Whether you’re scheduled for a routine procedure or a highly specialized surgery, Florida Hospital Memorial Medical Center offers a state-of-the-art facility staffed by the area’s top physicians and surgical specialists.
Breast surgery is no exception. Whether it's a lumpectomy, mastectomy or a breast biopsy, Florida Hospital Memorial Medical Center is there to make sure your experience goes smoothly and as pain free as possible.
Christopher Grove, MD, a general surgeon at Florida Hospital Memorial Medical Center, is here to discuss the different types of breast surgery and to assure you that at Florida Hospital Memorial Medical Center you'll be treated with respect and professionalism.
What You Need to Know Before Breast Surgery
Featured Speaker:
http://www.hcpphysicians.org/index.php/physicians/christopher-grove-md
Christopher Grove, MD
Dr. Grove is a board certified general surgeon who lives and practices in Daytona Beach, Florida. He received his medical degree from the University of Alabama School of Medicine in Birmingham, Alabama. He fulfilled his integrated general surgery residency at Wright State University in Dayton, Ohio. He is a fellow of the American College of Surgeons and fluent in all aspects of general surgery. Dr. Grove believes in “a personal touch” and makes it a point to contact his patients directly after surgery in case they have any questions or concerns. In his spare time he enjoys computers, scuba diving, camping, and racquetball. He is also an active member with the Boy Scouts of America and recently received the Outstanding Eagle Scout Award from the National Eagle Scout Association.http://www.hcpphysicians.org/index.php/physicians/christopher-grove-md
Transcription:
What You Need to Know Before Breast Surgery
Melanie (Host): If you’ve been diagnosed with breast cancer, your doctor may recommend surgery and can help you determine the kind of surgery that’s most appropriate for you. My guest today is Dr. Christopher Grove. He’s a board certified general surgeon with Florida Hospital. Welcome to the show, Dr. Grove. What a scary thing when women hear they have to have surgery and breast cancer surgery or surgery on their breast for any reason. Tell us what about the different types of surgeries out there to give them a little reassurance.
Dr. Christopher Grove (Guest): Thank you. I appreciate the opportunity to be on your show today. There are several types of breast cancer surgery now. It used to that a woman would lose her entire breast if they had breast cancer but now we certainly have much better options than that. The first option is to do breast conservation therapy. That basically means that you go in and you take out the breast cancer itself, take out the lump, so to speak, and then from there, we actually go and take out a sample of the lymph nodes. The other option is a modified radical mastectomy and that means that we go in and take out all of the breast tissue overlying the muscle which is obviously a much bigger surgery and much more disfiguring. Now we can offer something that’s much more cosmeticly pleasing to the patient and offers a lot less pain and a lot quicker getting back to work with much less chance of complications.
Melanie: Let’s start with the lumpectomy because we’re going to work our way through some of these and even cover breast reconstruction during surgery if you’re having a mastectomy. If you’re having a lumpectomy what can a woman expect? Is this a minimally invasive type procedure?
Dr. Grove: My favorite saying is that the only minor surgery is surgery on somebody else. With that said, it’s a fairly minor procedure when we go in and take out the lump and we don’t have to take out any extra breast tissue. We try to get just around the cancer, get negative margins around it so that the patient, hopefully, will not have to come back and have anything else take out. It’s an outpatient surgery. They come in, have it done and go home the same day and sleep in their own bed that night. It takes about a week to ten days to completely recover from that.
Melanie: Why would a woman not be able to have a lumpectomy and have to do a mastectomy?
Dr. Grove: There’s several factors that a surgeon will look at when the patient comes into the office. We have to look at the size of the tumor and that’s, not only just the size of it, but the size relative to the breast as well as they type of cancer that it is and any other mitigating factors that the patient may have. We do our best to try to offer breast conservation therapy in patients that meet all the criteria which is becoming more and more patients are meeting that criteria. We don’t like to do a mastectomy if we don’t have to but, certainly, some women prefer to have a total mastectomy just so they don’t have to worry about it anymore.
Melanie: That’s a good point right there. If you have a lumpectomy, is that still a concern for women that breast cancer could come back? If they have a mastectomy is that no longer a concern?
Dr. Grove: The studies show that the two operations are actually equivalent in five year survival. So, if you go with a lumpectomy or with a mastectomy, five years down the road you stand the same amount of chance of being alive from your breast cancer. There’s a slightly higher chance of a local recurrence, meaning the cancer coming back at the breast with a breast conservation therapy because you’ve left breast tissue there. Certainly, if the tumor comes back we can always go back and do a mastectomy and, like I said, the five year survival from that is the same. If we do a mastectomy, even though we take out all the breast tissue there’s still always some breast tissue remaining. It doesn’t reduce the risk of recurrent cancer to zero but it certainly is low.
