Treatment and Reconstruction in One Surgery
When a woman receives that terrifying breast cancer diagnosis, her only mission is survival — she fights for her future. At that time, she may hold no concern about whether she lives the remainder of her life with both, one or neither of her breasts.
“A few years after treatment, the memory and emotions of cancer fades,” said Tricia Merrigan, MD, FACS, Avera Medical Group breast surgeon. “But when you get out of the shower every day, you may have an opinion on what you see in the mirror.”
In the past, plastic surgery was often an after-thought. Today, doctors at the Avera Cancer Institute in Sioux Falls bring the conversation of implants, reductions and lifts to the table when planning for their patients’ individualized treatment plans.
“Whether the patient has a mastectomy or lumpectomy, she no longer must compromise the aesthetics of her breasts in order to save her life,” said Mark Shashikant, MD, Avera Medical Group plastic and reconstructive surgeon. “In fact, if you’ve ever considered changing the appearance of your breasts, we strive to make that happen on your cancer journey.”
Breast cancer surgery and plastic surgery can occur during the same operation. Prior to the operation, the plastic surgeon makes incision marks with a marker on the patient’s body to indicate her aesthetic desires. During the operation, the breast cancer surgeon works through these incision marks in order to remove the tumor and any affected tissue. Once the breast cancer surgeon has completed that role, the plastic surgeon steps in to reconstruct the patient’s breasts.
In April 2018, soon after her annual mammogram, Becky Brunick learned she had stage 1 invasive lobular carcinoma.
“When Dr. Merrigan told me I had breast cancer, she immediately said that this wasn’t going to end my life,” said Brunick, “that it was simply a bump in the road and that her team would take care of it.”
Those words meant the world to Brunick and her family. The encouraging and light-hearted nature of both Merrigan and Shashikant eased the stress as well.
Shortly after receiving her diagnosis, Brunick underwent genetic testing to see whether breast cancer was present in her family tree. She discovered breast cancer wasn’t in her mother’s nor father’s health history. “It provided some relief, knowing that this most likely won’t be passed on to my daughters,” said Brunick.
The next course of Brunick’s treatment was undergoing a lumpectomy as well as a breast reduction and lift.
Merrigan removed the tumor on the side of Brunick’s right breast and then, with the assistance of the radiation oncology team, delivered a single, concentrated dose of radiation to the exposed, affected area. Known as electron-based intraoperative radiation therapy (IORT), this boost of radiation helps reduce the length of radiation therapy a patient may have to undergo after surgery.
Once Merrigan finished her task, Shashikant entered the operating room to perform the breast reduction and lift, and was responsible for the surgery’s conclusion.
“When you have a multidisciplinary team working together, your care is more thorough and more seamless,” said Shashikant. “Our aim is to provide an outcome that gives you the best quality of life possible.”
“Avera’s breast conservation rate is 70 percent, above the national average,” said Merrigan. “Therefore, it’s important to think about cosmetics up front so you are comfortable with your breasts after cancer treatment. There are lots of options, and it’s covered by health insurance.”
Brunick only took off three days from work for the surgery. Also, the IORT delivered during surgery reduced her radiation schedule from six weeks to three weeks.
Even though she went through the surgery, radiation, fear and some tears, Brunick said she’s blessed her journey wasn’t as difficult as that of some women who have faced breast cancer. However, all women must start the journey in the same place.
“Get your mammo,” stressed Brunick. “Don’t be afraid of what might be on the other side; get it taken care of before it’s too late.”