Amy Klawitter took good care of her breasts. She performed regular monthly self-exams and went for annual mammograms. Healthy and happy – and only 42 years old – she didn’t think much about breast cancer.

Then, out of the blue, she received a breast cancer diagnosis that totally altered her perspective. But Klawitter was lucky. She was able to take advantage of a new form of treatment called oncoplastic surgery that gives women greater options with better results. It’s changing the way the medical profession approaches this disease.

“I went for my regular mammogram last December and was told everything looked fine, but there were a couple of things the doctor wanted to watch,” recalls Klawitter. “They said this was really common in someone my age, but I should come back in six months just to check.”

Klawitter did what she was told – something not every woman does. “Actually, the radiologist told me I was one of the few people to return,” Klawitter says. And following the letter of the law, it turns out, was the best thing she could have done.

A second mammogram produced a surprise. “They found a lump I couldn’t feel through regular self-exams,” Klawitter explains. “It was way up against the chest wall.” She wouldn’t have felt the tumor until it grew bigger.

The next day, Klawitter had a biopsy. And that’s when the ceiling crashed in on her.

“You absolutely do not expect this to happen to you,” she says. “My knee-jerk reaction was to just get [a mastectomy] done. I just wanted the cancer out. It was my freakout period.”

Instead, Klawitter was encouraged to meet with Dr. Hanadi Bu-Ali, a breast surgeon with Wheaton Franciscan Healthcare trained in a new kind of cancer treatment. Bu-Ali is an innovative breed of doc skilled in removing the cancer and reconstructing the breast all in one fell swoop. When the tumor is detected early and confined to one place, this option holds remarkable benefits for patients.

“When I saw Dr. Bu-Ali, she absolutely assured me that I would eventually care what my breast looked like,” says Klawitter. The oncoplastic surgery that she underwent was conducted with two objectives in mind: Remove the cancer with wide, clean margins, and use incisions that would produce the best possible cosmetic results. When Klawitter awoke, it would all be over.

“The first thing Bu-Ali did was go in and take out a few lymph nodes to see if the cancer had spread,” says Klawitter. While she was still in surgery, the tissue was sent to the lab. “Then she went in and removed the tumor.”

In Klawitter’s case, the biopsy came back positive. All the lymph nodes had to be removed. “I had two incisions: one for the lumpectomy and one in my armpit for the nodes. Dr. Bu-Ali did a great job.”

With the surgery behind her, Klawitter could get on with her life. Not only did the one-stop operation make healing “relatively easy,” as she puts it, but she also says it gave her a very positive physical appearance. “I had the surgery on a Tuesday and was back at work on Friday. The cancer incision is on the bottom of my breast where the bra line is. If you look at me straight on, you can’t even see it.”

 

Taking Back Control
Although oncoplastic surgery is no magic panacea for a serious illness, patients who elect it can look forward to a simpler, quicker and more pleasing recovery than ever before. It’s a new field that’s just taking root.

“It’s only been about five or six years that oncoplastic surgery has been a specialized field,” notes Bu-Ali. There just hasn’t been any formalized training available. “Oncoplastic surgery is evolving here. That’s unlike in Europe, where breast surgeons are trained in reconstruction right from the beginning.”

Now the United States is catching up. “The three professional entities responsible for approving breast fellowship [training programs] have been pushing for this to become more common,” notes Bu-Ali. “Right now, it’s not required as part of the curriculum. It really depends on the doctor’s interests and efforts. You have to go to workshops or work with experts. I am a board-certified general surgeon, but I have an extra year with a focus on plastic techniques.”

Wanting to look your best after breast cancer surgery is hardly frivolous. For many women, it’s essential. “There are women who have had a radical mastectomy and elect no further surgery,” says Dr. Deana Spagnoletti Johnson, a licensed counselor with Aurora Behavioral Health Services at Aurora Women’s Pavilion of Aurora West Allis Medical Center. “They feel the scar is part of life’s journey, like a cesarean is part of being a mother. It’s such a personal choice.”

But for women concerned about their appearance, oncoplastic surgery – along with all other improved breast cancer surgery techniques – can make a world of difference. “Reconstruction is a very valid way of handling cancer,” Johnson adds. “It is a very powerful way of taking back control. The cancer is no longer dictating what is happening. It’s a quality-of-life issue.”

 

A Team Approach
Not every woman is a candidate for oncoplastic surgery. Even so, newer techniques give most women a shot at a better appearance than was previously available. “It’s no longer like it was 30 years ago, where every woman got a mastectomy,” says Dr. Wendy Marie Mikkelson, a board-certified surgeon specializing in breast disease at Aurora St. Luke’s Comprehensive Breast Health Center.

