Disclosure :: this post is sponsored by Crescent City Physicians, Inc.
When a woman is diagnosed with breast cancer, it is very important for her to be educated on ALL of her surgical treatment options. Typically, a woman has two options:
Option 1 – “breast conservation” – a lumpectomy followed by radiation therapy. A lumpectomy involves removing the tumor with a healthy rim of normal, non-cancerous tissue around the tumor. Again, when a lumpectomy is chosen, the patient must undergo radiation therapy.
Option 2 – a mastectomy, removal of all of the breast tissue (often times without radiation). There are different types of mastectomy – traditional, skin sparing, and nipple sparing. After a mastectomy, a woman is a candidate for reconstructive surgery – either her own tissue or implant-based reconstruction. Often when a mastectomy is performed radiation can be omitted. However, if a patient has a tumor larger than 5 cm or multiple lymph nodes that are involved, radiation is prescribed after a mastectomy. It is crucial for a patient to understand that option 1 (breast conservation) and option 2 (mastectomy) are completely equivalent in terms of recurrence and long term survival. Some patients think that if they have the more aggressive surgery (i.e. mastectomy) it will translate into better long term survival and decrease recurrence. This is completely untrue. As a breast surgical oncologist, my job is to educate patients on these two options and help them choose the correct type of surgery that they desire.
Breast Conservation (Lumpectomy) for Breast Carcinoma
For decades, lumpectomies have been performed to remove breast cancer. Often breast cancers are not palpable. That is really the purpose of a mammogram – to detect small cancers before they become large and palpable. As a result, the surgeon must have assistance in locating the breast cancer and removing it with healthy normal tissue around the cancer. Thus, with the advent of routine mammography, breast cancers were being discovered that could not be felt by a surgeon. If a surgeon is unable to feel a breast cancer, how can it be removed?
Lumpectomies have traditionally been performed by inserting a metal wire into a woman’s breast. Traditionally, the morning of surgery, the patient will undergo a “localization” of her cancer under either ultrasound or mammographic guidance; a breast radiologist will insert a wire directly into the cancer. The surgeon will use the guidewire as a reference point for removing the cancer.
I am pleased to report that the barbarism of impaling a woman’s breast with a wire prior to a very emotional surgery is over. I am excited to report that in my practice, I no longer use wires to localize small, non-palpable breast cancers. My patients are no longer traumatized the morning of surgery with a wire hanging out of their breast. Those days are long gone.
Radioactive Seed Lumpectomy
For many years now, the major cancer centers across the United States no longer use guidewires when performing a lumpectomy. Instead, a tiny 5 millimeter radioactive seed the size of a grain of rice is used to locate the cancer and remove it. These seeds are deployed the day before surgery. Under ultrasound or mammographic guidance, a tiny seed is placed directly into the cancer. The radioactive seed itself does not eradicate the cancer. Instead, the seed emits a low level radioactive signal that is detected with a special probe in the operating room. The signal that is emitted is completely safe to the patient, family members, and health care workers. During surgery, I use the probe to detect a signal from the seed. This allows for maximum precision. I am able to map out my dissection of the tumor before even making an incision. The seed allows for constant feedback regarding 3-D spatial relationships and depth analysis; this translates into only removing essential tissue which means improved cosmetic outcomes.
The seed also allows for more efficient use of time in the operating room. With the wire, the localization occurs the morning of surgery with a surgery start time of 10-11 AM. With the seed, localization occurs the afternoon before surgery, uncoupling the radiological procedure from the operating room procedure. With a 7 AM start time, the remainder of the operating room can flow more harmoniously as opposed to a mid-morning start time. This saves health care dollars. Also, a fasting patient would much rather have surgery at 7 AM then at 10-11 AM.
Since implementing radioactive seeds into my practice, I have been very pleased with the results. I am able to achieve precise, clear margins with excellent cosmetic results. This allows for a woman to preserve her natural breasts.
Radioactive seed lumpectomy is the progressive forefront of breast surgical oncology. I am pleased to be able to offer this fantastic technological advancement in breast cancer care to the people of New Orleans and the Gulf South Region. I am proud to say that I am the first surgical oncologist in the Gulf South performing this procedure. It is a privilege to care for women with breast cancer. I never forget this. I will continue to strive for excellence in the care of New Orleanians with breast cancer.
About Dr. Colfry
Dr. Alfred John Colfry, III is a fellowship-trained breast surgical oncologist with Crescent City Physicians, Inc since 2015. Dr. Colfry attended medical school at Louisiana State University Health Sciences Center in Shreveport, LA. He then completed his residency in General Surgery at Atlanta Medical Center in Atlanta, GA and a fellowship in Breast Surgical Oncology at the prestigious University of Texas MD Anderson Cancer Center in Houston, TX. Dr. Colfry is one of the few physicians in Louisiana who specializes in radioactive seed localized lumpectomy. In addition to this state of the art technique, Dr. Colfry treats breast cancer using traditional methods, performs oncoplastic surgery, and manages benign breast disease as well as high-risk breast cancer patients. Dr. Colfry is Board Certified by the American Board of Surgery. His office is located at 3434 Prytania Street, Suite 320, NOLA 70115 and he can be reached at (504) 897-7142.