Beyond Breast Reconstruction: 3-D Areola Tattooing

As a leader in breast reconstruction, Penn Plastic Surgery offers comprehensive services for women at every stage of the breast reconstruction process, from the initial surgery to nipple reconstruction and tattooing.

Breast reconstruction is a surgical procedure, designed to re-create the shape and appearance of a woman’s breast. Most commonly, the procedure is done as part of a mastectomy – surgical removal of the entire breast as treatment for breast cancer.

After breast reconstruction, many women choose to have nipple reconstruction, including nipple tattooing. Nipple tattooing, or micropigmentation, re-pigments the area to make it look more realistic.

Mandy Sauler, micropigmentation

specialist

At Penn Medicine, nipple tattooing is performed by Mandy Sauler, a micropigmentation specialist in plastic surgery. Mandy grew up learning about the art of tattooing at her mother's body art shop, expecting to work alongside her as she perfected her craft.

After working for more than a decade as a tattoo artist, Mandy decided to apply her expertise on patients, focusing on permanent cosmetics and micropigmentation. She specializes in 3D nipple tattoos, along with tattoos for other cosmetic purposes. She is board certified by the American Academy of Micropigmentation and is a member of the Society of Permanent Cosmetics.

Learn more about nipple and areola enhancement or schedule an appointment with Penn Plastic Surgery.

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Trailblazer in Women's Sports Becomes Inspiration to Breast Cancer Community

“A breast cancer diagnosis takes you to a place that you cannot know unless you have been there,” said Rutgers University Women’s Basketball Coach C. Vivian Stringer. “Hearing the word cancer is like experiencing the death of a loved one.”

Coach Stringer holds many titles – mother, sister, daughter, widow, and inductee into the Basketball Hall of Fame. She is also a breast cancer survivor of almost 20 years and now, decades after her cancer journey began, she is a powerful voice of strength and hope within the breast cancer community.

Born a coal miner's daughter and raised in a town where people rarely traveled further than 50 miles, Coach Stringer became the first head coach ever to catapult three different college programs – Pennsylvania’s Cheyney University, University of Iowa and Rutgers University – from underdogs to the Final Four.

But Coach Stringer’s professional triumphs have continued to be eclipsed by personal tragedy. The year Cheyney went to the Final Four, her daughter’s childhood meningitis was misdiagnosed, leaving her with special needs. Her husband’s sudden death of a heart attack occurred the same year she took Iowa to the Final Four.

In June 1998, she was diagnosed with breast cancer.

Prior to her diagnosis, Coach Stringer missed out on two years of breast exams as she transitioned to her new role as head coach of the Rutgers Scarlet Knights. Her past experiences with nodules always turned out to be benign and she just didn’t give herself the focus she needed.

“At first I was so angry,” she said of her diagnosis. “I was angry at my body, and I felt like I had betrayed myself.”

Coach Stringer went on to feel fortunate that she was put in the hands of great doctors, and committed nurses, scientists, and researchers, like Gary Freedman, M.D. Dr. Freedman is a breast radiation-oncologist at Penn Medicine’s Roberts Proton Therapy Center.

“Over the years, Dr. Freedman has become a friend. He was patient, caring, and detailed with a dedicated focus on the work that needed to be done in order to get me well. His care wasn’t predicated on who I was or what I did, but that I was a person – scared just like anyone else.”

After her diagnosis, Coach Stringer’s first oncologist recommended she have a double mastectomy. But she was never convinced that the probability of recurrence with a double mastectomy was less than without the surgery— so she opted to keep her breasts.

“During my journey, I learned to utilize my resources, and that I didn’t have to accept a first diagnosis. It is so important for women to learn about their disease so they can better advocate for their health,” Coach Stringer said. “The most important thing to remember is that everyone has to make their own choices.”

Coach Stringer decided to keep her disease from the press and the public and initially did not tell her children, mother, or her team about her diagnosis— and only shared the news with her sisters, her assistant coaches, and the RU athletic director. Her sisters took time off of work to accompany her to her radiation treatments that took place after basketball practices.

“I remember sitting in the waiting room for my radiation treatment,” she said. “I remember looking at all the people who were wondering the same thing I was, how was it all going to end, but also being frightened to death about knowing the news, good or bad.”

Fortunately, she received solace from an unlikely source— a complete stranger who had experienced breast cancer. Lonni was a friend of a friend who lived thousands of miles away, who Coach Stringer began speaking with every night after her diagnosis.

It was only during those long, nightly phone calls with Lonni that Coach Stringer could let go and really talk about what she was going through.

“Though we never met before, I felt like I really knew this woman,” Coach Stringer said. “Speaking to someone who had experienced what I was going through lifted my spirits, and she got me involved in outreach and education.”

Coach Stringer slowly began telling her inner circle about her experience. When the mother of one of her players was diagnosed, Coach Stringer wanted to share, to tell her to have faith and that everything would be okay, but she just wasn’t ready yet. But when another member of the team was touched by breast cancer, she knew she could no longer remain silent.

Now Coach Stringer has shared her story with the world, both on the Oprah Winfrey Show and through her autobiography, titled Standing Tall: A Memoir of Tragedy and Triumph. She has found strength in helping others overcome the difficult moments in their lives, as she was helped all those years ago, by inspiring them with her story.

“Terrible things will happen. But we must remember that there is a reason, and while we might not know it, we are strong enough to handle it and provide a message of hope to others,” she said. “I am comforted in knowing that things are getting better, but we are not going to eradicate this disease unless we all kick in and do our part.”

Not only has Coach Stringer become a pioneer in women's sports, but she's also become an inspiration to cancer survivors everywhere.

For more information on how to support breast cancer research and patient care please contact Laura Ferraiolo by email lferr@exchange.upenn.edu or phone (215) 746-2948, or click here to make a gift.

