3/26/2015 Breast For Drs Crash Course Karen Barbosa DO 1 Breast - PDF document

3/26/2015 Breast For Drs Crash Course Karen Barbosa DO 1 Breast Dz Not all masses are Cancer Cysts, fibroadenomas, dense tissue, abscess Cysts Fibroadenomas Dense tissue Abscesses 2 Mammograms save Lives Standard of care Radiation What age? What about Ultra Sound? 3 3 1

3/26/2015 Ultra Sound Operator dependant Poor tech then poor image Artifact Focal point set wrong Incomplete evaluation one plane only Poor machine poor image Labeling image poorly 4 Breast MRI (bMRI) is NOT the Holy Grail Very sensitive unnecessary biopsies or surgery Not good screening test for the average risk person No cookie cutter answers 5 5 Breast MRI (bMRI) High risk pts Pts with Breast Cancer BRAC 1 / 2 Discordant results on imaging NOT screening NOT routine wk up 6 2

3/26/2015 Dedicated Breast Radiologist Everyone has a center, but who works there? CAD??? Does your Dr know how to drive that machine? 7 7 Know your risks! What in my family history is or is not important 10-20% of imaging can miss cancer Sadly, many Breast Surgeons won ’ t see a person until they have cancer Don ’ t wait! Dentist principle 8 8 Excerise 4 hrs cardio reduces risk by 30-40% Most take meds for lesser numbers Other advantages stress reliever sleep better cardio protective reduce risk of other cancers* 9 9 3

3/26/2015 Breast Specialist Do your homework! Dedicated Breast Surgeon? What conferences? Societies? What % of practice is Breast? 10 10 When in Doubt check it out Lump Breast pain Rash Color change 11 11 Don ’ t be rushed into the OR Fear factor Perspective 2-3 weeks vs 5-10 years “ Years for cancer to grow ” Get a second opinion 12 12 4

3/26/2015 Education = Empowerment Ask questions Be your own advocate Fight for quality Health care Share your knowlegde 13 13 What ’ s New in Surgery? Oncoplasty The fusion of cancer=onco & plastics=plasty Better cancer surgery that yeilds better cosmetic results 14 Oncoplasty It ’ s not new its been in Europe for yrs New concept to the US Several courses taught each yr Training for plastic surgeons as well as breast surgeons The marriage of two types of surgeries…better pt cosmesis 15 5

3/26/2015 Why do we need a change ? 16 Present Plan 1.Lumpectomy 2.Radiation 3.Send to Plastic Surgeon 17 Left Immediate Reconstruction Right Reduction Mammoplasty 18 6

3/26/2015 Right Immediate Implant with Left Mastopexy 19 Bilateral Immediate Saline Implant 20 BRCA 2 Gene Carrier Bilateral Mastectomy 21 7

3/26/2015 Conclusion:  Interdisciplinary Cooperation and detailed Discussion of the patient ’ s care plan BEFORE definitive tumor ablation:  improves patient outcomes; and  reduces invasiveness and number of surgical interventions  Avoids unnecessary complications 22 8