training focusing on reconstructive plastic surgery. He serves the greater Dallas area.

Dr. Gorman and Dr. Potter’s partnership is based on mutual respect for both each other and the patient. The two sat down in a joint interview to explain how their collaboration worked and how it benefitted the patient.

To start, Dr. Gorman was asked why she chose to work with Dr. Potter. She answered,

“We both have the same standard for our patients. He doesn’t do the easy way; he does the right thing for the patient. He can offer every option to our patients, so he’s not just limited to one kind of breast reconstruction. I think other plastic surgeons recommend what they do. And he does it all, so it makes it easy to recommend the best thing for each patient.”

Dr. Potter explained his reconstruction options:

“The two main types of reconstruction are either implant-based reconstruction or tissue-based reconstruction. Patients are not always a candidate for both. Sometimes there are limitations put on us by the patient’s body habitus, such as how much tissue they have to donate for breast reconstruction or prior surgeries that prevent utilizing tissue from certain areas. So most of the time, implants will always be available, but if patients have had multiple infections or have a history of radiation, there are higher complication rates for implant surgery.

However, some people don’t want an implant. They’ve never had an implant, and they never will have an implant. They just don’t want one. Implants require maintenance. You have a new device in the breast that has to be maintained, has to be monitored, and has to be replaced approximately every ten years. Whereas, when you have an all-tissue breast reconstruction, the patient doesn’t necessarily need other surgeries once they’ve completed the process because maintenance isn’t required. It’s really sitting down with the patient, seeing what co-morbidities or preferences they might have or bring to the table, and then selecting the best option.”

Several factors have to be taken into account when figuring the best approach to breast reconstruction. Dr. Gorman usually starts the process when discussing the initial breast cancer treatment.

“Usually, the patient is in my office first, so I try to get a good understanding of them, and I try to learn a little about what the patient would like to do. I usually have an idea of when he would like to offer somebody one or the other, considering the patient’s preference, their medical situation, their questions, and what they already know. I then go from there. Some factors I look for are if they’re a smoker, or if I see they’ve had several abdominal surgeries. If they’ve had radiation before, I know we’re going to have to do a flap to try to protect that implant, those kinds of things. I leave it open for Dr. Potter to use his expertise and talk to them about the pros and cons of each option available.

Some people don’t want a massive surgery. The flap is a longer, second operation, so many people want to avoid that. But in the long run, 20 years from now, that 8 hours in the operating room, they’re not going to remember that part. So, we try to talk them through what they want and what we think they’re tending to prefer and talk about the pros and cons. If they’re a smoker, there may be certain options that have reduced risk. Then we send them to Dr. Potter, and he finishes the conversation, and they make the final decision. And our offices coordinate scheduling whatever procedure we’ve decided together with the patient.”

Dr. Potter added:

“It’s a nice team approach. From the day they go into Dr. Gorman’s office, they’re starting to get questions answered; they begin to have reconstruction questions answered. As soon as they find out they’re going to need a mastectomy, they want to know what that next step will be. Dr. Gorman is very good at starting that discussion with them. After surgery, both offices work with the patients when they have issues in the postoperative period, so it’s a nice comprehensive approach to patient care. I think the patients really like it.”

Once the patients have met their doctors, the process can begin.

“Breast reconstruction is a process, so it’s not usually one operation and done. It starts the day of the mastectomy with either placement of a tissue expander (which is a temporary implant) or initial reconstruction using the patient’s own tissue in certain situations. But operations are usually staged about three months apart. So, if surgery was all the patient needed, they may complete reconstruction in six months or so. If they need chemotherapy or if they need radiation, they may not complete the reconstruction process for nine to twelve months. It’s kind of hard to say exactly how quickly they can have their surgery, but they’re staged depending on the procedure and patient’s needs and other treatments.”

Dr. Gorman said about the stages:

“A lot of people come in and say, ‘I want it all done in one operation,’ which we can sometimes do. But we talk to the patient about how sometimes that’s not the best solution for them because they’re going to end up having another operation down the road anyway. So, whether it’s one stage or two-stage, we tend to go with two-stage for improved cosmetic outcomes. Once again, those are just the different options we offer.

Another variation of the reconstruction options mentioned above is whether the DIEP flaps procedure is being performed. Dr. Potter is well known for his ability to perform this operation.

“Not everyone does the flaps. That’s a big operation, and Dr. Potter does a significantly high volume of these. He’s the DIEP flaps guy. If you mention DIEP flaps to anybody, his name comes up. We offer that to our patients, which is awesome.”

