In Part 1 of our PSP breast cancer series, Dr Valerie Gorman explains the benefits of using the Hologic LOCalizer™ during oncoplastic surgery procedures with partnering plastic and reconstructive surgeons.
Now in its 34th year, National Cancer Survivors Day (NCSD), which took place on June 6, 2021, initially launched to unite people around the world in recognition of cancer survivors, and to raise awareness of the ongoing challenges cancer survivors face. This annual celebration of life that kicks-off the first Sunday each June and extends further into National Cancer Survivors Month (NCSM), marks an important reminder for us to share resources, research, and the legislation being implemented to strengthen the survival rate of cancer patients everywhere.
At the time of this publication, the American Cancer Society estimated that in 2021 the United States will have 1,898,160 new cancer cases and 608,570 cancer-related deaths. That equals 5,200 new cases and 1,670 deaths every day, the Society notes. In addition, the statistics predict a total of 284,200 new male and female breast cancer cases on the rise, with 44,130 related deaths. But according to the American Association for Cancer Research, there are also more than 16.9 million people living with and beyond cancer in the United States alone.
In Part 1 of our Plastic Surgery Practice breast cancer series, we shine a spotlight on one of the latest technological advancements in surgical cancer treatments, the Hologic LOCalizer™. To learn more about the wire-free guidance system that is currently being used to identify cancerous lesions and improve surgical outcomes for breast cancer patients, we spoke with Valerie Gorman, MD, FACS, chief of surgery and medical director of surgical services at the Baylor Scott and White Waxahachie, Texas Surgical Specialists/Texas Breast Center. Gorman, who typically performs 15 to 25 lumpectomy procedures per month, also discussed best practices in oncoplastic surgery.
She transitioned away from the wire (needle) localization technique two years ago and began using a new system, designed to mark and guide to non-palpable breast lesions using a miniature radiofrequency identification (RFID) Tag. Another purpose of NCSD is to acknowledge the contributions of families, friends, healthcare providers—like Gorman and her medical team, and those engaged in the cancer research developments necessary to keep patients alive.
Plastic Surgery Practice: Why did you transition from using wire (needle) localization to Hologic’s LOCalizer™ device, and how has it improved your work flow?
Gorman: The wire-free miniature radiofrequency identification (RFID) Tag (“clip”) makes it easier for breast surgeons to pinpoint the exact distance and location of the cancerous lesion/s to be removed. It also enables multiple clips to be placed in the breast at one time with separate identification numbers. So, if there is a larger area of breast calcifications you’ll want to add two or three tags to triangulate the affected area being targeted, especially if there is more than one lateral, or medial lesion to be taken out.
Another reason I transitioned over to using the new wire-free device is because wire localization could only be done on the day of surgery, so my breast cancer patients had to arrive extra early to prepare for two different procedures in the same day—the wire placement to detect the affected tissue, and the breast cancer surgery to remove it. Depending on the complexity of radiology and operating room (OR) timelines, patients were required to wait hours inside of the day surgery area before we can finally schedule their case, because they could not go home wearing a wire. Using the miniature radiofrequency identification (RFID) Tag (“clip”), we’re now able to place the clip a week or two before surgery—or longer if needed, so there is much more flexibility with no limitations. This saves time for the radiologist, doctor, and patient.
In fact, some patients receive chemotherapy treatments prior to breast cancer surgery. The doctor can place the clip in the breast at the time of biopsy or before chemo to have it ready for upcoming breast surgery. And, if additional health issues arise that prevent the scheduled breast surgery, you don’t have to replace the clip.
For example, one of my cancer patients had a clip placement, and between the time we placed the clip and the time she was scheduled to have breast surgery, she broke her hip. It was a very protracted recovery period, but we didn’t have to do anything because the clip stayed in place until we were ready to do the surgery. As soon as she recovered from hip surgery, we were able to operate because the clip was still in place for many weeks.
PSP: Describe your oncoplastic surgery experience collaborating with plastic and reconstructive surgeons on patient cases.
Gorman: We have a supportive plastic surgeon, and our entire medical team is very close. When I partner with our plastic surgeon on lumpectomy procedures at Baylor Scott and White Waxahachie, Texas Surgical Specialists/Texas Breast Center, he’ll do a breast reduction at the same time. The LOCalizer™ helps me identify the location I need to put the incision, so he can plan the pedicle method for breast reduction.
During my previous training for the wire localization method, we were taught to go in right over the wire to pull the lesion and address any cosmetic issues once the cancer was removed. As doctors we can now try our best to make breast surgery outcomes cosmetically favorable— rebuilding the breast for each patient helping them during a difficult time. Hologic LOCalizer™ helps doctors plan effectively for patient cases, and in the OR to make sure we have all the advantages to perform the best oncoplastic reconstructive lumpectomy type techniques.
PSP: Why is it crucial for oncologists and plastic surgeons to support the needs of cancer patients in unison?
Gorman: Historically, I’ve worked with other plastic surgeons who didn’t have the same vision or care for the patient. It’s important to partner with a plastic surgeon who is willing to listen to the patient—and together as a team, and who also has the same goal for your patient—which is to treat the patient’s cancer in the best way possible, because we want our patients to do well. In addition, for patients who have always been unsatisfied with their breast size because it has kept them from doing certain activities, we can do a breast reduction with the lumpectomy and meet their goal while we’re taking good care of the cancer. A plastic surgeon who is not limited to only one approach and has many tools available to patients will be able to offer a menu of reconstruction options as needed, such a breast reduction with free nipple graft, nipple-sparing mastectomy, or a DIEP flap.
We want to treat the cancer and take it away from them in the best oncological way, so they don’t have any long-term effects from the disease or any recurring cancer. We aim to maintain the goals of each patient’s cosmetic results, which is different for each patient depending on their preference. Sensitivity is key to figuring out what that is, evaluating the resources, and making sure the whole team is on board.
PSP: What other features does this device offer that you appreciate most?
Gorman: I really like the pencil-size of the Surgical Probe. It’s smaller than my pinky, disposable, and doesn’t need a cover! It can be used during the lumpectomy within the cavity to identify when you’re getting close to the lesion and when you’re traveling from your incision over to it. The entire device is compact, so I don’t have to worry about another big device that needs to be hooked on a stand and have a wire connected to it. This just sits on the table, and the price is right. Surgery waiting room times and OR scheduling time crunches can also be costly, so the savings on that by using the Hologic LOCalizer™, pays for itself.
Tonya Johnson is associate editor of Plastic Surgery Practice
Review a Lumpectomy Case
Tech Demo: LOCalizer®