1 00:00:00,000 --> 00:00:02,300 Welcome to Live Well with UCI Health. 2 00:00:02,300 --> 00:00:03,800 My name is Gina Grad. 3 00:00:03,800 --> 00:00:06,500 I'm from ALT 98.7 and iHeartRadio, 4 00:00:06,500 --> 00:00:07,900 and I would like to welcome 5 00:00:07,900 --> 00:00:09,700 a very special guest today, 6 00:00:09,700 --> 00:00:12,400 Doctor Alexandra Lopez Aguilar. 7 00:00:12,400 --> 00:00:13,900 She's a board-certified 8 00:00:13,900 --> 00:00:15,400 surgical oncologist 9 00:00:15,400 --> 00:00:16,600 with advanced training 10 00:00:16,600 --> 00:00:17,700 in breast cancer surgery. 11 00:00:17,700 --> 00:00:20,100 And, as if that wasn't enough, 12 00:00:20,100 --> 00:00:21,300 is an assistant professor 13 00:00:21,300 --> 00:00:22,533 for the Department of Surgery 14 00:00:22,533 --> 00:00:24,733 at UC Irvine School of Medicine. 15 00:00:24,733 --> 00:00:26,500 Doctor, thank you so much for being here. 16 00:00:26,500 --> 00:00:27,400 Thank you for having me. 17 00:00:27,400 --> 00:00:28,400 We really appreciate it 18 00:00:28,400 --> 00:00:30,900 and there's so much to learn from you. 19 00:00:30,900 --> 00:00:32,600 I know we've come a long way 20 00:00:32,600 --> 00:00:34,400 when it comes to treating breast cancer. 21 00:00:34,400 --> 00:00:35,900 And I mean, even from, 22 00:00:35,900 --> 00:00:37,300 you know, my own family members 23 00:00:37,300 --> 00:00:38,400 to friends nowadays, 24 00:00:38,400 --> 00:00:39,233 I can I, 25 00:00:39,233 --> 00:00:40,133 I just hear about 26 00:00:40,133 --> 00:00:42,200 all the technological advances. 27 00:00:42,200 --> 00:00:44,200 I bet it's very, very interesting 28 00:00:44,200 --> 00:00:45,300 to see all the progress 29 00:00:45,300 --> 00:00:46,100 that's been made in 30 00:00:46,100 --> 00:00:48,333 what feels like kind of a short time. 31 00:00:48,333 --> 00:00:50,700 Yes. Absolutely. It... 32 00:00:50,700 --> 00:00:53,100 So if you go back to like the 1800s. 33 00:00:53,100 --> 00:00:53,900 They were doing. 34 00:00:53,900 --> 00:00:55,500 What's called a radical mastectomy 35 00:00:55,500 --> 00:00:56,600 to treat breast cancer, 36 00:00:56,600 --> 00:00:57,700 where you were 37 00:00:57,700 --> 00:00:58,800 removing the entire breast, 38 00:00:58,800 --> 00:01:01,300 all of the lymph nodes in the axilla 39 00:01:01,300 --> 00:01:02,600 and the muscle. 40 00:01:02,600 --> 00:01:03,333 So these were 41 00:01:03,333 --> 00:01:04,733 really disfiguring surgeries. 42 00:01:04,733 --> 00:01:05,533 These were horrible. 43 00:01:05,533 --> 00:01:07,300 And this was done for decades. 44 00:01:07,300 --> 00:01:09,133 It really wasn't until the 1970s, 45 00:01:09,133 --> 00:01:09,900 which is wild 46 00:01:09,900 --> 00:01:12,000 because that's not that long ago, 47 00:01:12,000 --> 00:01:12,900 or at least doesn't feel like 48 00:01:12,900 --> 00:01:13,700 it was that long ago. 49 00:01:13,700 --> 00:01:14,900 No, no, no, no, no, no. 50 00:01:14,900 --> 00:01:16,600 So, for basically, like, a hundred years 51 00:01:16,600 --> 00:01:18,900 this was the standard. Yes. 52 00:01:18,900 --> 00:01:19,800 And then we started 53 00:01:19,800 --> 00:01:21,200 moving away from that, doing things 54 00:01:21,200 --> 00:01:23,200 like modified radical mastectomies 55 00:01:23,200 --> 00:01:24,900 and then starting to really do 56 00:01:24,900 --> 00:01:27,600 like toward, you know, 80s, 90s, 57 00:01:27,600 --> 00:01:29,500 we started seeing things like lumpectomies 58 00:01:29,500 --> 00:01:31,800 come onto the page with radiation. 59 00:01:31,800 --> 00:01:33,933 And now we've gone 60 00:01:33,933 --> 00:01:35,000 from when you would remove 61 00:01:35,000 --> 00:01:36,100 all of the lymph nodes 62 00:01:36,100 --> 00:01:37,700 to really in a good portion of patients 63 00:01:37,700 --> 00:01:39,000 don't even have to have their, 64 00:01:39,000 --> 00:01:39,800 their sentinel lymph 65 00:01:39,800 --> 00:01:41,500 nodes checked anymore. Why? 66 00:01:41,500 --> 00:01:42,600 What's the difference? 67 00:01:42,600 --> 00:01:43,900 We've seen that 68 00:01:43,900 --> 00:01:44,900 especially in patients 69 00:01:44,900 --> 00:01:46,000 who are post-menopausal, 70 00:01:46,000 --> 00:01:47,100 who are hormone positive 71 00:01:47,100 --> 00:01:48,700 and have really small breast cancers... 72 00:01:48,700 --> 00:01:49,800 We've done studies in really 73 00:01:49,800 --> 00:01:51,900 just the last two years 74 00:01:51,900 --> 00:01:53,900 that show that the sentinel nodes 75 00:01:53,900 --> 00:01:55,200 don't really add that much, 76 00:01:55,200 --> 00:01:56,400 because vast majority 77 00:01:56,400 --> 00:01:57,400 of the time they're negative. 78 00:01:57,400 --> 00:01:58,700 So you don't have to necessarily 79 00:01:58,700 --> 00:02:00,300 put that population of patients 80 00:02:00,300 --> 00:02:02,933 through that extra procedure. 81 00:02:02,933 --> 00:02:04,200 And when you compare that 82 00:02:04,200 --> 00:02:05,700 to what we used to do in the past, 83 00:02:05,700 --> 00:02:07,333 it's wild how much it's changed. 84 00:02:07,333 --> 00:02:08,400 So it's really great 85 00:02:08,400 --> 00:02:11,300 about not necessarily having to do 86 00:02:11,300 --> 00:02:12,700 sampling in the axilla 87 00:02:12,700 --> 00:02:14,733 is, while it's just a small addition 88 00:02:14,733 --> 00:02:15,400 to the surgery 89 00:02:15,400 --> 00:02:16,000 that the patient's 90 00:02:16,000 --> 00:02:17,500 already having their lumpectomy, 91 00:02:17,500 --> 00:02:19,400 or their mastectomy, 92 00:02:19,400 --> 00:02:20,333 sentinel lymph node 93 00:02:20,333 --> 00:02:21,900 biopsies aren't without risk 94 00:02:21,900 --> 00:02:22,900 because these are, 95 00:02:22,900 --> 00:02:23,900 these patients can still have 96 00:02:23,900 --> 00:02:26,400 a very small risk of lymphedema. 97 00:02:26,400 --> 00:02:29,000 And that's where the arm can get swollen... 98 00:02:29,000 --> 00:02:31,300 And stay swollen? And could stay swollen. 99 00:02:31,300 --> 00:02:31,800 And many times 100 00:02:31,800 --> 00:02:33,533 we can do things to mitigate it, 101 00:02:33,533 --> 00:02:34,800 but it can stay swollen. 102 00:02:34,800 --> 00:02:35,933 And so if you ever see patients 103 00:02:35,933 --> 00:02:37,200 with large arms and 104 00:02:37,200 --> 00:02:39,000 sleeves on, that's... Like a compression sleeve. That's... 105 00:02:40,133 --> 00:02:41,500 Exactly, exactly. 106 00:02:41,500 --> 00:02:42,500 So they can have that. 107 00:02:42,500 --> 00:02:43,600 They can have pain. 108 00:02:43,600 --> 00:02:44,500 A lot of patients, 109 00:02:44,500 --> 00:02:45,400 just the discomfort 110 00:02:45,400 --> 00:02:46,500 of having the incision over 111 00:02:46,500 --> 00:02:48,600 there can take a little longer recovery. 112 00:02:48,600 --> 00:02:49,933 They can have some numbness. 113 00:02:49,933 --> 00:02:50,800 They can get something 114 00:02:50,800 --> 00:02:52,600 called axillary cording 115 00:02:52,600 --> 00:02:54,600 where you get this band of tissue 116 00:02:54,600 --> 00:02:57,000 that can kind of sit right at the axilla 117 00:02:57,000 --> 00:02:59,500 and sometimes extend down the arm. 118 00:02:59,500 --> 00:03:00,600 So these are, 119 00:03:00,600 --> 00:03:02,533 complications are not common, 120 00:03:02,533 --> 00:03:05,000 but they're not nonexistent. There are risks. 121 00:03:05,000 --> 00:03:05,533 Exactly. 122 00:03:05,533 --> 00:03:07,500 So anything that you can do that 123 00:03:07,500 --> 00:03:09,700 lessens that risk is wonderful 124 00:03:09,700 --> 00:03:10,700 for the patient. 125 00:03:10,700 --> 00:03:11,600 That's so interesting. 126 00:03:11,600 --> 00:03:13,100 Did we just not know to look for that? 127 00:03:13,100 --> 00:03:14,100 Or we needed a big enough 128 00:03:14,100 --> 00:03:15,500 sample size to realize, hey, 129 00:03:15,500 --> 00:03:17,100 this isn't really making a difference? 130 00:03:17,100 --> 00:03:17,400 Yes. 131 00:03:17,400 --> 00:03:18,100 So it's really, 132 00:03:18,100 --> 00:03:21,100 I think just the numbers and time 133 00:03:21,100 --> 00:03:22,500 to get data to show 134 00:03:22,500 --> 00:03:23,733 that these patients aren't 135 00:03:23,733 --> 00:03:25,400 having really high recurrence rates, 136 00:03:25,400 --> 00:03:27,400 that doing more surgery doesn't 137 00:03:27,400 --> 00:03:29,500 necessarily mean better outcomes, 138 00:03:29,500 --> 00:03:29,933 and it just 139 00:03:29,933 --> 00:03:31,200 sometimes takes a little longer. 140 00:03:31,200 --> 00:03:33,000 But the good news is breast 141 00:03:33,000 --> 00:03:33,600 is like 142 00:03:33,600 --> 00:03:34,600 10, 15 years 143 00:03:34,600 --> 00:03:37,200 ahead of most other oncology specialties 144 00:03:37,200 --> 00:03:38,400 because there's just so 145 00:03:38,400 --> 00:03:39,900 much, there's so much buy-in, 146 00:03:39,900 --> 00:03:40,800 and there's so many people 147 00:03:40,800 --> 00:03:42,200 who are interested in breast 148 00:03:42,200 --> 00:03:43,700 and, and getting, 149 00:03:43,700 --> 00:03:46,100 you know, funding for breast research. 150 00:03:46,100 --> 00:03:47,100 So we're really doing 151 00:03:47,100 --> 00:03:49,100 well in terms of like pushing the needle. 152 00:03:49,100 --> 00:03:50,600 That's awesome. And that's so heartening to hear because, 153 00:03:50,600 --> 00:03:50,900 you know, 154 00:03:50,900 --> 00:03:51,533 the joke is like, 155 00:03:51,533 --> 00:03:53,500 well, we're going to cure baldness 156 00:03:53,500 --> 00:03:56,000 before we cure anything for women. Yes. 157 00:03:56,000 --> 00:03:58,200 So to hear you say that we're ahead of 158 00:03:58,200 --> 00:04:00,500 the game is, is really wonderful news. 159 00:04:00,500 --> 00:04:01,600 Yeah I know there's, 160 00:04:01,600 --> 00:04:01,900 you know, 161 00:04:01,900 --> 00:04:02,900 obviously different stages 162 00:04:02,900 --> 00:04:04,600 of breast cancer and different kinds. 163 00:04:04,600 --> 00:04:05,300 I am wondering 164 00:04:05,300 --> 00:04:06,400 what the typical treatments are 165 00:04:06,400 --> 00:04:06,900 for somebody 166 00:04:06,900 --> 00:04:08,333 who is diagnosed with breast cancer. 167 00:04:08,333 --> 00:04:10,800 And I'm sure there's many options. 168 00:04:10,800 --> 00:04:11,533 Yes. 169 00:04:11,533 --> 00:04:13,733 So when somebody presents to clinic 170 00:04:13,733 --> 00:04:15,500 with a new breast cancer diagnosis, 171 00:04:15,500 --> 00:04:17,833 I usually tell them that this is a very, 172 00:04:17,833 --> 00:04:20,133 very multidisciplinary management of it 173 00:04:20,133 --> 00:04:22,533 because surgery, which as a surgeon, 174 00:04:22,533 --> 00:04:22,733 you know, 175 00:04:22,733 --> 00:04:24,300 is what I offer... Right. 