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Dr. William Gibson - Compassion in Medicine & Navigating a Diagnosis of Breast Cancer

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Disclaimer: The discussions on this podcast do not constitute medical advice, an evaluation, or a consultation. Nothing in the podcast episodes should be considered a replacement or substitute for a formal in-office evaluation by Dr. Hall or his associates. Explanation of off-label services and/or products do not constitute promotion and/or endorsement. Information and opinions presented here do not create a formal doctor-patient relationship. Discuss any potential medical procedures or interventions with your physician or surgeon first.

Show Notes

Navigating a Diagnosis of Breast Cancer

D r. Gibson is a general surgeon who specializes in the surgical treatment of breast cancer. If you are going through the process of navigating a new diagnosis of breast cancer, or have a friend or family member who has recently been diagnosed, this is a very important episode to listen to. Dr. Gibson and I discuss what you can expect from a new diagnosis, how to navigate the world of breast cancer treatment, and he gives some valuable advice to patients and family facing a new diagnosis of breast cancer.

In this episode of the Trillium Show, I’m joined by my good friend, Dr. William Gibson.

Dr. Gibson specializes in the surgical treatment of breast cancer and serves as the general surgeon at Parkwest Medical Center in Knoxville, TN. In this conversation, we explore breast cancer and what may come along with a diagnosis, both physical and emotional. Through the lens of compassion, Dr. Gibson shares his advice to patients who are navigating their breast cancer treatment and prevention, provides an in-depth look at oncoplastic breast surgery, and much more.

Transcript

Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I’m your host, Dr. Jason Hall.

Dr. Hall: So, welcome to this episode of The Trillium Show. On this show, I’ve got the distinct opportunity to have a good friend of mine as a guest today, Dr. William Gibson. Dr. Gibson is a breast surgeon here in Knoxville, Tennessee. He received his undergraduate degree from the University of Tennessee Knoxville in English and went to medical school at the UT Health Science Center in Memphis before doing a full general surgery residency at the Medical University of South Carolina in Charleston.

Dr. Gibson is board certified by the American Board of Surgeons, he’s a fellow in the American College of Surgeons, he’s a fellow in the American Society of Breast Surgeons, and is the former chairman of the Department of Surgery at Parkwest Hospital here in Knoxville. So Will, welcome to the show.

Dr. Gibson: Thanks, Jason. Glad to be here.

Dr. Hall: Before we get into the breast cancer thing, you and I are good friends; we’ve shared a lot of off-air conversations, and one of the things that we have talked about quite a bit in the past is that we both spent some time in college studying abroad. You were over in England in the mid-’90s about the same time I was in Austria. How did that experience shaped your college career, and did that still translate to changing the course of your career? Because I know, as we’ve kind of talked about in the past, I am a totally different person after having that experience, and I would love to get your thoughts on that for you.

Dr. Gibson: Yeah, that’s a great topic. That year abroad—for me it was my junior year of college—certainly shaped me as a person more than any year of my life, and I’ve been saying this for years. I find it impossible to believe I will ever have a year of education that will surpass that year. And of course, by education, I don’t mean what I read in the books, I mean the development as a person.

I also felt like I really began to understand the United States of America, and our history, and the concepts of liberty that we value so much in this country by seeing it from different perspectives, by living in another country, and then also meeting people from so many other countries and cultures at that time. So, the critical lessons for me that I learned from that year translate into my work as a physician because I think they taught me to understand people better which is, of course, the fundamental skill all physicians must have to have compassion and understanding of where people are coming from, even from different backgrounds. And that’s really, at the age of about 21, is where I began to be exposed to those thoughts.

Dr. Hall: I agree with you completely there. I think the interactions with other people and meeting and interacting with people from different countries, different parts of the world, certainly different socio-economic backgrounds, and seeing the United States from the perspective of someone who wasn’t born here, really does change the way that you interact with people. And unfortunately, the world in 2021 when we’re sitting here recording this, is a very different world than it was 30 years ago when we both traveled abroad. And I know like I do, you have two daughters who are contemplating doing something very similar to that. Would you let your daughters do something like that? Because I’m struggling with that right now.

