Breast Cancer Localizers
Better screening and improved breast cancer awareness has led to some cancers being identified before they are able to be felt through the skin. In such cases, it is necessary to “mark” the cancer prior to surgically removing it. In the early 2000’s, this was accomplished by inserting a wire into the cancerous area under radiologic guidance. This was sometimes logistically challenging, as the patient would have to get to the hospital several hours before surgery to undergo the localization procedure.
The wire could also get pulled out during the wait for surgery. Seed localization was introduced partly in response to these challenges. A tiny, radioactive “seed” is introduced into the cancerous area within several days of surgery. With this method, the logistic challenges are eliminated since patients do not need an extra procedure on the day of surgery.
Additionally, the seed does not have substantial risk of being dislodged. During the surgery, a small, handheld Geiger counter is used to detect the small level of radiation being emitted from the seed. However, because of the low dose radiation of the seed, it must be placed a few days prior to surgery. A further advance in cancer localization came in the form of magnetic seeds. These devices relied on magnetic energy rather than a low level of radioactivity.
Magnetic seeds may be able to remain in the body longer compared with the radioactive seed. The magnetic seed is localized using a hand held magnetic sensor.
Throughout history and to this day, surgery has had a major role in the treatment of breast cancer. In the late 19th century, the standard surgery for breast cancer was the radical mastectomy. This surgical procedure removed the breast, chest muscle, and all surrounding lymph nodes (small lumps of immune tissue).
By the mid 20th century, the standard surgery shifted towards the modified radical mastectomy, which did not remove the chest muscle. Some patients did not tolerate the psychological and social implications of losing their breast. Others developed severe swelling of the arm as a result of the removal of lymph nodes. Because of these drawbacks, breast cancer surgery shifted towards a breast conserving approach towards the end of the 20th century.
Early recognition through increased use of mammogram screening contributed to this shift since tumors were often recognized earlier at a smaller size. In most cases, breast conserving surgery, or lumpectomy, involves removal of the tumor and a small rim of surrounding tissue, while keeping the healthy breast tissue in place. Lumpectomy often involves post-operative radiation and may involve sampling of the lymph nodes that drain the breast.
Whether or not a patient is eligible for breast conserving surgery often depends on multiple factors to include tumor characteristics and patient preference. Sometimes, if a surgeon is not able to confidently feel the area that needs to be removed, new technologies are used to help localize the area of cancer or DCIS.
Breast cancer generally describes abnormal tissue growth in the breast. It is most common in females but may also occur in males. It is more common with increasing age. Breast cancer most commonly involves the ducts, or the passageways from the milk glands to the nipple. There is some overlap between treatment of breast cancer and a pre-cancerous condition known as Ductal Carcinoma in Situ (DCIS). In DCIS, cancerous cells are found within the duct but they have not invaded normal breast tissue beyond the duct.
In breast cancer, cancerous cells have invaded beyond the duct into normal breast tissue. Breast cancer and DCIS are often detected when a patient notices a lump or when an abnormal area is observed on a screening mammogram (essentially an x-ray of the breast). A biopsy (a method of getting a tissue sample) of the abnormal area or lump is often performed to obtain a definitive diagnosis.
Breast cancer often spreads through local lymphatics (passageways used by immune cells) to surrounding lymph nodes (small knots of immune tissue). From the lymph nodes, breast cancer occasionally “jumps” to distant organs, a process known as “metastasis.” Involvement of the lymph nodes is an important factor in determining the severity of the disease.
Magseed (endomag): Magseed is a small magnetic device designed to localize breast cancer within the breast. It can be placed into cancerous tissue with a needle with various forms of radiologic guidance. It relies on magnetic energy and does not emit any radiation. Therefore, it can be implanted 30 or more days prior to surgery and safely remain in the body much longer than the radioactive seed.
Sentimag (endomag): The Sentimag sensor is used to scan the breast and localize the magseed. Sentimag creates a magnetic field and detects the magnetic energy being emitted by Magseed. Once localized in this way, a surgeon can confidently remove the cancerous area. After removal, the removed tissue and remaining breast are re-scanned to make sure the magnetic seed was removed. The removed tissue is also x-rayed to make sure the Magseed is still within the tissue and the correct area was removed.
Post Operative Healing / Breast Marker
The cavity left over from the removed tissue often fills with fluid that eventually scars down over several years. This healing process may worsen the appearance of the breast and may also make post-operative radiation more difficult since the remaining tissue is distorted.
Recently, technologies have developed to place a 3- dimensional marker into the cavity. This marker may prevent some fluid accumulation and may prevent extensive tissue remodeling or scarring.
The Biozorb (Hologic) is a three-dimensional marker that is placed in the cavity immediately following lumpectomy. It marks the surgical excision site and provides a three-dimensional target for follow-on radiation. It is reabsorbed over the course of several years. The Biozorb may improve cosmetic results and reduce scarring following lumpectomy. It may also improve the accuracy of radiation to the area.
Watch below as I discuss the different types of breast implants.
The first “breast augmentation” surgery was done in 1895 when a lipoma (benign fat tumor) was successfully removed from a patients torso and transplanted to the breast following a mastectomy procedure for breast cancer. What followed for the next half-century was the experimentation of different materials used to augment the breast. Paraffin, liquid silicone, sponges, oils, and many other substances were used and met with disastrous complications including disease, infection, and death.
As the mid 20th century ushered in an era of glamour and vanity, prominent beauty icons such as Marilyn Monroe sported large breasts that ignited a renewed interest in breast enhancement. Again, faulty materials such as the Ivalon sponge, initially showed promise, but then collapsed and caused issues with pain, and rock-hard deformities.
In the 1960s, physicians and scientists finally realized the dangers of free floating substances and developed the first breast implants with a filling and an outer shell. In 1962, the first modern day breast implants were developed. These implants had a silicone envelope and filling.
Following these first implants, multiple generations of implants followed, all of which aimed to develop a shape that produced a natural appearance and remained in a stable position with a filling that wouldn’t leak over time.
In 1965, saline filled implants were also developed. These implants were inserted through smaller incisions and filled with saline solution inside the breast. In 1992, breast implants were labeled Class III medical devices and the FDA and American Society of Testing Methodology imposed more stringent quality control measures for shell thickness and filling gel cohesiveness.
Following these measures, and after a 14 year moratorium on cosmetic use of breast implants, the most modern generations of breast implants emerged. Today, the manufacturers of breast implants are held to stringent quality and safety measures that undergo constant updating. These new generations offer a variety of shapes, shells, filling, and surface textures in order to meet patient needs and preferences.
Ideal implant is designed with multiple implant shells and baffles to hold the saline filler and reduce the “sloshing effect.” Folding and wrinkling is reduced as well. Additionally, the edges have been reduced for a more efficient contouring to the chest wall.
The implant does not contain silicone filler material, only saline enclosed in a silicone shell. The implant has a lower rate of overt rupture and no silent rupture in recent FDA Core Clinical Trials.