May 29, 2025 • 40 mins
Centered on Health 5-29-25 - New updates for breast surgery with Dr. Thomas Noel
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
It's now time for Centered On Help with Baptists Help
on use Radio.
Speaker 2 (00:05):
Wait forty TELNYJS. Now here's doctor Jeff Tubbler.
Speaker 1 (00:12):
Good evening, everybody, and welcome to tonight's episode of Centered
On Health with Baptist Help here on news Radio eight
forty whas. I'm your host, doctor Jeff Tulblin. We're joined
from the studio with mister Jim Fenn, who's on call
waiting to take your calls to talk to tonight's guest.
Our phone number is five oh two, five seven one
eight four eighty four. If you want to call it
(00:33):
and be a part of the show, that's five oh two,
five seven one eight four eight four. One in eight
women in the United States will be diagnosed with breast cancer,
and in twenty twenty five, three hundred and twenty thousand
women and three thousand men will be diagnosed with invasive
breast cancer. This means that the chances are that you
will probably know somebody or be affected by breast cancer
(00:56):
in your lifetime, and early detection is the key, as
is an advanced care and we're very lucky tonight to
have doctor Thomas Nole with us tonight, who is providing
that advanced care for our community. Doctor Nole's a general
surgeon in the Baptist's Hospital Medical Group with his primary practice.
Speaker 2 (01:12):
In New Alberdy, Indiana.
Speaker 1 (01:14):
He has a clinical focus in breast surgery and he
recently has become a big part of the Baptist Health
Floyd Breast Surgery program and treats a variety of conditions,
including cancerous and non cancerous breast disease. He received his
MD from the University of Louisville School of Medicine and
completed his general surgery residency at the University of Missouri.
He then went on to Yale where he completed an
(01:35):
interdisciplinary breast surgery Fellowship. Welcome back to our show.
Speaker 3 (01:42):
Thank you, it's good to be here.
Speaker 2 (01:44):
Well, we're excited to have you back here.
Speaker 1 (01:47):
We always learn so much from you and what you're
doing here in our community. But I wanted to start
off by asking you, was it always your plan to
do something like breast surgery or did you go into
general surgery and did something kind of mark that interest
for you along the way.
Speaker 3 (02:04):
I think it was something that developed over time. I
kind of my dad was a plastic surgeon and did
a whole lot of breast cancer reconstructive surgery, so I've
been around it for a lot of my life, but
going into medical school, I really wanted to keep an
open mind and really choose what was the right fit
for me and not just do the same thing my
(02:25):
dad did. I was really drawn the cancer care just
because of how multidiscipline area it is. He really worked
with a lot of different types of doctors and a
really great collaborative environment. I think it's really satisfying to
treat cancer and it's just very intellectually stimulating. During residency,
I kept my options wide open. I considered more general
(02:48):
complex surgical oncology treating all kinds of abdominal cancers. But
I was really drawn the breast surgery just because of
the patients and the people you got to work with.
In a whole lot of cases, people do really well
and get their breath breast cancer completely treated, go on
with full lives, and I think that was really satisfying
(03:09):
for me to be a part of that. I think
the more time I spent with it, the more I
knew that was the field for me absolutely.
Speaker 1 (03:17):
And I love how you talked about interdiscipline and we're
gonna we're gonna talk about that, But what is the
extra training like to be a breast surgeon in particular,
and why do you think that that's important to have
that extra level of training.
Speaker 3 (03:32):
I think it just gave me a year after training
where all I was thinking about was how to treat
breast cancer. Coming out of residency, I really I knew
how to operate really well. It was very well trained
in the operating room. But that extra year really let
me expand my knowledge of a lot of I guess
more and more specific subcases of breast cancer, how to
(03:55):
better interact with the different specialties radiation oncology, metic oncology,
plastic surgery. About half of my year of fellowship was
actually spent not doing breast surgery, but spent in the
medical oncology clinic or with the radiation on cologies, or
with the plastic surgeons learning all their tricks in the
operating room. But I think it gave me a chance
(04:17):
just to really hone in and focus and kind of
have a finishing school for what I was going to
do for the rest of my life.
Speaker 1 (04:24):
You know, tell us a little more about about that
and the interdisciplinary approach, because you know, a lot of
times we think of, you know, we go to see
a surgeon and we're like, here's the problem, cut on it,
take care of it, and see you later. But what
is the role of the surgeon within this interdisciplinary approach
and who are the other people in the in that approach?
Speaker 3 (04:48):
Yeah, I think as the surgeon. A lot of times
the first person that the patient meets aside from you know,
the first person they meet is the radiologists doing their screening,
imaging that may detect something, may do a biopsye. But
often I'm the first person who really talks about a
plan for how to treat a cancer with them, and
it's vital that I kind of understand what everyone else
(05:10):
is going to think about this case and how they're
going to work, because the order of treatments can vary.
For a lot of women, we do surgery first or
remove the cancer, and then they meet with a medical
oncologist who has different types of medicines from endocrine therapy
to chemotherapy, immunotherapy, target therapies that can reduce the risk
of recurrence or treat cancer. But in some cases those
(05:33):
medicines are the first thing we should do, and we
should wait to do surgery until after we've given those
medicines a chance to work. So I think really knowing
the different medical and radiation oncologists I work with, knowing
their thought cross having a holistic understanding of the treatment
is vital to be a good surgeon. So you come
in and do your part at the right time.
Speaker 2 (05:56):
I love that.
Speaker 1 (05:56):
And do you find you kind of mentioned this, but
do most people come to you with a diagnosis or
more of a suspicion. Do you do the biopsies in
the office. What's sort of that process?
Speaker 3 (06:09):
Like I would say most of my patients already come
in with a diagnosis and screaming. My Mamarck mimography is
really really good. So women who are getting their annual mammogram,
we find tiny lit allegians that are concerning our prest program.
The radiologists do a great job of working those up
(06:30):
biopsy and so often they already have a diagnosis when
they come to meet me. But not always. Sometimes I
see patients who have felt the lump and I end
up being the first person they need, and I have
capability to do some ultrasound in the office. Sometimes if
tumors are really close in or near the skin. I
(06:50):
do biopsies in the office. A lot of times I'll
refer them to radiology to do really good image guided
biopsies just because they have capabilities to leave markers at
the side of the biopsy and it's a little more
streamline there.
Speaker 1 (07:06):
So, you know, as a breast surgeon, I know you
do lots of surgeries that we're focusing mostly tonight on
breast cancer surgery. So in Kentucky, how are we doing.
I know, the awareness of breast cancer is there. I mean,
I feel like, fortunately, breast cancer does get a lot
of press and awareness, But how are we doing locally
with our actually implementing the screening guidelines?
Speaker 3 (07:34):
You know, I don't think I have raw numbers of
you know, how many women out of the entire population
they're getting annual screening. I think a lot of women
I meet, they're religious, they do every year, they get
their mamogram out right, if something comes up, they do
extra screen But there are certainly some people who aren't
(07:57):
doing that. And unfortunately, when I see people who have
them in doing mamrams, it's usually because they found something right.
You know, we'll never know if it's something that could
have been caught sooner or later. But I think we're
working really hard to bolster our screening. We have a
lot of stuff going on with our screen program. We
do risk assessment looking at family history and other risk
(08:20):
factors when people go in for their screen event the ground.
If kind of these risk assessment models flag someone as
high risk, then we can suggests they go meet with
our High Risk RESK clinic where we can look at
expanded screening. So there's a lot of growth in the
screening there.
Speaker 1 (08:38):
And what is you know, if you're not high risk,
and we'll talk about some high risk issues, but if
you're not high risk and you're just what we would
consider average risk, what is the current recommendation for screening,
Who should get it, at what age and how often?
Speaker 3 (08:57):
This is a spot where there's always it depends which
organization you're listening to, but I go by what the
American Society of Breast Surgeons recommend. Their recommendation is at
age forty women should get annual mammograms who are at
average risk. In some cases, women who have very dense
(09:17):
breast ultrasound can be added on for additional screening. Fantastic, Well,
we're going on until I'm sorry.
