Think a hysterectomy is the only solution for fibroids? Think again. Treatment can involve a simple prick to the wrist

WASHINGTON D.C. – When Nicole Austin-Hillery looks at her wrist, she sees a small, pinhole-sized scar. It’s the only visible sign of her recent treatment for uterine fibroids.

Nicole Austin-Hillery
Nicole Austin-Hillery

“It is hardly noticeable at all,” she says. “It looks like I have a little tiny mole there. There’s absolutely nothing. I don’t even think about that.”

July is recognized as Fibroid Awareness Month. Nationwide, one in three women suffer from fibroids, including 80% of African American women and 70% of Caucasian women by the time they reach the age of 50. Oftentimes, the tumors can cause very heavy menstrual bleeding, pelvic pain, increased abdominal girth and urinary symptoms.

Earlier this year, Austin-Hillery, a D.C.-based civil and human rights attorney underwent uterine fibroid embolization (UFE) at MedStar Georgetown University Hospital. UFE is an established, minimally invasive procedure that treats fibroids without the need for major surgery. Several years ago, Austin-Hillery did have surgery to remove her fibroids, but the benign pelvic tumors came back.

“They eventually grew to even bigger sizes and in multiplicity beyond what they had been originally,” she says. “I could really feel the impact of those fibroids and how they were interfering with my daily activities, particularly when it came to exercise.”

She was looking for way to address her discomfort without undergoing another operation like a myectomy or hysterectomy. After researching UFE on her own, Austin-Hillery was referred to Interventional Radiologist Theresa Caridi, MD, who specializes in the procedure.

Dr. Theresa Caridi
Dr. Theresa Caridi

“One in five women are under the impression that a hysterectomy, or surgical removal of the uterus, is the only way to treat uterine fibroids. It’s not true,” said Dr. Caridi. “Treatments like uterine fibroid embolization can be just as effective and carry fewer risks of major complications than surgery.”

During UFE, the fibroid is starved of blood supply as portions of connecting uterine arteries are blocked by a microscopic substance known as embolic or bead.

“We deliver the substance through a small catheter that’s inserted into either the patient’s wrist or upper leg. It only takes one to two hours,” Caridi says. “The fibroids aren’t removed but, following the procedure, they shrink into scars over several months.”

Austin-Hillery went forward with UFE and had the procedure in February 2019. The procedure only required a local anesthetic, she remembers being somewhat aware throughout. Afterwards, she did feel some side effects like nausea and abdominal discomfort, especially during the first day or so following the procedure, but they improved relatively quickly. A far cry from the recovery following a myectomy or hysterectomy.

“MedStar Georgetown was great. They checked on me. I called them when I had questions. Around day three, I started to feel better,” Austin-Hillery says.

Best of all, she feels like uterine fibroid embolization worked. According to Dr. Caridi, the fibroids will continue shrinking for up to a year after the procedure, but Austin-Hillery says the difference is already noticeable.

“I’m continuing to see changes in my abdominal area. My menstrual cycles are much better,” she says. “My comfort level when I exercise is just off the charts. Overall it was a win-win for me.”

For more information, visit: MedStarGeorgetown.org/Fibroids.

To schedule an appointment with a MedStar Georgetown interventional radiologist, please call 202-444-5478 or complete an online appointment request form

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Debbie Asrate
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Women Replacing Breast Implants with Their Own Tissue, a Growing Trend

(Washington, D.C.) – When Cynthia Davis of Virginia was diagnosed with breast cancer in 2015 she elected a double mastectomy with implants.  Before her surgery she had chemo therapy.  Radiation followed.

As she recovered and went back to her active and athletic lifestyle that included bicycling, yoga and weight lifting, Davis noticed that she was experiencing pain and irritation associated with her implants.   

“The more active you are the more you use your chest wall,” says Davis now age 60.  “If you’re not doing anything it doesn’t bother you, but I went back to bike riding, the gym and yoga and the more I did, the more it bothered me.”

Cindi-Davis-with-paddle

In 2017, Davis saw an opportunity to try a new sport. Having rowed years earlier, she knew she enjoyed water sports. Last summer, she found and joined “GoPink!DC”  - a dragon boat team made up of breast cancer survivors and supporters.

“The more I paddled with the team, the more uncomfortable my chest became.  I realized that if I wanted to continue being active and do well on this team, I was going to have to do something about the implants.”

