What is the difference in long-term outcomes between lumpectomy and mastectomy procedures when performed by a skilled surgeon?

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A breast cancer diagnosis can bring about an overwhelming amount of decisions to be made. First and foremost on most patients’ minds is what are the treatment options and which have the best long-term outcomes. Choosing a doctor that you feel comfortable having open and honest communication with will help alleviate some of the stress associated with making treatment decisions.

Dr. Gorman is committed to giving her breast cancer patients an advanced, personalized, and targeted approach to breast cancer treatments. In some cases, people with breast cancer can choose between removing the entire breast (mastectomy) or breast-conserving surgery (lumpectomy) followed by radiation. In this article, we will discuss the differences in long-term outcomes between lumpectomy and mastectomy procedures when performed by a skilled surgeon.

What is a mastectomy?

Breast surgery that involves the removal of the entire breast is called a mastectomy. When faced with the choice between a mastectomy and lumpectomy (also known as breast-conserving surgery) plus radiation therapy, some women choose mastectomy. For some women, mastectomy is the only surgery option for breast cancer. Mastectomy is also used to treat breast cancer that has come back after lumpectomy and radiation therapy have been done.

Total (simple) mastectomy and modified radical mastectomy are the two main types of mastectomy. Your diagnosis and cancer type will determine the type of mastectomy you will have.

Total (Simple) Mastectomy

In a total (simple) mastectomy, the surgeon removes the entire breast and the lining of the chest muscle but does not take out any other tissue.

Total (simple) mastectomy can be used to treat:

  • Ductal carcinoma in situ (DCIS)
  • Paget disease of the breast with underlying DCIS
  • Invasive breast cancer
  • Breast cancer recurrence

Total mastectomy is also performed on high-risk women who want to prevent cancer based on personal preferences.

Sometimes a reconstruction of the breast is done at the same time as a mastectomy.

Modified radical mastectomy

The breast surgeon takes out the entire breast, the lining of the chest muscles, and the lymph nodes in the armpit area (axillary lymph nodes) during a modified radical mastectomy.

This type of surgery can be used to treat:

  • Invasive breast cancer
  • Inflammatory breast cancer
  • Paget disease of the breast with underlying invasive breast cancer

Sometimes a modified radical mastectomy is done at the same time as breast reconstruction. However, this is not done for inflammatory breast cancer.

What is a lumpectomy?

A lumpectomy is a surgical procedure used to remove breast cancer. In contrast to a mastectomy, a lumpectomy only removes the breast tumor and a small amount of healthy tissue around it. It leaves most of the skin and breast tissues where they are.

The breast looks as close as possible to how it did before surgery after a lumpectomy. Most of the time, the breast and nipple area keep their general shape. Lumpectomy is also called breast conserving surgery, partial mastectomy, and wide excision. This type of breast cancer treatment is used in early breast cancer.

Is there a difference in the long-term outcomes of a mastectomy vs. a lumpectomy?

For women with earlystage breast cancer, there is no difference in overall survival rates between a mastectomy and a lumpectomy with radiation. There are other differences between these two therapies, but neither is better than the other. It just depends on what’s best for the patient.

There have been multiple randomized trials comparing breast-conserving surgery and mastectomy, which found no survival advantage for either surgery option. In 1990, the American National Cancer Institute (NCI) consensus panel came to the conclusion that breast-conserving surgery was the optimal treatment based on these trials in the United States. Since then, the trend in surgical procedures has changed, with breast-conserving surgery first increasing and then dropping since 2006 while mastectomy rates have climbed. Bilateral mastectomies are primarily responsible for the rise in mastectomy rates.

Studies show that women with early-stage breast cancer who have breast-conserving surgery followed by radiation therapy have the same chance of surviving as women who have a mastectomy. This means that if there is no medical reason for you to have one surgery over the other, your doctor will let you choose.

Choosing between surgery to save the breasts and a mastectomy is a very personal decision. In addition, it comes at a very emotional time. Your feelings, preferences, priorities, and way of life all affect your choice. If you want to keep as much of your breast as possible, you might choose breast conserving therapy. Or, a mastectomy, which removes more breast tissue, may give you more peace of mind.

First, talk to your breast physician to find out if you can choose between a mastectomy and a lumpectomy plus radiation therapy. Some women may not have a choice because a mastectomy is the only surgery that can treat their advanced breast cancer. About 25% of women will need a mastectomy, but the other 75% can choose not to have one.

Most of the time, the size of the tumor compared to the size of the breast is the main thing a breast surgeon looks at to decide if a lumpectomy is a good option for the treatment of cancer. Whether lumpectomy is a realistic possibility is related to the % volume of the breast which requires excision to remove the cancer with adequate pathological margins, in comparison to the overall size of the breast, also taking into account where the tumor lies within the breast, as some areas of the breast are more cosmetically sensitive to volume loss than others.

Chemotherapy or hormone therapy may be suggested before surgery, especially if you have a large tumor or if your lymphatic system is involved. This is called neoadjuvant therapy, and it will help shrink the tumor before surgery to remove breast cancer.

Sometimes a woman can have a lumpectomy but should avoid radiation therapy, and in this case, she will need to have a mastectomy instead. Radiation therapy is not for everyone. Radiation therapy can be dangerous if you are pregnant or if you have certain health problems.

