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Topic: Any Recommendations for Surgeon in Philadelphia Area?

Forum: LCIS (Lobular Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for LCIS.

Posted on: Jan 15, 2015 02:43PM

phillydonna wrote:

Was diagnosed in 2013 with LCIS. Went through mammos, stereotactic and one surgical biopsy (right breast). This year, more LCIS and now in both breasts. Went through another round of mammos, ultrasound, MRI and stereotactic (both breasts). This was in Chester County Hospital through the VA. In December, went to Sloan Kettering for 2nd opinion with a doctor who researches LCIS. She has recommended surgical breast biopsies on both breasts to rule out cancer. My original surgeon only wanted to do surgery on one breast.

I would like to have this surgery and care closer to my home. Can anyone recommend a GREAT surgeon and team in the Philly area? I really would appreciate it.

This forum has been so helpful in knowing that there are others who are going through what I am. It has been difficult trying to explain LCIS to anyone! Never mind getting my head wrapped around it!

Thanks in advance!

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Jan 15, 2015 02:48PM Moderators wrote:

There are so many in the Philadelphia area, but posting only because the President and Founder of Breastcancer.org, Dr. Marisa Weiss, is a radiation oncologist at Lankenau Hospital (part of Jefferson Health). You may want to contact her team with whom she works. However, like we said, Philadelphia has great options!


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Jan 15, 2015 03:52PM phillydonna wrote:

Wow, the founder. Awesome! I know there are lots of options in Philly, that is why I am reaching out to the community. I'm not only looking for a great surgeon but opinions on the facility and care received during and after surgery.

Thanks for the recommendation!

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Jan 15, 2015 04:19PM krisnanbrandy123 wrote:

dr dahlia Sataloff

BRCA 1 pos. Surgery 7/8/2013 Prophylactic ovary removal Surgery 4/16/2014 Prophylactic mastectomy: Left, Right
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Jan 15, 2015 04:46PM Janetanned wrote:


Dr Sataloff has a great reputation!  She is associated with Pennsylvania Hospital, which is part of the U of Penn Health System.  I used Dr Brian Czerniecki at Penn.  He and his team were terrific.  He ordered an MRI on my 'good' side because he didn't believe the mammogram results.  The MRI found ILC.  My plastic surgeon at Penn was Dr. Steven Kovach.  He was also very good.  My overall experience at Penn continues to be very good and I would recommend Penn without reservation.

Janet 11/10/11 BMX/DIEP reconstruction, 1/6/12- 4 AC DD followed by 4Taxol DD, followed by 33 rads, 10yrs hormone blocker Dx 10/11/2011, ILC, <1cm, Stage IIIA, 4/30 nodes, ER+/PR+, HER2-
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Jan 15, 2015 06:03PM tgtg wrote:

I live in eastern Chester County and chose to remain suburban and local rather than go into Philadelphia for treatment. Dr. Scott Kripke was my surgeon at Paoli Hospital (in the Main Line Health system). I was fortunate to be able to choose Dr. Marisa Weiss at Lankenau (also part of Main Line Health) as my radiation oncologist! An A-1 team as far as I am concerned--couldn't be happier (well, like everyone here, of course, I would have been even happier to not have gotten the b.c. diagnosis at all)!

71 at diagnosis, Oncotype #, 12 Dx 12/21/2012, IDC, Right, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 1/7/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 3/18/2013 Whole-breast: Breast
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Jan 16, 2015 03:42AM Janetanned wrote:


I forgot to mention that Penn has satellite facilities in the suburbs that are beautiful.  Some on this board have used Penn at Valley Forge for office visits and chemo/radiation.  This facility is right off of RT 202, not too far from the King of Prussia Mall.  My daughter sees her GP there and is very satisfied with the care she receives.  I see some drs at Penn at Radnor.  The pharmacy is very convenient for me. 