Speaker 2 (09:26):
Go ahead, Oh, go ahead. I guess you'll go on until.
Speaker 3 (09:31):
Typically screening goes on until someone meets you with their
prescribing doctor, typically their primary care doctor. Sometimes, you know,
at some point Women's eighty eighty five, they can have
kind of a nuanced discussion about the utility of continued screening.
Speaker 2 (09:46):
Fantastic.
Speaker 1 (09:47):
Well, we're going to take a take a short break.
Tonight we are talking with doctor Thomas Knowle about breast
surgery and breast cancer. You are listening to Center on
Health with Baptist Health here on news radio eight forty WHAS.
Phone number five oh two, five seven one eight four
eighty four. If you'd like to call in and ask
a question, we will be right back after these messages.
(10:28):
I want to welcome everyone back to Center it on
Health with Baptist Help here on news radio eight forty WHS.
I'm your host, doctor Jeff Tublin. We're talking tonight with
doctor Thomas Nole, breast surgeon with the Baptist Hospital Medical Group.
Our phone number is five oh two, five seven one
eight four eight four. If you want to call in
and be a part of the conversation or ask a
(10:48):
question of doctor.
Speaker 2 (10:50):
Nol, Doctor Nol, We do have a caller on the line.
Speaker 1 (10:52):
We have Teresa who had a question for you about
breast surgery that she has had.
Speaker 2 (10:57):
So Teresa, are you on, Yes, thank you, You're welcome,
Welcome to the show.
Speaker 4 (11:04):
Thank you very much. First of all, like I said,
I emphasized with all the ladies who've had breast cancer,
I feel a great sadness for them that they have
to go through that. But my concern is that I
(11:27):
had silicone breast implants back in nineteen I think it
was nineteen eighty two. They were okay, and they've been okay,
and I've always had my mammograms and so forth. But
now the breast implants are leaking and I've had breast
(11:52):
ultrasounds and according to the according to the reports I've gotten,
it's not a big deal. I mean, they didn't put
it that way, but there's really not a whole lot
to be done. And of course the insurance if I
(12:15):
decided to do it, insurance would not pay for it.
So I've just seen my regular gynecologists and the mammograms.
But how concerned should I be about this and what
could it be doing to my body?
Speaker 3 (12:34):
Yeah, so you mentioned there were silicone breast implants, and
there's kind of two main types of breast implants that
exists that are saline filled in silicone. A silicone implant
from nineteen eighties was likely more of a liquid silicone
rather than a solid gel.
Speaker 4 (12:52):
It's definitely is gel, definitely.
Speaker 3 (12:55):
Yeah. So if it is leaking a lot of times,
your body form a pretty contained capsule around the implant,
so you know, it may be that silicone is well
contained in the capsule around the implant itself. In extreme cases,
if it's leaking out, it can develop into wounds or
work towards the skin, and certainly that would be a
(13:18):
reason to seek more care. But I think the best
person to evaluate that would be a plastic surgeon, which
I know is a source of confuse. And I'm a
breast surgeon, but I'm more of a breast cancer surgeon,
so I don't do implants or the reconstruction side. I
work with some really great plastic surgeons who do that.
I think they would be probably the best doctor to
(13:40):
evaluate any issue with the breast implant. You know, they
would want to see that imaging and they could consider,
you know, options whether removing that implant would be useful
a lot of times if they remove something, they would
put a different implant back in it's intact just to
fill the space or perform some sort of lift or reduction,
(14:02):
just to close down the space where the implant was.
In terms of the insurance coverage, that that's always a
sticky issue. But you know, certainly if this was causing
a problem, I'm sure that's something that they would work
with your insurance company for to try to get coverage
or make it affordable.
Speaker 4 (14:21):
Okay, well that's that's that's a possibility. But I'm glad
to know that it would be a plastic surgeon again
that I would see, not relying just on my gynecologists
stood and so forth.
Speaker 3 (14:40):
So thank you you're gecologists, I'm sure is a great resource.
But I think you know the plastic surgeon. They're the
surgeon who had take an implant out or placed one,
so they're really the expert, and I think thinking out
the expert's opinion is the right course of action.
Speaker 1 (14:56):
Theresa, thank you so much for calling in and being
being a part of the show tonight.
Speaker 4 (15:00):
Thanks you.
Speaker 2 (15:03):
Too.
Speaker 1 (15:04):
You do so doctor No, I want to go back
to something you were talking about before when you were
talking about screening for high risk patients. So we talked
about the recommendations for average risk, but I know about
just we're doing some really great work within this area.
So what are we doing to find people that are
(15:26):
at higher risk?
Speaker 2 (15:27):
And how is that working at that?
Speaker 3 (15:31):
So there's a whole lot of ways you can assess
someone's risk. The way we're using it, we're using this
risk assessment model called the tire AQUSIC Risk Assessment Model.
It takes in a whole lot of data about a patient,
including their family history, history of amograms prior bio these,
dynocologic history which has a lot to do with estrogen
(15:53):
exposure over their lifetime, and it gives you a pretty
discrete number about what you're made. A lifetime risk of
breast cancer is. You'd mentioned at the start of the
show one in eight women will have breast cancer, which
comes out to about a twelve or thirteen percent lifetime risk,
and we found it for women who have over a
(16:14):
twenty percent lifetime risk, some sort of additional screen makes sense.
So we've been trying to pull in all that data
from a survey when it comes in for her screen
mammogram and calculate her risk and if the numbers over
twenty percent, we provide a referral to our high risk
screening program. One of our medical oncologists, doctor okk runs At,
(16:36):
does a wonderful job and she has a whole host
of options. It can be more frequent screening, incorporating breast
MRI and even looking at genetic testing.
Speaker 2 (16:47):
Yeah, that's amazing.
Speaker 1 (16:48):
And to have that all kind of coordinated to find
these patients and to get them screened, you know, the
best way possible is amazing. And you know, I know
at Baptists, we're doing all sorts of things in your
in your team, so we who are the other people
on your team? We've had a breast nurse navigator on
our show before. What what is that and do you
(17:10):
incorporate that into what's happening at Baptists.
Speaker 3 (17:15):
Yeah, So thatptis Floyd Jill Crawford is our nurse navigator
and she's I describe her as the glue that holds
all the different parts of the team together. So she interacts,
she kind of goes to the office of the medical
Oncology team, raishuncology team my office, and really is that
single point of contact that a patient can have for
a really large and sometimes overwhelming team. Absolutely certainly with
(17:40):
a new diagnos of breast cancer in their meeting, for
five different doctors all involved in the care, it can
be kind of hard to coordinate all that. So that's
that's kind of Jill's role when patients first meet me.
She's almost always there in my clinic, in the room,
face to talk with the patient. Actor helps organize next steps,
(18:01):
make sure im the gene or anything else we need
to go forward with treatment gets done in a timely
fashion and we.
Speaker 1 (18:09):
And Jill is the one that we had on our
show before. And I can tell anybody that's listening that
that is an hour's worth of unbelievable information. So go
to the iHeartRadio app and find her episode because it
was really fantastic. Now, I did do my research about you,
doctor Noel, and you received the Gold Human as an
(18:29):
Honor Society, and it struck me, you know, as a
provider going into surgery to have that label, and I'm wondering,
how do you incorporate human as an aspect into what
you do every day.
Speaker 3 (18:46):
I think a lot of it is kind of taking
a step back from the very objective scientific here's this tumor,
is this big? This is the surgery we should do,
and looking at a lot of some of them more
human app aspects, how is the surgery going to affect
someone's life. There's not a lot of disease processes where
(19:06):
the patient has a lot of choice and what type
of surgery she gets. But in a lot of cases,
for less cancer, how patient can choose breast conservation therapy
with el empectomy, they can choose mass dectomy with the
flat closure or reconstruction, And a lot of that has
to do with their values, personal preferences, and you know
(19:26):
how that's going to affect screening or worrying about breast
cancer for the rest of their life. So I think
it certainly makes for much longer visits, you know, discussing
all that as opposed to if someone has a bad
gallbladder and telling me you need to take it out,
there's not too much thought about that. But here we
really kind of delve into what's important to the patient
(19:49):
and what's going to be the best thing for them
in terms of treatment.
