News

Calendar

HealthCasts

Spotlight

Patient Archive

Physician Archive

Clinician Archive

Videos

Portraits of Hope

Danielle Horsley

Breast cancer patient receives rapid diagnosis and treatment at Breast Health Center

Danielle Horsley normally does her monthly breast self-exam while in the shower, but on the night that she discovered a suspicious lump in her left breast she was laying on her back in bed.

"I don’t know why I did it (breast exam) this way, but I did it right before I went to sleep that night," said Horsley, who discovered the mass in early February 2009.

Horsley, 37, knew there was a possibility that the lump could be the unthinkable–breast cancer. Just a year prior, one of her sisters had been diagnosed with breast cancer at age 29.

The next morning, Horsley contacted her gynecologist, Brent Seibel, MD, a University of Florida College of Medicine – Jacksonville assistant professor of obstetrics and gynecology.

"I found it on a Wednesday night, called Thursday morning, and Dr. Seibel saw me on Friday at 11 a.m.," said Horsley.

Within 24 hours of her call, a treatment plan was quickly put into action. Seibel, who sees patients at Emerson Medical Plaza, referred Horsley to a multidisciplinary team of physicians at the Breast Health Center located in the same building.

The following week, Horsley underwent a mammogram and diagnostic ultrasound that confirmed an abnormality was present. A few days later, she was seen by breast surgeon, Laila Samiian, MD, a UF assistant professor of surgical oncology who specializes in treating breast cancer. Samiian evaluated Horsley and performed a biopsy on the same day to rule out cancer in the lymph nodes. By the time her pathology results were back, Horsley had an appointment scheduled with Samiian as well as a plastic surgeon. During the same appointment, they discussed her surgical options with her.

"Her biopsy showed that she had a very aggressive, fast-growing breast cancer," Samiian said. "We had to move as quickly as possible to improve her outcomes."

Since her younger sister had been treated for breast cancer and tested positive for BRCA mutation - the gene that increases a woman’s risk of developing breast cancer - Samiian felt that Horsley would be at high risk for developing additional breast cancers in the future. Therefore, Samiian recommended a prophylactic bilateral mastectomy, which involves removal of the diseased breast as well as the unaffected breast.

Two procedures, one surgery

Five weeks after discovering the lump, surgeons removed both of Horsley’s breasts at Shands Jacksonville. Samiian, a fellowship-trained breast surgeon, performed the surgery. During the same operation, the breast reconstruction process began. Christopher Vashi, a UF assistant professor of plastic surgery, put in expanders, which allowed Horsley’s skin and muscles to stretch in preparation for her permanent implants.

Samiian said surgical removal of both breasts is more common now than it was several years ago due to advances in technology such as MRI, genetic testing and breast reconstruction options.

"The most common reason for having a prophylactic bilateral mastectomy is being at high risk for developing breast cancer due to either a known genetic mutation - such as the BRCA gene - or family history," Samiian said. "Some women may have had a previous breast cancer treated by lumpectomy and radiation and end up developing a second breast cancer."

She added that, in some cases, patients cannot have radiation a second time and undergo mastectomy. They may choose to have the unaffected breast removed as a preventative measure to reduce their risk of another breast cancer and to achieve better symmetry during plastic surgery reconstruction.

The pros and cons

Vashi said there are advantages and disadvantages of bilateral breast reconstruction.

"The advantages are, of course, minimal risk of breast cancer, no need for annual mammograms, and symmetrical reconstruction," Vashi said. "Most patients are pleased with the outcome of this procedure."

The recovery time for this procedure is quick, but two surgeries are needed. The first is for the insertion of the expander, which is done at the time of the mastectomy. The second is to exchange the expander for a permanent implant.

Disadvantages of this procedure include implant infection, which is less than 1 percent. Infection is most likely to occur during the expansion process when a needle is inserted weekly into the expander to inflate it with saline to slowly stretch the skin. Infection is also more likely during the immediate post operative period when the expanders are replaced with the permanent implants. Another disadvantage of is this procedure is that the implants must be replaced every 10 years.

Reconstructing her new breasts

Horsley underwent eight rounds of chemotherapy over the 16 weeks following her surgery. On Sept. 1, seven months after finding the lump, she returned to Shands Jacksonville to have the expanders removed and the permanent implants put in by Vashi.

"In several months, we will raise a mound of tissue to create a nipple," Vashi said. "Once that has healed, we will then tattoo the areolas, and this will hide the scar from the nipple flap."

Vashi said the reconstruction process from start to finish takes about a year, giving the patient a break between procedures to heal.

After the areola is tattooed, a final touch-up procedure follows that could include anything from scar revision to aesthetics. These are usually short, small procedures and can be done in the physician’s office.

Looking ahead

In the meantime, Horsley will be resting and slowly getting back into the swing of things as she waits to schedule her final procedures.

"I am very happy with the outcome so far, and I am looking forward to seeing the finished product," Horsley said.

She said that she was most impressed with how quickly she was seen by various physicians and the quality of care.

"It was just over two weeks from me finding it to diagnosis, with ultrasound, mammogram and biopsy in between," said the mother of three. "I’m just truly grateful for all of my physicians at Shands and everyone who helped me through this."

top of page