176 00:04:24,300 --> 00:04:25,400 Is a huge portion 177 00:04:25,400 --> 00:04:27,000 of what we offer patients. 178 00:04:27,000 --> 00:04:29,200 But then there's also radiation 179 00:04:29,200 --> 00:04:30,800 that might be on the table, 180 00:04:30,800 --> 00:04:32,000 endocrine therapy 181 00:04:32,000 --> 00:04:34,133 might be on the table or hormone blockade 182 00:04:34,133 --> 00:04:36,000 and then sometimes chemotherapy. 183 00:04:36,000 --> 00:04:37,800 So usually it's some mix 184 00:04:37,800 --> 00:04:39,200 of those four things. 185 00:04:39,200 --> 00:04:40,200 And then we tailor 186 00:04:40,200 --> 00:04:41,400 it based on the individual needs 187 00:04:41,400 --> 00:04:42,100 of that patient 188 00:04:42,100 --> 00:04:43,733 and specific 189 00:04:43,733 --> 00:04:45,300 things that we see in their cancer. 190 00:04:45,300 --> 00:04:47,000 So we look at their receptors. 191 00:04:47,000 --> 00:04:48,133 Is this an estrogen 192 00:04:48,133 --> 00:04:49,733 positive progesterone positive, 193 00:04:49,733 --> 00:04:51,600 or a HER2 positive cancer. 194 00:04:51,600 --> 00:04:52,933 Because all of those things 195 00:04:52,933 --> 00:04:54,200 will affect our choice. 196 00:04:54,200 --> 00:04:55,400 And if they get chemo 197 00:04:55,400 --> 00:04:57,500 or if they get endocrine therapy. 198 00:04:57,500 --> 00:04:58,933 I've heard this before. 199 00:04:58,933 --> 00:05:00,433 I don't know anyone personally, 200 00:05:00,433 --> 00:05:01,833 and you don't hear about it in the news 201 00:05:01,833 --> 00:05:03,933 or anything, but true or false, 202 00:05:03,933 --> 00:05:06,766 men can also get breast cancer? True. 203 00:05:06,766 --> 00:05:08,166 Not common. 204 00:05:08,166 --> 00:05:08,633 Actually 205 00:05:08,633 --> 00:05:09,333 it accounts for less 206 00:05:09,333 --> 00:05:10,766 than 1% of breast cancers. 207 00:05:10,766 --> 00:05:12,033 But it happens. It does. 208 00:05:12,033 --> 00:05:14,733 And you do want to test 209 00:05:14,733 --> 00:05:16,833 for genetic mutations in these patients, 210 00:05:16,833 --> 00:05:18,766 because a man who presents with breast 211 00:05:18,766 --> 00:05:19,533 cancer is a little bit 212 00:05:19,533 --> 00:05:20,133 more likely to have 213 00:05:20,133 --> 00:05:21,033 something called the BRCA2 214 00:05:21,033 --> 00:05:22,033 mutation. Okay. 215 00:05:22,033 --> 00:05:23,333 So you want to check for that. 216 00:05:23,333 --> 00:05:24,733 Oh, I've heard of that, 217 00:05:24,733 --> 00:05:25,733 the BRCA, okay, yeah. 218 00:05:25,733 --> 00:05:26,133 Yeah. 219 00:05:26,133 --> 00:05:27,433 So, but these are very, 220 00:05:27,433 --> 00:05:28,933 very uncommon cases. 221 00:05:28,933 --> 00:05:29,633 But, so that's why 222 00:05:29,633 --> 00:05:30,933 you always encourage men 223 00:05:30,933 --> 00:05:32,333 that if they were to feel any changes, 224 00:05:32,333 --> 00:05:33,166 they'll present the same way 225 00:05:33,166 --> 00:05:33,633 they'll present 226 00:05:33,633 --> 00:05:34,833 with a lump in their breast. 227 00:05:34,833 --> 00:05:35,533 They could present with 228 00:05:35,533 --> 00:05:36,633 bloody nipple discharge. 229 00:05:36,633 --> 00:05:37,133 They can 230 00:05:37,133 --> 00:05:38,933 present with redness, inflammation. 231 00:05:38,933 --> 00:05:40,833 So anything that seems alarming to them, 232 00:05:40,833 --> 00:05:42,033 they should really present 233 00:05:42,033 --> 00:05:43,133 and get a mammogram. 234 00:05:43,133 --> 00:05:44,133 And then it's the same thing 235 00:05:44,133 --> 00:05:45,133 that you would do for a woman. 236 00:05:45,133 --> 00:05:46,233 They're still, 237 00:05:46,233 --> 00:05:46,833 in the past 238 00:05:46,833 --> 00:05:48,633 they used to do mastectomies for them for 239 00:05:48,633 --> 00:05:50,366 you know, any, any 240 00:05:50,366 --> 00:05:50,733 you know, 241 00:05:50,733 --> 00:05:51,966 somebody who comes off the street 242 00:05:51,966 --> 00:05:53,433 with a new breast cancer 243 00:05:53,433 --> 00:05:55,233 in a male would get a mastectomy. 244 00:05:55,233 --> 00:05:56,133 Now, we recognize 245 00:05:56,133 --> 00:05:56,933 that you can actually treat 246 00:05:56,933 --> 00:05:58,033 these patients with lumpectomy 247 00:05:58,033 --> 00:05:59,166 and radiation as well. 248 00:05:59,166 --> 00:06:00,166 Oh, wow. 249 00:06:00,166 --> 00:06:00,933 And I would think 250 00:06:00,933 --> 00:06:02,333 if for as uncommon as it is, 251 00:06:02,333 --> 00:06:03,933 it would actually be easier to tell 252 00:06:03,933 --> 00:06:05,133 because you're just dealing 253 00:06:05,133 --> 00:06:07,433 with less surface area with changes. 254 00:06:07,433 --> 00:06:07,733 Yeah. 255 00:06:07,733 --> 00:06:08,733 So more often than not, 256 00:06:08,733 --> 00:06:10,366 you can palpate their masses 257 00:06:10,366 --> 00:06:11,133 when they come in. 258 00:06:11,133 --> 00:06:12,433 These aren't ones that are detected 259 00:06:12,433 --> 00:06:14,133 with screening mammograms 260 00:06:14,133 --> 00:06:15,133 like you're seeing with women, 261 00:06:15,133 --> 00:06:16,133 because there's still 262 00:06:16,133 --> 00:06:17,933 there's not enough, 263 00:06:17,933 --> 00:06:20,366 patients who have male breast cancer 264 00:06:20,366 --> 00:06:21,833 to warrant doing a mammogram 265 00:06:21,833 --> 00:06:22,633 screening yearly. 266 00:06:22,633 --> 00:06:26,033 And by the way, I know I'm, I'm speaking 267 00:06:26,333 --> 00:06:28,333 just from my own experience, 268 00:06:28,333 --> 00:06:30,033 but I have heard, 269 00:06:30,033 --> 00:06:30,233 you know, 270 00:06:30,233 --> 00:06:30,933 growing up, 271 00:06:30,933 --> 00:06:32,766 just horror stories of how horrible 272 00:06:32,766 --> 00:06:34,633 and how painful mammograms are. 273 00:06:34,633 --> 00:06:36,533 They are not a big deal. 274 00:06:36,533 --> 00:06:38,166 Now, apologies to anyone 275 00:06:38,166 --> 00:06:39,133 who's not experiencing 276 00:06:39,133 --> 00:06:40,333 what I'm experiencing, 277 00:06:40,333 --> 00:06:41,133 but I'm just like, 278 00:06:41,133 --> 00:06:42,166 yeah, like it's 279 00:06:42,166 --> 00:06:42,933 not like a trick 280 00:06:42,933 --> 00:06:44,533 when like the doctor, the dentist is like, 281 00:06:44,533 --> 00:06:45,633 you're going to feel a little pressure 282 00:06:45,633 --> 00:06:45,933 and like, 283 00:06:45,933 --> 00:06:47,133 rips your gums open. 284 00:06:47,133 --> 00:06:48,966 You feel some pressure 285 00:06:48,966 --> 00:06:50,633 and then you move on. 286 00:06:50,633 --> 00:06:51,633 Yeah. It's not... 287 00:06:51,633 --> 00:06:52,333 I just feel like 288 00:06:52,333 --> 00:06:53,233 I don't want anybody 289 00:06:53,233 --> 00:06:54,633 to be too intimidated to 290 00:06:54,633 --> 00:06:55,566 have a mammogram, 291 00:06:55,566 --> 00:06:57,566 because it is just, in my experience, 292 00:06:57,566 --> 00:06:59,033 it is just not that bad. 293 00:06:59,033 --> 00:06:59,566 I agree 294 00:06:59,566 --> 00:07:00,733 they're not comfortable 295 00:07:00,733 --> 00:07:01,633 and I never tell anybody 296 00:07:01,633 --> 00:07:03,133 you're going to be comfortable, 297 00:07:03,133 --> 00:07:04,766 but it's over quickly 298 00:07:04,766 --> 00:07:07,033 and it can save your life. Yeah. 299 00:07:07,033 --> 00:07:08,233 And I think the other thing 300 00:07:08,233 --> 00:07:09,533 that people will often come 301 00:07:09,533 --> 00:07:10,166 concerned about 302 00:07:10,166 --> 00:07:11,566 is how much radiation exposure 303 00:07:11,566 --> 00:07:12,433 they're going to get. 304 00:07:12,433 --> 00:07:13,966 It's basically the equivalent 305 00:07:13,966 --> 00:07:15,833 of flying across the country 306 00:07:15,833 --> 00:07:16,433 on an airplane. 307 00:07:16,433 --> 00:07:17,066 Oh, I never actually 308 00:07:17,066 --> 00:07:18,333 So it's like a round-trip 309 00:07:18,333 --> 00:07:19,133 across the country. I never actually thought about that. 310 00:07:19,133 --> 00:07:20,566 So it's the same amount of radiation 311 00:07:20,566 --> 00:07:21,633 as doing that. Yeah. 312 00:07:21,633 --> 00:07:23,333 So that worry 313 00:07:23,333 --> 00:07:24,766 that this radiation exposure 314 00:07:24,766 --> 00:07:26,566 is going to be bad for you long term... 315 00:07:26,566 --> 00:07:27,866 You'll get one business 316 00:07:27,866 --> 00:07:30,833 trip of radiation. Yeah. Okay. Got it. 317 00:07:30,833 --> 00:07:32,533 Put it in terms we can all understand. 318 00:07:32,533 --> 00:07:32,833 Yeah. 319 00:07:32,833 --> 00:07:34,766 So when you first see a patient 320 00:07:34,766 --> 00:07:36,366 who's been diagnosed with breast cancer, 321 00:07:36,366 --> 00:07:38,133 how do you prepare them 322 00:07:38,133 --> 00:07:39,133 for what they're about to face? 323 00:07:39,133 --> 00:07:41,133 Because I imagine they're very scared. 324 00:07:41,133 --> 00:07:41,866 They, you know, 325 00:07:41,866 --> 00:07:42,833 the unknown 326 00:07:42,833 --> 00:07:45,133 is the most scary to most of us. 327 00:07:45,133 --> 00:07:47,233 So how do you, 328 00:07:47,233 --> 00:07:48,933 how do you emotionally 329 00:07:48,933 --> 00:07:50,166 and psychologically 330 00:07:50,166 --> 00:07:51,733 prepare them for what's to come? 331 00:07:51,733 --> 00:07:52,633 Yeah, 332 00:07:52,633 --> 00:07:54,233 it's tough because it is really, 333 00:07:54,233 --> 00:07:55,433 really vulnerable time. 334 00:07:55,433 --> 00:07:56,766 And I'm sure it's very different 335 00:07:56,766 --> 00:07:57,633 for every person. 336 00:07:57,633 --> 00:07:59,233 So there isn't just a one size fits all. 337 00:07:59,233 --> 00:08:00,133 Absolutely. 338 00:08:00,133 --> 00:08:01,833 But I try to contextualize it. 339 00:08:01,833 --> 00:08:05,133 I try to emphasize that this is a disease 340 00:08:05,133 --> 00:08:07,033 that is incredibly survivable. 341 00:08:07,033 --> 00:08:10,233 We're talking 97, 98%, five, 342 00:08:10,233 --> 00:08:11,833 ten-year survival for patients 343 00:08:11,833 --> 00:08:13,533 with early-stage breast cancer. 344 00:08:13,533 --> 00:08:14,233 You know, drops 345 00:08:14,233 --> 00:08:14,633 a little bit 346 00:08:14,633 --> 00:08:15,766 if you've got metastasized 347 00:08:15,766 --> 00:08:16,533 to the lymph nodes. 348 00:08:16,533 --> 00:08:18,166 But metastasis to the lymph nodes, 349 00:08:18,166 --> 00:08:19,633 even in that case, 350 00:08:19,633 --> 00:08:21,833 it's still at 87%, 351 00:08:21,833 --> 00:08:23,366 you know, relative survival. 352 00:08:23,366 --> 00:08:24,233 So it's really 353 00:08:24,233 --> 00:08:26,633 you're not seeing low numbers in survival 354 00:08:26,633 --> 00:08:27,566 until you start hitting 355 00:08:27,566 --> 00:08:29,033 the distant metastases. 