Speaker 1 (19:54):
Well, we are We're just thrilled to have you bringing
that level of humanism to this complicated decision process, and
I'm sure it's very overwhelming at times, just like you
were saying, we are going to get into some of
the things you talked about about the different types of
surgeries that you do, but we're going to take a
quick break here on Centered on Health with Baptist Health
on news radio eight forty wh whas. I'm your host,
(20:19):
doctor Jeff Tublin, and tonight we are talking with doctor
Thomas Noll about breast cancer and breast surgery. Our phone
number five oh two, five seven one, eight four eighty
four if you'd like to call in and ask you
a question, we'll be right back. Welcome back to Senate
(20:50):
on Health with Baptist Health here on news radio eight
forty whas. I'm your host, doctor Jeff Tublin, and tonight
we're talking with doctor Thomas no breast surgeon with the
Baptist Hospital Medical Group, about breast cancer and breast surgery.
We left the last section and we're moving into the
(21:13):
time where I want to pick your brain about the
actual surgeries that you do. We've learned so much about
screening and the importance of this comprehensive interdisciplinary care, but
when it comes to you and part of your role,
we need the expertise of your surgical skills. So I
wanted to ask you a few sort of definitions so
that kind of we all understand some of these terminologies.
(21:36):
But in terms of the types of surgery, what's the
difference between a lumpectomy and a mass dect tomy and
a partial mass dect tom and how do those come
into play in terms of how you decide which one
of those is the right thing for a patient.
Speaker 3 (21:55):
So really, in my mind, there's two big divisions of
breast surgery. The lumpect to me, which is the same
thing as a partial mass deck to me, that's removing
a small area of the breast, including the tumor target
of interest, with a core of normal tissue around it
to help make sure we have negative margins or don't
leave anything behind, but leave the bulk of the breast
(22:17):
tissue behind so the woman preserves her native breast sensation
and kind of the shape and contour. A common termual
here as well for that is breast conservation therapy. The
other main group is mass deck to me, which involves
removing all of the breast tissue or ninety nine point
nine percent of the breast tissue, so that involves removing
(22:41):
all of the breast tissue between the skin and the
chest wall, and that can involve removing some skin, no skin,
preserving the nipple, or kind of anywhere in between, saving
some skin for reconstruction. The choice for all those is
very individual for each patient. In cases where women have
(23:02):
a small tumor and a favorable location, all of those
surgeries are an option, and really it has comes down
to a lot of personal choice about how they want
to proceed. If preserving their breast is important, that can
be a factor, or removing the whole breast to reduce
risk of other breast cancers if they're a higher risk person,
(23:23):
that can be a choice. In some cases, if a
tumor is large or fills up too much volume of
the breast, doing breast conservation therapy, I'm backtomy partial mest
ectomy isn't really an option because we wouldn't be able
to leave behind enough tissue for acceptable cosmetic outcome. That
(23:44):
kind of becomes a lot of the nuance with a
lot of breast surgery being able to remove this cancer
but preserve a good cosmetic outcome with the shape and
contour of the breast, and.
Speaker 1 (23:58):
Does the choice of a lumpect to me versus the
mastectomy change the need for other therapies to go along
with it. It is one more complete and one needs like
radiation or is it the same in terms of it
removes the breast cancer surgically and the other types of
(24:19):
treatments are dependent on other factors.
Speaker 3 (24:24):
In most cases, if a woman chooses lumpectomy, radiation treatment
is recommended. We did a bunch of really really big,
high quality studies back in the nineteen seventies that were
kind of very foundational in developing modern breast cancer, and
those showed that getting a lumpectomy with radiation therapy to
(24:45):
the breast is equivalent to a mass dectomy in terms
of long term survival. So that study told us it
was safe to do lumpectomies if we did radiation with
it and not have to do mass dectomies for every
single breast cancer become much much more nuanced is we've
gone on learn more so there are a lot of
situations where maybe radiation can be omitted. There are cases
(25:08):
where a woman has a mess dec to me, she
may still need radiation therapy, depending on the exact tumor subtype,
so it always ends up being a very individualized discussion
that involves the whole care team. But generally lumpectomies are
associated with radiation therapy and a lot of cases messed
dec to me can't allow a little bit to avoid
(25:30):
radiation treatment.
Speaker 1 (25:33):
And the sparing of the native breast is certainly an
understandable positive about doing the lump lumpectomy. But is there
a difference and recurrence rate between the two.
Speaker 3 (25:49):
So if a woman gets a lumpectomy with radiation, the
recurrence rate is still very very low, slightly higher than
a mess dect to me, but the recurrence rate with
a mess dec tomy still not zero. Nothing we do
drops the recurrence rate down to zero, but a mess
sect to me gets you blow one percent. With a
lumpectomy with radiation be slightly hired three to four percent,
(26:13):
depending on what study you're looking at.
Speaker 1 (26:17):
And obviously when somebody has a masked ectomy and is
not doing the breast conserving part, there's going to be
inequity between the two breasts. And I know we've come
a very long way in the field of plastic surgery
and oncoplastics, so can you talk a little bit about
(26:37):
what oncoplastics means, like what is it, do you do it?
Or how does it help the patient?
Speaker 3 (26:46):
Yeah, so ongo plastics, it's a combination of the words oncology,
treating cancer and plastics. The idea of kind of reconstructive,
more aesthetic surgery, and really any breast surgery should involve
some sort of oncoplastic thought process. How are you going
to create a good cosmetic result while doing the best
cancer operation possible. For very small tumors, it doesn't require
(27:11):
a lot of extra work. You can remove the tumor
and it really doesn't create a substantial change the size
or shape of the breast. But with larger tumors sometimes
you have to spend more time rearranging tissue to fill
in the defect and create better cosmetic result preserving the
contour of the breast. There's different levels of oncoplastics. I
(27:37):
do lower level where I do some tissue rearrangement, create
pedical slaps the breast tissue that I rotate in fill defects.
And then there's more advance that involves plastic surgery techniques
you'd see in a breast reduction or breathlift, And those
are cases that I would do in coordination with a
(27:57):
plastic surgeon, where my primary focus is removing the tumor
and their focus is doing much more extensive reconstructive work
to create a good cosmetic outcome.
Speaker 1 (28:11):
You mentioned, you know, you doing some of it and
a plastic surgeon doing some of it. Are you are
you saying that these are two different times that they
have surgeries with two different surgeons, or are you doing
these surgeries together?
Speaker 2 (28:26):
I mean, is there a scenario where they go in.
Speaker 1 (28:29):
To get their breast surgeries from you and leave with
the oncoplastics already done, or have they done at two
different times?
Speaker 3 (28:37):
They would be done at the same time. That's kind
of how that would be done. So it would be
both surgeons and the operand the same time working together
in sequence. And those are great cases.
Speaker 2 (28:52):
Yeah.
Speaker 3 (28:52):
I like working with other surgeons and it really lets
us kind of put both of our skill steps together
to give patients the best oncologic and aesthetic outcome possible.
Speaker 2 (29:04):
I mean, that's fantastic.
Speaker 1 (29:06):
What is a recovery like from a surgery like that?
Speaker 3 (29:11):
So from a lumpectomy, typically that's a same day surgery
so if patient will come in have surgery, go home
the same day. I do a lot of stuff during
surgery to help with post operative pain, injecting numbing medicine
short and long acting. But typically after a lumpectomy, recovery
can be anywhere from two days to two weeks. Patients
(29:33):
are sore in terms of pain control. Typically ice packs,
tyland and ivey profen are all people need in combination
with all the numbing medicines, and people are back on
their feet pretty quickly. Can't do any strenuous activity for
a few weeks and have to avoid submerging incisions underwater,
but people are back on their feet pretty quickly from that.
(29:56):
With a mass sectomy, it's a longer recovery because it's
a bigger search. Typically after that patients will have some
drains to help manage fluid they can build up where
we've removed the breast tissue. Those stay in for a
week or two and then are removed in the clinic.
