Michael R. Anderson, MD (Host): Hello, everybody. And welcome to this episode of The Forecast. I'm your host, Dr. Michael Anderson, President and CEO of Fort Healthcare, and this is the official vodcast of Fort Healthcare. And with me today is a very special guest. We have Dr. Jamie Clementi. Dr. Clementi, welcome to The Forecast vodcast.

Jamie Clementi, MD: Hi. Thank you for having me today.

Host: Well, you are certainly welcomed on this Forecast episode and any future Forecast episodes as well. So for those that don't know, Dr. Clementi is a fellowship-trained breast surgeon here at Fort Healthcare. And Dr. Clementi, how long have you been with Fort Healthcare now?

Jamie Clementi, MD: It'll be two years this fall in October.

Host: Wow. You know, time flies. Now, Fort Healthcare has been around for over 80 years, and Fort Healthcare has never had a fellowship-trained breast surgeon. So Dr. Clementi, why don't we just start with just educate us a little bit on your educational process and what brought you to Fort Healthcare?

Jamie Clementi, MD: Yeah. So, starting with medical school, we do our medical school training. After medical school, every doctor does a residency training. For surgery, it's five years. I did five years of general surgery. So, that's everything inside the belly and out. And then, after that, I did an additional year of breast surgery training. So, that was specific to breast surgery, breast cancer, and benign breast disease. So, I went to Chicago for that.

Host: And I tell you, I think it's important for our patients community to know that fellowship training really makes you an expert's expert. And it's just wonderful to have you on our staff. It's wonderful to have you serving our wonderful community here. And I just can't thank you enough for all the great things that you do. So, thank you.

Jamie Clementi, MD: Yes, you're very welcome. I'm really happy to be at Fort. It truly is an amazing job. The opportunity that we have to provide general surgery in addition to specialized breast surgery in this very small, very close-knit community. You cannot find this in many places in the country, and I feel very lucky to be here.

Host: That is wonderful to hear. And I feel the same way. I mean, I've been practicing here for over 20 years now, but I haven't aged. I just feel like I haven't aged. I don't know. But anyway, I digress. So, let's talk a little bit about breast health. So Dr. Clementi, as a breast surgeon, when you are seeing patients in your office, what is typically the most common entity that you see or the top two things that you see when patients come to see you?

Jamie Clementi, MD: The top two would be changes on imaging, so that'd be number one, either on a mammogram or an ultrasound. They saw something different from prior, either new calcifications or a new we call it an asymmetry or just irregularity on the mammogram, or a palpable breast mass. So, that'd be the other finding.

So, I typically see patients, talk to them about their family history, any prior procedural history. We go over the imaging together. And then, I talk about the next step, which is a biopsy. And then, we go from there depending on the biopsy results.

Host: Okay. So, let me just take the breast mass, first and foremost, because I imagine that is fairly common, and I imagine it's pretty scary when anybody discovers a breast mass. So, take us through that. When you see somebody with a breast mass, new-onset breast mass, they usually make an appointment directly with you or do they come through their primary care physician?

Jamie Clementi, MD: Most often they come through their primary care physician. We like to get imaging beforehand so we can just have more information about the breast mass. And then, if there is no primary care physician though, we have an outpatient walk-in imaging through Fort Healthcare where we can help arrange imaging and be seen with me as well, so if there's any difficulties getting in.

Host: Yeah, no, that walk-in opportunity, it's a real big crowd-pleaser. That is so helpful to our patients. So when you see somebody with a new-onset breast mass, what are the typical symptoms that can go along with it?

Jamie Clementi, MD: Yes. So typically, the breast mass is just a new firm feeling in the breast, a new firm mass, typically not painful. Sometimes there might be some skin changes, some swelling, some nipple retraction, or just flattening of the nipple. And then, occasionally, there could be nipple discharge as well. So, a bloody, rusty nipple discharge. Some people have clear discharge or other color. So, I go over just different features of those findings and that discharge.

Host: So if a patient hasn't been imaged and you're seeing them with a new-onset breast mass, what sort of imaging studies do you pursue?

Jamie Clementi, MD: If I'm seeing them first, I do have an ultrasound in the office. I like to use that like my second set of eyes. It'll help me get some information to see if it's a solid-looking mass, is it a fluid-filled mass, something more like a cyst. But I always refer them for formal imaging, so that's a mammogram, where you go into compression and we take very specialized X-rays of the breast. Typically, there's an ultrasound as well, like a formalized ultrasound where we look at the entire mass, measure it, and have a specialized breast radiologist look at the imaging.

Host: You know, and that's fascinating that a lot of people don't realize that the imaging of the breast is so complicated that there's actually a radiology specialist that reads those breast studies.

Jamie Clementi, MD: There are specially trained radiologists that just look at breast imaging day in and day out

Host: So, take us through the most common differential. When somebody does have a breast mass and you do the diagnostic imaging workup, where does it usually take you? What are the most common entities that arise from that mass?

Jamie Clementi, MD: Yes. So, it could be a breast cancer. It could be a breast cyst, so just a benign non-cancerous fluid-filled cyst. It could be another mass that is not cancer called a fibroadenoma. That's just an overgrowth of breast tissue. Those are the three most common breast masses that we diagnose.

Host: ' So, you obviously have that conversation with them. If it's a cyst, can a cyst still be cancerous or is it mostly solid?

Jamie Clementi, MD: A cyst, a fluid-filled cyst is not cancerous. If there's any abnormal features, and I discuss those in detail, then we do pursue a biopsy and go and talk about those results.

