Melvin J. Silverstein, MD, FACS, medical director, Hoag Breast Center, Gross Family Foundation Endowed Chair in Oncoplastic Breast Surgery, Hoag Memorial Hospital Presbyterian, compares oncoplastic surgery with mastectomy for patients with breast cancer.

Mastectomy rates have risen in the United States over the last decade, Silverstein explains. Moreover, double mastectomy rates have increased by 10% during this time.

Patients with breast cancer are encouraged to meet with an oncoplastic surgeon for a second opinion after being recommended to have a mastectomy, Silverstein adds. Surgeons conduct mammographies, ultrasounds, magnetic resonance imaging scans, and evaluations by specialists in plastic surgery, medical oncology, pathology, and surgical oncology. The multidisciplinary approach is used to determine if this breast-conserving surgery is the best option for a patient. 

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Dr. Silverstein on Oncoplasty Versus Mastectomy for Patients With Breast Cancer

Melvin J. Silverstein, MD, FACS, director, Breast Program Hoag Memorial Hospital, professor of surgery, Keck School of Medicine, University of Southern California, gives an overview of the Van Nuys Prognostic Index for DCIS.

The Van Nuys Prognostic Index is based on five markers: tumor size, margin width, nuclear grade, age, and comedonecrosis. Possible scores range from 4 to 12. Low scores (4, 5, and 6) are typically seen in older patients with well excised, small, low-grade lesions, while high scores (10, 11, and 12) are typically seen in younger patients with poorly excised, larger, high grade lesions.

Patients with low scores do not need radiation therapy, as the predicted chance of recurrence is low compared with patients in the high group. Silverstein says this is not enough of a benefit for radiation to be worth it.

Dr. Silverstein Gives an Overview of the VNPI

Melvin J. Silverstein, MD, FACS, director, Breast Program Hoag Memorial Hospital, professor of surgery, Keck School of Medicine, University of Southern California, describes oncoplastic surgery.

Oncoplastic surgery is a combination of oncologic (cancer-removing) surgery and plastic surgery. In the past, surgeons were taught to remove a tumor in the breast at any cost.

The new approach is for surgeons to care about both getting the tumor out at an adequate margin and to make the breast look good. Rather than simply excising the tumor and closing the breast, surgeons design an operation that uses plastic surgical techniques in order make the breast look as good or better than before the operation.

Normally, this is done with a reduction excision, as most breasts are a little larger or ptotic than what the patient desires. A surgeon can do an oncoplastic reduction excision and achieve an adequate result.

View more from the 2014 Miami Breast Cancer Conference

Melvin J. Silverstein, MD, FACS

Articles

Dr. Silverstein on Oncoplasty Versus Mastectomy for Patients With Breast Cancer

Dr. Silverstein Gives an Overview of the VNPI

Dr. Silverstein Describes Oncoplastic Surgery