Some women stay a night in the hospital after a messtectomy,
(30:17):
but some women who are motivated have the option to
go home the same day of surgery, and typically recovery
from that. I would quote more at two to four weeks.
Speaker 1 (30:29):
Well, you are listening to Centered on Health with Baptist
Health here on news radio eight forty whas we're talking
tonight with doctor Thomas Nol, breast surgeon, about breast surgery
or breast cancer. We are going to be right back
after these messages, but I want to remind you to
download the iHeartRadio app.
Speaker 2 (30:47):
It's free, it's easy to use.
Speaker 1 (30:49):
It gives you access to tonight's show. It'll give you
access to Jill Crawford show about nurse navigation.
Speaker 2 (30:54):
We will be right back after this. Welcome back to Centered.
Speaker 1 (31:12):
On Health with Baptist Health here on News Radio eight
forty whas. I'm your host, doctor Jeff Tublin, and we're
talking tonight with doctor Thomas Nole, who is a breast
surgeon with the Baptist.
Speaker 2 (31:23):
Hospital Medical Group.
Speaker 1 (31:24):
Remember to download the iHeartRadio app to re listen to
this or any of our previous segments and to have
access to all the other features that the app has
to offer. So Doctor Noel, welcome back, and I wanted
to jump in. We've talked a lot about screening and
the surgeries, but there are patients who are at higher
risk and we hear a lot about some of those genes.
(31:47):
So we talked at the beginning about how common breast
cancer is, So when should someone actually think to themselves,
maybe they have an increased risk.
Speaker 2 (31:57):
Who's at risk?
Speaker 3 (32:01):
So the biggest thing that I think someone can look
at for intereses with family history. So that's looking at first, second,
and third degree relatives, so siblings, parents, grandparents, aunts, uncles, cousins,
looking at people who have the history of breast cancer
(32:21):
or other cancers. There's some association between breast cancer and
ovarian cancer, colon cancer, prostate pancreatic cancer, and melanoma, so
that whole family history is important. And also knowing how
old patients or patient's family members were when they had cancer.
If a patient's mom had cancer at thirty verse seventy five,
(32:44):
that's a very different story. That family history is a
big thing that can keep people in and also knowing
as family members have had genetic testing. That's really the
biggest thing.
Speaker 1 (32:59):
The genes that are most commonly associated with the breast
cancer gene or the BRACA one and the bracket two.
Speaker 2 (33:06):
Is that correct, yes, and so.
Speaker 3 (33:12):
Go ahead, Oh yeah, those are definitely the genes that
people hear about, but there's a whole host of other genes,
and when we do genetic testing, we're testing seventy different
genes at this point.
Speaker 2 (33:24):
Did you say seventy and zero? Okay, Yeah, that's a lot.
Speaker 1 (33:30):
And I think you know you mentioned this, and I
think it's really important to restate it. With these genetic markers,
it's important not just for breast cancer, but some of
these genes increase your risk for other cancers that might
require changing their screening for those particular cancers.
Speaker 2 (33:51):
Right, Certainly.
Speaker 3 (33:55):
A lot of these genes that increased risk of ovarian cancer,
pancreatic cancers, and those can be more challenging areas to screen.
I don't think I've ever met a woman who enjoyed
getting a mammogram, But it's much easier to image the
breast and screen for cancer than looking deep in the abdomen,
at the pancreas or over ease to screen. So I
(34:18):
think that's one advantage. Screen for breast cancer is much easier.
Speaker 1 (34:24):
And you know, obviously you're a surgeon and you do
mass sectomies, and we've talked about the indication of doing
them for cancer, but when is it appropriate for a
patient to consider or talk to their physician about prophylactic
meth set.
Speaker 3 (34:38):
To me, so I think that's always a nuanced discussion.
But certainly in the setting of a patient who has
a genetic mutation that confers a very high risk of
breast cancer, that would be time to have the discussion.
Or if a patient has just such a significant family
history in the absence of a genetic mutation and they've
(35:00):
been tested but no one in their family has a
gene they're still just a very strong family correlation that
confers high risk. It's not required to have profilactic surgery
even in patients with brack of one mutations. All of
our national guidelines talk about consider profilactic surgery and certainly
(35:26):
do it increased screen. But it's always a very personal decision,
and it's something that the timing of it can be
important too. If a patient wants to have kids have
the opportunity to breast feed, that might be a reason
to do that first and then consider profilactic surgery later.
Speaker 1 (35:45):
And I know that we're you know, we're advancing all
sorts of ways in terms of our understanding of these
cancers and which ones will be more aggressive and which
ones require certain therapy. We hear a lot about triple
negative breast cancers or ER positive breast cancers. What are
(36:05):
we talking about when we mentioned those terms, and how
does that affect the treatment approach?
Speaker 3 (36:12):
So we're talking about receptors on the cancer cells. So
there's a lot of different molecules in people's bodies that
stimulate cells to grow, and breast cancer is no different.
So a lot of breast cancers are stimulated by female
hormones estrogen and progesterone, or a growth factor called her too.
(36:33):
So those represent the big three receptors. We look at
er PR and HER two and that affects how we
treat cancers. Hormone positive cancers that are positive for the
estrogen and progesterone receptor. We have medicines that drastically reduce
estrogen at a person's body and starve the cancer. So
to speak, those medicines, it's not chemotherapy. It's typically a
(36:57):
pill a patient can take and they're very effective. In
cases of HER too positive breast cancers, those tend to
be more aggressive. But we've developed really good drugs that
target that receptor and can be used on their own
or in conjunction with chemotherapies to really effectively treat those cancers.
(37:19):
And then finally, this triple negative breast cancer is a
cancer that's not stimulated by any of those The estrogen
and progesterone and her too don't stimulate the cancer cells
at all. They're just growing on their own without stimulation
from those, and those cancers also are much more aggressive.
But we've had a lot of growth and now we
(37:41):
have really good immunotherapies that have really revolutionized the treatment
of triple negative breast cancers.
Speaker 1 (37:49):
So those receptors that you mentioned, those are things that
give us actual targets to treat, and if you're triple
negative that you don't have those to treat again, so
you have to have these other therapie.
Speaker 2 (38:00):
Is that what you're saying, Okay.
Speaker 3 (38:03):
Yes, exactly, we don't have a true targeted therapy for
a triple negative but we've developed really really good a
meino therapies that create really really amazing responses and a
lot of women.
Speaker 1 (38:15):
Well, I know I have asked you so much time
to talk about non cancer breast surgery.
Speaker 2 (38:21):
We have about fifteen seconds, so.
Speaker 1 (38:23):
I'm just going to ask you what is the most
common surgery that you do that is not for breast cancer.
Speaker 3 (38:31):
I would be removal of something called a fibroadenoma. It's
a benign growth in the breast of fibro epithelial tissue.
It can be a very discreete mobile heart lump someone
can feel in their breast. A lot of times they
develop in adolescents and involute, but sometimes they stay around
and they're bothersome and we can remove informatient.
Speaker 1 (38:52):
Well, doctor Nol, thank you so much. We always learn
so much when you come on. We love having you
in our community and what you're doing for our patients.
Speaker 2 (39:00):
That's going to do it.
Speaker 1 (39:01):
For tonight's segment of Centered on Health with Baptist Health,
I'm your host, doctor Jeff Tublin. I want to thank
our guests, doctor Thomas Nole for educating us, our producer
mister Jim Ben Teresa, our caller, and of course our listener.
Join us every Thursday night for another segment, and we
will see you next week and have a great, happy
and healthy weekend. This program is for informational purposes only
(39:35):
and should not be relied upon as medical advice. The
content of this program is not intended to be a
substitute for professional medical advice, diagnosis, or treatment. This show
is not designed to replace the physician's medical assessment and
medical judgment. Always seek the advice of your physician with
any questions or concerns you may have related to your
personal health or regarding specific medical conditions. To find a
(39:58):
Baptist health provider, please visit Baptistealth dot com.
It's now time for Centered On Help with Baptists Help
on use Radio.
