After mastectomy surgery, women with breast cancer are faced with many types of scars.
With every glance in the mirror, the physical scarring left after surgery serves as a constant reminder of their battle with the disease—creating emotional scars in its wake.
However, advances in surgical techniques have given surgeons the tools to rebuild the breast in such a way that these scars have less chance to form.
At Indiana University School of Medicine, the Department of Surgery is working to help stop some of the most common issues related to care after breast cancer surgery, such as scarring, breast reconstruction, and prevention of lymphedema (chronic swelling caused by the removal of lymph nodes).
“We’ve made many advancements in the care of breast cancer. Because of this, there are many options which can sometimes feel overwhelming,” said Carla S. Fisher, MD, an associate professor with the Department of Surgery and a member of the Indiana University Melvin and Bren Simon Cancer Center. “I think it is important for each patient to take the time to understand his or her options and also feel comfortable with the providers.”
Providing Hoosiers care
In the Indianapolis area, IU School of Medicine surgeons care for patients at IU Health University Hospital, Riley Hospital for Children, Richard L. Roudebush VA Medical Center, Eskenazi Health, and IU Health Methodist Hospital.
“As the busiest IU Health site, we see more than 200 breast cancer patients a year here at the IU North Hospital location. But across the board, we probably see 500 to 600 patients,” said Kandice K. Ludwig, MD, assistant professor of clinical surgery and a member of the Indiana University Melvin and Bren Simon Cancer Center.
Ludwig explained that the expertise of IU School of Medicine breast and plastic surgeons allows them to offer patients the best options in terms of improving cosmetics after their breast surgery. Many IU School of Medicine faculty surgeons have been trained in hidden scar surgery—a procedure in which incisions are made in areas that patients can’t see. Additionally, IU School of Medicine plastic surgeons offer all forms of complex reconstruction, including direct to implant reconstruction and autologous flaps.
Many patients who require surgery for the lymph nodes located beneath the armpit are at risk of developing swelling in the arms, known as lymphedema. Depending on the type of surgery, the risk of lymphedema can range from 5 to 20 percent. Lymphedema is usually managed with compression garments, physical therapy, massage, and exercise. For many patients, lymphedema is chronic and lifelong.
However, IU School of Medicine plastic surgeons and general surgeons are working on a newer surgical technique that can help prevent lymphedema.
“One of the procedures that we do with our plastic surgery counterparts for many of our breast cancer patients who need a lymph node dissection is a LYMPHA,” said Ludwig.
Ludwig explained that LYMPHA is an innovative microsurgical technique where blocked lymphatic vessels are drained into the blood circulation by surgically creating a bypass between a lymphatic passage and a blood vessel called a lymphatic-venous bypass. Recently, LYMPHA has been shown to prevent lymphedema when performed at the time of nodal dissection. This is a unique surgery, as it’s only performed in a handful of places.
Foundations for success
General surgery residents at the IU School of Medicine benefit from a wide range of clinical experience. They receive specialized surgical training in breast cancer with up-to-date surgical techniques with more comprehensive training and education.
“Our residents are exposed to breast surgery over approximately three years, which allows a nice level of exposure to breast surgery. During that time, they see increasingly complicated aspects of breast cancer care,” said Fisher, adding that residents also spend time during office visits, providing a well-rounded experience.
“They’re going to spend a lot of time in the operating room learning those procedures, but they also spend a lot of time in clinic with us as well.”
According to Ludwig, the department’s dedication to providing young doctors with top-notch education will be expanding beyond residency.
“In Summer 2020, the Department of Surgery is proud to start the first breast surgery fellowship,” said Ludwig. “The curriculum allows the fellow exposure to all aspects of multidisciplinary breast care, and not only does the fellow have rotations in breast surgery, medical and radiation oncology, and breast imaging, they will also spend time in cancer genetics, pathology, rehabilitation, and plastic surgery.”
For Ludwig, and the other surgeons treating patients battling breast cancer, October serves as only a reminder of the fight that’s waged year-round.
“What I always tell people is that even though Breast Cancer Awareness Month is in October, we live it 12 months a year,” explained Ludwig. “So it’s a great time to encourage people if they haven’t had their mammogram this year to go get it done. Talk to their family members about their family history of cancer. While October is a great time to talk about these things, don’t forget about it the other 11 months of the year—breast cancer doesn’t care what someone may have planned.”