Scott Webb (Host): A diagnosis of breast cancer is a frightening one for patients, but between surgical advances, targeted radiation therapy, and the multidisciplinary approach to patient care at Franciscan Health; there's never been more reason for optimism. And joining me to share her expertise and optimism today is Dr. Constanze Rayhrer. She's a Board Certified General Surgeon specializing in breast surgery at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, I appreciate your time today. We're going to talk about breast cancer surgery options, and I've got a bunch of questions for you. So I just want to start here. When a woman has had imaging that revealed a lump in the breast, whether that was through ultrasound, mammogram, MRI, whatever it was, what are the next steps?

Constanze Rayhrer, MD, FACS: Well, not every lump is something serious. So the next step is to define what the lump is. Most of the time, imaging abnormalities turn out to be non cancerous, but we never want to miss the cancerous imaging abnormalities. So the next step is usually to get a tissue biopsy and that can usually be done minimally invasively by numbing the breast and getting a needle sample of the area to determine what it is.

Host: Okay. So just sort of jumping ahead just a little bit here. If it turns out that a woman needs breast cancer surgery, and I'm sure we've all heard of lumpectomy and mastectomy, and maybe we know what those things are, but it's good to have an expert here. So what are each of those? And when or under what circumstances would a woman choose one or the other?

Constanze Rayhrer, MD, FACS: Most women today, because of the great advances we've had in breast cancer management over the last 20 years, most women do have the option of lumpectomy. We consider lumpectomy breast conservation, and we remove the area with the tumor in it with a little rim of normal tissue around it to make sure we got everything.

And then we determine what other treatments are needed afterwards to prevent it from coming back. So a lumpectomy, means just removing the tumor itself, preserving the breast, and it can be done very cosmetically. So that is an option today for most women. That's outpatient surgery; so minimal surgery, minimal impact on the body.

Mastectomy can be a woman's choice to choose that instead, and in rare circumstances it's what's required. And that means removing the breast mound, the breast tissue, and can be coupled with reconstruction.

Host: Yeah. So, doctor, when you think about lymph nodes and whether or not they've been affected by breast cancer and whether the breast cancer has spread, is that something that a patient would know or does it really need to be diagnosed by someone like yourself?

Constanze Rayhrer, MD, FACS: Our first step is to examine the lymph nodes in the area with imaging. Often it looks fine, but we still prove during surgery whether the lymph nodes are involved or not, and usually that's by removing a single lymph node called a sentinel node from the armpit. That's 20 years, so we usually don't have to remove a group of lymph nodes for women, minimizing the amount of surgery, and we send a single lymph node to the laboratory for the pathologist to examine for us.

Host: Yeah, let's talk a little bit more about surgery and what patients can expect, what women can expect. Generally, you know, yes, of course, we've talked about lumpectomy, mastectomy, but regardless, when we think about the surgery and just the basics. What can folks expect?

Constanze Rayhrer, MD, FACS: So most of the breast cancer surgeries that we do are outpatient now. So you come in in the morning and then you have your surgery, which usually is less than two hours. Women are all the way asleep for the surgery, and then you're able to go home. And then the surgeon follows up with you in the next week and makes sure that everything is healing fine.

 Mastectomy surgeries, usually women stay overnight, but there is a lot of difference in the type of surgery than say 20 years ago. So, most people are able to shower the next day, use their arm, wear a bra and go on about whatever they would like to do in a few days after surgery.

Host: Yeah, I was going to ask you about recovery and, and just generally speaking, like the recovery time and you know, how soon before women can get back to daily activities, as you say, but it sounds like it's pretty quick.

Constanze Rayhrer, MD, FACS: For a lumpectomy, it is pretty quick. Fortunately, one of our goals is to try to minimize the impact on our lifestyle of the management of the breast cancer. And get people back to normal as soon as we can. And our ability to reduce the amount of surgery over the years has really been a powerful way to keep from interrupting people's lives and give them the best treatment possible.

