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  • December 31, 2021

    By Anteneh Tesfaye, MD

    People generally don’t think about their digestive system—until it stops working properly. Then its impacts on daily life quickly become evident.


    Any type of digestive malfunction can be distressing, so I understand why patients are often concerned after a gastrointestinal (GI) cancer diagnosis. However, misinformation about what caused their cancer and what treatment will be like can add unnecessary stress to the emotional burden they already carry.


    GI cancer includes several types of cancer that develop in organs throughout the digestive system, such as the:


    • Colon
    • Esophagus 
    • Liver
    • Pancreas
    • Stomach

    These cancers comprise 26% of cancer cases worldwide and 35% of all cancer-related deaths. Symptoms for each type of GI cancer vary but typically include indigestion, weight loss, abdominal pain, nausea, and changes in bowel movements.  


    Treatment usually requires surgery and sometimes chemotherapy or radiation. Though the experience is not easy or comfortable, advanced treatment gives many patients longer, healthier, and higher-quality lives. 

    Knowing the truth about GI cancer diagnosis, treatment, and survivorship can help families spend less time worrying and focus more energy on healing. Here are five common myths—debunked—about GI cancer.


    Myths about #GastrointestinalCancer can add unnecessary stress to a patient’s cancer diagnosis. In this blog, Anteneh Tesfaye, MD, debunks 5 common myths so patients can focus on facts—and feeling better: https://bit.ly/3Jv4FVC.
    Click to Tweet
     

    1. Myth: Certain foods can cause GI cancer.

    The truth: The common saying that “you are what you eat” is well-intentioned, but it has led many to believe that a patient’s diet can directly cause cancer; however, no direct cause-and-effect relationship has been discovered.


    While the Western diet, which contains large amounts of processed products and foods with high levels of sugar, salt, and fat, has been linked to higher rates of colorectal cancer, a direct connection is still unknown. Plant-based diets such as veganism or the Mediterranean diet are often recommended instead. But GI cancer develops in people who eat these diets as well. 

     

    It has been shown that certain foods can help decrease the risk of getting cancer, and MedStar Health oncologists and nutritionists frequently collaborate to help patients looking for guidance on changing their diet before or after a cancer diagnosis. 


    If you’ve heard that sugar (glucose) “feeds” cancer cells, that’s also not true. All cells get their energy from glucose, whether they’re cancerous or not. If you cut glucose from your diet, your body will make it naturally to fuel your cells. And even if less glucose is available, cancer cells will use another source to get energy.


    The bottom line is that food can contribute to a patient’s cancer risk, but a patient’s diet is not a sole cause for a GI cancer diagnosis.

     

    2. Myth: Certain foods can cure GI cancer.

    The truth: No miraculous diet or pill can cure cancer.


    Unfortunately, many have tried to profit from patients’ devastation after a cancer diagnosis by claiming that certain foods or alternative pills can replace medical treatment. 


    I understand the appeal of these claims when a doctor has delivered bad news. But working with your provider to develop a treatment plan as soon as possible is your best hope for beating cancer. Delaying care or drastically changing your diet might cause further damage to your body.


    Alternative treatments (also known as herbal, botanical, or other “natural” products) may help in managing symptoms of cancer and cancer treatment. But using them instead of modern cancer treatment has been shown to be harmful.


    3. Myth: Having GI cancer surgery can further spread cancer.

    The truth: Though we might find more cancer cells after surgery, they likely existed before surgery.


    No matter how advanced our technology is, cancer cells that spread through the body can be too small to show up on the scans and tests we conduct before surgery. When we find them later, it might seem like the cancer spread after surgery, but it was already there; we just couldn’t see it.


    Deciding to have surgery for GI cancer is a significant decision for a patient to make. Even though surgery can be a difficult experience, it can help cure life-threatening cancers for many patients.


    Recovery can be long and uncomfortable—not because the cancer has spread but because the body requires time to heal from an invasive procedure involving this vital organ system that needs to function smoothly for comfortable everyday existence.


    4. Myth: People who have GI cancer surgery need a permanent colostomy bag.

    The truth: The majority of patients who have colon cancer do not need a colostomy bag after surgical treatment. If they do, most will be temporary.


    The first thing many people think of when they hear “colon cancer” is the colostomy bag that patients have after a colon surgery. During this surgery, a hole is created in the abdominal wall and one end of the colon is pulled through the opening, where waste is then collected in an external bag. Colostomy bags may be permanent in some cases but are temporary for most patients. 


