The Breast Health Program at St. Catherine of Siena Medical Center features cutting-edge diagnostic and therapeutic services, a multidisciplinary approach that fosters seamless care and improves outcomes, and a philosophy of personalizing and customizing treatment for each individual — all the elements patients and referring physicians seek at academic medical centers throughout New York without the burden of having to travel.
Part of Siena Women’s Health — a division of St. Catherine of Siena Medical Center that provides multispecialty services for women throughout life — the Breast Health Program is a comprehensive diagnostic, therapeutic and educational resource that tailors care to meet the individual medical and emotional needs of every woman with breast cancer. A screening mammography program and a variety of cutting-edge imaging modalities help detect breast cancer early, which increases the ease and effectiveness of treatment. Oncoplastic surgery offers patients enhanced cosmesis after lumpectomy, compared with standard surgical techniques. Multiple options for breast reconstruction — some incorporating microsurgery — mitigate the psychological effects of mastectomy.
“We offer the most advanced diagnostic tools to detect breast cancer early in a comfortable, compassionate setting,” says Anne Green, MD, Medical Director of Breast Imaging at St. Catherine of Siena Medical Center. “Our multidisciplinary team consists of a dedicated breast radiologist, an oncoplastic breast surgeon, a breast reconstructive surgeon, community medical oncologists and radiation oncologists, a breast health nurse navigator, genetic counselors, social workers, dietitians, and pathologists. All of us work with primary care and referring physicians to provide personalized treatment to every patient whose care they entrust to us.”
Anne Green, MD, Medical Director of Breast Imaging at St. Catherine of Siena Medical Center, discusses breast imaging results, supported by Meiling Alsen, RN, Breast Health Nurse Navigator.
Advanced Screening and Diagnostic Imaging
Early detection is paramount to effective breast cancer treatment and is a key area of focus for the Breast Health Program. The American College of Radiology (ACR) has designated St. Catherine of Siena Medical Center a Breast Imaging Center of Excellence for earning ACR accreditation in mammography, stereotactic breast biopsy, breast ultrasound — including ultrasound-guided breast biopsy — and breast MRI. Those services are available at the center’s Women’s Health and Outpatient Diagnostic Pavilion, as are needle localizations and MRI biopsies.
The Breast Health Program offers 2D digital mammography and digital breast tomosynthesis (DBT), also known as 3D mammography. The latter detects cancer at a higher rate and produces fewer callbacks for additional testing than the former, according to the ACR. Evidence of DBT’s efficacy continues to emerge: A 2019 study in JAMA Oncology found DBT outperformed digital mammography in the detection of small, node-negative invasive cancers, especially in women 40 to 49 years old.
“So far, in early studies, 3D mammograms have been found to benefit all patients, regardless of breast density,” Dr. Green says. “They find more invasive breast cancers and result in fewer false positives.”
“Open communication between providers is essential to treating breast cancer, and it’s an area in which our team excels. We speak with each other regularly at every stage of patients’ care, from evaluating treatment options to creating and carrying out a treatment plan.”
— Diana Yoon-Schwartz, MD, PhD, FACS, Administrative Director of Reconstructive Microsurgery at St. Catherine of Siena Medical Center
Diana Yoon-Schwartz, MD, PhD, FACS, Administrative Director of Reconstructive Microsurgery at St. Catherine of Siena Medical Center, thoroughly educates a patient about the breast reconstruction process.
The Breast Health Program’s personalized approach begins at the Women’s Health and Outpatient Diagnostic Pavilion, where patients who undergo a screening or diagnostic mammogram or breast ultrasound receive results before they depart.
“We want women to know before they leave whether everything is OK or they need additional workup,” Dr. Green says. “If a patient comes in for a mammogram and ends up needing more mammographic images, we perform those the same day so she doesn’t have to return. If a patient needs a breast ultrasound, the ultrasound technologist performs an initial scan, and then I perform a second and speak with the patient — which is a unique level of care.”
Patients who need a breast biopsy meet with Dr. Green and Breast Health Nurse Navigator Meiling Alsen, RN, and receive an appointment for the procedure before leaving the pavilion. Alsen is an advocate and resource for patients. She assists with appointment scheduling, provides comfort and education, and helps patients resolve everyday issues that may accompany breast cancer treatment, such as finding transportation to appointments and navigating insurance rules.
