Breast Cancer
A breast cancer diagnosis is a life-changing experience for most women. It is the start of an emotional and physical journey which, thankfully in most cases, has a successful outcome. The role of the breast surgeon is paramount in establishing the diagnosis, providing surgery with curative intent and streamlining further care and follow-up of the patient. Dr Kollias and his team provide care in keeping with current breast clinical practice for all breast cancer patients. Dr Kollias considers it an honour to be in a position where he may influence patients’ lives in such a positive way. For more information about the best current clinical practice in breast cancer, click here.
Dr Kollias also contributes information regarding his breast cancer procedures to the BreastSurgANZ Breast Quality Audit. This quality assurance activity is undertaken by breast cancer surgeons in Australia and New Zealand to improve the quality of surgical care for patients with early and locally advanced breast cancer. For more information about the BreastSurgANZ Breast Quality Audit, click here.
Breast Cancer Surgery
Each patient’s breast cancer journey is different. In particular, surgical options are tailored to meet the requirements to successfully treat the cancer and minimise deformity and cosmetic concerns of the patient. Dr Kollias has an extensive experience in standard and advanced breast cancer surgical techniques. Most cases of breast cancer are treated simply and effectively with breast conserving surgery (lumpectomy, wide local excision) or mastectomy. In some cases of breast conserving surgery, where larger breast volume resection is required to obtain tumour clearance, more complex procedures are necessary. These include oncoplastic breast cancer surgery which involves the surgical removal of the cancer (breast conserving surgery) as well as reconstituting or partially reconstructing the remaining breast to improve cosmetic outcome. In women who require mastectomy, Dr Kollias offers a variety of mastectomy options with or without nipple preservation, together with breast reconstruction using implant-based options (one and two-stage procedures) or autogenous tissue flap procedures (Latissimus Dorsi flap and TRAM flap methods). In addition, he maintains close ties with plastic and reconstructive colleagues for patients who choose or who are best suited for a free-flap tissue-based reconstruction.
Surgical procedures for the armpit lymph glands are also an important component of breast cancer surgery. These include removal of a few lymph glands (sentinel node biopsy) or removing all armpit lymph glands that drain the breast (axillary dissection). Dr Kollias will take time in discussing the appropriate armpit lymph gland surgery in your specific circumstance.
For further information about breast cancer statistics, risk factors, breast cancer types and treatment, visit the links below.
https://breast-cancer.canceraustralia.gov.au/
https://www.cancer.org.au/assets/pdf/understanding-breast-cancer-booklet
Neoadjuvant Chemotherapy and Hormone Treatment
Breast cancer treatment usually requires a combination of therapies which may include surgery, chemotherapy, radiotherapy, hormone treatment and other targeted treatments. Usually, surgery is performed first to obtain clearance of the tumour, followed by the other treatments which are aimed at improving outcomes. Sometimes, treatments such as chemotherapy or hormone treatment are given before surgery to “downstage” (reduce the size of the tumour) to allow safer and more effective surgery to take place, and to assess the response of the cancer to these treatments. Decisions to use chemotherapy or hormone treatment upfront are determined by the Multidisciplinary Team. Although this type of breast cancer treatment is considered contemporary or modern, Dr Kollias has been using neoadjuvant therapies for over 20 years. For more information about neoadjuvant chemotherapy/hormone treatment, click here.
Management of Hereditary Breast Cancer
A small number of women develop breast cancer due to mutations in their DNA that have been inherited from their mother or father’s side of the family. Treatment for these particular cancers requires special consideration by the Multidisciplinary Team. In this circumstance, the medical geneticist has an important role in providing further counselling and support for such women. Quite often, the recommendations for treatment of hereditary breast cancer are different to those of “sporadic” breast cancer.
Dr Kollias can provide risk assessments, and treatment options for women with a strong family history of breast cancer and/or mutation carriers. He works closely with the South Australian Familial Cancer Service, and has an extensive experience in risk reducing mastectomy and reconstruction in such cases.
For more information about the South Australian Familial Cancer Service, click here.
The Multidisciplinary Approach to Breast Cancer.
Dr Kollias is part of a multidisciplinary team of skilled healthcare professionals
The multidisciplinary approach has been shown in international research to improve outcomes for breast cancer patients. Dr Kollias works with a team of health care professionals which include other surgeons, medical and radiation oncologists, pathologists, radiologists, geneticists and breast care nurses to discuss your case. Each case is discussed at a “round table” meeting each Wednesday afternoon, with specific recommendations made about optimal breast cancer management.
We consider your individual needs, health issues and the pathology of your breast cancer to develop treatment plans that would best suit you and improve your outcome. These plans are discussed with you and you will then be referred to the appropriate specialists for further discussion and treatment.
You are not obligated to follow the treatment plan suggested by the multidisciplinary team, but it is certainly worthwhile taking into account the advice of a large body of experience. The multidisciplinary approach ensures that internationally accepted standards of ‘Best Practice’ are met.
The following health professionals may be involved in the care of a woman with breast cancer:
- general practitioner: provides ongoing care and works with other members of the treatment team
- surgeon: specialises in surgery, including biopsies
- pathologist: examines cells, tissue and blood from the body
- radiologist: examines mammograms, ultrasounds, X-rays and other imaging results and may perform biopsies or help locate cancers prior to surgery
- radiation oncologist: specialises in radiotherapy
- radiation therapist: assists in planning and giving radiotherapy
- medical oncologist: specialises in cancer drugs such as hormonal therapies, chemotherapy and targeted therapies
- breast care nurse: specialises in caring for people with breast cancer
- oncology nurse: specialises in caring for people with cancer
- research nurse: assists in the planning and coordination of clinical research studies and clinical trials
- psychologist, psychiatrist or counsellor: specialise in providing emotional support and managing anxiety and depression
- social worker: specialises in providing emotional support, counselling and advice about some practical and legal matters
- welfare worker: provides practical support and advice
- physiotherapist, occupational therapist: assist with exercise and pain management
- dietitian: specialises in providing advice about what to eat
- palliative care specialist, palliative care nurse: specialise in providing practical support and symptom relief
- community/district nurse: provides care and support at home
- community palliative care team: provide practical support and symptom relief at home
- plastic surgeon: specialises in breast reconstruction after breast surgery
- pharmacist: specialises in supplying, dispensing and manufacturing drugs
- pastoral care/religious representative: provides spiritual support.
For more information about multidisciplinary care, click here.
Other cancer speciality groups that Dr Kollias consults with during multidisciplinary team meetings include the following-
https://www.rah.sa.gov.au/health-professionals/clinical-services/medical/radiation-oncology
https://www.genesiscare.com/au/our-centres/st-andrews-adelaide-oncology/