Davis also noticed that cosmetically, because the implants were placed under her chest wall muscles that her breasts appeared to flex and there were certain yoga poses that were not possible because of her implants.

“A large part of my practice is fixing previous reconstructions with breast implants and replacing them with a woman’s own tissue,” says David H. Song, MD, Physician Executive Director of Plastic Surgery for MedStar Health and Chairman of Plastic Surgery at MedStar Georgetown University Hospital.

Davis went to see Dr. Song at MedStar Georgetown where he recommended a procedure that would replace her implants with her own tissue and make her more comfortable. The procedure Dr. Song recommended is called DIEP flap in which blood vessels called deep inferior epigastric perforators, as well as the skin and fat connected to them are removed from the lower abdomen and transplanted into the chest.

Dragon-Boat-teamDavis had the surgery in March of 2018.

“I’m thrilled,” says Davis.

“I woke up in recovery with the implants gone and when they asked me what my pain number was, I almost cried because I realized the pain in my chest was gone. Even with the stitches the pain was gone. I traded in my implants for a double DIEP.”

Davis had the surgery on a Wednesday and went home from the hospital four days later.

The DIEP flap procedure is performed using a surface incision from hip to hip.  Dr. Song says the use of a non-opioid pain medication called Exparel™ has been a “game changer.” 

“I believe that more than 90 percent of women needing breast reconstruction are candidates for a tissue-based procedure,” says Dr. Song.  “I can take tissue from the tummy, thigh, buttocks or back. In the case of a DIEP flap, patients get a tummy tuck and a breast reconstruction at the same time.”

In addition to DIEP flap, there are as many as 4 additional procedures that Dr. Song performs that use a woman’s own tissue for reconstruction.

(Video courtesy of Robin Barr)

Radiation therapy for breast cancer after reconstruction with implants is associated with complications. 

“Radiated implants put women at greater risk of pain, discomfort, hardened breasts and even ruptured implants,” says Dr. Song. “With radiation, the success rate for implants after five years is only about 65 percent.  The life span of implants is 10-14 years; when using your own tissue, once you’re done, you’re done.”

“I’m back to paddling with GoPink!DC twice a week,” says Davis.  “By the end of the summer I will be racing, and I’ll be pain free.”

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Marianne Worley
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Brendan McNamara 
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Combined Technology improve Breast Reconstruction Outcomes in Breast Cancer Patients

dsc_1156“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,” said Sarah Bessin, a 47-year-old breast cancer survivor.  

Bessin was diagnosed with breast cancer in July 2015. After she opted to begin breast reconstruction at the same time of her mastectomy in October 2015, Bessin reaped the benefits of undergoing breast reconstruction that combines two tissue-saving technologies to diagnose and avoid serious complications.

The unique combination of SPY Elite and Hyperbaric Oxygen Therapy at MedStar Georgetown saved Bessin’s breast tissue and improved her breast reconstruction outcome. To date, MedStar Georgetown University Hospital is the only center in the Greater Washington, D.C. region offering the combination of SPY Elite and hyperbaric oxygen therapy for patients with breast cancer.

“Everything that we do in plastic surgery involves blood flow. If blood flow is disrupted, skin above it can flake off and even die. This is the reason we need to be able to anticipate those problems intraoperatively so we can act quickly,” says Troy Pittman, MD, Bessin’s breast reconstruction surgeon.  

A New Valuable Player in the Operating Room

After a mastectomy, the plastic surgery team enters the operating room with a fluorescent imaging system, 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. This helps us diagnose a problem early on and initiate hyperbaric oxygen within 24 hours, if we need to,” says Dr. Pittman.

SPYing a Problem

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. dr-pittman-working-in-surgery

“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 works to ensure that patients remain safe and comfortable during their treatment regimen.”

Healing Tissue within Days

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. Although treatment begins within 24 hours after surgery, patients do not have to stay at the hospital. Patients will only visit the hyperbaric oxygen therapy chamber once or twice a day for about an hour. 

Bessin’s tissue healed in only 13 hyperbaric oxygen therapy treatments. Her hyperbaric oxygen therapy schedule started 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,” said Bessin. “I’m so grateful to my doctors for providing this therapy!”

Treatment Affords Rest and Relaxation Time

Bessin said she spent most of her time relaxing in the hyperbaric oxygen therapy chamber, which is a large glass tube. In the chamber, patients are required to leave most items outside of the chamber to minimize any chance of creating a spark in the oxygen chamber.  Patients cannot wear makeup, lotion, nail polish or outside clothing, nor can they bring in cell phones, 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!” said Bessin.

