Breast Cancer Causes: Family History Risks  

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Breast cancer, a condition marked by uncontrolled cell growth in the breast tissue, continues to be one of the primary health challenges faced by women in the United States and worldwide. It is a journey that no woman should have to embark on alone, and it’s one that demands a wealth of understanding, particularly about the role of family history in determining breast cancer risk. Recognizing this intricate tapestry of genetics and family history, Dr. Gorman and her dedicated team at Texas Breast Center provide not just treatment but holistic care that addresses each individual’s unique concerns and needs.

As we delve into the complexities of breast cancer risk, it becomes evident that this disease is a multifaceted issue, intertwining genetics, lifestyle, and environmental factors. The role of family history in determining one’s risk is particularly significant, offering insights into genetic predispositions and potential hereditary patterns. This understanding is crucial, as it guides both patients and healthcare providers in developing personalized strategies for risk assessment and management.

photos of family members

First-degree Relatives

First-degree blood relatives play a significant role in understanding your potential breast cancer risk. In the context of family health history, first-degree relatives refer to your father, mother, sister, brother, son, or daughter. These relationships share about 50% of their genes with you, hence why their health conditions can provide valuable insight into your own potential health risks.

Suppose a first-degree relative has been diagnosed with breast cancer. In that case, research indicates this could indicate a heightened risk of developing the disease yourself. The reasoning behind this lies in the shared genetic material between you and your first-degree relative. Certain gene mutations, such as those found in the BRCA1 or BRCA2 genes, can drastically increase the risk of breast cancer and are often passed down through generations. In addition, women with atypical hyperplasia and a first degree relative with breast cancer history have an increased risk for developing the disease.

However, a family history of breast cancer does not equate to a definitive future diagnosis. While it does raise risk levels, most cases of breast cancer are not linked to inherited gene mutations. Lifestyle factors, environmental exposures, pregnancy, and hormonal factors also significantly contribute to overall risk.

At the Texas Breast Center, we take your family history into account to provide a comprehensive risk assessment. Dr. Gorman’s approach is not only advanced but also personalized. She recognizes the importance of understanding the context of each patient’s health background, including the crucial role of first-degree relatives in determining risk. By using this information, she works with her team to develop a targeted approach, offering risk management strategies, preventive lifestyle advice, and when appropriate, genetic counseling and testing to provide a holistic health care plan.

Remember, having a close family member with breast cancer does not guarantee you will have the disease. It is one risk factor among many others, and it is important to consider it within the context of your overall health, lifestyle, and other personal risk factors. Knowing your family history is a powerful tool. It can guide you towards the necessary steps for early detection, timely medical intervention, and ultimately, it allows you to take control of your health.

Second-degree Relatives

When considering your family health history, second-degree relatives, including your grandmother, aunt, or niece, also play a critical role. These relatives share about 25% of their genetic material with you, meaning that their health conditions can still provide valuable insight into your potential health risks.

Should a second-degree relative be diagnosed with breast cancer, your risk of developing the disease may be slightly elevated. The risk associated with second-degree relatives is lower than with first-degree relatives due to the decreased proportion of shared genetic material. However, this does not make their health histories any less significant. Genetic mutations associated with breast cancer, such as those in the BRCA1 and BRCA2 genes, can still be passed along through second-degree relatives, albeit at a lower frequency.

It’s essential to remember that while the presence of breast cancer in second-degree relatives can increase your risk, most cases of breast cancer are sporadic and not due to inherited mutations. Other factors, including lifestyle, environment, and hormonal influences, can impact your breast cancer risk. Therefore, having a second-degree relative with breast cancer should be viewed as one piece of a much larger puzzle that contributes to your overall breast cancer risk.

At Texas Breast Center, we value your family’s health history as a pivotal part of your personalized breast health care journey. Dr. Gorman and her dedicated team employ a comprehensive approach, integrating the influence of both first and second-degree relatives into your overall risk assessment. By incorporating this information, we can design a targeted plan, involving advanced diagnostic screenings, preventative lifestyle recommendations, and when necessary, genetic counseling and testing.

Recognizing the importance of second-degree relatives in breast cancer risk assessment is crucial. While it doesn’t predict a certainty, it offers an opportunity for heightened vigilance, early detection, and proactive health care measures. Dr. Gorman can help you harness this knowledge, providing a platform for you to take the necessary steps to manage your health, underlining our belief that understanding and managing breast health is a collaborative, informed journey.

Multiple Family Members

When it comes to evaluating your risk of breast cancer, the significance of your family’s health history cannot be overstated. If more than one relative in your family has been diagnosed with breast cancer, it can be a key indicator of a higher risk of developing the disease. These relatives can be a combination of both first and second-degree relatives, including your mother, child, sisters, grandmothers, aunts, and nieces.

Having multiple family members with a breast cancer diagnosis can potentially suggest an inherited genetic mutation, such as in the BRCA1 or BRCA2 genes, which are associated with a substantially increased risk of breast cancer. This situation is often referred to as familial or hereditary breast cancer and it accounts for about 5-10% of all breast cancer cases. However, the presence of multiple breast cancer cases within a family may also reflect shared environmental or lifestyle factors that increase the disease’s risk.

It’s crucial to recognize that while having multiple family members with breast cancer increases your risk, it does not guarantee that you will develop the disease. The majority of breast cancer cases are actually not related to family history. Other factors, such as age, reproductive history, hormonal factors, lifestyle choices, and environmental exposures also contribute significantly to your overall risk.

The presence of multiple family members with breast cancer is an invitation for proactive health management. It offers an opportunity to heighten surveillance, encourage early detection, and equip you with the tools to manage your health effectively. At Texas Breast Center, we are your allies in this journey, offering expert advice, cutting-edge treatments, and compassionate care every step of the way.

Male Family Members

While breast cancer is predominantly associated with women, it is important to note that men can also be diagnosed with the disease. When a male family member, such as your father or brother, is diagnosed with breast cancer, it could indicate a potential inherited genetic mutation and, subsequently, an increased risk for you to develop the disease.

Male breast cancer comprises approximately 1% of all breast cancer cases, yet its significance should not be underestimated. The presence of breast cancer in a male relative such as a parent or child is often a signal of an inherited BRCA2 mutation. Although BRCA mutations increase the risk of breast cancer for both men and women, the probability of men developing breast cancer is still significantly lower compared to women. However, if a man carries a faulty BRCA gene, there is a substantial chance that he could pass it on to his children, potentially increasing their risk of developing breast cancer.

The medical diagnosis of breast cancer in a male relative underscores the importance of comprehensive family health history and genetic counseling. It’s also a stark reminder that breast cancer is not exclusive to women. However, having a male relative with breast cancer does not guarantee you will develop the disease; it merely points to a higher possibility. Multiple factors, including lifestyle choices, environmental exposures, and other genetic factors, contribute to your overall breast cancer risk.

If a male relative has been diagnosed with breast cancer, this necessitates a proactive approach to your health. Through regular screenings, potential genetic counseling and testing, and preventive lifestyle adaptations, you can help manage your risk.

Early Onset

Breast cancer is generally more common in older women, with most diagnoses made in women aged 50 and above. However, when a family member is diagnosed with breast cancer before the age of 50, it could signify an increased risk for other family members. Early-onset breast cancer often suggests a potential inherited genetic factor that can raise the risk of developing the disease.

Early-onset breast cancer, while less common, is often associated with inherited mutations in the BRCA1, BRCA2, or other related breast cancer genes. These gene mutations can be passed down from generation to generation, which could result in a higher risk of breast cancer amongst close relatives, especially if the disease occurs before the age of 50.