    Surgical treatment for colon cancer continues to advance, and a colostomy is not the only or even the most common surgery patients receive. Less than 35% of colon cancer survivors had a colostomy to treat their cancer. And it’s permanent in less than 10% of these patients. 


    I also want to note that life with a permanent colostomy bag can be just as fulfilling as life without one. It certainly requires more adaptability, but modern bags are designed for convenience so that patients can have near-normal life.


    5. Myth: Long-term quality of life after GI cancer will significantly decrease.

    The truth: Life will be different—but a support system can help patients manage the changes and keep enjoying life.


    Following GI cancer treatment, many patients experience changes in their quality of life. That's not a reflection of anyone’s personal strength; it’s just a natural progression after a major disruption to the digestive system.


    Recovery is slow; I encourage patients to take it one day at a time. Depending on the treatment, appetite loss, diarrhea, fatigue, nausea, and vomiting may continue a year or more after treatment. Experiencing ongoing physical difficulties can lead to depression and anxiety as well.


    MedStar Health specialists—from nutritionists to gastroenterologists to psychologists—are dedicated to helping patients cope with these changes and have a rewarding life. Several innovative, effective treatment options are available to give patients the chance to return to work, enjoy hobbies, and spend time with loved ones. It’s not easy, but it is possible.


    When in doubt, ask your doctor.

    When it comes to cancer, your health care provider is your best source of information.


    Early detection increases the likelihood of successful recovery from GI cancer treatment. By paying more attention to your body’s regular digestive process, you can more easily recognize when you don’t feel right. Be sure to see your doctor immediately if something seems off.


    Learn the facts about gastrointestinal cancer.

    Request an appointment with a gastroenterologist to discuss your risk factors and a personalized prevention or treatment plan.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • December 31, 2021

    By Anteneh Tesfaye, MD

    People generally don’t think about their digestive system—until it stops working properly. Then its impacts on daily life quickly become evident.


    Any type of digestive malfunction can be distressing, so I understand why patients are often concerned after a gastrointestinal (GI) cancer diagnosis. However, misinformation about what caused their cancer and what treatment will be like can add unnecessary stress to the emotional burden they already carry.


    GI cancer includes several types of cancer that develop in organs throughout the digestive system, such as the:


    • Colon
    • Esophagus 
    • Liver
    • Pancreas
    • Stomach

    These cancers comprise 26% of cancer cases worldwide and 35% of all cancer-related deaths. Symptoms for each type of GI cancer vary but typically include indigestion, weight loss, abdominal pain, nausea, and changes in bowel movements.  


    Treatment usually requires surgery and sometimes chemotherapy or radiation. Though the experience is not easy or comfortable, advanced treatment gives many patients longer, healthier, and higher-quality lives. 

    Knowing the truth about GI cancer diagnosis, treatment, and survivorship can help families spend less time worrying and focus more energy on healing. Here are five common myths—debunked—about GI cancer.


    Myths about #GastrointestinalCancer can add unnecessary stress to a patient’s cancer diagnosis. In this blog, Anteneh Tesfaye, MD, debunks 5 common myths so patients can focus on facts—and feeling better: https://bit.ly/3Jv4FVC.
    Click to Tweet
     

    1. Myth: Certain foods can cause GI cancer.

    The truth: The common saying that “you are what you eat” is well-intentioned, but it has led many to believe that a patient’s diet can directly cause cancer; however, no direct cause-and-effect relationship has been discovered.


    While the Western diet, which contains large amounts of processed products and foods with high levels of sugar, salt, and fat, has been linked to higher rates of colorectal cancer, a direct connection is still unknown. Plant-based diets such as veganism or the Mediterranean diet are often recommended instead. But GI cancer develops in people who eat these diets as well. 

     

    It has been shown that certain foods can help decrease the risk of getting cancer, and MedStar Health oncologists and nutritionists frequently collaborate to help patients looking for guidance on changing their diet before or after a cancer diagnosis. 


    If you’ve heard that sugar (glucose) “feeds” cancer cells, that’s also not true. All cells get their energy from glucose, whether they’re cancerous or not. If you cut glucose from your diet, your body will make it naturally to fuel your cells. And even if less glucose is available, cancer cells will use another source to get energy.


    The bottom line is that food can contribute to a patient’s cancer risk, but a patient’s diet is not a sole cause for a GI cancer diagnosis.