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.”

 

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Marianne Worley
Director of Media Relations
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Pager: 202-405-2824
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Yvette Rattray
Media & Communications Specialist
Office: 703-558-1593
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Breast Surgery without Opioids

“I absolutely cannot handle narcotics,” said Cathy Kalimon, after learning that treating her breast cancer would mean surgery and anesthesia.Cathy & husband horseback riding in Shenandoah

Cathy received her diagnosis in December 2015 shortly after she and her husband John returned from a getaway in the Shenandoah Mountains. Days later, Cathy met with breast surgeon Eleni Tousimis, MD and breast reconstruction surgeon Troy Pittman, MD. Cathy was scheduled for two surgeries. One surgery included two procedures in the same operation: a bilateral mastectomy with breast reconstruction. 

Cathy’s previous surgeries with standard anesthesia left her with unbearable nausea and vomiting. Dr. Tousimis comforted Cathy to let her know she had not forgotten her concern and introduced Cathy to her anesthesiologist.

“When she opened the office door, there he was! Dr. Wonderful!” Cathy said with a chuckle. “Or at least that's what I call him.”

Joseph Myers, MD is the anesthesiologist who developed the ComfortSafe Pyramid®, an alternative approach to anesthesia that can relieve pain without narcotics and their side effects.  The ComfortSafe Pyramid® is a checklist that prompts anesthesiologists to consider all the alternative pain relieving choices before a patient regains consciousness after surgery.

Many patients who undergo surgery with ComfortSafe experience:MGUH Clinic Cathy with Dr. Tousimis and Dr. Myers

  • Less pain
  • Less nausea
  • Less confusion
  • Awaken more rapidly
  • A reduced risk of narcotic addiction
  • Often return home sooner

The ComfortSafe technique was originally developed for the sickest patients in the hospital. Dr. Myers discovered that these sick patients, who could not tolerate standard anesthesia, did not need narcotics.

In February 2016, the American Pain Society published new Guidelines on the Management of Postoperative Pain in The Journal of Pain. The guidelines provide strong recommendations for using a variety of non-narcotic techniques and avoiding opioids when unnecessary. Aligning with these recommendations, the goal of ComfortSafe is to achieve maximum pain relief for all patients, with the fewest number of side effects.

“There are people who are terrified of anesthesia or have had such problems with anesthesia that sometimes they cannot bring themselves to have life-saving surgery. ComfortSafe can help these people make a good decision for their health,” said Dr. Myers. “It’s exciting to see progressive and forward-thinking surgeons willing to collaborate with the anesthesiologists to benefit our patients.”

OR - ComfortSafe & Breast Surgery - 1The collaboration between Dr. Tousimis, Dr. Pittman and Dr. Myers began in 2015 after discussing a research project, which included questions about pain. Together the doctors developed a non-narcotic anesthesia protocol for breast surgery patients.   

"I have always had a strong interest in reducing pain after breast cancer surgery," said Dr. Tousimis. “If a patient has a pain-free recovery, they breathe better, get out of bed sooner and have a faster recovery with a better outcome.”

“ComfortSafe is a total game changer and unique to MedStar Georgetown,” added Dr. Pittman. “One of the hardest parts of the journey through breast cancer is loss of control. The nausea, pain and disconnection associated with narcotics is the epitome of that loss of control. Patients simply do not want to feel sick and helpless. With ComfortSafe, all of this is minimized.”

Cathy felt her sense of control return immediately after meeting with her doctors for the first time.

“People hear ‘surgery’ and they automatically expect the worst, but I was so pleased to meet with all the members of my surgical team at MedStar Georgetown,” said Cathy. “I just remember thinking that I was so glad someone was finally going to listen to my concerns about the side effects of narcotics!”

Grateful for a smooth recovery, Cathy encourages patients to ask questions about their anesthesia and anesthesiologists while researching for surgeons.

“My experience with ComfortSafe in comparison to normal anesthesia is like night and day!” she said.

MGUH Clinic Dr. MyersSince ComfortSafe is not limited to breast surgery patients who are in need of an alternative anesthesia method, Dr. Myers looks forward to helping more patients and collaborating with other surgeons. Patients in Obstetrics and Gynecology, Urology and the Wound Healing Center at MedStar Georgetown have also benefited from ComfortSafe.