Dr. Gibson: I’m struggling with that as well. And the answer is yes, I’m going to because I don’t want to give up a sense of optimism about the world, and I don’t want to limit the experiences my daughters can have and want to have in this world. Now, is that with some apprehension that I’m sending one abroad this next summer for a educational event? Yes, it’s with some apprehension but she’s going to go, and I’m going to support her, and we’re going to take all the precautions, but I’m trusting her judgment. You raise good daughters and you trust that they can make good judgments.

Dr. Hall: Well, I think you and your wife have done a fantastic job in that. And we certainly see you guys as role models for us that you’re a couple years ahead in terms of raising the girls. Will, you’re an expert in breast cancer treatment from the surgical standpoint. Talk to our listeners a little bit about the scope of that problem. How many women every year in the United States get breast cancer?

Dr. Gibson: This is a topic that I go over with my patients all the time. I always ask women if they know the answer to that, and they don’t—and they don’t need to—but it’s when you tell them that one in eight women in the United States will experience breast cancer in their lifetime, I think it really starts to resonate with them because when every woman is diagnosed with breast cancer, she thinks she’s alone. She thinks she’s on an island, and there’s no explanation, but when you start to tell them about the statistics that one in eight women won’t get it in their lifetime, which translates into something under 300,000 per year for invasive cancers and another 50,000 non-invasive cancers per year in the United States, they start to understand the magnitude of this disease. And it is rampant.

Now, my perspective on it is, of course, very different. When I go to Walmart, I think every woman in there is going to end up in my office in the next week because I feel like we’re just swamped with this diagnosis from every angle.

Dr. Hall: That is shocking that the incidence is that high, and it’s going up, isn’t it?

Dr. Gibson: Yeah, if you look at the curve of incidence in the United States for about the last 30 years, it’s been a steady trend upward. Some of that is due to increased diagnostic capabilities, but I think there’s also a true increase in the number of women in this country who are getting breast cancer. The reasons for that are, of course, hotly debated. I think that we have to agree that it’s multifactorial; I don’t think anybody can put a finger on one solitary reason, and in fact, no one’s put a finger on even a number of reasons, yet. It defies explanation at this point in time.

Dr. Hall: And you mentioned, when you were giving us some statistics a minute ago, you mentioned that there are a lot more invasive cancers than there were non-invasive cancers. I did general surgery 15 years ago and a lot has changed. Could you go over the types of breast cancers, so that we kind of have a framework? And which ones are the most common?

Dr. Gibson: Sure. The types of breast cancers really are broken down according to the microscopic anatomy of a breast itself. So, breast tissue is there for a young mother to nurse a baby. That’s the evolutionary objective of breast tissue.

And at the microscopic level, there are really two fundamental components of breast tissue that do that job. There’s something called lobules, which to put it simply that I think of them as the little factories that make milk to nurse a baby. And the lobules are connected to ducts, which are transportation tubes that carry milk to the nipple. So, between those two parts of the breast, the lobules, and the ducts, they each have the ability to become cancer. And those two add up to about 99% of all breast cancers; there are a few rare ones that we don’t really need to discuss. The breakdown is that about 85% of all breast cancers arise from the ducts or as I said, the transportation tubes that carry milk to the nipple, and then about 15% are from the lobules.

Dr. Hall: So, we’ve got the ductal cancers, you’ve got the lobular cancers, and keep hearing, and on social media certainly, hear stories of young women—there are some in our community now—who have inflammatory breast cancer. What is that and where does that fall into the spectrum of things?

Dr. Gibson: Inflammatory breast cancer, glad to say is a rare phenomenon but it is a real phenomenon, and it represents a fairly aggressive form of breast cancer that is diagnosed—it’s what’s known as a clinical diagnosis. There’s not a specific test that defines a breast cancer as inflammatory, but it is a diagnosis that is created by an experienced clinician who sees redness and thickening of the skin on the breast with a biopsy confirmation of an invasive cancer. The reason that it’s an important diagnosis is that we tend to jump on it quickly and aggressively, and it’s treated with chemotherapy on the front end.

