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kwagnermd
(Physician
- Surgery - General
(Verified)
)
| Communities: Breast Cancer | Thank You's: 2 |
| Member Since: Jan. 2012 | Questions: 0 |
| Answers: 11 |
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Professional Info
Credential:
MD
Primary specialty:
Surgery - General
Secondary specialty:
Surgery - Breast
State Licenses:
TX
Languages:
English, some Spanish
Gender: Female
Age: 48
Medical school:
the University of Texas Medica Branch at Galveston
Residency:
The University of Oklahoma Health Sciences
Board certifications:
American Board of Surgery (General Surgery)
Professional memberships:
Am Society of Breast Surgeons, Am Society of Breat Diseases, Fellow of the Am College of Surgeons, Texas Medical Association, Bexar County Medical Society
Areas of expertise:
Breast Cancer, Breast Diseases
Research interests:
Breast Cancer
Awards and publications:
Peer awards as one of Texas' Best Surgeons, and San Antonio's Best Surgeons
Hospital affiliation:
Nix Health, Methodist Health Care System
Practice name:
Kathryn A Wagner MD PA
Practice address:
414 Navarro St., Ste 1407
San Antonio, TX
78205-2535
Practice phone number:
210-277-6255
Webpage:
www.breastsurgerysa.com
kwagnermd Activities
I don't think so because the chronic lymphedema has too much protein outside of the lymphatics and that won't resolve. It's permanent. this is why catching it early and treating prophylactically is so important.
Yes, for sure. Patients who have had lymphedema for years, even with alterations of the skin, chronic infections, and pain are excellent candidates for autologous lymph node transfer.
Autologous lymph node transfer may not result in complete recovery, but the improvement is dramatic in all cases. The number of infections decrease and the quality of life is much improved.
A couple of examples:
One patient I treated who had lymphedema for 20 years after mastectomy and radiotherapy had dramatic improvements.
Another patient was treated after 25 years of lymphedema from total hysterectomy and adenectomy with excellent results.
Autologous lymph node transfer may not result in complete recovery, but the improvement is dramatic in all cases. The number of infections decrease and the quality of life is much improved.
A couple of examples:
One patient I treated who had lymphedema for 20 years after mastectomy and radiotherapy had dramatic improvements.
Another patient was treated after 25 years of lymphedema from total hysterectomy and adenectomy with excellent results.
New answer by kwagnermd (Physician - Surgery - General (Verified))
2
Answers |
1 month ago
More info would be helpful such as this is your third time to have breast cancer or were there 3 primaries in the same breast? Are you pre or post menopausal? If previously treated for breast cancer, did you get any chemo? What was the size and grade of the tumor?
In general, an intermediate score [on the low side] with a low grade, low risk lesion in a postmenopausal woman would lead to no chemo recommendation, but with pathology in hand, the doctors at UCLA should be able to give you a good recommendation.
There are clinical trials regarding intermediate Oncotype DX scores out there, have you looked at them? More info would be helpful such as this is your third time to have breast cancer or were there 3 primaries in the same breast? Are you pre or post menopausal? If previously treated for breast cancer, did you get any chemo? What was the size and grade of the tumor?
In general, an intermediate score [on the low side] with a low grade, low risk lesion in a postmenopausal woman would lead to no chemo recommendation, but with pathology in hand, the doctors at UCLA should be able to give you a good recommendation.
There are clinical trials regarding intermediate Oncotype DX scores out there, have you looked at them?
In general, an intermediate score [on the low side] with a low grade, low risk lesion in a postmenopausal woman would lead to no chemo recommendation, but with pathology in hand, the doctors at UCLA should be able to give you a good recommendation.
There are clinical trials regarding intermediate Oncotype DX scores out there, have you looked at them? More info would be helpful such as this is your third time to have breast cancer or were there 3 primaries in the same breast? Are you pre or post menopausal? If previously treated for breast cancer, did you get any chemo? What was the size and grade of the tumor?
In general, an intermediate score [on the low side] with a low grade, low risk lesion in a postmenopausal woman would lead to no chemo recommendation, but with pathology in hand, the doctors at UCLA should be able to give you a good recommendation.
There are clinical trials regarding intermediate Oncotype DX scores out there, have you looked at them?