Physicians do not encourage ComfortSafe on new patients who have never had a negative experience with standard anesthesia. ComfortSafe is recommended to:

  • Patients who have experienced postoperative nausea and vomiting
  • Elderly patients who wish to avoid prolonged confusion following anesthesia
  • Patients who are at high risk for further reliance on opioids
  • Patients who are morbidly obese with obstructive sleep apnea and use CPAP
  • Critically ill and oxygen-dependent patients

Dr. Myers has administered anesthesia at MedStar Georgetown for 29 years. His experience helped him sense a bit of fear in Cathy after her last reconstruction surgery.

“I was so afraid of vomiting when I woke up,” said Cathy. “But I think Dr. Myers knew because he didn’t give me much time to think about it. He came right on over to my bed side and confidently said ‘Come on, let’s get up, let’s go’ and, then, he walked me out. I couldn’t believe it. I could really go home and it would be okay!” 

Patient Story: Comfort Safe & Breast Surgery – Cathy Kalimon’s Story

Media Contact

Marianne Worley
Director of Media Relations
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Pager: 202-405-2824
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Georgetown Hosts Research Summit on Concussions in Females

PINKconcussions and Georgetown University Medical Center will host the first summit to explore gender differences of female brain injuries including symptoms, treatment and recovery to develop a better model of care on Feb. 27 in Washington.

WASHINGTON (Feb. 12, 2016) — When physicians, researchers and scientists gather at Georgetown University later this month, they will tackle what they say is an underappreciated medical issue: brain concussions in girls and women.

Much research has been focused on concussions in male athletes, such as football players and boxers. Sex differences that affect the risk of concussion and the outcome after a concussion have had little study and even less national attention. But existing evidence is convincing enough that the American Medical Society for Sports Medicine released a 2012 position statement, declaring that in sports that are played the same way, female athletes sustain more concussions, have symptoms that are more severe and take longer to recover than their male counterparts.

Melissa Coyne knows what a sports-related concussion can do. She’s had three, but the first was the worst, says Coyne, who is director of games administration at US Lacrosse in Baltimore. It happened in 1995 when she was 16 years old in high school, playing basketball before her Lacrosse season started.

“I was going to save a ball from going out of bounds, and I had turned my head and thrown the ball and hit the wall,” Coyne says.

She was completely knocked out. And she didn’t feel right for about the next half year. The concussion “had a big effect on just every day-to-day thing — like reading, taking tests, not being able to sleep well, having my mood and appetite change.

“I think I wasn’t quite sure if it was all related to concussion, though my doctor told me it was,” Coyne says. “I had really serious sensitivity to loud sound and bright light for a while. Things like that I don’t think I was expecting — I don’t really think I had the first clue about what a concussion really could do.”

The second concussion happened later in high school and the third occurred when she was an undergraduate at the University of North Carolina at Chapel Hill — both while playing Lacrosse. Neither was as severe, but from the symptoms, she knew she had concussed. Coyne was out for a week after the second concussion and kept quiet about the third one about because she wanted to keep playing. “Even though I knew I had a concussion and wasn’t at 100 percent, I was going to play.”

“Double digit” concussions

As with many females who report a longer recovery after a concussion, Coyne’s experience illustrates the issues that the Georgetown meeting — the International Summit on Female Concussion and TBI (traumatic brain injury) — will be discussing. The Feb. 27-28 conference, the first known scientific meeting to discuss concussions in girls and women, will feature presentations and workshops with at least three dozen researchers, and will also host panels of sports reporters and female athletes who have had multiple concussions. The event is co-hosted by Georgetown University Medical Center and the non-profit advocacy group PINKconcussions.

Researchers aim to understand what is known and what isn’t in the clinical presentation and outcomes of concussions in girls and women, not only through athletics, but as a result of domestic violence, military combat and accidents.

Their goal is to develop a “white” paper on what gender-specific clinical practices and safety protocols should be researched as well as possible new strategies to treat females with concussions.

“The concussion research conducted to date on sex differences shows females on average have different injury rates, symptoms and rates of recovery than men." says Katherine Snedaker, a Connecticut clinical social worker who founded PINKconcussions, the first organization in the world to focus on solely on females with concussions from sports, abuse, accidents and military service. “Yet the medical community does not yet have any sex-specific guidelines, protocols or resources for females with concussions.”

Snedaker says that because females appear to need longer time to recover than males, they should be educated about this possibility in order to reset their expectations, and line up medical and social support if needed for a longer recovery. 