However, an early-onset diagnosis in the family does not confirm you will have breast cancer. It only implies a higher risk. At Texas Breast Center, we place significant importance on understanding your family’s health history. If there is a history of early-onset breast cancer in your family, this crucial information should be factored into your risk assessment and subsequently guide your breast health care management plan. This plan might include more frequent or earlier breast cancer screening, lifestyle adjustments, a healthy diet, and, where appropriate, genetic testing and counseling.

Understanding the potential implication of early-onset breast cancer in your family is a powerful tool for early detection and preventive health care. It allows for proactive risk management and heightened vigilance for any signs of the disease. At Texas Breast Center, we are here to help you navigate this journey, providing you with advanced, personalized, and compassionate care at every step of your breast health journey.

Bilateral Breast Cancer

Bilateral breast cancer, where both breasts are affected either simultaneously or sequentially, is another crucial factor when considering family history and breast cancer risk. When a family member has had cancer in both breasts, it could suggest an increased genetic susceptibility to the disease, thereby raising your own risk of developing breast cancer.

Bilateral breast cancer could indicate the presence of an inherited mutation in genes like BRCA1, BRCA2, or others related to breast cancer susceptibility. These genetic mutations can substantially raise the risk of developing breast cancer, and when observed in the context of bilateral breast cancer, can also suggest an increased likelihood of developing cancer in both breasts.

While bilateral breast cancer in a family member can be an important marker for elevated breast cancer risk, it doesn’t guarantee that you will develop the disease. The presence of bilateral breast cancer in your family history serves as a call for proactive health management. It creates an opportunity for heightened vigilance and early detection, empowering you to take the necessary steps to effectively manage your health. At Texas Breast Center, we are committed to helping you navigate this path, offering cutting-edge treatments, expert advice, and empathetic care at every stage of your journey.

Ovarian Cancer History

A family history of ovarian cancer can also increase your risk of developing breast cancer. This link is primarily due to the BRCA1 or BRCA2 gene mutations, which increase the risk of both breast and ovarian cancers. If a close relative has had ovarian cancer, consider discussing genetic testing with your healthcare provider to assess your risk.

Inherited Gene Mutations

Inherited mutations in the BRCA1 and BRCA2 genes are the most well-known genetic risk factors for breast cancer. These mutations can significantly increase your risk for breast cancer. Other gene mutations associated with breast cancer include p53, PTEN, and CHEK2. Genetic counseling and testing can provide information about these inherited risks and guide risk management strategies.

Other Related Cancers

Breast cancer risk is not solely influenced by a family history of breast cancer itself. Other related cancers, such as prostate cancer, pancreatic cancer, or other types of cancer, in your family can also be indicative of an increased risk of developing breast cancer. This suggests that certain inherited genetic mutations may not only predispose individuals to breast cancer but also to other forms of malignancies.

For instance, a BRCA mutation, while primarily associated with breast and ovarian cancer, has also been linked to a higher risk of prostate and pancreatic cancers. Similarly, mutations in other genes, such as PALB2, can increase the risk of both breast and pancreatic cancers. Therefore, a family history of these other cancers can provide vital clues about your potential inherited risk of developing breast cancer.

However, the presence of other related cancers in your family doesn’t necessarily mean you will develop breast cancer. It’s a single piece of the puzzle in the larger landscape of breast cancer risk. Your overall risk is influenced by a complex interplay of genetic, hormonal, environmental, and lifestyle factors.

At Texas Breast Center, we recognize the importance of a comprehensive family cancer history in understanding your unique breast cancer risk profile. Dr. Gorman, known for her commitment to providing advanced, personalized, and targeted breast cancer care, considers the entire scope of your family’s cancer history during risk assessment. This thorough evaluation can inform your personalized risk management strategy, including regular screening schedules, lifestyle modifications, and potentially genetic counseling and testing.

A family history of related cancers calls for an informed, proactive approach to your breast health. It’s an opportunity for attentive monitoring, early detection, and more effective risk management. At Texas Breast Center, we are here to support and guide you every step of the way, offering expert medical advice, leading-edge treatments, and compassionate care tailored to your unique needs.

Ethnic Background

Certain ethnic backgrounds, such as Ashkenazi Jews, are associated with a higher prevalence of BRCA1 and BRCA2 mutations, thus leading to an increased risk of breast cancer. Understanding your family’s ethnic background can help clarify your risk and inform screening recommendations.

Understanding these familial and genetic factors is critical in guiding breast cancer risk assessment and management strategies. However, keep in mind that having one or even multiple breast cancer risk factors does not guarantee a breast cancer diagnosis. Many women with one or more risk factors never develop the disease, and some women with breast cancer have no known risk factors other than being a woman and growing older.

In conclusion, a family history of breast cancer can significantly influence an individual’s risk of developing the disease. However, it’s important to remember that breast cancer is not exclusively hereditary. Environmental factors, lifestyle choices, and certain conditions such as obesity, high alcohol intake, lack of breastfeeding, early menstruation, late menopause, and exposure to hormone replacement therapy can contribute to breast cancer risk.

Dense breast tissue, characterized by a higher proportion of glandular and connective tissue to fatty or adipose tissue, can also increase the risk and make mammography screening more challenging. Factors such as age, hormone levels, and certain drugs can affect breast density.

Knowledge and awareness of both your familial and personal risk factors can empower you to take control of your breast health. Regular screenings, maintaining a healthy body weight, limiting alcohol intake, and understanding the implications of your birth control choices are ways to manage and reduce your risk.

If you have a family history of breast cancer or other related cancers, consider speaking with a healthcare provider or a genetic counselor. They can provide you with valuable information, discuss the possibility of genetic testing, and guide you towards the best preventative measures and screenings based on your risk.

At Texas Breast Center, we recognize that every patient is unique, and we are committed to providing advanced, personalized, and targeted care. Dr. Gorman and her dedicated team strive to empower patients with the knowledge and resources necessary to make informed decisions about their health. If you have concerns about your breast cancer risk, contact the Texas Breast Center to schedule an appointment.

In the realm of breast health, understanding your risk is the first step towards prevention and early detection. Through shared decision-making and a patient-centered approach, we can work together to navigate your breast cancer risk and ensure that you receive the most appropriate, tailored care.

Remember, knowledge is power. Take control of your health today.

See the other articles in the Causes series, including Age-Related Risks.

Texas Breast Center – Helping You 0n Your Journey

Our philosophy is rooted in a strong dedication to advanced, personalized, and targeted breast cancer care. We believe that every woman is more than just a patient – she is a person with a unique story and a unique health journey. Our mission is to walk with you, hand-in-hand, through each step of this journey, offering the most advanced treatments, answering your every question, and standing as a constant source of support and knowledge.

Moreover, we understand that breast cancer risk is not just a clinical concept—it’s an intimate part of a woman’s life, shaping her decisions and future. This understanding is our driving force. Through fostering a supportive environment and leveraging advanced targeted treatment strategies, we provide personalized care to every woman walking through our doors. Our comprehensive approach ensures that your journey toward understanding, managing, and potentially preventing breast cancer is one of empowerment, care, and expert support.

At Texas Breast Center, we blend our advanced medical expertise with warmth, understanding, and the unwavering belief that knowledge is indeed power. Join us as we delve deeper into the role of family history in influencing breast cancer risk. Our goal is to empower you to take proactive steps toward safeguarding your health and share important information to help prevent breast cancer. Your journey is our journey, and we’re here with you every step of the way.

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/

Insurance Coverage for DIEP Flap Procedures

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At Texas Breast Center, Dr. Gorman is dedicated to offering breast cancer patients the most cutting-edge, individualized, and targeted breast surgery and breast cancer treatments available. Because of this, she partners with other doctors to offer her patients a team approach to their treatment and recovery. She expertly guides patients through the process of determining the most appropriate cancer treatment options and the most beneficial surgical procedures. But, she is aware that she is not the final stage of the healing journey. Reconstruction after mastectomy for breast cancer is a common medical necessity. As a result, Dr. Gorman has partnered with Dr. Potter to offer breast reconstruction to her patients for more than 15 years.