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Something Stronger Than Me - A Previvor Story

Katrina is an editor for a medical publication, and lived in South Jersey with her two daughters and husband. In January 2013, she found out that she is a carrier for the BRCA1 mutation. Katrina is returning to her writing roots by blogging through the experience as she weighs family planning, surgical measures vs. surveillance, and the impact all of it will have on her family. In her spare time, she practices yoga and spends time with her extended family.

“Pour me something stronger than me.” ~Nashville

I jotted that lyric down last season, not long after finding out about my BRCA gene. And it came rushing back when we went to see Decoding Annie Parker, a 2013 movie that tells the story of Annie Parker and Dr. Marie Claire King.

The movie looks at parallel journeys — that of Annie Parker, a woman dealing with a heavy family history of breast cancer, and Mary-Claire King, the geneticist who spearheaded the discovery of the BRCA mutations.

Parker’s personal and family history of cancer is eventually explained by a mutation in BRCA1. This  gene sequence Dr. King’s team studied led to the discovery of its role in increasing the risk of breast and ovarian cancer.

The realism with which they portrayed Parker’s chemotherapy treatments hit me in the gut. The swelling. The hair loss. The vomiting. The scarves. I’ve watched four women very close to me endure it. One still is enduring it. They were and are the strong ones. Not me.

Not long after, my friend posted this photo essay in which a photographer documented his wife’s battle with cancer. You can feel the heartache, almost touch the physical pain.

All of these things scared me. I thought, “I don’t know if I can be that strong. I don’t know if I can fight like they did.” I’m sure if it came down to it I would, but in the moment I only felt weakness. I wanted to schedule my preventive surgeries right then and there. As much strength as I knew it would take to follow through, it won’t be the strength I would need to go through chemo. To put my girls through watching me suffer in my fight.

Living with the BRCA Mutation

There are days I manage to forget the decisions weighing on my shoulders, but not for long.

It’s in the 3-day walk for breast cancercommercials. It’s in my bee necklace that my best friend sent me. It’s in the Pandora bracelet we gave my best friend for her 30th birthday that I now wear.

But it’s mostly at night - when I’m feeding and rocking my baby or reading stories to my toddler that I think about all the memories we have yet to make. It’s then that I wonder what kind of example I’m setting for them or what they will think someday when they understand. Or what kind of torture it will be to not pick them up in the days and weeks after my mastectomy. Or if they will poke and prod at my “foobs” and ask why I’m not soft and comfortable for nighttime snuggles any more.

I can only hope they have vague memories of the days or weeks that mommy wasn’t be able to pick them up and millions of fresh memories of the times I did, of the times I ran with them, danced with them from kitchen dance parties to their own weddings.

I cannot help but shed tears over the chance that I passed this on to one or both of them. I pray that they will have many more options than I have or that this won’t even factor into their lives. (And all of this emotional weight, all of these decisions don’t even factor in the debate of whether to have another child).

Knowledge is Strength

Some days I feel very much like the oncologist quoted in this amazing pictorial, Before Angelina:

“When I told my friends about my upcoming procedure, some of them looked at me like I was crazy, like it was a brutal mutilation. They told me to just wait and to see what happened, but I told them the idea of getting the breast cancer diagnosis and having chemo was something I couldn’t face. Maybe I was a coward, but I felt like at that point I still had a choice.”

I see “Save the Tatas” a thousand times a day and all I can think is, “Take mine away. Save me from the tatas.” In many ways I’ve faced this reality head-on, but in many ways, I’m still trying to outrun it.

So my goal for this year is to continue to educate myself. For me, knowledge is strength when you feel you have none. And sometimes I’m more scared than strong.

Movies like Decoding Annie Parker and news stories like 
Before Angelina helped Katrina learn more about BRCA.  
For a list of supportive resources, including top BRCA reads, visit Basser.org

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What is Triple Negative Breast Cancer?

Triple-negative breast cancer is a type of invasive (infiltrating) ductal carcinoma (IDC) in which three of the most common receptors known to “fuel” breast cancer, estrogen, progesterone, and the HER-2/neu gene, are not present.

Invasive ductal carcinoma starts in a milk duct, breaks through the wall of the duct, and invades the tissue of the breast. Invasive ductal carcinoma is the most commonly diagnosed breast cancer, accounting for about eight 8 out of 10 of all cases of invasive breast cancers.

Invasive ductal carcinoma may feel like a hard, bumpy, irregularly shaped lump in the breast. The most common symptoms of IDC are a change in the look or feel of the breast or the nipple anda breast mass or a suspicious finding on a mammogram. Less common signs of IDC may include nipple discharge.

Triple-negative breast cancers are usually IDCs, whose cells lack certain receptors and tend to grow and spread more quickly than other types of breast cancer.

Treatment for Triple-Negative Breast Cancer

Like other breast cancers, women with triple-negative breast cancer will have surgery to remove the tumor and may require additional treatment such as chemotherapy.

Breast surgeons at Penn Medicine deal almost exclusively with breast cancer and disorders of the breast. They have popularized the concepts of breast conserving therapy and are pioneering the use of vaccines and immune-based therapies for the treatment of breast cancer. Penn is also a leader in the use of oncoplastic surgery, which uses techniques to remove the tumor and preserve or restore the breast's shape or appearance at the same time.

Breast-conserving surgery removes only the part of the breast affected by cancer and a surrounding margin of normal tissue. How much tissue is removed depends on the size and location of the tumor and other factors. Partial mastectomy, quadrantectomy, and lumpectomy are all types of breast-conserving surgery.

A mastectomy involves removing all of the breast tissue, sometimes along with other nearby tissues. In a simple or total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast.

A radical mastectomy is an extensive operation where the surgeon removes the entire breast, axillary lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but a modified radical mastectomy has proven to be just as effective without the disfigurement and side effects of a radical mastectomy. Radical mastectomy may still be done for large tumors that are growing into the pectoral muscles under the breast.