Since radiation can hurt the baby, it is not given to women who are pregnant. Depending on when the woman found out she was pregnant and when she was told she had breast cancer, she may be able to have a lumpectomy and put off radiation therapy until after she gives birth.

Some serious diseases of the connective tissues, like scleroderma or lupus, may make you more sensitive to the side effects of radiation therapy. However, in some women at higher risk of breast cancer recurrence, radiation therapy may still be used.

Radiation therapy to the same breast or the same side of the chest in the past may make you ineligible for radiation therapy if there is a recurrence. In most cases, breast radiation therapy can only be done once. After careful discussion with your radiation oncologist, radiation therapy may be given to the same breast again in very rare cases.

If you have a choice, you should carefully consider all of the outcomes before making a decision. A short delay before surgery won’t hurt your prognosis. Think about the risks and benefits of each surgery and choose the one that is best for you. No matter which choice you make, the chance of survival is the same.

How do patients choose between a mastectomy versus lumpectomy plus radiation therapy?

People with breast cancer can sometimes choose between the total removal of a breast (mastectomy) and surgery to save the breast (lumpectomy) followed by radiation. If there is only one site of cancer in the breast and the tumor is less than 4 centimeters, a lumpectomy followed by radiation is commonly a treatment option and is likely to work just as well as a mastectomy. Clear margins (no cancer cells in the tissue surrounding the tumor) are also a requirement for a lumpectomy.

When given the option, most women choose the less invasive lumpectomy, but there are a few things to consider before making the decision between lumpectomy and mastectomy. Consider how you feel about these factors:

  • How important to you is it to keep your breast? If keeping your breast is important to you, you might choose to have a lumpectomy with radiation instead of a mastectomy and avoid having the entire breast removed.
  • Do you want your breasts to be as close to the same size as possible? Most women look good cosmetically after having a lumpectomy. When a larger area of tissue needs to be removed, which happens very rarely, a lumpectomy can make the breast look smaller or distorted. There are different types of reconstruction for both lumpectomy (if there is a lot of distortion) and mastectomy. It is up to you and your health care provider to determine the best course of action if you require a significant amount of tissue removed and want breasts that are the same size.
  • How concerned are you about a recurrence of breast cancer? If removing the entire breast would make you less worried about your chances of recurrence, you might want to get a mastectomy.

Ultimately the decision to have a lumpectomy plus radiation therapy or a mastectomy is a very personal decision that should be made with the guidance of your skilled surgeon. Dr. Gorman at Texas Breast Center is a breast surgeon who specializes in surgical oncology and surgical diseases of the breast. She treats each patient as an individual and tailors their treatment plan to their unique needs knowing that no two people are the same and, therefore, treatment cannot be either.

Dr. Gorman has a vast amount of knowledge and experience when it comes to the treatment for breast cancer. She always considers and evaluates all of the treatment options and their likelihood of success before contemplating surgery. When surgery is needed, she implements a breast-conserving surgery when possible to reduce the impact on cosmetic appearance post-operation. For more information about Dr. Gorman and the breast cancer surgery treatments available at Texas Breast Center, visit our website or call our office to schedule a consultation.

https://pubmed.ncbi.nlm.nih.gov/7477145/
https://journals.lww.com/aosopen/Fulltext/2022/12000/Breast_Conserving_Surgery_or_Mastectomy___Impact.6.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504664/

Does Every Breast Cancer Patient Need Surgery?

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Many breast cancer patients wonder if surgery is always a required step in breast cancer treatment. In early-stage breast cancer, studies are finding that there are often breast cancer chemotherapy drugs and radiation treatments that are quite effective at eliminating cancer cells and reducing the amount of breast cancer surgery. At Texas Breast Center, our goal is to help patients find the most minimally invasive treatment with the best outcome for their particular type of breast cancer.

Dr. Gorman, as an experienced breast cancer surgeon, has a deep understanding of the benefits and downsides of surgery. Breast cancer surgery can significantly improve or greatly diminish a woman’s quality of life, sometimes without improving her long-term survival, depending on the particular circumstances surrounding the patient. The art of medicine and surgery for breast cancer is to match a patient’s goals and tumor features with the appropriate treatment strategy (such as chemotherapy, radiation therapy, hormonal therapy, surgery, or alternative medicine) in a way that maintains or improves cancer control while preserving or improving quality of life.

According to two new clinical trials, patients with early-stage breast cancer who respond well to neo-adjuvant chemotherapy or targeted therapy before surgery may be able to decrease the amount of surgery followed by radiation therapy, with a low risk of cancer returning. Dr. Gorman is dedicated to offering her patients an advanced, personalized, and targeted approach to breast surgery and the treatment of breast cancer. Call Texas Breast Center today to schedule a consultation and learn more about the types of breast cancer treatment we offer.

What is the de-escalation approach to cancer treatment?

In an effort to tailor the different types of treatments to a particular subtype of the disease, the de-escalation approach to cancer treatment focuses on using less treatment and fewer interventions to produce the same effects. If gene tests reveal that chemotherapy for breast cancer won’t be effective at reducing breast cancer cells and there are alternative cancer drugs available, some breast cancer patients may be able to skip chemotherapy, sparing them both short-term side effects and longterm effects.

De-escalation can also involve reducing surgery or performing a lumpectomy that preserves breast tissue rather than a mastectomy to treat breast cancer. The goal of de-escalating breast cancer treatment is to reduce morbidity and enhance the patient’s quality of life without jeopardizing the disease’s outcome.

