Feature

Breast Surgery Without a Trace

New Technique Uses Minimally Invasive Approach to Hide Scars 

During her annual physical examination in November 2019, Glennette Poland’s nurse practitioner found something in Poland’s breast that concerned her. 

“Feel this,” she said to Poland, 62, who lives in Mount Jackson. 

“I had to push really hard to feel it,” says Poland, “but it was there.” 

Poland was afraid—she’d had thyroid cancer six years previously. Although she had beaten the cancer, she didn’t care to repeat the experience. 

“The hardest part about the diagnosis was telling my husband and kids, because of the previous cancer,” Poland says. “It was hard for them. At that point, I didn’t know what stage it was—just that it was cancer.” 

As it turned out, Poland’s experience with breast cancer was much less difficult than she feared, thanks to the care and expertise of her surgeon, Shannon Tierney, MD, and the staff at Sentara RMH Funkhouser Women’s Center. 

Poland’s Treatment Journey

A few days after Poland’s mammogram, an ultrasound at the Women’s Center revealed a mass in her breast. The radiologist arranged for Poland to get a biopsy later that day. 

The call came two days later when she was at work at Generations Crossing in Harrisonburg. A nurse colleague accompanied her to a quiet room, where she learned her diagnosis of stage 1 invasive cancer. 

“That was a shock,” says Poland. “I had no clue. There was no history of breast cancer in my family.” 

During that call, a breast cancer patient navigator at the Women’s Center talked with Poland about what her next steps should be. First up was an appointment with the breast care surgeon, Dr. Tierney. Later she would consult with an oncologist, a genetic counselor, a dietitian and a family therapist. 

Dr. Tierney told Poland that removing her tumor would require a partial mastectomy—what most people call a lumpectomy. 

“She took her time with me, showing me drawings of everything,” Poland says. “She’s such a compassionate person.” 

When Poland met with the genetic counselor, she learned that her surprise at the diagnosis was well founded—there was no genetic cause for her cancer. 

Poland’s procedure was scheduled for Dec. 4. Since it was an invasive-type cancer, she was also scheduled for chemotherapy and radiation treatment. 

A few days before surgery, a radiologist inserted a radar device called a Savi Scout into Poland’s breast, so the surgeon would be able to locate the tumor easily in the operating room. 

“Using the device helps to shorten the surgery,” explains Dr. Tierney, “which is much nicer for patients.” 

Just before the operation, the anesthesiologist asked Poland if she would like to listen to music. Poland responded that she liked the Doobie Brothers. And just like that, as she was taken into surgery, Poland was listening to her favorite band. 

The surgery took almost three hours, during which Dr. Tierney also removed three lymph nodes. All were clear of cancer. 

One of the most interesting aspects of Poland’s surgery was the technique Dr. Tierney used, known as minimally invasive surgery with a hidden-scar approach. In this technique, the surgeon makes the incision around the patient’s areola. Remarkably, no visible scar remains after the incision heals.

Poland was very pleased with the care she received at the Women’s Center, as well as the outcome of her procedure.

“I can’t say enough about how kind, caring and supportive they all are,” she says.

Hidden Scars

Minimally invasive surgery involves smaller incisions, so it’s generally considered safer than open surgery. Patients often recover more quickly, spend less time in the hospital and feel more comfortable while they heal.

Using minimally invasive breast surgery, Dr. Tierney uses smaller incisions and specialized instruments to minimize external scarring, as well as oncoplastic approaches to rearrange the breast tissue to repair defects or dents. 

About 95% of Dr. Tierney’s lumpectomy and biopsy patients are eligible for minimally invasive surgery using the hidden-scar approach, Dr. Tierney says. The only patients who aren’t eligible are those who have had prior surgery in the breast area, or whose cancers are close to the skin surface. 

“Even the size of the tumor doesn’t matter quite as much, because oncoplastic surgery is so much better than it used to be,” Dr. Tierney notes. “As long as the cancer is in only one place and the breast is large enough in relation to the tumor, we can take advantage of this new approach.”

In addition to hiding scars along the edge of the areola, surgeons also can locate them out of sight under the breast or in the armpit, where the patient already may be getting lymph nodes removed. 

“I had an elderly patient who initially told me she wasn’t concerned about scarring,” recalls Dr. Tierney. “After her surgery, however, she was actually very pleased that she had no scarring.” 

