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dianeradfordmd
(Physician
- Surgery - Breast
(Verified)
)
| Communities: Breast Cancer | Thank You's: 9 |
| Member Since: Aug. 2011 | Questions: 11 |
| Answers: 37 |
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Professional Statement
I was called to a career in surgery early on, in my teens. My focus in breast surgery began during my residency in Scotland in the early 1980s, training with Professor Sir Patrick Forrest. My philosophy is patient-centered care with a team approach.
Professional Info
Credential:
MD
Primary specialty:
Surgery - Breast
Secondary specialty:
Surgery - Surgical Oncology
State Licenses:
MO
Languages:
English, French
Medical school:
Glasgow University Medical School, Scotland
Residency:
St. Louis University, Royal Infirmary Edinburgh, Western Infirmary Glasgow, Crosshouse Hospital Kilmarnock
Internship:
St. Louis University, Gartnavel Hospital Glasgow, Monklands Hospital Airdrie
Board certifications:
Surgery
Professional memberships:
American Society of Breast Surgeons, American Society of Breast Disease, AMA, American College of Surgeons, Royal College of Surgeons of Edinburgh, Society of Sugical Oncology, Roswell Park Surgical Society
Areas of expertise:
Breast cancer, benign breast disease, genetics of breast cancer
Research interests:
Tumor suppressor genes in breast cancer, transition from DCIS to invasion
Awards and publications:
Best Doctors 1996-2012,Who's Who in America, Who's Who in Medicine and Health Care,Woman of Distinction in the Sciences, 2010, Girl Scouts of Eastern MO,Fran Lefrak-Brown Illuminator Award, AMC Breast Cancer Research Center 2006 (jointly with fellow partners of the St. Louis Cancer & Breast Institute),Best Science Research Report: Roswell Park Cancer Institute, Buffalo, NY 1987,First Prize, Resident’s Competition, Missouri Chapter, American College of Surgeons, 1989,2. Lorimer Bursary and John Hunter Medal,Physiology, Lorimer Bursary, Biophysics, Distinction, Medical Chemistry.
Publications in British Journal of Surgery,Cancer Research,Am J Surgery, Cancer,Annals of surgery
Publications in British Journal of Surgery,Cancer Research,Am J Surgery, Cancer,Annals of surgery
Hospital affiliation:
St. John's Mercy Medical Center
Practice name:
Mercy Clinic St. Louis Cancer & Breast Institute
Practice address:
15945 Clayton Rd Suite 120
St. Louis, MO
63011
Practice phone number:
636-256-5000
Webpage:
http://www.stlcancer.com
Personal Bio (My story)
I came to the US in 1985 for my fellowship in surgical oncology and decided to stay. I arrived with my suitcases and, of course, my golf clubs. My interests include writing, cycling, and spending time with my family and our pets.
dianeradfordmd Activities
The incision will vary with the type of mastectomy being performed, and whether or not there is reconstruction. For example, in nipple-sparing mastectomy (NSM), one incision is made (which can be placed in several different ways, extending laterally from the edge of the areola, or vertically down from the areola being two examples). The incision length with vary with breast size. NSM is done in conjunction with immediate breast reconstruction. With skin-sparing mastectomy (SSM), the nipple and areola are removed, and the majority of the breast skin is left to provide a bigger skin envelope for reconstruction. For mastectomy without reconstruction, the incision is necessarily larger, as the goal is to have the remaining skin flaps lie flat on the chest wall. That way a prosthesis can be worn more easily.
In patients prone to keloid, steroid can be injected into the wound at the time of closure (Kenalog10) to minimize an exuberant scar.