Janet 11/10/11 BMX/DIEP reconstruction, 1/6/12- 4 AC DD followed by 4Taxol DD, followed by 33 rads, 10yrs hormone blocker Dx 10/11/2011, ILC, <1cm, Stage IIIA, 4/30 nodes, ER+/PR+, HER2-
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Jan 16, 2015 07:43AM marketingmama wrote:

I was just diagnosed with LCIS (found after a breast reduction/lift) and live in the Philadelphia suburbs. I made the decision to call the University of Pennsylvania though there are lots of great facilities closer to home (Crozer Chester Hospital, Bryn Mawr Hospital, Lankenau). I had a friend just treated for breast cancer at Penn and she couldn't say enough good things about her care. So went to the Rena Rowan Breast Cancer Center, which his part of the Abramson Cancer Center: http://www.pennmedicine.org/providers/practice/rena-rowan-breast-center. I saw Carla Fisher for my first appointment. She is a surgical oncologist. I really liked her but it's early on. She explained LCIS, my risks and ordered an MRI of my breasts as a next step. Once we see what that shows, we'll make more decisions about follow up.

I'm confused as to why your doc recommended biopsies since LCIS usually shows up randomly -- it's diffuse---and not in precise locations. My doc says, "we are not looking for more LCIS in your MRI" (since they know I have LCIS already), "we are looking for abnormalities that indicate the presence of more concerning (ie, cancerous) lesions."

Dx 12/2014, LCIS, Both breasts, 0/5 nodes Surgery 5/19/2015 Lymph node removal: Left, Right, Sentinel; Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/23/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/18/2015 Reconstruction (right) Surgery 11/29/2015 Reconstruction (right) Surgery 2/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 16, 2015 09:35PM leaf wrote:

Hmm, from what I've read, I wouldn't describe LCIS as 'diffuse' or 'not in precise locations'.

Before about 1990, a common treatment for LCIS was bilateral mastectomies, so they could look at the mastectomy specimens. This paper opines that Characteristically, LCIS is multifocal and bilateral in a large proportion of cases. Over 50% of patients diagnosed with LN contain multiple foci in the ipsilateral breast and about 30% of cases will have further LCIS in the contralateral breast [12-14] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC314428...

Foci means area, and multifocal means there are usually several areas of LCIS in a breast.

This reference has some photos at the bottom. http://www.pathologyoutlines.com/topic/breastmalig... I wouldn't call them 'diffuse' or 'not in precise locations'. They usually don't show up in imaging, so LCIS is usually an incidental finding on a biopsy done for other reasons, but they do occur in precise areas. We normally can't see them with our naked eye (as when the surgeon operates on a breast). With our present state of diagnosis, we only know where these precise LCIS areas are after we remove the tissue and look at them under the microscope.

ILC (invasive lobular carcinoma) often occurs in sheets, as opposed to IDC (invasive ductal carcinoma), which often forms lumps. ILC occurs in roughly 15% of the general population, but in women with LCIS who go on to get breast cancer, the % is higher than that, but less than 50%. (Different studies claim different numbers).


Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 17, 2015 12:58PM awb wrote:

marketmama----I think phillydonna's doctor is recommending surgical excisional biopsies since more LCIS was found; not because of the LCIS itself, but to make sure there is nothing more serious in there along with it, like DCIS or invasive

LCIS is thought to be a bilateral disease; it often is found to be multifocal and multicentric, which means it can be diffusely scattered throughout both breasts. They have never found any more LCIS during my close monitoring, but I just assume that I have it, probably in many spots. If they ever do detect anymore, I assume I will undergo another surgical excisional biopsy to rule out any invasive cancer or DCIS.


Anne

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/16/2003 Lumpectomy: Right Hormonal Therapy 10/30/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/5/2005 Prophylactic ovary removal Hormonal Therapy 2/28/2009 Evista (raloxifene)
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Jan 19, 2015 06:41AM marketingmama wrote:

Anne, you just described what I meant when using the word diffuse!

I guess I'm wondering why no one wants to do an excisional biopsy on me then. They found LCIS in a few places in one breast after a small breast reduction (so not a lot of tissue). Would they wait to do something like this until after my MRI? Thanks for the advice/thoughts!