Research on Chemotherapy as Breast Cancer Treatment without Surgery

Researchers at MD Anderson Cancer Center stated in a news release that “This research adds to growing evidence showing that newer drugs can completely eradicate cancer in some cases, and very early results show we can safely eliminate surgery in this select group of women with breast cancer,” said principal investigator Henry Kuerer, M.D., Ph.D. After receiving chemotherapy before surgery, patients who were thought to be in complete remission were examined by researchers to determine the likelihood of breast cancer reoccurring in these patients.

After a median follow-up of 26.4 months, the study found that 31 of the 50 patients who were tracked had a complete response to chemotherapy and none had a breast tumor recurrence. The study shows promise as a less invasive way to treat cancer, as these types of cancers usually recur within the first couple of years. According to Kuerer, “Patients often have surgery first, but these targeted therapies increase survival. So give it first — it shrinks tumors, allowing lumpectomy vs. mastectomy.”

50 women over age 40 with early-stage triple-negative breast cancer or HER2-positive breast cancer who had a breast lesion that measured less than 2 cm after receiving a conventional targeted chemotherapy regimen participated in the multi-center trial. Breast surgery was withheld, and patients continued with conventional radiation therapy if cancer was not found on biopsy.

The VACB classified 31 individuals among the participants as having a pathologic complete response, which means a pathologist could not find cancer in the tissue where the tumor was discovered. Even while the surgery-free plan seems to have been effective thus far, the trial only involved a limited number of well-screened women, who were observed for a median of 26 months. It’s a sizable amount of time, particularly for the particular breast cancer types analyzed, in which breast cancer recurrence frequently happens in the first several years. Experts agreed that a larger study with a comparison group would be necessary to determine whether changes in medical practice for the treatment of cancer are necessary, as the study was performed on a particularly small group. The study is a good start, but the results cannot be claimed as conclusive with such a small test group.

The chief executive officer of the American Cancer Society, Karen Knudsen, said, “What I really appreciate about the study is that it takes the next step and asks a bold question: How do we take all the advances that we’ve made in more tailored and specific cancer therapy, and convert that to reducing the number and types of interventions any one patient needs to incur?”

Read the article: Breast Reconstruction Surgery: A Team Approach

The Future of Breast Cancer Treatment

Utilizing every resource available in contemporary medicine is the traditional strategy for treating breast cancer. The removal of the tumor via surgery is seen as a crucially important step, along with radiation therapy for breast cancer, medication, hormone therapy, and, when indicated, immunotherapy to destroy cancer cells. It is especially important to utilize all of these interventions available when formulating a treatment plan to treat metastatic breast cancer as well as locally advanced breast cancer.

While the study results are quite promising and encouraging, it is important to note that more cancer research must be done before making this a part of routine breast cancer treatment protocols. Neoadjuvant chemotherapy treatments, or chemo drugs that are administered prior to surgery with the intention of having a less extensive surgical procedure, has become so advanced that oftentimes the cancer cells are gone before the time of surgery. With adjuvant therapy becoming more targeted and effective at treating breast cancer, there is great hope that in the future, surgery to remove breast cancer will be needed less often. The benefits of chemotherapy outweigh the risks, both physical and emotional, that are associated with surgery for many patients. Breast cancer patients should talk with their doctor to find out if neoadjuvant therapy would be beneficial for their particular type of breast cancer.

A breast cancer diagnosis can be alarming, which Doctor Gorman and her staff at Texas Breast Center are mindful of when providing compassionate care for patients. She is committed to providing her patients with a sophisticated, individualized, targeted approach to breast surgery and breast cancer treatment, along with top-tier treatment regimens. She never advocates for additional treatment that would be unnecessary for a patient but works to find the best possible treatment for the best quality of life and results. For in-depth information about breast cancer, risk factors, therapies for breast cancer, and preventive measures that can be taken, as well as to schedule a consultation with Dr. Gorman, visit the Texas Breast Center website.

https://www.nytimes.com/2022/10/25/health/breast-cancer-surgery.html

https://www.foxnews.com/health/breast-cancer-patients-respond-pre-surgical-treatment-may-skip-surgery

BioZorb® Implant Side Effects

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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 titanium 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.

Breast Cancer Recurrence: New Data in 2022

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In layman’s terms, breast cancer recurrence happens when cancer has come back after treatment. When a number of breast cancer cells evade initial treatment and later aggregate, they cause the cancer to return despite months or even years of remission. It is important to note that a minimum of a year must pass between the execution of cancer therapy and the appearance of growing cancer cells for the growth to be deemed a recurrence, rather than treatment failure or progression of cancer.

Every survivor of breast cancer faces a chance of recurrence, so it is essential to understand what to look for and how to take proactive measures. We have written a previous article that details risk factors of breast cancer recurrence and many of the prevention and treatment methods used to fight the growth of cancer cells. However, new data has arisen, giving us an even greater insight into the ins and outs of breast cancer recurrence.

New Data

Initially, recurrence was thought to happen within the first five years after treatment. Risk is greatest during these beginning years, but up-to-date studies reveal that the risk of recurrence lasts more than thirty years. Cancer cells can lay dormant, causing them to be undetectable for long periods, leading to a recent notable concern of the risks of late recurrence. The growing concern is attributed to a high cumulative incidence increase (which is an estimate of the risk that one may experience an event within a specific period). This means that more patients are at risk for late recurrence due to an increased number of long-term breast cancer survivors.

