What is Breast Cancer?

While most people are familiar with the idea and repercussions of breast cancer, not everyone may know what exactly breast cancer is or how it comes to be.

Kinds of Breast Cancer

Put simply, breast cancer is the continued growth of abnormal cells in the area of the breast. This area can include the ducts (that carry milk), lobules (that produce milk), and connective tissue (that holds everything together. Most breast cancers start in the lobules or ducts. And while this does mean cancers appear in the area that we traditionally think of as the breast, it includes the underarms as well.

But there is not one single type of breast cancer. And sometimes, the types overlap.

Invasive Ductal Carcinoma

With invasive ductal carcinoma, cancer cells start in ducts and spread out into the surrounding breast tissue. If it continues to spread to other parts of the body, it metastasizes.

Invasive Lobular Carcinoma

Invasive lobular carcinoma starts in the lobules and spreads to nearby breast tissue. This cancer can also metastasize.

Less Common Types

There are many other kinds of breast cancers, though most are less common. Medullary breast carcinoma starts similarly to invasive ductal, but grows slowly and only rarely spreads to the lymph nodes.

Mucinous or colloid carcinoma is a variation on invasive ductal carcinoma. However, the cancer cells float in mucin, an ingredient in the body’s natural mucus.

Paget’s Disease of the nipple originates with cancer cells collecting in and around the nipple, traditionally the ducts there. From there, it can spread to the areola and further.

Inflammatory breast cancer is also a variation on invasive ductal carcinoma. It is generally accompanied by symptoms of inflammation such as swelling, dimpling, and redness.

Triple-Negative breast cancer does not have the three common receptors found in breast cancers. These receptors are for estrogen, progesterone, and HER2 (human epidermal growth factor). Without the receptors, some methods of treatment are not available.

Ductal carcinoma in situ, or DCIS, is considered either the earliest stage of breast cancer or pre-cancer that is likely to lead to breast cancer. Cancerous cells are forming in the ductal lining, but they have not spread.

How Breast Cancer Spreads

Breast cancer cells start in ducts, lobules, and breast tissue. However, they can spread to the lymph nodes, raising the odds of metastasis–cancer cells spreading through the lymph system and the rest of the body. The more lymph nodes that have cancer cells, the more likely metastasis is. However, metastasis is not an inevitability. Some people with cancer cells in their lymph nodes do not have metastases. And, unfortunately, metastasis can occur despite there currently being no cancer cells in the lymph nodes.

What Are Breast Cancer Symptoms?

There are several possible changes to the breast that can be noticed in regular–monthly is recommended–self-breast checks. Keep an eye out for any changes to your regular breast shape, texture, or color. Some changes that may indicate the need to visit a doctor are:

  • A lump in the breast or armpit
  • Swelling or change in size to any part of the breast.
  • Discharge of any kind that is not milk coming from the nipple (including blood)
  • Puckering of the nipple/Inversion of the nipple
  • Flaky skin or redness around the nipple or the breast
  • Dimpling of the skin (like the skin of an orange) on the breast
  • Pain in any part of the breast

Any one of the symptoms on its own does not mean you have breast cancer. They could indicate an infection or changes due to hormonal shifts. However, if the signs continue or you are concerned, bring them to the attention of your doctor.

Risk Factors

There is no one sign that someone will or won’t get breast cancer, but there are some risk factors that can raise your chances. Some of these factors are genetic factors, while others come from a person’s lifestyle.

Some of the factors that cannot be reduced are:

  • Gender–being a woman increases your risk
  • Age–risk increase with age
  • Dense breasts–they are harder to see through on a mammogram, making early detection more difficult
  • Family history–the risk is increased if a close family relative (mother, sister, daughter) has had breast cancer
  • Personal history–previous breast conditions or breast cancer increase risk
  • Certain gene mutations–BRCA1 and BRCA2, as well as other mutations, can increase risk
  • Radiation exposure–while this may come from many sources, even medical treatment, it could potentially be a risk factor.
  • Starting your period young
  • Starting menopause older

Can Risk be Reduced?