In patients prone to keloid, steroid can be injected into the wound at the time of closure (Kenalog10) to minimize an exuberant scar.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Surgery, Breast Reconstruction Options, Breast Surgery, Scarring, Breast Reconstruction Scars, Mastectomy, Breast Cancer Surgery Scarring
2
Answers |
5 days ago
Basic starting points would be listening to the patient, breast examination and appropriate imaging. It is recommended that an image-guided biopsy be done (either stereotactic or ultrasound-guided), rather than an excisional biopsy operation. Fine needle aspiration can be performed as an alternative, but the core biopsy yields more information.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Process, Breast Cancer Diagnosis Process, Breast Cancer, Diagnosis Process, Breast Cancer Diagnosis, Cancer
1
Answer |
1 month ago
The first visit post-diagnosis will be a discussion of the biopsy results, type of cancer, and treatment options. Additional tests will be mentioned. This will take in the order of 45 minutes to an hour. There should be ample time for questions. Families are encouraged to take notes. Literature may be provided to the patient and family. There may be referrals to other team members such as radiation oncology, medical oncology, plastic surgery, social work or counseling.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) What To Expect, Bipsy, Breast Surgery Appointment, Cancer Treatment Process, Breast Cancer, Breast Surgery, Breast Cancer Treatment Process, Doctor Appointment, Breast Cancer What To Expect, Pathology Results, Breast Cancer Process, Doctor Appointment What To Expect
1
Answer |
1 month ago
The NCCN publishes guidelines for followup.
http://www.nccn.com/files/cancer-guidelines/breast/index.html#/86/
Physical exam is indicated every 4-6 months initially. Annual blood work and tumor markers are often drawn. There is a trend away from routine imaging in asymptomatic patients.
http://www.nccn.com/files/cancer-guidelines/breast/index.html#/86/
Physical exam is indicated every 4-6 months initially. Annual blood work and tumor markers are often drawn. There is a trend away from routine imaging in asymptomatic patients.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Tests, Cancer Treatment Process, Bilateral Mastectomy, Breast Cancer Treatment Process, Mastectomy, Breast Cancer Process, Cancer Tests
2
Answers |
1 month ago
The best risk reduction is to perform less axillary surgery, and thus cause less mechanical disruption of the lymphatics. The results of the American College of Surgeons Oncology Group Z0011 trial (published Feb 2011) showed that full dissection is not always necessary even if the sentinel node is positive. If we surgeons know that a full dissection must be done, then preop evaluation by a lymphedema specialist is helpful for baseline arm measurements.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Lymphedema, Lymphedema Risk Reduction
2
Answers |
1 month ago
Obesity is a risk factor. In terms of the surgery itself, lymphedema rates are reduced with sentinel node biopsy (2-5%) compared to full axillary dissection (20-35%). Radiation to the axilla and supraclavicular nodes increases lymphedema risk.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Lymphedema, Breast Surgery, Lymphedema Risk Factors, Surgery, Lymphedema Risk
1
Answer |
1 month ago
Image-guided biopsy is preferred. This can be done with a core biopsy using the stereotactic table or under ultrasound. There are many different biopsy needles available, but for all a small knick is made in the skin after injecting local. The devise is then inserted into the breast, and several cylinders of tissue are removed and placed in formalin then sent to pathology.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Biopsy, Breast Biopsy Options, Breast Cancer, Breast Biopsy, Breast Surgery, Biopsy Options, Breast Cancer Biopsy Options, Surgery, Breast Cancer Biopsy
1
Answer |
1 month ago
A loco-regional recurrence would be to the breast, chest wall, axillary or supraclavicular lymph nodes. Distant disease means disease elsewhere in the body outside those areas, such as liver, lungs, bone or brain etc. These are the two types of recurrences.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Local Recurrence, Distant Cancer Recurrence, Distant Recurrence, Cancer Recurrence, Local Cancer Recurrence
1
Answer |
1 month ago
Time enough to absorb the volumes of information provided, discuss issues with family, obtain second opinions if desired, and consult with other specialists such as radiation oncologists and plastic surgeons. Usually this will be two to three weeks. An MRI may be ordered as well, in the time between diagnosis and surgery. I usually allow a week between MRI and a surgery date to act on the results if need be. There is no set time limit. Some patients want surgery as soon as possible; others wish to research more themselves.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Biopsy, Cancer Treatment Process, Breast Cancer, Breast Cancer Treatment Process, Lumpectomy, Pathology Results, Mastectomy, Cancer Decisions, Breast Cancer Decisions, Breast Cancer Process
1
Answer |
1 month ago
Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.
Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.
Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Surgery Scars, Surgery Options, Scars, Breast Cancer, Breast Cancer Surgery, Breast Surgery, Questions For Doctor, Breast Cancer Treatment, Breast Surgery Options, Lumpectomy, Surgery
1
Answer |
1 month ago
There are some excellent on line resources such as the NIH.