“Meiling epitomizes the heart and hope of our program,” Dr. Green says. “When we recommend a biopsy, she meets the patient and follows her from then on. She empowers patients through education so they’re able to participate in decision-making about their care and treatment, which is very important. Meiling also provides emotional support to patients throughout their journey.”
“Meiling is an oncology nurse by training, so she has a wealth of experience in working with patients as they deal with a wide range of emotions following a cancer diagnosis,” says Jana Deitch, MD, FACS, Medical Director of Breast Health Services at St. Catherine of Siena Medical Center. “She facilitates our support groups and is always available to answer patients’ questions. She connects with patients on a different level, more like a friend than a medical provider.”
Diana Yoon-Schwartz, MD, PhD, FACS, Administrative Director of Reconstructive Microsurgery at St. Catherine of Siena Medical Center, says Alsen’s willingness to take extra steps to provide patients with peace of mind makes her an invaluable member of the breast health team.
“Meiling holds patients’ hands in the radiology suite if they’re nervous about an imaging exam or escorts them from one office to another on our campus to make appointments less stressful,” Dr. Yoon-Schwartz says. “She does it all with compassion. That’s what makes her amazing.”
If a patient’s biopsy results are abnormal, Dr. Green notifies her primary care or referring physician and helps her schedule an appointment with Dr. Deitch, a breast surgeon, to discuss surgical options. Drs. Deitch and Green, along with the rest of the Breast Health Program’s multidisciplinary team, meet twice monthly at a breast cancer tumor board to discuss all newly diagnosed cases.
“The group reviews each patient’s clinical history, radiology studies, pathology and treatment options to develop an individualized plan of care,” Dr. Green says. “We share that plan with all specialists involved in the individual’s care, including medical oncologists and radiation oncologists.”
“We take time to get to know our patients. Whether at a screening mammography appointment, a consult with the breast surgeon or breast reconstruction surgeon, or support group meetings years into a patient’s survivorship, everyone on our team is involved with each woman’s care and takes a deep interest in her well-being.”
— Jana Deitch, MD, FACS, Medical Director of Breast Health Services at St. Catherine of Siena Medical Center
Jana Deitch, MD, FACS, Medical Director of Breast Health Services at St. Catherine of Siena Medical Center, consults with a patient.
Surgery to remove all or a portion of the breast is integral to treatment for most breast cancer patients. Patients will meet with Dr. Deitch for a consultation either before undergoing a biopsy or after the biopsy once they have a diagnosis.
“Once a patient has been diagnosed, I spend more than an hour with her to review the imaging and what prompted the biopsy, what the pathology showed, and what it means to have breast cancer,” Dr. Deitch says. “We also talk about the treatment algorithm and surgical options, as well as whether additional imaging, genetic testing or consultations with other specialists are warranted.”
Dr. Deitch or the multidisciplinary group may determine a patient would benefit from treatment prior to surgery and refer her to a medical oncologist or radiation oncologist. The patient may also meet with Dr. Yoon-Schwartz to discuss breast reconstruction options before undergoing lumpectomy or mastectomy.
“We can perform oncoplastic reconstruction after lumpectomy, which is closure of the surgical cavity in a way that doesn’t leave an empty space in the breast,” Dr. Deitch says. “I use a patient’s own breast tissue to fill the defect left by the removal of a tumor. That prevents the skin from dimpling, so the look and shape of the breast don’t change.”
Oncoplastic surgery is a key differentiator for the Breast Health Program. Standard closure following lumpectomy can result in long-term cosmetic problems, according to Dr. Deitch.
“In our program, we pay significant attention to outcome and cosmesis,” she says. “A patient may not think the appearance of the breast is important at the time of surgery — her chief concern may be removal of the cancer — but in five years, she may feel differently.”
Experienced radiologic technologists provide personalized care for patients using 2D digital mammography and digital breast tomosynthesis, also known as 3D mammography.
A Spectrum of Breast Reconstruction Procedures
Breast reconstruction after mastectomy has well-documented potential to improve patients’ self-confidence and reduce the emotional upheaval of losing a breast, but Dr. Yoon-Schwartz believes it sometimes gets overlooked amid other aspects of cancer care, such as surgery and chemotherapy.