     

    2. Myth: Certain foods can cure GI cancer.

    The truth: No miraculous diet or pill can cure cancer.


    Unfortunately, many have tried to profit from patients’ devastation after a cancer diagnosis by claiming that certain foods or alternative pills can replace medical treatment. 


    I understand the appeal of these claims when a doctor has delivered bad news. But working with your provider to develop a treatment plan as soon as possible is your best hope for beating cancer. Delaying care or drastically changing your diet might cause further damage to your body.


    Alternative treatments (also known as herbal, botanical, or other “natural” products) may help in managing symptoms of cancer and cancer treatment. But using them instead of modern cancer treatment has been shown to be harmful.


    3. Myth: Having GI cancer surgery can further spread cancer.

    The truth: Though we might find more cancer cells after surgery, they likely existed before surgery.


    No matter how advanced our technology is, cancer cells that spread through the body can be too small to show up on the scans and tests we conduct before surgery. When we find them later, it might seem like the cancer spread after surgery, but it was already there; we just couldn’t see it.


    Deciding to have surgery for GI cancer is a significant decision for a patient to make. Even though surgery can be a difficult experience, it can help cure life-threatening cancers for many patients.


    Recovery can be long and uncomfortable—not because the cancer has spread but because the body requires time to heal from an invasive procedure involving this vital organ system that needs to function smoothly for comfortable everyday existence.


    4. Myth: People who have GI cancer surgery need a permanent colostomy bag.

    The truth: The majority of patients who have colon cancer do not need a colostomy bag after surgical treatment. If they do, most will be temporary.


    The first thing many people think of when they hear “colon cancer” is the colostomy bag that patients have after a colon surgery. During this surgery, a hole is created in the abdominal wall and one end of the colon is pulled through the opening, where waste is then collected in an external bag. Colostomy bags may be permanent in some cases but are temporary for most patients. 


    Surgical treatment for colon cancer continues to advance, and a colostomy is not the only or even the most common surgery patients receive. Less than 35% of colon cancer survivors had a colostomy to treat their cancer. And it’s permanent in less than 10% of these patients. 


    I also want to note that life with a permanent colostomy bag can be just as fulfilling as life without one. It certainly requires more adaptability, but modern bags are designed for convenience so that patients can have near-normal life.


    5. Myth: Long-term quality of life after GI cancer will significantly decrease.

    The truth: Life will be different—but a support system can help patients manage the changes and keep enjoying life.


    Following GI cancer treatment, many patients experience changes in their quality of life. That's not a reflection of anyone’s personal strength; it’s just a natural progression after a major disruption to the digestive system.


    Recovery is slow; I encourage patients to take it one day at a time. Depending on the treatment, appetite loss, diarrhea, fatigue, nausea, and vomiting may continue a year or more after treatment. Experiencing ongoing physical difficulties can lead to depression and anxiety as well.


    MedStar Health specialists—from nutritionists to gastroenterologists to psychologists—are dedicated to helping patients cope with these changes and have a rewarding life. Several innovative, effective treatment options are available to give patients the chance to return to work, enjoy hobbies, and spend time with loved ones. It’s not easy, but it is possible.


    When in doubt, ask your doctor.

    When it comes to cancer, your health care provider is your best source of information.


    Early detection increases the likelihood of successful recovery from GI cancer treatment. By paying more attention to your body’s regular digestive process, you can more easily recognize when you don’t feel right. Be sure to see your doctor immediately if something seems off.


    Learn the facts about gastrointestinal cancer.

    Request an appointment with a gastroenterologist to discuss your risk factors and a personalized prevention or treatment plan.

    Call 202-877-DOCS (3627) or Request an Appointment

  • December 10, 2021

    By Charlotte Gamble, MD, MPH

    By the end of 2021, approximately 60,000 new cases of endometrial cancer will be diagnosed in the U.S. Over 10,000 patients will die from it—and the majority of these people will be Black women.

    Endometrial cancer develops in the inner lining of the uterus and is the most common type of uterine cancer. Though more White patients develop the disease, studies show that Black women with endometrial cancer:

    • Are twice as likely to have high-risk histology—more aggressive, abnormal cancer cells
    • Get surgery less often, regardless of the cancer’s progression
    • Are more likely to be diagnosed after their cancer is at an advanced stage 
    • Have a 55% higher mortality rate than non-Black women

    As a Black woman and a gynecologic oncologist, I’m passionate about discussing endometrial cancer risks with my patients. With endometrial cancer specifically, genetic, societal, and personal factors converge into a perfect storm of risk for Black women. And there is still much to learn about the disease itself from a biological standpoint.

