Latest / Healthy Vitals / Breast Surgery & Reconstruction – What to Expect at Every Step, Part 1: Before Surgery

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Breast Surgery & Reconstruction – What to Expect at Every Step, Part 1: Before Surgery · Healthy Vitals

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  Scott Webb (Host): Welcome to the first episode of a three-part series
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  on breast surgery and reconstruction.
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  In part one today, I'm going to discuss the options that breast
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  cancer patients have and how the team of surgeons at Summa Health work
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  together to help patients make the best choices for their lives and goals.
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  Joining me is Dr.
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  Eve Klenotic.
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  She's a specialist in breast surgery and breast surgical oncology.
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  And I'm also joined by Dr.
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  Mike Tran.
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  He's a plastic surgeon, and they're both with Summa Health.
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  This is Healthy Vitals, a podcast from Summa Health.
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  I'm Scott Webb.
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  It's very nice to have you both here today.
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  We're going to do a three-part series, and this being part one of
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  this panel discussion about breast surgery and reconstruction, kind of
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  what patients can expect, you know, along the way, every step, if you will.
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  And Dr.
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  Klenotic, I'm going to start with you.
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  When you first meet a patient, what do you want them to understand
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  about the reconstruction options?
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  Dr. Eveline Klenotic:
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  First, thank you so much for having us, Scott.
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  When I meet patients for the first time, I want them to know that there
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  are options and they have choices.
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  Gone are the old days where doctor says A and you have to do A.
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  They do have options, whether they choose breast-conserving surgery or a mastectomy.
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  Host: Yeah.
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  And I think that that's going to be music to some folks' ears, especially
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  knowing that they have options.
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  There are options.
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  We all want them as patients and, of course, doctors are patients too.
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  So, Dr.
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  Tran, how do decisions like lymph node removal impact, you
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  know, let's say risk long-term?
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  Dr. Mike Tran:
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  The decision for lymph node removal is more related to the breast
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  cancer treatment side of things.
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  It does definitely affect your risk of developing BCRL, so-called
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  breast cancer-related lymphedema.
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  And a good way to kind of understand it is you think of the lymphatic
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  system like a network of streets that carries the fluid away from the arm.
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  So if we remove a few lymph nodes, there are usually still plenty of other streets
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  available, so the traffic keeps moving.
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  But if we remove more lymph nodes or add radiation to the mix, see more of
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  those streets get damaged or blocked.
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  And then now you have fewer open roads, and it's easier
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  for a traffic jam to happen.
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  And that traffic jam is essentially lymphedema.
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  So, you know, that is essentially an analogy for someone undergoing
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  surgery of the axilla, which affects the lymph node of the axilla.
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  So again, this does not mean that someone undergoing an axillary
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  lymph node dissection with radiation is going to get lymphedema.
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  It just affects and increase the risk of having it.
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  And the risk is not all or nothing.
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  So again, if you imagine removing a couple of sentinel lymph nodes is
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  completely different than having a lot more lymph nodes removed during
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  an axillary lymph node dissection.
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  And then, if you're required to have radiation after that,
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  that increases the risk.
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  So, I try to give a patient a realistic idea as to where
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  they fall on that spectrum.
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  Dr. Eveline Klenotic:
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  I love that, Dr.
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  Tran.
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  I'm going to steal that analogy for my next discussion.
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  Host: Yeah, it's a perfect analogy, especially for a layperson like me.
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  I understand, we all understand traffic and roadblocks and
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  road jams and all of that.
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  So, Dr.
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  Klenotic, when does oncoplastic surgery come into play versus
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  traditional reconstruction?
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  Dr. Eveline Klenotic:
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  Great question.
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  So, the term oncoplasty is typically used with breast-conserving surgery.
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  So meaning we are saving some of the breast tissue and reconstructing it,
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  reshaping it so that we are not leaving the patient with significant deformity,
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  as opposed to the traditional breast reconstruction, which is typically
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  accompanied after doing a mastectomy or removal of most of the breast
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  tissue, 95% of the breast tissue
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  Host: Okay,
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  Dr. Mike Tran:
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  for some patient, the right cancer treatment for them involves moving
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  only a portion of the breast.
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  So if she's keeping most of her breast, after removing the breast cancer,
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  the defect can be very deforming.
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  This can be a big dent, the distortion, the nipple can pull one way or the other.
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  There's asymmetry.
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  So instead of saying, you know, "Let's take the cancer out and see what it
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  looks like afterwards," we plan the reconstruction at the same time, right?
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  So, the excision is made by the breast surgeon who removes the cancer with the
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  appropriate margin, and then the plastic surgeon or reconstructive surgeon comes in
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  and then use the remaining breast tissue to rearrange it to restore the shape.
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  And the techniques that we use is very, very similar to the techniques we use
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  in breast lift or breast reduction.
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  And we may also operate on the opposite, the contralateral side
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  to improve the symmetry afterwards.
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  Host: Yeah.
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  And it makes perfect sense as you're saying, Dr.
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  Tran, like this is all a part of a plan, right?
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  And shared decision-making between surgeons and patients and all of that.
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  And rather than just saying, "Well, let's just see what it looks like when
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  we're done," you have this plan going in.
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  And it makes me wonder, Dr.