Dr. Gorman always has her patients in mind and strives to keep them informed of any changes or developments that could potentially affect them during their course of treatment. Recently there has been a change in insurance coding that could affect patients planning to have the DIEP flap method of breast reconstruction, which she would like to make patients aware of.

What is DIEP flap surgery?

DIEP flap surgery is a method of breast reconstruction. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. DIEP flap surgery involves transferring fat, skin, and blood vessels from the abdominal wall to the chest in order to reconstruct the breast. A DIEP flap is regarded as a muscle-sparing type of flap.

Using microsurgery, the surgeon reconnects the flap’s blood vessels to the patient’s existing blood vessels in the chest. Because no muscle is harvested for the DIEP flap, most women have a shorter recovery time and a reduced chance of losing abdominal muscular strength compared to the TRAM flap procedures.

Not every surgeon is qualified to do DIEP flaps, and the technique is not offered at all hospitals because it necessitates specialized training and knowledge in microsurgery. This is why it is important to find a skilled reconstructive surgeon like Dr. Potter, who has been performing these procedures for over 15 years.

Will health insurance companies cover DIEP flap surgery?

In spite of the fact that the DIEP flap surgery has been covered by the vast majority of commercial health insurance providers since 2007, doctors may soon be unable to bill insurance companies because the procedure will no longer have a unique billing code.

The Centers for Medicare & Medicaid Services (CMS) is a federal agency responsible for enforcing the use of specific billing codes for medical services. These codes are used by doctors to charge a medical insurance company, which may cover all or part of the amount, depending on the policy. There used to be separate ICD-10 codes for DIEP flap breast reconstruction and other perforator flap breast reconstruction surgeries.

The decision to group all breast reconstruction surgeries using flaps under a single code was made by CMS in 2019, and the agency plans to completely phase out the use of individual procedure-specific codes by the end of 2024. As a result, insurance companies will only pay what they would have paid for TRAM flap surgery, an older, less sophisticated, and less common treatment of cancer that is linked to more long-term risks than when a surgeon performs DIEP flap surgery. It’s estimated that the cost of TRAM flap surgery is between 70 and 90 percent less than that of DIEP flap surgery.

At that rate, health care professionals simply cannot afford to offer DIEP flap surgery, so patients are left with two options: pay out of pocket for the procedure (which can cost over $50,000) or settle with less ideal treatment options.

Some health insurance issuers have already stopped covering DIEP flap surgery even before the coding changes take effect next year. Some doctors are now declining to do the procedure altogether even if the patient’s insurance policy still covers it, while others will only do so if their patients can pay the full cost of the operation upfront.

All commercial health insurance policies may discontinue covering DIEP flap surgery between now and next year if CMS’s decision is not reversed soon.

What about the Women’s Health and Cancer Rights Act of 1998 (WHCRA) and the Affordable Care Act?

United States federal law and some state laws guarantee that women can use their health insurance plan to pay for breast reconstruction if they need it. Group health plans and health insurance companies (including HMOs) are obligated to cover all phases of medical care, including breast reconstruction, if they pay for a mastectomy under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). While the law does provide mandatory coverage for mastectomy and breast reconstruction, the regulation does not outline the specific procedures of breast reconstruction that must be covered, making this coding change problematic.

The WHCRA does not apply to some types of health insurance programs, including some self-funded, short-term, government health plans and plans sponsored by religious organizations. Medical assistance programs like Medicare and Medicaid are likewise excluded from the restrictions of the law. They operate by their own set of standards. Medicare covers breast reconstruction using breast prostheses if you had a mastectomy because of breast cancer. Medicaid coverage for breast reconstruction varies by state.

Under the Affordable Care Act, health insurance companies must cover breast cancer treatment and follow-up care. But again, it does not guarantee which specific procedure must be covered.

What can patients do?

Get in touch with your senator and local representative and ask them to lobby CMS to reverse the changes made to the descriptor of CPT code 19364 and restore billing codes S2068 (for DIEP flap surgery), S2066 (for SGAP surgery), and S2067 (for stacked flap surgery). Doing so helps guarantee that all forms of breast reconstruction will be covered by health insurance plans for women who have been diagnosed with breast cancer.

If you have had or are considering DIEP flap reconstruction, you may want to write about your experience and explain the significance of the procedure to you and your breast cancer therapy and how important health insurance coverage is for this surgery.

There are some financial assistance programs for women facing breast cancer that are available for breast cancer treatment that may be able to help with the medical expenses of breast reconstruction if it is not covered by your individual health policy.

A breast cancer diagnosis can be a stressful time, and Dr. Gorman makes it her mission to ease the burden through an advanced, personalized, and targeted approach to treatment. For more information about breast cancer treatment, breast cancer surgery options, and the compassionate care offered by Dr. Gorman at Texas Breast Center, visit the website or call to schedule your consultation.

Treating Breast Cancer in Older Adults

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Several forms of breast cancer are more likely to develop as people age. However, improvements in diagnosis and highly customized treatment regimens are raising the likelihood of recovery for elderly women and enabling many to lead longer, healthier lives despite developing breast cancer. There are several treatment choices for older adults with breast cancer that have positive outcomes, depending on the patient’s health and personal preferences.

What are the common types of breast cancer diagnosed in older patients?

Invasive ductal carcinoma, also known as IDC, and invasive lobular carcinoma, also known as ILC, are the two types of breast cancers in women most frequently diagnosed in this age group. Although they develop in different breast tissues, these tumors are treated similarly.

Hormone receptor positive tumors make up the majority of invasive malignancies in this age range. Breast cancers in elderly patients that are hormone-positive tend to grow slowly, which is hopeful news for patients and can mean a good prognosis and successful breast cancer management.

How does a patient’s age impact treatment decisions?

There is no reason to put off treating breast cancer in an older adult if she is otherwise healthy.

A patient’s treatment options become more challenging if she is ill, particularly if she has a condition like dementia or Parkinson’s disease. While these factors make treatment more complicated,  oncologists can still treat patients to increase comfort, even in these circumstances.

A patient’s functional age should be taken into account more so than their chronological age when making decisions about breast cancer treatment and breast cancer care. The functional age factors in the patient’s physical limits, comorbidities, and social support. For patients with breast cancer who are older but physically strong and otherwise healthy, all treatment options available to younger patients should be considered, including surgery if the patient has operable breast cancer. Chemotherapy, trastuzumab, and radiotherapy should be provided as routine adjuvant therapy to women with breast cancer who are older than 65 and whose life expectancy is greater than five years, and who are otherwise in good health. In patients who are frail, adjuvant therapies might be scaled back or abandoned. Enrollment in clinical trials should also be available to patients over the age of 65.

More FAQ’s about Treating Breast Cancer in Older Adults

What breast cancer treatment is most effective for elderly patients?

Doctors consider the features of the tumor when determining which treatment plan could be appropriate for a certain patient. This can help distinguish between tumors that may respond to other forms of treatment and those that are likely to respond to hormone-blocking therapy alone.

Mapping the genome of cancer cells through genomic breast cancer testing (also known as Oncotype tests) can help determine whether or not they will respond to hormone-blocking therapy, chemotherapy, or both. While Oncotype tests are not recommended for all patients, some with invasive tumors larger than 0.5 cm and estrogen-positive, the tests can reveal whether a particular breast cancer recurrence is likely following treatment.

