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Oncoplastics: The Latest in Breast Surgery and Recovery

October 15, 2018 11:00 AM with Dr. Katherine Kopkash

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When it comes to treating breast cancer, surgeons realize the importance of treating the disease, but also making patients as happy as possible about their appearance after surgery. Dr. Katherine Kopkash, NorthShore Oncoplastic Surgeon, shares information about her expertise and will answer questions about innovative breast surgeries, cosmetic options that are offered after treatment, and preventative care.

Ben (Moderator) - 11:01 AM:
Welcome to the Oncoplastics: The latest in Breast Surgery and Recovery chat. The chat is now open and you can submit your questions at any time.

  Caitlyn (Chicago, IL) - 11:13 AM:
My sister is scheduled for surgery. What can I expect for her in the weeks leading up to surgery? Any special instructions/diets/etc?
Katherine Kopkash
Hi Caitlyn! In the weeks leading up to surgery, she can do all of her normal activities (including standard diet, exercise, travel, etc). Prior to surgery is NOT the time to do a drastic diet change or change to exercise. In the week before surgery, there may be some medications that need to be held and this will be reviewed with her by the surgeon's team. Good luck with your sister's procedure!

  Jen (Lincolnwood, IL) - 11:15 AM:
Does insurance cover oncoplastic surgery?
Katherine Kopkash
Hi Jen! Yes, insurance covers oncoplastic surgery. There is a law that mandates private and public insurance coverage of cancer surgery and the reconstruction for cancer surgeries, even if it involves the other breast which is healthy (for symmetry).

  Ashley (Chicago, Illinois) - 11:18 AM:
If you are BRCA positive, what types of regular screening do you need to do in terms of the types of cancers BRCA may bring?
Katherine Kopkash
Hi Ashley! In terms of breast cancer, for our gene mutation carriers (including BRCA gene positive patients) we recommend a clinical breast exam (one performed by a physician or physician extender) every 6 months, once a year mammogram, and once a year MRI. We usually alternate the mammogram and MRI every 6 months so there is some type of breast imaging every 6 months.

  Ashley (Deerfield, IL) - 11:20 AM:
What do you suggest to use on scars after breast surgery?
Katherine Kopkash
Hi Ashley! Once the incision has completely healed (1 month after surgery), it is safe to use over the counter scar treatments, such as Mederma and Scar Away. For patients with significant scarring or scarring concerns, we sometimes use a short course of radiation therapy or laser treatment.

  Jen (Lincolnwood, IL) - 11:26 AM:
Is oncoplastic surgery performed for non-cancerous or precancerous conditions? I have a diagnosis of atypical hyperplasia. My surgeon at Swedish wants to remove a large piece of my breast as a precautionary "best practice" and I am concerned about disfigurement. Would insurance cover it in that case since it's not cancer?
Katherine Kopkash
Hi Jen! Yes, your insurance would cover an oncoplastic procedure for an atypia. In patients with "high-risk" lesions like atypia, I perform an excisional biopsy (small sampling of the area to ensure there is no cancer) through a hidden scar approach. This provides an accurate cancer assessment and an excellent cosmetic outcome. I would be happy to see you in consultation to fully discuss your options!

  Lisa (Glenview, IL) - 11:29 AM:
What techniques are different in oncoplastics than normal oncology breast surgeries?
Katherine Kopkash
Hi Lisa! Oncoplastics is based on removing the cancer and having a natural breast appearance after surgery. Oncoplastics focuses on hiding the incision in "hidden areas", such as at the areolar margin, the fold under the breast (the infra-mammary fold), or in the axilla (the armpit). Oncoplastic breast surgery also strives to maintain the natural volume and shape of the breast, reconstructing the breast tissue to avoid a "divot" or volume loss after surgery. Normal oncologic breast surgeries focus on removing the cancer.

  Jen (Lincolnwood, IL) - 11:34 AM:
My doctor has recommended surgery to excise a pre-cancerous condition (atypical ductal hyperplasia) in my left breast. Are oncoplastic procedures used for surgeries like this?
Katherine Kopkash
Hi Jen! Yes, oncoplastic procedures are definitely used for atypias that require an excisional biopsy such as yours. I usually perform a "hidden scar" approach for this, where I hide my incision either at the edge of the areola, under the breast, or in the axilla. This way, we are adequately removing your lesion but leaving you with an excellent cosmetic outcome.

  Quinn (Skokie, IL) - 11:38 AM:
What is the recovery time post-surgery? What kind of aftercare does NorthShore offer?
Katherine Kopkash
Hi Quinn! The recovery time really depends on what type of surgery you are having; an excisional biopsy for atypia would have a patient returning to work/normal activities often the next day while something like a mastectomy for reconstruction requires a few weeks off of work/away from normal activities. NorthShore offers everything from home nursing visits if needed to massage therapy and physical therapy to ensure you are back to your normal routine as soon as possible.

  Jen (Lincolnwood, IL) - 11:42 AM:
Dr. Kopkash, you mentioned "reconstructing the breast tissue to avoid a "divot" or volume loss after surgery." <--How is that achieved? Would it involve some kind of breast implant?
Katherine Kopkash
Hi Jen. We usually achieve this by rebuilding that part of the breast using the surrounding breast tissue, this is called a tissue advancement flap. Occasionally we require a small biologic implant, that absorbs over time, or a flap of tissue brought from another part of the body. It really depends on your breast size and the amount of tissue that needs to be removed.

Ben (Moderator) - 11:46 AM:
Dr Kopkash has to cut the chat short due to her schedule at the hospital. There are a few questions left in the queue, so feel free to submit any other questions you have and I will email them to her. Your questions will appear here on this page later, so please come back! Thank you Dr. Kopkash for all your expertise.

  Jen (Lincolnwood, IL) - 11:49 AM:
Thank you Dr. Kopkash, this has been very educational and helpful!
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