New Tools, Techniques are Revolutionizing Breast Cancer Surgery
Advances improve outcomes and reduce psychological impact
Over the past year, breast cancer surgery has gotten a makeover, thanks to several new technologies. As a result, patients are facing fewer repeat surgeries, better cosmetic outcomes, and less stress both during and after treatment.
South Jersey’s largest health system, Virtua Health, has used these advances to help many women in recent months, according to breast surgeon Elizabeth Revesz, MD.
“Breast cancer is very personal,” said Dr. Revesz of The Penn Medicine | Virtua Cancer Program. “Most patients can survive breast cancer, but they will have to deal with the aftermath. That’s why we take a comprehensive approach, including everything from early detection to the newest surgical procedures, to make those after-effects as minimal as possible.”
These new tools and techniques include:
LOCalizer™. Today, many patients are diagnosed early, before their cancer can be felt. Therefore, the cancer must be marked in some way so the surgeon can locate it. LOCalizer uses radio-frequency tags that can now be placed at the cancer site, enabling the surgeon to find and remove even very small cancers. This offers many advantages over the standard method of marking these masses, which is a wire inserted into the breast.
With the wire, patients must have another procedure the day of surgery in another part of the hospital, so the radiology department can place the wire. This makes the day longer and more stressful for the woman. Also, the patient is awake during wire placement, and the wire can be uncomfortable as it protrudes from the breast. Options for where to place the wire are limited, which can affect a woman’s cosmetic results.
With LOCalizer, tags can be placed in the breast up to 30 days before surgery. They are placed via a small needle through the skin, similar to having a biopsy. During surgery, the surgeon moves a compatible wand over the breast, and the wand beeps when it’s over the mass.
“LOCalizer enables better planning and allows the surgeon to choose the best approach,” said Dr. Revesz. “We can focus on the cancer and how best to remove it, instead of thinking about where the wire is and getting the wire out.”
Moreover, LOCalizer improves the surgeon’s ability to make incisions where scars will be hidden.
“When we can hide a woman’s scars, she doesn’t have a constant reminder of her cancer and surgery. That can have a huge psychological benefit,” said Dr. Revesz.
MarginProbe®. After the surgeon removes the cancerous mass, the hand-held MarginProbe detects whether cancer cells remain in the “margin” of tissue surrounding the mass. If the MarginProbe detects abnormal tissue, the surgeon can immediately remove more of the margin.
Traditionally, margins are tested after surgery using ultrasound and mammography. If abnormal cells are found in the margins, the woman would need a second surgery.
“At Virtua, MarginProbe has enabled us to decrease our number of re-operations significantly,” Dr. Revesz reported.
Not only does this reduce the stress and potential complications of another surgery, but it lessens uncertainty and its emotional impact on the patient.
MarginProbe also helps surgeons provide better cosmetic results.
“It enables surgeons to remove less tissue and keep the breast as intact as possible, by confirming negative margins during surgery,” the physician explained.
Dr. Revesz recalls one patient who was just 38 years old, with no apparent risk factors for breast cancer.
“I was able to use hidden-scar techniques, and I used MarginProbe to identify negative (cancer-free) margins,” said the surgeon. “When I saw her again in the office, I had tears in my eyes because I was so happy for her that she did so well.”
In addition, lighted retractors offer enhanced visibility of the surgical site, enabling surgeons to work through small incisions and in deep surgical pockets, where visualization is normally challenging. Retractors hold back skin and other tissue while the surgeon is operating. “It’s like having stadium lights on the surgical area,” said Dr. Revesz.
And a new technique called advanced oncoplastic closure allows surgeons to reshape the breast and re-establish its natural contours during breast-cancer surgery. Virtua breast surgeons took a special course on these techniques, she noted.
“At Virtua Health, we embrace all opportunities to help our patients,” added Dr. Revesz. “That includes using the most advanced techniques and technology while ensuring outcomes that meet the highest standards of care.”