“Over the years, breast conservation techniques have evolved. When it’s a small cancer, the patient may not always need a plastic surgeon. But there are times when a woman needs or chooses mastectomy. The plastic surgeon and I plan the incision together to get the cancer, but also to get the best cosmetic result.”

Often, the breast surgeon and the plastic surgeon are bent over the patient and performing their respective tasks simultaneously. It’s an approach with the same goal as oncoplastic surgery: to expose patients to only one major surgery while creating the most natural-looking breast possible.

In many cases, though the surgery may later require tweaking or the removal of a tissue expander, the bulk of the surgery can be done at one time, says Mikkelson. “It’s important that the surgeon emphasize there are more options when cancer is diagnosed early. Every woman’s cancer is different.”

It is this team approach that characterizes the improvements in today’s breast cancer surgery. “There is a game plan,” says Dr. David L. Larson, professor and chairman of plastic surgery at Froedtert and the Medical College of Wisconsin. “At MCW, every patient is presented at a conference of about 30 people, including general surgeons, plastic surgeons, a radiation oncologist, pathologist, nursing infrastructure. We look at each new patient. It’s not as piecemeal as it was 10 or 15 years ago. This represents the new standard of care.”

Even with a diagnosis that requires a full mastectomy, positive outcomes can be achieved through a partnership between the breast surgeon and the plastic surgeon. “I know what incision will be made before I walk into the operating room,” says Mikkelson.

“Immediate reconstruction offers a psychological advance,” adds Larson. “The patient wakes up with a mound, something she can put into a bra. Immediate reconstruction does not compromise further care, and the healing is easier than it would be with two or sometimes three operations.”

Sandy, a Milwaukee-area resident who asked that her last name not be used, knows this firsthand. The day before Christmas Eve, she got the news: She had the quickest-spreading, most invasive form of cancer in several places in both breasts. For her, mastectomy was the safest option. Even with this dramatic diagnosis, improved breast surgery techniques allowed Sandy to retain her own breast skin, as opposed to being forced to use skin grafted from another part of her body.

“Before the surgery, I went to see the plastic surgeon to map out how to do the incisions with the best chance of healing,” she says. During only one comprehensive surgery, expanders were inserted to stretch Sandy’s remaining skin to form a new breast mound. Thereafter, each week Sandy returned to the doctor to have fluid added until she reached her desired breast size. Then, in a simple follow-up procedure, the expanders were removed and the final implants added.

“By having reconstruction at the same time, I felt normal,” says Sandy. “My husband took me out to eat two weeks after the surgery. I said, ‘How do I look?’ And he said, ‘Go look in the mirror, you look normal.’ ”

Doctors and patients agree that it’s essential for women to ask questions and be informed about all their options. “A woman has time to make a good decision,” says Mikkelson. “It won’t negatively affect her cure.”

Janine S. Pouliot is a Virginia-based freelance writer.

 

Health Tips by Julie Sensat Waldren
Trouble breathing? Could be your personality. Neuroticism and interpersonal conflict may increase the risk of developing asthma in middle-aged adults, notes a report in Allergy.Researchers surveyed more than 5,000 German adults and found that both high levels of neuroticism and having broken off a life relationship increased the risk of asthma. However, unemployment and death of a close person did not increase the risk.

 

Fiber Per Day Keeps Diabetes Away. A low intake of dietary fiber in men older than 60 may increase the risk of Type 2 diabetes, notes a report in Diabetes Care. British researchers studied more than 3,000 men who were not diabetic. Seven years later, 162 had developed diabetes. After adjusting for factors including total caloric intake, men with the lowest daily fiber intake (20 grams or less) were at an increased risk of diabetes. Researchers concluded that fiber may protect against diabetes by helping lower liver fat and inflammation levels.

 

Unhappy? Swill Green Tea. Green tea lowers psychological distress, notes a study in the American Journal of Clinical Nutrition. Researchers surveyed more than 42,000 Japanese adults. After adjusting for age, sex and other factors, they found the odds of developing psychological distress were significantly lower among respondents who consumed five cups of green tea per day compared to those who drank less than one cup.

 

 

 

Holistic Workout Fights Chemo Fatigue. One difficult side effect of chemotherapy is fatigue, which can cause depression and physical weakness in cancer patients. Enrolling in an intense program that exercises the mind as well as the body can help chemo patients feel less exhausted, notes a study in the online British Medical Journal.The six-week program included resistance training, cardiovascular activity, stretching, yoga breathing, Pilates movement, relaxation training and massage for nine hours each week.

 

CT Scans Can Use Less Radiation. Medical College of Wisconsin radiologists have discovered how to significantly reduce the radiation delivered during computed tomography (CT) angiography, a common technique used to evaluate vascular disease. Turning on the radiation beam only intermittently produces the same image quality as a constant beam during CT angiography, notes a report in the American Journal of Roentgenology.The new technique cuts the radiation dose by two-thirds.