Speaker 2 (00:05):
Wait forty TELNYJS. Now here's doctor Jeff Tubbler.
Speaker 1 (00:12):
Good evening, everybody, and welcome to tonight's episode of Centered
On Health with Baptist Help here on news Radio eight
forty whas. I'm your host, doctor Jeff Tulblin. We're joined
from the studio with mister Jim Fenn, who's on call
waiting to take your calls to talk to tonight's guest.
Our phone number is five oh two, five seven one
eight four eighty four. If you want to call it
(00:33):
and be a part of the show, that's five oh two,
five seven one eight four eight four. One in eight
women in the United States will be diagnosed with breast cancer,
and in twenty twenty five, three hundred and twenty thousand
women and three thousand men will be diagnosed with invasive
breast cancer. This means that the chances are that you
will probably know somebody or be affected by breast cancer
(00:56):
in your lifetime, and early detection is the key, as
is an advanced care and we're very lucky tonight to
have doctor Thomas Nole with us tonight, who is providing
that advanced care for our community. Doctor Nole's a general
surgeon in the Baptist's Hospital Medical Group with his primary practice.
Speaker 2 (01:12):
In New Alberdy, Indiana.
Speaker 1 (01:14):
He has a clinical focus in breast surgery and he
recently has become a big part of the Baptist Health
Floyd Breast Surgery program and treats a variety of conditions,
including cancerous and non cancerous breast disease. He received his
MD from the University of Louisville School of Medicine and
completed his general surgery residency at the University of Missouri.
He then went on to Yale where he completed an
(01:35):
interdisciplinary breast surgery Fellowship. Welcome back to our show.
Speaker 3 (01:42):
Thank you, it's good to be here.
Speaker 2 (01:44):
Well, we're excited to have you back here.
Speaker 1 (01:47):
We always learn so much from you and what you're
doing here in our community. But I wanted to start
off by asking you, was it always your plan to
do something like breast surgery or did you go into
general surgery and did something kind of mark that interest
for you along the way.
Speaker 3 (02:04):
I think it was something that developed over time. I
kind of my dad was a plastic surgeon and did
a whole lot of breast cancer reconstructive surgery, so I've
been around it for a lot of my life, but
going into medical school, I really wanted to keep an
open mind and really choose what was the right fit
for me and not just do the same thing my
(02:25):
dad did. I was really drawn the cancer care just
because of how multidiscipline area it is. He really worked
with a lot of different types of doctors and a
really great collaborative environment. I think it's really satisfying to
treat cancer and it's just very intellectually stimulating. During residency,
I kept my options wide open. I considered more general
(02:48):
complex surgical oncology treating all kinds of abdominal cancers. But
I was really drawn the breast surgery just because of
the patients and the people you got to work with.
In a whole lot of cases, people do really well
and get their breath breast cancer completely treated, go on
with full lives, and I think that was really satisfying
(03:09):
for me to be a part of that. I think
the more time I spent with it, the more I
knew that was the field for me absolutely.
Speaker 1 (03:17):
And I love how you talked about interdiscipline and we're
gonna we're gonna talk about that, But what is the
extra training like to be a breast surgeon in particular,
and why do you think that that's important to have
that extra level of training.
Speaker 3 (03:32):
I think it just gave me a year after training
where all I was thinking about was how to treat
breast cancer. Coming out of residency, I really I knew
how to operate really well. It was very well trained
in the operating room. But that extra year really let
me expand my knowledge of a lot of I guess
more and more specific subcases of breast cancer, how to
(03:55):
better interact with the different specialties radiation oncology, metic oncology,
plastic surgery. About half of my year of fellowship was
actually spent not doing breast surgery, but spent in the
medical oncology clinic or with the radiation on cologies, or
with the plastic surgeons learning all their tricks in the
operating room. But I think it gave me a chance
(04:17):
just to really hone in and focus and kind of
have a finishing school for what I was going to
do for the rest of my life.
Speaker 1 (04:24):
You know, tell us a little more about about that
and the interdisciplinary approach, because you know, a lot of
times we think of, you know, we go to see
a surgeon and we're like, here's the problem, cut on it,
take care of it, and see you later. But what
is the role of the surgeon within this interdisciplinary approach
and who are the other people in the in that approach?
Speaker 3 (04:48):
Yeah, I think as the surgeon. A lot of times
the first person that the patient meets aside from you know,
the first person they meet is the radiologists doing their screening,
imaging that may detect something, may do a biopsye. But
often I'm the first person who really talks about a
plan for how to treat a cancer with them, and
it's vital that I kind of understand what everyone else
(05:10):
is going to think about this case and how they're
going to work, because the order of treatments can vary.
For a lot of women, we do surgery first or
remove the cancer, and then they meet with a medical
oncologist who has different types of medicines from endocrine therapy
to chemotherapy, immunotherapy, target therapies that can reduce the risk
of recurrence or treat cancer. But in some cases those
(05:33):
medicines are the first thing we should do, and we
should wait to do surgery until after we've given those
medicines a chance to work. So I think really knowing
the different medical and radiation oncologists I work with, knowing
their thought cross having a holistic understanding of the treatment
is vital to be a good surgeon. So you come
in and do your part at the right time.
Speaker 2 (05:56):
I love that.
Speaker 1 (05:56):
And do you find you kind of mentioned this, but
do most people come to you with a diagnosis or
more of a suspicion. Do you do the biopsies in
the office. What's sort of that process?
Speaker 3 (06:09):
Like I would say most of my patients already come
in with a diagnosis and screaming. My Mamarck mimography is
really really good. So women who are getting their annual mammogram,
we find tiny lit allegians that are concerning our prest program.
The radiologists do a great job of working those up
(06:30):
biopsy and so often they already have a diagnosis when
they come to meet me. But not always. Sometimes I
see patients who have felt the lump and I end
up being the first person they need, and I have
capability to do some ultrasound in the office. Sometimes if
tumors are really close in or near the skin. I
(06:50):
do biopsies in the office. A lot of times I'll
refer them to radiology to do really good image guided
biopsies just because they have capabilities to leave markers at
the side of the biopsy and it's a little more
streamline there.
Speaker 1 (07:06):
So, you know, as a breast surgeon, I know you
do lots of surgeries that we're focusing mostly tonight on
breast cancer surgery. So in Kentucky, how are we doing.
I know, the awareness of breast cancer is there. I mean,
I feel like, fortunately, breast cancer does get a lot
of press and awareness, But how are we doing locally
with our actually implementing the screening guidelines?
Speaker 3 (07:34):
You know, I don't think I have raw numbers of
you know, how many women out of the entire population
they're getting annual screening. I think a lot of women
I meet, they're religious, they do every year, they get
their mamogram out right, if something comes up, they do
extra screen But there are certainly some people who aren't
(07:57):
doing that. And unfortunately, when I see people who have
them in doing mamrams, it's usually because they found something right.
You know, we'll never know if it's something that could
have been caught sooner or later. But I think we're
working really hard to bolster our screening. We have a
lot of stuff going on with our screen program. We
do risk assessment looking at family history and other risk
(08:20):
factors when people go in for their screen event the ground.
If kind of these risk assessment models flag someone as
high risk, then we can suggests they go meet with
our High Risk RESK clinic where we can look at
expanded screening. So there's a lot of growth in the
screening there.
Speaker 1 (08:38):
And what is you know, if you're not high risk,
and we'll talk about some high risk issues, but if
you're not high risk and you're just what we would
consider average risk, what is the current recommendation for screening,
Who should get it, at what age and how often?
Speaker 3 (08:57):
This is a spot where there's always it depends which
organization you're listening to, but I go by what the
American Society of Breast Surgeons recommend. Their recommendation is at
age forty women should get annual mammograms who are at
average risk. In some cases, women who have very dense
(09:17):
breast ultrasound can be added on for additional screening. Fantastic, Well,
we're going on until I'm sorry.
Speaker 2 (09:26):
Go ahead, Oh, go ahead. I guess you'll go on until.