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Chemotherapy Decision, Patient Decisions, Breast Cancer, Chemotherapy
2
Answers |
3 months ago
Yeah. I hate this question. And I get it whenever the patient's cancer was missed on mammo. I think that so much emphasis has been put on screening mammos yet it is often not well known that mammos miss up to 20% of breast cancers on screening studies. [Reference: www.cancer.gov/cancertopics/factsheet/detection/mammograms] Crummy, I know, but when you look at the stats, it's still the best we have right now for mass screening. And it is responsible for the decrease in mortality and increase in early stage diagnosis over the last decade or so. [Reference: Regular mammograms may decrease the risk for deadly breast cancer by 49%, a new case-control study suggests.
According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%.
"Our study adds further evidence that mammography screening unambiguously reduces breast cancer mortality," said senior researcher Suzie Otto, PhD, from the Department of Public Health at Rotterdam's Erasmus Medical Centre, the Netherlands, in a news release.
The study was published online December 6, 2011 in Cancer Epidemiology, Biomarkers, and Prevention]
So even though it did not pick up the first cancer, odds are that it will pick up the next one if it occurs. That's why we still order it in these cases. Ultrasound is too time consuming and misses the non invasive cancers. MRI is very expensive and not specific enough for mass screening although we do use it in high risk patients even though we don't have a whole lot of data. MRI also does not pick up DCIS well unless high grade. Some argue that a previous diagnosis of cancer automatically puts you into a high risk category and therefore you should have screening MRI annually, but that is not yet standard of care and therefore not always covered by insurance. Yeah. I hate this question. And I get it whenever the patient's cancer was missed on mammo. I think that so much emphasis has been put on screening mammos yet it is often not well known that mammos miss up to 20% of breast cancers on screening studies. [Reference: www.cancer.gov/cancertopics/factsheet/detection/mammograms] Crummy, I know, but when you look at the stats, it's still the best we have right now for mass screening. And it is responsible for the decrease in mortality and increase in early stage diagnosis over the last decade or so. [Reference: Regular mammograms may decrease the risk for deadly breast cancer by 49%, a new case-control study suggests.
According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%.
"Our study adds further evidence that mammography screening unambiguously reduces breast cancer mortality," said senior researcher Suzie Otto, PhD, from the Department of Public Health at Rotterdam's Erasmus Medical Centre, the Netherlands, in a news release.
The study was published online December 6, 2011 in Cancer Epidemiology, Biomarkers, and Prevention]
So even though it did not pick up the first cancer, odds are that it will pick up the next one if it occurs. That's why we still order it in these cases. Ultrasound is too time consuming and misses the non invasive cancers. MRI is very expensive and not specific enough for mass screening although we do use it in high risk patients even though we don't have a whole lot of data. MRI also does not pick up DCIS well unless high grade. Some argue that a previous diagnosis of cancer automatically puts you into a high risk category and therefore you should have screening MRI annually, but that is not yet standard of care and therefore not always covered by insurance.
According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%.
"Our study adds further evidence that mammography screening unambiguously reduces breast cancer mortality," said senior researcher Suzie Otto, PhD, from the Department of Public Health at Rotterdam's Erasmus Medical Centre, the Netherlands, in a news release.
The study was published online December 6, 2011 in Cancer Epidemiology, Biomarkers, and Prevention]
So even though it did not pick up the first cancer, odds are that it will pick up the next one if it occurs. That's why we still order it in these cases. Ultrasound is too time consuming and misses the non invasive cancers. MRI is very expensive and not specific enough for mass screening although we do use it in high risk patients even though we don't have a whole lot of data. MRI also does not pick up DCIS well unless high grade. Some argue that a previous diagnosis of cancer automatically puts you into a high risk category and therefore you should have screening MRI annually, but that is not yet standard of care and therefore not always covered by insurance. Yeah. I hate this question. And I get it whenever the patient's cancer was missed on mammo. I think that so much emphasis has been put on screening mammos yet it is often not well known that mammos miss up to 20% of breast cancers on screening studies. [Reference: www.cancer.gov/cancertopics/factsheet/detection/mammograms] Crummy, I know, but when you look at the stats, it's still the best we have right now for mass screening. And it is responsible for the decrease in mortality and increase in early stage diagnosis over the last decade or so. [Reference: Regular mammograms may decrease the risk for deadly breast cancer by 49%, a new case-control study suggests.
According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%.