356 00:08:29,033 --> 00:08:30,566 And what 357 00:08:30,566 --> 00:08:31,733 just for us lay people 358 00:08:31,733 --> 00:08:33,333 like when it says stage one, stage two. 359 00:08:33,333 --> 00:08:34,966 What, what stage would you say 360 00:08:34,966 --> 00:08:37,133 is when the number... 361 00:08:37,133 --> 00:08:38,766 where it starts to fall off? Stage four. 362 00:08:38,766 --> 00:08:40,233 So when you start seeing that 363 00:08:40,233 --> 00:08:41,733 the cancer's spread to bone 364 00:08:41,733 --> 00:08:43,933 to liver, to brain, to lungs, whatever... 365 00:08:43,933 --> 00:08:45,533 And that's what stage four means. Correct. It's spread. 366 00:08:45,533 --> 00:08:46,733 It's spread, and spread 367 00:08:46,733 --> 00:08:47,733 not just to 368 00:08:47,733 --> 00:08:49,033 the lymph nodes in the axilla, 369 00:08:49,033 --> 00:08:50,533 but elsewhere in the body. 370 00:08:50,533 --> 00:08:51,033 Okay. 371 00:08:51,033 --> 00:08:53,166 But even those patients can actually 372 00:08:53,166 --> 00:08:54,133 be controlled. 373 00:08:54,133 --> 00:08:55,233 What we say 374 00:08:55,233 --> 00:08:56,633 when they first walk through the door 375 00:08:56,633 --> 00:08:57,966 and they have basically stage 376 00:08:57,966 --> 00:08:59,133 one through three, 377 00:08:59,133 --> 00:09:01,033 it is still curable at that point. 378 00:09:01,033 --> 00:09:02,833 You can rid that patient of the cancer, 379 00:09:02,833 --> 00:09:03,433 which is another thing 380 00:09:03,433 --> 00:09:05,333 I like to focus on for patients, 381 00:09:05,333 --> 00:09:06,633 is to let them know 382 00:09:06,633 --> 00:09:07,766 this is a problem, 383 00:09:07,766 --> 00:09:09,433 but this is a treatable problem. 384 00:09:09,433 --> 00:09:11,433 And, you know, 385 00:09:11,433 --> 00:09:12,433 for most patients 386 00:09:12,433 --> 00:09:14,133 in not more than a year, 387 00:09:14,133 --> 00:09:15,033 you're going to be done with this. 388 00:09:15,033 --> 00:09:16,633 And this is going to be a bad memory. 389 00:09:16,633 --> 00:09:18,033 Right. 390 00:09:18,033 --> 00:09:20,233 With stage four, it's more about 391 00:09:20,233 --> 00:09:21,633 we can control this now. 392 00:09:21,633 --> 00:09:23,333 We can control this with treatment. 393 00:09:23,333 --> 00:09:24,133 But you're now living 394 00:09:24,133 --> 00:09:25,833 with a chronic disease. Okay. 395 00:09:25,833 --> 00:09:26,633 And a disease 396 00:09:26,633 --> 00:09:28,433 that may kill you in the long term, 397 00:09:28,433 --> 00:09:30,933 but is, is still pretty controllable. 398 00:09:30,933 --> 00:09:32,633 And we've seen people 10 years out 399 00:09:32,633 --> 00:09:33,533 with stage four 400 00:09:33,533 --> 00:09:34,133 that are still... 401 00:09:34,133 --> 00:09:35,433 That are living with stage four. Yeah. 402 00:09:35,433 --> 00:09:38,033 That's so interesting because, you know, 403 00:09:38,033 --> 00:09:39,333 most of us don't understand 404 00:09:39,333 --> 00:09:41,166 what each stage represents. 405 00:09:41,166 --> 00:09:42,733 And to know that, 406 00:09:42,733 --> 00:09:44,366 you know, up to stage three, 407 00:09:44,366 --> 00:09:46,366 this means it's still contained... 408 00:09:46,366 --> 00:09:48,133 For the most part. Yeah. Okay. 409 00:09:48,133 --> 00:09:50,333 And then, do we 410 00:09:50,333 --> 00:09:52,166 and like you said, it can be cured. 411 00:09:52,166 --> 00:09:54,133 You're not just living in remission. 412 00:09:54,133 --> 00:09:55,733 You're cured. You're cured. 413 00:09:55,733 --> 00:09:56,933 So when we say remission 414 00:09:56,933 --> 00:09:59,933 and cure, it's, they're synonymous. Remission, 415 00:10:00,233 --> 00:10:01,733 for all intents and purposes, 416 00:10:01,733 --> 00:10:03,033 you have no residual disease. 417 00:10:03,033 --> 00:10:03,933 There's no evidence 418 00:10:03,933 --> 00:10:04,966 that you have anything in your 419 00:10:04,966 --> 00:10:06,166 body. I see. Remission always 420 00:10:06,166 --> 00:10:06,933 seems like something's 421 00:10:06,933 --> 00:10:08,533 lurking in the corner. 422 00:10:08,533 --> 00:10:10,333 Cure is a much better word, right? Yes. 423 00:10:10,333 --> 00:10:12,166 That's why I prefer to use the word cure. 424 00:10:12,166 --> 00:10:14,033 Because I think, you know, 425 00:10:14,033 --> 00:10:14,933 if there's a cell 426 00:10:14,933 --> 00:10:16,333 floating around somewhere... 427 00:10:16,333 --> 00:10:18,533 Yeah. And it's not causing any problems, 428 00:10:18,533 --> 00:10:19,833 you're still, 429 00:10:19,833 --> 00:10:20,333 you're cured. 430 00:10:20,333 --> 00:10:20,533 Yeah. 431 00:10:20,533 --> 00:10:21,233 There's nothing there. 432 00:10:21,233 --> 00:10:22,733 That makes perfect sense. 433 00:10:22,733 --> 00:10:23,833 So what should a patient 434 00:10:23,833 --> 00:10:24,633 know when weighing 435 00:10:24,633 --> 00:10:25,566 whether to have 436 00:10:25,566 --> 00:10:28,433 a breast-conserving lumpectomy, 437 00:10:28,433 --> 00:10:30,033 a full mastectomy? 438 00:10:30,966 --> 00:10:33,166 I, at this age, I 439 00:10:33,166 --> 00:10:34,633 now know several women who... 440 00:10:34,633 --> 00:10:36,366 Now it's a little bit funny. 441 00:10:36,366 --> 00:10:37,333 They said, well, 442 00:10:37,333 --> 00:10:39,233 you know, the bright side is, 443 00:10:39,233 --> 00:10:39,433 you know, 444 00:10:39,433 --> 00:10:40,433 I had a mastectomy, 445 00:10:40,433 --> 00:10:41,566 but I got implants 446 00:10:41,566 --> 00:10:43,533 and I got to pick my size. Yes. 447 00:10:43,533 --> 00:10:44,833 Yeah. Thought that was pretty funny. 448 00:10:44,833 --> 00:10:46,433 So how do you decide? 449 00:10:46,433 --> 00:10:48,133 It's a very personal decision. 450 00:10:48,133 --> 00:10:48,533 And this is, 451 00:10:48,533 --> 00:10:51,533 I think, another area where breast 452 00:10:51,733 --> 00:10:54,333 surgery... or we've just come a long way 453 00:10:54,333 --> 00:10:56,033 because I think medicine 454 00:10:56,033 --> 00:10:56,433 used to be 455 00:10:56,433 --> 00:10:58,566 a lot more paternalistic in the past. 456 00:10:58,566 --> 00:11:00,833 And now there's a lot more teamwork 457 00:11:00,833 --> 00:11:02,733 involved in decision making and care. 458 00:11:02,733 --> 00:11:05,566 After all, it's your body, your choice. 459 00:11:05,566 --> 00:11:06,533 We're not going to do anything 460 00:11:06,533 --> 00:11:09,333 that you're not on board with. 461 00:11:09,333 --> 00:11:10,233 So I say this is, it's 462 00:11:10,233 --> 00:11:11,433 a very personal decision 463 00:11:11,433 --> 00:11:12,333 because patients will 464 00:11:12,333 --> 00:11:13,133 sometimes come in 465 00:11:13,133 --> 00:11:15,633 with preconceived notions of, 466 00:11:15,633 --> 00:11:16,733 I want to just completely 467 00:11:16,733 --> 00:11:17,533 remove my breast, 468 00:11:17,533 --> 00:11:18,633 or I absolutely 469 00:11:18,633 --> 00:11:20,033 do not want to remove my breast. 470 00:11:20,033 --> 00:11:21,133 Please do the least amount 471 00:11:21,133 --> 00:11:22,566 of surgery as possible. 472 00:11:22,566 --> 00:11:23,733 And you can usually work 473 00:11:23,733 --> 00:11:25,133 with both options. 474 00:11:26,333 --> 00:11:26,933 There are 475 00:11:26,933 --> 00:11:27,933 some scenarios 476 00:11:27,933 --> 00:11:29,833 where mastectomy is necessary, 477 00:11:29,833 --> 00:11:30,733 and usually I'll tell 478 00:11:30,733 --> 00:11:31,633 patients it's, 479 00:11:31,633 --> 00:11:33,566 if there is a very high tumor- 480 00:11:33,566 --> 00:11:34,733 to-breast ratio, 481 00:11:34,733 --> 00:11:37,033 meaning this tumor is really large 482 00:11:37,033 --> 00:11:38,833 for the size of your breast, 483 00:11:38,833 --> 00:11:40,366 a lumpectomy is not so much 484 00:11:40,366 --> 00:11:41,433 on the table anymore, 485 00:11:41,433 --> 00:11:42,833 because you're just not going to be 486 00:11:42,833 --> 00:11:43,433 able to. 487 00:11:43,433 --> 00:11:44,566 There's not going to be enough 488 00:11:44,566 --> 00:11:45,933 not, non-diseased 489 00:11:45,933 --> 00:11:47,933 tissue left over to have a breast. Sure. 490 00:11:47,933 --> 00:11:49,433 And so that's where 491 00:11:49,433 --> 00:11:51,133 your hands are a little bit more tied 492 00:11:51,133 --> 00:11:52,033 in terms of what to do. 493 00:11:52,033 --> 00:11:53,833 But outside of that, it's 494 00:11:53,833 --> 00:11:55,933 very much about patient preference. Wow. 495 00:11:55,933 --> 00:11:56,433 And so, 496 00:11:56,433 --> 00:11:57,733 but I'll explain to patients 497 00:11:57,733 --> 00:12:01,033 that a lumpectomy followed by radiation 498 00:12:01,033 --> 00:12:03,233 has the same recurrence risk 499 00:12:03,233 --> 00:12:04,533 as a mastectomy. 500 00:12:04,533 --> 00:12:06,733 Oh. But if you're not willing 501 00:12:06,733 --> 00:12:09,733 to go, undergo radiation post-op 502 00:12:09,766 --> 00:12:11,433 then that plays... Mastectomy is a better option. 503 00:12:11,433 --> 00:12:12,566 Then maybe a mastectomy 504 00:12:12,566 --> 00:12:13,966 is a better option for you to decrease 505 00:12:13,966 --> 00:12:15,433 your local recurrence rate. 506 00:12:15,433 --> 00:12:17,166 But, but yeah, what's nice is 507 00:12:17,166 --> 00:12:18,966 they have the same recurrence rate. 508 00:12:18,966 --> 00:12:20,833 So a lot of patients 509 00:12:20,833 --> 00:12:23,833 will choose to do lumpectomy because 510 00:12:23,933 --> 00:12:25,033 easier recovery, 511 00:12:26,233 --> 00:12:28,733 less surgery, less pain. 512 00:12:28,733 --> 00:12:30,533 So it's it's a little bit 513 00:12:30,533 --> 00:12:31,133 a little bit easier 514 00:12:31,133 --> 00:12:32,966 to have the same ultimate outcome. 515 00:12:32,966 --> 00:12:35,833 I have what I am going to get out 516 00:12:35,833 --> 00:12:36,333 in front of 517 00:12:36,333 --> 00:12:39,433 and say is a very stupid question. 518 00:12:39,633 --> 00:12:40,233 No such thing. 519 00:12:40,233 --> 00:12:43,166 Oh, challenge accepted. 520 00:12:43,166 --> 00:12:43,566 Okay. 521 00:12:43,566 --> 00:12:46,633 So I truly don't know 522 00:12:46,633 --> 00:12:47,133 the difference 523 00:12:47,133 --> 00:12:49,233 between chemotherapy and radiation. 524 00:12:49,233 --> 00:12:50,733 What is the difference? 525 00:12:50,733 --> 00:12:51,166 Of course. 526 00:12:51,166 --> 00:12:54,333 So chemotherapy is a systemic treatment 527 00:12:54,333 --> 00:12:56,033 that we give for breast cancer 528 00:12:56,033 --> 00:12:58,033 or really any other type of cancer. 529 00:12:58,033 --> 00:12:59,933 The radiation that we talk about 530 00:12:59,933 --> 00:13:00,833 when we talk about radiation 531 00:13:00,833 --> 00:13:02,966 in breast cancer is a local therapy. 