While this information seems alarming, and certain factors make recurrence more likely, thankfully, those who have a recurrence are not in the majority, and research has allowed us to identify the most prominent contributors to recurrences. The study also notes that because of the allotted time between the research participants’ first diagnoses and present day, as well as the study’s focus on late recurrence (requiring an extended follow-up), there have been significant changes and improvements in treatment procedures and technology since the participants’ initial treatment. Therefore, the study results are uncertain in association with today’s regimens. Because of this, such studies are paramount and must be completed repetitively to find continual up-to-date results.

Recurrent Breast Cancer

While the chances of a recurrence are not common, it is still valuable to consider the risk factors and to understand the realities of the different types of recurrences.

Types of Recurrence

If a recurrence does occur, a breast surgeon will categorize it by its appearance in proximity to the initial breast cancer. The three forms are:

Local recurrence

  • This refers to when the breast cancer returns to the same chest area as the original tumor.
  • Changes in appearance or feel (such as thickening of the skin or new lumps) are typical indicators of a local recurrence.

Regional recurrence

  • It is deemed regional recurrence if cancer cells show growth in nearby lymph nodes (found in the armpit or collarbone) to the initial cancer area.
  • Regional recurrence is differentiated from local recurrence solely because of the involvement of lymph nodes.
  • Symptoms of regional recurrence may involve newfound pain or lumps in the arm attached to the side of the body with the original breast cancer.

Distant recurrence

  • When cancer has traveled to different parts of the body (such as bone or organs), it is considered a distant recurrence.
  • Another name for this is metastatic breast cancer.
  • Bone pain, weakness, and extreme fatigue may point to metastatic breast cancer.
  • It is considered stage IV cancer, as the cancer has extended to other parts of the body.

Which breast cancer is most likely to recur?

The initial diagnosis is a significant indicator of the chance of recurrence. Recurrent breast cancer is most likely to appear in patients who had an original tumor with more than three positive lymph nodes.

What are the chances of recurrence of breast cancer?

The cumulative incidence of recurrence is between 8.5-16.6% for fifteen to thirty-two years after a primary diagnosis. Chances of late recurrence are typically higher for those whose initial breast cancer was found in the lymph nodes and resulted in tumors over 2o millimeters. The chances are higher for women who were 35 or younger during their primary diagnosis. According to the recent data, 2,595 of the 20,315 women involved in the research study were diagnosed with a recurrence more than ten years following their initial bout with breast cancer.

Is recurrent breast cancer worse?

Recurrent breast cancer may prove more challenging to manage, and the therapy used in your initial treatment may no longer be effective in your specific case. Metastatic cancer may also require more aggressive treatment, as the cancer has spread to more than just one part of your body. Recurrent breast cancer should not automatically be considered worse than the primary diagnosis, but it will often require different methods of treatment or therapy.

Treatment

Even simple cells can become tumors if not adequately treated. It is impossible to guarantee a 100% chance of freedom from cancer recurrence. Still, treatment may be able to halt the growth of undetected cells for many years, and there are methods of prevention that the doctor-patient duo can take to reduce your risk of recurrence.

While a breast cancer diagnosis can seem bleak, both Dr. Gorman and the researchers of this recent study recognize the significant evolution of modern-day regimens and their success rate. If your breast cancer comes back, treatment is available. Depending on the type of breast cancer, treatment may entail surgical treatment and radiation therapy. More aggressive treatment regimens and therapy approaches may be merited for those at a higher risk of late recurrence. Survivors are also encouraged to stay under extended surveillance by making regular check-ins with their doctors and surgeons.

Risk Factors and Therapy

The chances of recurrence are significantly lowered by the proactive utilization of hormone, chemo, or radiation therapy following the initial removal of cancer cells. You can play a role in lowering the recurrence risk factors by opting for therapy options (such as radiation treatment or endocrine therapy) recommended by your oncologist. Such regimens may attempt to prevent breast cancer recurrence or aid in reducing the potential of recurrence. Exercise and a healthy diet are also easy, proactive measures to implement for holistic well-being and to reduce the risks of recurrence.

Dr. Gorman and Texas Breast Center

Remember that recurrent breast cancer is not your fault. Though a breast cancer diagnosis can be alarming or dismaying, Dr. Gorman holds fast to the fact that “treatment for breast cancer has improved significantly over the last few years, and success rates continue to rise.” There is great hope. Dr. Gorman understands the significant emotional and physical impact a breast cancer diagnosis can play in one’s life. Her team at Texas Breast Center is dedicated to offering patients personalized, advanced care in the treatment of breast cancer recurrence and the prevention of recurrence, as well as support that lasts long after your treatment regimen.

Our previous article: https://www.texasbreastcenter.com/breast-cancer/breast-cancer-recurrence-what-and-why

New Data: https://www.medscape.com/viewarticle/963031?uac=390358FV&faf=1&sso=true&impID=3870849&src=mkm_ret_211213_mscpmrk_BC_Monthly

 

Breast Cancer in Men

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Breast cancer is represented by the pink ribbon. Research is fundraised through walks decked out in pink, and breast cancer awareness gear can be found covered in slogans like “big or small, save them all” or better yet, “fight like a girl.” And while the runs, marches, and merchandise can go a long way in raising money, they can also go a long way in implying some wrong information. If nearly all breast cancer awareness is geared towards women, does that mean men cannot–or do not–get breast cancer? No. Men may be less likely to get breast cancer than women, but there is still a risk.