Breast reconstruction may be an option at the time of a lumpectomy or mastectomy, or after surgery to treat breast cancer.

Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. However, using chemotherapy to treat triple negative breast cancer is an effective option.

Who is At Risk for Triple-Negative Breast Cancer?

Breast cancers with these characteristics tend to occur more often in younger women and in African-American women.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.

Hear our stories and find out more today.

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Can Alcohol Consumption Increase My Risk of Breast Cancer?

Recent studies have shown alcohol is a leading cause of preventable cancer.

In addition, The World Health Organization has labeled alcohol as the world's third largest risk factor for disease burden, saying it can cause neuropsychiatric disorders and other chronic diseases such as heart diseases, cirrhosis of the liver, and various cancers. It added that 30 percent of cancer deaths are caused by five behavioral and dietary factors, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.

But how can drinking alcohol affect a woman’s risk for breast cancer?

According to the American Cancer Society:

The use of alcohol is clearly linked to an increased risk of developing breast cancer.

The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.

Hear our stories and find out more today.

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Digital Breast Tomosynthesis: More Accurate Images for Women with Dense Breasts

Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Someone is said to have dense breast tissue (as seen on a mammogram) when they have more glandular and fibrous tissue and less fatty tissue.

A number of factors can affect breast density, such as age, menopausal status, the use of drugs (such as menopausal hormone therapy), pregnancy, and genetics.

According to a new report in the journal, Radiology, because women with dense breasts have a slightly greater risk of breast cancer than women with less dense breasts, new laws and recommendations in many states now require physicians to inform a patient if they have dense breasts.

In fact, the newly recognized The Breast Density Notification Act, sponsored requires mammography facilities in Pennsylvania to notify women of their breast density. Pennsylvania Governor Corbett signed the legislation into law in recognition of National Breast Cancer Awareness Month.

Although the relationship between dense breast tissue and breast cancer is small, it’s one that can only be seen through a medical imaging – such as a mammogram.

Also, dense breast tissue can make mammograms less accurate. Because dense breast tissue shows up as white on a mammogram, it can be more difficult to spot cancer, which looks the same.

Digital Breast Tomosynthesis: More Accurate Images for Women with Dense Breasts

A revolutionary way to perform mammograms combining traditional mammography with 3D technology, called digital breast tomosynthesis (DBT), allows for more accurate pictures of the breasts and is helpful in women with dense breasts.

“DBT is more accurate – even more accurate than digital mammograms – because it uses traditional X-ray technology to capture images of the breast, while moving along a small arc around the breast to record images at different depths and angles,” says Emily Conant, MD, director of women’s imaging at the Hospital of the University of Pennsylvania. “In preliminary research, it has been shown to reduce the number of false-positives and some false-negatives making mammography more accurate.”

Like a traditional mammogram, the breast is compressed for about four to five seconds while a series of low-dose X-rays are taken to capture high-resolution images of the breast. These images are then digitally “stacked” to construct a total 3D image of the breast. This 3D image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles. Radiologists can also magnify images to reveal minute details.

“DBT allows Penn radiologists to manipulate and see parts of the breast that we couldn’t before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Breast images through DBT also allow radiologists to make new recommendations for follow-up screening and tests.

“DBT lets us to see the through some of the density of a breast,” says Dr. Conant. “For all women, and especially those with dense breasts, we can personalize screening to improve our outcomes of breast cancer screening.”

Women who get their mammograms using the new DBT technology may find they are called less often for follow-up visits and more tests.

These new imaging advantages and advances in risk assessment are part of a collaborative effort between radiologists, medical oncologists, and surgeons to try to improve breast cancer detection for women.

Technology continues to evolve, but collaborative research across all disciplines at Penn Medicine means patients who come to Penn for their mammograms benefit from the latest medical breakthroughs.

The DBT technology is still new and Penn researchers are studying ways to decrease its radiation exposure without losing image integrity.

“DBT is just one more step to improving breast care on an individual, personalized basis,” says Dr. Conant. “Combining personal history, genetic testing and new breast images creates a better, overall picture for breast health.”

For more information about breast cancer diagnosis and treatment at Penn Medicine, or to schedule an appointment, please visit PennMedicine.org/cancer/breast-cancer or call 800.789.PENN (7366).

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.

Hear our stories and find out more today.

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"I Feel Like I've Beat Cancer." - Carlette, Breast Cancer Survivor

Growing up, cancer was a common topic in Carlette Knox’s household.

One of five daughters, Carlette’s mother was a two-time breast cancer survivor who eventually lost her fight with pancreatic cancer in 2011. Her father died of colon cancer, and many members of her family fought cancer in some form.

Yet when Carlette felt a lump in her breast in fall of 2009 at the young age of 34, she blew it off hoping it would go away on its own.

“At the time, my mother was going through treatment for pancreatic cancer, and I had a lot going on in my life,” she remembers. “Plus, I had already had a mammogram just a few months before, so I didn’t think it could be cancer.”

Six weeks later in December, when the lump hadn’t gone away, Carlette made an appointment for another mammogram that confirmed what she’d known deep down inside – she had breast cancer.

What Carlette didn’t know at the time, however, was that she was BRCA positive. Carlette carried a mutation on the breast cancer gene that made her predisposed to developing breast and ovarian cancer.

“My mother was diagnosed at the age of 35 and she experienced the devastating loss of her mother to this disease while growing up,” says Carlette who underwent BRCA mutation testing in 2010. “I also witnessed two of my aunts lose their battles with cancer. I knew firsthand the impact this disease had on the women in my family; the need to attack this diagnosis head on was evident.”