532 00:13:02,966 --> 00:13:03,366 Okay. 533 00:13:03,366 --> 00:13:04,133 So when you think 534 00:13:04,133 --> 00:13:05,233 about the different things 535 00:13:05,233 --> 00:13:06,333 that we offer patients 536 00:13:06,333 --> 00:13:06,966 who walk in the door 537 00:13:06,966 --> 00:13:07,833 with a breast cancer, 538 00:13:07,833 --> 00:13:09,633 of the four main things that we do –– 539 00:13:09,633 --> 00:13:11,133 surgery, radiation, 540 00:13:11,133 --> 00:13:13,733 chemotherapy and endocrine therapy... Okay. 541 00:13:13,733 --> 00:13:15,033 Surgery and radiation 542 00:13:15,033 --> 00:13:16,333 are local therapies. 543 00:13:16,333 --> 00:13:16,766 They are to 544 00:13:16,766 --> 00:13:19,166 prevent the... They're there to treat the cancer 545 00:13:19,166 --> 00:13:20,633 and prevent it from coming back 546 00:13:20,633 --> 00:13:23,333 in that spot in the breast. Okay. Okay? 547 00:13:23,333 --> 00:13:25,233 And then the 548 00:13:25,233 --> 00:13:26,233 endocrine therapy 549 00:13:26,233 --> 00:13:27,333 and the chemotherapy 550 00:13:27,333 --> 00:13:28,833 are systemic treatments. Whole body... 551 00:13:28,833 --> 00:13:30,833 Endocrine therapy is a pill that you take 552 00:13:30,833 --> 00:13:31,933 and that blocks hormones. 553 00:13:31,933 --> 00:13:32,833 So if you had a hormone 554 00:13:32,833 --> 00:13:33,966 positive breast cancer 555 00:13:33,966 --> 00:13:35,133 it decreases the chance 556 00:13:35,133 --> 00:13:36,366 that that tries to come back. 557 00:13:36,366 --> 00:13:37,733 But it's treating the whole body. 558 00:13:37,733 --> 00:13:38,333 I see. 559 00:13:38,333 --> 00:13:41,166 Chemotherapy is treating the whole body 560 00:13:41,166 --> 00:13:43,966 for, whether it's targeted or... Thank you. 561 00:13:45,133 --> 00:13:46,033 Oh I can, 562 00:13:46,033 --> 00:13:47,133 I can finally be free 563 00:13:47,133 --> 00:13:48,633 of not knowing the answer to that. 564 00:13:48,633 --> 00:13:50,333 That really does help a lot. Yeah. 565 00:13:50,333 --> 00:13:51,233 So we talked about 566 00:13:51,233 --> 00:13:52,333 you know, obviously 567 00:13:52,333 --> 00:13:54,333 the progress we've made from the 1800s, 568 00:13:54,333 --> 00:13:54,733 but what 569 00:13:54,733 --> 00:13:55,933 new surgical procedures 570 00:13:55,933 --> 00:13:57,233 and techniques are available 571 00:13:57,233 --> 00:13:58,766 now that maybe weren't available before, 572 00:13:58,766 --> 00:14:01,433 and do we offer them here at UCI? 573 00:14:01,433 --> 00:14:03,933 So, so I think a lot has, has changed. 574 00:14:03,933 --> 00:14:04,766 Now we offer 575 00:14:04,766 --> 00:14:05,933 things called targeted 576 00:14:05,933 --> 00:14:07,033 axillary dissections 577 00:14:07,033 --> 00:14:08,166 where if somebody presents 578 00:14:08,166 --> 00:14:09,766 with positive lymph nodes, 579 00:14:09,766 --> 00:14:10,433 when they, 580 00:14:10,433 --> 00:14:11,633 when they first present, 581 00:14:11,633 --> 00:14:13,633 we'll clip the node that was positive. 582 00:14:13,633 --> 00:14:15,366 And then after they receive 583 00:14:15,366 --> 00:14:16,933 neoadjuvant chemotherapy 584 00:14:16,933 --> 00:14:19,333 during surgery, we'll remove that node. 585 00:14:19,333 --> 00:14:20,533 So we've had it marked. 586 00:14:20,533 --> 00:14:22,533 We send it to pathology at that time. 587 00:14:22,533 --> 00:14:23,833 Have them look at it. 588 00:14:23,833 --> 00:14:25,633 And if, when they look at it 589 00:14:25,633 --> 00:14:27,333 there's no cancer left behind, 590 00:14:27,333 --> 00:14:28,333 we spare that patient 591 00:14:28,333 --> 00:14:30,633 an axillary dissection. They're done. 592 00:14:30,633 --> 00:14:31,233 Wow. Whereas before 593 00:14:31,233 --> 00:14:32,833 if they presented with lymph nodes 594 00:14:32,833 --> 00:14:34,766 that were positive at the get-go, 595 00:14:34,766 --> 00:14:35,833 they were pretty committed 596 00:14:35,833 --> 00:14:37,566 to an axillary dissection. 597 00:14:37,566 --> 00:14:39,133 So that's... How new is this? 598 00:14:39,133 --> 00:14:40,333 This has probably been 599 00:14:40,333 --> 00:14:42,166 maybe the last 10 years or so. 600 00:14:42,166 --> 00:14:43,966 Oh wow. Yeah, it's, it is, it is 601 00:14:45,133 --> 00:14:48,633 not really super, super new or super old. 602 00:14:48,733 --> 00:14:50,366 That's very interesting. Yeah. 603 00:14:50,366 --> 00:14:51,666 So I've read that lymphedema 604 00:14:51,666 --> 00:14:52,666 is a side effect 605 00:14:52,666 --> 00:14:53,566 for many breast cancer 606 00:14:53,566 --> 00:14:55,266 patients after surgery. 607 00:14:55,266 --> 00:14:57,466 So what is that? How do we treat it? 608 00:14:57,466 --> 00:14:58,666 What do we do about that? 609 00:14:58,666 --> 00:15:00,066 Yeah. Good question. 610 00:15:00,066 --> 00:15:02,600 So lymphedema we'll see... 611 00:15:02,600 --> 00:15:04,266 You have about a 20 to 30% 612 00:15:04,266 --> 00:15:05,600 risk of getting lymphedema 613 00:15:05,600 --> 00:15:07,366 if you're doing an axillary dissection. 614 00:15:07,366 --> 00:15:07,666 Okay. 615 00:15:07,666 --> 00:15:09,000 If you're just doing a sentinel lymph 616 00:15:09,000 --> 00:15:09,566 node biopsy, 617 00:15:09,566 --> 00:15:10,200 which is what we're doing 618 00:15:10,200 --> 00:15:11,466 the vast majority of the time, 619 00:15:11,466 --> 00:15:12,566 your risk is like somewhere 620 00:15:12,566 --> 00:15:13,666 between 5 to 10%. 621 00:15:13,666 --> 00:15:15,266 So very low risk for just an 622 00:15:15,266 --> 00:15:16,400 axillary sentinel node. 623 00:15:16,400 --> 00:15:18,766 But that's part of why we're so excited 624 00:15:18,766 --> 00:15:19,866 in the breast community 625 00:15:19,866 --> 00:15:20,366 that we're 626 00:15:20,366 --> 00:15:21,766 kind of like trying to de-escalate 627 00:15:21,766 --> 00:15:23,566 how much we're going in the X-ray, 628 00:15:23,566 --> 00:15:26,366 because even a small axillary dissection, 629 00:15:26,366 --> 00:15:27,966 it's not without risk. 630 00:15:27,966 --> 00:15:28,166 Right? 631 00:15:28,166 --> 00:15:30,366 Everything. But axillary dissection, 632 00:15:30,366 --> 00:15:30,866 more risk. 633 00:15:30,866 --> 00:15:31,800 So you've got about a 20 634 00:15:31,800 --> 00:15:33,266 to 30% risk of lymphedema. 635 00:15:33,266 --> 00:15:34,466 And what that is, 636 00:15:34,466 --> 00:15:35,666 or the way that it presents is 637 00:15:35,666 --> 00:15:37,966 you'll get swelling in that arm. 638 00:15:37,966 --> 00:15:39,066 So if you've ever seen somebody 639 00:15:39,066 --> 00:15:39,766 that has a 640 00:15:39,766 --> 00:15:40,766 large arm on one side 641 00:15:40,766 --> 00:15:41,566 compared to the other, 642 00:15:41,566 --> 00:15:43,666 that's often lymphedema. 643 00:15:43,666 --> 00:15:45,666 And so slightly more prone to infection, 644 00:15:45,666 --> 00:15:47,066 if they get little nicks. 645 00:15:47,066 --> 00:15:48,066 Wouldn't be able to get blood 646 00:15:48,066 --> 00:15:49,966 draws from that arm. Does it stay that way? 647 00:15:49,966 --> 00:15:51,000 Yes, it can. 648 00:15:51,000 --> 00:15:52,466 Some, some cases are permanent. 649 00:15:52,466 --> 00:15:55,166 Some cases will improve with time. Okay. 650 00:15:55,166 --> 00:15:57,866 And that, but it can be, 651 00:15:57,866 --> 00:15:59,866 you can decrease the risk for that. 652 00:15:59,866 --> 00:16:00,366 Number one, 653 00:16:00,366 --> 00:16:01,266 if you're doing a targeted 654 00:16:01,266 --> 00:16:02,266 axillary dissection 655 00:16:02,266 --> 00:16:03,666 and not doing a complete axillary 656 00:16:03,666 --> 00:16:03,966 dissection, 657 00:16:03,966 --> 00:16:05,400 that's the best thing you can do. Okay. 658 00:16:05,400 --> 00:16:06,266 But for patients 659 00:16:06,266 --> 00:16:08,366 who do need an axillary dissection here 660 00:16:08,366 --> 00:16:09,000 at UCI, 661 00:16:09,000 --> 00:16:11,000 we offer a lymphoid venous bypass. 662 00:16:11,000 --> 00:16:11,566 And that's 663 00:16:11,566 --> 00:16:13,266 where the plastic surgeon comes in. 664 00:16:13,266 --> 00:16:14,666 And they'll connect 665 00:16:14,666 --> 00:16:16,966 these lymphatic channels with the vein. 666 00:16:16,966 --> 00:16:18,566 And then that reduces that risk 667 00:16:18,566 --> 00:16:19,500 that you have of 20 668 00:16:19,500 --> 00:16:22,566 to 30% down to more like 5 to 10% back. 669 00:16:22,566 --> 00:16:22,800 Like it 670 00:16:22,800 --> 00:16:23,266 kind of brings 671 00:16:23,266 --> 00:16:25,666 you down to the risk of a sentinel biopsy. 672 00:16:25,666 --> 00:16:26,366 Oh, that's amazing. So it's huge 673 00:16:26,366 --> 00:16:28,966 and it's super great for patients 674 00:16:28,966 --> 00:16:30,000 because it can take 675 00:16:30,000 --> 00:16:30,966 what's one of the most 676 00:16:30,966 --> 00:16:34,666 feared complications of breast surgery 677 00:16:34,666 --> 00:16:36,366 in general and kind of make it 678 00:16:36,366 --> 00:16:38,966 almost negligible, which is awesome. Wow. 679 00:16:38,966 --> 00:16:40,166 But it's not offered everywhere. 680 00:16:40,166 --> 00:16:41,366 So it's one of the things where it's 681 00:16:41,366 --> 00:16:43,166 nice to be at an academic center 682 00:16:43,166 --> 00:16:45,166 where you have plastic surgeons 683 00:16:45,166 --> 00:16:46,666 who can, who can offer that. 684 00:16:46,666 --> 00:16:47,766 That's very good to know. 685 00:16:47,766 --> 00:16:49,400 So if somebody goes to their doctor 686 00:16:49,400 --> 00:16:50,366 and says, this is what I want, 687 00:16:50,366 --> 00:16:50,666 and they're like, 688 00:16:50,666 --> 00:16:51,600 we don't know what you're talking about, 689 00:16:51,600 --> 00:16:53,466 or we don't offer that, that's that 690 00:16:53,466 --> 00:16:55,966 this is not just universally done. 691 00:16:55,966 --> 00:16:57,366 Correct. Okay. 692 00:16:57,366 --> 00:16:58,766 That's, that's great to know. 693 00:16:58,766 --> 00:17:01,233 And during your training 694 00:17:01,233 --> 00:17:03,533 or maybe when you were a newer surgeon, 695 00:17:03,533 --> 00:17:05,533 were they like, okay, we got this thing. 696 00:17:05,533 --> 00:17:06,933 Like, is this something that you kind of 697 00:17:06,933 --> 00:17:09,133 had to learn about lifetime? Yes, I did. 698 00:17:09,133 --> 00:17:10,133 And so it was also 699 00:17:10,133 --> 00:17:11,033 another interesting thing. 700 00:17:11,033 --> 00:17:11,533 I remember 701 00:17:11,533 --> 00:17:12,833 at the beginning of my training, 702 00:17:12,833 --> 00:17:15,833 there had been, so I think it was 703 00:17:16,133 --> 00:17:18,366 in the 2010s, early 2010s, 704 00:17:18,366 --> 00:17:19,433 Z11 came out 705 00:17:19,433 --> 00:17:20,566 and that was a big deal 706 00:17:20,566 --> 00:17:21,966 for early-stage breast cancer. 