The Thursday, Sept. 29, webcast is approved for CME credit

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Women with breast cancer often seek immediate breast reconstruction after a mastectomy to help them regain a semblance of their body and for their psychological peace of mind.

One of the most often performed breast reconstruction surgical procedures, using muscle tissue from a patient’s back, will be demonstrated live on the Internet by surgeons at Thomas Jefferson University Hospital, in advance of Breast Cancer Awareness Month, which begins in October.

Jefferson surgeons who specialize in treating breast cancer will perform immediate breast reconstruction after mastectomy at 4:30 p.m. on Thursday,
September 29, in a webcast from Jefferson University Hospital. The webcast can be viewed at www.jeffersonhospital.org/webcast.

The 60-minute webcast will not only include the live reconstruction, but cover the entire medical path that a patient diagnosed with breast cancer takes during diagnosis and treatment, from an abnormal mammogram, MRI and other diagnostic imaging, to genetic testing and risk assessment, a biopsy, sentinel node biopsy and mastectomy, said breast surgeon Anne Rosenberg, M.D., clinical associate professor of Surgery, Jefferson Medical College of Thomas Jefferson University, Philadelphia.

“We want to present women with the latest and best options for diagnosing and treating breast cancer,” said Dr. Rosenberg. “This webcast will demonstrate simply and clearly what a patient can expect if she is diagnosed with breast cancer.”

Dr. Rosenberg will host the webcast with plastic surgeon Steven Copit, M.D., clinical assistant professor of Surgery, Jefferson, who will perform the reconstruction.

The Jefferson surgeons will demonstrate latissimus dorsi flap surgery, in which tissue, sometimes including underlying fat and muscle, is taken from the back and tunneled to create a breast mound to reconstruct the breast.

“So when the patient wakes up from surgery, there is a breast mound already in place and the patient is spared the experience of seeing herself with no breast at all, “said Dr. Copit. “It looks better [to the patient] and offers them a psychological advantage.”

Once the shell is in place, the plastic surgeon uses an expander, a balloon-like object, underneath the chest muscles. The expander is inflated to maintain the new breast’s shape until an implant-- a silicone or saline filled implant-- can be put in about three months later, Dr. Copit said.

“The patient is typically under general anesthesia for a total of four hours during both the mastectomy and reconstruction procedures.

Three months following the implant procedure, another procedure is performed to recreate the breast’s nipple, Dr Copit said. The surgeon reconstructs the nipple and areola with tissue from the reconstructed breast. Tattooing is added to complete the nipple and areola reconstruction.

Dr. Copit said that not every patient is a good candidate for breast reconstruction using back tissue; it depends, for one thing, on the amount of tissue available to recreate the breast.

The patient may be in the hospital for three to six days after surgery, and it may take three to four weeks for her to heal completely.

Prior to seeing the reconstruction procedure live, webcast viewers will see patients undergoing procedures including:

• A breast biopsy-- the removal of breast tissue through surgery or by withdrawing tissue through a needle for examination by a pathologist. A biopsy is recommended when a significant abnormality is found either on physical examination and/or by an imaging test. Examples of abnormality can include a breast lump felt during physical self-examination or tissue changes noticed from a mammogram. Before a biopsy is performed, it is important to make sure that the threat of cancer cannot be disproved or ruled out by a simpler, less invasive examination. A lump may be determined to be harmless when examined by
  ultrasound. If this result is not decisive, the presence of cancer or a variety of benign breast conditions can be determined using a biopsy.
• Genetic testing or risk assessment-- providing individuals with information and guidelines based on their family history and/or genetic test results that will assist them and their families in the prevention of cancer occurrence and in the early detection of cancer. Family history is the primary indicator of an inherited risk for cancer. The staff of the Hereditary Cancer Program at Jefferson, for example, evaluates a person's family history and develops a written risk assessment and a cancer screening program for each individual and their at-risk family members. The Jefferson Hereditary Cancer Center takes a multidisciplinary approach to cancer risk evaluation and is one of few centers that offer cancer risk counseling for any type of cancer.
• Sentinel node biopsy-- to determine whether cancer has spread to the lymph nodes. Sentinel node dissection involves injecting a radioactive isotope and/or blue dye into a patient's breast before her surgery. This marker follows the same path that malignant cells would follow as they might spread from the tumor in the breast to the nodes. The surgery begins as the dye reaches the first layer of nodes. This first or sentinel node is identified and removed, and examined for any signs of cancer.
• Mastectomy-- There are several types of procedures for surgery of the breast where cancerous tumors are found. One is a total (or simple) mastectomy, in which the surgeon removes the entire breast and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system allowing the cancer to spread to other parts of the body. Another type is a modified radical mastectomy in which the surgeon removes the entire breast, some of the lymph nodes under the arm and the lining over the chest muscles. In some cases, part of the chest wall muscles is also removed.

Jefferson’s Kimmel Cancer Center is a National Cancer Institute (NCI) designated cancer center. This recognition for excellence in cancer research and treatment allows patients access to the very latest in care. Doctors at Thomas Jefferson University Hospital have been cited as among the nation’s best for cancer treatment by “Best Doctors in America.”

Jefferson’s breast surgeons have also made important contributions to the lumpectomy procedure and to overall guidelines for surgical care of breast cancer.

Jefferson Medical College of Thomas Jefferson University is accredited by the ACCME to provide continuing medical education for physicians

The webcast can be viewed at www.jeffersonhospital.org/webcast at 4:30 p.m. on Thursday, Sept. 29.