Genetic testing for breast cancer in the elderly can now provide information on more advanced breast tumors, including those that have invaded the lymph nodes. With the aid of these findings, your doctor is better equipped than ever to suggest a treatment strategy for controlling breast cancer.

Do larger breast cancer tumors necessitate a mastectomy in every case?

A mastectomy is not necessary for all large tumors. The size of the tumor in relation to the size of the breast influences whether a lumpectomy or mastectomy should be performed during breast cancer surgery. If the patient had very large breasts, a 2-centimeter tumor would likely be manageable with a lumpectomy; nevertheless, if the patient had small breasts, a mastectomy would likely be advised.

Do older adults need to get a mastectomy if they have invasive breast cancer?

Mastectomy is one form of treatment for invasive breast cancer, but it isn’t always necessary, especially with all of the treatment options available today. The treatments your doctor prescribes, as well as their administration in what order, rely on a number of variables.

The patient and doctor together could decide the best course of action is to undergo chemotherapy first and then have a lumpectomy rather than a full mastectomy following chemotherapy if the tumor is small enough to do so.

New developments in breast-conserving surgery (lumpectomy) and mastectomy with reconstruction, such as oncoplastic breast reduction, nipple-sparing mastectomy, aesthetic flap closure, and other methods, can provide alternatives that preserve your appearance and self-image if surgery is the best option for you. Dr. Gorman always strives for breast-conserving surgery whenever possible.

Do older adults that have breast cancer need chemotherapy?

Although a chemotherapy regimen can be difficult, chemotherapy can be an effective strategy to shrink a tumor. However, chemotherapy may not always be required, depending on the patient’s particular circumstances.

The information obtained from the Oncotype genetic profile of cancer can help determine whether chemotherapy will be helpful in postmenopausal patients with invasive cancer whose tumor is larger than 1 centimeter and hormone receptor positive. Adjuvant chemotherapy may be associated with improved survival outcomes in elderly patients with breast cancer.

Even if elderly breast cancer patients have cancer in their lymph nodes, depending on the results of the tests, they may be able to forego chemotherapy in favor of hormone-blocking medication, which is easier to take and has fewer adverse effects. Hormone therapy can be given orally and spread out over five years.

Do all lymph nodes have to be removed if breast cancer has spread to them?

Not all the time. Fewer surgeries to remove axillary lymph nodes are currently being performed by surgeons. The risk of lymphedema was higher a few years ago when the recommendations were different, and breast cancer that had spread to the lymph nodes required the removal of every one of them.

Adjuvant radiation therapy to the residual lymph nodes has been shown in recent studies to be as effective as axillary lymph node removal at controlling local cancer in some patients with cancer in the lymph nodes.

Another method of avoiding axillary lymph node dissection is first to use chemotherapy to reduce the cancer’s size. Fewer lymph nodes may need to be removed if there is a positive response.

How common is triple negative breast cancer in older patients?

Triple negative breast cancer affects about 10% of older women with breast cancer. It is more common for elderly women to be diagnosed with a hormone receptor positive breast tumor.

What is the prognosis for invasive breast cancer in women aged 70 and up?

Although receiving a cancer diagnosis is frightening at any age, older people may feel more vulnerable. But there are reasons not to worry because, thanks to breast cancer research, treatment options have advanced greatly, especially with an early breast cancer diagnosis.

Most frequently, in individuals aged 70 or older, the invasive cancer is hormone receptor positive, indicating a slower-growing cancer and is diagnosed while it is still an early stage breast cancer.

The data shows that the majority of people who are treated for invasive breast cancer survive. Even if you are diagnosed later in life, you can still successfully complete your treatment, carry on with your life, and eventually pass away from causes unrelated to breast cancer. This is especially true for those who are capable of taking care of themselves and are in good overall health without another comorbidity at the time of their diagnosis.

Dr. Gorman is dedicated to offering patients of any age an advanced, personalized, and targeted approach to breast surgery and the treatment of breast cancer. Early detection is crucial when it comes to treatment options for breast cancer. Consult your doctor to discuss your symptoms and determine whether you require additional evaluation if you are concerned about any new changes in your breasts or possible breast cancer symptoms. To schedule a consultation with Dr. Gorman or to learn more information about breast cancer treatment, visit the Texas Breast Center website or call the office today.

Read the article on Age as an Influencer on the Risk of Breast Cancer

https://pubmed.ncbi.nlm.nih.gov/29492945/

The Stages of Breast Cancer

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Following a breast cancer diagnosis, medical professionals will look to see whether and how far the disease has spread. Staging is the term for this process. The cancer’s stage indicates how much cancer is present in the body. Determining the stage helps doctors evaluate the cancer’s severity and the most effective course of treatment. When discussing survival statistics, breast cancer doctors also refer to the stage of the malignancy. At Texas Breast Center, Dr. Gorman is dedicated to offering her patients the most advanced, personalized, and targeted approach to treating breast cancer with breast surgery. Her compassionate care, expertise, and dedication to continuing medical education make her patients feel at ease knowing she is on their team. To schedule an appointment with Dr. Gorman, call Texas Breast Center today.

What are the different stages of breast cancer?

Most patients want to know what their breast cancer stage is as soon as they receive the initial medical diagnosis of breast cancer. Breast cancer is understood to have five stages. The American Joint Committee on Cancer TNM staging system (AJCC cancer staging manual) is the staging method most frequently utilized for breast cancer. The most recent TNM system, effective January 2018, has both pathology and clinical staging systems for breast cancer.

Dr. Gorman will provide you with further information about the stage of your breast cancer when you speak with her at your appointment. She will take the time to thoroughly explain what your particular stage means, as well as listen to and answer any of your questions.

Stage 0

The earliest stage of breast cancer, also known as ductal carcinoma in situ, occurs when abnormal but non-invasive cells are found in the lining of the breast milk duct. There is no proof that the cancer has spread (metastasis), and it is still quite treatable at this point. This stage is also known as pre-cancer or early-stage breast cancer. Dr. Gorman will assist you in developing a treatment strategy.

Stage 1

In the next stage, there is undeniable proof of the presence of breast cancer cells rather than abnormal cells. The good news is that stage I breast cancer has a high chance of being successfully treated when diagnosed early and therapy is initiated.

Typically, Stage I is separated into stage Ia and stage Ib. Ia refers to a tumor size that is less than 2 cm in size and does not show signs of spreading to the axillary lymph nodes. When there is only a small amount of evidence of cancer in the breast and lymph nodes, but either no tumor is present in the breast tissue or the tumor is smaller than 2 centimeters, the diagnosis is Ib.

Stage 2

When cancer is identified as being stage II breast cancer, the tumor is larger and is still growing, but at this point, it is only inside the breast tissue or lymph nodes. Again, there are subsections for stage II that deal with the size of any tumor and whether or not there is spread to nearby lymph nodes. By its very nature, stage II cancer is considered invasive breast cancer and will require a more aggressive course of treatment than stage I cancer. However, the prognosis is still favorable, with excellent breast cancer survival rates, providing treatment is initiated early.

Stage 3

A stage III cancer diagnostic indicates that the tumor has spread to other areas of the body. At this point, it will not have started to affect other distant organs. Many oncologists classify this cancer as being “advanced.” The majority of recent treatment option developments have, however, made substantial strides at this stage. Chemotherapy and/or radiation therapy are potential treatment options at this stage.

Stage III cancer treatment is divided into two categories based on the severity of the disease and how many lymph nodes are involved. Some stage III breast cancer is also called inflammatory breast cancer. The tumor may just need to be shrunk with chemotherapy first, and if the patient responds well to the medication, breast cancer surgery may then be explored in the future. It’s crucial to keep an optimistic attitude and observe how your cancer responds to treatment.

