Maggie McKay (Host): There’s so much information about breast cancer awareness and prevention, sometimes it might be overwhelming to take it all in. So joining us is plastic surgeon, Dr. Alicia Billington, to break it down and tell us some of the main things we need to know, and also discuss options in reconstructive surgery and what each involves.

Welcome to BayCare HealthChat, a podcast from BayCare Health System. I'm Maggie McKay. Thank you so much for joining us today, Dr. Billington.

Alicia Billington, MD, PhD: Thanks so much for having me. I'm excited to be here.

Host: You know what? This is a topic that is so important to so many people. So let's just start with who gets breast cancer?

Alicia Billington, MD, PhD: Well, the scary thing is anyone can get breast cancer. So it's a disease that we typically think about as happening in older women. But what we're seeing is that younger and younger women are getting breast cancer as well. And I also think it's important to note that men can get breast cancer. So, while they are a small percentage, about less than 1 percent of the overall number of individuals who can get breast cancer, men can get breast cancer as well.

Host: And what about prevention? What can we do?

Alicia Billington, MD, PhD: So prevention is important. There are lots of things that we do in our daily lives that can contribute to cancer formation. So things like alcohol, we see that even one drink a day can increase your risk of breast cancer 7 to 10%. And if you drink two to three drinks per day, it can double that risk. So certainly that plays a role. Other things like obesity, especially after menopause, it helps with creation of estrogen, which can feed tumor creation. So obesity is something that people can work on by being more active, losing weight, working on diabetes prevention.

And then other things that can affect breast cancer deal with the reproductive system.People who have never had children or who get pregnant after 30 are a little bit of a higher risk of breast cancer. And then it looks like certain contraceptives, particularly oral contraceptives, can have an increased risk of breast cancer. Although this does decline after stopping birth control.

Host: So what should we be watching out for? What should we be aware of?

Alicia Billington, MD, PhD: I think it's very important that every woman does a monthly breast exam. Some of the organizations do not necessarily recommend doing these exams, but I think it's important because every woman needs to know what their breast naturally feels like. And if there's a change, they need to go in and they need to see a physician to see if it is normal or if it's something that's abnormal.

Other things that they can look out for are if there's any swelling in part of their breast, if there's any skin dimpling, meaning it can look like an orange peel sometimes if the skin changes. They can see if they have any breast or nipple pain. Sometimes the nipple can retract or change as well. If there's any unusual discharge or if they have any lymph nodes that feel swollen underneath their armpit and areas like that. The other thing that we can do is get appropriate screening based on our family history and our age.

Host: And what do you recommend for screenings? How often and how young, how old?

Alicia Billington, MD, PhD: That's a great question. What I recommend is that everyone starts getting mammograms at age 40. Now, if you have a family history of breast cancer in your mom or your sister, you're going to want to potentially get an earlier mammogram. So you look at the age that they were at their diagnosis. So if you have a mom that had breast cancer at age 42, you're going to want to do that 10 years before her diagnosis. So starting at age 32, you would actually get imaging. And there are different imaging modalities out there. Mammograms are typically good for capturing calcifications, irregular masses, asymmetries, but they're not great at everything. So sometimes if the breasts are very dense, someone might be asked to get an ultrasound to assess the breast further to see if there are any masses and if there are, whether they're fluid or solid.

And then finally, there is another modality called an MRI, and that unfortunately does have a little bit of a higher false positive rate. So we use that as an adjunct. We use it specifically for those that are at a higher risk of getting breast cancer as a screening mechanism.

Host: What types of treatment are there for breast cancer?

Alicia Billington, MD, PhD: The treatment really depends on the type of breast cancer that the individual has. So, it also depends on the size, the location, whether it's one breast or both breasts, whether there's disease in the lymph nodes as well. So the first thing I think most people typically think of is surgery, and surgery can be on a smaller scale, taking the cancer out and tissue around it, and that's called a lumpectomy.

Or it can involve taking out all of the breast tissue, and that's called a mastectomy. So when someone has a lumpectomy because it's not taking the whole breast out, you have to additionally have radiation to decrease your risks. And the studies show that a lumpectomy plus radiation has been equivalent to a mastectomy.

The other modalities of treatment in addition to radiation, which I've already mentioned, are chemotherapy. There are also hormonal drugs that we use now that specifically target estrogen creation. And there are other targeted drug therapies such as monoclonal antibodies, and then even immunotherapies that attack certain key pathways in the cancer genesis.

Host: So, basically, everyone's different. It depends what kind you have and maybe-

Alicia Billington, MD, PhD: Absolutely. Everyone is different. So you could have two best friends that have breast cancer in the same breast and they get completely different treatments based on the tumor location. One might be right underneath the nipple areola complex, so the nipple might have to be taken. One might be, you know, way larger than the other, and that can affect the incision placement. So all of these things really matter. It's a complex decision tree.

Host: And when it comes to reconstruction, what types are there?

Alicia Billington, MD, PhD: I always start by telling patients the first option is no reconstruction, because sometimes people don't know that that's even an option. So the first thing I tell patients is you can go completely flat if you are getting a mastectomy. Sometimes when you go completely flat, you can get a concavity deformity and some patients might desire a little bit of fat grafting kind of to flatten that area out a little bit more.So that's the first option.

The second option I talk to patients about is what most patients are more familiar with, which is an implant-based reconstruction. Sometimes we cannot put an implant in at the time of the mastectomy because the tissue might be too thin or we might have had to take a lot of skin with the mastectomy.

So sometimes we'll have to put a tissue expander in, which is essentially a water balloon that we blow up over time, and then we stretch out the skin until we can swap it out with an implant.

And the third type of option that patients have would be autologous reconstruction, meaning using their own tissues.So sometimes we'll use their back tissue, their back muscle or latissimus dorsi, and other times we'll use their tummy tissue, with their rectus muscle, or sometimes we can dissect around that muscle and just use the skin and the fat in their belly to recreate a breast.

Host: That's amazing. Was that available, all of those options, say 10, 20 years ago?

Alicia Billington, MD, PhD: These options have been available for a long time. However, there are a lot of advances, especially with regards to the tummy techniques. So when it first was started, we took the entire rectus muscle to give a good blood supply to the flap. And then it evolved to the point where we could use a microscope to dissect out the vessels.

So you would actually dissect out vessels in the chest, dissect out vessels in the abdomen, cut them, and then suture them together under a scope. And that field continues to evolve with changes looking at sensation, looking at nerves. So it's something that I think 20 years from now, we might even have more advancements in.

Host: That's good news. In closing, is there anything else you'd like to add?

Alicia Billington, MD, PhD: I would just say that anyone that is listening to this probably knows someone that has breast cancer because one in eight women get it in their lifetime. So whoever is listening today, please encourage your friends and family to go out, get their screening, get their mammogram. And if you are a woman, please make sure that you are getting screened yourself.

Host: Right, just stay on top of it and don't skip those mammograms yearly.

Alicia Billington, MD, PhD: That's right.

Host: Thank you so much for your time and sharing your expertise. This has been fascinating.

Alicia Billington, MD, PhD: Thank you for having me.

Host: That's Dr. Alicia Billington. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts.

For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library. I'm Maggie McKay and that wraps up this episode of BayCare HealthChat presented by BayCare Health System.

Thanks for listening.