Dr. Hall: What causes—is it that cancer in the skin of the breast that causes the redness and the skin changes, or is it something else with that tumor and how that tumor is growing that does that?

Dr. Gibson: It’s generally thought to be invasion of what’s called dermal lymphatics, which are little channels within the skin that carry lymph fluid, and the cancer cells from inside the breast invade outward toward the skin and create the redness and the thickening that I described. The exact reason why some cancers choose to behave that way is unknown.

Dr. Hall: Essentially, they’re blocking off the plumbing.

Dr. Gibson: They are. Within the breast.

Dr. Hall: One of the things that I very vaguely remember from past history with this is estrogen receptors, progesterone receptors, something that we were talking about during training, the HER2 receptors and things, what are those, and why are they important?

Dr. Gibson: I’m glad you brought that up. Those are very important topics and the term that we use to describe these, the overriding term, is called biomarkers. And with each diagnosis of breast cancer, which typically comes from a needle biopsy of a tumor in the breast, that tissue is evaluated by a pathologist, which is a type of doctor that looks at tissue under the microscope and can describe the microscopic findings, and they can test that tissue—even tiny slivers of tissue that come from a needle—to determine if that tissue is responsive to hormones, specifically estrogen and progesterone, like you mentioned, and then another test, they look for amplification or overproduction of a receptor on breast cancer cells called HER2/neu. And essentially what that means, it’s another growth factor—it’s called human epidermal growth factor—it’s another source of nutrition for breast cancer. So, all of these biomarkers indicate to us what a breast cancer is feeding on. So, if we know what it’s feeding on, it helps us create a strategy for treatment.

Dr. Hall: So, whether or not these different receptors are there is going to alter your ultimate treatment plans?

Dr. Gibson: That’s certainly true. So, it’s fortunate that most breast cancers are the hormone-sensitive type, meaning they have estrogen and progesterone receptors. That’s favorable for breast cancers for two reasons: one, the hormone-sensitive tumors tend to be—this is not true across the board, but they tend to be more slow-growing and a little less aggressive than the ones that are not hormone-sensitive; and it’s also an actionable item, there’s something we can do about that because we have good medications that are hormone blockers, that—and this usually comes in most cases, at the end of a woman’s treatment for breast cancer—they start taking a pill—most often it’s once a day for five years—that is a hormone blocker. And the thought process behind that is if these tumors were feeding on estrogen, and we have the ability to block any estrogen within the body, then it serves to starve out any potential upstart new tumors that would try to form. Now, of course, that doesn’t work with a hundred percent efficiency, but it reduces the risk of any other cancers quite a bit.

Dr. Hall: So, would you consider that chemotherapy? Or is that—where does that fall into the spectrum?

Dr. Gibson: That’s a great question. It’s not chemotherapy, that’s called endocrine therapy, endocrine meaning hormone gland-producing organs of the body. Chemotherapy, by definition, implies killing cells rather than prevention of growth, which is the goal of endocrine therapy. Chemotherapy involves killing cells.

Another thing you mentioned—and when we’re talking about biomarkers—is HER2/neu. HER2/neu brings up an interesting point because the holy grail in terms of the goals of treating cancer—not just breast cancer, but pancreas cancer, colon cancer, whatever it may be—the Holy Grail is to discover or invent drugs that target that cancer and kill it effectively without killing lots of other cells around it or creating collateral damage like we know most chemotherapy drugs do. So, a HER2/neu-amplified breast cancer on its surface represents kind of an aggressive breast cancer, and that’s not good news, we don’t ever like that. But we have some medications that represent the closest thing we have in medicine today to this holy grail of targeted therapies, specifically treating breast cancers with HER2/neu amplification. The medicines we mainly use are called Herceptin and Perjeta.

