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or research studies that test new treatments.” The multi-team clinic has a 64% greater rate of clinical trial participation than standard clinical practices where patients see multiple doctors on different days. Breast Surgical Oncology has 21 surgeons who provide exceptional surgical care for patients with breast cancer and other diseases of the breast. Last year, they saw 3,461 new patients and consults, and performed 2,997 operations in the Nellie B. Connally Breast Center and at MD Anderson in League City, West Houston, Memorial City, Sugar Land and The Woodlands. The team performs multiple procedures including: • Mastectomy, including skin-sparing and nipplesparing • Tissue-sparing breast surgery, including partial mastectomy and oncoplastic reconstruction • Axillary lymph node assessment, including sentinel lymph node biopsy techniques and targeted axillary dissection Limiting side effects through surgery Our surgeons are helping our patients get back to living longer, healthier lives by employing surgical techniques that limit side effects. Some of these techniques include: Sentinel lymph node surgery: Our surgeons were among the first to utilize sentinel lymph node surgery as an alternative to axillary lymph node assessment. While essential for care, traditional more extensive axillary surgery can cause lymphedema, a debilitating condition that includes arm swelling. Axillary lymph node surgery can also lead to numbness and nerve damage. Sentinel lymph node surgery is a less invasive procedure that aims to remove the first few nodes that accept lymphatic drainage from the primary breast tumor. “Sentinel node surgery provides accurate staging and focuses on the nodes most likely to contain metastatic disease from the primary tumor. This limits the surgery to what needs to be removed and leaves other uninvolved (healthy nodes) intact,” Hunt says. “This improves a patient’s quality of life because we are minimizing side effects like lymphedema.” Skin- and nipple-sparing mastectomy: During this type of mastectomy, the surgeon removes the breast tumor and mammary gland while saving the breast skin, nipple and areola (darker skin around the nipple). For eligible patients, this technique facilitates reconstruction with improved cosmetic outcomes. Minimally invasive approaches: The breast surgical team is also leading in minimally invasive approaches for localizing small breast tumors and lymph nodes. They have used radioactive seed localization for breast lesions too small to be seen or felt during surgery and for localizing small deposits of metastatic disease in the axillary lymph nodes. With these techniques, a radiologist places a tiny radioactive seed in the abnormal breast tissue or lymph node usually on a day prior to surgery. In the operating By Craig Carson After five months of chemotherapy, a double mastectomy and breast reconstruction surgery near her home in Florida, Maria Doherty was still experiencing complications related to breast cancer. She was diagnosed with triplenegative, ER positive and HER2 positive breast cancers in 2017, and now she and her husband were beginning to feel worried and desperate. Her local oncologist recommended she seek another opinion at MD Anderson. Here, Maria met with Joanna Lee, M.D., assistant professor of Breast Surgical Oncology, who helped her feel at ease. “After meeting the doctors who would be helping me, my confidence started to grow. I knew I was at the best place, but then it started to feel like I was at the right place,” she says. Lee recommended a takedown of her previous reconstruction to determine if the cancer was still spreading. On May 14, 2018, Lee worked together with Dalliah Black, M.D., an associate professor of Surgical Oncology, and David Adelman, M.D., associate professor of Plastic Surgery, to undo her reconstruction and perform a mastectomy and sentinel lymph node biopsy on her left breast. During the surgery, they removed 14 cancerous lymph nodes and determined a correct diagnosis: triple negative breast cancer. With the right diagnosis and staging, Maria could continue with the right treatment. “Dr. Lee saved my life,” Maria says. “The doctors at MD Anderson are amazing, and I feel like I want to shout that from the mountain tops.” Finding confidence in MD Anderson 16 MD Anderson Cancer Center room, the surgeon uses a probe to locate the seed and target the removal of the abnormal tissue, leaving normal tissue intact. The group is now embracing newer technologies for localizing breast lesions and lymph nodes that do not require radioactive sources. “With breast cancer survival rates getting better and better, our work is moving beyond extensive surgical procedures to developing surgical techniques that improve the general well-being of the patient after surgery,” Hunt says. Researching less invasive surgical techniques Our researchers are constantly seeking new and better ways to treat breast cancer. Hunt is leading research on less invasive surgical approaches to breast cancer. “It has been hard for physicians and patients to accept that you’re going to do something less radical and still get the same results,” Hunt says. Hunt was part of a national trial that published results of a study on de-escalation of axillary surgery in almost 900 patients with early (stage II) breast cancer. This Phase III trial enrolled patients who had breast-conserving therapy
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