Snedaker became interested in the issue of concussion recovery not only because she says she has had a “double digit” number of concussions — from field hockey, car accidents and other accidents that each resulted in 6-8 weeks of headaches — but because her son was concussed when he was in the sixth grade and experienced post concussion syndrome for two years. 

Her son’s experience led Snedaker to lead a city-wide concussion plan which tracks concussions across all 11,000 school children; she also helped get concussion guidelines enacted for all youth sports in her hometown of Norwalk, Conn. Data she and school nurses have collected demonstrates a high prevalence of concussions in girls. “While we have found that fewer girls play sports compared with boys, for the last year-and-a-half of collection, the girl athletes have concussed at twice the rate as the boys,” she says.

Snedaker says the Georgetown summit will “be an educational event for those who attend,” and she hopes the researchers will develop “recommendations on what gender-specific clinical practices and safety protocols should be researched and/or implemented to best treat females with concussions.”

Studying concussion in female animal models

“We want the smartest people in this country and Canada on this subject to talk about their data, their ideas, the need for research on the issue of concussion in women,” says David Milzman, MD, associate dean and professor of emergency medicine at Georgetown University School of Medicine and an emergency physician at MedStar Washington Hospital Center.

“There is very little solid data now about sex in concussion presentation or outcomes. It is not clear there is a difference — and that is why we need to investigate it,” says Milzman, the scientific chair of the summit.

If differences do exist, it may be due to a number of reasons, he says, including fluctuations in the estrogen cycle and lower body mass and musculature supporting the neck and head.

Georgetown neuroscientist Mark Burns, PhD, says that one reason so little is known about female concussions is that, until recently, basic research has been limited to male animal models.  

“In the last few years, there has been a growing awareness of fundamental differences between males and females,” says Burns, who leads Georgetown’s Laboratory for Brain Injury and Dementia. “The basic view for many, many years was always, ‘We’re all the same except for our reproductive systems,’ and that’s turned out to be just plainly not true. That understanding has led the National Institutes of Health to push for basic research that uses both male and female animals.”

Burns, who is also helping to organize the conference, plans to present data on inflammatory differences in male versus female mice after brain trauma. “We can see already that there are differences in behavior, inflammatory responses in the brain and the amount of cell death that occurs.

“If and when we discover sex differences in concussions, we can use our male and female mice to go back and try to figure out the mechanisms of action,” Burns says.

“For me, the most exciting part of the summit is the prospect of sitting down with preclinical and clinical researchers, discussing gaps in knowledge and identifying a roadmap to direct scientific research and improve patient treatment.”
 

Researchers, clinicians, advocacy groups and others interested in attending the conference, click here.

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Marianne Worley

Director of Media Relations
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Latest Mammography Technology Offered at MedStar Georgetown

Three Dimensional View of the Breast Offers More Detailed, More Accurate Results

(Washington, D.C) Patients who come to MedStar Georgetown University Hospital for their doctor recommended mammograms are now receiving the latest mammography technology; 3D or three- dimensional mammography also known as breast tomosynthesis.

03_Dimensions_110_2009-05-07_LCC_RCC.all2Like traditional mammography, 3D mammography uses X-rays to produce images of breast tissue in order to detect lumps, tumors or other abnormalities. 3D mammography is capable of producing more detailed images of breast tissue.

“While there are no large multi-center trials yet on tomosynthesis, early studies suggest that it is superior to standard digital mammography with both increased sensitivity and specificity,” said Amy Campbell, MD, director of Breast Imaging at MedStar Georgetown.  “At MedStar Georgetown we are doing this without increasing the radiation dose to the patient.”

Tomo news release

Traditional mammography produces just two images of each breast, a side-to-side view and a top-to-bottom view. 3D mammography produces many X-ray images of the breast from multiple angles to create a digital three-dimensional rendering of internal breast tissue. This allows radiologists to view the breast in 1-millimeter ‘slices’ rather than just the full thickness, improving the ability to detect abnormalities while reducing false alarms due to overlapping tissue.

3D mammography can be used for routine screening mammography and may be particularly effective for women with dense breast tissue or for those at high risk for developing breast cancer.

Media Contact

Marianne Worley

Director of Media Relations
Office: 703-558-1287
Pager: 202-405-2824
[email protected]

 

Learn more:

JAMA 2014 study: Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography

Breast Reconstruction Patients Celebrate “Closing the Loop” on BRA Day

 

“I really do feel like my life is back to normal!” said Cori Perry, a breast cancer survivor who completed her breast reconstruction treatment at MedStar Georgetown University Hospital. “I want women to know that there is life after breast cancer.”

