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The Hidden Scar Advantage


Cutting-edge breast cancer surgery places Touro at the forefront of the Gulf South region.


In 1923, Touro was one of only 15 hospitals in the country approved to use insulin for diabetes. And, Touro was one of the first hospitals in the United States to unveil a physical therapy department.

Now Touro is the only hospital in the Gulf South region to combine the precision of radioactive seed surgical guidance with the remarkable results of Hidden Scar breast cancer surgery.

John Colfry, M.D. — who was fellowship-trained at MD Anderson Cancer Center in Houston — is a breast surgical oncologist pioneering the procedure in the area. Dr. Colfry says that only the largest cancer treatment centers in the country are offering this technology. But with Touro’s vision for progressive medicine and Dr. Colfry’s extensive leg work, the surgical advances are available right here in New Orleans. 

“It’s simply better surgery with more accurate outcomes,” says Dr. Colfry. “It’s the future of breast surgery.”

What is radioactive seed surgical guidance (breast seed localization)?

Breast seed localization is a procedure performed by a radiologist the day before a lumpectomy. A tiny metal seed, about the size of a grain of rice, is inserted into abnormal breast tissue using a mammogram or ultrasound to guide its placement. The seed, implanted by Touro radiologist, Dan Rupley, M.D., contains a small amount of radiation, which Dr. Colfry uses like a GPS during breast surgery. A special probe picks up the signal of the seed, giving him 3-D spatial relationship feedback to help accurately remove the cancerous tissue and a small healthy margin area around the cancer.

ADVANTAGES: Dr. Colfry says that nationally, about 20 percent of lumpectomies require a second surgery to confirm a margin of tissue that is cancer-free. At Touro, that number is less than 5 percent. “That’s the most important thing,” he says. “Our re-excision rate is so low. The seed is much more precise.”
Oncologists who don’t use the seed instead place a wire in the patient’s breast to indicate the cancer’s location. “The woman goes in to surgery with a wire hanging out of her,” Dr. Colfry says. “It’s Stone Age technology — not very sophisticated.”

Wire localization consumes operating room time, elevating costs. In addition, the wire doesn’t offer the same precision. “While I am operating, the seed is constantly giving me real time feedback on cancer location,” Dr. Colfry says.

What is Hidden Scar surgery?
Hidden Scar surgery involves an advanced surgical approach using a highly specialized retractor that gives surgeons trained in its use the ability to remove underlying breast tissue through a single incision. The use of one incision, frequently at an increased distance from the tumor, preserves the nipple, the areola and breast skin, and it results in a less-visible scar line.

There are two main types of Hidden Scar surgery:
The Hidden Scar Lumpectomy allows the incision to be concealed in areas of the breast that are cosmetically inconspicuous. Even if the cancer is distant from the incision, the Hidden Scar precision retractors allow surgeons to tunnel to reach the cancerous tissue. “We then remove these tiny specimens … very precise, so we’re not disturbing the native, healthy tissue,” Dr. Colfry says.

Hidden Scar Nipple-Sparing Mastectomy uses the natural crease where the breast meets the abdomen to remove the underlying breast tissue. The areola and nipple are unaffected.

ADVANTAGES: With Hidden Scar surgery, surgeons can preserve a natural-looking breast. No scars are visible on the main portion of breast tissue. Hiding the scar may also ease the emotional impact of breast cancer surgery, and less visible scarring means a more natural-looking breast after reconstruction.

Who can have Hidden Scar surgery?
From Dr. Colfry’s perspective, nearly everyone with a smaller, lower-staged cancer is eligible for the surgery.
“When I see new cancer patients, they are petrified, which is totally understandable,” he says. “My job is to help educate the patient on lumpectomy versus mastectomy.” He feels strongly that mastectomy can be overkill. “I achieve excellent cancer control with lumpectomy,” Dr. Colfry adds. “We don’t need the knee-jerk reaction that the whole breast has to be removed. For many patients, that’s not the right answer.”

For a patient with a large, advanced-stage cancer, mastectomy may be indicated. Also, a woman testing positive for breast cancer predisposing gene mutations (thereby increasing breast cancer chances) is also more likely to be a traditional double mastectomy candidate.

But for women with a small cancer who feel a full mastectomy automatically means a better outcome, Dr. Colfry is quick to explain that there is no benefit in survival or recurrence in removing more breast tissue preventatively.

What is the ultimate Touro difference?
“It’s more of a family atmosphere here,” Dr. Colfry says.
More importantly, his collaborative work with Dr. Rupley means there’s a multidisciplinary team working on every surgery. “I don’t perform a case without talking to him,” Dr. Colfry says. “That communication is a key to our re-excision rate being so low. He and I are very methodical; very thorough about every step of the process. That is the approach patients deserve.” touro.com/cancer/hidden-scar