There are a few other further-down-the-line medicines. But those medicines target those cells and kill them very effectively without creating a tremendous amount of side effects for the patient who’s taking them. So, while we don’t like to see those type of aggressive tumors, I have a lot of experience seeing those medications completely dissolve those tumors and they’re gone, which is always a reassuring finding.

Dr. Hall: That’s awesome. That’s awesome that we’re getting closer to that holy grail, getting rid of the cancer without damaging what’s not. Now, the staging, as I was doing some research for this, I kind of went on some websites and saw that the staging for breast cancer has gotten incredibly complicated, and some of this factors into it. What’s changed and what’s important for patients to know about the staging of breast cancer and how that ties into things.

Dr. Gibson: You’re right that it’s gotten more complicated. And so a stage, when you talk about the stage of any cancer, most people are familiar with the stages, generally are 1 through 4 in escalation of severity. A Stage 4 tumor typically represents a tumor that has spread to other organs or has metastasized, and that’s true for breast cancer as well. And across the board, staging typically implies, how big is a tumor and has it spread?

But breast cancer staging is more complex because it incorporates the biomarkers we just talked about. What’s important in terms of predicting how a patient is going to do with a diagnosis of breast cancer is more complicated than just how big is it and where has it gone? The biology of the tumor matters as much or more than the size. So, that’s why these biomarkers are incorporated along with size. And fortunately for me, they’ve made an app for that. [laugh]. Sounds silly.

Dr. Hall: You’ve got to be joking me.

Dr. Gibson: Sounds silly. Sounds like something that we ought to know right off the top of our heads, but when you’re incorporating all of these factors, including the biology and the size, it’s easy to punch in the numbers and spit out a stage. And patients have access to that as well, which is kind of nice.

Dr. Hall: What’s it called?

Dr. Gibson: It’s called Breast TNM.

Dr. Hall: Okay, so we’ll put a link to that in the [show notes 00:15:20] so people can check that out. For patients out there, staging is important because it helps surgeons like Dr. Gibson determine appropriate treatments. There are lots of different treatment options for breast cancer that can be very confusing. Will, could you talk a little bit about basic surgical treatment plans or treatment options for patients that are facing a diagnosis of breast cancer?

Dr. Gibson: I’d like to back it up one step before we get into that, just as you talked about treatment options. With every diagnosis of breast cancer, when we’re formulating a treatment plan, we quickly come to a fork in the road, and we really have two options as first-line treatment. The vast majority go to surgery; there is a subset of patients, and it’s typically those with more aggressive tumors—the HER2/neu-amplified tumors being part of that—where they go for chemotherapy first, okay? And that’s appropriate; I believe that’s the right thing to do for a lot of tumors.

When a woman is diagnosed with breast cancer, unanimously her response and her opinion is, “Get this thing out of me,” and that is a very understandable and normal human response. And it’s very difficult sometimes to try to explain the rationale behind chemotherapy as first-line treatment for more aggressive tumors. That being said, in my heart of hearts, I do believe it’s the right thing and we see better results. And it’s not just my belief; there’s data that shows it better results with chemotherapy for the more aggressive tumors. And the way it works logistically is most patients who are diagnosed with breast cancer tend to see a surgeon first.

Where I work at Parkwest Hospital, when a woman is diagnosed, they typically get in to see me within about 72 hours, or less if possible, but we try not to make them wait very long because there’s a lot of anxiety over that new diagnosis. I bring them in and go over these topics that we’ve discussed—the staging, the biomarkers, and whatnot—and try to formulate a plan. And for that subset that does need chemotherapy first, I have a lot of wonderful colleagues in this town who are medical oncologists who do a wonderful job treating women with the appropriate chemotherapy regimens. The remainder of those, which is probably about 80%, do go to surgery first, which is probably why it’s appropriate to see a surgeon first because the vast majority need a surgeon first. So, when we talk about formulating a surgical plan for a breast tumor, again, it’s kind of a fork in the road, we have two fundamental options there.

