HJAR Mar/Apr 2021

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2021 53 Yara Robertson, MD, FACS Surgical Oncologist CARTI, Inc. and progesterone status and whether the HER2/neu protein is overexpressed, and how aggressive it is. We can then work col- laboratively with the patient’s multidisci- plinary care team to create a treatment plan perfectly tailored to their specific cancer. For more aggressive cancers, chemother- apy is often a more effective initial treatment than surgery. In the time that patients actu- ally have and recover from their surgery, a single cancer cell could potentially spread to another area of the body and lead to a worse prognosis. Instead, some patients should start with chemotherapy or immunotherapy, both of which systematically treat the cancer and reduce, or completely eradicate, its ex- istence across the entire body. Then, if and when they have surgery, we approach it with a more complete road map. This can also af- ford the patient more surgical options. For example, since the chemotherapy may have shrunk the tumor, we can transition from a mastectomy to a breast-conserving surgery. Additionally, chemotherapy and immu- notherapy can have added effects that posi- tively impact the patient’s overall recovery and well-being. When patients undergo these therapies ahead of surgery, lymph nodes in their axillary region, the armpit, that may have previously registered cancer cells may no longer do so. If this is true, it allows us to potentially avoid taking a large amount of lymph nodes, which reduces the patient’s risk of developing lymphedema, or arm swelling, that can become a severe side effect of treatment. The goal of a preoperative biopsy is to give patients the knowledge they need to make the most informed decision. Identify- ing the breast cancer’s receptor status before going into surgery gives us more oncologi- cally safe options for treating their particular cancer. In most cases, breast cancer is not a surgical emergency, so it is important for patients and physicians to remember that we have time to fully understand the diag- nosis and create a well-informed decision regarding treatment. Additional Recommendations Regarding Breast Cancer Reconstruction Surgery We understand that not all patients want to have post mastectomy reconstruction and, of course, it may be preferable for some patients to wait on reconstruction after a mastectomy due to additional adjuvant treatment that may be required. However, once a patient is deemed a candidate for surgery and desires a mastectomy, it is important that the surgical team include the breast cancer surgeon and the patient’s plastic surgeon of choice. Together, they can ensure the patient’s reconstructive goals are met during the initial surgery. Outside of select cases, including those patients who will undergo postmastectomy radiation therapy, reconstruction should be done immediately following a mastectomy. Known as immediate-delayed breast re- construction, this process includes a skin- sparing, or nipple sparing, mastectomy followed by the insertion of a saline-filled tissue expander during the same surgery. By doing this, we preserve the natural shape of the breast skin envelope and allow the patient to heal from one surgery instead of two. This tandem surgery effort gives the patient the best oncologic and cosmetic outcomes possible. The Importance of Shared Decision Making Self-advocacy is a must for optimal care. What that means is that the patient should feel comfortable speaking up, asking ques- tions and taking an active role in their di- agnosis and treatment plan. With so many advancements in breast cancer treatment, there are more options available to patients. It is very important to understand these op- tions so that patients and healthcare provid- ers can work together to decide what will work best for an optimal outcome. n Marian Miler, MD, completed a fellowship in breast oncology at City of Hope National Medical Center in Duarte, California, and completed a residency in general surgery at Orlando Health in Orlando,Florida, where she was named general surgery chief resident. She earned a medical degree from the University of Toledo College of Medicine in Toledo, Ohio, and a Bachelor of Science in Chemistry fromWright State University in Dayton, Ohio. Yara Robertson, MD, FACS, completed a fellowship in breast surgical oncology at the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. She completed a residency in general surgery at the University of Arkansas for Medical Sciences in Little Rock.She earned amedical degree fromQuillen College of Medicine at East Tennessee State University in Mountain Home,Tennessee.