How can you tell if a guy has breast cancer?

Breast cancer in men displays similarly to how it does in women. The symptoms are the same, and some are even more easily found due to the smaller amount of breast tissue in most men. With less breast tissue, lumps are more easily noticed and, therefore, diagnosed.

The most common symptoms of male breast cancer are:

  • Scaling, flaking, or redness of the skin of the nipple; can show as puckering or dimpling as well, or can happen to the skin over the whole breast, not just the nipple.
  • A painless thickening, swelling, or lump in the breast.
  • Nipple discharge, retraction, or ulceration.
  • Pain or pulling in the nipple area.

If the cancer cells spread further than the initial breast tumor, there can be additional symptoms and side effects, such as:

  • breast pain
  • bone pain
  • swelling in the underarm lymph glands

If anyone, no matter the person’s gender, experiences these symptoms, they should speak to their doctor. The sooner any breast cancer cells can be found, the more likely any treatment options are to work, and the less rigorous treatment needs to be.

How common is breast cancer in men?

While it is commonly known that breast cancer will develop in approximately one in eight women over the course of their lifetimes, the statistics on male breast cancer are less well known. When you search google for ‘how common is breast cancer,’ every answer on the first page is about women. Most sites collecting data on cancer categorize breast cancer as ‘female breast’ cancer to clarify that their data does not include men, despite many other cancer types (stomach, colorectum, leukemia, etc.) gathering data for both men and women. While this makes it easy to do cancer research for women, it makes it difficult to find information for male cancer patients.

One source, however, found that one out of every one hundred breast cancer diagnoses is given to a man. So, while men are at less of a risk than women, there is still a chance of breast cells becoming cancerous.

The American Cancer Society did offer that approximately 2,550 new male breast cancer cases are diagnosed each year. With breast cancer being 100 times more common in women than men, and with a man’s risk of diagnosis averaging around one in 1,000, it is easy to see why it’s not as prominently discussed. However, the risk is still there, and men should know what to look for to minimize risk.

However, just as with women, some men have more risk factors than others. These risk factors do not guarantee that this person will get breast cancer, nor does avoiding the risk factors guarantee that the person will avoid a breast cancer diagnosis. However, if you have these factors in your history, or are aware of them, be mindful of the signs, symptoms, and possible screening guidelines for breast cancer.

What are the risk factors for men?

Some of the risk factors for male breast cancer include:

  • Family history of breast cancer–you have a higher chance of developing breast cancer if you have a close family member who has, or has had, breast cancer.
  • Age–most male breast cancer diagnoses happen after 50 and are most commonly between age 60-70. It is usually rare for a man to get breast cancer under the age of 35.
  • Radiation therapy treatment–having a history of radiation therapy to the chest can increase the risk of breast cancer.
  • Liver disease–liver cirrhosis and other liver diseases can reduce androgen (commonly referred to as male hormones) levels and increase estrogen (commonly referred to as female hormones) levels in men, increasing risk.
  • Testicle surgery or disease–surgical removal of a testicle (orchiectomy), testicular injuries, or testicle diseases or conditions such as mumps orchitis or undescended testicles can increase breast cancer risk.
  • Estrogen exposure–those who take, or have taken in the past, estrogen or estrogen-related drugs (used for hormone therapy for prostate cancer) can have a higher risk of breast cancer.
  • Obesity–obesity can be associated with higher estrogen levels, leading to an increased risk factor.
  • Enlarged breasts–having enlarged breast tissue, known as gynecomastia, can come from infection, drug or hormone treatments, as well as other causes. Having additional tissue can make it difficult to notice early signs of breast cancer.
  • Breast cancer genes–mutations to the BRCA1 and BRCA2 genes dramatically increase the risk of breast, ovarian, and other cancers. People of all genders should be aware of the potential danger of the mutation of these genes.
  • Klinefelter’s syndrome–Klinefelter’s syndrome is genetic and can be considered a form of being intersex. It occurs when a boy has more than one X chromosome, leading to lower androgen levels and higher estrogen levels. This increased amount of estrogen can increase the risk factor.

Can trans men get breast cancer?

Anyone can get breast cancer. However, transgender men and non-binary people occupy a unique space regarding risk factors and following the breast cancer story from start to finish. Many AFAB (assigned female at birth) men or non-binary people carry the same risk factors that cisgender (non-transgender) women have, especially if they have not taken steps such as gender-affirming surgery or hormone therapy.

Most data on the subject of transgender and non-binary people and their risk and experience with breast cancer comes from individual case studies and anecdotal experiences rather than extensive cancer research. One such study conducted in 2013 in the Netherlands examined nearly 800 AFAB trans men taking testosterone and discovered only one case of breast cancer. Overall, the study stated that “The rate of breast cancer among trans men in this study was estimated to be much lower than the rate of breast cancer among cisgender women and similar to the rate among cisgender men in the Dutch population” (1).

Do top surgery or binding affect breast cancer risk?

Binding, a practice not uncommon among trans men and non-binary people, compresses the breast tissue to make the chest seem flatter to help reflect the person’s gender identity more accurately and comfortably. Binding can sometimes cause adverse symptoms such as shortness of breath, pain, and skin infections, especially when done by more risky methods (tape, ace bandages, leaving binders on for too long). However, binding has not been linked to breast cancer.