BRA Day - Cori and her husband
Cori and her husband at the Closing the Loop photo exhibit.

Cori, along with other patients who underwent breast reconstruction, attended the first “Closing the Loop” photo exhibit in the plastic surgery suite on Breast Reconstruction Awareness Day (BRA Day), October 20, 2015. The exhibit honored patients who journeyed through breast cancer treatment and breast reconstruction. The event also provided encouragement to patients currently going through the process.

At the entrance of the exhibit, the plastic surgery team pinned a pink, satin ribbon with two loops on every attendee. The ribbon represents a meaningful part of the timeline for breast cancer patients: life after breast cancer treatments.

“The original breast cancer ribbon we see has a beginning and an end, but this ribbon is different,” explained Troy Pittman, MD, a breast reconstruction plastic surgeon. “The extra loop added to the bottom of the ribbon symbolizes ‘closing the loop on breast cancer.’ This is exactly what this exhibit is all about ... celebrating the fact that there is life after breast cancer treatment.”

Artwork of the breast reconstruction ribbon hangs on one wall of the plastic surgery office. The piece is surrounded by framed photographs of patients traveling on vacation, doing yoga, visiting family and friends and on other adventures. Dr. Pittman wanted the photos to show his patients living full and beautiful lives, unlike the stereotypical clinical ‘before and after’ photos where the focus is breast cancer and surgery. The head or face of the person is often left out of clinical photos.

BRA Day Event
This is only the beginning of photographs displayed in the Closing the Loop exhibit.

“For me, this is really about the patients and celebrating the fact that they got through the journey! I love to see these faces with smiles, the light in their eyes … and the hope,” said Dr. Pittman.

Dr. Pittman educates patients about the need for a board-certified plastic surgeon to be a part of the breast cancer journey right at the beginning of the treatment planning. BRA day, started in 2012 by The American Society of Plastic Surgeons (ASPS), serves as an opportunity to educate patients about their options after breast cancer treatment.

“Five percent of women with breast cancer who undergo a mastectomy decide to have reconstruction because these women are not given their breast reconstruction options,” said Dr. Pittman. “BRA Day is about getting the message out there … Women can have a smoother road to satisfying breast reconstruction when a plastic surgeon is involved in their care. This photo exhibit conveys a powerful visual message. We want women to look at these photographs and feel empowered, to know that there can be a fulfilling life after breast cancer and breast surgery. They can exercise, travel and yes, even wear a bikini.”

DSC_0654 A
Troy Pittman, MD and Shawna Willey, MD at the exhibit.

“It troubles my heart to think that some women might not have been given the same options during their treatment,” said Cori.

Limited access to plastic surgeons contributes to the lack of conversation around reconstruction options, according to Dr. Pittman. For a better understanding, he compared major metropolitan areas with multiple plastic surgeons on every corner to more remote areas that are limited in specialized providers. Despite the lack of conversation around plastic surgery during some cancer appointments, Dr. Pittman urges patients not to be afraid to initiate the conversation. He says that patients should ask breast surgeons about seeing a plastic surgeon who can provide reconstruction options while planning a mastectomy or lumpectomy.

“Many women start their breast cancer treatment in fear, but I automatically felt like I was in good hands…” said Carla Stolper, who was celebrating her first day after chemotherapy treatment at the exhibit. “Dr. Pittman was able to guide me through this process and make this experience of going through cancer much easier.”

Carla traveled to MedStar Georgetown from Thailand after she received her cancer diagnosis in early January. She spent many days away from her family, but was most grateful for the team of breast cancer and plastic surgery doctors and nurses by her side.

BRA Day Props
Fun and festive props in the exhibit's photo booth room.

“They really did all they could to make me feel comfortable,” said Carla. “I felt confident and comfortable from the beginning because of Dr. Pittman’s honesty, his easy manner in communication, and … plus he always looks so very dapper.”

Breast reconstruction surgery is a highly individualized process, according to Dr. Pittman. His philosophy involves really “seeing” the patients, listening to their concerns and never using the “one size fits all” approach.

The photo display in the clinic is only the starting point for the “Closing the Loop” exhibit. Moving forward, Dr. Pittman and team plan to add more photos to the exhibit as other patients complete the breast reconstruction process.