“I was introduced to the risk assessment program and with the help of a genetic counselor underwent testing to determine my cancer risks,” remembers Carlette. “When I learned I had a genetic mutation, I felt targeted. I don’t know why, I just took that diagnosis very personally – more so than my breast cancer diagnosis.”

However, that knowledge helped Carlette make the decision to have a bilateral mastectomy, complete removal and reconstruction of her breasts, as well as an oophorectomy, removal of her ovaries to reduce her risk of breast and ovarian cancer. Carlette also underwent chemotherapy to treat the breast cancer she had already developed.

“Learning about BRCA put into perspective my risk of breast cancer recurrence and ovarian cancer. My decision to remove the non-impacted breast tissue was supported by clinical trial data as well as my personal experience," she says.

"Seeing the effects of this disease throughout generations of women in my family was not a tradition I was willing to keep. While the procedure to have my ovaries removed itself was minimally invasive, the decision was not without much emotional turmoil on the inside. In my mind, this would change my landscape as a woman at such a young age. Ultimately, after researching the effects of ovarian cancer, I embraced this option as a blessing not a curse."

Today, Carlette is physically and emotionally better than she could have ever imagined.

“I don’t look or feel like any of what I went through. It may sound a bit crazy, but I’m grateful for the journey. My faith is stronger and as a result of this life changing experience I’ve been able to embark upon yet another journey.”

Carlette has become an advocate for women with breast cancer and the BRCA mutation at “Life Worth Living.”

“Life Worth Living is the realization of my passion to raise awareness, empower and support those impacted by cancer and to broadcast the message of hope aspiring them to live,” says Carlette.

“Today, I feel like I have beat cancer. I did everything I could do from a care standpoint, and I want to give as much as I can, because I keep seeing younger women impacted by a breast cancer diagnosis. I want help women find their voice and tap into the hope of overcoming their diagnoses and treatments.”

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.
Hear our stories and find out more today.

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What are Types of Breast Cancer Surgery?

Only you and your physician can decide what type of breast surgery is best to treat your cancer.

Breast-conserving surgery removes only the part of the breast affected by cancer and a surrounding margin of normal tissue. How much tissue is removed depends on the size and location of the tumor and other factors. Partial mastectomy, quadrantectomy, and lumpectomy are all types of breast-conserving surgery.

A mastectomy involves removing all of the breast tissue, sometimes along with other nearby tissues. In a simple or total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast.

A radical mastectomy is an extensive operation where the surgeon removes the entire breast, axillary lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but a modified radical mastectomy has proven to be just as effective without the disfigurement and side effects of a radical mastectomy. Radical mastectomy may still be done for large tumors that are growing into the pectoral muscles under the breast.

Breast reconstruction may be an option at the time of a lumpectomy or mastectomy, or after surgery to treat breast cancer.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.

Hear our stories and find out more today.

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The Cure is Within: Lauryn's Breast Cancer Story

My mother’s sister, my aunt, had breast cancer and I started mammograms early because of her diagnosis. I had my daughter at 41, and nursed her for almost two years – so I missed a few mammograms in between.

At 43, I had my first mammogram since having my daughter, and that’s when I learned I had cancer.

I’ll never forget the moment in September 2012 when I got the call from my gynecologist, Dr. Bernadette Wheeler. My 2 year old was running around and I walked to a quiet place in my home to listen closely.

Breast cancer. Surgery. Breast removal. Appointments. These are the words I heard.

I brought my daughter to my parents’ home, who have always been extremely supportive, so I could have some time to myself to reflect on this news I’d just received. Soon thereafter, I met with Dr. Wheeler who helped me make an appointment with Penn breast surgeon, Dahlia Sataloff, MD. I felt more comfortable getting all of my care at Penn Medicine, and now at Penn’s Abramson Cancer Center.

Surgery – And a Surprise

On October 24, I was scheduled to have my left breast removed. I was scared, but ready to have this cancer taken out, and start on my journey back to health.

As I was lying in the room, getting ready for surgery, I heard a familiar voice. The curtain opened and there was my best friend, Lynette. She’d driven all the way from Savannah, Georgia to be with me on this day. I was elated. Her visit, and knowing she came all the way up to support me, was the best thing about the day.

The surgery lasted about six hours. I had reconstruction of the breast done at the same time, and everything went according to plan. I was healing well, and the nursing staff was excellent in preparing me for what to expect at home.

Next Steps - Chemotherapy

Because I had positive lymph nodes, I needed both radiation treatment and chemotherapy after surgery, but chemotherapy was first. Again, I felt most comfortable coming to Penn’s Abramson Cancer Center for all of my treatment, so for 16 weeks, I was a “frequent flyer” at Penn getting my chemotherapy.

It was a tough road. Treatments left me nauseous and tired. I’d taken some time off of work, which was helpful, and of course, my parents were there to support me and help me with my daughter. Robin Herzog, a clinical nurse practitioner at the Abramson Cancer Center, was a great source of support for me too. She encouraged me to never give up and really understood what I was going through emotionally.

Around this time, I also had genetic testing to see if I carried the BRCA gene mutation. It was important for me to know because I have a daughter, but thankfully, I did not carry the gene mutation.

The End in Sight

Once my chemotherapy treatments were over, radiation was next. I was able to have my radiation treatments at the Abramson Cancer Center located at Penn Medicine Valley Forge. It was convenient for me, and knowing that I was still being cared for by Penn Medicine I never had to worry about one doctor not talking to another, everyone was on the same team - my team.

Dr. Nagda was my radiation specialist, and after 23 weeks of radiation treatment, I am now, cancer free.

You know, at two, my daughter didn’t really “get” that I had cancer. We talked about how I was sick, and how I had a “boo boo” but I wanted her to guide the way and let her actions and questions tell me how much I needed to tell her.

But even at two, she was always there for me. Throughout my treatment, I wrote her letters – letters that told her how much she helped me, what it was like to go through treatment for breast cancer, and how one day she, too, will have the strength to fight anything life throws her way.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.
Hear our stories and find out more today.