Dx 12/2014, LCIS, Both breasts, 0/5 nodes Surgery 5/19/2015 Lymph node removal: Left, Right, Sentinel; Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/23/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/18/2015 Reconstruction (right) Surgery 11/29/2015 Reconstruction (right) Surgery 2/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 19, 2015 09:05AM leaf wrote:

An MRI may show some 'suspicious areas' that they may want to excise. Obviously, they want to arrange it so if you have an excision, you only have to have one surgery, not several.

In addition, almost everything about LCIS is controversial.

For example, this paper says not all LCIS areas may need to be excised. If they are ' strictly concordant' they do not. http://www.ajronline.org/doi/full/10.2214/AJR.07.3... In the case cited in the abstract, it sounds like since a spiculated mass is a high-risk mammographic finding, this is discordant with a LCIS diagnosis; they would want to do an excision to make sure there is not something worse going on. This is just one author's opinion; other papers opine that all known LCIS spots need to be excised.

Here is a website that gives you some idea about how they classify breast MRIs http://www.radiologyassistant.nl/en/p47a585a7401a9... and BIRADS http://www.radiologyassistant.nl/en/p53b4082c92130/bi-rads-for-mammography-and-ultrasound-2013.html

Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 19, 2015 08:59PM awb wrote:

marketingmama------they probably are not recommending further excisional biopsies since you've essentially already had them, by having the breast reductions. (rather than removing tissue surrounding the suspicious area AFTER the initial finding of LCIS, they removed the tissue BEFORE during the breast reductions) and since they did not find any invasive bc or DCIS, there is no need to remove more tissue. The MRI is probably just precautionary. Praying nothing more serious is found.

Anne

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/16/2003 Lumpectomy: Right Hormonal Therapy 10/30/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/5/2005 Prophylactic ovary removal Hormonal Therapy 2/28/2009 Evista (raloxifene)
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Jan 20, 2015 12:21PM marketingmama wrote:

Thanks Anne. Appreciate the good wishes. I'm not really sure about how much more LCIS there could be since of the tissue they removed, they only found LCIS in one breast. Additionally, I didn't have that much removed to begin with. Went from a D to a C on one side and from a large C to an average C on the side where they found the LCIS.

Oh well, guess we'll see what happens once I have the MRI.

Leaf, great info. Nothing like lack of concurrence on this issue. Ugh!!

Dx 12/2014, LCIS, Both breasts, 0/5 nodes Surgery 5/19/2015 Lymph node removal: Left, Right, Sentinel; Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/23/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/18/2015 Reconstruction (right) Surgery 11/29/2015 Reconstruction (right) Surgery 2/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 20, 2015 01:14PM phillydonna wrote:

Hi All,

Thanks for the recommendations and information, it's good to hear what others experiences are. And yes, they want to do the surgical biopsies to make sure there is nothing else but LCIS in there.

Now on to finding a doctor for the biopsies (sigh).

 


 

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Jul 25, 2019 10:02AM PhillyRae wrote:

I see this is an old thread but have the same question- any recent recommendations for a specific surgeon or breast specialist in the Philly area? I just came back home from a pretty awful experience with Main Line Health at Lankenau Medical Center. I can handle poor service but I was appalled about the lack of communication between the radiologist, surgeon and doctor. I'm hoping I can find both a great doctor but also a better system that gives doctors access to my information.

Alternatively, how does one research this sort of thing? I see that Penn is among the top 12 hospitals for cancer so am thinking their Rena Rowan Breast cancer is my best bet.... but without friends referrals (I'm new to Philly) and/or data, I'm not sure where to look. I've never been so disappointed in google. But it has brought me here so am hopeful!

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Jul 25, 2019 11:21AM Moderators wrote:

Dear PhillyRae,

Welcome to the BCO community. We are sorry about your diagnosis but glad that you reached out for some help. As this is an older thread it might be more helpful if you try to send a private message to a member on this thread who is still active in the community. You can click on a member's name and it will take you to their page and a place to send a pm. You can also use the search function and use the word Philadelphia. It will take you to other members and topics that use that word in their posts. Let us know how we can be of further help. Here is a link to a page on our main site about Where to go when seeking a second opinion.