Host: Yeah, and you touched a little bit earlier on reconstruction and reconstructive surgery. So what does that entail? And is that covered by insurance?

Constanze Rayhrer, MD, FACS: So, any reconstruction is covered by insurance, that's mandated by law, and a lot of people do have that worry. But all insurance companies have to cover the reconstruction. Depending on the type of reconstruction, I would usually couple with a plastic surgeon, and we work together. The plastic surgeons that we have, have several options for reconstruction, so it's a full conversation beforehand and it really depends on what the woman's choice is for the type of reconstruction.

There's so many different varieties and so that really affords us the opportunity to customize our surgical management and the reconstruction to each woman individually.

Host: Yeah, really patient centered, as you say, the women's choice, lots of choices, lots of options anyway, so yeah, conversations beforehand, and you've given us a sense a little bit about the recovery time and so forth, and you know, uh, Doctor, it seemed like back in the old days, you know, I'm 56, but it seemed like anytime you heard the word cancer, that immediately and automatically involved chemotherapy, radiation therapy, that kind of thing.

Is that something that breast cancer patients also have to go through? Is that just pretty standard?

Constanze Rayhrer, MD, FACS: So that again, is something we can really customize today. All that money that went into research and breast cancer research over the years has really come back to help us. So we have developed really specific testing for each woman, even before the surgery. What the woman needs afterwards, as far as radiation and chemotherapy, really depends on her individual cancer.

So it's a pretty large discussion and a lot of testing beforehand, but in that way, the management of breast cancer is really ahead of the management of many other cancers because we've benefited from all that energy, all those donations that went into breast cancer research.

 With a lumpectomy, a lot of women will have radiation. And the radiation you can think of it a little bit like having the surgery. It's focused at the area where the tumor was, not to the whole body. And we begin that usually about a month after the surgery. It's very doable. The methodology of the radiation has really evolved over the last, even five years.

And it's quite remarkable what we can do with less today. Chemotherapy, we reserve for the more aggressive cancers and not everybody needs that. A lot of women are fine without chemotherapy. They're not candidates necessarily, but when a woman needs it, we have also had a lot of advancements with chemotherapy.

Chemotherapy is medication that is given intravenously and protects the entire body. It's not focused like the radiation therapy. So when someone needs that protection of their entire body, we'll often give the chemotherapy before surgery, minimize the amount of surgery we can do. And it's also very specific to the individual and customized for them.

Host: No one ever wants cancer, of course, but where we're living here today in 2025, perhaps there's never been more room for optimism for cancer patients. Am I hearing that right?

Constanze Rayhrer, MD, FACS: Oh, you definitely are. Even our statistics are changing as far as when we look at the staging is, are we stage 1, 2, 3, 4 with our breast cancers? But the statistics as far as how well people do in each

is really beginning to evolve. Our therapies have gotten so much better over the years. It's really exciting.

Host: Yeah, it's amazing. Just want to give you a chance here at the end, Doctor, final thoughts, takeaways, when we think about breast cancer surgery and the options and the patient centered care with Franciscan Health. What are your final thoughts?

Constanze Rayhrer, MD, FACS: I think Franciscan Health is really unique in that it has set up for us a really beautiful collaborative effort between different specialists. It's a team. And when a woman comes into Franciscan, she gets this incredible team that is on the edge of technology. We have everything available, state of the art, and there's so much we can do.

Breast cancer is such a frightening diagnosis, but it doesn't have to be anymore. And I think Franciscan has really developed a nice venue for people to come and get their care.

Host: Yeah, as you say, multidisciplinary seems to be the buzz term in medicine, but it means so much to patients, and their families to have those teams of experts consulting with them, working with them, helping them, saving them, all that good stuff. So thank you so much.

Constanze Rayhrer, MD, FACS: Thank you.

Host: And to learn more about breast cancer treatment at Franciscan Health, visit franciscanhealth.org/breastcancercare.

And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.