so in in preparation for being here today one of our coaches who said to me
today one of our coaches who said to me
today one of our coaches who said to me so why do you do what you do so the
so why do you do what you do so the
so why do you do what you do so the reason I do what I do is that when I was
reason I do what I do is that when I was
reason I do what I do is that when I was going through Medical School I realized
going through Medical School I realized
going through Medical School I realized that I was a fixer and I needed to fix
that I was a fixer and I needed to fix
that I was a fixer and I needed to fix things so he became a general surgeon
things so he became a general surgeon
things so he became a general surgeon and as I went into general surgery more
and as I went into general surgery more
and as I went into general surgery more and more of my patients would say you’re
and more of my patients would say you’re
and more of my patients would say you’re not a typical surgeon and I’d say what
not a typical surgeon and I’d say what
not a typical surgeon and I’d say what do you mean by that will you talk to my
do you mean by that will you talk to my
do you mean by that will you talk to my to us you talk as if we’re really
to us you talk as if we’re really
to us you talk as if we’re really important and you’re not here just to
important and you’re not here just to
important and you’re not here just to operate and so that’s how I ended up in
operate and so that’s how I ended up in
operate and so that’s how I ended up in breast cancer surgery because my day
breast cancer surgery because my day
breast cancer surgery because my day starts usually with many worried women
starts usually with many worried women
starts usually with many worried women and I’ll give you a little story about
and I’ll give you a little story about
and I’ll give you a little story about how that goes I walk into an exam room
how that goes I walk into an exam room
how that goes I walk into an exam room and there she is
and there she is
and there she is sometimes with a significant other and
sometimes with a significant other and
sometimes with a significant other and sometimes not and she’s sitting on the
sometimes not and she’s sitting on the
sometimes not and she’s sitting on the table and she’s looking like a deer in
table and she’s looking like a deer in
table and she’s looking like a deer in the headlights
the headlights
the headlights and she most of the time at this point
and she most of the time at this point
and she most of the time at this point knows that she has breast cancer and the
knows that she has breast cancer and the
knows that she has breast cancer and the first thing I have to do is I have to
first thing I have to do is I have to
first thing I have to do is I have to walk up to her and hold her hands and
walk up to her and hold her hands and
walk up to her and hold her hands and say this is curable because breast
say this is curable because breast
say this is curable because breast cancer is curable and the thing about
cancer is curable and the thing about
cancer is curable and the thing about breast cancer is that breast cancer is
breast cancer is that breast cancer is
breast cancer is that breast cancer is not just one disease it’s at least four
not just one disease it’s at least four
not just one disease it’s at least four different diseases and in about the year
different diseases and in about the year
different diseases and in about the year 2000 and Scientific American there was a
2000 and Scientific American there was a
2000 and Scientific American there was a scientific article that said it may not
scientific article that said it may not
scientific article that said it may not just be for diseases it may be ten
just be for diseases it may be ten
just be for diseases it may be ten different varieties of disease and so
different varieties of disease and so
different varieties of disease and so what I try to tell them even though
what I try to tell them even though
what I try to tell them even though they’re sitting there with a pile of
they’re sitting there with a pile of
they’re sitting there with a pile of papers from dr. Google is that we have
papers from dr. Google is that we have
papers from dr. Google is that we have to treat breast cancer individually we
to treat breast cancer individually we
to treat breast cancer individually we have to understand what kind of breast
have to understand what kind of breast
have to understand what kind of breast cancer this particular patient has so
cancer this particular patient has so
cancer this particular patient has so I’m going to take you through a journey
I’m going to take you through a journey
I’m going to take you through a journey a journey that will look at what breast
a journey that will look at what breast
a journey that will look at what breast cancer has been and where we’ve come
cancer has been and where we’ve come
cancer has been and where we’ve come when it comes to surgery
when it comes to surgery
when it comes to surgery because over the course of time
because over the course of time
because over the course of time especially since the late 1970s we’ve
especially since the late 1970s we’ve
especially since the late 1970s we’ve added other treatment options to the
added other treatment options to the
added other treatment options to the surgical treatment of breast cancer and
surgical treatment of breast cancer and
surgical treatment of breast cancer and those are not what we’re going to talk
those are not what we’re going to talk
those are not what we’re going to talk about today those include hormonal
about today those include hormonal
about today those include hormonal treatment and chemotherapy putting me to
treatment and chemotherapy putting me to
treatment and chemotherapy putting me to take you back and next slide for me I
guess we don’t have another slide ok I
guess we don’t have another slide ok I had a diagram next one these are the
had a diagram next one these are the
had a diagram next one these are the faces of breast cancer these are the
faces of breast cancer these are the
faces of breast cancer these are the patients who you all see on a daily