Dr. Potter gave a little more detail into the DIEP procedure, saying:

“It’s a complex reconstructive procedure. Not every surgeon offers these techniques. Because of its complexity, patients are better served by an experienced team like ours. For the last 13 years, we’ve been providing that operation in Dallas. We have a very efficient team, which is important for patients so that they’re not under anesthesia too long. We’re also refining the technique and leading some of the advances. We are are now providing Resensate™ to candidate patients. Resensate is a technique to provide reinnervation to the breast.”

Reinnervation is the restoration of nerves to a place where there has been nerve damage, like a surgical site. This has been a concern of plastic surgeons for as long as this has been a profession. To explain the importance of Resensate and its work in reinnervation, as well as patient expectations, Dr. Gorman explained,

“The biggest thing when you’re educating patients about breast reconstruction after they get a mastectomy is that they’ll say, ‘oh well, my friend had implants, so this is kind of like that, at least I get a breast augmentation and implants like my friend did.’ And then you have to remind them, ‘your friend kept her breast, and yes, she has the same implants in there, but it’s very different.’ And the sensation is the most significant difference there probably. The way they feel and look are different, too, but the sensation is very different. And we have heard a wide variety of comments from patients who have had this procedure, from ‘they feel like they are floating in front of me,’ to ‘I have some intermittent feeling, it comes back over months,’ to somewhere in between. I think that’s the most significant difference, once they get over the initial surgery and diagnosis and treatment. Settling back into everyday life, it is a constant reminder. It is hard to forget what they’ve been through because it is so different. So gaining feeling back will be huge because it is one of the big reminders for them.”

Now that there is a general understanding of the types of breast reconstruction and the process of moving between the breast cancer surgeon to the plastic surgeon, Dr. Potter discussed some of the common questions he gets asked at appointments.

“There are lots of questions about tissue-based operations versus implant-based operations. There are lots of questions about the types of implants given, and the recent Allergen textured surface recall. And really, the most common question is ‘which operation is best for me? We try to take patients through that question because that discussion is never the same for any two patients. Recovery is always a concern. Most questions here deal with downtime, recovery, time off work, and number of surgeries.

Recovery varies with the operation and the patient. With the first operation–the mastectomy and the tissue expander–it can be anywhere from 2-4 weeks of downtime. Implant surgeries are usually less downtime for the first stage, and tissue surgeries can be up to 6-8 weeks, depending on what they choose.”

The recent concerns about textured implants have resulted in many questions regarding implant safety. He continued,

“Overall, implants are very safe. A recently identified process called Breast Implant-Associated Anaplastic Large Cell Lymphoma has brought renewed scrutiny to breast implants. Allergen was asked to voluntarily recall their textured surface implant line because 80% of the cases found worldwide were associated with that implant surface. But it’s an extremely rare process.

Despite its rare occurrence, many patients going through breast cancer treatment do not want to worry about other potential problems linked to the reconstruction. This is leading more patients to inquire about tissue-based options.”

In summary, whether receiving a tissue or implant breast reconstructive surgery, Drs. Potter and Gorman know to listen to you, to listen to each other, and work with the best materials to ensure the best outcome for you.

When asked for their final thoughts, Dr. Gorman had this to say,

“The team we’ve formed between our offices and the options we offer together are what I want to emphasize. Between the two of us, we can more thoroughly follow-up. If a patient goes to see him, he will ask me any questions that need asking. If they need to have drains removed but don’t want to drive all the way to him, they can stop in our office to get them taken out. We do a lot of that for the patient, which I think is pretty great for them. We navigate them through the post-breast reconstruction hassle. We can say ‘yes, we’ve talked to them, you’re good to go here or do this’ so they don’t have to go back and forth between us and say ‘well Dr. Gorman said this’ then they say ‘well Dr. Potter said to let you know that.’ This way, the patient doesn’t have to do all that on their own.”

Dr. Potter followed up in agreement.

“It is a very personal, very comprehensive approach. Patients are going to appreciate the individualized attention that they are going to get every step of the way. And the way our offices work together, it helps to coordinate and make sure the patient doesn’t have to determine which office to go to.”

Drs. Potter and Gorman work cohesively to ensure their patients are receiving the best care. By staying in contact, there is no risk of loss of information. By working with each other consistently, they learn how the other works and can better inform patients on what to expect. Dr. Potter’s expertise in types of breast reconstruction and Dr. Gorman’s cancer-oriented breast surgery go hand in hand to create a strong team approach for treatment, recovery, and your best outcome.