     

    Research on racial disparities in U.S. health care continues to grow alongside much-needed awareness about higher rates of several health conditions across the hardest-hit populations. 

     

    While we don’t have all the answers to solve disparities in diagnosis and treatment today, we know more than enough to reduce them—starting with better informing Black patients and their health care providers about the risks, symptoms, and treatment options for endometrial cancer.

     

    Risk factors Black women need to know.

    Several risk factors for endometrial cancer are universal, but Black women face additional genetic and social challenges that increase their chances of an advanced diagnosis.

    Epigenetics is a change in gene function caused by environmental factors such as social, economic, and cultural inequities. Some evidence points to epigenetics as a possible reason why Black women develop more aggressive endometrial cancers. Stress compounded through generations—from slavery through segregation and ongoing racial tensions—may cause higher rates of abnormal cell behavior, resulting in more advanced cancers.

    Implicit bias in the medical profession can lessen the quality and effectiveness of treatment, which is already complex and time sensitive —especially with aggressive cancers. Medical professionals must acknowledge and confront personal attitudes and beliefs about patients; implicit biases negatively influence health care delivery and patient outcomes, specifically for Black people.

    Lower rates of hysterectomy and radiation may also be to blame. Research shows that Black women are less likely to receive surgery and subsequent radiation than White women. 

    Inadequate screening methods, such as some tools to measure endometrial thickness—a possible sign of endometrial cancer—miss almost five times more cases of endometrial cancer in Black women than white women. This is partly because non-cancerous uterine fibroids can make the lining harder to measure, and fibroids are more common in Black women.

    Lynch syndrome is associated with approximately 3% of endometrial cancer diagnoses. This inherited gene mutation is also associated with cancers involving colon, ovary, urothelial tract (bladder and ureters), pancreas, stomach, or brain (glioblastoma). If you have a family history of the above cancers or Lynch syndrome, talk with your doctor about genetic testing to help determine your risk. 

    Obesity is a leading risk for developing endometrial cancer, in part because it increases patients’ estrogen levels. As obesity rates increase, younger women are developing endometrial cancer. Other factors that can increase estrogen and a woman’s risk of endometrial cancer include:

    • Type 2 diabetes
    • Never getting pregnant
    • Starting menstruation before age 12
    • Taking certain hormone therapies for breast cancer, such as tamoxifen

    Symptoms and diagnosis.

    One of the few qualitative studies of Black patients’ experiences with endometrial cancer shows that diagnosis and treatment are often delayed because women are unaware of their symptoms and risk. 


    Providers may not suspect endometrial cancer right away because of the crossover of gynecologic cancer symptoms, particularly in younger patients. While most cases develop after menopause, we’ve treated patients in their 20s and 30s for endometrial cancer. 

    The longer the cancer goes undetected, the further it spreads—and the less responsive it becomes to treatment. This is why early recognition of symptoms and timely diagnosis are critical to achieve good outcomes.

    Abnormal bleeding is the most recognizable symptom of endometrial cancer. See a doctor if you experience bleeding between periods, heavy bleeding after age 40, and any vaginal bleeding after menopause. If your bleeding patterns change, or you start having bleeding during or after sex, you should also talk with your doctor. Sometimes patients experience bloating and lower abdominal pain or cramping.

    Do not accept these symptoms as normal—if they last longer than two weeks, see a doctor because something may be wrong. The earlier you get checked out, the sooner we can help you feel better. Even if your symptoms are not caused by cancer, there are many ways to treat heavy or bothersome vaginal bleeding. 

    If you or your doctor suspect you might have endometrial cancer, you should feel empowered to ask for exams or tests to find out for sure. These include:

    • Pelvic or transvaginal ultrasound for a detailed image of the uterus and surrounding area
    • Uterine biopsy (tissue sampling) to test cells for cancer 
    • Chest X-ray, CT scan, or MRI to see if the cancer has spread

    Endometrial cancer is categorized by four stages, depending on where it spreads:

    1. Stays in the uterus 
    2. Spreads to the cervix
    3. Travels outside of the uterus but not beyond the pelvis
    4. Spreads outside the pelvis to organs such as the bowel, bladder, or abdomen (metastatic cancer)

    If you have endometrial cancer, your doctor will order imaging and laboratory tests to determine the disease stage. From there, they will work with you to create a treatment plan that fits with your overall health goals and lifestyle. 


