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AS I SEE IT


control when followed by radiation— and are often easier on the patient— they can sometimes result


in less-


than-desirable cosmetic outcomes. At North Hills, we are helping to pioneer a new approach to lumpectomies known as oncoplastic surgery. Patients who are appropriate candidates for lumpectomy and choose oncoplastic surgery can avoid some of the potential shortcomings of standard surgery.


Oncoplastic Surgery Oncoplastic surgery is a relatively recent advance in breast-conserv- ing treatment. It combines plastic and reconstructive surgery techniques that emphasize achieving a better cosmetic outcome with no compromise in tumor removal and disease control. Among the elements emphasized in breast oncoplastic surgery are tech- niques to minimize or avoid unnec- essary “divots” when cancer tissue is removed. Oncoplasty also puts a pre- mium on minimizing scarring and achieving better breast symmetry after surgery. This approach is understand- ably popular with women, and many who have been pleased with the out- come of their surgery have contributed to the growth of our patient base via word-of-mouth. Oncoplastic surgery is gaining pop-


ularity for several reasons. For one, approximately one-third


of standard


lumpectomies might result in major deformities and asymmetries, accord- ing to a study published by Gabriela Santos, MD, in the August 2015 issue of the Annals of Surgical Oncology. Another reason for the growing popu- larity of oncoplasty is that in an effort to improve overall results following breast cancer surgery, the American Society of Breast Surgeons recently included a recommendation for use of oncoplas- tic techniques within its newly pub- lished “Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients.”


The School of Oncoplastic Surgery is another important contributor to the growing use of oncoplastic breast can- cer surgery. The school was founded by breast surgeon and medical inventor Gail Lebovic, MD, and has been held annually in Dallas since 2007, with a second 2016 session being held later this year. The school includes a sculp- ture lab, anatomy lab and interaction with live models to provide surgeons with hands-on experiences. It also introduces surgeons to recently devel- oped tools and technologies that are helping to refine breast cancer surgery. One of those recently developed


technologies has been a valuable part of the expansion of our breast cancer practice at North Hills. Our center was among the first facilities in the world to begin doing oncoplastic surgery using an implant that consists of a small bio-absorbable coil that holds six small marker clips arranged in a three- dimensional array.


The implant is sutured into place


during the lumpectomy and remains in a stable position after surgery. It replaces missing tissue volume that is removed by lumpectomy. Over time the device can allow breast tissue to fill in the lumpectomy space, thereby helping to maintain the normal breast appearance. The coil holding the clips is dissolved slowly by the body over time. The three-


dimensional array of clips also provides a better target for post-surgical radiation treatment. In addition, it more clearly defines the tumor site for follow-up mammograms and other imaging. Cross has performed more than 130 lumpectomies incorporating this device over the past three years. To date, these outcomes, which have been presented at a number of surgical and other clinical meetings, have been favorable. The tiny implantable device has also been shown to provide a more precise target for “boost” radiation. As word about that protocol and its benefits has spread, the ability to have a shorter course of radia- tion has helped to draw patients from a four-state area to our center. As with any new technology, we


had some initial discussions with our payers about reimbursement. We find that using HCPCS Code C9728 code, we are receiving reimbursement for use of the device. It has been gratifying to see our approach to breast cancer surgery validated around the country. Adoption of oncoplastic techniques is growing. Many other surgeons around the US are now recognizing the clinical benefits of offering oncoplastic surgery with a three-dimensional implant. About one- third of the facilities using the device are ASCs.


When it comes to clinical care, our


experience and the growth of onco- plastic techniques have demonstrated that ASCs have a pivotal role to play in expanding the availability of innovative, high-quality breast cancer care.


Michael J. Cross, MD, is a fellow of the American College of Surgeons, past board member of the American Society of Breast Disease and co-director of the School of Oncoplastic Surgery. Dawn Ashby, RN, CASC, is the administrator of North Hills Surgery Center in Fayetteville, Arkansas. Write her at dashby@nhscnwa.com.


ASC FOCUS MAY 2016 15


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