The Path to Breast Cancer Surgery Recovery

Breast cancer and accompanying treatment can be a grueling experience, both physically and emotionally. And while relief can come with successful surgery, recovery can difficult. Here is some information about what to expect from recovery and a few tips to make it easier.

Your Hospital Stay

After surgery, you will stay in the hospital for the first steps of recovery. How much time you spend in the hospital differs depending on the type of surgery, whether it was outpatient or inpatient, whether reconstruction was performed, and other factors.

A lumpectomy is traditionally an outpatient procedure. It does not require an extended stay in the hospital—less than 23 hours—as the stay is merely to give the surgeon and nurses enough time to make sure there are no adverse aftereffects. Once they are satisfied, you may leave the hospital to better rest and fully recover.

A mastectomy, however, can require an extended stay. When lymph nodes are removed, and breast reconstruction is performed, you may have to stay in the hospital 1-2 days. Without the reconstruction, this may drop to overnight, though this is still considered an inpatient procedure. More complex reconstruction may require a longer stay. Always ask your doctor how long they expect you will have to stay before you can leave the hospital.

Anesthesia

Anesthesia keeps a patient unconscious, painless, and calm during surgery and is carefully catered to each patient’s needs. Medications can be changed due to an individual’s allergies or previous experiences. Anesthesiologists will also adapt their medicines depending on the procedure. For example, general anesthesia is commonly used for these procedures.

General anesthesia can, in a small number of people, cause adverse reactions and symptoms. A sore throat can come from the tube placed in the throat to help with breathing during the procedure. Nausea, vomiting, delirium, itching, chills, and muscle aches are common side effects. Some may be caused by accompanying pain medication, but each sensation should pass rather quickly.

Pain

As with any surgery, some level of pain should be expected after breast surgery. Initially, this will come from the surgery itself, based around the incision sites and where the tissue was removed. If lymph nodes were removed, there would likely be more pain. As healing begins, the pain will settle more when you are still and be triggered more by a range of motion. As the breast, breast tissue, lymph nodes, and underlying muscles are so central to the body, almost any movement of the body can affect this area. Your surgeon will inject local anesthetic during surgery to reduce post-operation pain.

To help control pain levels, your surgeons will prescribe medication that will drop off into over-the-counter medicines that will drop off into no medication when you are ready. When the pain is still severe, you may be placed on something like tramadol for the early days. You will be weaned off of these drugs and onto over the counter pain medication within the first few days to prevent complications.

Drain

When tissue is removed from a surgical site, there is a risk of seroma. Seroma is a build-up of fluid to fill in a suddenly empty space in the body–a place where there once was tissue, and now there is not. Seroma can be uncomfortable or even painful, and can sometimes scar. To prevent this issue, the surgical team will place a drain in the breast that removes any fluid that attempts to fill the healing space after a mastectomy.

After the surgery, you will be given instructions on how to care for your drains. You will be told how to empty them, what to look for in them, and when they will be removed. They will likely look like a small tube leaving–and stitched to–the breast that travels to a hand-sized bulb. This bulb will be kept in a compressed position, setting up a vacuum to pull out any fluids that should be pulled out.

The bulbs have measurement labels on their exterior so that you can easily see how much fluid has drained. You will have to keep track of these measurements as you empty, clean, and recompress the drains throughout the day. These numbers help determine how long the drain will stay in place.

Living with drains can be inconvenient until you get used to them. You must always be aware of the tubes, so they don’t catch on something. Though the bulbs tend to come with loops you can strap around your surgical bra’s straps to keep them out of the way, the tubes are still something to keep in mind. There are also belts and shirts explicitly made to hold drains and their tubes.

Bathing is also tricky with drains. While you have to wait until your doctor has said you will be alright to bathe in the first time, you should not submerge your drains, so a bath is not a good idea (for your drains or your scars). Most doctors recommend gently patting yourself clean and dry with a sponge bath.

There are a few factors that you need to pay more attention to in your drains than others. You should alert your surgeon if you start to notice signs of infection, fluid leaking around the tubing, drainage increasing, decreasing, or thickening, the bulb losing suction, bright red drainage, or if the drain falls out.

What to Wear After Surgery

One reason surgery can be intimidating is that you don’t know how you’ll look when the scars have healed, and the swelling has gone down. Even with breast reconstruction, there may be changes to your appearance. Clothing can be a touchy subject. Not only will it fit you differently, but you will be sensitive for a time as your body heals.

Bras, in particular, will be difficult. Surgical bras are given and recommended in some situations, which offer some support while putting minimal pressure on incisions. They clasp in the front to avoid instigating the pain that comes from moving too much. A nurse can help adjust it easily while in the hospital, and it can be used to hand the drains to keep them out of the way of your arm.