    Related reading:
    Why you shouldn’t delay cancer screenings.

    Treatment options to ask about.

    Endometrial cancer treatment typically involves a combination of surgery, chemotherapy, and radiation. 


    Early-stage endometrial cancer often can be cured with
    surgery, since there is a low risk of the cancer coming back. A total hysterectomy —removal of the uterus and cervix—is the most common surgical treatment. We will usually remove the fallopian tubes and ovaries, as well as some pelvic lymph nodes to help us see if the cancer has spread, and also to decrease the hormonal stimulation from the ovaries that may contribute to cancer recurrence. 

    Locally advanced cancer (that has spread to the cervix or lymph nodes) has a higher risk of recurrence and might also require radiation, chemotherapy, or both, depending on how far the cancer has spread and how many cancer cells remain after surgery. Sometimes, if the cancer is already very advanced, we may jump straight to chemotherapy to help treat cancer cells all over the body, and keep surgery as a possibility for the future. 

    There are also some types of aggressive cancers (uterine serous, clear cell, carcinosarcomas) that need radiation and chemotherapy treatment even if the cancer is just in the uterus. It is important to ask your doctor to go through your pathology report with you in detail so that you understand exactly what type of cancer you have. I often suggest that patients have a trusted family or friend at their visit or available on the phone so that they can ask other questions that my patients may not think of during these important conversations. 

    With work, childcare, and everything in between, treatment can be difficult to navigate. But your health is worth the time it takes. Talk with your doctor about resources that can help you manage other priorities while receiving treatment.


    Spreading #EndometrialCancer awareness can help more patients seek treatment sooner—particularly Black women, who are often diagnosed at advanced stages. Learn more about this #UterineCancer & research on its disproportionate effect on Black women: https://bit.ly/3EH6QTh.
    Click to Tweet

     

    Actions patients can take now.

    Trust yourself. You know your body better than anyone, and if something feels different, advocate for your health. Be persistent about getting an answer for why you’re experiencing certain symptoms.


    I understand how hard it can be for women to prioritize their health, and you are worth it. If your provider doesn’t share your level of concern, request a cancer screening test or seek a second opinion. 

    Related reading: How and why to get a second opinion for cancer diagnosis using video visits.

    I entered the medical profession to take care of women because they play a central role in the health of our communities. One of the most rewarding and enjoyable aspects of my career has been joining the steering committee of the Endometrial Cancer Action Network for African-Americans (ECANA).

    We promote awareness of endometrial cancer and its effects on Black women, and provide a support network for Black patients to share the burden of pain and challenges that accompany a cancer diagnosis and treatment. If you or someone you know is affected by endometrial cancer, I encourage you to join our community to better advocate for yourself and other women.

    You deserve prioritized health care.

    Get personalized endometrial cancer treatment from specialists who understand your unique risk factors.

    Call 202-877-DOCS (3627) or Request an Appointment

  • April 12, 2017

    By MedStar Health

    If you are currently undergoing treatment for breast cancer, it’s important to know about possible complications that may occur afterward. One such complication is lymphedema. Lymphedema is the persistent swelling of the arm that may occur after mastectomy and lymph node removal during breast cancer treatment, due to the buildup of excess lymphatic fluid.

    But what are the risk factors of lymphedema? Moreover, what treatment options are available for those who receive this diagnosis?

    Factors That Increase the Risk of Lymphedema

    At MedStar Georgetown University Hospital, we have observed that approximately 20 percent of women who undergo breast cancer treatment will end up with lymphedema. While there is no way of knowing during treatment who would be diagnosed, there are some risk factors we’re aware of that may increase the chances of getting lymphedema after breast cancer treatment.

    For example, women with a higher chance of lymphedema have had many of their lymph nodes removed. Another risk factor is exposure to radiation during treatment, since this can cause scarring and blockages. Women who smoke or are obese are also more likely of developing lymphedema after breast cancer treatment.

    While not all risk factors are avoidable, some are. If a patient is looking for ways to reduce their risks, smoking cessation and weight loss are two options.

    Diagnosis of Lymphedema

    Some patients get relief by having the affected area massaged and the excess fluid drained. But most patients end up needing surgical treatment for more long-term relief.

