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Monday, March 29, 2021

Taking Control of Her Health

Posted By: Advancing Care
Breast tumor
Amanda Crumley at home with her husband, David, and boys Mason, 10, and Hunter, 3. Photos by John Halpern

A mother of two takes preventive measures by undergoing breast tumor removal and reconstruction in a single surgery.

As seen in the May 2021 Issue of Advancing Care.

With a family history of breast cancer, Amanda Crumley, of Bethel, NY, made sure that she continued her annual mammograms and didn’t delay her care.

When her radiologist found an unusual mass in her left breast, she was referred to Miriam David, MD, Director of Women’s Imaging at Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth), who performed a needle biopsy to examine the cells of the mass. Thankfully, it was not found to be cancerous.

While she was advised to monitor the tumor for changes with consistent follow-up, the possibility that the tumor could one day become malignant weighed heavily on Crumley, age 42. “I have seen too many young moms die from breast cancer,” she explains.

Crumley consulted with Maria Castaldi, MD, Chief of Breast Surgery at Westchester Medical Center.

While not cancerous, there was a “possibility there could be a carcinoma that is not diagnosed by needle sampling but is associated with this type of lesion,” says Dr. Castaldi.

In consultation with Dr. Castaldi, Crumley — a mother of two young boys — decided to take a proactive stance and, despite the pandemic, undergo a combined surgery to remove the lesion.

I had a lot of anxiety and stress and when I found out I had a tumor. Even though it wasn’t cancerous, I didn’t want to take a wait-and-see attitude, as it could change. My surgeons supported me in this. Educate yourself on your options. It’s a hard decision, and it can be scary to have surgery. Don’t be afraid to be proactive — you only have one life. Know that there are options.
— Amanda Crumley

“I wanted to beat it before it got to me,” says Crumley, citing her family history. “I said ‘Whatever I need to do, let’s get it done.’”

Because of the size of the mass in Crumley’s breast, Dr. Castaldi explained that there was no guarantee that the breast would maintain its original shape and form after the surgery. While new treatments are resulting in more favorable outcomes for many of the 250,000 new cases of breast cancer diagnosed each year, postsurgical concerns about body image remain, Dr. Castaldi says.

“Many women are choosing preventive surgeries, particularly if they have the BRCA gene mutation, which indicates they have inherited an increased risk of developing breast cancer,” she says. It’s estimated that more than half the women with the BRCA1 or BRCA2 gene mutation will develop breast cancer before age 70. They also have an increased risk of getting cancer at an early age.

For these women, says Dr. Castaldi, as well as others undergoing surgery, breast reconstruction is high on their list of concerns. She therefore brought in Kaveh Alizadeh, MD, Chief of Plastic and Reconstructive Surgery at WMCHealth, for a joint consultation with Crumley.

Together, they decided that Dr. Castaldi and Dr. Alizadeh would work side by side to perform a combined surgery to remove the tumor and reconstruct her breast. (See below.)

“The advantage of two surgeries at once is that the patient gets a complete treatment for diagnostic, curative and reconstructive management,” says Dr. Alizadeh. WMCHealth’s coordination of care across the Network allows multiple experts to “participate in the care of the patient at the same time.”
Crumley says that she is grateful to Westchester Medical Center and the team, and extremely pleased with the outcome of her surgery. “I definitely made the right choice for me. It’s 100 percent worth the relief. You’re going to be okay with the team at Westchester Medical Center.”

What to Expect: Minimal Trauma, Maximum Results

According to Dr. Castaldi, breast surgery becomes a cooperative procedure with the breast surgeon and the plastic surgeon. The goal is to remove the tumor and preserve the structure and form of the breast without increasing risk or compromising the success of cancer treatment.

With Crumley, the dual procedure allowed Dr. Castaldi to remove enough breast tissue to make sure the entire lesion was excised. Once Dr. Castaldi removed the tumor, Dr. Alizadeh then performed a reduction and lift on Crumley’s right breast and used the tissue to reform her left breast so that both breasts were uniform and symmetric and most closely resembled her native breast. In doing so, Dr. Alizadeh was able to not only reconstruct the defect but also lift and symmetrize her breasts, for an enhanced outcome.
“Six or seven hours later, I woke up with a lot of stitches,” says Crumley. “But I would do it again in a heartbeat because I have two small children.”

For more information about Women’s Imaging at Westchester Medical Center, please visit westchestermedicalcenter.org/womens-imaging-center. For services elsewhere at WMCHealth, call 914.493.2500 (Valhalla), 845.334.3088 (Kingston), 845.431.8776 (Poughkeepsie), 845.368.5900 (Suffern) or 845.988.9905 (Warwick) to make an appointment.