Some potential risk factors come from lifestyle practices and can be adjusted for. Some of these factors are:

  • Alcohol–drinking in excess can increase risk
  • Obesity–obesity can increase your risk, particularly after menopause
  • Taking hormones–certain forms of hormone replacement therapy (progesterone and estrogen, primarily) can increase risk when taken for over five years after menopause. Some birth control pills can also increase breast cancer risk
  • Not having children or having them at an older age can increase risk.
  • Excercise–by not exercising, breast cancer risk can increase. Maintaining a healthy exercise schedule for yourself, you can lower your risk.

Prevention

The best way to prevent breast cancer in yourself is to maintain the risk factors that you can. Beyond that, keep yourself familiar with your breasts with a monthly breast self-check. More than anything, this keeps you familiar with the size, texture, and sensation of your breast so that you might be more likely to notice a change should one appear.

Also, speak with your doctor about breast cancer screening. They know the best time to start screening and will help you to the next steps if there are any concerns. Checking in on your breasts yourself, having your doctor check, and having regular screenings will help you be prepared and catch anything early should there be any signs of breast cancer to find.

Dr. Gorman

Valerie J. Gorman, MD, FACS, works to ensure that her patients are informed and receive a personalized approach to cancer treatment and breast cancer surgery. If you have questions about breast cancer or how it is treated, she or the team at Texas Breast Center in Waxahachie are happy to help answer your questions.

Dr. Gorman is board certified by the American Board of Surgery and serves as Medical Director of Surgical Services and Chief of Surgery at Baylor Scott & White Medical Center – Waxahachie.


The FDA Granted Approval for New Breast Cancer Medication

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.


New Study Associates Dairy Milk Intake With Increased Breast Cancer Risk

A recent study by the researchers at Loma Linda University Health has discovered a link between dairy milk and an increased risk of breast cancer. The study called Dairy, soy, and risk of breast cancer: those confounded milks was published to the International Journal of Epidemiology.

The study used a participation group of 52,795 North American women with a mean age of 57.1 years who were all free of breast cancer. The study then followed them for nearly eight years, taking into account their diets, demographics, family history, and other factors. A food frequency questionnaire, or FFQ, was used to estimate the women’s dietary intake. In contrast, a baseline questionnaire covered the other factors, including physical activity, hormonal and other medication use, alcohol consumption, reproductive and gynecological history, and breast cancer screening.

How much dairy milk?

At the end of the study period, the participation group yielded 1,057 new breast cancer cases. Using the FFQ, the study revealed that there is “fairly strong evidence that either dairy milk or some other factor closely related to drinking dairy milk is a cause of breast cancer in women,” according to Gary E. Fraser, MBChB, Ph.D., first author of the paper. He continued, “Consuming as little as 1/4 to 1/3 cup of dairy milk per day was associated with an increased risk of breast cancer of 30%. By drinking up to one cup per day, the associated risk went up to 50%, and for those drinking two to three cups per day, the risk increased further to 70% to 80%.”

While the particular fat content of the dairy milk–skim versus whole, etc.–had a minimal variation, when compared to minimal or no milk intake, high consumption of dairy milk and dairy calories were associated with a higher risk of breast cancer. Cheese and yogurt yielded no critical associations.

However, there was no clear association found between soy products and breast cancer. Fraser noted that “the data predicted a marked reduction in risk associated with substituting soy milk for dairy milk. This raises the possibility that dairy-alternate milks may be the optimal choice.”

One suggested reason for the link between dairy milk and breast cancer is the sex hormone content of dairy milk. Because cows are lactating when their milk is collected, approximately 75% of a dairy herd is usually pregnant. Breast cancer in women is hormone-responsive. Therefore, taking in this additional level of hormones could cause a higher blood level of it, and then insulin-like growth factor-1, which is thought to increase the risk of breast cancer, as well as other cancers.

Does Dairy Cause Cancer?

Does dairy cause cancer? There is certainly no proof of that being the case. But now there is some evidence of a link between dairy and breast cancer. “This work suggests the urgent need for further research,” Fraser said. “Dairy milk does have some positive nutritional qualities, but these need to be balanced against other possible, less helpful effects.

Risks

It is, however, worth remembering that just because an association was found does not imply causation. The numbers are just strong enough to keep researchers watching the intake of dairy, even when other factors were removed. And while Fraser stated that, “By drinking up to one cup per day, the associated risk went up to 50 percent, and for those drinking two to three cups per day, the risk increased further to 70 to 80 percent,” even that does not mean you are increasing your risk to 50% or 80% by drinking milk.