Top surgery, a mastectomy performed to align the patient’s breasts and chest with their gender identity, is a different form of mastectomy from those performed for breast cancer purposes. Top surgery mastectomies remove fatty tissue but may leave behind some glandular (milk-producing) tissue and lymph vessels, where cancer may form. People who receive top surgery should still perform regular breast self-checks and discuss the risks of cancer with their doctor.

Can male breast cancer kill you?

There is a risk of death as with any cancer, depending on when the breast cancer cells are discovered. According to the American Cancer Society, the prognosis for breast cancer in men is similar to that in women. The odds of surviving five or more years after the initial diagnosis are, on average:

  • 96%–when cancer is still only affecting the breast tissue at diagnosis
  • 83%–when cancer has spread through the breast to nearby areas, such has the local lymph system (underarm, etc.)
  • 23%–when the disease has spread throughout the body

Just as is recommended to women, it is essential to be aware of any changes in the breast so that if cancer cells start to grow, treatment can begin as soon as possible.

What is the survival rate of male breast cancer?

As mentioned above, 2,550 new cases of breast cancer in men are diagnosed annually. Unfortunately, this same cancer also leads to around 480 deaths in men. While this is significantly lower than the close-to-40,000 women who die of breast cancer annually, it is still a statistic that can be lowered.

Most male breast cancers are diagnosed after patients discover a lump in their chest. However, many tend to leave this concern alone until other, more severe, symptoms arise, such as blood coming from the nipple. However, by this time, the cancer has likely spread further, making the necessary treatment harsher and the risks involved a little grimmer.

By informing male patients of the possible risk factors for breast cancer, they can be more aware should they notice something out of place in their chest. Self-breast checks can be just as necessary for men, transgender, and non-binary people as for cisgender women, and everyone should have the chance to be informed of their risk.

If you have questions about your risk factors, any changes in your breasts, or simply about breast cancer, speak with your doctor, or Dr. Gorman at the Texas Breast Center is happy to help answer any questions. Her goal is to keep all patients informed and prepared.

Read the article on Gender Influences and the Cause of Breast Cancer

  1. Gooren LJ, van Trotsenburg MA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10:3129-34.

History of Breast Cancer

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March is Women’s History Month. The history of women and the history of breast cancer go hand in hand. But how far back does the history of breast cancer go? How long have we known about it, and how long have we been able to treat it? This article will discuss treatments and diagnoses of breast cancer since antiquity.

Who first discovered breast cancer?

When did breast cancer start?

Breast cancer, and cancer as a whole, has likely been around as long as humanity has. Evidence of prostate cancer has been found on skeletons of both a Russian king (approximately 2,700 years old) and an Egyptian mummy (about 2,200 years old). But the earliest record we have of breast cancer can be found on the Edwin Smith Surgical Papyrus, an Egyptian papyrus dating back to 3000-2500 BC. While the papyrus does not offer much in the way of treatment options, it does give a way to identify an incurable disease as “cool to touch, bulging and spread all over the breast.”

Ancient Greece, around 460 BC, gave us the term carcinoma (karkinoma). Carcinoma is a cancer that starts in skin or organ tissue cells rather than in structures like blood vessels or bones. However, breast cancer treatment was still relatively unsuccessful as it was believed that disease was caused by imbalances of the four humours, phlegm, yellow bile, black bile, and blood. To treat illnesses, one had to remove or increase the humours within the body. Galen, a well-known Greek physician from around 168 BC, claimed that breast cancer was caused by too much black bile and began to treat the condition with surgery to remove the tumor, though he let the incisions bleed to continue removing excess bile.

While the surgery that Galen performed spread throughout Greece, the increase in religious philosophies and medical approaches prevented the practice from going much further. Early Christianity believed surgery to be more barbaric than their faith healing preference, a tradition that persisted through much of the world between 476 and 1500 AD. However, between the 10th and 15th centuries, Abu Al-Qasim Al-Zahrawl and Ibn Sina, a pair of Islamic physicians, revived the Greek practices, including surgery, and wrote many medical texts. Their ideas and practices spread throughout Europe.

The 16th, 17th, and 18th centuries, known more commonly as the Renaissance period, saw a growth in surgical practice. Where once ‘surgeon’ was simply a title tagged onto the end of ‘barber’, and a procedure could be performed after a haircut, surgeons now had their own trade. John Hunter, a Scottish surgeon, proposes the first idea of breast cancer in stages. While not as clearly defined as those we have today, there were some stages where surgery was necessary, while others were not. This was also a time of no anesthesia, so these early lumpectomies and mastectomies had to be performed quickly and accurately.

As the 19th century rolled around, significant improvements were made to the safety of surgery. With the introduction of hygiene to medical practices (albeit slowly), disinfection and surgical garments became more common. Anesthesia was also developed, helping prevent patient shock and give the doctors more time to perform the breast cancer surgery. William Halsted, an American surgeon, developed the radical mastectomy procedure in 1894. This procedure removes the entire tumor in a single piece together with the breast, the axillary lymph nodes, lymphatic vessels, and pectoral muscles. This was the first time breast cancer was considered treatable and even curable. Two years later, Thomas Beatson, a British surgeon, announces that oophorectomies–operations to remove one or both ovaries– can reduce tumors in advance breast cancer.