Stage 4

Breast cancer that has reached stage IV has spread to other parts of the body and is also known as metastatic breast cancer. The brain, bones, thoracic wall (chest wall), sternum, skin, clavicle, liver, or lungs may be areas it has spread to at this stage. Stage IV breast cancer is often managed as a chronic condition because it is not thought to be curable. The outlook for many women is significantly better thanks to modern medical advancements, combined with a positive mental attitude and view on life. There is always hope at every stage because breast cancer research, clinical trials, and improvements in breast cancer treatment are continuous.

See the related article on Does Every Breast Cancer Patient Need Surgery?

More FAQ’s about Breast Cancer Staging

What procedures are used to determine the stages of breast cancer?

The following diagnostic tests can be used to determine the stage of breast cancer:

  • Mammogram
  • Breast MRI
  • Blood tests
  • Bone scan
  • PET scan
  • CT scan
  • Breast biopsy
  • Ultrasound

How fast does breast cancer spread?

All types of cancers are capable of spreading, but whether they do and how quickly they spread depends on a few different factors. The type of breast cancer you actually have is the main factor your doctor uses to assess whether or not your disease will spread quickly. Different breast cancers develop at varying rates. Given that every cancer diagnosis is unique, it is challenging to provide a general prediction of how quickly breast cancer may spread.

Finding the typical growth rate of breast cancer is as challenging as figuring out how long breast cancer takes to develop. The amount of time it takes for a tumor to double in size has been studied in many ways, but the results are highly variable depending on the type of breast cancer and the patient.

It’s difficult to pinpoint the exact rate at which breast cancer can grow and spread because different forms of the disease frequently exhibit varied characteristics. However, doctors are aware that some forms of breast cancer tend to be more aggressive and spread quickly, whereas other forms usually advance more slowly.

Generally speaking, the likelihood that your tumor will spread to neighboring tissue and other parts of your body increases as it grows. Several variables, including breast cancer grades, can affect how quickly your breast cancer grows. Special proteins called receptors have a role in the growth and survival of cancer cells. Breast tumors with hormone receptors, which depend on the growth hormone estrogen, progress more slowly than other types.

Other types, however, may be more aggressive and rapidly growing. These include triple-negative breast cancer, which lacks hormone receptors and HER2, and HER2-positive tumors (also sometimes referred to as HER2/neu proteins), which depend on a different type of protein for growth.

It is more likely that cancer that has spread to other places in your body will do so again. Your chance of the cancer spreading increases with the stage of breast cancer you have.

Can you do anything to prevent or slow the spread of breast cancer?

There is no guaranteed method for preventing breast cancer. However, there are certain things you can do to reduce your breast cancer risk. While breast cancer cannot always be prevented, it can occasionally be slowed down, prevented from spreading, or even have its size reduced. You can accomplish this by following all prescription instructions, completing all prescribed treatments, attending all scheduled visits with your oncologist or breast cancer surgeon, and actively participating in your breast cancer treatment.

Correct drug administration, a nutritious diet, regular exercise, and stress management are all things you can control. All of these things can help you become more physically fit and which leads to a more positive outlook on life, which can have a positive impact on your breast cancer diagnosis.

What are the survival rates at each of the breast cancer stages?

In the United States, non-metastatic invasive breast cancer patients have a 90% five-year survival rate. For women with non-metastatic invasive breast cancer, the ten-year survival rate is 84% on average.

Women with invasive breast cancer have a 99% five-year survival rate if the disease only affects the breast. Sixty-five percent (65%) of breast cancer diagnoses in women are at this stage. In the United States, women between the ages of 15 and 39 are less likely than women over the age of 65 to have their breast cancer detected at an early stage (68% of cases in this age range). This might be because, unless a person is at a greater risk, the majority of mammography and breast cancer screening doesn’t start until age 40.

The five-year survival rate is 86% if the malignancy has progressed to the lymphatic system. The five-year survival rate is 29% if the cancer has progressed to a distant area of the human body.

The likelihood of recovery for any given person is dependent on a variety of factors, including the size of the tumor, the number of lymph nodes that have cancer, and other characteristics of the tumor that affect how quickly a tumor will grow and how well the treatment works. It is important to remember that these statistics are averages. As a result, it can be challenging to calculate each person’s likelihood of surviving.

When it comes to breast cancer survival and the best treatment options, early diagnosis is crucial. If you have any concerns about recent changes in your breasts or possible breast cancer symptoms, speak with your doctor to discuss your symptoms and determine whether you require a physical examination, additional testing, or medical imaging.

Dedicated to giving her patients the finest care possible, breast surgeon Valerie Gorman, MD, FACS, puts all of her passion and determination into her work. She believes that treating every patient from the time of their initial diagnosis will provide her with a long-term perspective on their disease and how it is progressing. Dr. Gorman’s kindness and attentiveness are just two reasons that patients choose her for their breast cancer surgery. To request an appointment with Dr. Gorman, call Texas Breast Center or visit the website for more information.

Statistics from https://www.cancer.net/cancer-types/breast-cancer/statistics

Benefits of Breast Cancer Awareness: Resources, Information, and Support

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National Breast Cancer Awareness Month is in October, and not only should you wear pink this month, but you should also learn what you can do to inform yourself, your friends, and your family about the risk factors and symptoms of breast cancer. It also involves offering assistance to those who have received a medical diagnosis of breast cancer, undergone breast cancer treatment, or lost a loved one to the disease.

Breast Cancer Awareness month aims to equip you with the tools you need to protect yourself, as well as with breast cancer information materials and support services. Breast cancer is the most common cancer in the United States, and early breast cancer detection is the key to saving lives. Texas Breast Center extends an open invitation to everyone to take part in Breast Cancer Awareness Month and urges women to self-examine their breasts and educate others in their communities about breast cancer prevention and risks.

The Benefits of Breast Cancer Awareness Month

Breast Cancer Awareness Month is more than just pink ribbons and is significant because it raises money for life saving research into the disease’s causes, treatments, and cure while also raising public awareness of the disease. It educates on the importance of routine breast screening and early detection.

Public education represents one facet of awareness. Campaigns for Breast Cancer Awareness Month assist in educating people about the warning signs and symptoms of the disease as well as preventative measures, such as how to do a self-exam, where to find the right breast cancer screening, and the value of routine mammograms. For those impacted by breast cancer, the month also spotlights cutting-edge, effective procedures and treatments, even those that may not be well-known to the general public.

Raising money for research is one of the other main objectives of Breast Cancer Awareness Month. Through various events organized throughout the month, including races, walks, social media campaigns, and others, participants are able to raise more money to fund life-saving research and continue creating innovative treatments that have improved outcomes, lowered the mortality rate over time, and given patients with the disease hope.

Most importantly, Breast Cancer Awareness Month is a time to honor the breast cancer survivors who battled the disease and to express support and solidarity for those who have been affected by breast cancer.

Early Detection

The growing participation in Breast Cancer Awareness month over the last thirty-plus years has helped increase awareness about the importance of early detection of breast cancer. Though it can affect women of any age, women over 50 are most frequently diagnosed with breast cancer. To find any early indicators and increase your chances of receiving successful treatment, it is crucial to regularly examine yourself and have your health assessed by a medical professional.

Every month, you should perform a breast self-exam. Lay down on your back and raise your right arm to conduct a self-exam. Check the entire right breast and armpit region with three fingers on your left hand for lumps, knots, or extra skin thickness. In the shower, you can also carry out this examination by elevating your arm above your head. It is also advised to check your breasts in the mirror to check for any visible symptoms like skin puckering or dimpling.