“Breast reconstruction makes patients whole again,” she says. “People sometimes forget the psycho-emotional challenges of breast cancer, and how feeling physically complete can play a role in fighting the disease. We know the immune system is an important component of combating cancer. Studies at the basic science level have shown that excessive amounts of chronic stress can promote the progression and spread of certain cancers. The benefits of breast reconstruction potentially include improved body image, self-esteem, well-being and a possible survival advantage. If a patient has reconstructive surgery and it makes her feel better, then it may improve her body’s ability to fight cancer.”
Drawing on her background in the molecular genetics of cancer and carcinogenesis, Dr. Yoon-Schwartz individualizes reconstructive planning for patients during presurgical consultations by making recommendations based on cancer type and the probable plan of treatment, including adjuvant therapies, such as chemotherapy or radiation therapy.
“Each patient’s care plan is carefully considered and customized,” Dr. Yoon-Schwartz says. “I provide personalized care and guidance based upon the specifics of each individual case, and I inform each patient about the options, timing, benefits and risks of reconstruction.”
St. Catherine of Siena Medical Center’s Breast Health Program team offers supportive services in a compassionate environment, close to home.
Dr. Yoon-Schwartz has incorporated many recent advances in breast reconstruction into her repertoire, including autologous tissue transfer procedures, which use the abdomen, buttocks, thigh or back to aid in reconstruction of the breast. Certain free tissue transfer procedures, such as the DIEP flap, involve microsurgery, a technique that allows the surgeon to reconnect the blood vessels of transferred tissue using operating microscopes and specialized instruments. Dr. Yoon-Schwartz performs microsurgery, which allows the patient to have the options of advanced, specialized procedures available locally without travel.
“For certain patients, I perform the Goldilocks procedure, which is an immediate, autologous, single-staged breast reconstruction procedure that uses the redundant skin and subcutaneous fat from the lower pole of the breast to form a natural breast mound without the use of implants,” Dr. Yoon-Schwartz says. “I also offer autologous fat grafting, which uses fat taken from another part of a patient’s body to enhance reconstruction and sometimes as a primary option for certain select patients.”
Autologous tissue reconstruction is not appropriate for all patients, and reconstruction with implants remains the most common type, according to Dr. Yoon-Schwartz.
“Two significant advances in breast reconstruction are the types of implants and the methods we use to place them,” Dr. Yoon-Schwartz says. “Cohesive gel implants — gummy bear implants — which were FDA-approved in 2012 and are made of highly cross-linked silicone gel, are stronger and cause less rippling than noncohesive silicone implants. Techniques for placing implants have also come a long way. Instead of always putting implants under the muscle, we can now place them over the muscle in select cases using pre-pectoral breast reconstruction techniques.”
As breast reconstruction continues to evolve, Dr. Yoon-Schwartz and her colleagues in the Breast Health Program are committed to staying on the forefront of the field.
Dr. Yoon-Schwartz’s commitment to innovation also includes Exparel.
This medication is a nonopioid analgesic, which is injected at the time of surgery to manage postoperative pain following a variety of procedures. Exparel hastens good recovery by providing lasting non-narcotic pain relief. That is especially important for cancer patients who have had multiple procedures and may have a higher pain burden, according to Dr. Yoon-Schwartz.
“I’m proud to be part of an exceptional group of compassionate breast health specialists who serve patients from one location in their own community, where they are most comfortable receiving care.”
— Anne Green, MD, Medical Director of Breast Imaging at St. Catherine of Siena Medical Center
Siena Women’s Health’s Breast Health Services is staffed by board-certified physicians and clinicians providing personalized care from start to finish.
Plans for Expansion
The Breast Health Program has enjoyed significant growth in recent years, as more patients and referring physicians have become aware of everything it has to offer. To keep up with that trend, the breast health team plans to extend services to Commack in the near future (see sidebar “Coming Soon: Breast Health Services in Commack”) and incorporate cutting-edge localization for identifying tumors prior to biopsy, tomosynthesis biopsy and advanced surgical techniques.
“We’re doing the latest, most innovative things right here in Suffolk County, and the care patients receive here is as good as, if not better than, what’s available in Manhattan,” Dr. Yoon-Schwartz says. “It’s important for referring physicians to know that a team of well-trained, compassionate breast health specialists can care for their patients close by, with excellent outcomes.”
Siena Women’s Health will be expanding Breast Imaging Services at 500 Commack Road in Commack.
Visit stcatherines.chsli.org for additional information about the Breast Health Program.