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Can Men Get Breast Cancer?

We tend to think of breast cancer as only a woman’s disease. While it is true breast cancer affects mostly women, male breast cancer makes up less than one percent of all breast cancer cases.

The following types of breast cancer are found in men:

• Invasive ductal carcinoma. Cancer that has spread beyond the cells lining the ducts in the breast. Most men with breast cancer have this type of cancer.
• Ductal carcinoma in situ. Abnormal cells that are found in the lining of a duct.
• Inflammatory breast cancer. A type of cancer in which the breast looks red and swollen and feels warm.
• Paget disease of the nipple. A tumor that has grown from ducts beneath the nipple onto the surface of the nipple.

Treatment for male breast cancer is much like treatment for breast cancer in women. Surgery for breast cancer may or may not be followed by chemotherapy, hormone therapy and/or radiation therapy for male breast cancer.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.
Hear our stories and find out more today.

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What Are Some Risk Factors for Breast Cancer?

Risk factors affect the chance of getting breast cancer, Having a risk factor, or even several, does not mean that someone will get breast cancer. Most women who have one or more breast cancer risk factors never develop the disease, while many women with breast cancer have no apparent risk factors (other than being a woman and growing older).

There are different kinds of risk factors. Some factors, like age or race, can't be changed. Risk factors for breast cancer that cannot change include:

• Gender. Being a woman is the leading risk factor for developing breast cancer. The chance of a woman developing invasive breast cancer sometime during her life is just under one in eight.
• Aging. Risk of developing breast cancer increases as women age.
• Menstrual periods. Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer.
• Genetics. Between five percent and 10 percent of breast cancer cases are thought to be hereditary.
• Family history. Breast cancer risk is higher among women whose close blood relatives have the disease.
• Personal history. Women with cancer in one breast have a three- to four-fold increased risk of developing cancer in the other breast or in another part of the same breast.
• Race and ethnicity. Caucasian women are slightly more likely than African American women to develop breast cancer, but African American women are more likely to die of breast cancer. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.
• Dense breast tissue. Women with dense breasts have more glandular tissue and less fatty tissue and are at higher risk of breast cancer. Dense tissue and tumors have similar density, so tumors can be harder to detect in women with denser breasts.
• Benign breast conditions. Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer. Benign conditions include: Non-proliferative (non-spreading) lesions; Proliferative (spreading) lesions without atypia; Proliferative (spreading) lesions with atypia.
• Lobular carcinoma in situ (LCIS). Women with LCIS have a seven- to 11-fold increased risk of developing cancer in either breast.
• Previous chest radiation. Women who had radiation therapy to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma), especially before the age of 30, are at significantly increased risk for breast cancer.
• Diethylstilbestrol (DES) exposure. From the 1940s through the 1960s, some pregnant women were given DES because it was thought to lower their chances of miscarriage. These women have a slightly increased risk of developing breast cancer. Women whose mothers took DES during pregnancy may also have a slightly higher risk of breast cancer.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.

Hear our stories and find out more today.

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Breast Cancer Survivor Finds the Cure is Within at Penn's Abramson Cancer Center

Carole Gross is a fighter.

Eight years ago, she battled thyroid cancer.

She won.

But this year, a new fight was chosen for her – this time, the battle would be in her breast.

Within two weeks of her diagnosis of breast cancer following a routine mammogram, Carole had a lumpectomy at Doylestown Hospital, a member of the Penn Cancer Network.

“I’m a ‘get it done’ kind of person,” says Carole. “I just wanted it out so we could move to the next step.”

A mother of two, Carole was also working as a physical therapist with home health care division of Doylestown Hospital. Because of her busy schedule, she knew having follow-up treatment that included radiation therapy close to her home in Doylestown was essential.

She chose Penn Radiation Oncology Doylestown. It was there she met William Rate, MD, PhD, radiation oncologist at Penn Medicine.

“Dr. Rate was amazing,” she says. “He asked me about myself – he put me as a person before my cancer diagnosis. He just made me feel I was important – that I was comfortable with the whole process. And, he presented information to me in a very understanding and reassuring way.”

Dr. Rate explained how her radiation treatment would proceed, and ensured her he would be with her every step of the way.

He was.

When a scan showed something on Carole’s hip, Dr. Rate personally consulted with his colleagues and asked Carole if he could make appointments for her so she could focus on her treatments.

“Within a half hour of Dr. Rate’s phone call, all of my imaging studies and reports were sent to another specialist I could see for my hip,” says Carole. “Everything was seamless, but Dr. Rate made me so comfortable with the process.”

Carole’s treatments spanned her children’s summer break, and she was able to bring her kids with her to her treatments. She jokes that her kids felt comfortable, because they knew her mom was being treated so well.

“What could have been a very negative situation turned out to be positive,” says Carole. “As soon as we walked through the door, we were greeted like we were friends, or part of the family. They valued me as a person; they didn’t just see me as a diagnosis.”

Following her radiation treatment, Carole was diagnosed with chronic leukemia. Dr. Rate was still there for her.

“Dr. Rate continues to look at the ‘whole picture’ and the ways in which each treatment or piece of care I receive fit into my overall care plan,” says Carole. “Even though he was primarily treating my breast cancer, I found it reassuring he was a part of my entire course of care.”

Finally Carole adds: “His staff is amazing also and very personable and professional.

“Penn Radiation Oncology allowed me to have treatment at the Abramson Cancer Center within my own community,” says Carole. “It was a wonderful opportunity.”

“I wouldn’t have wanted my cancer treatment anywhere else.”

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.
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Breast Cancer Survivor Says It's Time to Fight

Tomika Bryant

Tomika Bryant was diagnosed with breast cancer and treated at the Abramson Cancer Center in 2013. In this article, she discusses her diagnosis and how she learned to heal. She can be found blogging at My Mommy's Neighborhood and supporting other women at Pink Ribbon Stilettos.