Self-examinations are helpful, but screening mammograms offered by healthcare providers are crucial for early diagnosis since they can identify breast abnormalities before a lump can be felt, which ultimately saves lives. Women 40 and older should get mammograms every year. Visit with your physician if you have a family history of breast cancer to evaluate the need for increased screening. An annual exam is also advised for women, especially if there is a family history of breast cancer. Routine mammography is one of the most crucial steps you can take to keep your health, prevent disease, and live a healthy life.

Lowering Your Risk

Even though there is no guaranteed way to avoid developing breast cancer, there are steps you can take to potentially lessen your risk. According to the breast cancer research of the American Cancer Society, there are several ways to lessen the risk you will develop breast cancer.

  • Maintain a Healthy Weight or Lose Weight if Needed: Breast cancer risk increases after menopause in adults who are overweight or obese. To reach or maintain a healthy weight, maintain a balance between your food intake and physical activity.
  • Keep Moving: Low risk of breast cancer risk is connected to moderate to vigorous exercise levels. Include 150 to 300 minutes a week of moderate-intensity exercise!
  • Limit Alcohol Consumption: Alcohol should be avoided or consumed in moderation as it raises the risk of breast cancer. Alcohol consumption, even at low levels, has been associated with an increase in risk. If you chose to drink alcohol, limit your consumption with this in mind.
  • Breastfeeding: The majority of research indicates that breastfeeding, particularly if it lasts for a year or more, may indeed reduce the risk of breast cancer.

In addition, taking hormone replacement therapy and some birth control medications (a combined oral contraceptive pill) have been linked to an increased risk of breast cancer.

Support for Breast Cancer Patients

While October is dedicated to raising awareness and preventing breast cancer, it is also a time for charities and organizations to promote the support services they offer to breast cancer patients and survivors. Pick your favorite non-profit organization or breast cancer foundation and make a financial donation to help further the work they are doing for Breast Cancer research and support. In addition to supporting a 501(c)(3) organization financially, you can also provide support to patients facing breast cancer.

There are numerous ways in which you can assist and support someone who has received a cancer diagnosis. Start by being there and providing a listening ear. Consider leaving a supportive note on someone’s CaringBridge page. Think about the assistance that a cancer patient’s family could find useful. You can either bring food or work with others to put together a group to provide food. You can send a note, leave your favorite book, or make a movie recommendation. Keeping in touch and showing support can mean the world to someone.

The success rates of breast cancer treatment continue to rise along with the amount of research being done. We recognize that a breast cancer diagnosis is personal and can still feel disorienting, despite advances in research. Texas Breast Center is dedicated to supporting you at every turn. Through a specialized, tailored treatment plan and ongoing support after your initial treatments, the team wants to establish a connection with you and give you hope.

Breast surgery expert Valerie J. Gorman, MD, FACS, focuses on surgical oncology and surgical diseases of the breast. You will have access to a wide range of treatment choices, including hormone therapy, while under her care, as well as a regimen of care tailored to your particular breast cancer.

Our goal is for each of our patients to go from being a breast cancer patient to a breast cancer survivor. Texas Breast Center is dedicated to promoting Breast Cancer Awareness in October and beyond by providing information, support, and more resources as we work together to save lives.

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.

Dr. Valerie Gorman Faculty for Women in Breast Surgery

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Hologic’s women in breast surgery conference

Dr. Valerie Gorman, MD, FACS, a Waxahachie-based breast surgeon specializing in surgical oncology and surgical diseases of the breast, was selected for faculty at the prestigious Women in Breast Surgery conference. The Tampa, Florida-based conference was sponsored by Hologic, a groundbreaking enterprise designed to support women’s health by providing effective, state-of-the-art technology to healthcare professionals. Hologic constructed this two-day conference around the personal and professional development of women breast cancer surgeons.

Four renowned female surgeons, including Dr. Gorman, led the courses, merging the medical field and the business world through incorporating topics such as improving workflow efficiency, leadership and a seat at the table, getting the word out to build your brand, and offering a negotiation workshop. Dr. Gorman and her peers, who came from all over the United States, provided new breast surgeons and breast fellows (the medical community’s term for surgery residents and breast fellowships) with leadership and marketing tactics. “It was an honor to be a part of this,” said Dr. Gorman, “and to provide the tips and tricks I wish I had known when I was starting in the field rather than learning these strategies the hard way. This is really exciting work for the breast surgeon community.”

Educating the medical community on breast cancer surgery practices

Breast cancer technology

Gorman’s practice, Texas Breast Center, is considered a center of excellence for training among medical personnel. The conference’s sponsor, Hologic, sends its representatives and other physicians to be trained by Dr. Gorman and her team on the technology of the BioZorb, a marker device used for stereotactic body radiation targeted therapy, and the wireless technology she employs. Dr. Gorman is grateful for the opportunity to train other physicians and industry persons on breast cancer treatment and care advancements. “Bringing them into the process of these surgical techniques and utilization of the BioZorb to gain a first-person understanding of the tools they are selling or using is essential to promoting healing and recovery for patients; education is key,” emphasizes Dr. Gorman. Her desire to raise awareness and educate others in the field led her to present at the Women in Surgery conference.

Strategies for breast surgeons

Dr. Gorman emphasizes the importance of empowering women, physicians and patients alike, through education. Her presentations at this conference aimed to help women claim their spot at the table among the leading breast cancer surgeons by providing insight into the business side of surgery, an aspect that is often neglected within the medical field. Additionally, effective business tactics would lead to larger public exposure of surgeons and, thus, more conversations surrounding breast cancer and breast care in general. Through a nationwide increase of young women entering the field with successful business strategies and tailored care for patients enduring breast cancer surgery, Dr. Gorman hopes this will lead to greater self-awareness and detection of early-stage breast cancer among the public.

Why is breast cancer awareness critical?

Breast cancer is one of the most common cancers detected in females, ranking second only under skin cancer. This means that, statistically, most women will either be diagnosed or know someone who has been diagnosed with breast cancer. Awareness helps us begin to topple this statistic. It leads to more women participating in self-checks, earlier detection, and an understanding of the risk factors that may indicate breast cancer. Opening the door for these actions to become regular practices starts with preparing and enabling newer breast cancer surgeons with the information surrounding strong business tactics and state-of-the-art care for patients and their communities. The Hologic Conference on Women in Breast Surgery sought to jumpstart these efforts, aligning with Dr. Gorman’s mission.

Dr. Gorman was also selected to present at the 20th Annual Meeting of the American Society of Breast Surgeons.

 

 

Black Women and Breast Cancer

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Black History Month

Officially recognized in 1976, February is dedicated as Black History Month in the United States of America. Commemorating the victories and legacies of African Americans and recognizing the hardships they have faced throughout our history, it is a pinnacle time of awareness and memorialization in the lives of American citizens. In honor of this past month’s observations, we wanted to provide information on women’s health surrounding the realities of breast cancer for black women.

Black Women and Breast Cancer

According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer for black women. Falling second to lung cancer, breast cancer is also a top cause of cancer-related mortality. It is crucial for black women to understand the likelihood of a diagnosis, the risks surrounding breast cancer, and ways to routinely check for potential breast tumors. There are many questions surrounding the truth on breast cancer statistics, particularly pertaining to black women. Educating people on the realities of breast cancer plays a key role in women knowing what to watch for regarding their breasts and in changing some of the socially constructed elements surrounding medical and breast care for black women.

What is breast cancer?

Essentially, breast cancer is the uncontrolled development of breast cells. This is why it is recommended that women examine their breasts regularly for evidence of changes to the breast such as puckering or discoloration, as they are often the first symptoms to appear.

What would lead to a breast cancer diagnosis?