patients who you all see on a daily
patients who you all see on a daily basis in your Ladies Home Journal and in
basis in your Ladies Home Journal and in
basis in your Ladies Home Journal and in the People magazine these are young
the People magazine these are young
the People magazine these are young these are old these are the celebrities
these are old these are the celebrities
these are old these are the celebrities they come in African American and Asian
they come in African American and Asian
they come in African American and Asian they’re men I swear this was amazed that
they’re men I swear this was amazed that
they’re men I swear this was amazed that Richard Roundtree actually had breast
Richard Roundtree actually had breast
Richard Roundtree actually had breast cancer in 1993 and Peter Criss of KISS
cancer in 1993 and Peter Criss of KISS
cancer in 1993 and Peter Criss of KISS had breast cancer so this is what you
had breast cancer so this is what you
had breast cancer so this is what you have to remember next slide
wouldn’t it be great if we actually were
wouldn’t it be great if we actually were able to take care of breast cancer in a
able to take care of breast cancer in a
able to take care of breast cancer in a one-day kind of fashion where did we
one-day kind of fashion where did we
one-day kind of fashion where did we come from though
come from though
come from though next the picture on your left is a
next the picture on your left is a
next the picture on your left is a picture of a very ancient instrument
picture of a very ancient instrument
picture of a very ancient instrument that was how we used to remove not that
that was how we used to remove not that
that was how we used to remove not that I ever did I wasn’t that old but remove
I ever did I wasn’t that old but remove
I ever did I wasn’t that old but remove the breast the picture on your right is
the breast the picture on your right is
the breast the picture on your right is the modern-day giant and surgery dr.
the modern-day giant and surgery dr.
the modern-day giant and surgery dr. Halstead dr. Halsted did what we learn
Halstead dr. Halsted did what we learn
Halstead dr. Halsted did what we learn to be one of the major reasons that we
to be one of the major reasons that we
to be one of the major reasons that we could cure breast cancer is the radical
could cure breast cancer is the radical
could cure breast cancer is the radical mastectomy the radical mastectomy
mastectomy the radical mastectomy
mastectomy the radical mastectomy actually was everything that we could
actually was everything that we could
actually was everything that we could find on the chest wall it cured more
find on the chest wall it cured more
find on the chest wall it cured more patients but the problem is when you
patients but the problem is when you
patients but the problem is when you cure more patients we also at that type
cure more patients we also at that type
cure more patients we also at that type of surgery we did a lot more disfiguring
of surgery we did a lot more disfiguring
of surgery we did a lot more disfiguring teachers so by the 1970s we realized we
teachers so by the 1970s we realized we
teachers so by the 1970s we realized we didn’t have to do radical procedures so
didn’t have to do radical procedures so
didn’t have to do radical procedures so in the late 1970s we just left the
in the late 1970s we just left the
in the late 1970s we just left the muscle in place and we took the breast
muscle in place and we took the breast
muscle in place and we took the breast we would give the patient a very nice
we would give the patient a very nice
we would give the patient a very nice flat chest and these slides are not my
flat chest and these slides are not my
flat chest and these slides are not my slides that my latest version so I’m
slides that my latest version so I’m
slides that my latest version so I’m going to apologize because I had some
going to apologize because I had some
going to apologize because I had some really good pictures for you so I know
really good pictures for you so I know
really good pictures for you so I know they’re not going to be here and so it’s
they’re not going to be here and so it’s
they’re not going to be here and so it’s making me Norbit more nervous so I’m
making me Norbit more nervous so I’m
making me Norbit more nervous so I’m just going to tell you this story when
just going to tell you this story when
just going to tell you this story when we do the modified radical mastectomy we
we do the modified radical mastectomy we
we do the modified radical mastectomy we leave the muscle and we take less lymph
leave the muscle and we take less lymph
leave the muscle and we take less lymph nodes
nodes
nodes what happened was we realized that we
what happened was we realized that we
what happened was we realized that we didn’t have to always take all those
didn’t have to always take all those
didn’t have to always take all those lymph nodes and we could just take the
lymph nodes and we could just take the
lymph nodes and we could just take the lower two levels we still did
lower two levels we still did
lower two levels we still did mastectomies but what we found is that
mastectomies but what we found is that
mastectomies but what we found is that we could actually reconstruct the breast
we could actually reconstruct the breast
we could actually reconstruct the breast and we could reconstruct the breast and
and we could reconstruct the breast and
and we could reconstruct the breast and make it look almost like you were born
make it look almost like you were born
make it look almost like you were born with well over the last 10 years we
with well over the last 10 years we
with well over the last 10 years we actually realized that we could take the
actually realized that we could take the
actually realized that we could take the breast leave the nipple in place in the
breast leave the nipple in place in the
breast leave the nipple in place in the correct patient and the patient would
correct patient and the patient would
correct patient and the patient would look almost like themselves I wish I had
