Atrium Health Navicent Specialty Center

Breast Surgery

Dr. Dale and Dr. Conforti have over 20 years of experience in treating breast cancer and performing breast cancer research. Breast cancer is the most common cancer diagnosed in women with over 270,000 new cases in the US this year. Fortunately, over 80 % of these women will be cured of their cancer and lead healthy productive lives. Both Dr. Conforti and Dr. Dale see most of their breast patients in the Peyton Anderson Cancer Center's Breast Center. This allows patients to have a thorough surgical evaluation and have the expertise of a dedicated breast radiologist to help perform and interpret mammogram, ultrasound, or even MRI findings on site and the same day.

If a biopsy is needed it can usually be performed the same day with results available within 1-2 days. The breast center is nationally recognized for delivering outstanding comprehensive multidisciplinary oriented care. Dr. Dale and Dr. Conforti firmly believes in the multidisciplinary approach to cancer care offering their patients a "one stop shop" for all their breast care needs.

Screening mammography helps detect the cancer in its' earliest form, Ductal Carcinoma in Situ (DCIS) This early form of breast cancer cannot spread and often carries a very good prognosis with the proper treatment. Surgical resection of the cancer by either Lumpectomy (removal of just the cancer also called segmental mastectomy) or mastectomy (removal of the entire breast) is usually required.

We also work closely with outstanding plastic surgeons who offer the latest options for reconstruction including the autologus DIEP free flap. Due to this close working relationship in many cases reconstruction can be performed at the same time as the cancer surgery.

For those patients eligible for breast conserving therapy, in conjunction with the Radiation Oncologists at the cancer center we offer several different types of radiation treatments to help reduce the chance of the breast cancer recurring in the future. On such technique is partial breast irradiation therapy.

Brachytherapy is a technique that delivers a local dose of radiation therapy directly to the cancer site and reduces the treatment time from once daily for 6 weeks to twice daily for 5 days. For those patients who have Invasive forms of breast cancer one of the most important questions is "Has my cancer spread?" If there is spread of these invasive, or spreading type, cancers the most common site is into the regional lymph nodes in the axilla or arm pit.

Both Dr. Conforti and Dr. Dale trained at the John Wayne Cancer Institute where the technique of Sentinel Node biopsy was first introduced during his time there. Dr. Dale was one of the first Surgeons nationwide to offer Sentinel Node Biopsy to his breast cancer patients in 1995. This technique revolutionized how we treat breast cancer by allowing a minimally invasive approach to identify the first (sentinel) draining node of a cancer. This determines whether the cancer has spread or not, if there is no cancer in the sentinel node then the cancer probably has not spread beyond the breast.

Our cancer center offers the most up to date tests to determine if a patient needs chemotherapy to treat the whole body such as the Mamaprint and Onco-type genomic tests. For those patients needing chemotherapy we work closely with our medical oncology colleagues to ensure a seamless transition and rapid induction of chemotherapy. In addition, our surgeons work closely with the Peyton Anderson Cancer Centers genetic counselors to help patients determine their risk of developing another breast cancer or other types of cancers via genetic screening. The cancer center also offers access to the many American Cancer Society programs, the Komen foundation programs, and many other resources are available in the patient learning center. Additionally, our patients have access to many support groups and therapy classes offered at the cancer center to ensure not only a physically rewarding recovery but also a mental and spiritual one as well.

Dr. Dale and Dr. Conforti also specialize in non-cancerous breast conditions such as fibrocystic changes, breast pain, nipple discharge, breast abscess or infection (mastitis), fibroadenomas of the breast, and second opinion regarding abnormal mammography or ultrasound of the breast. These conditions can mimic cancer and are very concerning to patients. Many times, surgery is not required and a thorough workup and diagnosis is often given in the first visit. Both Dr. Conforti and Dr. Dale, their office staff, and nursing staff are dedicated to delivering world class care to our patients and their families right here in central Georgia.

Treatments include: surgery, chemotherapy, and radiation therapy depending on the type and size of the cancer

The Right Surgical Oncologist for Breast Surgery

Anytime you hear the word "cancer", it can instill feelings of anxiety. Any type of cancer can be life threatening, but due to advances in medicine, doctors can treat cancer if caught in time. Surgery by a surgical oncologist removes tumors. Cancer itself is difficult to cope with. Patients need to know about what kind of treatment options are available to them. If you find that breast surgery is the right treatment for you, know that not all breast surgeries are alike.