"Our study adds further evidence that mammography screening unambiguously reduces breast cancer mortality," said senior researcher Suzie Otto, PhD, from the Department of Public Health at Rotterdam's Erasmus Medical Centre, the Netherlands, in a news release.
The study was published online December 6, 2011 in Cancer Epidemiology, Biomarkers, and Prevention]
So even though it did not pick up the first cancer, odds are that it will pick up the next one if it occurs. That's why we still order it in these cases. Ultrasound is too time consuming and misses the non invasive cancers. MRI is very expensive and not specific enough for mass screening although we do use it in high risk patients even though we don't have a whole lot of data. MRI also does not pick up DCIS well unless high grade. Some argue that a previous diagnosis of cancer automatically puts you into a high risk category and therefore you should have screening MRI annually, but that is not yet standard of care and therefore not always covered by insurance.
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Breast Cancer Screening, Breast Cancer, Breast Imaging, Mammography
1
Answer |
3 months ago
So you want to offer this person support but don't know her that well. It's a very nice thought, to help someone else get through the tough times in the early phases of diagnosis and treatment. Perhaps since you don't know her that well, if the opportunity presents itself with other mutual friends around, when she mentions it or someone asks how she is doing, you could speak up then. Or if you'd rather it be private, you could send her a card with a short note offering support and giving her the option to follow up with you. No loss if she never calls, no embarrassment in public etc.. Either way, you offered and that is very touching. People react in strange ways to bad news, be it illness or death in the family or whatever. Some rally, some retreat. The newly diagnosed can feel terribly lonely and overwhelmed, so your offer may be welcomed. If not, pat yourself on the back anyway. You are awesome!
So you want to offer this person support but don't know her that well. It's a very nice thought, to help someone else get through the tough times in the early phases of diagnosis and treatment. Perhaps since you don't know her that well, if the opportunity presents itself with other mutual friends around, when she mentions it or someone asks how she is doing, you could speak up then. Or if you'd rather it be private, you could send her a card with a short note offering support and giving her the option to follow up with you. No loss if she never calls, no embarrassment in public etc.. Either way, you offered and that is very touching. People react in strange ways to bad news, be it illness or death in the family or whatever. Some rally, some retreat. The newly diagnosed can feel terribly lonely and overwhelmed, so your offer may be welcomed. If not, pat yourself on the back anyway. You are awesome!
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Support, Emotional Support, Cancer
2
Answers |
3 months ago
What would you say to a patient that decided (for sure) to stop radiation treatment halfway through?
I did not mean to imply that SOC is always the right treatment for every patient, just that as a physician, it must be offered and encouraged for reasons above. If my patients choose "informed refusal" I support them but make darn sure they understand that they may be compromising their own cure rate and that recurrence rate will likely be higher. I do not want to be blamed for their choice should they regret it in the future. I think that's fair. It would be unethical to NOT be sure the patient knows of possible complications to refusing treatment. Documentation is for me and my liability carrier. I have never dropped a patient for making an informed refusal of SOC.
kwagnermd (Physician - Surgery - General (Verified)) replied to answer by kwagnermd (Physician - Surgery - General (Verified))
2
Answers |
3 months ago
I would recommend you go back to the original plastic surgeon and see what he/she can do to reduce the size for you. The blood supply must not be messed with so do not go to someone else without approval of the original surgeon. I have had some patients get "contouring" with the liposuction machine in the office with nice results.
Reducing reconstructed breasts is usually not a problem. Just be sure that whoever is doing the reduction is familiar with the details of your original free flap procedure so that the reduction procedure does not jeopardize the blood supply to the portions of your breasts that will remain and are not being reduced.
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Breast Reduction, Flap Reconstruction, Breast Reconstruction
2
Answers |
3 months ago
I always use a vacuum assisted core needle device as the vacuum sucks tissue into the needle, which is usually hollow,taking a larger sample that the needle alone could take. More is almost always better for the pathologist to get the diagnosis correct and if there is plenty of tissue, the receptors, and genetic studies such as Mammaprint can also be performed.
For stereotactic biopsies and MRI-guided biopsies, I use a vacuum-assisted device.
For ultrasound-guided biopsies, I have found both core needles and vacuum devices to be equally successful in my experience, although the scientific literature reports fewer false-negatives with the vacuum-assisted devices. I prefer to use the smaller, less expensive, less scary core needle when possible. If a lesion is very small or subtle on the sonogram, I tend to use the vacuum-assisted device to obtain larger specimens and ensure adequate sampling.
