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Published on October 14, 2015

cancer patient talking to doctor

Advanced Options for Treating Breast Cancer

For most women, breast health awareness means getting their annual clinical exam and mammogram, receiving the “all clear” letter in the mail, and moving on with their lives.

But for those whose journey leads to a breast cancer diagnosis, there are decisions to make about surgery and treatment. Julie Reiland, MD, Breast Surgeon with Avera Medical Group Comprehensive Breast Care, believes it’s important for women to know about the latest options in order to make the decision that’s right for them.

“Women don’t pay attention to breast cancer unless they get it,” Reiland said. First and foremost, women are concerned about whether they’ll survive, and whether or not the cancer will come back. “But when the dust settles, they begin to become concerned about what the breast will look like after surgery.”

For women with early-stage breast cancer, oncoplasty is an approach that combines removal of the lump with “lift, nick and tuck” plastic surgery techniques to make the breast look better.

Better cosmetic results

Some 30 percent of women are dissatisfied with their breasts after breast cancer surgery, compared to only 7 percent after oncoplasty. “That means 93 percent are much happier with their cosmetic result after oncoplasty,” Reiland said. She and Tricia Merrigan, MD, with Avera Comprehensive Breast Care, are the only breast surgeons in the region who offer these techniques, and Reiland lectures nationally and internationally on the topic.

“Oncoplasty is starting to be recognized nationwide, for example, the American College of Surgeons is offering a course for general surgeons. This is groundbreaking, because it recognizes that maybe the cosmetic result is important to a woman after she’s treated for breast cancer,” Reiland said.

Another option is nipple sparing mastectomy which works best for women who have A, B and sometimes C cup size. “We make an incision under the breast, take out the entire breast but leave the nipple and skin envelope,” Reiland explained. The breast skin is later filled with a silicone implant.

At the time of a breast cancer diagnosis, most women just want the cancer out “tomorrow,” Reiland said. “Don’t panic,” she said. “Breast cancer is slow growing and there’s time to make an informed decision.”

If a woman has early-stage breast cancer in one breast, lumpectomy followed by external beam radiation has the same high chance of a cure as mastectomy. Lumpectomy removes the cancer, and radiation prevents a recurrence of cancer at the site by killing any remaining cancer cells.

Cutting-edge options

Avera is one of 10 cancer centers in the U.S offering electron-based intraoperative radiation therapy (IORT) in the treatment of breast cancer through an international research trial. IORT, a radiation boost to the actual tumor site during surgery, shortens post-operative radiation treatments from six weeks to three weeks after lumpectomy.

Women over age 60 can often have the single-dose IORT during surgery with no other radiation treatments. Studies have shown that women over age 60 with small breast cancers have similar low rates of recurrence after single dose IORT as women in the same age group who have six weeks of radiation.

Side effects of the six weeks of external beam radiation are few, but can include a sunburn-like effect on the skin and fatigue. Because IORT shortens treatment, it lessens those side effects. And for the women over age 60 who can have single-dose IORT, they’re completely done with treatment once surgery is complete.

“To date, more than 75 patients have had IORT at Avera. Cutting down on the follow-up radiation time really helps in terms of morale and getting back to their life,” Reiland said. “Having their breasts look normal or even maybe better is also a huge emotional benefit for women.”

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