Modern Breast Cancer Treatments

The 20th century brought vast change to breast cancer treatment. Tumors were shrunk using radiation. Chemotherapy was introduced in the 1940s, and Robert Egan introduced mammography as a breast cancer detection option in 1962. The first modern autologous breast reconstruction was performed in 1979, allowing for more natural feeling breasts. More medications, procedures, and treatments for breast cancer have been researched and implemented, as well as potential causes and risk factors. The BRCA1 and BRCA2 genes–commonly known as the breast cancer gene– were discovered in 1995. A few years later, new breast cancer subtypes–HER2 positive, triple-negative, progesterone receptor-positive, and estrogen receptor-positive–were classified in 2000.

Even today, new research is still being performed to improve upon the surgeries, treatments, and post-op for breast cancer patients to have the best possible results. Dr. Gorman was involved in a study using the Biozorb implantable marker that helps target radiation therapy as well as post-operation imaging. She also contributes to the study on Accelerated Partial Breast Irradiation, or APBI, a method that shortens the amount of time the patient needs to spend getting radiation therapy and uses a higher dose of radiation in a more targeted beam–assisted by the Biozorb marker. She also uses oncoplastic techniques which help with postoperative cosmesis.

Breast Cancer Treatment Today

With today’s understanding of the disease, treatment is far more effective than it has been in the past. One primary reason for this is the improved breast cancer screening guidelines and understanding of breast cancer risk factors such as family history or having the so-called ‘breast cancer genes’. Knowledge of these risk factors can help set up specific screening procedures for those with a higher risk of breast cancer while still having a standard screening arrangement for those with lower risk. Getting a regular mammogram and breast self exam are easy steps to keep an eye out for early potential signs and symptoms. The sooner breast cancer is caught, the easier it is to treat.

Once a breast cancer diagnosis is reached, a treatment plan is agreed upon; no patient’s treatment plan and recovery are exactly alike. Treatment plans can–but do not necessarily–include breast surgery, radiation therapy, chemotherapy, hormone therapy, targeted medical therapy, as well as cosmetic surgery to aid in the patient’s self-image after an oncological procedure. Each of these treatment options has benefits and downsides and side effects and is more useful in some situations than others. The different surgical approaches can be applied depending on the tumor’s size and how far the breast cancer cells have spread. There are options to save more of the breast tissue and chest muscles if the breast cancer is caught early enough.

Combination treatments–surgery accompanied by radiation therapy or chemotherapy alongside medical therapy, for example–can help by approaching the breast cancer from different angles, ensuring thorough results with no cancer cells left behind and decreasing recurrence. With a combined effort from a full oncological team, the survival and recovery rates have increased exponentially since the days of the Edwin Smith Surgical Papyrus.

Dr. Gorman and her team at the Texas Breast Center work together to treat breast cancer from all angles. Dr. Gorman focuses on treating from the surgical side and works closely with medical and radiation oncologists to form a personalized treatment plan best suited to each patient. She also looks to the future of treatment by keeping aware of current and ongoing breast cancer research to best treat her patients. If you have questions or are ready to find your next steps in treatment, reach out to the Texas Breast Center. The team is prepared to help.

Breast Cancer Recurrence: What and Why?

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When breast cancer comes backs, it is called recurrence. While those who have a recurrence are not in the majority, they are certainly not a rarity or an impossibility. Recurrences typically happen within the first five years after treatment but can occur at any time and have a few ways of returning. To help ease some of the worries of these first few cancer-free years, we want to give some clarity and explanation into what breast cancer recurrence is and what to look for.

See updated data from 2022 on the recurrence of breast cancer.

Causes

Breast cancer recurrence occurs when cells from your original breast cancer manage to escape being treated and begin growing again. This process can sometimes take years. The cancer cells will lay dormant until something kick starts them into growing again.

Risks

Many of the recurrence risk factors are determined by the original tumor and cancer, though the patient determines some. These risk factors include:

  • A large tumor–A larger tumor increases the risk of cells being left behind.
  • Close or positive tumor margins–During surgery, when the surgeon removes the cancer, they will remove a small amount of healthy tissue around it. The tissue is then examined with a microscope. If it is clear of cancer, the margin is considered negative. However, if there are any cells left (considered a positive margin), risk or recurrence increases.
  • Lymph node infection–The risk of recurrence increases if cancer was found in lymph nodes at your original diagnosis.
  • No radiation treatment post-surgery–While most who undergo a lumpectomy choose to receive radiation therapy in the area of cancer afterward to reduce the risk of recurrence, some do not.
  • Inflammatory breast cancer–This type of breast cancer increases the risk of a local recurrence.
  • Specific cancer cell characteristics–Having triple-negative breast cancer or cancer resistant to hormone therapy can increase your risk.
  • No endocrine therapy–For certain types of breast cancer, not receiving endocrine therapy can raise the risk of recurrence in cancer patients.
  • Younger age–Those of a younger age during their initial breast cancer diagnosis, specifically under 35, have a higher risk of their cancer returning, despite generally older generally being a risk factor of cancer in general.
  • Obesity–Increased body mass index increases the risk of breast cancer coming back.

Prevention

There are methods and steps you can take to reduce your risk of recurrence of breast cancer, many in your initial treatment.

