Breast reconstruction without implants

Usually, women who’ve had to undergo mastectomies have limited choices on their reconstruction options. But that is changing.

“It’s funny because people do come into the office and say, ‘Oh I wish I could just take this and put it up here and I tell them, as a matter of fact, you can,” Dr. Patricia Clark said.

Clark works at the Ironwood Cancer Center. She said more women are choosing to use their body’s natural tissue to replace their breasts.

Vickie Aguilar had the procedure done last year.

“I like the idea of everything being taken out and still having natural breasts, and going from there,” she said.

Aguilar was diagnosed with breast cancer last spring.

Eight weeks later, she was cancer free and feeling great.

“Sometimes I feel like it was a dream, because I knew I had cancer and I have scars to show me what I went through but literally it was two months from diagnosis to surgery, and then finding out I was cancer free,” Aguilar said.

Clark says more women are opting for their natural tissue over implants even if they’re having the surgery as a precaution.

“People who have a BRCA mutation like Angelina Jolie had, we do it for them, and those women will often look like they just had a cosmetic breast lift,” Clark said.

If you have a little extra in other places, that’s OK too.

“We can take the abdominal skin and fat, then we can take the inner thigh,” Clark said. “If there’s a little extra on the bottom we can take that and then you can build up to a size that you want.”

A couple things to keep in mind: One of the things that are really unique about this surgery is doctors are able to preserve the nerves in the tissue. Because of that, the surgery can take up to eight hours or more.

But the recovery is fast, just a two-day hospital stay and minimal pain because the cuts aren’t deep.

Only really thin women aren’t good candidates because there isn’t a lot of fat to use in the reconstruction.

 

Link to article and video…

Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle?

Purpose
An estimated 10% of breast and ovarian cancers result from hereditary causes. Current testing guidelines for germ line susceptibility genes in patients with breast carcinoma were developed to identify carriers of BRCA1/2 variants and have evolved in the panel-testing era. We evaluated the capability of the National Comprehensive Cancer Network (NCCN) guidelines to identify patients with breast cancer with pathogenic variants in expanded panel testing.

Methods
An institutional review board–approved multicenter prospective registry was initiated with 20 community and academic sites experienced in cancer genetic testing and counseling. Eligibility criteria included patients with a previously or newly diagnosed breast cancer who had not undergone either single- or multigene testing. Consecutive patients 18 to 90 years of age were consented and underwent an 80-gene panel test. Health Insurance Portability and Accountability Act–compliant electronic case report forms collected information on patient demographics, diagnoses, phenotypes, and test results.

Results
More than 1,000 patients were enrolled, and data records for 959 patients were analyzed; 49.95% met NCCN criteria, and 50.05% did not. Overall, 8.65% of patients had a pathogenic/likely pathogenic (P/LP) variant. Of patients who met NCCN guidelines with test results, 9.39% had a P/LP variant. Of patients who did not meet guidelines, 7.9% had a P/LP variant. The difference in positive results between these groups was not statistically significant (Fisher’s exact test P = .4241).

Conclusion
Our results indicate that nearly half of patients with breast cancer with a P/LP variant with clinically actionable and/or management guidelines in development are missed by current testing guidelines. We recommend that all patients with a diagnosis of breast cancer undergo expanded panel testing.

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Breast cancer gene mutations easier, cheaper to detect

Good news in the fight against breast cancer. It’s now easier than ever to find out if you’re at risk of the disease.

This is thanks to tests that can pinpoint dozens of gene mutations.

Local breast surgeon Patricia Clark explained why this is such a game changer for all women, not just those with a family history of breast cancer.

“Now we can run 80 genes, 100 genes very cheaply,” she said. “So, now 80 genes cost $250 and what we found out through the study is 50 percent of women who have genetic mutations – breast cancer and genetic mutations – never met the guidelines to even be tested.”

Until now, genetic testing for breast cancer was reserved for a select few, mostly because of the cost.

Tests used to cost nearly $5000 and only detected a handful of mutations.