Although there are many different varieties of cancer, tumor biology at its base level remains consistent, and they all have similar characteristics. The genes in the human body regulate and control cell proliferation. The job of genes, which are found in the nucleus of cells, is to ensure that as old cells die, they are replaced by new cells. Mutations can develop, causing this process to be disrupted. This change can significantly affect the regeneration process, removing control from the genes and allowing the cells to continue making new cells without restriction. The production of additional cells can lead to the formation of a tumor. The emergence of a malignant tumor (which is an aggressive form of cells and can spread to other areas of the body via the blood and lymph systems) is what typically generates a breast cancer diagnosis.

Breast Cancer Risk for Black Women

Age, ancestry, family history, and type of diagnosis affect the severity and likeliness of breast cancer.

Who has the highest risk of breast cancer?

Despite a lower incidence of breast cancer development, black women’s lives are approximately 40% more likely result in breast cancer death. Women of a younger age, meaning below the age of 45, also tend to have the highest risk. There is no simple answer to this disproportion, as these starkly contrasting numbers seem to arise from a combination of factors, including both sociological conditions and genetic factors.

Disparities of Breast Cancer and Race

In recent years, there have been increasing conversations surrounding the tragic breast cancer disparities of medical care and attention for people of color. These risks and realities prove particularly tangled and problematic in the world of health care and surgical access. While this is true, Dr. Gorman of Texas Breast Center is eager to dismantle this problem through targeted, attentive care for each person who comes under her expert care.

The prevalence of breast cancer is still far greater than we like to see, which is why Dr. Gorman and her team at Texas Breast Center fight endlessly to see these numbers decrease. Particularly among black women, the statistics of more aggressive forms of breast cancer diagnoses, such as triple-negative breast cancer, are astronomically higher.

What is triple-negative breast cancer?

Triple-negative breast cancer is a form of breast cancer that tests negative for all three receptors: estrogen, progesterone, and HER-2. This kind of breast cancer is one of the more aggressive and invasive breast cancer types, with high spread and growth rates. Both age and race play into the likeliness of this diagnosis, as it is most common in women under forty and in black women.

Not all black women are at the same risk of developing triple-negative breast cancer. Research shows that particularly those born in Western Africa and the United States are at an increased risk for triple negative breast cancer in comparison to those born in East Africa. This difference is especially notable when compared to white women or women of other races. According to the American Cancer Society, black women in the United States are actually twice as likely as white women to receive this diagnosis. This may be a reason for the lower rate of survival among black breast cancer patients. Educating oneself on the risks of breast cancer can help black women act in anticipation and preparation and increase the chances of survival through early detection.

Dr. Gorman at Texas Breast Center

While statistics surrounding breast cancer can seem overwhelming and may evoke fear, Dr. Valerie Gorman combats this with the truth that “treatment for breast cancer has improved significantly over the last few years, and success rates continue to rise.” Breast cancer outcomes and treatments have never seemed more optimistic.

Dr. Gorman and her team at Texas Breast Center, located in Waxahachie, are devoted to caring for every patient in a manner tailored to their unique case, conducting each interaction with expert care, attention, and skill. Providing honest, advanced information on the risk factors of breast cancer and the leading treatment options is a top priority of this Texas-based breast surgeon. She dedicates herself to the wellbeing of every single patient and, in doing so, aims to topple the disparities that black women diagnosed with breast cancer face and help reduce the rates of breast cancer mortality, one case at a time.

Staying informed

As a leading surgeon, Dr. Gorman advocates for preventative measures and staying on top of breast health. Regular self-breast checks, mammography screening, a regular clinical breast exam, assessing controllable risk factors, and remaining informed on the latest news surrounding breast care are all steps that can increase the chances of detecting breast cancer while it is still in the early stages.

If you have any questions surrounding breast cancer or breast cancer risk factors, don’t hesitate to contact Dr. Gorman and her team at Texas Breast Cancer.

 

https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32293?referrer_access_token=tNmZThNQBcGMkZz0Mw1KaU4keas67K9QMdWULTWMo8PjlxlDClmn9SMF_cvVV7b6CVxSyInTq9HeXJidKb9BxMA8NsR

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

 

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.

The FDA Granted Approval for New Breast Cancer Medication

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The FDA, or U.S. Food and Drug Administration has recently approved two new medications for breast cancer treatments. The approval for these treatments was expedited due to the COVID-19 pandemic. One of these medications targets metastatic triple-negative breast cancer, while the other targets HER2-positive  cancers.

Richard Pazdur, the director of the FDA’s Oncology Center for Excellence, stated, “As part of FDA’s ongoing and aggressive commitment to address the novel coronavirus pandemic, we continue to keep a strong focus on patients with cancer who constitute a vulnerable population at risk of contracting the disease. At this critical time, we continue to expedite oncology product development.”

 

FDA Approval

The drug’s applications were granted by the FDA under the provision known as “accelerated approval” due to today’s current conditions. This means that the drugs may be distributed and administered under specific criteria. There will still be further data from further clinical trials required before full approval is granted.

The medications may be administered to patients only when certain conditions are met. For Todelvy, this means that it is “reasonably likely to predict a clinical benefit to patients” who have are in serious condition and have unmet medical needs. For Tukysa, the medication must be administered alongside chemotherapy, and there must be at least one prior attempt at treatment.

 

Trodelvy

Trodelvy, also known as sacituzumab govitecan, is one of the medications to receive accelerated approval. Produced by Immunomedics, Trodelvy received approval based on results from a clinical trial (phase 1/2) of 108 patients.  These patients had all received at least two treatments previously for their metastatic cancer.

It was given intravenously. It is formed of a combination of SN-38 (a metabolite of irinotecan, a chemo drug) and a monoclonal antibody that targets an antigen that induces cancer cell growth.  The response rate in breast cancer patients in the trial was 33%, and 55.6% of those responders maintained their response at least six months.

Some common side effects of Trodelvy are nausea, fatigue, anemia, low white blood cell counts, as well as hair loss, rash, and abdominal pain. There are chances of more severe side effects to keep an eye out for, such as severe diarrhea and neutropenia–an abnormally low level of neutrophils.

 

Tukysa

Tukysa is the brand name of tucatinib, a tyrosine kinase inhibitor of HER2 proteins. When taken with capecitabine and trastuzumab in adult patients, it is intended for advanced metastatic, HER2-positive breast cancer, including brain metastases. The patients must have attempted at least one anti-HER2-based treatment geared towards metastasis.

This medication has been shown to inhibit the phosphorylation of both HER2 and HER3 in-vitro, or in lab studies. Further clinical trials will be performed.

Some common side effects of Tukysa are fatigue, liver problems, decreased appetite, hand-foot syndrome, and mouth sores, as well as others. The liver problems can become more severe, as can diarrhea, leading to other health problems.

 

Breast Cancer Treatment

Many adjustments have had to be made in day-to-day life with the introduction of the Novel Coronavirus. This includes the treatment of breast cancer, the testing of medication, and FDA processes of approval. These new medications have been pushed forward into the market more speedily than usual, but that does not mean they were pushed forward recklessly.

Each was pushed forward by the Food and Drug Administration with certain conditions to met before application. Each must also continue testing before the FDA approves it fully.

Texas Breast Center’s Covid-19 Safe Care

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Dr. Gorman and the Texas Breast Center are still taking patients, but understand that there is hesitance in this time of COVID-19. To help ease fears and discomfort for patients, we have implemented certain safety measures, following Baylor Scott & White’s COVID-19 Safe Care Plan.

In-Office Policies

While some things have changed in the processes for patients and visitors to the Texas Breast Center, we are back to a full schedule. To maximize our patients’ safety, we are offering virtual care via video conferencing with your doctor for some appointments. There is also a drive-thru option for specimen collection. The waiting room is currently closed according to the Centers for Disease Control and Prevention guidelines, so when a patient arrives, they will wait in their car until an exam room is ready. When they are informed a room is ready, they will be escorted directly to their rooms. To encourage social distancing for both the patient and physician, only one visitor will be allowed to accompany the patient back. Everyone must wear a mask, including patients, visitors, and medical team members.

