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Journal of Medical Oncology & Therapeutics | Volume 4
March 18-19, 2019 | London, UK
Oncology & Cancer Therapy
International Conference on
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Novel surgical options in breast cancer
Diane M Radford
Cleveland Clinic Foundation, USA
This talk focuses on advances in oncoplastic surgery
techniques for breast cancer, and surgical methods to
reduce lymphedema.
Nipple-sparing mastectomy (NSM) in the United States was
first described by Drs. Joseph Crowe and Randall Yetman of
the Cleveland Clinic (CCF) in 2004. Incision placement for the
procedure can be inframammary, periareolar, lateral, upper
outer quadrant, lateral with a periareolar extension, medial,
and transareolar. When the tumor is superficial in location,
preserving the skin anterior to the tumor can compromise
the oncologic goal of clear margins. The technique of Tumor
Ultrasound-guided Incision (TUGI) for NSM developed by Dr.
Stephen Grobmyer and colleagues at CCF overcomes this
problem.
The techniques employs intraoperative ultrasound to locate
the tumor and delineate the skin overlying it. The incision is
then based on the tumor location, removing the skin anterior
to the tumor en bloc with the NSM. This approach balances
oncologic safety and technical outcomes.
Lymphedema is the nemesis of axillary nodal surgery for
breast cancer, impacting patient quality of life and resulting
in significant functional, psychological, and social morbidity.
Although the increased use of sentinel node biopsy, either
when nodes are clinically negative, or following neo-adjuvant
therapy (NAC), has resulted in lower lymphedema rates, the
rates following full axillary dissection can be up to 77%.
Techniques to reduce lymphedema include axillary reverse
mapping (ARM), meticulous dissection of arm lymphatics
with loupe magnification, microsurgical lymphaticovenous
bypass, and a triple mapping technique following NAC which
incorporates Indocyanine Green (ICG) fluorescence for
sentinel node bypass.
Speaker Biography
Diane M Radford is a staff breast surgical oncologist with the Cleveland Clinic in Cleveland,
Ohio, and Director of the Breast Program at Cleveland Clinic Hillcrest Hospital. Originally
from Scotland, she trained on both sides of the Atlantic, including the Professorial Unit,
Royal Infirmary of Edinburgh, the Western Infirmary, Glasgow, and St. Louis University.
She has completed fellowships in Surgical Oncology (Roswell Park Cancer Institute) and
IntegrativeMedicine(UniversityofArizona).HerpeershaverecognizedherasaBestDoctor
every year since 1996 as well as a Top Doctor nationally. She has authored numerous peer-
reviewed journal articles and textbook chapters. Active on social media since 2011, she
has lectured nationally and internationally on social media for health care professionals
including at the Harvard course “Achieving Healthcare Leadership and Outcomes Through
Writing, Publishing, and Social Media,” and at the American Society of Breast Surgeons
annual meeting. She participates in the tweet chat #bcsm (breast cancer social media) and
has been featured as a guest expert. She serves on the Editorial Board of the Annals of
Surgical Oncology, Multi-Media section, and co-authored a guide for other members of the
board on how to use Twitter. Her Twitter followers number over 15,000.
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