The 50% increased risk of breast cancer is a 50% increase to your current risk. If the average woman has a 1/8 chance of being diagnosed with breast cancer, that gives her approximately a 12% chance to increase the risk of breast cancer by 50% would only bring her risk up to a total of 18%. The 80% increased risk of drinking milk products 2-3 times a day would bring the total risk up to 21.6% risk of breast cancer. And while that certainly isn’t the happiest number to think about, it is certainly not as frightening as a jump to 80% risk would be.

Fraser and the rest of the researchers who worked on the study advise taking a look at current dietary guidelines, taking this increased risk of breast cancer with dairy intake into account.

If you have any questions about your risk, or possible next steps, Dr. Gorman and the Texas Breast Center are happy to help.


Texas Breast Center’s Covid-19 Safe Care

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

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

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

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

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

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

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

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

Dr. Potter explained his reconstruction options:

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

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

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

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

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

Dr. Potter added:

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

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

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

Dr. Gorman said about the stages:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Potter followed up in agreement.

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

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


Breast Self Exam: What to Look For

Last month was breast cancer awareness month, a time to highlight the importance of cancer screening and breast health. The Center for Disease Control has named breast cancer as the most common cancer for women in the United States. Approximately 12% (that is, 1 in every eight women) will be diagnosed with invasive breast cancer over her lifetime.

These statistics shift depending on other factors like age, race, and certain genetic factors. For example, African-American women are far more likely to be diagnosed with triple-negative breast cancer than women of other races, and to die of breast cancer of any kind. Asian, Native American, and Hispanic women tend to have lower risks of developing breast cancer, though they should still be aware of the signs and symptoms.

Why is Breast Cancer Screening Important?

In September of 2019, the American Cancer Society announced a new stance on breast self-exams. They stated that self-checks do not tend to reveal any early signs of cancer when women are also getting their scheduled breast cancer screening mammograms and regular checks by their health professionals. That’s not to say that people do not come to their doctors after spotting changes in their breasts. However, these changes are often noticed during dressing or bathing.

Despite this announcement, breast checks can still provide valuable insight. It is easiest to spot changes in your breast if you are familiar with it in the first place. If you are doing a regular breast self-exam, you will be ready to catch anything out of the ordinary–whether that be during your exam or while getting dressed.

How to do a Breast Self-Exam

There are two basic steps to a breast check. You’ll want to examine the breasts by looking and by feeling. Both of these steps can be further broken down from there. Try to do all parts of the exam on the same day and around the same time in your cycle every time: a week after your period ends is a standard time to do it. If you don’t get a period, set a date every month to do your breast self-exam.

Look

For the looking portion of the check, you will want to stand in front of a mirror. You will be standing in a few different poses and looking at a few different angles–front, right, and left.

In each of your poses, you will want to look at a few factors. Make a note of the shape of your breasts, especially in comparison to one another. It is far from unusual for one to be larger than the other, but sudden or drastic changes in size should not happen. Keep an eye out for a change in the usual vein patterns in your breasts. If the veins have increased or expanded significantly, you may want to speak with your doctor. Symptoms display in your nipples if they are consistently itchy, red, swollen, scaly, inverted, or are producing discharge. Finally, check the skin on your breasts for dimpling, redness, rash, puckering, or anything that could be considered like an orange peel. These could all be signs of something happening beneath the surface.

The best way to look for all of these symptoms is to examine your breasts from all angles. First, face the mirror with your arms down at your sides. Turn to the left and the right to check both sides of each breast. Next, place your hands on your hips with your elbows out to your sides, keeping your shoulders up and back. Repeat the pattern of front, left, and right. This same pose can be done hunched forward. This adjustment allows the breasts to hang so that you can see the underside.

Now, raise your arms straight above your head. You can clasp them together or leave them in a superman pose, but try to remember what you have done in previous breast exams so that you know what to expect. Once you have made a thorough observation, lean forward at the hips so that your breast hang forward again, keeping your arms above your head.

