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Amanda Wilde (Host): One-on-One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health.

Today, we're talking with Dr. Ashley Hendrix, breast surgical oncologist at Regional One Health Cancer Care. We'll talk about surgical options and what patients can expect in terms of preparation, the procedure itself and recovery. Welcome, Dr. Hendrix.

Dr Ashley Hendrix: Thanks so much for having me today.

Amanda Wilde (Host): Well, start us off where you start off with a patient. When someone comes to you with a breast cancer diagnosis, what can they expect during that first appointment?

Dr Ashley Hendrix: So, the first meeting is a lot of getting to know you as well as explanation of a path report. So going through line by line the elements of it, so that the patient understands exactly the biology of their disease.

When it comes to breast cancer care, surgical as well as systemic care, it's a multidisciplinary care. Oftentimes, the surgeon is the first step. And so, I talk about not just the surgical options, but the expectations of some other therapies they may receive, that surgery may have a decision-making plan in. We'll sit down, we'll go through all those things. We'll talk about what's important to the patient, what's important in their care, but also how to marry what we need to do for their cancer care with what their desires are.

Amanda Wilde (Host): And how do you determine what their desires are? I know those first meetings and getting the path report can just be overwhelming and very emotional. So how do you approach that side of patient care?

Dr Ashley Hendrix: We'll go through their imaging and how this was found, the amount of disease that has to be removed, the options between removing just the disease with a normal area of tissue around, which is called breast conservation, or lumpectomy, or a partial mastectomy depending on where you train and what part of the country you're in, versus the removal of the entire breast, and if that's necessary based on their disease or the patient desires as far as the additional therapies we would recommend.

Amanda Wilde (Host): So how do you determine what is best for each patient? I hear you're listening to the patient too, but some cancers probably are more aggressive than others. That must change what you might recommend.

Dr Ashley Hendrix: So the biology of cancer when it comes to surgery as far as the aggressiveness often comes into play with their systemic therapy that they'll be recommended. When it comes to surgical decisions, it depends on how much disease, so how much cancer is within their breast, as well as what's their genetic risk, and so taking a really detailed family history. And for those patients that need genetic testing, their genetic predisposition may determine their cancer care, but it really comes down to the amount of disease relative to the patient's breast size that would be a disease-determining factor for surgical resection.

When it comes to someone who has the option for both, either a lumpectomy or a mastectomy, that comes down to a shared decision-making between myself and them as far as what they're most comfortable with in terms of do they want to have or not want to have radiation, how comfortable do they feel getting mammograms following up long-term.

Some women choose mastectomy because the adjuvant care for radiation or followup is not something that they emotionally or physically want to undergo in the future. We know for people who have disease that can be resected with a lumpectomy, but also with a mastectomy. Their outcomes are equal when it comes to the surgical outcomes from that perspective and where their systemic outcome changes comes down to the biology and the adjuvant therapy that they'd be recommended systemically.

Amanda Wilde (Host): So, what can a patient expect then in terms of preparing for one of these procedures, the surgery itself and recovery from these different procedures?

Dr Ashley Hendrix: Sure. For patients who undergo breast conservation, it's a small procedure in comparison to a mastectomy, and that there is a smaller amount of tissue that is resected. They always go home same day after that procedure unless they have some kind of anesthetic complication with nausea or overt sleepiness. They expect to be up moving around the next day. recovery for that takes about two weeks. Patients who work a job where they're going into an office, they do a lot of computer work, I'll often tell them, "Take the weekend," and they oftentimes go back to work the next week. Patients who have a more active job or more active lifestyle as far as activities outside of work, I'll tell them that really no vigorous activity for about two weeks to allow healing process.

Amanda Wilde (Host): So that seems like a minimal recovery time. For some patients though, it's more complicated than just one surgery. So, how do you help those patients? You alluded to when we began that you also help through like radiation and other forms of treatment. How do you help those patients who need those procedures?

Dr Ashley Hendrix: With mastectomy, which is what I assume you mean by more aggressive surgery, more additional surgery, so when you're removing the entire breast, we use a combination of multimodal pain control with anesthetic preoperative blocks that allow patients to be more comfortable afterwards. So to be honest, their recoveries are much better than they were three to five years ago. People are up moving around the same day. They feel fairly well. A lot of patients after mastectomy will even go home the same day, depending on what time their surgery was in the day. They do have a drain associated with it, and so they're a little bit less mobile than our patients who are undergoing breast conservation. So oftentimes, we'll have the drain somewhere between one to two weeks. So that keeps them out of doing activities.