Speaker 3 (09:31):
Typically screening goes on until someone meets you with their
prescribing doctor, typically their primary care doctor. Sometimes, you know,
at some point Women's eighty eighty five, they can have
kind of a nuanced discussion about the utility of continued screening.
Speaker 2 (09:46):
Fantastic.
Speaker 1 (09:47):
Well, we're going to take a take a short break.
Tonight we are talking with doctor Thomas Knowle about breast
surgery and breast cancer. You are listening to Center on
Health with Baptist Health here on news radio eight forty WHAS.
Phone number five oh two, five seven one eight four
eighty four. If you'd like to call in and ask
a question, we will be right back after these messages.
(10:28):
I want to welcome everyone back to Center it on
Health with Baptist Help here on news radio eight forty WHS.
I'm your host, doctor Jeff Tublin. We're talking tonight with
doctor Thomas Nole, breast surgeon with the Baptist Hospital Medical Group.
Our phone number is five oh two, five seven one
eight four eight four. If you want to call in
and be a part of the conversation or ask a
(10:48):
question of doctor.
Speaker 2 (10:50):
Nol, Doctor Nol, We do have a caller on the line.
Speaker 1 (10:52):
We have Teresa who had a question for you about
breast surgery that she has had.
Speaker 2 (10:57):
So Teresa, are you on, Yes, thank you, You're welcome,
Welcome to the show.
Speaker 4 (11:04):
Thank you very much. First of all, like I said,
I emphasized with all the ladies who've had breast cancer,
I feel a great sadness for them that they have
to go through that. But my concern is that I
(11:27):
had silicone breast implants back in nineteen I think it
was nineteen eighty two. They were okay, and they've been okay,
and I've always had my mammograms and so forth. But
now the breast implants are leaking and I've had breast
(11:52):
ultrasounds and according to the according to the reports I've gotten,
it's not a big deal. I mean, they didn't put
it that way, but there's really not a whole lot
to be done. And of course the insurance if I
(12:15):
decided to do it, insurance would not pay for it.
So I've just seen my regular gynecologists and the mammograms.
But how concerned should I be about this and what
could it be doing to my body?
Speaker 3 (12:34):
Yeah, so you mentioned there were silicone breast implants, and
there's kind of two main types of breast implants that
exists that are saline filled in silicone. A silicone implant
from nineteen eighties was likely more of a liquid silicone
rather than a solid gel.
Speaker 4 (12:52):
It's definitely is gel, definitely.
Speaker 3 (12:55):
Yeah. So if it is leaking a lot of times,
your body form a pretty contained capsule around the implant,
so you know, it may be that silicone is well
contained in the capsule around the implant itself. In extreme cases,
if it's leaking out, it can develop into wounds or
work towards the skin, and certainly that would be a
(13:18):
reason to seek more care. But I think the best
person to evaluate that would be a plastic surgeon, which
I know is a source of confuse. And I'm a
breast surgeon, but I'm more of a breast cancer surgeon,
so I don't do implants or the reconstruction side. I
work with some really great plastic surgeons who do that.
I think they would be probably the best doctor to
(13:40):
evaluate any issue with the breast implant. You know, they
would want to see that imaging and they could consider,
you know, options whether removing that implant would be useful
a lot of times if they remove something, they would
put a different implant back in it's intact just to
fill the space or perform some sort of lift or reduction,
(14:02):
just to close down the space where the implant was.
In terms of the insurance coverage, that that's always a
sticky issue. But you know, certainly if this was causing
a problem, I'm sure that's something that they would work
with your insurance company for to try to get coverage
or make it affordable.
Speaker 4 (14:21):
Okay, well that's that's that's a possibility. But I'm glad
to know that it would be a plastic surgeon again
that I would see, not relying just on my gynecologists
stood and so forth.
Speaker 3 (14:40):
So thank you you're gecologists, I'm sure is a great resource.
But I think you know the plastic surgeon. They're the
surgeon who had take an implant out or placed one,
so they're really the expert, and I think thinking out
the expert's opinion is the right course of action.
Speaker 1 (14:56):
Theresa, thank you so much for calling in and being
being a part of the show tonight.
Speaker 4 (15:00):
Thanks you.
Speaker 2 (15:03):
Too.
Speaker 1 (15:04):
You do so doctor No, I want to go back
to something you were talking about before when you were
talking about screening for high risk patients. So we talked
about the recommendations for average risk, but I know about
just we're doing some really great work within this area.
So what are we doing to find people that are
(15:26):
at higher risk?
Speaker 2 (15:27):
And how is that working at that?
Speaker 3 (15:31):
So there's a whole lot of ways you can assess
someone's risk. The way we're using it, we're using this
risk assessment model called the tire AQUSIC Risk Assessment Model.
It takes in a whole lot of data about a patient,
including their family history, history of amograms prior bio these,
dynocologic history which has a lot to do with estrogen
(15:53):
exposure over their lifetime, and it gives you a pretty
discrete number about what you're made. A lifetime risk of
breast cancer is. You'd mentioned at the start of the
show one in eight women will have breast cancer, which
comes out to about a twelve or thirteen percent lifetime risk,
and we found it for women who have over a
(16:14):
twenty percent lifetime risk, some sort of additional screen makes sense.
So we've been trying to pull in all that data
from a survey when it comes in for her screen
mammogram and calculate her risk and if the numbers over
twenty percent, we provide a referral to our high risk
screening program. One of our medical oncologists, doctor okk runs At,
(16:36):
does a wonderful job and she has a whole host
of options. It can be more frequent screening, incorporating breast
MRI and even looking at genetic testing.
Speaker 2 (16:47):
Yeah, that's amazing.
Speaker 1 (16:48):
And to have that all kind of coordinated to find
these patients and to get them screened, you know, the
best way possible is amazing. And you know, I know
at Baptists, we're doing all sorts of things in your
in your team, so we who are the other people
on your team? We've had a breast nurse navigator on
our show before. What what is that and do you
(17:10):
incorporate that into what's happening at Baptists.
Speaker 3 (17:15):
Yeah, So thatptis Floyd Jill Crawford is our nurse navigator
and she's I describe her as the glue that holds
all the different parts of the team together. So she interacts,
she kind of goes to the office of the medical
Oncology team, raishuncology team my office, and really is that
single point of contact that a patient can have for
a really large and sometimes overwhelming team. Absolutely certainly with
(17:40):
a new diagnos of breast cancer in their meeting, for
five different doctors all involved in the care, it can
be kind of hard to coordinate all that. So that's
that's kind of Jill's role when patients first meet me.
She's almost always there in my clinic, in the room,
face to talk with the patient. Actor helps organize next steps,
(18:01):
make sure im the gene or anything else we need
to go forward with treatment gets done in a timely
fashion and we.
Speaker 1 (18:09):
And Jill is the one that we had on our
show before. And I can tell anybody that's listening that
that is an hour's worth of unbelievable information. So go
to the iHeartRadio app and find her episode because it
was really fantastic. Now, I did do my research about you,
doctor Noel, and you received the Gold Human as an
(18:29):
Honor Society, and it struck me, you know, as a
provider going into surgery to have that label, and I'm wondering,
how do you incorporate human as an aspect into what
you do every day.
Speaker 3 (18:46):
I think a lot of it is kind of taking
a step back from the very objective scientific here's this tumor,
is this big? This is the surgery we should do,
and looking at a lot of some of them more
human app aspects, how is the surgery going to affect
someone's life. There's not a lot of disease processes where
(19:06):
the patient has a lot of choice and what type
of surgery she gets. But in a lot of cases,
for less cancer, how patient can choose breast conservation therapy
with el empectomy, they can choose mass dectomy with the
flat closure or reconstruction, And a lot of that has
to do with their values, personal preferences, and you know
(19:26):
how that's going to affect screening or worrying about breast
cancer for the rest of their life. So I think
it certainly makes for much longer visits, you know, discussing
all that as opposed to if someone has a bad
gallbladder and telling me you need to take it out,
there's not too much thought about that. But here we
really kind of delve into what's important to the patient
(19:49):
and what's going to be the best thing for them
in terms of treatment.
