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Published on June 08, 2018

Dr Tricia Merrigan pointing to breast illustration

Leading-Edge Approaches in Breast Surgery

When a woman is diagnosed with breast cancer, her treatment plan most often includes surgery.

Avera offers innovative surgical options to not only remove the cancer, but also offer the best possible cosmetic result.

“When a woman finds out she has breast cancer, how her breasts will look after surgery is often the furthest thing from her mind. But a year down the road, after treatment is over, she will care,” said Julie Reiland, MD, FACS, breast surgeon. “Studies show a woman with a good cosmetic result after her cancer treatment has better long-term quality of life.”


Oncoplasty is breast surgery to remove the breast cancer while incorporating techniques that improve the appearance of the breast.

“When a woman has a lumpectomy, there are numerous techniques we use to remove extra skin and improve the cosmetic appearance. We do equalizing work on the other breast to make them look like they belong together,” Reiland said.

Reiland, Wade Dosch, MD and Tricia Merrigan, MD, are among only 11 percent of breast surgeons who use oncoplastic techniques. Reiland also trains other surgeons nationwide and internationally in oncoplasty.

Breast surgeons also use surgical techniques to hide scars for less visible reminders.

"We approach each treatment as an individual problem to solve and incorporate methods that allow us to, for example, complete breast reduction during cancer surgery or to use nipple-saving procedures to provide that whole-patient care and consideration,” Merrigan said.

Plastic and Reconstructive Surgery

Avera Medical Group Plastic and Reconstructive Surgeons Mark Shashikant, MD and Barry Martin, MD, offer surgical skills to help patients feel whole again after cancer.

All patients have access to plastic surgery consultations, and plastic surgeons take part in weekly tumor conferences, where they can offer insight on every surgical case.

“With our expert team, we can offer nipple-saving and scar-reducing approaches that will remove those visible signs of the cancer,” Shashikant said.

Plastic surgeons may also provide breast reconstruction surgery after mastectomy, or combine breast reduction or enhancement techniques with reconstructive surgery after lumpectomy.

“Quality of life, post-surgery, is an important consideration during the planning for treatment,” said Martin.


Electron-based intraoperative radiation therapy (IORT) is a combination of surgery and radiation therapy in one procedure for patients who are 50 and older and who have small tumors.

“Typically, after a lumpectomy, a woman will require daily radiation treatments for six weeks,” Reiland said. The daily treatment regimen can be a concern, especially for women who live in rural areas. “With IORT, a woman may be able to receive a single dose of radiation in the operating room and be done.”

Avera’s IORT uses electron-based radiation to deliver radiation, and this differs from low-voltage (LV) X-ray-based IORT, offered at some cancer centers.

The difference is a matter of physics and the depth at which low-voltage X-rays or electrons are able to penetrate tissue. LV X-rays only penetrate about a half centimeter, while electrons penetrate up to 3 centimeters within any direction of the tumor site. Reiland says electron-based IORT is endorsed by national radiation oncology experts, and she describes it as the best and safest IORT treatment possible.

Many patients have breast surgery options within their own community, and sometimes, optimal care can be provided to patients utilizing a combination of local and Sioux Falls-based services.

“Surgery is an important decision. Each patient should discuss your options with your primary care provider and local surgeon, so you are well educated and make the right choice for you and your specific case of cancer,” said Roger Werth, MD, Clinical Vice President of Avera’s General Surgery Service Line at Avera and Avera Medical Group general surgeon in Aberdeen.

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