Web MD features a breast cancer health center. Cancer Connect has up to date information. The American Cancer Society is a reliable source. The Web can be wonderful tool.
Web MD features a breast cancer health center. Cancer Connect has up to date information. The American Cancer Society is a reliable source. The Web can be wonderful tool.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Survival Rates, Breast Cancer Recurrence, Recurrence Rates, Breast Cancer, Survival Rates, Breast Cancer Recurrence Rates
1
Answer |
1 month ago
Cording, also described as axillary web syndrome, can occur after axillary surgery such as full axillary dissection, sentinel node biopsy and after excision of masses from the axillary tail of the breast. It presents as a visible and palpable cord of subcutaneous tissue running from the axilla to the elbow.
It is thought to be a superficial thrombophlebitis (inflammation of the superficial veins), a variant of Mondor's disease (superficial thrombophlebitis of the breast). http://www.ncbi.nlm.nih.gov/pubmed/21987036
Other authors describe it as an inflammation of the lymphatics in the upper arm.
Cording generally resolves in about 12 weeks. Anti-inflammatory drugs can help, as can massage, range of motion exercises, and physical therapy.
Adhesions is a term used for intra-abdominal scarring from prior surgery or infection.
It is thought to be a superficial thrombophlebitis (inflammation of the superficial veins), a variant of Mondor's disease (superficial thrombophlebitis of the breast). http://www.ncbi.nlm.nih.gov/pubmed/21987036
Other authors describe it as an inflammation of the lymphatics in the upper arm.
Cording generally resolves in about 12 weeks. Anti-inflammatory drugs can help, as can massage, range of motion exercises, and physical therapy.
Adhesions is a term used for intra-abdominal scarring from prior surgery or infection.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Surgery Side Effects, Adhesions, Breast Surgery, Surgery, Cording, Surgery Side Effects
1
Answer |
2 months ago
Massage after mastectomy is generally considered to be beneficial. There was some concern a few years ago that massage may spread breast cancer cells. This notion has been overturned.
It has been shown that massage reduces anxiety, pain and requirements for pain medication. A study form the University of Miami showed that massage also increased levels of a brain chemical called dopamine, which helps produce a feeling of well-being. In addition there was an increase in protective white blood cells that help boost the immune system (called natural killer cells) from the first to the last day of the study.
It has been shown that massage reduces anxiety, pain and requirements for pain medication. A study form the University of Miami showed that massage also increased levels of a brain chemical called dopamine, which helps produce a feeling of well-being. In addition there was an increase in protective white blood cells that help boost the immune system (called natural killer cells) from the first to the last day of the study.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Surgery Recovery, Breast Surgery, Surgery, Breast Surgery Recovery, Massage, Mastectomy
2
Answers |
3 months ago
Advice about exercise will vary depending on what procedure has been performed, and whether a drain has been placed or not. Return to exercise will be the fastest following lumpectomy and sentinel node biopsy. Usually I allow patients to return to their usual routine within a couple of days provided it is not painful.
If a drain is in place I usually allow arm movements up to the level of the shoulder till the drain comes out (about 7 days). Following drain removal, range of motion is extended and full ROM is generally reached in about 2 weeks. If not, physical therapy would be recommended.
When mastectomy has been performed with reconstruction, the plastic surgeon may have more restrictions on arm movements in the immediate post-op period.
Long term I encourage exercise, both cardio and weight-training. The notion of weight-training causing lymphedema has been debunked. We know that regular cardiovascular exercise improves survival, so my advice would be to lace-up and get moving.
If a drain is in place I usually allow arm movements up to the level of the shoulder till the drain comes out (about 7 days). Following drain removal, range of motion is extended and full ROM is generally reached in about 2 weeks. If not, physical therapy would be recommended.
When mastectomy has been performed with reconstruction, the plastic surgeon may have more restrictions on arm movements in the immediate post-op period.
Long term I encourage exercise, both cardio and weight-training. The notion of weight-training causing lymphedema has been debunked. We know that regular cardiovascular exercise improves survival, so my advice would be to lace-up and get moving.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Surgery Recovery, Breast Surgery, Post Surgery Exercise, Surgery, Exercise
2
Answers |
4 months ago
Below is some additional information from the NIH website http://www.cancer.gov/cancertopics/factsheet/Risk/menopausal-hormones
Should women with a history of cancer take menopausal hormones?
