I believe it is widely known in Santa Clarita that breast care is excellent because of good teamwork by top quality specialists in each of the necessary specialties. This includes breast specialist radiologists, surgical, medical and radiation oncologists, reconstructive surgeons and pathologists. It was not available 20 years ago, and a brief review of the evolution of breast surgery is helpful to make clear what women must look for today.
In the early 1980’s standard treatment was a modified radical mastectomy, and women who wanted to keep their breast were in some cases told they were selfishly endangering their lives, other times to see a psychiatrist. But then a new generation of cancer specialists provided the first revolution in treatment. This meant that many women could have a lumpectomy (also called wide excision) using techniques that completely removed the cancer with a good rim of normal tissue around it (margins), but did not deform the breast. Radiation treatments were then devised that would generally not leave visible changes of the breast after a couple of months.
However this still left a considerable number of women with tumors that could not be safely treated in this fashion, thus still requiring traditional mastectomy followed later by limited reconstruction. The second revolution occurred with the demonstration that a skin-sparing mastectomy properly done provided cure rates equivalent to traditional radical mastectomy. This involved removing the breast tissue but leaving the skin envelope and shape intact by filling it with either natural tissue moved in place (a flap) or an implant all in the same surgery. Some surgical oncologists are now able to use areola sparing techniques as well. It requires a team of a breast surgeon and one or more reconstructive plastic surgeons who work seamlessly together, and thus has become a very highly specialized process. These options mean that wide excision is the first choice, but mastectomy isn’t cosmetically inferior, and often allows skipping radiation treatments. An old fashioned mastectomy almost never needs to be done.
As might be expected, this is a rapidly evolving area and requires that the surgeons be constantly striving to improve and innovate. The most complex of these surgeries may need to be done at UCLA, as the goal is always to do the procedures where the outcome will be best. We are seeing with time that more expertise develops locally, and more can be done at Henry Mayo Hospital.
So in the last twenty years women in Santa Clarita have been able to go from psychiatric involvement to happy cosmetic outcome and cure even with locally advanced disease. Of course, to have the best outcome a woman needs to be well informed and learn how and where to get this level of care.
UCLA Cancer Center – Santa Clarita is located at 23929 McBean Parkway, Suite 215 in Valencia. For more information, please call 661-255-5350 and visit www.cancer.med.ucla.edu .