707 00:17:21,966 --> 00:17:23,733 And it was all with lumpectomies 708 00:17:23,733 --> 00:17:24,533 and looking at 709 00:17:24,533 --> 00:17:25,833 whether or not those patients 710 00:17:25,833 --> 00:17:26,833 needed axillary dissection. 711 00:17:26,833 --> 00:17:28,233 So it was basically decreasing the, 712 00:17:28,233 --> 00:17:30,333 the need for that. 713 00:17:30,333 --> 00:17:33,033 But patients who had had mastectomies 714 00:17:33,033 --> 00:17:34,233 didn't fall into that. 715 00:17:34,233 --> 00:17:35,833 So what we were doing 716 00:17:35,833 --> 00:17:37,166 when I was first starting 717 00:17:37,166 --> 00:17:38,733 residency, was we were sending 718 00:17:38,733 --> 00:17:40,733 frozen sections of people's lymph nodes 719 00:17:40,733 --> 00:17:41,966 that were getting mastectomies, 720 00:17:41,966 --> 00:17:43,933 and if a lymph node was positive 721 00:17:43,933 --> 00:17:44,433 in the OR, 722 00:17:44,433 --> 00:17:45,833 you were doing the axillary dissection then. 723 00:17:45,833 --> 00:17:47,633 Then then we had AMAROS, 724 00:17:47,633 --> 00:17:48,966 which is with this other study 725 00:17:48,966 --> 00:17:51,033 that showed that these patients, 726 00:17:51,033 --> 00:17:52,766 as long as they had less than three 727 00:17:52,766 --> 00:17:53,766 lymph nodes that were positive, 728 00:17:53,766 --> 00:17:55,033 they didn't need a completion 729 00:17:55,033 --> 00:17:56,633 axillary dissection. 730 00:17:56,633 --> 00:17:58,933 And so we were able to expand 731 00:17:58,933 --> 00:18:00,033 the population 732 00:18:00,033 --> 00:18:01,333 that did not need 733 00:18:01,333 --> 00:18:03,233 extra surgery in their axilla. 734 00:18:03,233 --> 00:18:03,966 And that was just something 735 00:18:03,966 --> 00:18:05,533 that I saw in real time. 736 00:18:05,533 --> 00:18:07,066 And were you were, 737 00:18:07,066 --> 00:18:08,233 did you trust it right away 738 00:18:08,233 --> 00:18:09,033 or were you like, 739 00:18:09,033 --> 00:18:11,166 I don't know, we have our ways? Yeah. 740 00:18:11,166 --> 00:18:13,166 So I think everything takes a minute 741 00:18:13,166 --> 00:18:14,233 for people to get buy-in. 742 00:18:14,233 --> 00:18:14,833 And right now, 743 00:18:14,833 --> 00:18:15,933 the thing that we're kind of 744 00:18:15,933 --> 00:18:17,233 seeing slowly 745 00:18:17,233 --> 00:18:19,233 get the buy-in from practitioners 746 00:18:19,233 --> 00:18:20,233 is this whole idea 747 00:18:20,233 --> 00:18:20,833 that maybe you don't 748 00:18:20,833 --> 00:18:21,733 really need to sample 749 00:18:21,733 --> 00:18:23,333 the lymph nodes all the time. That is amazing. 750 00:18:23,333 --> 00:18:24,933 So it's a niche group, right? 751 00:18:24,933 --> 00:18:26,633 It's only these early-stage 752 00:18:26,633 --> 00:18:27,766 hormone-positive. 753 00:18:27,766 --> 00:18:29,066 Most people would not be comfortable 754 00:18:29,066 --> 00:18:31,233 offering it in premenopausal patients. 755 00:18:31,233 --> 00:18:33,333 So it's really the postmenopausal group. 756 00:18:33,333 --> 00:18:34,433 So and that's a, 757 00:18:34,433 --> 00:18:35,633 that's what I mean by it's 758 00:18:35,633 --> 00:18:37,833 so now. it's so bespoke 759 00:18:37,833 --> 00:18:38,433 as opposed to like 760 00:18:38,433 --> 00:18:39,533 let's just chop you in half 761 00:18:39,533 --> 00:18:41,033 and good luck to you. Exactly. 762 00:18:41,033 --> 00:18:42,833 Much more individualized. 763 00:18:42,833 --> 00:18:43,933 Well, we've talked about, 764 00:18:43,933 --> 00:18:44,833 you know, the procedures 765 00:18:44,833 --> 00:18:45,433 and the techniques. 766 00:18:45,433 --> 00:18:46,133 I'm wondering 767 00:18:46,133 --> 00:18:48,633 about the breast reconstruction for, 768 00:18:48,633 --> 00:18:50,366 you know, mastectomies and things like that. 769 00:18:50,366 --> 00:18:52,166 So when the tumor's removed, 770 00:18:53,333 --> 00:18:53,733 is it 771 00:18:53,733 --> 00:18:54,433 all done 772 00:18:54,433 --> 00:18:55,833 in one shot or do you come back 773 00:18:55,833 --> 00:18:57,533 later for that sort of thing? 774 00:18:57,533 --> 00:18:59,433 Usually we try to combine it 775 00:18:59,433 --> 00:19:01,133 with our plastic surgery. Okay. 776 00:19:01,133 --> 00:19:02,433 So our options are 777 00:19:02,433 --> 00:19:04,166 if you're going the lumpectomy route 778 00:19:04,166 --> 00:19:06,533 but you need a bigger lumpectomy, 779 00:19:06,533 --> 00:19:07,733 and so are, we, 780 00:19:07,733 --> 00:19:08,766 we can decide to do something 781 00:19:08,766 --> 00:19:10,433 called an oncoplastic reduction. 782 00:19:10,433 --> 00:19:12,433 So we're taking out, as the breast 783 00:19:12,433 --> 00:19:13,833 surgeon I'd be taking out the cancer. 784 00:19:13,833 --> 00:19:15,033 And then plastic surgery 785 00:19:15,033 --> 00:19:17,133 would come in during the same operation, 786 00:19:17,133 --> 00:19:18,433 rearrange the breast 787 00:19:18,433 --> 00:19:19,733 and kind of give you a smaller 788 00:19:19,733 --> 00:19:21,633 lifted breast. Okay. 789 00:19:21,633 --> 00:19:23,566 As you're all part of the one package. 790 00:19:23,566 --> 00:19:24,333 So it's nice 791 00:19:24,333 --> 00:19:25,733 because you're only in the OR 792 00:19:25,733 --> 00:19:26,433 that one time. 793 00:19:26,433 --> 00:19:27,233 Sometimes you may need 794 00:19:27,233 --> 00:19:28,333 to go back for adjustments 795 00:19:28,333 --> 00:19:29,433 or plastics down the road 796 00:19:29,433 --> 00:19:30,733 for cosmetic reasons, 797 00:19:30,733 --> 00:19:32,433 but it takes care of everything there. 798 00:19:32,433 --> 00:19:33,933 The other option is, 799 00:19:33,933 --> 00:19:35,733 if you're doing a full mastectomy, 800 00:19:35,733 --> 00:19:36,833 we try to have plastics there 801 00:19:36,833 --> 00:19:39,166 at the same time for the recon then, too. 802 00:19:39,166 --> 00:19:40,966 And so they'll put in, 803 00:19:40,966 --> 00:19:42,633 they can either do direct to implant, 804 00:19:42,633 --> 00:19:43,933 but more often than not 805 00:19:43,933 --> 00:19:44,833 they're putting something called 806 00:19:44,833 --> 00:19:46,433 tissue expanders in place. Okay. 807 00:19:46,433 --> 00:19:46,733 That's what 808 00:19:46,733 --> 00:19:48,166 I was just going to ask about. 809 00:19:48,166 --> 00:19:49,766 Yes, I have a couple friends 810 00:19:49,766 --> 00:19:50,633 who have that. 811 00:19:50,633 --> 00:19:51,666 Who've done tissue expanders? 812 00:19:51,666 --> 00:19:51,966 Yes. 813 00:19:51,966 --> 00:19:54,566 Actually, three or four. Wow. 814 00:19:54,566 --> 00:19:56,933 And they were in for a while, 815 00:19:56,933 --> 00:19:58,433 and that's just to stretch the skin, 816 00:19:58,433 --> 00:19:59,066 I imagine. 817 00:19:59,066 --> 00:19:59,933 Yeah. Yep. 818 00:19:59,933 --> 00:20:00,833 So what we do 819 00:20:00,833 --> 00:20:01,966 is we combine this with a skin- 820 00:20:01,966 --> 00:20:03,833 sparing mastectomy, so... 821 00:20:03,833 --> 00:20:04,966 Or a nipple-sparing 822 00:20:04,966 --> 00:20:06,333 mastectomy, depending on, 823 00:20:06,333 --> 00:20:07,233 you know, we can... 824 00:20:07,233 --> 00:20:08,733 There's a group of patients 825 00:20:08,733 --> 00:20:10,433 who would qualify for nipple sparing. 826 00:20:10,433 --> 00:20:12,233 If you've got smaller breasts, 827 00:20:12,233 --> 00:20:13,766 not a lot of nipple ptosis, 828 00:20:13,766 --> 00:20:14,566 depending on also 829 00:20:14,566 --> 00:20:16,133 where the tumor is in relation 830 00:20:16,133 --> 00:20:17,733 to the nipple areola complex. 831 00:20:17,733 --> 00:20:19,633 We could maybe offer nipple sparing, 832 00:20:19,633 --> 00:20:20,533 but if not, 833 00:20:20,533 --> 00:20:22,233 then you could get a skin-sparing mastectomy. 834 00:20:22,233 --> 00:20:23,333 So we remove the nipple, 835 00:20:23,333 --> 00:20:25,633 but we retain the majority of the skin 836 00:20:25,633 --> 00:20:26,633 of the breast. Got it. 837 00:20:26,633 --> 00:20:28,233 So then the breast surgeon 838 00:20:28,233 --> 00:20:30,433 comes in, removes all of the tissue. 839 00:20:30,433 --> 00:20:32,333 Plastic surgery comes, in places 840 00:20:32,333 --> 00:20:33,766 the tissue expander in. 841 00:20:33,766 --> 00:20:34,533 And what that is, 842 00:20:34,533 --> 00:20:36,333 is it's kind of a placeholder. 843 00:20:36,333 --> 00:20:37,233 So you'll look... 844 00:20:37,233 --> 00:20:39,766 Yeah. Semi-flat at the beginning of, 845 00:20:39,766 --> 00:20:40,933 right after your surgery. 846 00:20:40,933 --> 00:20:42,233 And then over the subsequent weeks 847 00:20:42,233 --> 00:20:43,533 they'll inject saline. 848 00:20:43,533 --> 00:20:44,833 They'll kind of stretch it 849 00:20:44,833 --> 00:20:46,733 and it helps stretch the remaining skin 850 00:20:46,733 --> 00:20:48,033 which we've left most of it. 851 00:20:48,033 --> 00:20:49,433 But you've lost some. 852 00:20:49,433 --> 00:20:50,833 And so then it stretches it and helps 853 00:20:50,833 --> 00:20:52,633 you get to the size you ultimately want. 854 00:20:52,633 --> 00:20:55,633 And then down the road you plan for your, 855 00:20:55,933 --> 00:20:57,133 your permanent implant 856 00:20:57,133 --> 00:20:59,933 to be placed. Right. God, that's so cool. 857 00:20:59,933 --> 00:21:00,566 Because, you know, 858 00:21:00,566 --> 00:21:01,766 you think 859 00:21:01,766 --> 00:21:02,966 I would imagine before 860 00:21:02,966 --> 00:21:04,333 this was an option like, 861 00:21:04,333 --> 00:21:04,933 well, you know, 862 00:21:04,933 --> 00:21:06,033 and, and truly like, well, 863 00:21:06,033 --> 00:21:07,533 I'm just lucky to be alive. Yes. 864 00:21:07,533 --> 00:21:08,366 But you now 865 00:21:08,366 --> 00:21:09,966 you have the rest of your life to live 866 00:21:09,966 --> 00:21:12,333 and your your body feels unfamiliar 867 00:21:12,333 --> 00:21:13,133 and you don't... 868 00:21:13,133 --> 00:21:14,366 It doesn't look 869 00:21:14,366 --> 00:21:15,233 and feel like what 870 00:21:15,233 --> 00:21:16,333 you want it to look and feel like. 871 00:21:16,333 --> 00:21:19,333 So the fact that that doctors take 872 00:21:19,366 --> 00:21:21,833 the reconstruction seriously 873 00:21:21,833 --> 00:21:23,533 is really, really nice. 874 00:21:23,533 --> 00:21:24,533 And I'm sure it just 875 00:21:24,533 --> 00:21:26,133 it makes all the difference in the world 876 00:21:26,133 --> 00:21:26,933 for patients. 877 00:21:26,933 --> 00:21:27,733 Oh, absolutely. 878 00:21:27,733 --> 00:21:28,566 It's a huge... 879 00:21:28,566 --> 00:21:29,433 because it's just, 880 00:21:29,433 --> 00:21:32,133 it's not appropriate to say, 881 00:21:32,133 --> 00:21:33,733 okay, we've cured you of your cancer, 882 00:21:33,733 --> 00:21:36,733 now go live another 50 years, 883 00:21:36,733 --> 00:21:37,733 not liking 884 00:21:37,733 --> 00:21:38,933 what you're seeing in the mirror. 