    To find out the best treatment options, you should meet with a multidisciplinary team that includes oncologists, physical therapists and other medical professionals who will help with diagnosis and immediate action.

    A common way to diagnose lymphedema is called bioimpedance, which is a way to measure electrical flow through body tissue. Once it is confirmed that the lymphatic channel - which contains clear, thin lymphatic fluid - is blocked, a team of doctors will determine the best treatment. In the meantime, they will try to reduce the swelling, often by wrapping the arm with a sleeve to get some relief.

    Treatment Options for Lymphedema

    One surgical option for mild to moderate lymphedema is a lymph node transfer.  Lymph nodes are located in multiple places throughout your body; as a result, doctors can take lymph nodes from anywhere - such as the neck, groin or back - and transplant them wherever they’re needed using a microsurgical technique.

    It’s akin to bringing in a pump and activating it by making sure blood can flow in and out to avoid swelling.

    Another procedure that may be considered is lymphaticovenular bypass, also known as LV bypass. This is referred to as super-microsurgery, as it involves connecting the lymphatic channel right into a vein to ensure proper flow.

    If lymphedema is more severe, liposuction may need to be performed on this area. This surgery uses a cannula to suck out the extra swollen tissue and fat that’s behind lymphedema. All three of these options work best in a team environment where they are being managed before and after surgery.

    Recovery for Lymphedema Treatment

    Whatever path is chosen, most patients can look forward to a quick recovery. Most treatment options take about three to four hours to complete, and you can usually return home the next day. They typically involve small incisions, followed by a wrap to protect and compress the area that was treated. The patient returns to the doctor a week later to have the sutures removed.

    Expect to see results immediately, as the swelling will greatly reduce at first. Since lymph nodes are typically still dormant at the time of diagnosis and treatment, the arm may swell in the future, however, as they start functioning properly again, the swelling will recede once more.

    Due to advancements in less invasive treatment options, lymphedema is no longer a lifelong concern for life after breast cancer treatment.

    We are here to help.


    If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

  • April 06, 2017

    By MedStar Health

    Breast cancer patients who undergo mastectomies are often faced with the decision of how best to reconstruct their breasts. Currently, implant reconstruction is the most common way of rebuilding the shape of their breasts after surgery. However, one drawback of implants is that they typically need to be replaced every 10 to 15 years.

    An alternative to implant reconstruction that's growing in popularity is known as natural breast reconstruction, or breast reconstruction using natural tissue. This method uses skin and fat from certain body parts to create a natural-feeling breast.

    But what exactly does natural breast reconstruction entail, and is it the right choice for you?

    What Is Natural Breast Reconstruction?

    The human breast consists mainly of fat, especially after a woman's child-bearing age. At its core, natural breast reconstruction involves transplanting fat from one area of the body — such as thighs, buttocks and back — to another.

    Natural breast reconstruction is also known as DIEP flap, or deep inferior epigastric artery perforator flap. This procedure removes extra skin and fat from the lower abdominal area, where many women carry surplus tissue. However, the muscle and function of the abdominal area will still be maintained after the surgery.

    Once this tissue is removed, blood vessels from the tissue are attached to blood vessels in the breast area. The arteries and veins from the removed tissue are sewn to arteries and veins in the chest area using a microscope to restore blood flow to the tissue and make the transplant a success.

    Natural Breast Reconstruction Myths vs. Facts

    Because synthetic implants are still the prevailing choice for breast reconstruction, several myths have propagated throughout the medical community regarding the downsides of natural breast reconstruction. Many patients worry that the surgery will be too long, that the recovery will be too difficult, or that there will be a significant chance of failure.

    However, these concerns are usually unfounded. Typically, the surgery lasts about five hours when in the hands of an experienced physician. Patients usually recover in the hospital for two to three days, with nonopioid medications that mitigate the pain well.

    A full recovery typically occurs within two to six weeks, with an average recovery time of four weeks. This is only slightly longer than implant breast reconstruction, which has an average recovery time of three weeks.

    In addition, the risks of failure and complications are minimal. The failure rate of natural breast reconstruction is very low, at around 0.7 percent, and can be lowered with the right surgical team. The hernia rate from this type of operation is less than 2 percent.

    By dispelling these myths around natural breast reconstruction, an operation that once seemed scary becomes something realistic and tolerable, and perhaps preferable for certain situations.