On top of that, if you didn’t meet the guidelines, you weren’t tested because insurance companies wouldn’t pay for it.

She said thanks to advances in technology, gene testing is not only cheaper but dozens of genes can now be analyzed.

Clark was part of the study leading up to this.

“So our study proved that with the better technology now that we’re doing multi-panel genes, we’re missing half the patients who have these genetic mutations. That’s huge and that impacts not only their family members, who’s at risk in their family, but it also impacts our treatment because our treatments are now based more on the genetics of the individual tumors,” she said. “It used to be if someone got chemotherapy, if the tumor is over a centimeter they got chemotherapy. Now because of genetic revolutions, a lot of those women won’t need chemotherapy at all.”

Not only easing women’s fear but empowering them as well.

“Now people are able to take much more control of their health,” she said. “They’re able to purchase these tests directly and I think it’s time for doctors to treat their patients like a team member.”

Breast cancer isn’t the only cancer these tests can detect. Dr. Clark has said she has had test results showing melanoma and colon cancer as well.

You can get these tests online or you can ask your doctor to order one for you.

Many of these companies will test family members free of charge if they find a genetic mutation in someone’s pane

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Do I Have to Reconstruct My Breast After a Mastectomy?

WHEN VETERAN WOMEN’S health journalist Catherine Guthrie found a lump above her left breast in 2009, the then 38-year-old tried hard not to freak out. But having already survived extensive back surgery to correct scoliosis as a kid and armed with a deep understanding of the ins and outs of breast cancer from her work, she dreaded what was to come. “Now, I’d been pushed out of the press box and onto the playing field,” she writes in her new memoir, “FLAT: Reclaiming My Body from Breast Cancer.”

That transition from knowledgeable commentator to participant in the drama of breast cancer thrust Guthrie into a “surreal” world of treatment, medical mistakes, complications and anxiety. It also transformed her body and forced her to reassess aspects of her identity; as a queer woman who’d come to terms with her sexuality a decade and a half before her diagnosis, Guthrie had already weighed what it meant to be a woman from various perspectives, but the decision she faced to either reconstruct her breasts after a double mastectomy or leave her chest flat was a different kind of reckoning, and one that many women with breast cancer face regardless of their sexual orientation.

One of breast cancer’s harshest cruelties is how it can impact a woman’s identity through the surgical restructuring of the chest. It also forces patients to make a series of life-altering decisions in quick succession. While many of these decisions revolve around treatment plans, such as whether you’ll need chemotherapy or radiation, some of them will leave lasting scars and reminders of the cancer journey and raise some difficult questions: Lumpectomy or mastectomy? Reconstruct or go flat? One breast or both?

It can be truly overwhelming to wade through all of this when you’re newly diagnosed and in shock or emotional. “These women come in, they’re very frightened. They’re being asked to make very large decisions without time to sit and really settle with it,” says Dr. Patricia Clark, a breast surgeon at Ironwood Cancer & Research Centers in Scottsdale, Arizona. Therefore, it’s incumbent upon the breast surgeon to “take quite a bit of time interviewing them, trying to pull them out of this adrenaline-soaked condition that they’re in where they’re making fast choices and a lot of times are looking for the simplest, easiest option just because they’re stressed,” and want to get it over with.

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Silver Cross Recognizes “Top Docs” for Outstanding Patient Satisfaction

24 Physicians Rank in the top 1% of hospitals nationwide

New Lenox, IL (August 8, 2012)– Silver Cross recently recognized 24 physicians on the hospital’s medical staff for outstanding patient satisfaction from April 2011- through March 2012.

“The Top Docs ranked in the top 1% compared to all other physicians throughout the country,” says Paul Pawlak, President/CEO of Silver Cross Hospital. “It is because of the service and care these doctors provide, Silver Cross has been recognized as a Thomson Reuters 100 Top Hospitals National Award winner for seven consecutive years.”