885 00:21:38,933 --> 00:21:40,566 Like this is already a horrible ordeal , 886 00:21:40,566 --> 00:21:42,333 to have to go through a baseline to 887 00:21:42,333 --> 00:21:42,766 then say, 888 00:21:42,766 --> 00:21:43,566 oh, and you're going to have to 889 00:21:43,566 --> 00:21:44,933 constantly be reminded of it. 890 00:21:44,933 --> 00:21:45,233 Yeah. 891 00:21:45,233 --> 00:21:45,966 So I mean, it's 892 00:21:45,966 --> 00:21:47,166 never going to be perfect, right? 893 00:21:47,166 --> 00:21:47,933 We're not... 894 00:21:47,933 --> 00:21:50,533 Yeah. But you will feel put back together. 895 00:21:50,533 --> 00:21:51,633 You won't feel like you were left 896 00:21:51,633 --> 00:21:52,633 in that state. 897 00:21:52,633 --> 00:21:54,633 I actually saw a video 898 00:21:54,633 --> 00:21:55,633 not too long ago 899 00:21:55,633 --> 00:21:58,733 of plastic surgeons and tattoo artists 900 00:21:58,733 --> 00:21:59,833 that do these really amazing, 901 00:21:59,833 --> 00:22:01,733 like, three dimensional nipples. 902 00:22:01,733 --> 00:22:02,933 Oh, my gosh, I love this so much. 903 00:22:02,933 --> 00:22:04,833 And I always show my patients... The best! 904 00:22:04,833 --> 00:22:06,333 Yes, I always show patients 905 00:22:06,333 --> 00:22:07,233 who aren't good candidates 906 00:22:07,233 --> 00:22:08,433 for things like nipple sparing, 907 00:22:08,433 --> 00:22:09,566 but they're really concerned 908 00:22:09,566 --> 00:22:10,566 about losing that 909 00:22:10,566 --> 00:22:11,833 because it's such an integral part 910 00:22:11,833 --> 00:22:13,933 of being a woman. Right? 911 00:22:13,933 --> 00:22:14,933 So I showed it to them 912 00:22:14,933 --> 00:22:16,366 and it is so amazing. 913 00:22:16,366 --> 00:22:16,933 It's amazing. 914 00:22:16,933 --> 00:22:18,333 You can't tell the difference... Nope. 915 00:22:18,333 --> 00:22:20,166 And you know it. 916 00:22:20,166 --> 00:22:21,533 I think it is a huge comfort 917 00:22:21,533 --> 00:22:22,433 to a lot of people to know 918 00:22:22,433 --> 00:22:23,733 that you have this option 919 00:22:23,733 --> 00:22:26,333 to look and feel normal again. 920 00:22:26,333 --> 00:22:27,166 And it's, you know, 921 00:22:27,166 --> 00:22:29,733 I also know someone who had the option. 922 00:22:29,733 --> 00:22:30,033 She's like, 923 00:22:30,033 --> 00:22:31,733 I wanted a tattoo of a flower. 924 00:22:31,733 --> 00:22:33,933 I'm like, you do your thing, girl. 925 00:22:33,933 --> 00:22:36,933 But the, the realisticness of some of these tattoos is unbelievable. 926 00:22:37,533 --> 00:22:39,033 They are true artists. 927 00:22:39,033 --> 00:22:40,533 I agree. 928 00:22:40,533 --> 00:22:41,333 Oh my god. 929 00:22:41,333 --> 00:22:44,333 And I had breast reduction surgery 930 00:22:44,433 --> 00:22:47,233 and I had wanted to do it for 931 00:22:47,233 --> 00:22:49,333 two decades. But I was scared then. 932 00:22:49,333 --> 00:22:49,733 And you know, 933 00:22:49,733 --> 00:22:50,833 you hear these horror stories. 934 00:22:50,833 --> 00:22:52,633 And now we got into like, 935 00:22:52,633 --> 00:22:54,433 you know, the 2020s. 936 00:22:54,433 --> 00:22:55,566 And I was like, oh, okay. 937 00:22:55,566 --> 00:22:58,133 And I just kind of casually see. I think I'm ready. Yeah. 938 00:22:58,133 --> 00:22:58,933 And seeing how, 939 00:22:58,933 --> 00:22:59,633 how the, 940 00:22:59,633 --> 00:23:00,833 the options had changed 941 00:23:00,833 --> 00:23:01,733 and sort of evolved 942 00:23:01,733 --> 00:23:03,766 and I, I'm so glad 943 00:23:03,766 --> 00:23:05,366 I waited just because for me 944 00:23:05,366 --> 00:23:06,366 it was the right thing to do. 945 00:23:06,366 --> 00:23:07,933 And I liked seeing, 946 00:23:07,933 --> 00:23:10,033 you know, how the technology had evolved. 947 00:23:10,033 --> 00:23:11,033 So, yeah, 948 00:23:11,033 --> 00:23:13,433 I mean, I trust me, I'm on board. 949 00:23:13,433 --> 00:23:14,033 Knock me out, 950 00:23:14,033 --> 00:23:16,433 wake me up, give me a smaller size. 951 00:23:16,433 --> 00:23:17,433 We're in a good place. 952 00:23:18,633 --> 00:23:19,166 Yeah. 953 00:23:19,166 --> 00:23:19,933 So. 954 00:23:19,933 --> 00:23:20,966 But you know, 955 00:23:20,966 --> 00:23:22,033 we talked about a little bit, 956 00:23:22,033 --> 00:23:24,733 but in terms of other options 957 00:23:24,733 --> 00:23:26,133 besides implants, 958 00:23:26,133 --> 00:23:27,733 does anyone ever just say, 959 00:23:27,733 --> 00:23:27,966 you know, 960 00:23:27,966 --> 00:23:29,333 I'd rather just not keep going 961 00:23:29,333 --> 00:23:31,633 through these surgeries? I'm, I'm good. 962 00:23:31,633 --> 00:23:32,766 Yeah. We, absolutely. 963 00:23:32,766 --> 00:23:35,433 We can have an aesthetic flat closure. 964 00:23:35,433 --> 00:23:36,333 And that's an option 965 00:23:36,333 --> 00:23:37,633 if somebody, you know, 966 00:23:37,633 --> 00:23:39,733 needs, wants a mastectomy 967 00:23:39,733 --> 00:23:41,233 and they don't want any reconstruction, 968 00:23:41,233 --> 00:23:42,633 you can just go flat. 969 00:23:42,633 --> 00:23:45,633 And that, there's a whole group of of, 970 00:23:45,833 --> 00:23:46,533 you know, patients 971 00:23:46,533 --> 00:23:47,966 and survivors of breast cancer 972 00:23:47,966 --> 00:23:50,633 who really rally behind that and, 973 00:23:50,633 --> 00:23:51,533 you know, 974 00:23:51,533 --> 00:23:54,033 empower each other with... I love it. With that choice 975 00:23:54,033 --> 00:23:55,366 because it's awesome, too. 976 00:23:55,366 --> 00:23:56,033 And that's the thing. 977 00:23:56,033 --> 00:23:56,233 I mean, 978 00:23:56,233 --> 00:23:57,166 I would just imagine 979 00:23:57,166 --> 00:23:58,833 just depending on your tolerance 980 00:23:58,833 --> 00:24:00,033 and mine's very low, 981 00:24:00,033 --> 00:24:03,433 but just going through this process and, 982 00:24:03,533 --> 00:24:03,933 you know, 983 00:24:03,933 --> 00:24:05,533 whether you do chemo or radiation 984 00:24:05,533 --> 00:24:06,733 and the surgeries, it'd be like, 985 00:24:06,733 --> 00:24:07,433 you know what? 986 00:24:07,433 --> 00:24:08,433 I'm going to choose 987 00:24:08,433 --> 00:24:10,566 as, as few surgeries as possible. 988 00:24:10,566 --> 00:24:11,333 And when we're done 989 00:24:11,333 --> 00:24:12,733 here, we're done here. Yeah. 990 00:24:12,733 --> 00:24:14,766 So I absolutely understand that. 991 00:24:14,766 --> 00:24:16,333 So what is the recovery 992 00:24:16,333 --> 00:24:18,833 like for a breast surgery? 993 00:24:18,833 --> 00:24:20,533 Depends on the surgery that you do. 994 00:24:20,533 --> 00:24:22,633 So I always counsel patients 995 00:24:22,633 --> 00:24:26,333 a lumpectomy, shorter surgery, ambulatory. 996 00:24:26,366 --> 00:24:28,233 You go home the same day. Oh you do? 997 00:24:28,233 --> 00:24:28,633 Yes. 998 00:24:28,633 --> 00:24:31,633 And quicker recovery, less pain. 999 00:24:32,333 --> 00:24:33,133 For sure. 1000 00:24:33,133 --> 00:24:34,133 So I usually tell them 1001 00:24:34,133 --> 00:24:35,133 about one to two weeks, 1002 00:24:35,133 --> 00:24:37,333 but most patients will feel pretty good 1003 00:24:37,333 --> 00:24:38,833 within the first few days. 1004 00:24:38,833 --> 00:24:39,933 You'll be a little bit sore. 1005 00:24:39,933 --> 00:24:40,766 I always send patients 1006 00:24:40,766 --> 00:24:41,933 home with pain medication, 1007 00:24:41,933 --> 00:24:42,766 usually a combination 1008 00:24:42,766 --> 00:24:44,166 of Tylenol, ibuprofen, 1009 00:24:44,166 --> 00:24:45,566 and then depending on how much we do, 1010 00:24:45,566 --> 00:24:47,033 maybe something a little bit stronger. 1011 00:24:47,033 --> 00:24:49,133 Do you use a nerve blocker? 1012 00:24:49,133 --> 00:24:51,233 I will give, I'll give local 1013 00:24:51,233 --> 00:24:52,033 and sometimes local 1014 00:24:52,033 --> 00:24:53,233 directly into the muscle 1015 00:24:53,233 --> 00:24:55,133 that will kind of serve as a nerve blocker. Okay 1016 00:24:55,133 --> 00:24:56,366 And sometimes we'll have anesthesia as well. 1017 00:24:56,366 --> 00:24:57,833 I had surgery and was, like, this really wasn't bad. 1018 00:24:57,833 --> 00:24:59,833 She's, like, ice took care of that. Yeah. 1019 00:24:59,833 --> 00:25:01,866 Yes, yes, yes, yes. Absolutely. 1020 00:25:01,866 --> 00:25:03,300 So besides what you do, 1021 00:25:03,300 --> 00:25:04,500 which is a miracle 1022 00:25:04,500 --> 00:25:05,666 and we thank you for it... 1023 00:25:05,666 --> 00:25:06,966 And I, you know 1024 00:25:06,966 --> 00:25:07,766 plastic surgeon 1025 00:25:07,766 --> 00:25:09,566 what other specialists are sort of 1026 00:25:09,566 --> 00:25:11,300 part of that breast cancer team 1027 00:25:11,300 --> 00:25:12,566 at UCI Health. Yeah. 1028 00:25:12,566 --> 00:25:14,966 So when when somebody walks in the door 1029 00:25:14,966 --> 00:25:16,366 with a new breast cancer diagnosis, 1030 00:25:16,366 --> 00:25:17,966 you know, I'll explain to them 1031 00:25:17,966 --> 00:25:20,266 this is a multidisciplinary approach. 1032 00:25:20,266 --> 00:25:21,866 We have a multidisciplinary approach. 1033 00:25:21,866 --> 00:25:23,700 So not only do you see a breast surgeon, 1034 00:25:23,700 --> 00:25:25,100 you see a breast 1035 00:25:25,100 --> 00:25:26,300 radiologist who's doing 1036 00:25:26,300 --> 00:25:27,466 your mammograms, 1037 00:25:27,466 --> 00:25:28,166 who's often calling you 1038 00:25:28,166 --> 00:25:29,466 with the results of those. 1039 00:25:29,466 --> 00:25:31,466 We also have medical oncologists 1040 00:25:31,466 --> 00:25:32,366 because they're the ones 1041 00:25:32,366 --> 00:25:32,866 who are going to be 1042 00:25:32,866 --> 00:25:34,266 deciding about the chemo. 1043 00:25:34,266 --> 00:25:35,266 They're the ones that are going to be 1044 00:25:35,266 --> 00:25:36,700 maybe giving you the endocrine therapy 1045 00:25:36,700 --> 00:25:38,166 if you qualify for that. 1046 00:25:38,166 --> 00:25:39,266 And we have a radiation 1047 00:25:39,266 --> 00:25:40,466 oncologist as well, 1048 00:25:40,466 --> 00:25:40,766 and they're 1049 00:25:40,766 --> 00:25:40,966 the ones 1050 00:25:40,966 --> 00:25:42,966 that would be offering radiation. 1051 00:25:42,966 --> 00:25:44,300 So if you had a lumpectomy 1052 00:25:44,300 --> 00:25:46,466 and you needed radiation adjuvantly 1053 00:25:46,466 --> 00:25:47,666 after your surgery, 1054 00:25:47,666 --> 00:25:49,566 radiation oncology is who does that. 1055 00:25:49,566 --> 00:25:50,300 So it's a big... 1056 00:25:50,300 --> 00:25:50,700 and of course 1057 00:25:50,700 --> 00:25:51,666 our breast pathologists 1058 00:25:51,666 --> 00:25:52,066 because they're 1059 00:25:52,066 --> 00:25:53,266 the ones that are telling us, okay, 1060 00:25:53,266 --> 00:25:54,866 this is the type of breast cancer it is, 1061 00:25:54,866 --> 00:25:55,866 these are the receptors 1062 00:25:55,866 --> 00:25:56,900 that are involved. 