Did she really say those words to me? I can hear her talking but it seems that she is speaking a different language. I know my daughter is reading out loud so maybe that is why I cannot understand her. I just let her know that I would need to call her back.

Once the cloud in my head cleared, she confirmed what I already knew. Somehow, I could feel something just wasn't right. Everywhere I looked it seemed like cancer was there. It appeared on TV shows, in books, people talked about it on the radio, and even my daughter wanted to donate money to the cancer society. And now it was inside of ME.

The diagnosis was Triple Negative. You would think hearing negative from a medical professional would be a sigh of relief, but not for me. I heard the words but I rejected what they meant and marked them return to sender. Further research highlighted it is an aggressive form that is becoming more common in women under 50. The main question that was stuck in my head, with tears in my eyes was, "What am I supposed to do now?” The first thing I needed to accept was this diagnosis is not a death sentence. It will only kill me if I let it and I have no intention of that happening. It was time to fight!

Tomika with her husband, Sy, and her son, Nadir and daughter, Eliza

The medical professionals, friends, survivors and literature produced various options for me to consider. After reviewing my choices, I realized that a bilateral mastectomy was right choice. I truly believe this is the best way for me to avoid a recurrence. When I made that choice, I knew my fight was going to inspire others that would follow me.

Another significant part of this process is having a group of professionals that you truly trust to help you along this journey. I received an overwhelming amount of support for the staff at the University of Pennsylvania. From my first consultation, the doctors (Dr. Julia Chou, Dr. Suhail Kanchwala, and Dr. Keerthi Gogineni) and supporting staff were open and welcome to answer each of my questions. I felt extremely comfortable and knew that I could trust them with this very important journey.

The healing, I learned is mental, physical and spiritual. Mentally, you must learn all that you can about the prescribed treatment plan and believe that you will beat this. Physically, you might have to push yourself beyond the norm. There will be days where all you want to do is sleep and just take your meds, but your body needs movement to recover. Pray, and have faith like you have never prayed before. These steps helped me enter surgery on July 26th with a clear mind and belief that I was going to be a survivor.

Strut Strong, Proud to be a Survivor

Pink Ribbon Stilettos was born based on my journey. Through this journey, I realized women do not receive all of the support needed for this mental, physical and spiritual fight. It has definitely made me stronger and increased my desire to help others. And now, Pink Ribbon Stilettos will help others Strut with Breast Cancer. Strut with confidence that you will be a survivor. Strut with strength that you will be a fighter. Strut with faith that this will only make you stronger.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.


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Friday! Penn Women’s Cancer Conference

The Abramson Cancer Center is pleased to present the Penn Women’s Cancer Conference, a day-long conference dedicated to topics on women’s cancer including prevention, diagnosis, treatment, genetics and living well after breast cancer and gynecologic cancer treatment.

This conference was one of the first in the country to address the issues and concerns of breast and gynecologic cancer survivors and their families.

Whether at risk for women’s cancer, newly diagnosed or long term survivor, attendees received up-to-the-minute information including; the latest laboratory research, treatment advances, clinical trials, and survivorship issues.

There are two different tracts for the day including Focus On Gynecologic Cancers Conference and Life After Breast Cancer Conference.

Join Us for Focus On Gynecologic Cancers Conference

Date: Friday, October 25, 3013
Time: 7:30 am to 2:30 pm
Location: Hilton Hotel, 4200 City Avenue, Philadelphia PA

Register for Focus on Gynecologic Cancers Conference here.

Can’t Make the Conference?

Can’t make this year’s conference? Be sure to follow @PennMedicine on Twitter with the hashtag #OvarianACC to follow the day’s topics and discussions, or watch the live stream at pennmedicine.org/Abramson/ovarianlive.

Join us for the 21st Life After Breast Cancer Conference

Date: Friday, October 25, 3013

Time: 7:30 am to 3:30 pm
Location: Hilton Hotel, 4200 City Avenue, Philadelphia PA

Register for the 21st Life After Breast Cancer Conference here.

Can’t Make the Conference?

Can’t make this year’s conference? Be sure to follow @PennMedicine on Twitter with the hashtag #BreastACC to follow the day’s topics and discussions, or watch the live stream at pennmedicine.org/Abramson/womenscancerslive.

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Breast Cancer News from ASCO 2013

Christine Wilson, cancer survivor, shares her experiences from the The American Society of Clinical Oncologists (ASCO) national conference in 2013. Every year in the first week of June, over 30,000 cancer specialists and researchers from around the world gather to present their latest findings on the prevention, diagnosis and treatment of science. At a recent continuing medical education meeting, experts from the Abramson Cancer Center summarized some of the most important research from ASCO 2013 for a packed room of over 300 local oncologists. 

In this blog, Chris presents information from Kevin Fox, MD, director of the Rena Rowan Breast Center at Penn Medicine

Extending Tamoxifen Therapy Beyond Five Years

Tamoxifen has proven remarkably effective in preventing recurrences of hormone dependent breast cancer, but it is also associated with some significant side effects. A major study done in Great Britain showed a slight advantage to extending tamoxifen therapy for 10 years, but also a higher incidence of pulmonary embolism and uterine cancer. The study reinforces the need for women with this type of breast cancer to talk to their doctors about their preferences.

Neoadjuvant Therapy for HER2 Positive Patients

Neoadjuvant therapy means treating people before their surgery. It is in Dr. Fox’s words, “a rich area for clinical research.” For patients with aggressive or high risk disease, it offers the prospect of attacking the cancer when it is in its earliest stage, for other women, it can provide a way of making breast conserving surgery possible. It also subjects women to additional treatment. The two major issues with neoadjuvant therapy are:

1. Which women will benefit from this approach?
2. How can the success of this treatment be measured. Most trials measure success in terms of disease free survival, progression free survival or overall survival, but these endpoints cannot be applied to neoadjuvant trials. The current outcomes measurement is called pathologic complete response, pCR, or the complete disappearance of all evidence of disease prior to surgery.

