Dr Lily Gutnik

My name is Lily Gutnick, I’m a breast surgical oncologist from the U.S at the University of Alabama at Birmingham.

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Dr Lily Gutnik Breast surgical oncologist

I’m a breast surgical oncologist from the U.S at the University of Alabama at Birmingham. I am also the assistant program director of global surgery and a member of the O’Neal Comprehensive Cancer Center.

I am in addition to obviously clinical care with breast cancer patients, women of African ancestry and in sub-Saharan Africa.

But for me, breast cancer is really about women’s empowerment through health feel as whole as possible as themselves as possible and really very empowered.

I came to the Paris Breast Center because I really wanted to learn more and experience what oncoplastic surgery really is like. In the U.S. it’s a field that still was very much in its infancy.

Right now, breast surgery and plastic surgery are very separate, although of course we work very well together, we work very closely together to provide the best care for the patients. But a true oncoplastic surgeon in the sense that exists in countries like France and the UK and even parts of Germany is something that is pretty unusual right nowin the U.S.

For me, it’s something that I’m very interested in. I think it makes a lot of sense from the patient perspective. I think it helps the patient when it’s just one surgeon taking care of the oncological part of the surgery, as well as the reconstruction. It makes it a little easier for the patient. They have fewer follow up appointments in terms of with different providers.

In the U.S., where every visit requires a co-pay, saving an extra provider to see, for the patient to see would also helped them financially as well. And we know in the U.S. financial toxicity is a very important and unfortunate detrimental side effect of cancer care. And then from just even a technical perspective, it’s something very interesting to me to be able to expand my skill set and perform some of the reconstructive aspects of the breast surgery.

 

I was in Paris for about five weeks total, so even though five weeks seems like a very short amount of time and it was it went by very quickly.

I learned a lot. I filled two notebooks worth of notes. There was just a lot, you know, both from the oncological aspect as well as from the reconstructive aspect. So, for example, on the oncological aspect, a nipple sparing mastectomy, the way I was seen it done here in Paris is completely different than the way I was trained to do it.

I was only trained in one approach, and that was those using the Bovie electrocautery for the entire dissection, whereas here it was done completely differently with tumescence and a scissors approach.

The way I learned to even place incisions for nipple-sparing mastectomy was somewhat different than the way I learned here. And even the indications for nipple-sparing mastectomy, I believe, were much broader here in Paris than what I was trained in the U.S., which is wonderful. I mean, it really expanded my skillset and just expanded my indications and my approach of who I can offer this procedure to from the reconstructive side as well.

I definitely learned like even in, for example, direct implant is the most common I definitely learned like even in, for example, direct implant is the most common form of reconstruction that I saw here in Paris, and it was something I very rarely saw in my training in the U.S.

Most of the time, majority of the time when a patient received implant base reconstruction in the U.S., they would first start with a tissue expander at the time of mastectomy and later have a second procedure for exchange for implant.

So even that just seems like a small nuance was really something fascinating and different. And again, and seemingly with excellent outcomes in terms of other technique like :

  • Latissimus Dorsi Flap, I’ve never seen one in the U.S. other than for covering large chest wall defects and not for reconstructive technique.
  • Lipofilling.

Though I’ve seen in the U.S. it was really more for just small kind of shaping here and there. After an implant filling defects, it was used for those kinds of scenarios, but not as a large portion of reconstruction techniques as I saw it here, which was again fascinating. Another thing I saw here that I’ve never seen before is the LICAP flap.

Again, I saw about two or three of them in five weeks in Paris. I’ve never even heard of this in the U.S. and again, to seeing the results I thought were phenomenal and seemingly the long term outcomes are just as good as well. So again, in five weeks, I learned and saw things that I’ve never even heard of in the U.S. and that were truly remarkable and valuable.

 

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