In the first weeks after surgery, you’ll likely want to stick to bras or shirts like made in this way. Clasps, buttons, or ties in the fronts. Pants or skirts that can be easily stepped into. Nothing overly complicated or that has to be pulled over the head. This will pull on the arm and shoulder, and therefore the sensitive muscles beneath the breast. Advice commonly given by previous patients of breast cancer surgery recommend loose tops and shirts for a while. Give yourself time to adjust to your new appearance with some comfortable wear.

For the first year after surgery, bras should have no underwire. The seams should be soft, and the band should be wide to minimize any pressure on one particular place. Cups should be both full and separated. And you’ll likely want to be fitted by an expert for your new bra size. Make sure to find someone who has the training, perhaps at a lingerie shop or department store to ensure the best fit.

If you are using a breast prosthesis, you may want to find a bra with a bra pocket. These are small pockets sewn into the inside of the bra to hold a prosthetic in place. Mastectomy bras can be purchased with the pocket, or you can adapt a regular bra by sewing a pocket in yourself. Or, many find, a regular bra with a full cup that fits well enough will hold a prosthetic without a pocket. Of course, it all depends on your comfort level and what you like best.

Movement and Exercise

After breast cancer surgery–and other breast cancer treatment like radiotherapy–it can be essential to keep the affected muscles moving. Yes, they are sensitive and difficult to move. But that is precisely why you must exercise them. You don’t want them to weaken or stiffen further from disuse.

Exercise, in this case, does not mean a workout. Overworking your arms and shoulders in this condition would be easy and could be harmful. But simple exercises and movements to ensure that everything is staying in use will help in the long run. Within the first week of surgery–the first 3-7 days, if possible–you should start with the easiest movements. Use the arm on the side of the surgical site to comb your hair, practice deep breathing approximately six times a day, and raise the affected arm above the head (lay it on a pillow, so it is above) and clasp your hands open and closed 15-25 times. These are simple exercises you can do without straining too much or even getting out of bed.

Once you’ve healed more and your surgeon gives the okay, you may start other exercises. Again, these are not particularly strenuous. You are still recovering. Your muscles are not prepared to comfortably remain above your head long enough to pull a shirt on, let alone lift weights. These exercises are merely meant to keep the muscles in the area near the operation flexible. Side effects of any major surgery can be weakening of unused muscles and difficulty getting back to full strength. If you practice these minor arm exercises early, you can prevent these.

Some simple exercises can be done while sitting at your table. The Shoulder Blade Stretch is done while facing the table with your palms placed on its surface. Your back should be straight, the unaffected arm (the arm away from the surgical area) should be bent slightly. The affected arm (closest to the surgical area) should be straight. Without turning your body, slowly slide your affected arm forward until you can feel your shoulder blade moving. Relax, then slowly pull your arm back. Then you repeat 5-7 times.

If you prefer to lay down while you stretch, you can try Elbow Winging. This stretch helps the movement of the shoulders and the chest and is performed while lying on your back. It can do this stretch on a bed or the floor (whatever is most comfortable for you and your stage of healing). Once you are lying flat, bend your knees and place your feet flat on the floor. Place your hands behind your neck and clasp them together, bringing your elbows up, so they point up towards the ceiling. Carefully press your elbows out and down towards the floor. This will take a while. Your first attempt after your operation will likely not reach the floor. But as you heal, you will get closer and closer. Repeat this motion 5-7 times.

Be careful not to push yourself too soon after surgery. Wait until a surgeon has said it will be okay to exercise, so you don’t strain your wound. But remember that when you get the chance, moving is an integral part of healing.

Recovery

Recovery is unique for each person. Some feel no aftereffects from anesthesia while others hate what it does to them. Some patients’ only clothing issues come from adjusting to the surgical bra they are given immediately after surgery, while others take longer to adjust to their new appearance. Recovery is not a straight path. It is a branching and varying road from breast cancer to health. But it’s not one traveled alone.

Not only will you have your support network of family members and friends, but your medical team is there to support you as well. The surgical team will work with you to find your best procedure, find your best medications based on experience and family history, and prepare you for recovery.

Dr. Valerie Gorman knows about the concerns and fears that come with a breast cancer diagnosis. But she and her team will work with you to create the best treatment plan for your needs and lifestyle and help you find the easiest recovery path.

Dr. Gorman’s team have walked alongside many people who have been diagnosed with breast cancer and understand your situation. It is our privilege to walk with you, answer your questions, and help you through this difficult process.


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.


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.


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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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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