Why is Breast Surgery Performed?

• There is not one reason for performing breast surgery. Reasons may include:
• Removing cancer from the breast (breast-conserving surgery)
• Removing the entire breast (mastectomy)
• Restoring the shape of the breast after cancer removal (breast reconstruction)

Breast surgery may also determine if cancer has spread, or to relieve symptoms in advanced stages of cancer.

Will I Have to Lose My Breast?

Not in all cases. In earlier stages, the surgical oncologist may be able to perform breast-conserving surgery. There are also radiation treatments. Treatments will vary depending on the type of cancer you have and how advanced it is. Even if you do need a mastectomy, many different types can be performed depending on your cancer stage and severity.

What treatment you decide on is entirely up to you.

What Happens In Breast Surgery?

Breast-conserving surgery may also be referred to as a lumpectomy or partial mastectomy. In this surgery, the surgical oncologist works to remove the cancer cells as well some healthy surrounding tissue to keep cancer from spreading. The amount of tissue removed may be small or large depending on the amount of cancer present. This is different from a mastectomy because they only remove a partial amount of the breast.

Breast-conserving surgery is usually performed on those with early stage breast cancer. While the woman will keep her breast, often she will need radiation therapy in addition to breast conserving surgery. In these cases, the surgeon may insert some metallic chips to help with radiation therapy.

In a mastectomy, the surgical oncologist removes the entire infected breast. This includes the breast itself and nearby tissues. There are many types of mastectomies. They include:

Simple Mastectomy:

The most common type. The surgeon removes the entire breast and nipple but leaves underarm lymph nodes and muscle tissue below the breast. In many cases, the patient can go home as soon as the next day if they stay in the hospital.

Double Mastectomy:

A mastectomy done on both breasts.  It is done, many times it is a preventative measure if the patient is at high risk of developing cancer in the other breast.

Skin-Sparing Mastectomy:

Like a simple mastectomy, but the surgeon preserves most of the skin over the breast except the nipple and areola. They remove the same amount of tissue as a simple mastectomy. This is useful for patients considering reconstruction. This method works as good as a simple mastectomy but it is best for patients with smaller tumors and those not close to the skin's surface.

Modified Radical Mastectomy:

This procedure is a simple mastectomy, but includes removal of underarm lymph nodes.

Nipple-Sparing Mastectomy:

This type of mastectomy is best for patients who are in the early stages of cancer with no signs in the skin or near the nipple. The surgical oncologist only removes the breast tissue without removing the nipple. Sometimes the surgeon will still give radiation to the nipple to reduce future cancer risk.

Radical Mastectomy:

This is the most extensive surgery of all. It involves the removal of the entire breast, underarm lymph nodes, and chest muscles under the breast. This surgery used to be common but more doctors are favoring less extensive surgeries. It is still used for larger tumors.

What if I Want Breast Reconstruction?

If you think you may want breast reconstruction, bring it up to your doctor before surgery. This will help them determine which surgery is best for your needs. Sometimes, they will be able to perform a breast reconstruction at the same time as the initial tumor removal. Even if you do not want reconstruction surgery immediately, it is still good to bring it up to your doctor when discussing surgery options.

What if I Have Advanced Breast Cancer?

Surgery in advanced stages is a little different from those in the initial stages. If the cancer is too advanced, surgery will do little to treat the cancer itself. The doctor may still elect surgery if the symptoms are unbearable for the patient or to slow the progress. Some things that warrant advanced stage surgery include:

• When the cancer is pressing on the spinal cord
• When the cancer is causing an open wound
• When there is liver blockage
• To relieve pain or other symptoms in the patient

How Will I Find A Surgeon?

Once you receive a diagnosis, you will get a surgeon. You will get a surgeon even if the doctor thinks you may have breast cancer. It is best that you have a surgeon who specializes in breast cancer because they will have a special expertise that another breast surgeon will not. They also will be able to provide suggestions best for your course of treatment. You want to find a doctor that is a recognized breast surgical oncologist and performs many breast cancer surgeries a year. Also, look for a surgeon who has completed a breast surgical oncology fellowship.

Finding the right surgical oncologist will help guarantee that you have the most comfortable treatment possible.