Being diagnosed of having cancer is in and of itself ominous, but when it comes to breast cancer, specifically for women it is not just life and death, psychological factors like self-identity and esteem are just as important.

In the U.S., more than 250,000 new cases of breast cancer are expected in 2020, according to the National Cancer Institute. Oncoplastic surgeons at Baystate Health are working closely to address the impact cancer will have on womens physical health and their psychological well being.

Baystate Breast Surgical Oncology and Breast Specialist Danielle Lipoff knew she wanted to dedicate her life to oncology at just 14 years old after seeing a surgical procedure on TV.

Oncology is the study of cancer. An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. The field of oncology has three major areas: medical, surgical and radiation. Lipoff chose the surgical aspect.

I was like, yeah, thats going to do. I want to go to med school and thats what I want to do, said Lipoff. I spent a long time trying to talk myself out of surgery, trying to talk myself out of breast care just to make sure.

Lipoff was part of a multidisciplinary tumor board at Massachusetts General Hospital shortly after she finished grad school, that looked at the Suppression of Ovarian Function (SOFT) and Tamoxifen and Exemestane Trial (TEXT).

SOFT was designed to determine the value of adding ovarian suppression to tamoxifen and to determine the role of the aromatase inhibitor exemestane plus ovarian suppression.

TEXT was designed to determine the value of exemestane as compared with tamoxifen in women treated with ovarian suppression.

The two clinical trials dictated practices on cancer care that are now used, Lipoff told MassLive.

Performed at Baystate Medical Center in Springfield, oncoplastic surgery is a combination of cancer surgery and plastic surgery that removes the part of the breast that has cancer in an attempt to preserve the physical appearance of a womans natural shape pre-operation. It is done in one surgical procedure.

Using advanced radiologic imaging, surgeons are able to locate cancerous tumors and make more precise incisions and to remove the cancer in its entirety with minimal disturbance to the surrounding tissue.

In the U.S., breast cancer is the most common cancer for both men and women. There are 279,100 new cases expected in the U.S. in 2020, according to the National Cancer Institute. The next most common cancers are lung cancer and prostate cancer.

Survival from breast cancer has significantly improved and the potential late effects of treatment and the impact on the quality of life have become increasingly important.

Oncoplastic surgery began in the early to mid-1980s, mostly by European and American surgeons and is considered a major advancement for women with breast cancer. The process involves planning the lumpectomy and immediate reconstruction together. It may involve operating on both breasts, including one that may not have cancer, to make the two breasts symmetrical.

Baystate Medical Center Surgical Oncology and Breast Specialist Danielle Lipoff works in partnership with Plastic and Reconstructive Surgeon William Collins to perform oncoplastic surgery on women that have suffered from breast cancer. (Douglas Hook / MassLive)

Lumpectomy is a surgical operation in which a lump is removed from the breast, typically when cancer is present but has not spread.

Five percent of breast cancers are genetically related. They are related to genetic mutation. One of the biggest risk factors within breast cancer is family history, said Lipoff. So, thats definitely part of the conversation we have when patients come in. How many family members have been diagnosed with breast cancer and ovarian cancer with both connected to genetic mutations.

The genes most commonly affected in hereditary breast and ovarian cancer are the breast cancer 1 and breast cancer 2 genes. About 3% of breast cancers, about 7,500 women per year, and 10% of ovarian cancers, roughly 2,000 women per year, result from inherited mutations in the BRCA1 and BRCA2 genes, according to the Centers for Disease Control and Prevention.

Lipoff told MassLive that the genetic tests that are done now are completely different from five years ago. Doctors across the world are learning about new mutations connected to breast cancers almost every day.

The right surgery will depend on many factors: the size and location of the cancer, how advanced the cancer is, whether the cancer has spread and whether genetic testing indicates BRCA1 or BRCA2 or other genetic mutations.

Hollywood film star Angelina Jolie announced six years ago that she had undergone a double mastectomy because she carries a genetic mutation that greatly increases her risk of potentially fatal breast cancer.

Jolie said she began the process to have both of her breasts removed in early 2013 because she lost her mother, actress Marcheline Bertrand, to ovarian cancer when her mother was just 56.

At Baystate Medical Center, Surgical Oncology and Breast Specialist Danielle Lipoff and Plastic and Reconstructive Surgeon William Collins work closely together to discuss breast-conserving surgery. (Todd Lajoie)

Theres no other diagnosis like breast cancer that can affect a womans sense of self, said Lipoff. Theres that conversation that all starts with the patients in regard to how they feel about the size and shape of their breasts. How does it connect to their sense of self their sexuality and their sensuality.