Dr. Tierney says she finds it fulfilling to offer such options to women here in the Valley. Before she started her practice at Sentara RMH in August 2019, she worked for 10 years at a large hospital system in Seattle where there was little opportunity for employing new surgical techniques.

Another Patient’s Experience with the Hidden-Scar Approach

Sandra Dean learned she had breast cancer following a routine mammogram last July. By the end of the month, she had been to the Sentara RMH Imaging Center for a diagnostic mammogram, had a biopsy, been diagnosed with stage 1 breast cancer and been scheduled for surgery.

Dean was one of Dr. Tierney’s first patients at Sentara RMH.

“Dr. Tierney said she was going to use a new type of minimally invasive surgery on me,” says Dean, 73.

Like Poland, Dean had a tiny radar device implanted in her breast, so the surgeon would know exactly where to find the tumor. As is usually the case, her partial mastectomy was performed as outpatient surgery, so Dean was back home resting later the same day. 

After her surgery, however, Dean began experiencing a buildup of fluid. She called the Women’s Center, only to learn that Dr. Tierney had already left for the day. 

“But a little while later, I got a call,” Dean says. “They told me Dr. Tierney had come back in to drain the fluid. She was very accommodating.” 

After she recovered from the surgery, Dean began radiation treatments in October. When she got on the table to prepare for her first treatment, the nurse was unable to see the scar from her breast surgery. 

“It’s just at the edge of the areola, so it blends right in,” Dean says. 

Dean says her total experience at Sentara RMH was very satisfying. 

“Everyone at the Funkhouser Women’s Center—from the receptionist to the technicians—was so pleasant,” she says. “Their positive attitudes helped me feel less anxious.”

Dean is happy with her results and recovery. Since her surgery, she has continued with her ballroom dancing classes. 

“I didn’t miss one week,” she says. 

Patient-Centered Breast Care

Dr. Tierney offers Sentara RMH patients a range of treatments for breast cancer. After hearing their options, patients get to choose what’s best for them based on their priorities, lifestyle, insurance, finances and what “feels right to them,” Dr. Tierney says. 

If a woman is fearful of a particular treatment, such as radiation, Dr. Tierney usually can offer another option. And for women who fear that lumpectomy will cause a defect in their breast, minimally invasive surgery with the hidden-scar approach can help alleviate those concerns. 

“I want these women to be able to look at themselves years later in a dressing room and not even remember they had breast surgery,” says Dr. Tierney. “With the hidden-scar approach, there’s no constant reminder of what they went through.”

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Meet Dr. Shannon Tierney

Sentara RMH breast surgeon Shannon Tierney, MD, MS, FACS, is a graduate of the Washington University School of Medicine in St. Louis, Mo. After completing her general surgery residency at the University of Virginia School of Medicine, she completed a fellowship in breast surgery at the Memorial Sloan Kettering Center. A fellow of the American College of Surgeons and board-certified in general surgery, Dr. Tierney joined the Sentara RMH medical staff in 2019. 

In her spare time, Dr. Tierney enjoys spending time with her family, cooking, reading and traveling.

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Why Get Your Mammogram at Sentara RMH?

Breast care surgeon Shannon Tierney, MD, says the most important thing a woman can do for her breast health is to get regular screening mammograms—particularly at the Sentara RMH Funkhouser Women’s Center. 

“There are definitely advantages to getting mammograms done here at the Women’s Center,” she says. 

The main benefit is having a team of familiar, fellowship-trained breast radiologists reading patients’ mammograms consistently from year to year, as well as their ability to perform any needed diagnostic studies and biopsies. Caregivers at the Women’s Center also have the ability to compare mammograms with ultrasound, MRI or scintimammography to look for correlations. 

“If diagnostic imaging and/or biopsies are needed, scheduling can be quick and easy, since our radiologists already will have read the patient’s screening mammogram,” notes 

Dr. Tierney. 

That can add several days to the process, she says. 

Finally, having the breast surgeon, nurse practitioners and radiologists on hand means they can consult together quickly regarding best practices for the management or treatment of questionable lesions. 

“My office is right there at the Women’s Center,” says Dr. Tierney, “so if they need to run down the hall to ask me about something, 

I’m available.”

Both 2D and 3D digital mammography services are offered at the Funkhouser Women’s Center and on the Mobile Health Services Van.

Sentara RMH also offers a High-Risk Breast Program aimed at identifying and educating women who may be at greater risk for developing breast cancer.

For more information, visit Sentara.com/Harrisonburg.

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