From Reconstruction to Going Flat – Helping Women Look & Feel Better After Breast Cancer with Oncoplastic Surgery

Barry Rosen, MD, Guest Contributor

Barry-Rosen-OR-photo-1.jpgRecovery from breast cancer can be a difficult journey, both physically and emotionally. An important part of recovery from the trauma of cancer diagnosis is to be able to put the entire experience in the rear view mirror, so to speak. But it’s hard to do that if you have a daily reminder in the form of a disfiguring scar.

It was once common for surgeons to focus solely on removing a breast cancer tumor with little regard for the appearance of the breast. But we now know we can deliver excellent cosmetic outcomes without compromising oncologic safety. There have been tremendous advances in the past 20 years in the diagnosis and treatment of breast cancer that enable us to help our patients look and feel better after breast cancer.

One of these important advances is oncoplastic surgery (OPS). Though popular in Europe for several decades, it’s only begun to gain traction in the United States within the last 10 years. OPS combines breast surgery with plastic and reconstructive techniques to achieve the best possible cosmetic outcomes without compromising cancer care. It can be as simple as closing the cavity and hiding the scar, or performing a more complex procedure like a breast lift or reduction in conjunction with removing the tumor.

OPS is more of a philosophy than a specific technique. Oncoplastic principles can be applied to any type of breast cancer operation — whether it’s breast conserving surgery (lumpectomy) or total removal of the breast (mastectomy). OPS isn’t about vanity; it’s about recovery. It’s performing the operation in a way that gets a woman back to feeling as good, if not better, about herself than she did before surgery.

For some women, this means rearranging the tissue at the time of lumpectomy to fill the space in the treated breast left by the tumor. Or it could mean reconstruction following a mastectomy.

But some patients may choose to forego reconstruction altogether — a growing trend known as “going flat.” According to a study published in the Journal of Clinical Oncology, approximately 25 percent of double mastectomy and 50 percent of single mastectomy patients opt out of reconstruction.

The reasons are varied. Some choose to go flat for comfort, some are athletes, some are looking to avoid the potential complications and longer recovery associated with reconstruction. Regardless of the reason, more patients are looking for their chest walls to be as flat as possible following breast cancer surgery.

Unfortunately, these women’s wishes are sometimes ignored. According to a September 2018 article in Cosmopolitan, many women are finding that physicians are either not discussing going flat as an option, or are deliberately ignoring patients’ desires to opt out of reconstruction.

Women report waking up after surgery to find their surgeons left extra skin in case they change their minds and want to pursue reconstruction later. This forces women to choose between living with sagging skin where their breasts once were, or undergoing an additional operation to remove the skin. This is avoidable. A woman’s decision to go flat should be as respected as another woman’s decision to undergo reconstruction.

However, while “going flat” may sound like it would be a simpler procedure than, say, reconstructing a breast from the remaining tissue, it’s not as straightforward as one might anticipate. Every general surgeon has the skill set to learn the procedure — but it’s not regularly taught in surgical training or fellowships, which may be why some women are seeing such poor outcomes after mastectomies without reconstruction.

My colleagues and I are hoping to change that. As co-director of the upcoming CME course, A Team Approach to Oncoplastic Surgery, my goal is for every attendee to learn practical skills that they can apply immediately and improve the care they’re providing their patients. Many oncoplastic techniques are basic and can be mastered in a short time; others require advanced procedures that are ideally performed in partnership with a fellowship-trained plastic surgeon. We want to help breast and plastic surgeons offer their patients the full-spectrum of oncoplastic procedures – from breast reconstruction to “going flat.”

Oncoplastic surgery is the ultimate precision medicine. It’s truly “one-size-fits-one.” What works for one woman may not work for another. It’s about designing the operation to fit the patient, and then finding the most qualified person or people to do that particular procedure. It’s also about caring enough to ask the patient the right questions, presenting her with the full range of options, and then honoring her wishes.

Every woman deserves to feel good in her own body, and it’s our responsibility as surgeons to help our breast cancer patients fulfill that goal.

Dr. Rosen is a breast surgeon and founding member of Advanced Surgical Care of Northern Illinois. A nationally recognized expert in oncoplastic surgery, he teaches for the American Society of Breast Surgeons (ASBrS), the School of Oncoplastic Surgery, and the National Consortium of Breast Centers. Dr. Rosen’s practice philosophy is centered on delivering individualized, precision care to every patient.

Following the (Investment) Money in Medical Devices

It will come as no surprise to medical device startups that the funding climate in medical devices is still challenging. We talked recently with two experts who come to this question with two different perspectives.

– Alice McKeon is VP Healthcare Investment Banking at Network 1 Financial, which is based in Red Bank, N.J.

– Dan Clark is a Cofounder and the Chief Marketing Officer at Linear Health Sciences, makers of the Orchid Safety Release Valve.