 “We really wanted to point people into the right direction on BRA day,” said Dr. Pittman, “but we also wanted to show them that life does go on … and that loop does get closed.”

 

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Watch Dr. Pittman discuss BRA Day

Common Chemotherapy Is Not Heart Toxic in Patients With BRCA1/2 Mutations

SAN ANTONIO (Dec. 9, 2014) — Use of anthracycline-based chemotherapy, a common treatment for breast cancer, has negligible cardiac toxicity in women whose tumors have BRCA1/2 mutations — despite preclinical evidence that such treatment can damage the heart.

The findings, to be presented Wednesday at the 2014 San Antonio Breast Cancer Symposium (SABCS), represent a unique effort between cardiologists and oncologists at Georgetown Lombardi Comprehensive Cancer Center and MedStar Heart & Vascular Institute in Washington to answer a vital clinical question.

"Our study was prompted by evidence from animal studies suggesting that mice with BRCA1/2 mutations in the heart were susceptible to heart damage — treatment with anthracyclines led to reduced cardiac function and heart failure much more frequently in these mice than in those without these mutations," says the study's principal investigator, Ana Barac, MD, PhD, an assistant professor of medicine at Georgetown University School of Medicine and director of the cardio-oncology program at MedStar Heart & Vascular Institute.

"This was a very relevant question to explore for women with breast cancer who are BRCA1/2 mutation carriers because they often require treatment with anthracyclines," says Barac.

"Although there was no clinical suggestion of an excess risk of heart toxicity in mutation carriers, it is always important to carry out a study to evaluate whether findings in the preclinical setting — in laboratory animals — are actually valid concerns clinically," says co-author Claudine Isaacs, MD, co-director of the breast cancer program at Georgetown Lombardi.

"These results are very reassuring," Isaacs adds.

"Overall this is great news for our patients with BRCA mutations," says the study's co-investigator Filipa Lynce, MD, an oncologist with MedStar Georgetown University Hospital. "Our results provide reassurance that these patients do not appear to have increased heart toxicity when compared with non-mutation carriers," says Lynce, who will present the study at SABCS.

The study included 81 participants — 39 BRCA1/2 carriers and 42 patients without the mutation. Women with metastatic disease and HER2-positive breast cancer were not included. The analysis also excluded patients who had history of hypertension because of its confounding effect on myocardial strain.

The participants had an echocardiogram 45 months, on average, after treatment with anthracyclines. The study used two measures to determine heart function: left ventricular ejection fraction (LVEF) — the percentage of blood that leaves the heart after each contraction — and global longitudinal strain (GLS), which correlates with LVEF but "is considered to be a more sensitive, global measure of cardiac function," Barac says.

The researchers found that most women had normal LVEF (91 percent) and normal GLS (85 percent). LVEF was borderline reduced (the heart pumped a little less blood than normal) in one BRCA1/2 mutation carrier and borderline or mildly reduced in six non-mutation carriers. They also found reduced GLS present in four mutation-carriers and seven non-mutation carriers.

"We found that mutation carriers who received anthracycline treatment do not have an increased risk of cardiac dysfunction, and that reduced cardiac function was very low in all patients, suggesting low risk of cardiac problems late after chemotherapy treatment," Barac says. "Our results are applicable only to patients without significant cardiovascular risk factors, particularly hypertension."

The study was supported by a grant from Georgetown Lombardi's Fisher Center for Familial Research. Barac is supported by a GHUCCTSA KL2 award, which is funded in whole or in part with federal funds (KL2TR000102 previously KL2RR031974) from the National Institutes of Health, through the Clinical and Translational Science Awards Program (CTSA).

About Georgetown Lombardi Comprehensive Cancer Center

Georgetown Lombardi Comprehensive Cancer Center, part of Georgetown University Medical Center and MedStar Georgetown University Hospital, seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Georgetown Lombardi is one of only 41 comprehensive cancer centers in the nation, as designated by the National Cancer Institute (grant #P30 CA051008), and the only one in the Washington, DC area. For more information, go tohttp://lombardi.georgetown.edu.

About Georgetown University Medical Center

Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.

Media Contact

Marianne Worley
703-558-1287
[email protected]

BRA Day Raises Awareness about Breast Reconstruction Options and Insurance Coverage

Wednesday, October 15 is Breast Reconstruction Awareness (BRA) day. BRA day is a collaborative effort between The American Society of Plastic Surgeons, The Plastic Surgery Foundation, plastic surgeons, breast centers, nurse navigators, corporate sponsors and breast cancer support groups designed to promote education, awareness and access regarding post-mastectomy breast reconstruction.