Speaker 1 (19:54):
Well, we are We're just thrilled to have you bringing
that level of humanism to this complicated decision process, and
I'm sure it's very overwhelming at times, just like you
were saying, we are going to get into some of
the things you talked about about the different types of
surgeries that you do, but we're going to take a
quick break here on Centered on Health with Baptist Health
on news radio eight forty wh whas. I'm your host,
(20:19):
doctor Jeff Tublin, and tonight we are talking with doctor
Thomas Noll about breast cancer and breast surgery. Our phone
number five oh two, five seven one, eight four eighty
four if you'd like to call in and ask you
a question, we'll be right back. Welcome back to Senate
(20:50):
on Health with Baptist Health here on news radio eight
forty whas. I'm your host, doctor Jeff Tublin, and tonight
we're talking with doctor Thomas no breast surgeon with the
Baptist Hospital Medical Group, about breast cancer and breast surgery.
We left the last section and we're moving into the
(21:13):
time where I want to pick your brain about the
actual surgeries that you do. We've learned so much about
screening and the importance of this comprehensive interdisciplinary care, but
when it comes to you and part of your role,
we need the expertise of your surgical skills. So I
wanted to ask you a few sort of definitions so
that kind of we all understand some of these terminologies.
(21:36):
But in terms of the types of surgery, what's the
difference between a lumpectomy and a mass dect tomy and
a partial mass dect tom and how do those come
into play in terms of how you decide which one
of those is the right thing for a patient.
Speaker 3 (21:55):
So really, in my mind, there's two big divisions of
breast surgery. The lumpect to me, which is the same
thing as a partial mass deck to me, that's removing
a small area of the breast, including the tumor target
of interest, with a core of normal tissue around it
to help make sure we have negative margins or don't
leave anything behind, but leave the bulk of the breast
(22:17):
tissue behind so the woman preserves her native breast sensation
and kind of the shape and contour. A common termual
here as well for that is breast conservation therapy. The
other main group is mass deck to me, which involves
removing all of the breast tissue or ninety nine point
nine percent of the breast tissue, so that involves removing
(22:41):
all of the breast tissue between the skin and the
chest wall, and that can involve removing some skin, no skin,
preserving the nipple, or kind of anywhere in between, saving
some skin for reconstruction. The choice for all those is
very individual for each patient. In cases where women have
(23:02):
a small tumor and a favorable location, all of those
surgeries are an option, and really it has comes down
to a lot of personal choice about how they want
to proceed. If preserving their breast is important, that can
be a factor, or removing the whole breast to reduce
risk of other breast cancers if they're a higher risk person,
(23:23):
that can be a choice. In some cases, if a
tumor is large or fills up too much volume of
the breast, doing breast conservation therapy, I'm backtomy partial mest
ectomy isn't really an option because we wouldn't be able
to leave behind enough tissue for acceptable cosmetic outcome. That
(23:44):
kind of becomes a lot of the nuance with a
lot of breast surgery being able to remove this cancer
but preserve a good cosmetic outcome with the shape and
contour of the breast, and.
Speaker 1 (23:58):
Does the choice of a lumpect to me versus the
mastectomy change the need for other therapies to go along
with it. It is one more complete and one needs like
radiation or is it the same in terms of it
removes the breast cancer surgically and the other types of
(24:19):
treatments are dependent on other factors.
Speaker 3 (24:24):
In most cases, if a woman chooses lumpectomy, radiation treatment
is recommended. We did a bunch of really really big,
high quality studies back in the nineteen seventies that were
kind of very foundational in developing modern breast cancer, and
those showed that getting a lumpectomy with radiation therapy to
(24:45):
the breast is equivalent to a mass dectomy in terms
of long term survival. So that study told us it
was safe to do lumpectomies if we did radiation with
it and not have to do mass dectomies for every
single breast cancer become much much more nuanced is we've
gone on learn more so there are a lot of
situations where maybe radiation can be omitted. There are cases
(25:08):
where a woman has a mess dec to me, she
may still need radiation therapy, depending on the exact tumor subtype,
so it always ends up being a very individualized discussion
that involves the whole care team. But generally lumpectomies are
associated with radiation therapy and a lot of cases messed
dec to me can't allow a little bit to avoid
(25:30):
radiation treatment.
Speaker 1 (25:33):
And the sparing of the native breast is certainly an
understandable positive about doing the lump lumpectomy. But is there
a difference and recurrence rate between the two.
Speaker 3 (25:49):
So if a woman gets a lumpectomy with radiation, the
recurrence rate is still very very low, slightly higher than
a mess dect to me, but the recurrence rate with
a mess dec tomy still not zero. Nothing we do
drops the recurrence rate down to zero, but a mess
sect to me gets you blow one percent. With a
lumpectomy with radiation be slightly hired three to four percent,
(26:13):
depending on what study you're looking at.
Speaker 1 (26:17):
And obviously when somebody has a masked ectomy and is
not doing the breast conserving part, there's going to be
inequity between the two breasts. And I know we've come
a very long way in the field of plastic surgery
and oncoplastics, so can you talk a little bit about
(26:37):
what oncoplastics means, like what is it, do you do it?
Or how does it help the patient?
Speaker 3 (26:46):
Yeah, so ongo plastics, it's a combination of the words oncology,
treating cancer and plastics. The idea of kind of reconstructive,
more aesthetic surgery, and really any breast surgery should involve
some sort of oncoplastic thought process. How are you going
to create a good cosmetic result while doing the best
cancer operation possible. For very small tumors, it doesn't require
(27:11):
a lot of extra work. You can remove the tumor
and it really doesn't create a substantial change the size
or shape of the breast. But with larger tumors sometimes
you have to spend more time rearranging tissue to fill
in the defect and create better cosmetic result preserving the
contour of the breast. There's different levels of oncoplastics. I
(27:37):
do lower level where I do some tissue rearrangement, create
pedical slaps the breast tissue that I rotate in fill defects.
And then there's more advance that involves plastic surgery techniques
you'd see in a breast reduction or breathlift, And those
are cases that I would do in coordination with a
(27:57):
plastic surgeon, where my primary focus is removing the tumor
and their focus is doing much more extensive reconstructive work
to create a good cosmetic outcome.
Speaker 1 (28:11):
You mentioned, you know, you doing some of it and
a plastic surgeon doing some of it. Are you are
you saying that these are two different times that they
have surgeries with two different surgeons, or are you doing
these surgeries together?
Speaker 2 (28:26):
I mean, is there a scenario where they go in.
Speaker 1 (28:29):
To get their breast surgeries from you and leave with
the oncoplastics already done, or have they done at two
different times?
Speaker 3 (28:37):
They would be done at the same time. That's kind
of how that would be done. So it would be
both surgeons and the operand the same time working together
in sequence. And those are great cases.
Speaker 2 (28:52):
Yeah.
Speaker 3 (28:52):
I like working with other surgeons and it really lets
us kind of put both of our skill steps together
to give patients the best oncologic and aesthetic outcome possible.
Speaker 2 (29:04):
I mean, that's fantastic.
Speaker 1 (29:06):
What is a recovery like from a surgery like that?
Speaker 3 (29:11):
So from a lumpectomy, typically that's a same day surgery
so if patient will come in have surgery, go home
the same day. I do a lot of stuff during
surgery to help with post operative pain, injecting numbing medicine
short and long acting. But typically after a lumpectomy, recovery
can be anywhere from two days to two weeks. Patients
(29:33):
are sore in terms of pain control. Typically ice packs,
tyland and ivey profen are all people need in combination
with all the numbing medicines, and people are back on
their feet pretty quickly. Can't do any strenuous activity for
a few weeks and have to avoid submerging incisions underwater,
but people are back on their feet pretty quickly from that.
(29:56):
With a mass sectomy, it's a longer recovery because it's
a bigger search. Typically after that patients will have some
drains to help manage fluid they can build up where
we've removed the breast tissue. Those stay in for a
week or two and then are removed in the clinic.
Some women stay a night in the hospital after a messtectomy,
(30:17):
but some women who are motivated have the option to
go home the same day of surgery, and typically recovery
from that. I would quote more at two to four weeks.
