3/26/2015 Breast For Drs Crash Course Karen Barbosa DO 1 Breast - - PDF document

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Breast For Drs Crash Course

Karen Barbosa DO

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Breast Dz

Not all masses are Cancer

Cysts, fibroadenomas, dense tissue, abscess

Cysts Fibroadenomas Dense tissue Abscesses

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Mammograms save Lives

Standard of care Radiation What age? What about Ultra Sound?

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Ultra Sound

Operator dependant Poor tech then poor image Artifact Focal point set wrong Incomplete evaluation one plane only Poor machine poor image Labeling image poorly

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Breast MRI (bMRI) is NOT the Holy Grail

Very sensitive unnecessary biopsies

• r surgery

Not good screening test for the average risk person No cookie cutter answers

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Breast MRI (bMRI)

High risk pts Pts with Breast Cancer BRAC 1 / 2 Discordant results on imaging NOT screening NOT routine wk up

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Dedicated Breast Radiologist

Everyone has a center, but who works there? CAD??? Does your Dr know how to drive that machine?

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Know your risks!

What in my family history is or is not important 10-20% of imaging can miss cancer Sadly, many Breast Surgeons won’t see a person until they have cancer Don’t wait! Dentist principle

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Excerise

4 hrs cardio reduces risk by 30-40% Most take meds for lesser numbers Other advantages

stress reliever sleep better cardio protective reduce risk of other cancers*

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Breast Specialist

Do your homework! Dedicated Breast Surgeon? What conferences? Societies? What % of practice is Breast?

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When in Doubt check it out

Lump Breast pain Rash Color change

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Don’t be rushed into the OR

Fear factor Perspective

2-3 weeks vs 5-10 years

“Years for cancer to grow” Get a second opinion

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Education = Empowerment

Ask questions Be your own advocate Fight for quality Health care Share your knowlegde

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What’s New in Surgery?

Oncoplasty The fusion of cancer=onco & plastics=plasty Better cancer surgery that yeilds better cosmetic results

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Oncoplasty

It’s not new its been in Europe for yrs New concept to the US Several courses taught each yr Training for plastic surgeons as well as breast surgeons The marriage of two types of surgeries…better pt cosmesis

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Why do we need a change ?

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Present Plan

1.Lumpectomy 2.Radiation 3.Send to Plastic Surgeon

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Left Immediate Reconstruction Right Reduction Mammoplasty

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Right Immediate Implant with Left Mastopexy

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Bilateral Immediate Saline Implant

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BRCA 2 Gene Carrier Bilateral Mastectomy

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Conclusion:

• Interdisciplinary Cooperation and

detailed Discussion of the patient’s care plan BEFORE definitive tumor ablation:

• improves patient outcomes; and
• reduces invasiveness and number of

surgical interventions

• Avoids unnecessary complications