For ultrasound-guided biopsies, I have found both core needles and vacuum devices to be equally successful in my experience, although the scientific literature reports fewer false-negatives with the vacuum-assisted devices. I prefer to use the smaller, less expensive, less scary core needle when possible. If a lesion is very small or subtle on the sonogram, I tend to use the vacuum-assisted device to obtain larger specimens and ensure adequate sampling.
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Biopsy, Breast Tissue Sample, Breast Biopsy, Vacuum Assisted Device, Core Needle
2
Answers |
3 months ago
I tell patients to schedule the mammo just at the end of menses or shortly thereafter so it doesn't hurt so much. Try a morning appt and do not use deodorant, lotion, or powder as it sometimes can show up as calcifications [which are really on the skin but the radiologist can't tell]. This could result in a call back and unnecessarily upset you. Bring your deodorant with you and put it on after your mammo. And lastly don't assume that "no news is good news". If you haven't gotten a letter in a couple of weeks, call the doctor who ordered the mammo to get results. Human error happens.
I tell patients to schedule the mammo just at the end of menses or shortly thereafter so it doesn't hurt so much. Try a morning appt and do not use deodorant, lotion, or powder as it sometimes can show up as calcifications [which are really on the skin but the radiologist can't tell]. This could result in a call back and unnecessarily upset you. Bring your deodorant with you and put it on after your mammo. And lastly don't assume that "no news is good news". If you haven't gotten a letter in a couple of weeks, call the doctor who ordered the mammo to get results. Human error happens.
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Preparing For Mammogram, Breast Cancer Screening, Breast Cancer, Mammogram, Breast Imaging
3
Answers |
3 months ago
Malignant cells have a unique ability to break off from the mother tumor, float through the blood stream or lymphatics, get stuck somewhere, and not die. In fact they can survive quite well and continue to divide forming a new tumor mass [metastasis]. Then they have this nasty ability to produce a sort of hormone that causes blood vessels to grow to it thereby ensuring their continued survival. Sneaky little suckers. The good news is that some of our newer 'targeted' therapies take advantage of this ability and are effective at killing some of these tumors. Not the most scientific answer but hope this helps.
Malignant cells have a unique ability to break off from the mother tumor, float through the blood stream or lymphatics, get stuck somewhere, and not die. In fact they can survive quite well and continue to divide forming a new tumor mass [metastasis]. Then they have this nasty ability to produce a sort of hormone that causes blood vessels to grow to it thereby ensuring their continued survival. Sneaky little suckers. The good news is that some of our newer 'targeted' therapies take advantage of this ability and are effective at killing some of these tumors. Not the most scientific answer but hope this helps.
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Tumor Formation, Breast Cancer, Metastatic Breast Cancer, Metastatic Cancer, Metastases, Tumors, Cancer
1
Answer |
3 months ago
Due to the high risk of breast and ovarian cancer, most will recommend mastectomies and then ovary and tube removal as soon as child bearing is completed. This is the greatest risk reduction but is still not 100%. There is no consensus on how to follow patients with mutations regardless of cancer diagnosis or not. The NCI is currently doing clinical trials for patients with known mutations to try and answer this question. Here's a link: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA#a18
Due to the high risk of breast and ovarian cancer, most will recommend mastectomies and then ovary and tube removal as soon as child bearing is completed. This is the greatest risk reduction but is still not 100%. There is no consensus on how to follow patients with mutations regardless of cancer diagnosis or not. The NCI is currently doing clinical trials for patients with known mutations to try and answer this question. Here's a link: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA#a18
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) BRCA-1, Breast Cancer Surveillance, High Risk Surveillance, Breast Cancer Screening, Breast Cancer, Surveillance, BRCA Mutations, BRCA-2, Ovarian Cancer
1
Answer |
3 months ago
When the survivor has a deleterious mutation of the BRCA 1 or 2 gene that carries an elevated risk, or if ovarian cancer runs in the family.
When the survivor has a deleterious mutation of the BRCA 1 or 2 gene that carries an elevated risk, or if ovarian cancer runs in the family.
New answer by kwagnermd (Physician - Surgery - General (Verified)) in topic(s) Breast Cancer, Cancer Screening, Ovarian Cancer Symptoms, Ovarian Cancer Risk, Ovarian Cancer, Ovarian Cancer Screening
1
Answer |
3 months ago
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