Speaker 1 (30:29):
Well, you are listening to Centered on Health with Baptist
Health here on news radio eight forty whas we're talking
tonight with doctor Thomas Nol, breast surgeon, about breast surgery
or breast cancer. We are going to be right back
after these messages, but I want to remind you to
download the iHeartRadio app.
Speaker 2 (30:47):
It's free, it's easy to use.
Speaker 1 (30:49):
It gives you access to tonight's show. It'll give you
access to Jill Crawford show about nurse navigation.
Speaker 2 (30:54):
We will be right back after this. Welcome back to Centered.
Speaker 1 (31:12):
On Health with Baptist Health here on News Radio eight
forty whas. I'm your host, doctor Jeff Tublin, and we're
talking tonight with doctor Thomas Nole, who is a breast
surgeon with the Baptist.
Speaker 2 (31:23):
Hospital Medical Group.
Speaker 1 (31:24):
Remember to download the iHeartRadio app to re listen to
this or any of our previous segments and to have
access to all the other features that the app has
to offer. So Doctor Noel, welcome back, and I wanted
to jump in. We've talked a lot about screening and
the surgeries, but there are patients who are at higher
risk and we hear a lot about some of those genes.
(31:47):
So we talked at the beginning about how common breast
cancer is, So when should someone actually think to themselves,
maybe they have an increased risk.
Speaker 2 (31:57):
Who's at risk?
Speaker 3 (32:01):
So the biggest thing that I think someone can look
at for intereses with family history. So that's looking at first, second,
and third degree relatives, so siblings, parents, grandparents, aunts, uncles, cousins,
looking at people who have the history of breast cancer
(32:21):
or other cancers. There's some association between breast cancer and
ovarian cancer, colon cancer, prostate pancreatic cancer, and melanoma, so
that whole family history is important. And also knowing how
old patients or patient's family members were when they had cancer.
If a patient's mom had cancer at thirty verse seventy five,
(32:44):
that's a very different story. That family history is a
big thing that can keep people in and also knowing
as family members have had genetic testing. That's really the
biggest thing.
Speaker 1 (32:59):
The genes that are most commonly associated with the breast
cancer gene or the BRACA one and the bracket two.
Speaker 2 (33:06):
Is that correct, yes, and so.
Speaker 3 (33:12):
Go ahead, Oh yeah, those are definitely the genes that
people hear about, but there's a whole host of other genes,
and when we do genetic testing, we're testing seventy different
genes at this point.
Speaker 2 (33:24):
Did you say seventy and zero? Okay, Yeah, that's a lot.
Speaker 1 (33:30):
And I think you know you mentioned this, and I
think it's really important to restate it. With these genetic markers,
it's important not just for breast cancer, but some of
these genes increase your risk for other cancers that might
require changing their screening for those particular cancers.
Speaker 2 (33:51):
Right, Certainly.
Speaker 3 (33:55):
A lot of these genes that increased risk of ovarian cancer,
pancreatic cancers, and those can be more challenging areas to screen.
I don't think I've ever met a woman who enjoyed
getting a mammogram, But it's much easier to image the
breast and screen for cancer than looking deep in the abdomen,
at the pancreas or over ease to screen. So I
(34:18):
think that's one advantage. Screen for breast cancer is much easier.
Speaker 1 (34:24):
And you know, obviously you're a surgeon and you do
mass sectomies, and we've talked about the indication of doing
them for cancer, but when is it appropriate for a
patient to consider or talk to their physician about prophylactic
meth set.
Speaker 3 (34:38):
To me, so I think that's always a nuanced discussion.
But certainly in the setting of a patient who has
a genetic mutation that confers a very high risk of
breast cancer, that would be time to have the discussion.
Or if a patient has just such a significant family
history in the absence of a genetic mutation and they've
(35:00):
been tested but no one in their family has a
gene they're still just a very strong family correlation that
confers high risk. It's not required to have profilactic surgery
even in patients with brack of one mutations. All of
our national guidelines talk about consider profilactic surgery and certainly
(35:26):
do it increased screen. But it's always a very personal decision,
and it's something that the timing of it can be
important too. If a patient wants to have kids have
the opportunity to breast feed, that might be a reason
to do that first and then consider profilactic surgery later.
Speaker 1 (35:45):
And I know that we're you know, we're advancing all
sorts of ways in terms of our understanding of these
cancers and which ones will be more aggressive and which
ones require certain therapy. We hear a lot about triple
negative breast cancers or ER positive breast cancers. What are
(36:05):
we talking about when we mentioned those terms, and how
does that affect the treatment approach?
Speaker 3 (36:12):
So we're talking about receptors on the cancer cells. So
there's a lot of different molecules in people's bodies that
stimulate cells to grow, and breast cancer is no different.
So a lot of breast cancers are stimulated by female
hormones estrogen and progesterone, or a growth factor called her too.
(36:33):
So those represent the big three receptors. We look at
er PR and HER two and that affects how we
treat cancers. Hormone positive cancers that are positive for the
estrogen and progesterone receptor. We have medicines that drastically reduce
estrogen at a person's body and starve the cancer. So
to speak, those medicines, it's not chemotherapy. It's typically a
(36:57):
pill a patient can take and they're very effective. In
cases of HER too positive breast cancers, those tend to
be more aggressive. But we've developed really good drugs that
target that receptor and can be used on their own
or in conjunction with chemotherapies to really effectively treat those cancers.
(37:19):
And then finally, this triple negative breast cancer is a
cancer that's not stimulated by any of those The estrogen
and progesterone and her too don't stimulate the cancer cells
at all. They're just growing on their own without stimulation
from those, and those cancers also are much more aggressive.
But we've had a lot of growth and now we
(37:41):
have really good immunotherapies that have really revolutionized the treatment
of triple negative breast cancers.
Speaker 1 (37:49):
So those receptors that you mentioned, those are things that
give us actual targets to treat, and if you're triple
negative that you don't have those to treat again, so
you have to have these other therapie.
Speaker 2 (38:00):
Is that what you're saying, Okay.
Speaker 3 (38:03):
Yes, exactly, we don't have a true targeted therapy for
a triple negative but we've developed really really good a
meino therapies that create really really amazing responses and a
lot of women.
Speaker 1 (38:15):
Well, I know I have asked you so much time
to talk about non cancer breast surgery.
Speaker 2 (38:21):
We have about fifteen seconds, so.
Speaker 1 (38:23):
I'm just going to ask you what is the most
common surgery that you do that is not for breast cancer.
Speaker 3 (38:31):
I would be removal of something called a fibroadenoma. It's
a benign growth in the breast of fibro epithelial tissue.
It can be a very discreete mobile heart lump someone
can feel in their breast. A lot of times they
develop in adolescents and involute, but sometimes they stay around
and they're bothersome and we can remove informatient.
Speaker 1 (38:52):
Well, doctor Nol, thank you so much. We always learn
so much when you come on. We love having you
in our community and what you're doing for our patients.
Speaker 2 (39:00):
That's going to do it.
Speaker 1 (39:01):
For tonight's segment of Centered on Health with Baptist Health,
I'm your host, doctor Jeff Tublin. I want to thank
our guests, doctor Thomas Nole for educating us, our producer
mister Jim Ben Teresa, our caller, and of course our listener.
Join us every Thursday night for another segment, and we
will see you next week and have a great, happy
and healthy weekend. This program is for informational purposes only
(39:35):
and should not be relied upon as medical advice. The
content of this program is not intended to be a
substitute for professional medical advice, diagnosis, or treatment. This show
is not designed to replace the physician's medical assessment and
medical judgment. Always seek the advice of your physician with
any questions or concerns you may have related to your
personal health or regarding specific medical conditions. To find a
(39:58):
Baptist health provider, please visit Baptistealth dot com.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
Ridiculous History
History is beautiful, brutal and, often, ridiculous. Join Ben Bowlin and Noel Brown as they dive into some of the weirdest stories from across the span of human civilization in Ridiculous History, a podcast by iHeartRadio.
© 2025 iHeartMedia, Inc.