1063 00:25:56,900 --> 00:25:58,300 And so it's a big, big group. 1064 00:25:58,300 --> 00:26:00,066 And we have meetings and tumor boards 1065 00:26:00,066 --> 00:26:01,900 all the time to discuss these patients 1066 00:26:01,900 --> 00:26:03,366 to make sure that everybody's on board. 1067 00:26:03,366 --> 00:26:05,266 And we have a plan that's personalized. 1068 00:26:05,266 --> 00:26:06,466 And... That's amazing. You know 1069 00:26:06,466 --> 00:26:07,466 good to get that patient 1070 00:26:07,466 --> 00:26:08,066 to the next step. 1071 00:26:08,066 --> 00:26:09,100 I always wondered about that. 1072 00:26:09,100 --> 00:26:09,666 Like you see on 1073 00:26:09,666 --> 00:26:10,266 medical shows, 1074 00:26:10,266 --> 00:26:11,466 all of these doctors 1075 00:26:11,466 --> 00:26:12,266 getting together 1076 00:26:12,266 --> 00:26:13,766 and talking about a patient. I'd be like, 1077 00:26:13,766 --> 00:26:14,366 if that was me, 1078 00:26:14,366 --> 00:26:15,500 they would just be talking about 1079 00:26:15,500 --> 00:26:16,866 little me and debating. 1080 00:26:16,866 --> 00:26:18,666 And I mean like that... You really do that. 1081 00:26:18,666 --> 00:26:19,266 We do. 1082 00:26:19,266 --> 00:26:20,300 That is who we do. 1083 00:26:20,300 --> 00:26:20,966 Because, you know, 1084 00:26:20,966 --> 00:26:21,566 we want to make sure 1085 00:26:21,566 --> 00:26:23,166 that we're doing the best thing 1086 00:26:23,166 --> 00:26:23,900 for that patient. 1087 00:26:23,900 --> 00:26:24,966 And so 1088 00:26:24,966 --> 00:26:27,766 really having more sets of eyes and, 1089 00:26:27,766 --> 00:26:27,966 you know, 1090 00:26:27,966 --> 00:26:30,566 more opinions and looking at the data 1091 00:26:30,566 --> 00:26:31,700 and talking about that data 1092 00:26:31,700 --> 00:26:33,366 and how it applies to that person, 1093 00:26:33,366 --> 00:26:34,966 that's what's going to get this person 1094 00:26:34,966 --> 00:26:35,566 through this. 1095 00:26:35,566 --> 00:26:36,466 And, you know, 1096 00:26:36,466 --> 00:26:37,900 give them the extra 50 years. 1097 00:26:37,900 --> 00:26:38,766 That's incredible. 1098 00:26:38,766 --> 00:26:39,666 Do you ever feel like 1099 00:26:39,666 --> 00:26:41,266 you really have to dig your... 1100 00:26:41,266 --> 00:26:42,166 Has there been experience 1101 00:26:42,166 --> 00:26:43,866 where you had to really dig your heels in 1102 00:26:43,866 --> 00:26:45,500 and just really disagree with somebody 1103 00:26:45,500 --> 00:26:48,066 during this conversation? 1104 00:26:48,066 --> 00:26:49,066 You know, a few times 1105 00:26:49,066 --> 00:26:50,066 there's some disagreements. 1106 00:26:50,066 --> 00:26:50,766 Like everybody, 1107 00:26:50,766 --> 00:26:52,466 you know, might have their, 1108 00:26:52,466 --> 00:26:54,300 their particular anecdotal things, 1109 00:26:54,300 --> 00:26:55,266 but at the end of the day, it's 1110 00:26:55,266 --> 00:26:56,266 like we're going by data 1111 00:26:56,266 --> 00:26:57,766 and going by what we've got. 1112 00:26:57,766 --> 00:26:59,500 Most of the time, we'll have an agreement. 1113 00:26:59,500 --> 00:27:00,366 And.. Doctor House 1114 00:27:00,366 --> 00:27:01,766 doesn't just like throw his cane 1115 00:27:01,766 --> 00:27:02,866 and walk out of the room. 1116 00:27:02,866 --> 00:27:03,966 It's not like that. 1117 00:27:03,966 --> 00:27:04,966 No, no, 1118 00:27:04,966 --> 00:27:05,900 not, not, not 1119 00:27:05,900 --> 00:27:07,666 nearly that dramatic. Okay, I've watched a lot of medical drama. 1120 00:27:07,666 --> 00:27:09,966 So I just want to see if that's real. Oh, girl, me too. 1121 00:27:09,966 --> 00:27:11,566 Obsessed with The Pitt, by the way. 1122 00:27:11,566 --> 00:27:13,466 Oh, it is so good. So good. 1123 00:27:13,466 --> 00:27:14,500 That's a really good show. 1124 00:27:14,500 --> 00:27:17,100 And, and actually pretty accurate. 1125 00:27:17,100 --> 00:27:18,966 That's what everybody says – like 1126 00:27:18,966 --> 00:27:20,666 out of all of the medical dramas, 1127 00:27:20,666 --> 00:27:23,166 like, they got a lot right apparently. 1128 00:27:23,166 --> 00:27:24,066 Yeah, yeah, I kind of... 1129 00:27:24,066 --> 00:27:24,766 I was very sad 1130 00:27:24,766 --> 00:27:25,866 with the way they portrayed 1131 00:27:25,866 --> 00:27:27,266 the surgical resident in it 1132 00:27:27,266 --> 00:27:27,900 at the beginning. 1133 00:27:27,900 --> 00:27:29,866 Oh, she came off as kind of harsh. 1134 00:27:29,866 --> 00:27:30,366 Yeah. 1135 00:27:30,366 --> 00:27:32,366 But, but overall... 1136 00:27:32,366 --> 00:27:32,666 You know, 1137 00:27:32,666 --> 00:27:33,300 let's sprinkle 1138 00:27:33,300 --> 00:27:34,666 in some medical professionals 1139 00:27:34,666 --> 00:27:35,966 with personality disorders. 1140 00:27:35,966 --> 00:27:37,466 Yes. Just to spice things up. Yes. 1141 00:27:37,466 --> 00:27:38,566 I mean, not to say they're not, 1142 00:27:38,566 --> 00:27:40,700 that's not the truth. Right? 1143 00:27:42,066 --> 00:27:42,466 But, you know, 1144 00:27:42,466 --> 00:27:43,100 there's no need to 1145 00:27:43,100 --> 00:27:46,100 broadcast all the pathologic natures to the world. 1146 00:27:46,266 --> 00:27:47,366 We don't need to look that far 1147 00:27:47,366 --> 00:27:49,066 behind the curtain. 1148 00:27:49,066 --> 00:27:49,666 Exactly. 1149 00:27:49,666 --> 00:27:50,866 Well, I love that 1150 00:27:50,866 --> 00:27:52,700 there's all these awesome advancements. 1151 00:27:52,700 --> 00:27:53,466 And I'm wondering 1152 00:27:53,466 --> 00:27:54,566 if you know of anything 1153 00:27:54,566 --> 00:27:55,966 that's sort of on the horizon 1154 00:27:55,966 --> 00:27:57,666 that maybe isn't ready yet, 1155 00:27:57,666 --> 00:27:58,700 but you're hearing 1156 00:27:58,700 --> 00:27:59,466 sort of whispers 1157 00:27:59,466 --> 00:28:01,666 about the next level of care for... 1158 00:28:01,666 --> 00:28:02,966 Yeah. Breast cancer. 1159 00:28:02,966 --> 00:28:05,100 So, so again, 1160 00:28:05,100 --> 00:28:06,766 we're really just ahead of every, 1161 00:28:06,766 --> 00:28:09,666 I think, other oncology 1162 00:28:09,666 --> 00:28:10,966 team in what we're doing. 1163 00:28:10,966 --> 00:28:11,766 And so one of the things, 1164 00:28:11,766 --> 00:28:13,100 and it's already here, 1165 00:28:13,100 --> 00:28:14,100 but it's just kind of slowly 1166 00:28:14,100 --> 00:28:15,100 being rolled out to places... 1167 00:28:15,100 --> 00:28:17,066 But the robotic mastectomy has been now 1168 00:28:17,066 --> 00:28:18,466 FDA approved. Really. 1169 00:28:18,466 --> 00:28:18,966 And so 1170 00:28:18,966 --> 00:28:20,566 I think you're going to be hearing 1171 00:28:20,566 --> 00:28:21,666 and seeing more of that 1172 00:28:21,666 --> 00:28:22,766 in the next few years 1173 00:28:22,766 --> 00:28:23,466 as people, 1174 00:28:23,466 --> 00:28:24,166 as the surgeons 1175 00:28:24,166 --> 00:28:26,566 get trained in how to do it. 1176 00:28:26,566 --> 00:28:28,300 So I think a lot of younger surgeons, 1177 00:28:28,300 --> 00:28:28,866 like, for example, 1178 00:28:28,866 --> 00:28:30,066 when I was in my training, 1179 00:28:30,066 --> 00:28:31,766 I got robotic training. You did? 1180 00:28:31,766 --> 00:28:33,500 But people who are a little bit, 1181 00:28:33,500 --> 00:28:34,900 you know, further in their careers, 1182 00:28:34,900 --> 00:28:36,366 they may have not had robotic training. 1183 00:28:36,366 --> 00:28:38,700 So as we roll it out, it's going to be 1184 00:28:38,700 --> 00:28:39,866 it's going to be a really great thing 1185 00:28:39,866 --> 00:28:40,900 to offer to patients because smaller incisions. 1186 00:28:42,366 --> 00:28:43,766 How do you feel about it? I'm really excited about it. 1187 00:28:43,766 --> 00:28:45,700 I think. So ergonomically it'll be great. 1188 00:28:45,700 --> 00:28:45,900 You know, 1189 00:28:45,900 --> 00:28:46,766 especially for nipple, 1190 00:28:46,766 --> 00:28:47,900 nipple-sparing mastectomies. 1191 00:28:47,900 --> 00:28:49,066 It's, it's really 1192 00:28:49,066 --> 00:28:50,566 it'll, it'll be a really nice thing 1193 00:28:50,566 --> 00:28:51,866 because the incisions 1194 00:28:51,866 --> 00:28:53,066 will be even smaller. 1195 00:28:53,066 --> 00:28:53,866 A lot of times 1196 00:28:53,866 --> 00:28:55,666 they're hidden in the side. 1197 00:28:55,666 --> 00:28:56,700 Now, a lot of the times 1198 00:28:56,700 --> 00:28:57,466 we're able to do inframammary 1199 00:28:57,466 --> 00:28:59,366 nipple-sparing mastectomies, 1200 00:28:59,366 --> 00:29:01,166 but with the robot, it can be, 1201 00:29:01,166 --> 00:29:01,366 you know, 1202 00:29:01,366 --> 00:29:02,700 a smaller incision and on the side. 1203 00:29:02,700 --> 00:29:04,500 So even better hidden. 1204 00:29:04,500 --> 00:29:06,166 And if you can have similar outcomes, 1205 00:29:06,166 --> 00:29:08,166 which with FDA approval, we've proven 1206 00:29:08,166 --> 00:29:09,300 we can. Why, 1207 00:29:09,300 --> 00:29:09,766 why not? 1208 00:29:09,766 --> 00:29:11,366 Why not push the envelope further? 1209 00:29:11,366 --> 00:29:14,166 So that's exciting. We also have 1210 00:29:14,166 --> 00:29:16,566 this, the LumiSystem has now come out 1211 00:29:16,566 --> 00:29:19,166 where we're looking at being able to 1212 00:29:19,166 --> 00:29:21,566 see margins in real time... 1213 00:29:21,566 --> 00:29:23,866 Really? By having cancer cells light up. 1214 00:29:23,866 --> 00:29:25,300 And so I think we're going to be seeing 1215 00:29:25,300 --> 00:29:26,966 that being used intraoperatively 1216 00:29:26,966 --> 00:29:28,100 to decrease chances 1217 00:29:28,100 --> 00:29:29,166 for lumpectomy patients 1218 00:29:29,166 --> 00:29:29,700 that they end up 1219 00:29:29,700 --> 00:29:30,900 having more positive margins 1220 00:29:30,900 --> 00:29:32,366 that require going back. 1221 00:29:32,366 --> 00:29:33,700 So I think 1222 00:29:33,700 --> 00:29:34,566 we're going to be seeing 1223 00:29:34,566 --> 00:29:35,666 even more advancements 1224 00:29:35,666 --> 00:29:36,666 that really change the game 1225 00:29:36,666 --> 00:29:37,566 for breast cancer patients. 1226 00:29:37,566 --> 00:29:39,166 I mean, I'm hoping 1227 00:29:39,166 --> 00:29:41,566 that in my lifetime we'll find, 1228 00:29:41,566 --> 00:29:41,966 you know, 1229 00:29:41,966 --> 00:29:43,966 maybe axillary surgery becomes 1230 00:29:43,966 --> 00:29:45,166 almost obsolete 1231 00:29:45,166 --> 00:29:48,366 or just as a prognostic marker 1232 00:29:48,466 --> 00:29:49,666 where you're just sampling nodes 1233 00:29:49,666 --> 00:29:50,966 just to see how the patient's 1234 00:29:50,966 --> 00:29:51,866 going to do with this 1235 00:29:51,866 --> 00:29:53,700 very specific treatment. 