Host: Okay. So, take us through that. So, you have a we'll just say a concerning mass, and you feel like it needs to be biopsied. Take us through that process. Like, how do you talk about it with the patient and then what proceeds from there?

Jamie Clementi, MD: So, once we've reviewed the imaging together, depending on, well, if we're dealing with a solid mass, we do an ultrasound-guided biopsy of a solid mass. So, that would be back in the radiology area. I discuss how I numb up the area, and then we take a special biopsy device that takes a couple tissue samples of that mass, and we send it off to pathology.

The recovery time from the biopsy is pretty quick. A lot of people go back to work the same day, although I'm always happy to tell them to take the day off. And it's a very small incision for the biopsy, and we usually get our results back in about 48 hours.

Host: So, that's a pretty fast turnaround. So if it's a non-cancerous,

lump, what treatment options are for that?

Jamie Clementi, MD: So if it's a non-cancerous lump and the woman is low risk, so again, I'm looking at all their family history, I use a risk calculator, then I say we can just observe it. We get a six-month ultrasound imaging, just make sure nothing's changing, and then another six months, and then we go back to our normal routine.

If the mass is painful, if it's bothersome, if for any reason it's causing anxiety, then I'm happy to excise the mass. So in the operating room, I would remove it, and that's a same-day surgery.

Host: If it's a cyst, if it's a benign cyst, what treatment options do you offer with that, Dr. Clementi.

Jamie Clementi, MD: Yes. So for a benign cyst, if it's small and not causing pain or a lot of discomfort with laying or movement, we can just leave them alone. If it is a big enough fluid-filled cyst, I can in the office drain it. So, I numb up the area, I use my ultrasound in the office and take the fluid off with a needle and syringe.

Host: So, it's just right there in the office, you can take care of it. That's pretty fantastic. The office ultrasound, it must be pretty helpful to have that.

Jamie Clementi, MD: One of my best friends. I love that ultrasound, so...

Host: Well, we all need our friends, right? And anything that helps us take care of our patients is a friend to me. After treatment, after somebody has an ex-excision, let's just say a person goes through removing the breast mass, which is benign or the cyst. What kind of recovery is that like if you have to take them to the operating room because they do have symptoms from the mass? Take us through that process.

Jamie Clementi, MD: So once the procedure is over, the same-day surgery, you do go home that night. I recommend expecting soreness and swelling for about three to five days after surgery, sometimes up to two weeks. We go home in a special surgical bra, and I recommend ice packs and anti-inflammatories. Usually, we can go back to exercising, swimming, all of our normal activities two weeks after surgery.

Host: How big is the risk of infection afterwards?

Jamie Clementi, MD: It's a small risk of infection. We do everything sterily in the operating room. And then, I cover it with a special dressing as well to prevent infection risk. But we always check within one week after surgery. You see me back in the office, and we make sure that there's no infection going on.

Host: Yeah. And that's so important. Anybody who operates, any surgeon is always at front of mind about surgical infection. So, happy to hear that the risk is quite, quite low. And for those that are wondering on this episode, breast cancer is a very large topic. And hopefully, we can have Dr. Clementi on again in the future to discuss breast cancer specifically. It is a topic worth its own episode. So today, we wanted to focus a little bit on the benign etiologies and the breast mass workup. So Dr. Clementi, I can't thank you enough, for being on this episode of the Forecast Vodcast.

Jamie Clementi, MD: Happy to be here. I know there's lots of questions about this. And yes, breast cancer is very nuanced, which is why I always set aside at least 45 minutes for a discussion. But I'm happy to answer any more questions. I know there's a lot of scare and concern, and every woman's treatment is different. It's individualized, and I'm happy to help them kind of navigate their way.

Host: Well, I know everybody who sees you, we get so much positive feedback, Dr. Clementi. I mean, your patients really, really enjoy seeing you under the most stressful conditions that a person can go through. So, thank you for taking such great care of your patients.

Jamie Clementi, MD: Oh, it's my pleasure. I did want to add too, because we're talking about Okay new updates too with breast. Wisconsin recently passed Gail's Law, where it is a change to insurance coverage and insurance mandates so that additional breast screening is covered for women with dense breast tissue. So, there's been a lot of discussion about women with dense breast tissue that's identified on their mammograms, and they have a lot of questions about that. What does that mean? Do I need more imaging?

At Fort, we offer screening breast MRIs. It's something that we've been working on here. And so, that's something I also see patients for. So, high-risk breast cancer screening and dense breast screening as well. So, any further questions about that, send anyone my way, I'm happy to talk about it

Host: Well, thank you for sharing that. Again, that's not something that's highlighted much at all and such an, an important initiative to cover that advanced screening and to be able to use the MRI for that I bet is quite helpful in evaluating the dense tissue.

Jamie Clementi, MD: Yes. Our radiology department, especially our breast radiology at Fort, is really special. And I would not be able to do as much work if we didn't have the support here in radiology. So, thank you, Dr. Anderson and the entire radiology department for prioritizing this. It really is remarkable.

Host: You are most ertainly welcome. I mean, just the cutting-edge work that you're doing, It is. We have to make sure we give you every resource to put you in a position of success and help those patients. So absolutely, I'm glad that you have it, I'm glad you're using it, and I'm glad patients are benefiting from it. That is so, so important.

Well, Dr. Clementi, thanks again for being on this episode of The Forecast. This is Dr. Michael Anderson. I'm going to say have a great rest of your day. Please share us on your social media channels, and please tune in to future vodcasts.