Now, there are a lot of variations under these headings, but we have breast conservation surgery, which is typically known as lumpectomy, where only the tumor and a small amount of surrounding tissue is removed, and this preserves the vast majority of the woman’s breast, tries to preserve a normal cosmetic outcome, and certainly less physical and psychological trauma than the alternative operation which is a mastectomy, or removal of the entire breast. In my own practice—which I think reflects the nation pretty well—my own practice is about 70% of patients have breast conservation surgery and about 30% have a mastectomy. And in that 30% that has a mastectomy, some of those are because the tumor, usually at size or extent, demands it, and then there’s another portion of women who could, I think, safely have a lumpectomy but they choose to have one or both breasts completely removed, which is the maximum risk reduction that we can do surgically to not only remove the current tumor but decrease their chance of developing others.

Dr. Hall: I was looking through your bio getting ready for this and saw that you were a member of a group called the Society of Oncoplastic Surgeons and that’s something that’s fairly new. Is that a treatment type? What is oncoplastic breast surgery, exactly?

Dr. Gibson: Oh, I’m glad you asked. This represents, I think, a considerable improvement in the surgical care for breast cancer that’s occurred even over the fairly short time of my career, so far. I’ve been in practice just a little over 15 years, and even 15 years ago when I went into practice, surgeons taking care of breast cancer were very compassionate and committed to the care of their patients, which our fundamental goal is the eradication of breast cancer; we want to get that cancer successfully out of every woman who’s diagnosed with it. And at that time, cosmetics weren’t really taken into account. It was cancer above all else. Sorry if you don’t like the way it looks, but we got your cancer out and you’re alive; so be it.

Well, over time, we evolved as a group of surgeons that thought we can be nicer than that; we can do better than that. And out of this evolved this concept of oncoplastic surgery, ‘onco’ meaning tumor or cancer, ‘plastic’ meaning plastic surgery or reformative surgery as it’s known. And so we’ve started combining these techniques to take out breast tumors, but what I always say is leave a woman as close to God made her as possible with very little visible alteration in her anatomy. I’ve put a lot of effort into this and a lot of my colleagues have, and I think we’re doing overall a much better job than we were ten years ago. And the concepts that we mainly use are trying to hide incisions, and there are a few places where we can make incisions on the breast to remove tumors that are less prominent.

Now, it’s impossible to make an incision on human skin and not leave a scar, okay? So, that’s an unrealistic expectation. We do leave scars, but we try to hide them and make them less prominent. Then the other things we can do is reposition the tissue. I always say that it’s very fortunate for me, my job is a lot better by virtue of how forgiving breast tissue is.

You can take out 10 or 20% of a breast with a lumpectomy, and then reshape it and reform it a little bit, and it looks like you were never there. And that leaves patients a lot happier than if they’re left with a significant visible deformity in the breast. And frankly, it’s not that hard to do, but the results are really good. And I think we’ve come a long way in the last decade or so in terms of successfully removing the tumors while leaving a woman as she wants to look.

Dr. Hall: So, is every woman who has who is either able to or chooses breast conservation therapy, a candidate for an oncoplastic resection, or are there certain criteria that women meet that make them better candidates than others?

Dr. Gibson: Yeah, there are a lot of variables in answering that question, and a lot of times it boils down to tumor size, and breast size, then tumor size as a proportion of breast size, then it boils down to the patient’s other health risk factors. Doing oncoplastic surgery is not a major and invasive operation like doing a heart transplant or something, but we still want to minimize risk, and there are certain patients, frankly, I’m really thinking of the eighty-year-olds and up who I frequently see, probably it’s not so advantageous for them because it prolongs the operation a little bit, moves around some tissue, creates risk for bleeding and whatnot, and their cosmetic benefit isn’t probably their top priority. But for anybody else for whom that is a priority, yeah, almost everybody else is a candidate for it.