Melanie: If the cancer is localized to the breast itself, you can do your lumpectomy or mastectomy. What if it’s spread out into the lymph nodes? Do you prophylactically remove some lymph nodes? Tell us about lymph node removal.
Dr. Grove: The lymph node evaluation has come a long way over the last several years. We used to go in and take out all the lymph nodes which meant that women would get swelling in the arm; they would have increased risk of injuring the nerves that innervate the muscles surrounding the arm and into the back. Now we use something called “single lymph node biopsy”. The patient will come in and have a radioactive tracer injected into the breast. Then, we take them to the operating room and use a radioactive gamma counter to find those lymph nodes that light up. That allows us to take out one or two lymph nodes instead of multiple lymph nodes which greatly reduces the amount of swelling they have and nearly eliminates the risk of nerve injury but not totally eliminate it.
Melanie: What are some of the after effects of lymph node removal for the women? They hear about lymphedema and things along those lines. Tell us a little bit about what happens after.
Dr. Grove: The side effects of a lymph node dissection are mainly a fluid collection or a seroma up under the arm as well as some numbness and tingling under the arm. The worst case scenario is what we call “lymphedema” which is swelling of the arm. Again, for women that develop that, there are even now physical therapy sessions that are available for that called “lymphedema clinics” where we can even reduce the side effects of lymphedema. The goal with single node biopsy is that we’ve greatly reduced that risk and so we’re seeing this less and less. Certainly, there’s still always that risk. If it does develop, there are at least some treatment options now.
Melanie: Dr. Grove, as a general surgeon, tell us what’s going on in the world of breast reconstruction during mastectomy and how women can feel a little bit better about themselves post-surgery.
Dr. Grove: The idea of reconstructing the breast right after surgery is one of those things that have kind of come and gone in waves. The reason for that is that we certainly would like to reconstruct every breast that we can at the time of surgery so that when you do wake up cosmetically, it’s more pleasing to you; you feel whole again and women are a lot happier if they have immediate breast reconstruction. The problems that we face and have to make a decision on each individual basis is to whether a patient is eligible for that has to do with the size of the tumor, whether they’re going to need chemotherapy and radiation therapy afterwards; as well as whether it’s moved into the lymph nodes or not. Our problem is that if we reconstruct a breast immediately and we have to radiate that area, then we can either lose a breast flap or contract a breast implant capsule. There are a couple different types of breast reconstructions and one of those is a saline implant and the other is a flap reconstruction. Certainly, if a woman would like to have her own tissue there, then we’re able to do a tummy tuck, so to speak, at the same time. We bring tissue up from the belly and place it up under the chest wall and it allows a woman to have actual live tissue up in the breast. The other option is to do the saline implants and they usually start with tissue expanders to expand that area. Both of those can be done either immediately during surgery or, most commonly now, after they have undergone treatment for their breast cancer and are then ready to proceed.
Melanie: What do you tell women that ask you about the BRCA gene and prophylactic mastectomy?
Dr. Grove: I highly recommend that anybody that is under the age of 40 or who has a significant family history of breast cancer to undergo BRCA testing first. The studies are very definitive that prophylactic mastectomy in somebody who is BRCA positive is very worthwhile to at least consider. I don’t push anybody to absolutely have the bilateral mastectomy if they are BRCA positive but I certainly think that they need that information ahead of time. They’ve come a long way with gene testing and we can have the answer on the BRCA test fairly quickly now. You used to have to wait two or three weeks and now we can have it within a few days so that we can help make that decision prior to going to the operating room.
Melanie: What great information. in just the last few minutes, Dr. Grove, give women listening and the spouses that love them, your best advice and information – what you tell people every single day when they are considering breast surgery for a myriad of reasons.
Dr. Grove: The first thing I always want to reassure women about is that breast cancer used to be a death diagnosis. If you got it, you were not going to live from it. We very much have some good tools in the toolbox now and much less deformative surgery and much better options in order to treat breast cancer. Breast cancer, in my opinion, is a treatable disease and we do our best on every patient to go for a cure, if at all possible. I let them know that I’m going to be with them throughout the process. We have a medical oncologist and surgical oncologists. We have radiation oncologists. So, it’s a whole team approach to approaching breast cancer now. They certainly will not be alone on that path.