look almost like themselves I wish I had
look almost like themselves I wish I had my slides because I could show you a
my slides because I could show you a
my slides because I could show you a patient who gave me permission to show
patient who gave me permission to show
patient who gave me permission to show you what she looks like and she has two
you what she looks like and she has two
you what she looks like and she has two breasts one is fake and the other one is
breasts one is fake and the other one is
breasts one is fake and the other one is hers and they look identical but by the
hers and they look identical but by the
hers and they look identical but by the 1980s we realized that what we could do
1980s we realized that what we could do
1980s we realized that what we could do is we could take a portion of the breast
is we could take a portion of the breast
is we could take a portion of the breast and by taking a portion of the breast
and by taking a portion of the breast
and by taking a portion of the breast and a little rim of normal tissue we can
and a little rim of normal tissue we can
and a little rim of normal tissue we can make that patient live just as long as
make that patient live just as long as
make that patient live just as long as the mastectomy patient but we needed to
the mastectomy patient but we needed to
the mastectomy patient but we needed to do radiation and in the 1980s when we
do radiation and in the 1980s when we
do radiation and in the 1980s when we did this study what we realized was that
did this study what we realized was that
did this study what we realized was that radiation had to be the whole breast ten
radiation had to be the whole breast ten
radiation had to be the whole breast ten minutes a day five days a week for six
minutes a day five days a week for six
minutes a day five days a week for six and a half weeks
well that’s fast-forward now about 15 to
well that’s fast-forward now about 15 to 18 years ago what we also found is that
18 years ago what we also found is that
18 years ago what we also found is that maybe we can do less maybe more is less
maybe we can do less maybe more is less
maybe we can do less maybe more is less and so what we did was
and so what we did was
and so what we did was we started to use partial breast
we started to use partial breast
we started to use partial breast radiation techniques where we actually
radiation techniques where we actually
radiation techniques where we actually insert a device into the breast after
insert a device into the breast after
insert a device into the breast after the fact and the patient would go to the
the fact and the patient would go to the
the fact and the patient would go to the radiation facility they’d have this
radiation facility they’d have this
radiation facility they’d have this device sticking out of their breast now
device sticking out of their breast now
device sticking out of their breast now mind you it was bandaged in between so
mind you it was bandaged in between so
mind you it was bandaged in between so we didn’t have to make them walk around
we didn’t have to make them walk around
we didn’t have to make them walk around with this device fluttering in the wind
with this device fluttering in the wind
with this device fluttering in the wind and so what they would do is up to this
and so what they would do is up to this
and so what they would do is up to this machine and just radiate the area around
machine and just radiate the area around
machine and just radiate the area around the breast tumor cavity and when they
the breast tumor cavity and when they
the breast tumor cavity and when they did that we were able to do it in a
did that we were able to do it in a
did that we were able to do it in a shorter time period twice a day for five
shorter time period twice a day for five
shorter time period twice a day for five days and the catheter only had to be in
days and the catheter only had to be in
days and the catheter only had to be in there for a week it decreased the amount
there for a week it decreased the amount
there for a week it decreased the amount of radiation damage to the rest of the
of radiation damage to the rest of the
of radiation damage to the rest of the chest wall but not everybody could have
chest wall but not everybody could have
chest wall but not everybody could have this but a good portion of our patients
this but a good portion of our patients
this but a good portion of our patients could do this so about 10 plus years ago
could do this so about 10 plus years ago
could do this so about 10 plus years ago some very bright people said why can’t
some very bright people said why can’t
some very bright people said why can’t we do this in the operating room
we do this in the operating room
we do this in the operating room wouldn’t this be wonderful to have it
wouldn’t this be wonderful to have it
wouldn’t this be wonderful to have it done all at the same time so there are
done all at the same time so there are
done all at the same time so there are three different types of equipment that
three different types of equipment that
three different types of equipment that have been used to do this intraoperative
have been used to do this intraoperative
have been used to do this intraoperative radiation two of them use a low-voltage
radiation two of them use a low-voltage
radiation two of them use a low-voltage type of equipment and one uses electrons
type of equipment and one uses electrons
type of equipment and one uses electrons all three are still being used today but
all three are still being used today but
all three are still being used today but in September the American Society of
in September the American Society of
in September the American Society of radiation oncologists actually published
radiation oncologists actually published
radiation oncologists actually published some guidelines that now makes it that
some guidelines that now makes it that
some guidelines that now makes it that it can be used outside of an
it can be used outside of an
it can be used outside of an experimental study because up until this
experimental study because up until this
