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Leader in Breast Cancer Surgery

Patients travel from all over for Hoag’s leading-edge care. Thanks to Melvin J. Silverstein, M.D., F.A.C.S., Gross Family Foundation Endowed Chair in Oncoplastic Breast Surgery, Hoag’s innovations now come to them.

Dr. Silverstein is the pioneer of oncoplastic breast surgery, a specialized surgical approach combining the principles of oncologic surgery with the techniques of plastic surgery – saving a breast without deforming it. In most cases, the breast looks better than before surgery. Dr. Silverstein began developing oncoplastic techniques almost 30 years ago when he was the Medical Director of the Van Nuys Breast Center, the first free standing Breast Center in America, which he founded.

During the last 15 years, Dr. Silverstein has trained 36 surgical breast fellows within the USC/Hoag Breast Fellowship Program. This spring, Sadia Khan, D.O., became the first recipient of the Muzzy Family Endowed Fellowship in Oncoplastic Breast Surgery.

Fellows are trained in all phases of breast care, including oncoplastic surgery and intraoperative radiation therapy (IORT). The competitive program receives more than 60 applications every year and accepts two to three fellows. Hoag is currently training two fellows.

These fellows go on to bring Dr. Silverstein’s techniques and teachings to such leading medical institutions as Johns Hopkins, Cleveland Clinic, Rush Medical School, Georgetown, the City of Hope and others.

“The fellowship combines all the resources of USC and Hoag, but the main attractions of the program are oncoplastic surgery and IORT,” said Dr. Silverstein. “Those are two fields that represent the future of breast cancer treatment. There are few facilities in the United States that offer both of these experiences.”

IORT is a radiation therapy technique that delivers a concentrated dose of radiation to the cancer tumor site during surgery, after the tumor has been removed. Hoag was the first hospital in Orange County to offer IORT as a complete replacement for traditional radiation therapy and has done more IORT cases than any hospital in the country, Dr. Silverstein said.

While participating in the fellowship, many of the fellows have published papers about the techniques they’ve learned, including an impressive seven papers published in the last 12 months. In one recent paper, published in the Breast Journal, fellows Sadia Khan, D.O. and Jessica Ryan, M.D., documented 66 cases of breast conservation (extreme oncoplasty) in patients with large tumors who were told at other facilities that they had no choice but to undergo a mastectomy.

Many of the cases used a new technique developed at Hoag, called “split reduction surgery.” The split reduction alters the incision site on a patient’s breast to accommodate tumors that other oncologists said could not be removed without a mastectomy.

“Hoag is the most advanced place in the world for saving breasts for patients who are told they need a mastectomy,” Dr. Silverstein said. “People who were told to have a mastectomy elsewhere come to Hoag and many can have their breasts saved.”

The USC/Hoag Breast Fellowship Program is certified by the Society of Surgical Oncology, the American Society of Breast Surgeons and the American Society of Breast Disease. Dr. Silverstein said he is proud of the work that his fellows have gone on to accomplish and he is humbled by the thought of his legacy.

“My greatest legacy is training young people,” Dr. Silverstein said. “I’ve treated 6,000 patients, but if each fellow I trained treats 6,000 patients, I will reach 216,000 patients. It’s an overwhelmingly positive thought.”