Dr. Hall: That is a great improvement because from a reconstructive side, trying to take care of a reconstructive problem later—so six months, a year, two years later—is much more difficult than having the opportunity to address that problem immediately and trying to fix it. And we’ll get into—breast reconstruction is an entire other show because there’s a lot that goes into the breast reconstruction, a lot of options that we can talk about there, but I think it’s fantastic that you’re able to offer that because the psychological ramifications of a woman waking up from an operation, either deformed or missing one or both breasts is very, very significant. I think it can’t be overlooked.

Dr. Gibson: It really is. And I know you’re going to cover that, but you have a tremendous amount of experience and expertise on that and I look forward to hearing what you have to say when you cover that in a whole show, but I’ll say just briefly, as I mentioned, so in my own practice about 30% of patients either choose or require mastectomy, and in the vast majority of those, I recommend plastic surgery consultation. And my plan would be for what’s called immediate reconstruction, meaning that we proceed with sometimes it’s a staged procedure, but at least proceeding with the first stage of reconstruction on the same day as we do the mastectomies. And that’s for the reasons you said.

I think it softens the blow psychologically of a mastectomy because it is a significant psychological blow. And fortunately, we have good resources and good technology to offset a lot of that. One other thing I’ll mention is that the use of bilateral—or both sides, double mastectomy—with reconstruction in the United States is far greater at this point in time than we need in terms of the adequate treatment of cancer, but fortunately, we still have freedom of choice in this country. Our insurance plans are still, while they’ve certainly got their problems, they allow us some freedoms to choose the operations, that the woman can choose whatever operation she wants, with a diagnosis of breast cancer, and a lot of women who could be treated adequately with a lumpectomy would have a lot of anxiety over the potential for this diagnosis, again in their lifetime. And I think the younger they are and the more anticipated life they see ahead of them, they’re more likely to choose a double mastectomy.

So, we do it a lot, and the funny thing I’ve learned about this, sometimes I—I used to feel bad about some women choosing an operation that I thought was more invasive than they needed, but having been through this process again, and again, and again, I’ve learned they don’t regret it. I think that their anxiety is assuaged successfully by removal of breast tissue, and they are—a lot of times they’re young moms raising kids and that’s their biggest priority. And they don’t feel like they have this specter of another potential diagnosis of breast cancer hanging over them. And so even though, sometimes I wish we could get them through with a smaller operation because I think they would recover quicker and be happy with it, in the final analysis, they’re not unhappy when they choose the more aggressive operation.

Dr. Hall: And I’ve seen that in my own practice, in my own former life doing lots of breast reconstruction, lots of microsurgical breast reconstruction, the patients who chose bilateral mastectomy, or were forced to choose bilateral mastectomy and reconstruction, were typically very, very happy with their outcome, both from a cancer risk standpoint, but also from a cosmetic standpoint because just from a purely reconstructive standpoint, it is much easier to make breast symmetric or closer to symmetric, when you’re taking care of both sides at the same time, than when you’re trying to match a single reconstruction with a natural breast that’s never had a knife touch it at all. The cosmetic outcomes in those from—at least from a symmetry standpoint—tend to be better.

Dr. Gibson: I certainly agree. I never cease to be amazed at what you and your other colleagues in plastic surgery can do. And it’s always fun to see the final product after that. And yes, the women are happy with their results and it’s always satisfying to see them pleased.

Dr. Hall: Breast reconstruction is just one of many fantastic parts of plastic surgery. That leads me to my next question is, you know, you mentioned earlier that you would send patients out for reconstruction. Which patients do you send for a consultation for reconstruction? All of them? Is there a certain group that sees a plastic surgeon before having cancer removed?

Dr. Gibson: Almost all of them. My default choice would be to send every woman who’s going to have a double mastectomy or a single mastectomy for reconstruction. There are a few reasons why a plastic surgeon may choose not to do that on the same day as the mastectomy and those usually have to do with other health problems associated with that patient, smoking being one, poorly controlled diabetes being another. There are a few cases where I don’t make that referral and I just make the executive decision that this patient is—in most of those cases, this is for a bad cancer and this patient is going to need chemotherapy and/or radiation quickly after their mastectomy, and I feel like occasionally the reconstruction might compromise the other adjuvant modes of treatment for their cancer.