experimental study because up until this last month everything that we did
last month everything that we did
last month everything that we did interoperative ly really was under an
interoperative ly really was under an
interoperative ly really was under an experimental study electrons electrons
experimental study electrons electrons
experimental study electrons electrons is the type of radiation that we are
is the type of radiation that we are
is the type of radiation that we are most comfortable with it’s what we’re
most comfortable with it’s what we’re
most comfortable with it’s what we’re used to being able to manipulate to do
used to being able to manipulate to do
used to being able to manipulate to do treatment for all types of cancer
treatment for all types of cancer
treatment for all types of cancer including breast cancer and so what we
including breast cancer and so what we
including breast cancer and so what we now have at our disposal is the ability
now have at our disposal is the ability
now have at our disposal is the ability to tell a patient that we can do it all
to tell a patient that we can do it all
to tell a patient that we can do it all at the same time not everybody can have
at the same time not everybody can have
at the same time not everybody can have this it has to be a patient with a small
this it has to be a patient with a small
this it has to be a patient with a small tumor someone who doesn’t have any
tumor someone who doesn’t have any
tumor someone who doesn’t have any cancer in their lymph nodes at the
cancer in their lymph nodes at the
cancer in their lymph nodes at the time and it has to be something that we
time and it has to be something that we
time and it has to be something that we can actually do and feel comfortable
can actually do and feel comfortable
can actually do and feel comfortable about doing so I had a patient she came
about doing so I had a patient she came
about doing so I had a patient she came to me recently and she walked and I told
to me recently and she walked and I told
to me recently and she walked and I told you about dr. Google well they also come
you about dr. Google well they also come
you about dr. Google well they also come in not even knowing what kind of cancers
in not even knowing what kind of cancers
in not even knowing what kind of cancers they have and she said to me before you
they have and she said to me before you
they have and she said to me before you even start I will only have an incision
even start I will only have an incision
even start I will only have an incision this big I am NOT doing chemo I won’t
this big I am NOT doing chemo I won’t
this big I am NOT doing chemo I won’t take that hormone blocking pill and I
take that hormone blocking pill and I
take that hormone blocking pill and I want it all done at one time okay so the
want it all done at one time okay so the
want it all done at one time okay so the good news is she fit all the criteria
good news is she fit all the criteria
good news is she fit all the criteria but there was one thing I had to tell
but there was one thing I had to tell
but there was one thing I had to tell her the machine I do radiation with me
her the machine I do radiation with me
her the machine I do radiation with me and her incision has to be bigger and
and her incision has to be bigger and
and her incision has to be bigger and she said well how big and I said I can’t
she said well how big and I said I can’t
she said well how big and I said I can’t tell you as big as I have to make it I
tell you as big as I have to make it I
tell you as big as I have to make it I won’t guarantee a nice you have to
won’t guarantee a nice you have to
won’t guarantee a nice you have to guarantee me I said I can’t guarantee I
guarantee me I said I can’t guarantee I
guarantee me I said I can’t guarantee I said I can guarantee that you’ll be
said I can guarantee that you’ll be
said I can guarantee that you’ll be happy I’ll do it all at one time
happy I’ll do it all at one time
happy I’ll do it all at one time and I’ll try to hide most of your scar
and I’ll try to hide most of your scar
and I’ll try to hide most of your scar so it took me a while she had to go away
so it took me a while she had to go away
so it took me a while she had to go away and come back a couple of times just to
and come back a couple of times just to
and come back a couple of times just to get to the point where she could be calm
get to the point where she could be calm
get to the point where she could be calm about her decision but we did it and
about her decision but we did it and
about her decision but we did it and even though her incision was not this
even though her incision was not this
even though her incision was not this big when she came back a week after
big when she came back a week after
big when she came back a week after surgery she said okay you were right
surgery she said okay you were right
surgery she said okay you were right it’s okay so the take-home message today
it’s okay so the take-home message today
it’s okay so the take-home message today really is that breast cancer is curable
really is that breast cancer is curable
really is that breast cancer is curable and we can do more in a smaller amount
and we can do more in a smaller amount
and we can do more in a smaller amount of time with less treatment if we find
of time with less treatment if we find
of time with less treatment if we find it early
it early
it early yes breast cancer is scary and yes
yes breast cancer is scary and yes
yes breast cancer is scary and yes everybody should have knowledge and
everybody should have knowledge and
everybody should have knowledge and education about what their diseases
education about what their diseases
education about what their diseases before they come in for treatment and
before they come in for treatment and
before they come in for treatment and can make that decision and for all the
can make that decision and for all the
can make that decision and for all the women in the audience get your
women in the audience get your
women in the audience get your mammograms thank you
mammograms thank you
mammograms thank you [Applause]
”
Be First to Comment