One of the roles of naturally occurring estrogen is to promote the normal growth of cells in the breast and uterus. For this reason, it is generally believed that menopausal estrogen use by women who have already been diagnosed with breast cancer may promote further tumor growth. Studies of hormone use to treat menopausal symptoms in breast cancer survivors have produced conflicting results.
In one trial, 434 breast cancer survivors receiving either estrogen alone or estrogen plus progestin were followed for 2 years before the study was stopped because researchers concluded that even short-term use of hormone replacement therapy posed an unacceptable risk of breast cancer recurrence. Among these study participants, 26 women in the group receiving hormone replacement therapy had another occurrence of breast cancer compared with 7 women in the group receiving no hormone replacement therapy (16). In another study, which included 378 women who were followed for 4 years, 11 women receiving hormone replacement therapy had another occurrence of breast cancer compared with 13 women receiving no hormone replacement therapy, so the risk of breast cancer recurrence was not increased (17). A review of 15 studies comprising a total of 1,416 breast cancer survivors and 1,998 women without a history of breast cancer found no increase in risk of cancer recurrence with hormone replacement therapy use (18).
There is limited research on the risks associated with menopausal hormone use by women who have had other cancers, particularly gynecological cancers. One review of the published research found that no firm conclusion could be drawn about the safety of hormone use in women with a history of cancer. However, survivors of gastric and bladder cancer and meningioma may be at higher risk of a recurrence. Survivors of gynecological cancers may be at higher risk because these cancers tend to be more hormone-dependent, but more studies are needed (19).
References
Holmberg L, Anderson H. HABITS (hormonal replacement therapy after breast cancer-is it safe?), a randomised comparison: Trial stopped. Lancet 2004; 363(9407):453–455.
von Schoultz E, Rutqvist LE. Menopausal hormone therapy after breast cancer: The Stockholm randomized trial. Journal of the National Cancer Institute 2005; 97(7):533–535.
Batur P, Blixen CE, Moore HC, Thacker HL, Xu M. Menopausal hormone therapy (HT) in patients with breast cancer. Maturitas 2006; 53(2):123–132.
Biglia N, Gadducci A, Ponzone R, Roagna R, Sismondi P. Hormone replacement therapy in cancer survivors. Maturitas 2004; 48(4):333–346.
dianeradfordmd (Physician - Surgery - Breast (Verified)) replied to answer by member7797 (Current Patient)
4
Answers |
5 months ago
Risk of recurrence will depend in staging (tumor size and presence or absence of nodal metastases).
Your chance of developing a new primary breast cancer has been greatly reduced by having a bilateral mastectomy.
A study by El-Tamer et al Ann Surg Oncol. 2004 Feb;11(2):157-64 found no difference in overall survival and breast-cancer specific survival between BRCA mutation carriers and non-carriers.
Your chance of developing a new primary breast cancer has been greatly reduced by having a bilateral mastectomy.
A study by El-Tamer et al Ann Surg Oncol. 2004 Feb;11(2):157-64 found no difference in overall survival and breast-cancer specific survival between BRCA mutation carriers and non-carriers.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Recurrence, Breast Cancer, BRCA Mutations, BRCA-2, Recurrence, Cancer Recurrence, Mastectomy
1
Answer |
5 months ago
A nice review of hereditary breast cancer is found in the textbook The Breast by Bland and Copeland. The chapter by Lynch, Marcus, Lynch Snyder and Rubenstein (chapter 21), reviews hereditary predisposition.
BRCA 1 and 2 account for the majority of inherited breast cancer. Other syndromes which include increased risk of breast cancer are:
Li-Fraumeni (p53)
Cowden's disease (pTEN)
Hereditary diffuse gastric cancer (CDH1)
CHEK 2
Peutz-Jeghers syndrome
Ataxia telangiectasia, Fanconi's anemia and Bloom's syndrome also confer increased risk.