Make a note of anything you find that is different from normal and keep an eye on it. Many symptoms we attribute to breast cancer can also be symptoms of things like PMS, a swollen lymph node due to another infection, or many other factors, though, so observe first. However, if you have strong concerns, don’t hesitate to call your health professional for answers.

Feel

To start the feeling check, you will want a comfortable and flat place to lie down. You will lay flat on your back with your right arm up behind your head (if you are starting with your right breast). The goal is to get your breasts as flat as possible.

Once you are in a comfortable position, you will want to start feeling along the outer edge of your breast, near your armpit. You will want to use the pads of your fingers rather than your fingertips and move in small, smooth circles. Perform each circle at more than one pressure–light, medium, and firm–between the size of a dime and a quarter. By varying the amount of pressure, you can check more of the breast tissue. Move in a slow, up and down pattern across until you have covered the entire breast. Another option is to start at the nipple and perform your press checks in a spiral outwards. So long as you have a pattern to ensure you cover the entire breast and become familiar with it, this should be sufficient. Try to follow the same pattern every time you do your breast self-exam.

Once you have finished your exam lying down, it is best to give your breasts an exam while standing or sitting up as well. You will use the same pattern you have established for yourself, using firm, medium, and light pressure and the pads of your fingers to feel for anything unusual in the breast tissue you might have missed while lying down.

When is a Breast Lump Cancer?

It’s not entirely uncommon to find some kind of lump or bump when doing your breast self-exam. Hormones, infections, and other causes can cause temporary lumps that you may detect during your monthly checks. There are common attributes that a cancerous lump will have, though none are a guarantee. If you are concerned about anything you find, have your doctor examine it as well.

Your fingers can detect the most common criteria for a cancerous lump during your breast self-exam. The lump will be a firm, painless mass. The edges are sometimes irregular. If you have a lump that is getting larger over time, that may also be a cause for concern.

Of course, each case is unique. Some cancerous lumps may be painful or soft, and some may feel perfectly round. They can be more challenging to detect in people with more dense breast tissue or scar tissue on their breast–for example, those who have had previous breast surgery. These denser tissues can also make it somewhat more difficult for mammograms to detect cancer. People with dense breast tissue or scar tissue should be particularly familiar with their breasts so that they can detect changes early.

What Causes Breast Cancer?

While there is no one singular cause of breast cancer, there are several risk factors that could increase the likelihood of a diagnosis. Some are environmental factors that may be controlled, while others are physical characteristics or part of your history.

Gender, race, age, and genetics are all potential risk factors. Women are more likely to develop breast cancer, and this risk increases once they reach the age of 55. Some genes, like the BRCA1 and the BRCA2 genes, can be passed through generations and are considered a potential cause. If a first-degree relative (a daughter, sister, or mother) has or had breast cancer, your risk doubles. Because of the importance of hormones as a risk factor, your menstrual history may also be a factor. Those who started their period early–before the age of twelve–may have an increased risk.

Some risk factors are situational or environmental. Tobacco and alcohol use can increase your risk, especially in younger patients, as can being overweight or obese. Some previous benign or noncancerous breast conditions may influence your risk later on. Hormone use, such as hormone replacement therapy, both current and in the past, can increase your risk. One risk factor that is easier to lower is living a sedentary. Exercising regularly will decrease your risk of developing breast cancer.

Breast Self-Exam Results

The primary purpose of a breast self-exam is to help you to familiarize yourself with your breasts. If you know what the skin, muscle, and tissue feel like on a typical day, then you will be better prepared to notice anything abnormal should something come up.

These tests are not a reason to avoid getting a mammogram or having a physician examine you, especially if you are among those with risk factors. If you do come across something in one of your breast self-exams that has you concerned, bring it up with your doctor, or with Dr. Gorman at the Texas Breast Center. As a surgeon specializing in surgical oncology and surgical diseases in the breast, she can help you understand whether your lump, change in skin texture, or any change is a cause for concern. And, if it is, she and her team will help you set up a treatment plan.

Valerie J. Gorman, MD, FACS, is board certified by the American Board of Surgery and serves as Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center – Waxahachie. Her goal is to ensure that all of her patients have an informed, personalized approach to breast surgery and cancer treatment.