There will also be a screening process upon entry checking for any temperatures above 99.6 F as well as asking about potential COVID-19 symptoms such as cough, shortness of breath, sore throat, or others. If the patient answers yes to the questions or has a fever, they will be quickly moved to a separate, designated area, to prevent the spread of infection. If a visitor has a fever or answers, yes, health services will be offered. If the visitor does not need them at that time, we will request that they return home and contact their primary care doctor.

Policies and procedures are a little different when it comes to surgery rather than a general appointment or checkup at the facility.

Pre-Surgery Policies

While a surgeon’s preparatory efforts start happening well in advance of the surgery, usually a patient does not need to take any action until the day before. However, under the Safe Care guidelines, patients have a few tasks they must take care of in the week leading up to their surgery to assist in potential disease control.

Each patient is enrolled in a digital care journal five days in advance to help monitor them for fever or other symptoms of COVID-19. This online journal also offers resources to each patient who has questions. Then, 48 hours before the procedure, each patient will be tested, even if not symptomatic. Many people infected with COVID-19 are asymptomatic and can spread the virus without being aware of the risk. This is why both the testing and the personal journal are essential to your treatment. The results will determine how you and your medical team members proceed from there.

If your test comes back negative, you do not have the virus. You will not be called with the results if this is the case and can proceed with your surgery as expected. However, be aware that if the test is taken within the first 1-2 days after being infected, the results may show negative. So processes are in place at the hospital to keep patients safe, including masks worn by all hospital staff. If the COVID-19 test reveals a positive result, you have an active infection. In this case, you will be called by a healthcare team member to give you information on how to care for yourself and protect those around you. We will notify the local health department of your positive test–we are required to do so–so that you do not have to worry about it. Your surgeon and team will make a case-by-case determination on whether to postpone your procedure or continue as scheduled based on specific health needs and requirements.

When surgery takes place, all patients and visitors are screened upon entry to the building. On the day of the procedure, each patient is allowed one visitor, and then one for every 24 hours they remain admitted.

Personal Health and Safety

The Centers for Disease Control and Prevention has given us many guidelines and pointed us in a direction to follow to best care for our patients. In following these guidelines and setting up some ourselves to keep our patients safe, we have implemented new options and arrangements. As stated above, virtual care and telemedicine options are now available before and after procedures and surgeries whenever appropriate so that patients may stay home and away from hospitals.

Along these lines, Virtual Waiting Rooms have been implemented. These are patient portals used to communicate updates about care, scheduling, etc. between the hospitals, doctors’ offices, and surgery centers. These ‘waiting rooms’ can be used to set up messaging via text or phone calls as well so that there is the absolute minimum time spent in common areas.

Everyone within the buildings, including staff, patients, and visitors, must be masked and participate in social distancing to assist each other in minimizing the spread of COVID-19. We have also implemented touch-free protocols, involving paperless registration, and enhanced cleaning protocols, including UV-light disinfection.

Dr. Gorman

Dr. Gorman understands that for our breast cancer patients, the COVID-19 pandemic is only increasing the stress and anxiety in an already challenging and uncertain time. However, with the Safe Care plan, we are doing everything we can to help our patients navigate and continue on their journey to recovery.

Exploring New Findings in Breast Cancer Research

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The week of December 10, Dr. Valerie Gorman attended the annual San Antonio Breast Cancer Symposium to give a poster presentation for her research in 5-day SBRT radiation. This symposium is an opportunity for those involved in breast cancer research to share what they have learned.

The SABCS’ stated objective states that the conference “is designed to provide state-of-the-art information on the experimental biology, etiology, prevention, diagnosis, and therapy of breast cancer and premalignant breast disease, to an international audience of academic and private physicians and researchers.” Research is brought from all of these categories to be shared and help other practitioners improve their own research or treatments.

Dr. Gorman praises this conference for the multidisciplinary spread of study. As her breast cancer team is interdisciplinary, she can gather information that will interest every member of her team. She noted that there were presentations this year on “molecular studies on circulating tumor cells, more targeted therapies, and many other topics. Together with our oncology colleagues and team members, we’re able to use these to treat our patients in a collaborative, multidisciplinary fashion.”

For example, while Dr. Gorman does not specialize or perform chemotherapy treatment, she took note of several tailored researched studies into chemotherapy. There is new research being done on HER2 positive cancer, or breast cancer that tests positive for human epidermal growth factor receptor 2. HER2 protein excess is found in approximately 20% of breast cancers, caused by a gene mutation in the cancer cells. There is also chemotherapy targeting metastatic breast cancer, which is cancer that has spread beyond the point of origin–in this case, the breast and lymph nodes nearby. Patients with these cancers tend to have a lot of, and many kinds of chemo throughout their treatment. These new studies are helping us to learn how to “study the tumor and retailor the chemotherapy to the individual patient and their needs.”

The presentation that Dr. Gorman and her team were most interested in, however, came from the University of Florence in Italy. They presented on the ten-year results of breast cancer patients who had been treated with Accelerated Partial Breast Irradiation (APBI), a treatment Dr. Gorman has been using and perfecting for many years.

The use of radiation therapy on breast cancer is a common occurrence. This treatment directs high energy rays directly at the cancerous area to kill any cancerous cells left over after surgery. Traditionally, radiation therapy is implemented over 30 days. This regimen includes visits every weekday for six weeks and can potentially lead to burns on the surrounding tissue as well as changes in the patient’s appearance. However, APBI shortens the number of days needed for the treatment. Some protocols of APBI give radiotherapy twice a day for five days, while others–including Dr. Gorman’s practice–only give it once a day for five days. While the treatment itself takes little time in office, doctors know transport and waiting room time can take up valuable time from the patient’s personal and work life. By minimizing how many office visits are required, these doctors are giving their patients more of their life back.
The presentation that the University of Florence gave reveals new results from patients ten years after their surgeries and radiotherapy treatments. The results found that survival rates at the ten-year mark for those who received APBI–as with the five-year mark–matched the survival rate of those who received longer treatments. However, APBI has better cosmetic results and less burn damage.

Dr. Gorman is pleased to know that this treatment helps her patients, not only by treating their breast cancer but also by lessening the impact that breast cancer has on their personal life. With few in-office treatments, there is less time away from the office or the family. The APBI also produces more favorable cosmetic results, which can help with a healthier mindset as you approach healing.
Dr. Gorman and her team offer APBI when necessary to provide the breast results and the least interference in her patients’ lives. They also provides necessary breast cancer surgery to best help a given case. As the Chief of Surgery and Medical Director of Surgical Service of Baylor Scott and White Medical Center in Waxahachie, Dr. Valerie Gorman, MD, FACS is ready to answer your questions and design a personalized cancer treatment plan for you.

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

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

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

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

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

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

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

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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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Streamlined Treatment for Breast Cancer Reduces Your Treatment Time

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Partial breast radiation offered by Dr. Valerie Gorman, Breast Surgeon at Texas Breast Center, may reduce some treatment time by two-thirds.New radiation option cuts time by two-thirds

By Valerie Gorman, MD, FACS, Breast Surgeon at Texas Surgical Specialists

If you receive a diagnosis of breast cancer, it can be overwhelming. You’ll have to sort through a lot of information quickly and make decisions about what treatment is best for you.

For many of my patients with early stage breast cancer, lumpectomy – removing the tumor surgically – is the recommended treatment option. But you have to have radiation after a lumpectomy. That’s part of the package.

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