diagnosis. “It is critical to identify the specific type of breast cancer and whether the tumor is invasive or in-situ,” said Zainab Basir, MD, Medical College of Wisconsin breast pathologist. “Sentinel lymph nodes are also examined at the time of surgery. If cancer has spread to the draining nodes, the surgeon removes all nodes in the same operation, preventing the need for a second procedure.” The pathology report (including details on markers such as estrogen, progesterone receptors and Her-2-neu FISH) is the basis for individualized treatment options considered at the weekly tumor board.
Surgery: Tailoring Options
Breast cancer patients benefit from a team approach that includes radiologists, surgical oncologists, plastic surgeons, radiation and medical oncologists and pathologists. “Once a week, our entire team reviews cases at tumor board,” said Amanda Kong, MD, MS, Medical College of Wisconsin surgical oncologist. “We carefully consider the type and stage of breast cancer, and quality of life goals before recommending treatment.”
For example, total removal of a breast (mastectomy) may be appropriate for some, but that’s no longer assumed. Breast-conserving surgery (lumpectomy) is another option. “For some women with early stage cancers, breast-conserving surgery followed by radiation is equally as effective as mastectomy at controlling cancer,” Dr. Kong said.
Amanda Kong, MD, MS
Breast surgeons at Froedtert & The Medical College are on the forefront of numerous surgical approaches:
• Oncoplastic surgery: Surgical oncologists and plastic surgeons collaborate in the same procedure to remove large tumors without mastectomy, then reshape remaining tissue to minimize deformities.
• Sentinel lymph node biopsy (SLNB): Instead of removing all lymph nodes, surgeons identify and remove a few, testing to see if the cancer has spread. SLNB can decrease the likelihood of lymphedema (painful arm swelling).
• Skin-sparing mastectomy: Surgical oncologists remove the entire breast through a small incision, preserving the skin overlying the breast. This technique allows for immediate reconstruction by a plastic surgeon.
Reconstructive Surgery: Rebuilding Confidence
“Breast cancer attacks more than a woman’s health; it threatens her sense of femininity,” said John Hijjawi, MD, Medical College of Wisconsin plastic surgeon and director, reconstructive breast surgery. “Our team treats the whole patient.”
Medical College of Wisconsin plastic surgeons work with surgical oncologists, often reconstructing the breast as part of the cancer operation. “The patient goes to sleep with a breast and wakes up with one,” Dr. Hijjawi said, “an approach that dramatically reduces psychological stress. About 90 percent of our mastectomy patients choose reconstruction. In our broad-based program, we’ll find a form of reconstruction to fit each patient.”
Among reconstructive surgeries available:
• Deep inferior epigastric perforator (DIEP) flap: Rebuilds the breast using a woman’s own abdominal tissue, without sacrificing abdominal muscles or nerves. Since the extra tissue is used in reconstruction, a tummy tuck is a side benefit. Froedtert & The Medical College were the first in the area to offer the DIEP flap, and train surgeons from across the country in the technique.
• Implants filled with saline or silicone gel: An important alternative for women who are not good candidates for reconstruction using their own tissue.
• Reconstruction of the nipple and areola (darker skin surrounding the nipple)
Radiation Oncology: Optimizing the Cure Radiation oncology plays an important role in reducing the risk of breast cancer recurring or metastasizing. After lumpectomy or mastectomy, it helps attain optimal local cancer control and a higher cure rate in some patients. “With newer radiation methods, we individualize treatment to each patient,” said Julia White, MD, Medical College of Wisconsin radiation oncologist. Three dimensional conformal radiation therapy and intensity modulated radiation therapy are examples of advanced technologies that literally shape radiation to the tumor.
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John Hijjawi, MD, Medical College of Wisconsin plastic surgeon, explaining breast reconstruction to a patient.
Clinical Cancer Center
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