Most of the time, I tell patients for mastectomy with or without reconstruction and some of that reconstruction planning and restrictions are very plastic surgeon-dependent, they'll be out of vigorous activity from somewhere over four to six weeks. Then, after surgery, in that recovery process, they do have to undergo radiation. Patients actually can work and do normal activities during radiation. It's something that can be fatiguing towards the end of therapy. But the actual day to day, the daily treatment, they can still do the normal activities, they can still work. Oftentimes, they're able to exercise and do their kind of normal activities.

Amanda Wilde (Host): When you're doing a lumpectomy or mastectomy, patients who want reconstructive surgery, are there different procedures you have to do to prepare them for that further surgery rather than those who don't want reconstructive surgery?

Dr Ashley Hendrix: Yes. So in looking at patients and they're undergoing lumpectomy or mastectomy, oftentimes I'm talking about reconstruction and considering it as an option in the very first meeting. So patients who have very large breasts who may have wanted at some point to be smaller can often undergo what we call an oncoplastic reduction at the same time with their lumpectomy or patients where there might be a size difference between the breast after resection of the cancer, an oncoplastic reduction is a really good option for them.

The oncoplastic reduction surgery is very similar to a breast reduction or a mastopexy. They have a very same feel, a very same recovery process, versus reconstruction after a mastectomy, which oftentimes is a multi-step procedure. Whether it be with a temporary implant and then to a permanent or a permanent implant with some finesse fat grafting later or soft tissue rearrangement with their own tissue, and then potentially additional procedures later for fine tuning. It's about understanding the patient's desires, their desires to heal emotionally after their cancer from any surgical perspective and how they themselves want to feel about themselves afterwards.

The only hard and fast contraindication to reconstructive surgery is smoking and uncontrolled diabetes. So from that perspective, everything else is about what the patient desires and what's physically capable.

Amanda Wilde (Host): Well, it sounds like things have advanced significantly in the last 10 or 12 years, both in imaging so that you can see the cancer earlier, possibly catch it earlier. There are more reconstructive options. There's more talk about options not to reconstruct. So just looking toward the future, just wondering what is the future of surgical oncology treatment for breast cancer, do you think? Are you seeing advances in your field right now that you can bring to your patients?

Dr Ashley Hendrix: Yes, a lot of things have changed in the last 10 years. We are catching cancers at earlier and earlier stages, especially in patients who have dense breast. The thing that feels old now, but actually it's probably the newest, is something called tomosynthesis. That's a 3D mammography, and it's been proven to help to catch cancers in patients who have dense breast at much smaller sizes than traditional mammography. Traditional mammography, which now seems like old news, was actually pretty new, so in the last couple of decades, which is digital mammography from analog mammography. And so, digital's better than analog and tomosynthesis is better than digital. And so, we're seeing things at smaller stages. At smaller stages, it allows you to do less surgery and patients are able to do smaller procedures and have great outcomes.

Really, the systemic adjuvant therapy field is massively increasing at a rate that is very exciting from my perspective. I hope that it doesn't put me out of a job. But to be quite frank, if it does put me out of a job, I'm okay with that too. But women are living longer and longer, and I would love to say, it's all about surgery. But really, to be honest, it has a lot to do with their systemic options and their systemic therapy and how well patients respond to that.

Where my field may advance is really figuring out the patients and intervening for the patients where systemic therapy isn't going to work. And that's really exciting, to be able to realize that there's going to be a specific patient population that really is just a surgical patient population versus those who are really just going to be a systemic therapy option.

Amanda Wilde (Host): So really, more individualized options for treatment as we know more and more and as technology advances.

Dr Ashley Hendrix: Yes. I would like to say we're treating the biology of cancer now and not just because it's a cancer.

Amanda Wilde (Host): Well, thank you so much for this great information on what to expect with breast cancer treatment. It is a scary diagnosis, but then we more and more have ways to treat it early and just get more and more positive outcomes, and it looks like that that trend will continue into the future.

Dr Ashley Hendrix: Thank you so much for having me today. I appreciate getting to talk about this thing that I do all day, things that are exciting and things that I can really intervene on patient care with.

Amanda Wilde (Host): Thank you. It's great to know doctors like you are out there for people dealing with this diagnosis.

You can learn more about Regional One Health Cancer Care by visiting www.regionalonehealth/cancercare. For an appointment, call 901-515-9595. Thanks for making One-on-One with Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow. Until then, be well.