The Path to Breast Cancer Surgery Recovery

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

Your Hospital Stay

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

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

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

Anesthesia

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

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

Pain

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

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

Drain

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

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

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

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

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

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

What to Wear After Surgery

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

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

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

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

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

Movement and Exercise

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

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

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

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

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

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

Recovery

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

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

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

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


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

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

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

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

Total Costs

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

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

Stages

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

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

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

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

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

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

Treatments

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

Surgery

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

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

Chemotherapy

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

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

Radiation

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

Medication

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

Other Treatments

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

Health Insurance

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

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

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

Ask Questions/Dr. Gorman

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

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

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

 

 

 

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

 

 


What is Hidden Scar Breast Cancer Surgery?

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

Breast Cancer Surgery

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

Breast Cancer Scars

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

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

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

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

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

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

Hidden ScarTM Breast Cancer Surgery

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

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

Hidden Scar Mastectomy

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

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

Hidden Scar Lumpectomy

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

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

Dr. Gorman and Hidden Scar

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

 


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

What is BioZorb?

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

What is BioZorb Made of?

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

How Does BioZorb Help?

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

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

What are some facts about BioZorb?

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

When should BioZorb be used?

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

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

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

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

Dr. Gorman and BioZorb

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

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

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


An Overview of Invasive Ductal Carcinoma

What is Invasive Ductal Carcinoma?

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

What Causes Invasive Ductal Carcinoma?

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

Is Invasive Ductal Carcinoma Dangerous?

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

What are the stages of Invasive Ductal Carcinoma?

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

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

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

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

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

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

Survival Rate of Invasive Ductal Carcinoma

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

Is Invasive Ductal Carcinoma Curable?

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

Dr. Valerie Gorman

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


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

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

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

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

Hologic Products

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

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

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

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

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

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

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

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

About Hologic, Inc.

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

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

Forward-Looking Statements

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

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

SOURCE: Hologic, Inc., used by permission.

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

2 Compared to original Trident system

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

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

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

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

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


FAQs About Mastectomy

What are the types of mastectomy?

 

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

 

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

What is recovery like for a mastectomy?

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

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

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

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

What are mastectomy recovery tools?

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

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

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

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

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

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

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

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

What will my mastectomy scars look like?

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

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

How does breast reconstruction work?

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

What are the risks of a mastectomy?

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

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

Should I have radiation or chemo with my mastectomy?

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

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

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

Can men get a mastectomy?

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

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

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

How do I take blood pressure after a mastectomy?

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

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

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

What do I ask my surgeon?

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

 

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

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

Who performs a mastectomy?

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

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

 

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

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


FDA Warns Against Robotic Surgery for Breast Cancer

FDA General Warning

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

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

Some Benefits of Surgery via Robotic Aids

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

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

This new FDA warning, however, might put a damper on those benefits. Even if the surgery goes off without a hitch and you recover faster than average because you used a robot surgeon, you now have a new worry. In a study done primarily on cancer surgeries (especially cervical and breast surgeries such as mastectomies), it has been discovered that there may be long term survival effects from using a robotic surgeon.

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

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

A Hands-On Approach

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

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


Mastitis and Inflammatory Breast Cancer: Things You Should Know

What is Mastitis?

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

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

Are the symptoms of Mastitis and breast cancer similar?

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

What Should I Do If I Have Mastitis?

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

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

What Should I Do If I Have Inflammatory Breast Cancer?

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

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

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


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

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

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

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

Possible Changes in Physical Appearance Due to Breast Cancer Include:

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

Hair Loss and Breast Cancer

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

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

Lymphedema As Result of Cancer Treatment

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

Lymphedema Signs and Symptoms:

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

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

Changes in Your Sex Life Due to Breast Cancer

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

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

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

Finding Help and Support During and After a Breast Cancer Diagnosis

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

Resources:

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


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

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

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

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

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What To Say To Someone With Breast Cancer

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

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

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

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

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Scarring After Breast Cancer Surgery

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

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

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Fluid Collection After Breast Surgery – Seroma

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

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

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What Is Invasive Lobular Breast Cancer?

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

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

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Lumpectomy Surgery Recovery – What To Expect

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

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

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

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

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

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

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

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Streamlined Treatment for Breast Cancer Reduces Your Treatment Time

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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