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Jul 25, 2019 11:51AM Janetanned wrote:

I have had all of my cancer treatment at PENN. I was very happy with how I was treated by all of my doctors and staff at the hospital. I was offered many options for treatment and participation in studies. I can't recommend a specific surgeon since mine left the system a number of years ago to head a cancer center in Florida. My RO was Dr Gary Freedman (highly recommended), my MO is Dr Jennifer Matro (also highly recommended), and my PS was Dr Stephen Kovach (highly recommended). I saw Dr Susan Domchek for genetic screening.

Keep in mind that The Perlman Center (Rena Rowan/PENN) is an urban setting with all of the issues that come along with an urban setting - traffic, parking, very large, etc. If this a problem, Penn has a number of suburban settings. I'm familiar with their Valley Forge, and Radnor settings, both of which are very nice. I work for the PENN Health system so i am somewhat biased, but I would have sought treatment at PENN or Jefferson if I did not work for PENN. Both are excellent in my opinion.

Janet 11/10/11 BMX/DIEP reconstruction, 1/6/12- 4 AC DD followed by 4Taxol DD, followed by 33 rads, 10yrs hormone blocker Dx 10/11/2011, ILC, <1cm, Stage IIIA, 4/30 nodes, ER+/PR+, HER2-
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Jul 25, 2019 12:13PM Betrayal wrote:

I will second Janetanned's recommendation to go to PENN if you want coordinated breast care. You need a system with a communication system that works between all sites. Plus you have a larger pool of physicians to choose from to find a good fit.

Dx 1/7/2016, DCIS/ILC/IDC, Left, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 2/1/2016 Lymph node removal: Sentinel Surgery 2/1/2016 Lumpectomy: Left Surgery 3/4/2016 Lumpectomy: Left Radiation Therapy 3/31/2016 Whole-breast: Breast Hormonal Therapy 6/25/2016 Arimidex (anastrozole) Hormonal Therapy 5/19/2017 Femara (letrozole)
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Jul 25, 2019 12:40PM Mavericksmom wrote:

I went to Fox Chase Cancer Center, because I had gone through their Risk Assessment program in 2004 after my first time with breast cancer.

Here is the pros and cons.

Pros first:

Hospital billing, while slow, no worry (or at leas a lot less worry) that someone on your team won't take your insurance.

Always a well qualified doctor available, no matter what the area of cancer.

The teams really DO communicate with each other.

Clean facility.

In a quiet neighborhood, and has ample free parking (2 parking garages) Also indoor patient drop off area.

Staff is super friendly

They have mental support, which I used, a wonderful social worker, Denise! She was awesome and helped me more than I can say!


Cons: If you want a BMX and are not BRCA positive, go elsewhere. Even having breast cancer twice and coming from a family where my mother, two of three sisters and a cousin on my mom's side were diagnosed with breast cancer, because I was BRCA neg. my surgeon (Dr. Daly) refused to remove my "healthy" breast. I am still struggling with that and regret I didn't go elsewhere for a second opinion. In the end, the decisions we make are ours.

That said, my doctors have been very good, but I had my ups and downs with some. I really like Dr. Whitaker, my MO. I have been referred to other doctors there for gastroenterology and I am having a new Risk Assessment done since things have greatly changed since 2003, but I won't see them until August/October.

They do use NP's and PA's and don't give notice that you are seeing one of those and not a doctor. I don't know why they aren't up front about it because I had a wonderful NP when I went for my pre-biopsy appointment and I had a PA for most of my post surgical PS appointments, also well qualified. In other words, I was happy with the care, but felt I should have been told when I would see a PA or NP instead of the doctor. All appointments list as if you are seeing the doctor.

The billing is antiquated, no online or telephone payment system.

Some of the schedulers are not the greatest and have made mistakes that I thankfully caught before they caused a problem.

I don't think anywhere is 100% great. To those who have had 100% awesome experiences somewhere, I say great, but I don't think that is the norm.


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