    Making the Right Choice for You

    The benefits of a successful natural breast reconstruction are invaluable. Rebuilding breasts with their own body tissue provides patients significant improvements in their mental attitude and bodily sensation.

    Of course, there are real downsides to natural breast reconstruction surgery, including the risk of infection or serious bleeding, and not every patient is a good candidate for the surgery.

    However, if you are curious about natural breast reconstruction, schedule a consultation with an experienced breast reconstruction surgeon. They can help by answering questions and empowering you with the knowledge you need to make the best decision.

  • March 22, 2017

    By MedStar Health

    Sarah Bessin, a 47-year-old breast cancer survivor, received her diagnosis in July 2015. In October, Bessin opted to begin breast reconstruction at the same time as her mastectomy. The team at MedStar Georgetown University Hospital was able to save Bessin’s breast tissue and improve her breast reconstruction outcome through the unique combination of the following two tissue-saving technologies to diagnose and avoid serious complications:

    • The SPY Elite fluorescent imaging system that gives breast surgeons and plastic surgeons the ability to assess the quality of blood flow in the breast tissue in order to make the critical decision on whether to insert implants immediately or wait.

    • Hyperbaric oxygen therapy to facilitate the healing process.

    “My surgeon told me he would decide during surgery whether or not I could undergo breast reconstruction immediately, but I’m so glad he decided to wait before proceeding with implants. It gave me a chance to heal, and the results of my reconstruction are just remarkable,” Bessin shared.  

    “Everything that we do in plastic surgery involves blood flow. If blood flow is disrupted, the overlying skin can die. This is the reason we need to be able to anticipate these problems intraoperatively so we can act quickly,” said Troy Pittman, MD, Bessin’s breast reconstruction surgeon. 

    SPY Elite: A New Valuable Player in the Operating Room

    After a mastectomy, the plastic surgery team enters the operating room with a fluorescent imaging system called SPY Elite. SPY Elite has a long arm that connects to an infrared lamp device, which is used for scanning over a patient’s body. A special contrast is injected through the patient’s IV line, and a TV monitor shows the scans of breast tissue and blood vessels in real time.

    A breast reconstruction surgeon will move the SPY Elite lamp over different areas of the breast to detect the quality of blood flow in breast tissue before proceeding with the surgery. The system’s monitoring of the blood flow helps surgeons determine if the patient’s tissue is in a safe state to move forward with surgery and place an implant.

    If blood flow is limited, surgeons will add hyperbaric oxygen therapy after surgery to promote healing in the tissue.

    “SPY Elite lets me look at the blood supply of the breast tissue and the nipple in real time,” Dr. Pittman said. “This helps us diagnose a problem early on and initiate hyperbaric oxygen therapy within 24 hours, if we need to.”

    SPYing a Problem During Bessin’s Procedure

    During Bessin’s procedure, the SPY Elite imaging system informed Dr. Pittman’s team that there were worrisome vascular changes in her breast skin following the mastectomy. To avoid compromising the vascular health of the skin, Dr. Pittman decided on a different plan.

    The new breast reconstruction approach for Bessin meant waiting on the implants and placing tissue expanders, a type of deflated temporary implant, in the surgery site. This plan allows for healing time in the hyperbaric oxygen therapy chamber. 

    “Our goal is to get patients in for treatment as soon as possible. We are aggressively treating the patient to save their breast tissue and augment their healing,” said Kelly Johnson-Arbor, MD, medical director of Hyperbaric Medicine in the Department of Plastic Surgery. “Our dedicated team of physicians, nurses and technicians work to ensure that patients remain safe and comfortable during their treatment regimen.”

    Healing Tissue Within Days with Hyperbaric Oxygen Therapy

    Hyperbaric oxygen therapy exposes patients to pure oxygen in a pressurized space. Sending patients to the hyperbaric oxygen chamber treats the initial blood flow issue and can help the patient avoid future healing problems. Treatment begins within  24 hours after surgery and does not require patients to stay in the hospital. 

    Bessin’s tissue healed in only 13 hyperbaric oxygen therapy treatments. Her hyperbaric oxygen therapy schedule began with two visits to the hospital per day, which later decreased to one visit per day near the end of her treatment.  

    “I bounced back quite quickly. I’m already working my normal schedule, and my energy level is back to normal,” Bessin shared. “I’m so grateful to my doctors for providing this therapy!”