And while I certainly want to be sympathetic to their psychological outcome, as we talked about before, we really can’t afford to do that at the compromise of their cancer outcome. So, I’m glad to say that’s a very small number of patients, but sometimes we just have to treat the cancer aggressively first and hopefully come back and do what’s called delayed reconstruction. So, we don’t burn a bridge by not doing it immediately, but it does make that first step a little harder.

Dr. Hall: That’s an important point to really drive home is that the ultimate goal of our treatment, whether it’s you as a general surgeon, breast surgeon, removing the tumor, referring those over to plastic surgery for reconstruction, or waiting, the ultimate goal is to take care of the cancer first and deal with the side effects of that disease as soon as we can, safely. And I think safety is the ultimate goal with all of our options. You’ve been doing this for a long time, you’ve worked with a lot of plastic surgeons here locally. Do you think about the reconstruction, the reconstructive options, the effect of chemotherapy and radiation when you’re planning your surgery, or do you let the plastic surgeon drive that ship? Or is it a team decision? How are those decisions made?

Dr. Gibson: I’d characterize that as a team decision. It’s certainly not something that I ignore, but neither do I make all the final decisions on the approach to reconstruction. But I have good open communication with each of the plastic surgeons with whom I work, and we plan the incisions together, we plan the type of reconstruction, whether it’s going to be one-stage or two-stage, which we don’t always know; sometimes that’s what’s called a game time decision. But we formulate a plan.

The best cosmetic outcome we can achieve is what’s called a nipple-sparing mastectomy, where the woman’s nipple and areolar complex is preserved and not taken out. Like in a traditional, old-fashioned mastectomy, that was always removed, leaving a straight skin scar across the middle of the breast. But there are much better ways of preserving that now. Not in every patient, it sort of depends on the patient’s body habitus and the size and location of tumor, but we can do that a lot, and so that’s part of the team concept of planning the reconstruction with a plastic surgeon.

Dr. Hall: Breast cancer and breast cancer treatment is a team sport. There are lots of people involved in that, so if you’re a patient who is listening to this, and unfortunately were just diagnosed with breast cancer, or you have family or friends that are facing this, breast cancer is a team sport; there are a lot of people involved. That is really one of the most important aspects of this.

Dr. Gibson: It really is. And I would say to your audience, if you’re a patient who has just received this diagnosis and you’re trying to navigate this unfamiliar territory, make sure you find a treatment team that does participate in a multidisciplinary tumor conference every week or at least every couple of weeks. I participate in two of those here in town that are both very healthy, very collegial, full of intelligent people sitting around the table, talking about each new diagnosis of breast cancer. And by ‘multidisciplinary’ what I mean is different specialties of doctors all meeting together and offering input from their own unique perspective on how to best manage each patient who is diagnosed.

And so, when you have a surgeon, and a radiologist, and a medical oncologist, and a plastic surgeon, and a radiation oncologist all making plans together, you have a—I mean, it’s an extension of the old saying, “Two heads are better than one.” You have a whole team of smart people all looking at this patient’s details together and coming up with a plan. And so, most sophisticated places in the United States have that; it’s not unique, it’s not uncommon, but I would suggest to any patient make sure that your case is discussed somewhere in a multidisciplinary conference because you want a lot of people looking over your data.

Dr. Hall: Absolutely. I certainly second that. Are there any other tips or pointers that you can give women or their families who are facing a new diagnosis, who may be listening to this and feeling like they’re in the weeds and don’t know where to go?

Dr. Gibson: Yeah. When this new diagnosis comes up, as I mentioned before, every woman is shocked and can’t believe it happened to her, and she thinks at that moment that she’s the only person in the world who has this diagnosis, but that’s not true. So, I think the first step would be—most people hopefully have a good relationship with either a primary care physician or their Ob/Gyn, and that’s a good place to start to ask some questions. And then those physicians usually are well-connected to people, hopefully, people like me, who do this all the time, and they can quickly accelerate the care into the office of someone who does this full time.