A study* from The American Society of Plastic Surgeons shows:

  • 89 percent of women want to see the results of breast reconstruction surgery before undergoing cancer treatment.
  • Less than 23 percent of women know the wide range of breast reconstruction options available.
  • Only 22 percent of women are familiar with the quality of outcomes that can be expected.
  • Only 19% of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.

These numbers tell us that we simply aren’t doing enough to educate women about their reconstructive options. The choice to undergo reconstructive surgery after mastectomy or lumpectomy is a personal choice. In addition to coping with the new diagnosis of cancer, these women are faced with the options of surgical treatment that they fear will leave them “disfigured” or “less of a woman.”

For women undergoing partial mastectomy or lumpectomy, the amount of tissue needed to remove the full tumor is often so large that they are left with a significant deformity of the breast.

But there are many choices available to address these cosmetic concerns.

Plastic surgeons have expanded on our breast reduction techniques to develop a technique called Oncoplastic Surgery. This procedure is planned much like a traditional breast reduction or breast lift. The tissue that is normally discarded after a breast reduction is left attached to the breast and used to fill in the defect left by the removal of the tumor.

The breast can be reconstructed after mastectomy on one side (unilateral) or both sides (bilateral). And thanks to the Women’s Health and Cancer Rights Act of 1998, federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. Reconstructive options include:

  • Saline or silicone breast implants
  • Tissue expanders followed by the placement of breast implants
  • Autologous reconstruction, a procedure that uses tissue from the abdomen, back, inner thighs or buttocks to reshape the breast mound. Following breast reconstruction, the nipples can be reconstructed and the areola can even be tattooed on the reconstruction to make the breast appear more real and natural.

Breast reconstruction is a highly individualized process. To find out what options are available to you or your loved one, it’s best to make an appointment with a Board-Certified Plastic Surgeon that specializes in breast reconstruction.

Plastic surgeons have the fortunate job of giving back to women what their diagnosis of breast cancer has taken away. Our goal is not only to reshape and rebuild the breast, but also to rebuild our patient’s self-esteem, dignity and confidence.

To make an appointment with one of our Breast Reconstruction surgeons at MedStar Georgetown University Hospital, please call 202-444-8751.

**Source: The survey was conducted online within the United States by Harris Interactive on behalf of ASPS from July 26-30, 2012 among 1,204 adult women ages 18 and older. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contact the [email protected].

Media Contact

Marianne Worley
703-558-1287
[email protected]

FREE First Annual Breast Symposium Offers Leading Experts in Everything from Latest Treatments to Life after Breast Cancer Treatment

"Breakthroughs In Breast Cancer Treatment"

(Washington, D.C.) - Leading experts in surgical oncology, radiation oncology, genetics, rehabilitation and more will be on hand for the First Annual Breast Cancer Symposium on the campus of MedStar Georgetown University Hospital onThursday October 23 from 6 p.m. to 8:30 p.m.

Physician experts will focus on the latest advances in breast cancer treatment and participants will have the opportunity to ask questions. Topics will include: breast surgical oncology, medical oncology, plastic and reconstructive surgery including nipple sparing mastectomy, radiation oncology including minimally invasive radiation treatments like Intraoperative Radiation Therapy (IORT), physical medicine and rehabilitation for conditions like lymphedema, and a unique support group that pairs survivors with people newly diagnosed called SOS or “Survivors Offering Support.”

“During Breast Cancer Awareness Month we know breast cancer is on the minds of a lot of women who want to learn about the latest treatment options,” said Eleni Tousimis, MD, Symposium director and director of the Betty Lou Ourisman Breast Health Center at MedStar Georgetown. “We’re able to offer a whole panel of our clinicians who will present the newest information, then take questions from our community. It’s a great opportunity for anyone facing breast cancer or who has a friend or loved one about to make some decisions about their care.”

The symposium will take place in salon CHF at the Georgetown Hotel and Conference Center, 3800 Reservoir Road, NW, Washington, D.C. 20007.

The event is free but space is limited and registration is recommended. A complimentary buffet dinner will be served. Please call 202-342-2400 to register.

Media Contact

Marianne Worley
Phone: 703-558-1287
[email protected]

Patient Contact: 202-342-2400