1236 00:29:53,700 --> 00:29:54,966 And maybe with really, 1237 00:29:54,966 --> 00:29:55,766 really good treatments, 1238 00:29:55,766 --> 00:29:57,266 we won't even need breast surgery. 1239 00:29:57,266 --> 00:29:58,500 I mean, we may get there. 1240 00:29:58,500 --> 00:29:59,866 I think it'll be a while. 1241 00:29:59,866 --> 00:30:00,100 Sure. 1242 00:30:00,100 --> 00:30:01,866 But, we're making a lot of progress. But you can see 1243 00:30:01,866 --> 00:30:03,166 the way things are going and... 1244 00:30:03,166 --> 00:30:04,166 Yeah, it's, it's 1245 00:30:04,166 --> 00:30:06,566 definitely going... Just in last 50 years 1246 00:30:06,566 --> 00:30:08,366 it's been a complete 180. 1247 00:30:08,366 --> 00:30:10,366 And how we first approached 1248 00:30:10,366 --> 00:30:11,300 breast cancer. 1249 00:30:11,300 --> 00:30:12,066 In addition 1250 00:30:12,066 --> 00:30:14,166 to the multidisciplinary aspect 1251 00:30:14,166 --> 00:30:15,700 and the tumor boards that we have, 1252 00:30:15,700 --> 00:30:16,466 we also 1253 00:30:16,466 --> 00:30:17,600 here at UCI 1254 00:30:17,600 --> 00:30:18,966 offer this amazing thing 1255 00:30:18,966 --> 00:30:20,566 called integrative oncology. 1256 00:30:20,566 --> 00:30:21,600 And this is where we're kind of looking 1257 00:30:21,600 --> 00:30:23,700 at the patient from a holistic manner, 1258 00:30:23,700 --> 00:30:25,500 not just looking at what treatments 1259 00:30:25,500 --> 00:30:26,866 they're receiving from the outside, 1260 00:30:26,866 --> 00:30:28,566 but also other things that they can do 1261 00:30:28,566 --> 00:30:29,700 to improve outcomes, to 1262 00:30:29,700 --> 00:30:32,300 change the ecosystem of the patient. 1263 00:30:32,300 --> 00:30:32,600 You know, 1264 00:30:32,600 --> 00:30:33,900 looking at diet changes, 1265 00:30:33,900 --> 00:30:35,466 looking at exercise changes 1266 00:30:35,466 --> 00:30:36,900 that they can make, 1267 00:30:36,900 --> 00:30:38,766 acupuncture, meditation, 1268 00:30:38,766 --> 00:30:39,966 things like yoga. 1269 00:30:39,966 --> 00:30:40,366 And it's 1270 00:30:40,366 --> 00:30:42,566 this really amazing approach 1271 00:30:42,566 --> 00:30:44,166 of, to the patient 1272 00:30:44,166 --> 00:30:46,300 to change the environment 1273 00:30:46,300 --> 00:30:47,566 that the cancer is working in. 1274 00:30:47,566 --> 00:30:48,566 And we've seen and we're 1275 00:30:48,566 --> 00:30:49,966 running clinical trials now 1276 00:30:49,966 --> 00:30:51,900 to show that there are improvements 1277 00:30:51,900 --> 00:30:52,900 in outcomes in patients 1278 00:30:52,900 --> 00:30:53,900 who are also using 1279 00:30:53,900 --> 00:30:55,300 this other intervention. 1280 00:30:55,300 --> 00:30:56,266 So it's really exciting 1281 00:30:56,266 --> 00:30:57,266 that we can offer that here 1282 00:30:57,266 --> 00:30:58,566 with Doctor Dang running it. 1283 00:30:58,566 --> 00:30:59,266 That's amazing 1284 00:30:59,266 --> 00:31:00,566 because you think, you know, 1285 00:31:00,566 --> 00:31:03,166 so many people are so jaded –– like, well, 1286 00:31:03,166 --> 00:31:03,766 what can, 1287 00:31:03,766 --> 00:31:05,600 you know, breathing calmly do for me? 1288 00:31:05,600 --> 00:31:07,300 But you think, well, 1289 00:31:07,300 --> 00:31:08,366 if one thing is true, 1290 00:31:08,366 --> 00:31:10,566 like if we know that things damage cells, 1291 00:31:10,566 --> 00:31:12,766 I imagine the opposite can be true, 1292 00:31:12,766 --> 00:31:15,100 which is those cells become regenerative 1293 00:31:15,100 --> 00:31:16,700 the more you're taking care of yourself. 1294 00:31:16,700 --> 00:31:19,066 It doesn't seem that farfetched. 1295 00:31:19,066 --> 00:31:20,266 Stress reduction, 1296 00:31:20,266 --> 00:31:21,300 sleep improvement, 1297 00:31:21,300 --> 00:31:22,666 all of these things are huge 1298 00:31:22,666 --> 00:31:23,366 things that you can do 1299 00:31:23,366 --> 00:31:24,966 to help yourself with outcomes. 1300 00:31:24,966 --> 00:31:26,166 So you have this group 1301 00:31:26,166 --> 00:31:27,700 that sort of supports 1302 00:31:27,700 --> 00:31:30,266 overall lifestyle changes. 1303 00:31:30,266 --> 00:31:31,766 And we also offer psychosocial 1304 00:31:31,766 --> 00:31:34,166 support because it is a huge 1305 00:31:35,366 --> 00:31:35,966 thing 1306 00:31:35,966 --> 00:31:37,566 to be told you... It's a huge life event. A 1307 00:31:37,566 --> 00:31:38,700 huge life event to be told 1308 00:31:38,700 --> 00:31:39,600 you have a breast cancer. 1309 00:31:39,600 --> 00:31:40,600 It feels like 1310 00:31:40,600 --> 00:31:42,166 your body has turned against you. 1311 00:31:42,166 --> 00:31:43,300 And most of these patients 1312 00:31:43,300 --> 00:31:44,666 are otherwise healthy. 1313 00:31:44,666 --> 00:31:45,566 So they're coming in 1314 00:31:45,566 --> 00:31:47,766 with this surprise news 1315 00:31:47,766 --> 00:31:49,466 and it's devastating. 1316 00:31:49,466 --> 00:31:53,066 So it is completely natural to need and 1317 00:31:53,066 --> 00:31:55,266 and want some support in that regard. 1318 00:31:55,266 --> 00:31:56,366 And so we offer that here as well. 1319 00:31:56,366 --> 00:31:56,966 That's wonderful 1320 00:31:56,966 --> 00:31:57,566 because you 1321 00:31:57,566 --> 00:31:59,066 especially would want that support, 1322 00:31:59,066 --> 00:31:59,466 I imagine, 1323 00:31:59,466 --> 00:32:01,266 from somebody who 1324 00:32:01,266 --> 00:32:02,766 focuses on this as opposed to, 1325 00:32:02,766 --> 00:32:03,100 you know, 1326 00:32:03,100 --> 00:32:03,866 maybe a therapist 1327 00:32:03,866 --> 00:32:04,766 who means well and just goes, 1328 00:32:04,766 --> 00:32:05,666 this must be so awful, 1329 00:32:05,666 --> 00:32:07,266 I have no idea what you're going through. 1330 00:32:07,266 --> 00:32:08,966 That's one way. 1331 00:32:08,966 --> 00:32:11,766 But to come in, for somebody to already 1332 00:32:11,766 --> 00:32:13,266 be sort of in this world 1333 00:32:13,266 --> 00:32:14,766 and help guide you around 1334 00:32:14,766 --> 00:32:17,366 this new territory makes so much sense. 1335 00:32:17,366 --> 00:32:18,966 So obviously, as a woman, I'm 1336 00:32:18,966 --> 00:32:20,666 incredibly grateful that you chose 1337 00:32:20,666 --> 00:32:22,866 to go into breast cancer surgery, 1338 00:32:22,866 --> 00:32:23,766 but I'm wondering why. 1339 00:32:23,766 --> 00:32:24,366 I mean, there's 1340 00:32:24,366 --> 00:32:25,566 there's all kinds of cancers. 1341 00:32:25,566 --> 00:32:26,266 There's all kinds of ways 1342 00:32:26,266 --> 00:32:27,266 to help people. Was this... 1343 00:32:27,266 --> 00:32:29,566 Was there a specific reason for you? 1344 00:32:29,566 --> 00:32:31,366 Yes. So, absolutely. 1345 00:32:31,366 --> 00:32:32,500 So I, I knew that 1346 00:32:32,500 --> 00:32:34,466 I wanted to work in cancer surgery 1347 00:32:34,466 --> 00:32:37,366 actually as a resident. Very early on. I just, 1348 00:32:37,366 --> 00:32:38,666 I loved the pathology. 1349 00:32:38,666 --> 00:32:40,566 I really loved the patients. 1350 00:32:40,566 --> 00:32:42,166 I liked being able to offer them 1351 00:32:42,166 --> 00:32:43,666 an opportunity for cure. 1352 00:32:43,666 --> 00:32:45,066 And then 1353 00:32:45,066 --> 00:32:46,566 in my surgical oncology fellowship, 1354 00:32:46,566 --> 00:32:47,266 where I got exposure 1355 00:32:47,266 --> 00:32:47,966 to all different types 1356 00:32:47,966 --> 00:32:49,266 of cancer surgeries, 1357 00:32:49,266 --> 00:32:50,166 I really fell in love 1358 00:32:50,166 --> 00:32:51,866 with the breast cancer population. 1359 00:32:51,866 --> 00:32:52,900 I just, 1360 00:32:52,900 --> 00:32:53,866 I loved that 1361 00:32:53,866 --> 00:32:55,700 the patients overall did well, 1362 00:32:55,700 --> 00:32:56,900 that they would come to you 1363 00:32:56,900 --> 00:32:57,700 in this vulnerable 1364 00:32:57,700 --> 00:32:58,700 time in their life, 1365 00:32:58,700 --> 00:33:01,466 and you as a surgeon could fix it. 1366 00:33:01,466 --> 00:33:01,866 It was like, 1367 00:33:01,866 --> 00:33:02,300 it was part of 1368 00:33:02,300 --> 00:33:03,566 what drew me to surgery to begin with 1369 00:33:03,566 --> 00:33:04,966 is the ability to fix a problem, 1370 00:33:04,966 --> 00:33:07,866 because surgery has such acute issues 1371 00:33:07,866 --> 00:33:08,366 that you can 1372 00:33:08,366 --> 00:33:10,066 then solve... Do something about. 1373 00:33:10,066 --> 00:33:10,866 With something with that 1374 00:33:10,866 --> 00:33:12,100 you do with your hands, right? 1375 00:33:12,100 --> 00:33:13,366 That being able to 1376 00:33:13,366 --> 00:33:14,666 fix somebody's problem, 1377 00:33:14,666 --> 00:33:16,366 let them go on with their life 1378 00:33:16,366 --> 00:33:17,300 and then have this 1379 00:33:17,300 --> 00:33:18,966 longitudinal relationship with them 1380 00:33:18,966 --> 00:33:20,566 just was perfect. 1381 00:33:20,566 --> 00:33:22,300 I was just like, this is a dream job. 1382 00:33:22,300 --> 00:33:23,266 Then I get to be friends 1383 00:33:23,266 --> 00:33:25,766 with that patient for, for years. 1384 00:33:25,766 --> 00:33:27,766 So so I think that's what really kind of 1385 00:33:27,766 --> 00:33:29,066 was the final, 1386 00:33:29,066 --> 00:33:29,366 you know, 1387 00:33:29,366 --> 00:33:31,266 decision maker for me 1388 00:33:31,266 --> 00:33:33,100 for going into breast surgery. 1389 00:33:33,100 --> 00:33:35,466 Doctor Alexandra Lopez Aguilar, 1390 00:33:35,466 --> 00:33:36,666 you're amazing. 1391 00:33:36,666 --> 00:33:39,100 Thank you so much for sharing your time, 1392 00:33:39,100 --> 00:33:40,300 your expertise with us. 1393 00:33:40,300 --> 00:33:41,866 This actually, I, 1394 00:33:41,866 --> 00:33:42,566 you know the phrase 1395 00:33:42,566 --> 00:33:44,666 all information is good information. 1396 00:33:44,666 --> 00:33:45,500 So even if it's 1397 00:33:45,500 --> 00:33:47,166 kind of a scary subject, 1398 00:33:47,166 --> 00:33:49,300 I hope other people feel as 1399 00:33:50,266 --> 00:33:51,066 comfortable and 1400 00:33:51,066 --> 00:33:52,466 confident as I do 1401 00:33:52,466 --> 00:33:53,700 now after talking to you, 1402 00:33:53,700 --> 00:33:55,300 just having that information. 1403 00:33:55,300 --> 00:33:56,466 So thank you again. 1404 00:33:56,466 --> 00:33:57,900 We really, really appreciate it. 1405 00:33:57,900 --> 00:33:58,966 Thank you so much for having me. 1406 00:33:58,966 --> 00:33:59,900 It was a pleasure.