Melanie: Why should they come to Florida Hospital for their care?
Dr. Grove: Florida Hospital is a wonderful hospital. I think that they not only take care of the patient medically but spiritually and emotionally and offer that support. We have breast cancer navigators that are with the patient from the time that they go in for their biopsy through the time that they are in our office for follow up and all the way through their oncology follow ups. That person is with them and can answer questions and guide them through the process. I think it adds a lot to the patient experience and takes away a lot of the fear. Certainly, many hospitals can do a good job of taking care of the patient with the medical aspect but I think that we add that extra component to it.
Melanie: Thank you so much for being with us today. You’re listening to Health Chat by Florida Hospital. For more information you can go to fhsurgery.com. That’s fhsurgery.com. This is Melanie Cole. Thanks so much for listening.
What You Need to Know Before Breast Surgery
Melanie (Host): If you’ve been diagnosed with breast cancer, your doctor may recommend surgery and can help you determine the kind of surgery that’s most appropriate for you. My guest today is Dr. Christopher Grove. He’s a board certified general surgeon with Florida Hospital. Welcome to the show, Dr. Grove. What a scary thing when women hear they have to have surgery and breast cancer surgery or surgery on their breast for any reason. Tell us what about the different types of surgeries out there to give them a little reassurance.
Dr. Christopher Grove (Guest): Thank you. I appreciate the opportunity to be on your show today. There are several types of breast cancer surgery now. It used to that a woman would lose her entire breast if they had breast cancer but now we certainly have much better options than that. The first option is to do breast conservation therapy. That basically means that you go in and you take out the breast cancer itself, take out the lump, so to speak, and then from there, we actually go and take out a sample of the lymph nodes. The other option is a modified radical mastectomy and that means that we go in and take out all of the breast tissue overlying the muscle which is obviously a much bigger surgery and much more disfiguring. Now we can offer something that’s much more cosmeticly pleasing to the patient and offers a lot less pain and a lot quicker getting back to work with much less chance of complications.
Melanie: Let’s start with the lumpectomy because we’re going to work our way through some of these and even cover breast reconstruction during surgery if you’re having a mastectomy. If you’re having a lumpectomy what can a woman expect? Is this a minimally invasive type procedure?
Dr. Grove: My favorite saying is that the only minor surgery is surgery on somebody else. With that said, it’s a fairly minor procedure when we go in and take out the lump and we don’t have to take out any extra breast tissue. We try to get just around the cancer, get negative margins around it so that the patient, hopefully, will not have to come back and have anything else take out. It’s an outpatient surgery. They come in, have it done and go home the same day and sleep in their own bed that night. It takes about a week to ten days to completely recover from that.
Melanie: Why would a woman not be able to have a lumpectomy and have to do a mastectomy?
Dr. Grove: There’s several factors that a surgeon will look at when the patient comes into the office. We have to look at the size of the tumor and that’s, not only just the size of it, but the size relative to the breast as well as they type of cancer that it is and any other mitigating factors that the patient may have. We do our best to try to offer breast conservation therapy in patients that meet all the criteria which is becoming more and more patients are meeting that criteria. We don’t like to do a mastectomy if we don’t have to but, certainly, some women prefer to have a total mastectomy just so they don’t have to worry about it anymore.
Melanie: That’s a good point right there. If you have a lumpectomy, is that still a concern for women that breast cancer could come back? If they have a mastectomy is that no longer a concern?
Dr. Grove: The studies show that the two operations are actually equivalent in five year survival. So, if you go with a lumpectomy or with a mastectomy, five years down the road you stand the same amount of chance of being alive from your breast cancer. There’s a slightly higher chance of a local recurrence, meaning the cancer coming back at the breast with a breast conservation therapy because you’ve left breast tissue there. Certainly, if the tumor comes back we can always go back and do a mastectomy and, like I said, the five year survival from that is the same. If we do a mastectomy, even though we take out all the breast tissue there’s still always some breast tissue remaining. It doesn’t reduce the risk of recurrent cancer to zero but it certainly is low.
Melanie: If the cancer is localized to the breast itself, you can do your lumpectomy or mastectomy. What if it’s spread out into the lymph nodes? Do you prophylactically remove some lymph nodes? Tell us about lymph node removal.