BRCA 1 and 2 account for the majority of inherited breast cancer. Other syndromes which include increased risk of breast cancer are:
Li-Fraumeni (p53)
Cowden's disease (pTEN)
Hereditary diffuse gastric cancer (CDH1)
CHEK 2
Peutz-Jeghers syndrome
Ataxia telangiectasia, Fanconi's anemia and Bloom's syndrome also confer increased risk.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) BRCA-1, Genetics, Cancer Risk, BRCA-2, Increased Risk Of Breast Cancer, Breast Cancer Risk, Genetic Mutations
1
Answer |
5 months ago
The main advantage of the perforator flap over the transverse rectus abdominis (TRAM) flap is the reduction in donor site complications such as abdominal wall herniation and weakness. Nevertheless, there is still some risk of abdominal wall hernia. This is reported to be 0.7% according to Spear.
The other main long term complication of the DIEP flap is fat necrosis (12.9%) which can often be felt as a mass in the reconstructed breast.
The other main long term complication of the DIEP flap is fat necrosis (12.9%) which can often be felt as a mass in the reconstructed breast.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Breast Surgery Side Effects, Breast Surgery, Breast Reconstruction, Long Term Side Effects, DIEP Flap, Breast Reconstruction Side Effects, DIEP Flap Breast Reconstruction
1
Answer |
5 months ago
Ductal hyperplasia refers to a proliferative condition in which there is increased cellularity of the lining epithelium. It is classified into usual (regular or ordinary) hyperplasia and atypical hyperplasia. The diagnosis is made on breast biopsy.
Atypical lobular hyperplasia is characterized by abnormal cells within one or more of the breast lobules.
Both atypical ductal and atypical lobular hyperplasia are associated with an increased risk of breast cancer. The Gail model incorporates the presence of atypia into risk assessment http://www.cancer.gov/bcrisktool/
If the 5 year risk of breast cancer calculated by this model is 1.67% or more, then chemporeventive drugs such as tamoxifen, raloxifene or exemestane may be offered to reduce risk.
Patients with atypia found on a core needle biopsy should undergo excisional biopsy of the surrounding tissue to exclude a nearby cancer.
Atypical lobular hyperplasia is characterized by abnormal cells within one or more of the breast lobules.
Both atypical ductal and atypical lobular hyperplasia are associated with an increased risk of breast cancer. The Gail model incorporates the presence of atypia into risk assessment http://www.cancer.gov/bcrisktool/
If the 5 year risk of breast cancer calculated by this model is 1.67% or more, then chemporeventive drugs such as tamoxifen, raloxifene or exemestane may be offered to reduce risk.
Patients with atypia found on a core needle biopsy should undergo excisional biopsy of the surrounding tissue to exclude a nearby cancer.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) Ductal Hyperplasia, Breast Cancer, Cancer Risk, Atypical Lobular Hyperplasia, Breast Cancer High Risk, Breast Cancer Risk, High Risk Of Breast Cancer, Hyperplasia
1
Answer |
5 months ago
You choice to have bilateral mastectomy has certainly reduced the likelihood of a new cancer in the same breast and vastly reduced the chance of a cancer in the opposite breast. Adjuvant chemotherapy (and hormonal therapy when indicated) has reduced your chance of recurrence. Oophorectomy has diminished your chance of ovarian cancer.
It would be glib to say "don't worry". I just read an article by a survivor of endometrial cancer who thinks about her cancer 24/7. Thinking about cancer will be inevitable for someone who has undergone treatment. I advise my patients to reverse their thought process, think about the cancer not coming back, rather than it coming back.
I strongly recommend regular exercise, which has been shown to reduce recurrence rates.
When a patient misses a followup appointment with me, it means they are not dwelling on their cancer, and are off doing other things, and that's good.
It would be glib to say "don't worry". I just read an article by a survivor of endometrial cancer who thinks about her cancer 24/7. Thinking about cancer will be inevitable for someone who has undergone treatment. I advise my patients to reverse their thought process, think about the cancer not coming back, rather than it coming back.
I strongly recommend regular exercise, which has been shown to reduce recurrence rates.
When a patient misses a followup appointment with me, it means they are not dwelling on their cancer, and are off doing other things, and that's good.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified)) in topic(s) BRCA-1, Stage II (Stage 2) Breast Cancer, Worry, Breast Cancer Recurrence, Breast Cancer, BRCA Mutations, Cancer Recurrence, Anxiety
1
Answer |
5 months ago
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