    Hyperbaric Oxygen Therapy: Rest and Relaxation Time

    Bessin recalled that she spent most of her time relaxing in the hyperbaric oxygen therapy chamber, which is a large glass tube. In the chamber, patients cannot wear makeup, lotion, nail polish or outside clothing, nor can they bring in a cellphone, books or paper. A glass of water and a cotton gown are permitted inside the chamber. During treatment, a nurse or technician stays in the room the whole time to administer the hyperbaric oxygen therapy, answer questions or assist with movie selections.

    “Georgetown has a great movie selection,” Bessin pointed out.

    Access for Every Breast Reconstruction Patient at MedStar Georgetown

    Dr. Pittman has used SPY Elite with hyperbaric oxygen therapy at MedStar Georgetown for five years. For breast reconstruction, Dr. Pittman’s team uses SPY Elite on almost every patient, but particularly in those who want to begin breast reconstruction with an implant immediately after a mastectomy.

    “SPY Elite and hyperbaric oxygen therapy allow us to aggressively treat patients safely and predictably,” said. Dr. Pittman. “This approach gives our patients the best chance for success.”

    To date, MedStar Georgetown University Hospital is the only center in the greater Washington, D.C., region to offer both SPY Elite and hyperbaric oxygen therapy for patients with breast cancer.

  • March 17, 2017

    By MedStar Health

    The last several years have produced significant advances in the field of genetic testing. Doctors are utilizing preventative measures to decrease cancer risk, and are now using genetic testing to help patients and their families understand their cancer risks. So how does genetic testing work and what are the potential positive outcomes for those with a breast cancer diagnosis?  What are the concerns about the risk?

    When and How Genetic Testing Is Used

    Genetic testing can be considered at various stages, depending on the individual and their background. For example, an individual recently diagnosed with breast cancer may undergo genetic testing in an attempt to understand why she developed cancer and whether her family is at risk.

    On the other hand, healthy women with a family history of breast cancer may want to know their risks.

    Modern genetic testing can be performed using either a blood test or a saliva sample collected to look for specific genetic information. The sample is sent to a lab, where a team of specialists looks for unique genetic mutations that indicate an increased risk for breast cancer.

    Today, there are two primary forms of genetic testing:

    • Single or limited numbers of gene testing which analyzes a small number of genes to test for the presence of mutations.

    • Multigene panel testing which analyzes many genes for mutations. While this field is evolving rapidly, some of the gene mutations included in these panels do not yet have clearly defined cancer risks or clear data on the impact of more intensive screening or prevention options.

    While both tests are useful, many factors such as family history, personal preference, health coverage and a need for immediate results, will influence which test is most appropriate for an individual.

    Benefits We've Seen from Genetic Testing

    Georgetown University's Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research in Washington, D.C., has served as the epicenter for research to improve cancer identification and diagnosis, including the use of genetic testing.

    People who test positive for mutations in BRCA1 or BRCA2 (two of the most common cancer genes) can take preventative action to decrease their risk of developing or succumbing to ovarian or breast cancer. This is one of the most compelling benefits of modern genetic testing.

    There are, of course, concerns regarding the added stress of knowing one carries a mutation or from receiving an inconclusive outcome from testing. However, multiple studies conducted at the Fisher Center have concluded that the benefits of genetic testing far outweigh those challenges, as the genetic testing results allow patients to make better-informed decisions about the most effective treatment options and course of action in their medical care.

    What's more, genetic testing can also determine that some relatives of people with a known mutation in a breast cancer gene understand that they do not carry mutated genes. This can relieve a significant amount of mental and emotional stress and alleviate a person's concern about an increased risk for cancer. 

    What to Keep in Mind

    It is possible to test for either one gene or multiple genes associated with breast cancer. While this is an exciting possibility, choosing which test to perform can be extremely complicated, but working with a genetics counselor will help ensure you choose the right test for you.

    Genetic testing is complex, and in many cases, the results of the test may have implications for other members of their family such as a sibling or cousin. Patients should keep in mind that results may not resonate in the same way with their family members and should be prepared for how to handle that conversation. A genetic counselor can be instrumental in helping to understand genetic test information and in disseminating the information gleaned from it.

    Finally, it's critical to keep in mind that genetic predisposition only accounts for 10 to 15 percent of all breast cancer cases.

    The Case for Genetic Testing

    If you were tested over three or five years ago, you should consider getting tested again in light of the recent advances that have taken place. Genetic testing for breast cancer has the potential to increase the health and longevity of women and men around the country.