Dr. Grove: The lymph node evaluation has come a long way over the last several years. We used to go in and take out all the lymph nodes which meant that women would get swelling in the arm; they would have increased risk of injuring the nerves that innervate the muscles surrounding the arm and into the back. Now we use something called “single lymph node biopsy”. The patient will come in and have a radioactive tracer injected into the breast. Then, we take them to the operating room and use a radioactive gamma counter to find those lymph nodes that light up. That allows us to take out one or two lymph nodes instead of multiple lymph nodes which greatly reduces the amount of swelling they have and nearly eliminates the risk of nerve injury but not totally eliminate it.
Melanie: What are some of the after effects of lymph node removal for the women? They hear about lymphedema and things along those lines. Tell us a little bit about what happens after.
Dr. Grove: The side effects of a lymph node dissection are mainly a fluid collection or a seroma up under the arm as well as some numbness and tingling under the arm. The worst case scenario is what we call “lymphedema” which is swelling of the arm. Again, for women that develop that, there are even now physical therapy sessions that are available for that called “lymphedema clinics” where we can even reduce the side effects of lymphedema. The goal with single node biopsy is that we’ve greatly reduced that risk and so we’re seeing this less and less. Certainly, there’s still always that risk. If it does develop, there are at least some treatment options now.
Melanie: Dr. Grove, as a general surgeon, tell us what’s going on in the world of breast reconstruction during mastectomy and how women can feel a little bit better about themselves post-surgery.
Dr. Grove: The idea of reconstructing the breast right after surgery is one of those things that have kind of come and gone in waves. The reason for that is that we certainly would like to reconstruct every breast that we can at the time of surgery so that when you do wake up cosmetically, it’s more pleasing to you; you feel whole again and women are a lot happier if they have immediate breast reconstruction. The problems that we face and have to make a decision on each individual basis is to whether a patient is eligible for that has to do with the size of the tumor, whether they’re going to need chemotherapy and radiation therapy afterwards; as well as whether it’s moved into the lymph nodes or not. Our problem is that if we reconstruct a breast immediately and we have to radiate that area, then we can either lose a breast flap or contract a breast implant capsule. There are a couple different types of breast reconstructions and one of those is a saline implant and the other is a flap reconstruction. Certainly, if a woman would like to have her own tissue there, then we’re able to do a tummy tuck, so to speak, at the same time. We bring tissue up from the belly and place it up under the chest wall and it allows a woman to have actual live tissue up in the breast. The other option is to do the saline implants and they usually start with tissue expanders to expand that area. Both of those can be done either immediately during surgery or, most commonly now, after they have undergone treatment for their breast cancer and are then ready to proceed.
Melanie: What do you tell women that ask you about the BRCA gene and prophylactic mastectomy?
Dr. Grove: I highly recommend that anybody that is under the age of 40 or who has a significant family history of breast cancer to undergo BRCA testing first. The studies are very definitive that prophylactic mastectomy in somebody who is BRCA positive is very worthwhile to at least consider. I don’t push anybody to absolutely have the bilateral mastectomy if they are BRCA positive but I certainly think that they need that information ahead of time. They’ve come a long way with gene testing and we can have the answer on the BRCA test fairly quickly now. You used to have to wait two or three weeks and now we can have it within a few days so that we can help make that decision prior to going to the operating room.
Melanie: What great information. in just the last few minutes, Dr. Grove, give women listening and the spouses that love them, your best advice and information – what you tell people every single day when they are considering breast surgery for a myriad of reasons.
Dr. Grove: The first thing I always want to reassure women about is that breast cancer used to be a death diagnosis. If you got it, you were not going to live from it. We very much have some good tools in the toolbox now and much less deformative surgery and much better options in order to treat breast cancer. Breast cancer, in my opinion, is a treatable disease and we do our best on every patient to go for a cure, if at all possible. I let them know that I’m going to be with them throughout the process. We have a medical oncologist and surgical oncologists. We have radiation oncologists. So, it’s a whole team approach to approaching breast cancer now. They certainly will not be alone on that path.
Melanie: Why should they come to Florida Hospital for their care?
Dr. Grove: Florida Hospital is a wonderful hospital. I think that they not only take care of the patient medically but spiritually and emotionally and offer that support. We have breast cancer navigators that are with the patient from the time that they go in for their biopsy through the time that they are in our office for follow up and all the way through their oncology follow ups. That person is with them and can answer questions and guide them through the process. I think it adds a lot to the patient experience and takes away a lot of the fear. Certainly, many hospitals can do a good job of taking care of the patient with the medical aspect but I think that we add that extra component to it.
Melanie: Thank you so much for being with us today. You’re listening to Health Chat by Florida Hospital. For more information you can go to fhsurgery.com. That’s fhsurgery.com. This is Melanie Cole. Thanks so much for listening.