The bottom line for now is that, if the decision is made to give neoadjuvant therapy to HER2 positive patients, the regimen should trastuzumab and one additional agent. Questions remain, however, as when to use this therapy and how best to measure its success.

In another study, neoadjuvant therapy did result in changing the decision about the type of surgery from mastectomy to breast conservation in 43% of patients.

Sentinel Lymph Node Dissection

Sentinel lymph node dissection has now been established as standard for most women with breast cancer. Two studies presented at ASCO 2013 addressed issues related to this procedure.

• The first determined that although microscopic signs of cancer can be found in 25% of sentinel nodes identified as negative when they are more closely examined, this finding has little clinical significance, and in Dr. Fox’s words “is not worth doing.”
• The AMAROS trial randomized women undergoing SNL biopsy with a positive lymph node into either completion lymph node dissection or radiation therapy. The study found no difference in the axillary recurrence rate-which was very low in both groups--but did determine that women who had the additional surgery had twice the incidence of lymphedema as those who got radiation therapy.

The Natural History of Small HER2 Positive Tumors

HER2 Positive tumors are known to have a poorer prognosis, but the tendency has been not to treat very small tumors aggressively. A new analysis showed that patients with small HER2 Positive tumors do benefit from systemic adjuvant therapy.

The breast cancer program at Penn's Abramson Cancer Center has Expert Surgeons who perform the most complex surgeries and reconstruction with some of the best outcomes in the nation.
Learn the facts and request a consultation today.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within.



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I Was The One - A Story of Breast Cancer and Survivorship

Liz Barker is a mother, a wife, a writer and a breast cancer survivor. In this blog, she remembers he diagnosis at 34 years old - while pregnant with her son. 

What are the odds of being the One?

We know the basics: Breast cancer will, on average, strike one out of 9 women. What we don’t know is who that unlucky “one” will be. Is there a certain typecast to be that “one?"

Unfortunately, as was the case with my diagnosis, there is often no stereotypical reason to be the “one.” In 1991, I became that “one.”

At the time, I was a healthy 34 year old with no family history of the disease. To make matters worse, I was also 5 ½ months pregnant with a healthy baby. Imagine the shock factor!

Initially, I was advised at another health system to terminate this healthy pregnancy “to save my life” and “to live to be a mother to my toddler son and a wife to my husband.” This doctor did not know my back story though, and why his rash recommendations were a double whammy to me.

One year prior, we had just buried our 3-year-old daughter Lauren, who endured a tragic death from a hospital infection after surgery. Lauren had Down Syndrome. What were the odds of my first baby having Down Syndrome, a genetic defect, when I was only 29, and again, no family history?

With odds like this, I should have been playing the lottery.

Champion By Choice

After the shock of the breast cancer diagnosis wore off, and with the help of my supportive family, I got a second opinion with cancer specialists, rather than act on the advice of that local surgeon. The plan was for me to have the mastectomy and begin a course of chemo one month later, when I began my third trimester of pregnancy. Chemo during the last trimester would not be as detrimental because the fetus’s vital organs would already be formed. I was told that my son “might be slow or might be small.” I didn’t care because after losing Lauren, my heart was broken and I did not want to give up on this healthy baby.

Surgery went fine. I only had two lymph nodes that were malignant. I tolerated chemo well enough both during and after pregnancy while juggling my toddler and then my newborn. In retrospect, I don’t know how I pulled this off, but I wasn’t working, that’s for sure.

My son Bryan was born perfect, at eight pounds even, despite being induced at 38 weeks. But, of course I worried about the long-term effects of the cancer and chemo on him, and of my continued good health. I was determined to survive and to enjoy my family. I ate healthy, I walked and exercised, and I stayed positive. After my traditional medical treatments and reconstruction, I then went through a homeopathic care plan with a doctor of naturopath. The homeopathic remedies were dispensed to cleanse my body of the chemo toxins and to build up my immune system. I also took advantage of my employer’s disability insurance that allowed me a respite to do these things and to heal my mind/body/spirit. I am forever thankful to them for supporting me through this very difficult time.

Today, at age 56, I am a 22-year cancer survivor. Bryan graduated from University of Pennsylvania this past spring and won a full scholarship for graduate school to obtain his PhD in neuroscience!

And, he has been a varsity athlete for years. So much for the “slow and small” prediction about him… There isn’t a day that goes by that I am not thankful for having him.

Two years ago, at would have been Lauren’s 25th birthday, I wanted to do something special to honor her. With the help of so many wonderful people, I hosted a very successful fundraiser to benefit handicapped children and The Arc. The event created such good karma for me that I was inspired to dust off my long time “book quest dream,” writing my personal story to inspire others. The apt title is Changed by Chance…Champion by Choice. I plan to be published soon.

Please visit my blog at www.changedbychance.com to learn more about me and my amazing story. Namaste.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the cure is Within.




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Is "Less" More When It Comes to Breast Cancer Treatment?

Carla S. Fisher, MD, is an assistant professor of surgery at the Perelman School of Medicine and a breast surgeon. Dr. Fisher sees patients at the Rena Rowan Breast Center. In this blog post, Dr. Fisher discusses ductal carcinoma in situ, or DCIS, and why sometimes when it comes to treatment for breast cancer, less is more.


In 2011, I wrote an article for this blog about the evolution of the surgical treatment of breast cancer. I discussed the progression of breast cancer surgery from a deforming procedure to breast preservation with better outcomes. As I considered what to write about in 2013, I was immediately drawn to a story I recently listened to on National Public Radio (NPR).