The power and policies emanating from Washington DC are on the minds of many people these days. How will the Trump Administration affect the investment climate in medical devices?Wall Street Bull image

“The short answer is, no one really knows,” McKeon said. It’s unclear what will happen to the Affordable Care Act (Obamacare). That in turn raises questions in potential investors’ minds. Continue reading “Following the (Investment) Money in Medical Devices”

When Catheter Stabilization Isn’t Enough for Patient Safety

1462041601658Many drivers have experienced the kind of fender-bender or sudden stop that made them glad they were wearing a seat belt. But a seatbelt can only protect us from so much — which is why airbags and more advanced safety approaches were invented.

To use another auto analogy, think of the breakaway hoses at gas stations pumps. They prevent the full hose from being pulled out of the pump when an absent-minded driver drives away without removing the nozzle from the gas tank.

Similarly in nursing care, there’s only so much that catheter stabilization can do when it comes to protecting IV lines. Given those limitations, a better safety option is now being developed to address a pain point for nurses: accidental dislodgement of IV lines. Continue reading “When Catheter Stabilization Isn’t Enough for Patient Safety”

Why IV Lines Fail: A Crazy Little Thing Called Dislodgement

With something like 300 million peripheral IV lines sold in U.S. each year – and a failure rate that’s often cited as being 50% – researchers continue to try to understand a problem that’s a daily headache in vascular access and infusion therapy.

4-1Common causes of line failure are dislodgement, infection, thrombosis, phlebitis and occlusion. Peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) tend to be better secured than peripheral IVs, but they are also subject to high failure rates.

“Intravenous catheter dislodgement is a significant and avoidable problem,” said vascular access consultant Leigh Ann Bowe-Geddes, BSN, RN, CRNI, VA-BC, a well known vascular access clinical consultant and former president of the Association for Vascular Access. Continue reading “Why IV Lines Fail: A Crazy Little Thing Called Dislodgement”

When a ‘Low Profile’ Is a Good Thing

When a company comes up with something better, it typically wants a high profile for the technology. But it’s not always the case with Focal Therapeutics.

That’s because the company recently launched a low-profile version of the BioZorb® implant used in breast conservation treatment (BCT).

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Breast surgeon Alison Laidley compares the original, spiral version of BioZorb (left) to the new BioZorb Low Profile (right).

Focal’s new BioZorb LP (for “low-profile”) design means more women who need breast cancer surgery could benefit from the implantable device. BioZorb is used in “reconstructive lumpectomy” and other types of BCT. It marks in three dimensions the site from which a breast tumor is removed.

The BioZorb LP device is designed to be implanted in smaller breasts, peripheral areas of the breast, and locations with less tissue coverage.

“Everyone understands the need for delivering more personalized medicine,” said Alison Laidley, M.D., a prominent Dallas breast surgeon with Texas Breast Specialists who was among the first physicians to use BioZorb LP. “The new designs of this device enable us to provide it to many more patients.” Continue reading “When a ‘Low Profile’ Is a Good Thing”

Does the Mammography Debate Miss a Key Point?

Every time the US Preventive Services Task Force issues a recommendation about when women should start getting mammograms – and how often they should have these screenings – it sends shockwaves through the breast-cancer world.

modiglianiThis last time was no different.

But now two influential breast cancer experts assert that – as important as the debate is – it misses an essential point about evaluating a woman’s individual risk of getting breast cancer.

Those experts – Dallas breast surgeon Dr. Peter Beitsch and Nashville breast surgeon Dr. Pat Whitworth – say the key question is how to evaluate “risk.”

The latest recommendations from the task force call for women at “average risk for breast cancer” to begin every-other-year screening at age 50. It casts doubt on the true value of screening beginning at age 40 – citing the high number of false-positive test results in women 40 to 50, plus potential harm from overdiagnosis and unnecessary treatment. Continue reading “Does the Mammography Debate Miss a Key Point?”

Cost Conundrum: How Accountable Are ACO’s?

Among the many ways the Affordable Care Act tries to drive down healthcare costs is through Accountable Care Organizations.

acoJust what are ACOs? HMOs in drag? And are they working?

Here’s how we see the ACO landscape today:

  • Although their launch has been somewhat troubled, Accountable Care Organizations are here to stay.
  • The Centers for Medicare and Medicaid Services (CMS) is driving the adoption of ACOs, with some private payers joining in.
  • Data collection and analysis hold out the promise of reducing inefficiencies.
  • ACOs don’t take on a lot of risk if they can avoid it. That in turn will affect how much money they can actually save the healthcare system.
  • In a related development, some payers – including a new industry alliance – are looking closely at the role of health insurance third-party administrators (TPAs), to see if further cost can be taken out of the system there.

What Is an ACO?

First, a bit about terminology. While ACOs undertake some responsibility for the cost of delivering care, they are not “all in,” as are HMOs. (For a good video explaining ACOs, see this from Kaiser Health News.)

Here’s how healthcare economist Austin Frakt, writing in the New York Times, explains the differences between ACOs and HMOs: Continue reading “Cost Conundrum: How Accountable Are ACO’s?”