  • Chemotherapy–Those with an increased chance of recurrent breast cancer have been shown to have a decreased risk when treated with chemo.
  • Hormone therapy–If you have receptor-positive breast cancer, taking hormone therapy in your initial treatment can reduce your risk. This treatment method can sometimes continue for five or more years.
  • Targeted therapy–If your cancer produced additional HER2 proteins, targeted drug and treatment might reduce your risk.
  • Radiation therapy–A previous breast cancer patient with a large tumor, a breast-sparing operation, or inflammatory cancer would have reduced risk if treated with radiation treatment.
  • Bone-Building–Bone building medications can reduce the risk of recurrence taking place in bones, otherwise known as bone metastasis, for those with a high risk.
  • Healthy Diet–To decrease your risk of breast cancer recurrence, be sure to include plenty of fruits, vegetables, and whole grains in your diet, as well as limiting alcohol to one drink a day.
  • Exercising–Exercising regularly may help reduce your risk.

Kinds of Recurrence

Recurrent breast cancer can take one of three forms, defined by where it appears in reference to the primary cancer and treatment. The three types are local, regional, and distant recurrence.

Local

A local recurrence occurs when cancer cells grow in the same area as your previous cancer. If a lumpectomy was used for treatment (rather than a full mastectomy), cancer might start to regrow in the breast tissue that remains. If a complete mastectomy were performed, the tissue along the skin or chest wall would hold the recurring breast cancer.

Some signs that local recurrence is occurring are:

  • One or more painless lumps, nodules, or irregular areas of firmness under the skin
  • Newly thickened areas along mastectomy scars
  • Changes to the skin (inflammation, redness, changes in texture)
  • Nipple discharge

Many of the signs of a local recurrence are similar to those of initial breast cancer. After treatment, it does not hurt and may help to continue self-breast exams to keep an eye out for any changes, just in case.

Regional

Regional recurrence also happens rather close to the original site of infection. However, the difference between regional and local recurrence is a matter of lymph nodes. In regional recurrence, the local lymph nodes, such as those under the arm, will be infected with cancer.

Signs of regional recurrence cancer may include a lump or swelling in lymph nodes, so continue your self-checks in these areas:

  • Under the arm
  • Along the neck
  • Near and in the groove above the collarbone

This kind of recurrent breast cancer can almost be considered a subset of local recurrence and can many times be found by being familiar with your own body. Regular self-breast checks are just as necessary after breast cancer treatments as they are before.

Distant

Distant recurrence is when cancer recurred somewhere in the body away from the original site. This can include other organs such as the lungs or even bones. In this case, the patient is generally treated much in the same way as those diagnosed with stage IV breast cancer. However, treatment can vary from standard stage IV treatment based on the responses to previous treatments.

Treatment

Treatment, many times, is determined by the kind of breast cancer recurrence found. Local will be treated differently from regional will be treated differently from different.

Local Treatment

Local breast cancer recurrence is, if possible, treated with surgical treatment. If a lumpectomy and radiation were used previously, then a mastectomy would be the first choice treatment. If a mastectomy was performed prior, the tumor would be removed, and the patient will be treated with radiation therapy if not already received.

Either way, both of these plans are likely to be accompanied by chemotherapy, targeted therapy, hormone therapy, or some combination to ensure a full recovery.

Regional Treatment

Sometimes breast cancer will come back in the lymph nodes. This can be treated by removing the lymph nodes themselves, followed by radiation in the surrounding area, if not already received. Systemic (targeted, hormone, or chemotherapy) treatment after surgery may be discussed on a case-by-case basis to ensure that any remaining cancer cells are eliminated.

Distant Treatment

The primary treatment for distant recurrent breast cancer will be a form of system treatment (hormone, targeted, or chemotherapy) based on how your cancer has responded before. You and your doctor can create a treatment plan that serves you well, knowing what has worked with these breast cancer cells previously and what has not.

Dr. Gorman

Dr. Valerie Gorman and the Texas Breast Center are aware of the risks of recurrent breast cancer and the chances that your breast cancer may come back. This is why she and her team stay with you through your personalized treatment and long after to make sure you know that you always have a support system, whether you need it or not.

Dr. Gorman specializes in surgical oncology and surgical diseases of the breast. She serves as the Medical Director of Surgical Services at Baylor Scott & White Medical Center as well as the Chief of Surgery.

Breast Reconstruction Surgery: A Team Approach

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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.

The Breast Reconstruction Interview

Dr. Gorman and Dr. Potter recently sat down for an in-depth interview on breast reconstruction surgery.

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.

Here are some highlights of the interview.

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.”

Breast Reconstruction Options

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.”

Factors Taken into Account for Reconstruction

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.

Dr. Gorman:

“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.”

The Breast Reconstruction Process

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

Dr. Potter:

“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.

The DIEP Flap Procedure

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.”

Common Questions About Breast Reconstruction

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.

Read the article on Breast Cancer Recovery

Final Thoughts on a Team Approach to Breast Reconstruction

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

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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 After Breast Cancer Surgery

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?

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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.

How Much Does Breast Cancer Surgery Cost?

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?

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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

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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 completed over 100 BioZorb procedures, 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 in the long term.

Read the article: Biozorb Potential Side Effects

FAQs About Mastectomy

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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

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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.

Scarring After Breast Cancer Surgery

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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

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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.

A collection of fluid, called a seroma, 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

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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 from their breast cancer treatment 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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