According to our patients, these doctors rank in the Top 1% in the country for patient satisfaction:

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In addition, these doctors rank in the Top 10% in the country for patient satisfaction:

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Silver Cross regularly surveys all patients at the hospital and benchmarks its performance against over 2,000 hospitals using the Press Ganey patient satisfaction process.  As part of the survey, patients are asked to rank their physician on several indicators including the time the physician spent with the patient, the physician’s concern for patients’ questions and worries, how well he/she kept the patient informed, friendliness and courtesy of the physician, and the skill of the physician.

Revolutionary Oncoplastic Breast Surgery Performed at Silver Cross Hospital

Dr Clark  in The NewsNew Lenox, IL (February 13, 2013) — Silver Cross Hospitalis now performing another revolutionary procedure – oncoplastic breast surgery, which combines the latest plastic surgery techniques with breast surgical oncology. For 46 year-old Hope Barrera having oncoplastic breast surgery enabled her to have her cancerous tissue removed while conserving as much of her breast tissue as possible.

As in Barrera’s case, most women who would need to have a large lumpectomy would be left with a distorted breast. During Oncoplastic Breast Surgery, the lumpectomy defect is immediately reconstructed using the remaining natural breast tissue. The breast is sculpted to realign the nipple and areola, minimize defects, and to restore a natural look to the breast shape. The opposite breast can often be modified to create balance and symmetry.

After not having a mammogram in 5 years, Hope decided to go the Silver Cross Center for Women’s Health. Her mammogram results showed what was initially thought to be calcification spots or calcium deposits in her right breast. She then had a biopsy of the deposits. “The Center for Women’s Health staff made me feel so comfortable during my biopsy procedure,” said Romeoville resident Hope Barrera. “They held my hand to calm me down while they explained the details of the procedure.”

It was then determined that her biopsy results were positive indicating the spots were actually malignant. “When I was diagnosed with cancer, instantly I was so scared for myself and the future of my husband, Vincent and our two daughters,” said Barrera. “But through the support I received from the staff at the Center for Women’s Health and my surgeon, Dr. Patricia Clark, I was able to deal with my illness in a positive way.”

At her initial meeting with Dr. Clark, Barrera shared that she had a breast reduction 5 years prior. “As is common for many women, Hope’s breast reduction surgery left her with a lot of scar tissue and abnormal areas identified on her mammogram,” said Patricia Clark, M.D., who is a board certified general surgeon at Silver Cross Hospital. As a result of the previous surgery, scar tissue, and multiple suspicious areas discovered on her breast MRI, Hope’s case was even more complicated to correct. Oncoplastic breast surgery offered the best hope to safely excise all of the lesions without the need for mastectomy.

Careful preoperative planning included review of the previous surgical technique. Dr Clark’s training and experience with breast reduction and mastopexy techniques allowed her to predict the altered blood supply to the breast and design a surgical approach to preserve this while safely removing the lesions. With the help of MRI guided needle localization performed at Silver Cross Hospital, Dr Clark was able to remove the cancer and the remaining suspicious lesions in both breasts through Barrera’s original incisions. Adjacent breast tissue was rearranged to fill the lumpectomy defect caused by removal of the cancer and restore the natural breast shape. The innovative combination of plastic surgery and cancer surgery techniques left Hope with complete excision of her cancer, a very good cosmetic result, and no need for further surgery.

“I am so grateful to Dr. Clark for her excellent surgical skills and ability to successfully perform such a complicated surgery,” said Hope. “I highly recommend others to seek treatment with her. She was also so attentive to my family and me. I just love the way she took care of me.”

Benefits to Oncoplastic Breast Surgery

Benefits for patients who have oncoplastic breast surgery include:

  • typically a single surgery,
  • generally no use of drains,
  • may be outpatient or require one night in the hospital,
  • and recovery time is faster than with mastectomy and reconstruction.

Not all patients are suitable candidates for oncoplastic reconstruction but for many oncoplastic techniques reduce the trauma of a breast cancer diagnosis.