Not every mutation results in a patient having to go through the harrowing surgical procedure of a mastectomy. Oncoplastic surgery involves saving more of a womans breast tissue, with the aim of a better cosmetic outcome. After the surgeon completely removes cancerous tissue, the plastic surgeon then reshapes or reconstructs the remaining breast tissue to achieve a more natural look without using implants.

This kind of breast surgery allows women to keep much of their breasts. The type and extent of surgery are based on the size of the breast, the size of the mass and the type of cancer.

If they do opt to go to implant reconstruction, then it becomes they see themselves out of the corner of their eye and they dont remember they have the breast cancer anymore because they look like themselves, Lipoff said.

She added that ultimately the surgery cant recreate a breast with the same sensation and feel it had before, but the surgery does attempt to give the best sense of self that is available.

Any cancer diagnosis is going to be a significant hit on the patients psyche one way or the other, said Lipoff. Everybody deals with it differently. But we do know quality of life is improved with breast conservation. [Womens] sense of self, sexuality [and] sensuality is improved with breast conservation. Most of our patients retain all sensitivity within the nipple and skin with breast conservation, so to be able to provide that is significant.

Breast surgery scars have shown to significantly impact a womans psychological and emotional recovery and quality of life after surgery because scars can have a large impact on a womans self-confidence, intimacy, and body image. All Baystate Health breast surgeons are hidden scar trained and certified, according to Lipoff.

When women come to the hospital, they will undergo a series of meetings with not only doctors to better understand their condition and what can be done to address the concern itself, but also social.

Baystate Medical Center Plastic Surgeon William Collins works in partnership with Breast Surgeon Danielle Lipoff to perform oncoplastic surgery on women that have suffered from breast cancer. (Douglas Hook / MassLive)

When conducting our visit and we have our meeting, I am trying to get a sense of what their goals are and then we work through the reconstructive process in a way that helps them approach [and] achieve those goals in terms of size symmetry and shape, said Baystate Plastic and Reconstructive Surgeon William Collins.

Collins studied for five years in general surgery and then went on to plastic surgery. He told MassLive, the combination of anatomy, oncology and long-term relationships with patients attracted Collins to the role.

The Baystate doctors emphasized the phycological impact the diagnosis can have for women when they come to the hospital and that this surgery can be as effective at fighting cancer and as an added plus, gives women more options.

We know that, if the full plan is put together, breast conservation and mastectomys overall survival for breast cancer is exactly the same, Lipoff said, emphasizing that she always looks to preserve the breast first and foremost. Then it becomes a patient choice as to whether they want it to be breast conservation versus mastectomy.

Lipoff explained that there are different levels of reconstruction. There are smaller on the oncoplastic techniques where she can rearrange breast tissue to put together the deficit from other tissue removed to leave a good symmetry.

I cant always do that, Lipoff said. Sometimes its a larger cancer and thats when I call on my colleagues and plastic surgical department to assist.

The plastic surgery essentially combines the emphasis on reconstruction with the secondary goal of preserving the patients appearance and optimizing breast shape symmetry, Collins added. The ultimate goal is to remove the cancer.

At Baystate Medical Center, Surgical Oncology and Breast Specialist Danielle Lipoff and Plastic and Reconstructive Surgeon William Collins work closely together to discuss breast-conserving surgery. (Todd Lajoie)

It is of the utmost importance for Lipoff and Collins' departments to work harmoniously to coordinate treatment for patients' specific cases and needs. Collins added that he and Lipoff are in constant communication.

No two surgeries are the same. Each patient is unique because diagnosis differs from the next.

Every reconstructive and oncoplastic operation is tailored to each patient, said Collins. Thats what makes it exciting. Every day is a new challenge. Its very gratifying to help these people during this time.

For Collins and Lipoff, it isnt just about the glamour of being a surgeon. Both Lipoff and Collins follow their patients' post-surgery to monitor their progress. Collins told MassLive that he develops really meaningful relationships that are incredibly gratifying and fulfilling.

Even the most challenging days makes you excited to come to work, Collins said.

Baystate Health has produced a free virtual Breast Health Series during Breast Cancer Awareness Month, which viewers can participate in from the comforts of their own homes that started on Oct. 14.

Collins and Lipoff will be speaking on their work at the hospital on Oct. 21 in the lecture called The Restorative Breast Collaboration. The link is available at the Baystate Health website along with the virtual Breast Health Series.

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Read more:
Beyond just surviving: Cancer and plastic surgery team at Baystate Medical Center healing both body and self- - MassLive.com

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