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  Tran, like, are there some surgical approaches today that really can help
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  reduce long-term complications or risks?
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  Dr. Mike Tran:
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  I'm glad you asked that.
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  That's a very nice segue.
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  Host: I try.
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  Dr. Mike Tran:
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  Yeah.
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  Throughout history, we've always tried to improve and and
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  strive for better outcomes.
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  So, breast surgery nowadays has become much more tailored and individualized.
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  On the cancer treatment side, I hate to overstep my boundaries, but it
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  seems to me that with mastectomies, we're trying to preserve much more
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  of the patient's normal breast skin.
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  And in some patients, we can preserve the nipple.
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  With the lymph nodes, we're trying to preserve those that don't need to actually
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  be removed as much as possible while maintaining a safe oncological treatment.
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  And on the reconstructive side, you know, implant reconstruction has changed quite a
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  bit in terms of, like, where the implant's placed, how we support the tissue.
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  We use a matrix to protect the anatomy.
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  With the reconstruction, we're now using more and more of patient's own tissue.
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  We now use sophisticated techniques with an emphasis on functional
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  preservation of the donor site.
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  And then, finally, even for patients that are high risk for lymphedema, we
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  now use super microsurgical techniques where we reconnect very small lymphatic
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  vessels to a nearby vein at the time of the lymph node surgery to prevent
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  or lower the risk of having lymphedema.
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  It's not something we have routinely years ago, but now it's another tool
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  that helps us with the lymphedema and complications of surgery
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  Host: Right.
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  Yeah.
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  And wondering, Dr.
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  Tran, maybe what are, let's say, one to two questions you wish every
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  patient would ask before surgery?
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  Dr. Mike Tran:
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  So, sort of paternalistic here, but you want to ask questions that help you choose
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  between reconstructive options from at least from a reconstructive standpoint.
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  So first, I like for patient to come in and, you know, ask, "What
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  are all of my reasonable options?"
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  See, it's not just the most common option, but all the reasonable option for me.
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  Because sometimes patient comes in, and they believe that reconstruction is
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  just one surgery and one-size-fits-all.
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  And it's just, you know, one reconstruction that
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  they're supposed to have.
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  That's usually not the case.
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  And after that, once we've kind of discussed through all the reconstructive
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  options that's appropriate for that particular patient, then I would like
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  for them to start thinking about, "If I choose this particular option, what am
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  I signing up for over the next year?"
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  Not just what happens on surgery day, right?
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  Because breast cancer treatment is a sequence.
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  Treatment can involve surgery, it can involve radiation.
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  Radiation can affect the reconstruction, and then
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  reconstruction affects the recovery.
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  So, what you want to understand is not just the next operation,
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  but the overall plan, right?
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  How many options or operation might I need?
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  How long is recovery?
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  What's going to happen if I need radiation?
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  Does this involve an implant that may need another operation someday?
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  Can I use my own tissue?
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  What does it do to the donor site?
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  Questions like that.
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  Host: Yeah.
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  And as I said as we got rolling here, Dr.
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  Klenotic, we're going to do three parts to this series, and we hope folks will listen
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  to all three parts and listen in order.
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  But either way, as we finish up today part one, why is it important to
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  involve both the breast surgeon and reconstructive surgeon in planning?
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  Dr. Eveline Klenotic:
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  We truly feel that being able to see both the breast surgeon and the
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  plastic surgeon or reconstructive surgeon provides patients with
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  wealth of knowledge and options.
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  They're able to see some samples of images of like before and after, kind of ask
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  questions, and it would empower them to make the best choices for themselves.
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  And cancer diagnosis is quite overwhelming, and sometimes that
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  first visit, they might still be in the processing phase of the
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  diagnosis and may not be able to retain information or process the
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  options that we're giving them.
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  But then if they also see the plastic surgeon, then they'll have more
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  questions and be able to absorb the information better and make
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  the best decisions for themselves.
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  Host: Right.
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  Dr. Mike Tran:
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  It's a huge advantage for us to have these conversation beforehand.
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  Surgery is a big deal, right?
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  So, the best operation obviously is usually planned outside of the OR.
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  And we each have our own jobs, and we're able to meld and
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  complement whatever we do.
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  See, the breast surgeon focuses on what has to come out and
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  treat the cancer safely.
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  And the reconstructive surgeon, they're thinking about what tissue is being
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  removed, what's left over, what's the skin going to look like afterwards, and
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  how are we going to rebuild the breast in a way that's safe, it's durable,
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  and it fits what the patient wants.
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  So, all these things affect each other.
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  And so again, it's just a huge advantage for us to be able
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  to confer prior to surgery.
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  Host: Right.
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  Yeah, it certainly sounds like a team approach at Summa Health.
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  And I love hearing all of it today.
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  I can't wait for part two where we're going to talk more about surgical
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  approaches and reconstruction choices.
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  But for today, thank you so much.
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  Dr. Eveline Klenotic:
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  Thank you.
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  Dr. Mike Tran:
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  Absolutely.
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  No problem.
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  Host: And for more information, go to summahealth.org/breast.
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  And if you enjoyed this episode of Healthy Vitals, we'd love
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  it if you'd leave us a review.
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  Your review helps others find our educational content.
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  I'm Scott Webb.
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  Thanks for listening, and we'll talk again next time.