The story was entitled “When Treating Abnormal Breast Cells, Sometimes Less Is More” and it discussed two women’s very different decisions for the treatment of their ductal carcinoma in situ, or DCIS.

DCIS is a very early form of breast cancer. On a staging scale of 1 to 4, DCIS represents stage 0.

Each year approximately 70,000 women are diagnosed with DCIS and it accounts for approximately 1/3 of all breast cancers that are diagnosed.

Like invasive breast cancer, the surgical options for patients with DCIS include lumpectomy and mastectomy. Treatment for DCIS can also include radiation and a medication called tamoxifen.

In the story that I mentioned, one woman chose to undergo bilateral mastectomy (removal of both breasts) as treatment for her DCIS and the other patient elected to forego surgery altogether and was being treated with tamoxifen only. Treating DCIS with tamoxifen only is currently not the standard of care but has been suggested as a possibility for certain types of this early stage of breast cancer.

I mention this story on NPR because it reminded me of our continuing evolution in the surgical treatment of breast cancer. Treating any form of breast cancer with medication only would have been unheard of even 50 years ago!

How do these changes in surgical (or non-surgical) management occur? These changes do not (and should not) happen quickly. They require large groups of patients followed for many years on clinical trials. While new treatment options are exciting, they require close observation and follow up to make sure they are safe and effective.

At the Abramson Cancer Center, we have over 20 clinical trials for women with breast cancer. Our clinical trials include everything from intraoperative imaging of breast cancer to surgical vaccines to radiation using proton therapy. Patient participation in clinical trials is always voluntary but it is what has allowed us to transition from “radical mastectomy” to “breast conservation” surgery.

When it comes to breast cancer treatment, we have shown that “sometimes less is more." As we look to the future, we know that the advances in the treatment of this cancer will only continue to improve. I look forward to that.

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the cure is Within.



Hear our stories and find out more today.

The breast cancer program at Penn's Abramson Cancer center offers hope with the most advanced therapies and clinical trials available in the region.
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Cancer Awareness Month for October: Breast Cancer, Liver Cancer

October is breast cancer and liver cancer awareness month. Be sure to subscribe to the Focus On Cancer blog and like the Abramson Cancer Center Facebook page for more information on breast and liver cancer throughout the entire month.

At a Glance: Breast Cancer

• Twelve percent of women, or 1 in 8, will develop breast cancer.
• While there’s no guaranteed way of prevention, regular mammograms are still the most important screening in the detection of breast cancer; the procedure likely saves thousands of lives each year.
• Women should begin doing self breast exams, to check for lumps and other changes in breast skin, in their early 20s.
• Although rare, men can also develop breast cancer. 1 in 5 men diagnosed with breast cancer have a close male or female relative with the disease.

Learn more about the treatment for breast cancer at the Abramson Cancer Center.

At a Glance: Liver Cancer

• There are two main types of liver cancer: primary liver cancer forms in the tissues of the liver. Secondary liver cancer spreads to the liver from another part of the body.
• Liver cancer is typically not associated with symptoms in its early stages. As the disease progresses, patients may experience jaundice, fatigue, weight loss and loss of appetite, abdominal bloating and pain on the right side of the abdomen, and pain in the right shoulder blade.
• Liver cancer risk factors include Cirrhosis (from genetics, alcoholism, or Hepatitis B and Hepatites C), tobacco use, and aflatoxin (a food fungus).
• Patients at Penn Medicine with liver cancer receive treatment from nationally recognized medical experts with years of experience with gastrointestinal cancers. Penn Transplant Institute has performed more than 1,500 liver transplants.

Learn more about the treatment for liver cancer at the Abramson Cancer Center.

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Vitamins and Supplements During and After Breast Cancer Treatment

If you have been diagnosed with breast cancer, are currently undergoing treatment for breast cancer, or a breast cancer survivor, you may have a lot of questions about vitamins and supplements.

Join us LIVE tonight from 6:30 to 8 pm ET from Living Beyond Breast Cancer's March community meeting to learn how vitamins and supplements affect your treatment plan and follow-up care.

During this chat, you will also get information about the latest research on the role of specific vitamins and supplements in reducing risk of recurrence and explore how to obtain evidence-based information to discuss with your doctor and care providers.

Date: TONIGHT, March 13, 2013
Time: 6:30 to 8 pm, ET
Location: Visit Oncolink.org/webchat to register for the chat, get a reminder about the chat, and submit your questions.

You can also listen to a recording of the chat on Oncolink after the chat.

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Schedule Your Mammogram at Penn Medicine

February is Cancer Prevention Awareness Month. Here at the Abramson Cancer Center, we are committed to providing outstanding comprehensive cancer care and cancer information including ways to prevent cancer. Further, cancer researchers at Penn are at the forefront of learning new ways to prevent and detect cancer.

In this article, we discuss mammograms. And how a new type of mammogram offered at Penn may improve accuracy.

The mammogram remains the most important screening device in the detection of breast cancer and it likely saves thousands of lives every year.

Beginning at the age of 40, all women should have an annual mammogram to check for breast cancer. Depending on a woman’s personal risk, her physician may recommend she begin annual mammograms before the age of 40.

A revolutionary way to perform mammograms combining traditional mammography with 3D technology, called digital breast tomosynthesis (DBT), allows for more accurate pictures of breast health.

Like traditional mammogram, the breast is compressed for about four to five seconds while a series of low-dose X-rays are taken to capture high-resolution images of the breast. These images are then digitally “stacked” to construct a total 3D image of the breast. This 3D image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles. Radiologists can also magnify images to reveal minute details.

Women who get their mammograms using the new DBT technology may find they are called less often for follow-up visits and more tests.

Learn more about DBT at Penn, and how you can schedule your DBT mammogram at Penn.

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