Any cancer treatment can be used as a primary treatment, but the most common primary cancer treatment for the most common types of cancer is surgery. If your cancer is particularly sensitive to radiation therapy or chemotherapy, you may receive one of those therapies as your primary treatment. Chemotherapy: Special medicines that shrink or kill cancer cells that we cannot see. Radiation therapy: Using high-energy rays (similar to X-rays) to kill cancer cells. Hormone therapy: Blocks cancer cells from getting the hormones they need to grow. About 67% of cancer survivors have survived 5 or more years after diagnosis. About 18% of cancer survivors have survived 20 or more years after diagnosis. 64% of survivors are age 65 or older. Stage 4 cancer isn't usually curable, but treatment may improve overall survival and quality of life. Treatment options and survival rates for stage 4 cancer greatly depend on the type of cancer, how well it responds to treatment, a person's overall health, and several other factors.

1. Oncoplastic Breast
Cancer Surgery
A blend of art and science
Dr.Shizan Pervez
Ascension Medical Group

2. 2
1 in 8 women will develop
breast cancer
 Most common cancer in the US (14%)
 Most common cancer in women
(29%)
 2017 new cases
• Invasive 250,000
• DCIS (non-invasive) 63,000
 Nearly half are diagnosed between
ages 45-65
 Deaths per year – 40,000
National
Statistics

3. 3
State of
Wisconsin
Statistics
Incidence/100,000
• WI 127.9/US 123.5
• Outagamie Co. 131.9
2017 new cases – 4,800
• Early stage (50%)
• DCIS (20%)
Deaths per year - 750
5 year survival – 98%
75% screening mammography
rate

4. 4
How are we
doing?
Breast cancer incidence
• Increased 1980s
• Stabilized late 1980s
• Declined after 2002
• Stable since 2005

5. 5
How are we
doing?
Death from breast cancer has
decreased by 39% since 1990
Screening mammography rates
are 73% (75% in WI)
More cancers are found in an
early stage
But…mortality remains 50%
higher in black women

6. 6
Non-Modifiable
Risk Factors
• Age/Race/Gender
• Family history
• High breast density
• Prior radiation
treatment
• Type 2 diabetes
• Atypical ductal
hyperplasia

7. 7
Modifiable
Risk Factors
• Obesity (especially post-
menopausal)
• 66% in WI are
overweight or obese
• Hormone therapy
• Increase physical
activity
• Decrease alcohol intake
• Less than 1 drink/day

8. 8
• Age 40-44
• Consider annual screening
• Talk to your physician
• Age 45-54
• Annual screening
• Age 55+
• Consider annual or biannual
screening
• Talk to your physician
• Continue screening as long as life
expectancy is at least 10 years
• High Risk
• Earlier screening
• Mammogram + MRI
• Consider genetic testing
• Referral for risk reducing
treatment (medical and/or
surgical)
American Cancer Society
Screening Mammogram
Guidelines

9. 9
The goal is to combine the best possible cancer outcome with the best
possible cosmetic outcome – individualizing for each woman and her
wishes – ideally with little to no scars.
The goal is to help a woman to feel whole again as a part of her cancer
journey.
Oncoplastic Surgery is a Blend of
Art and Science
Onco = Cancer
Plastic = Aesthetic

10. 10
History Lesson
Egyptian Edwin Smith Papyrus: 3000 BC
• Describes cauterization
• States “There is no cure”
Halsted Radical Mastectomy: 1882-1932
Modified Radical Mastectomy: 1932-1985
Lumpectomy w/ Axillary LND: 1985 – 1994
Sentinel LN Biopsy: 1994 – present
Oncoplastic Techniques: 2010s - present

11. 11
History:
The Problem with Breast Cancer Surgery
Halsted Radical Mastectomy

12. Current:
The Problem with Breast Cancer Surgery
• Two possible surgical treatment options
• 20% Mastectomy
• 80% Lumpectomy (Breast Conserving Surgery)
• With traditional techniques, both surgical options leave
prominent scarring
Skin Sparing Mastectomy Lumpectomy
Constant visible reminder of surgery and of cancer

13. PATIENT SURVEY: Surgical Scars Impact Self-
Confidence, Body Image, and Intimacy
Online survey of 500 breast cancer surgery patients
(250 mastectomy + 250 lumpectomy)
Researching Options
 70% of patients are thoroughly researching their surgical options
 69% wished they had time to explore other surgical options
 Most patients do online research (68%) but also 71% seek advice from family and friends.
 Most physicians discussed Nipple Sparing Mastectomy (73%), but for the remaining patients,
64% wished their physicians had told them about it. Of this group, 61% would have
considered this approach if mentioned.
Self-Confidence
 Most patients are unhappy with the location of their scar (72%) with 84% of mastectomy and
67% of lumpectomy patients feeling self-conscious as a result.
 76% of women who have had a mastectomy choose certain clothing to cover up their scar
Body Image
 Most women are uncomfortable with their scars when undressed: 81% of mastectomy
patients and 64% of lumpectomy patients
Intimacy
 83% of mastectomy patients and 68% of lumpectomy patients didn’t realize how uncomfortable
they’d feel when their partner sees them undressed
LIT 12728 Wakefield Research Data Report: Survey of Breast Cancer Surgery Patients
About Wakefield: Washington DC based market research consultancy firm specializing in strategic and tactical research for corporations and
organizations throughout the Americas, Europe, Africa, the Middle East, and Asia.

14. Hidden Scar Mastectomy

15. Modified Radical Mastectomy
Nipple Sparing Mastectomy
(Lateral Incision)
Skin Sparing Mastectomy
The Evolution Of Breast Cancer Surgery:
Mastectomy
Hidden Scar™ Bilateral Nipple Sparing Mastectomy
Photo Courtesy of Beth DuPree, MD

16. Breast Conserving Surgery
(Lumpectomy)
Traditional Lumpectomy
Incision is placed directly
over tumor
 Scar is visible when healed
Hidden Scar Lumpectomy
Incision is made in a place that is
hard to see
 Scar is hidden when healed

17. Lumpectomy
The Evolution Of Breast Cancer Surgery:
Lumpectomy
Hidden Scar™ Lumpectomy
Photo Courtesy of Sunny Mitchell, MD

18. Level 3/4 Oncoplastic Aproaches

19. Oncoplastic Mammaplasty
Wise Pattern

20. 20
• Pros:
• Accurate target for XRT
• Bioabsorbable
• Can help with cosmesis
• Cons:
• Up to one year to resorb
• Potential for pain
• Potential for infection
BioZorb Marker

21. 21
• Radioactive Seeds
• Radiofrequency Seeds
• Magnetic Seeds
• Blue Dye Injection
• These all separate the
localization and surgery,
shorten OR day, minimal risk
of displacement, most have no
radiation
Other
Localization
Options

22. Dr.Shizan Pervez
Medical Oncology
MBBS.MD.MS.&DM
Ascension Medical Group
Member American Society of Breast Surgeons
Hidden Scar Certified
Certification of Training from the School of
Oncoplastic Surgery