And that’s where plans are made and women really have some peace of mind when they know that a plan is underway. So, in addition to local resources, the physicians who are going to provide your care there, everybody wants to educate themselves and we all have tremendous access to information these days, so there are some reliable websites that I point patients to all the time. The Mayo Clinic—of course, a renowned institution—has some educational material on breast cancer; the American Cancer Society has a reliable website; and there’s a nice one called breast360.org; that is nice.

So, when doing research online and trying to educate oneself, I wholeheartedly encourage that. I think it’s wonderful to familiarize yourself with terms and start to read the overviews of what goes into breast cancer treatment. The one thing I would caution folks about doing is getting into, whether it be chat rooms or any other type of information online where you start to get into the individual and nuanced experiences of patients who may have had their own unique experience and it may not reflect the experience that most women are going to have. And I think that I would just be cautious about reading individual responses and stick to larger, peer-reviewed-type websites.

Dr. Hall: That is a great point. And the internet is wonderful because there’s a lot of information out there, but it’s terrible because there’s a lot of information out there. [laugh].

Dr. Gibson: Well said.

Dr. Hall: And we’ll put links to those websites in the [show notes 00:36:39]. One thing I would add here is, with any new diagnosis, especially anything that you’re facing—whether it is a diagnosis of breast cancer, whether you’re having elective surgery—and are apprehensive about an upcoming procedure, keep a notebook with you, whether it’s the notes app on your phone, whether it’s a physical notebook and a pen because you are going to think of questions that concern you when you’re in the shower when you’re sitting at a stoplight. Those are going to be front-of-mind then, but as soon as you walk into one of our offices, you’re going to forget it, and that lingering question is going to keep you up at night. So, keep a notebook, write down your questions. When you come in to see your surgeon, your oncologist, your plastic surgeon, pull those lists of questions out so you get your questions answered. Because that apprehension and fear is really the worst part of that.

Dr. Gibson: I certainly agree with that, and it’s very customary for people to arrive to my office with a pre-printed list of questions and we go over them all. Most of the time, I’ll answer them in my routine speech because I know what they’re going to ask because I’ve heard it before, because people tend to have the same concerns, and they’re all valid. The one addition I would make to your good advice there is when you come for a consultation with a breast cancer surgeon or an oncologist, not only bring your questions and your notes but bring a family member—

Dr. Hall: Absolutely.

Dr. Gibson: —to preferably be the scribe to answer and write down the answer to the questions so that the patient herself can focus on listening and communicating. I know I put a lot of effort in my office on face-to-face communication. “Let’s establish a rapport and a connection here.” There’s so much information that is transmitted verbally in that one office visit, especially considering the unfamiliarity the terms, it’s overwhelming.

And so what I always say is when a woman leaves, and she’s going to have a cup of coffee if she doesn’t remember, “When do you take the hormone pill?” “What does a oncoplastic surgery look like?” I tell them, “Don’t worry. I remember. It’s my job. I will take you through this and I remember. But it’s best to have a family member there to help write this down so that when they’re reviewing it all, they’ve got the best access to the information, if they can.”

Dr. Hall: Will, this has been a lot of fun, man. I think we’re going to wrap it up. We appreciate you coming on the show. Where’s the best place for women who are facing a new diagnosis of breast cancer to find you?

Dr. Gibson: I can be found on my group’s website, that’s Premier Surgical Associates here in Knoxville, Tennessee, and all the surgeons in our group are listed on our website. And I’m William Gibson. Easy to find it; Premier Surgical. Thanks.

Dr. Hall: Well, thanks for listening, everybody. We appreciate it. And we’ll see you soon. So, I want to thank Dr. Gibson for being here today. This has been a really important show. I think it’s going to be really valuable information for patients who are facing a new diagnosis of breast cancer, or people out there who have family or friends who are facing a new diagnosis of breast cancer to get some really valuable information. We’ll share all the links to the websites and apps that Dr. Gibson mentioned in the [show notes 00:40:08], and thanks again for listening.


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