Patient Empowerment
The Johns Hopkins Breast Center strive to empower women with information about the breast cancer as a disease and the treatment options available based on her specific situation and clinical needs. By doing so we enable her to directly participate in the decision about her care and treatment options. The patient becomes a member of her own health care team. Her care partner (usually spouse or other family member) are also included in this learning process to the degree that the patient desires. This expands her power base and begins the foundation of a solid support system for her as she proceeds into treatment.

State of the Art Breast Reconstruction
Now for breast reconstruction: The Johns Hopkins Avon Foundation Breast Center offers comprehensive, state of the art breast reconstruction for our patients. We have been fortunate to be at the forefront of providing all forms of reconstruction including micorvascular surgical options of DIEP flap and S-GAP. There are three plastic surgeons within our Breast Center who specialize in reconstruction and perform high volumes of each of the various options available. Restoring a woman's silhouette can be an important part of her breast cancer treatment. We also offer the option of speaking with other Johns Hopkins breast cancer survivors ,who are survivor volunteers on our team, and who have had a specific form of breast reconstruction performed that a patient may be considering having done here with us. To schedule an appointment call 443-287-2778 (BRST)

 Johns Hopkins Division of Plastic and Reconstructive Surgery
 3D CT Angiography of Abdominal Wall Vascular Perforators to Plan DIEAP Flaps

Oncoplastic Surgery Available - to schedule an appt call 443-287-2778
Oncoplastic surgery of the breast is now being offered by the Avon Breast Center at Johns Hopkins. This novel approach to breast cancer surgery allows the breast surgeon to remove a large area of breast tissue around the cancer to achieve negative margins while still providing a good cosmetic result. This is accomplished by using plastic surgery techniques to reshape the breast immediately following a lumpectomy. Oncoplastic surgery makes it possible to treat some breast cancers with lumpectomy that would have previously been treated by mastectomy. Using these techniques we can provide conservative surgery and not jeopardize the cosmetic results or the cancer management. In some cases this may mean reshaping the opposite unaffected breast at the same operation. A team consisting of one of our breast surgeons and one of our plastic reconstructive surgeons provides this integration of breast conserving surgery.

Comprehensive patient education program
For the patient and her care partner. This enables the patient to choose options such as inpatient vs outpatient surgical care, lumpectomy vs mastectomy, reconstruction vs externally worn prosthesis, and adjuvant therapy options. It also provides information about her disease and treatment that reduces her fear of the unknown. Efforts are underway to further enhance this program to develop a customized patient education program tailored to the specific condition and treatment needs of each patient.

The Breast Cancer Multidisciplinary Clinic
The Breast Cancer Multidisciplinary Clinic is designed to evaluate patients with known breast cancer. The clinic is committed to a single day comprehensive patient evaluation by surgical oncologists and radiation oncologists incorporating all the resources available for the education, diagnosis, treatment and research of breast cancer by some of the top breast cancer clinicians and specialists in the country.

Home Health care provided by specially trained Johns Hopkins Home Health care nurses
Registered nurses trained in the special nursing and psychological needs of breast cancer patients come to the hotel or private home of the patient during the first 24 hours after her after her lumpectomy and axillary node dissection (if needed) or mastectomy surgery. For continuity of care, whenever possible the same nurse who saw the patient the evening of surgery also sees her again for a home visit the next morning.

Breast Cancer in Older Women
Each year, 200,000 women are diagnosed with breast cancer. They may be our mothers, sisters, grandmothers and friends. Breast cancer, which is the number two leading cause of cancer death among women, increases in prevalence as women age. In fact, half of those diagnosed are over age 65. That is why it is so important for older women to seek treatment from a program which recognizes that older people with cancer are unique, both in the problems they present and the way the cancer behaves in them. The Geriatric Oncology Program at Johns Hopkins Bayview Medical Center offers a multidisciplinary approach to this particular patient population, ensuring that they receive care that is both effective and appropriate. For more information about the Geriatric Oncology Program, call 410-550-1711.

Rapid Access for a surgical and radiology appointments
Recognizing that women's anxiety is highest when waiting for their initial appointment to be evaluated for a breast health problem, we strive to give patients surgical appointments as soon as is feasibly possible after contacting the Breast Center. She is also able to obtain a rapid appointment for a mammogram if she has a known breast health problem or suspects that she might.

Results Today
The majority of the time a woman can find out within 24 hours of being seen by a breast cancer specialist in the breast center whether she does or does not have breast cancer. This type of rapid response was implemented as a result of patients providing us feedback that it is a priority for them to know as soon as possible.

Multidisciplinary conferences to evaluate the patient's individual needs
Patients are cared for by a team of nationally and internationally known faculty who have expertise in surgical oncology, medical oncology, radiation oncology, clinical trial access, plastic surgery, genetic counseling, risk assessment, dedicated to breast cancer care when care issues are complex and warrant more extensive discussion by the team

Mammography and diagnostic imaging services
When a patient comes for a diagnostic mammography due to having a breast abnormality warranting further evaluation she receives the highest quality imaging services available. To further reduce anxiety and keep the patient informed and part of the treatment team she is also told about her results while there because the radiologist reads the x-rays in real time. This prevents patients being called at home at a later time to return for more x-rays too if additional evaluation is needed to determine the cause of the abnormal finding in x-ray. Additionally, we have the ability to perform digital mammograms as part of a clinical trial. Our radiologists are specialists in breast imaging as well.

Breast Cancer Counseling and Support Services
Patients are provided one on one counseling to assist them psychologically with developing ways to cope and reduce stress. They are also provided assistance from social workers who help with insurance issues, family support needs, and other psychosocial aspects of their personal care. When special needs arise that are best addressed through psychotherapy this service is also made available. In addition to this patients are connected up with Johns Hopkins breast cancer survivor volunteers who have been specially trained and selected to offer emotional support and function as a partner with the patient. She helps and supports her and her family psychologically through each aspect of treatment, having experienced the same diagnosis and treatment herself in the recent past at Johns Hopkins. Special support programs have also been designed to help children cope with their mother having been diagnosed with breast cancer.

Pathology services that are state of the art
Ensuring that your pathology results are right is of utmost importance. Great care is given here by the pathology faculty when reviewing and determining if there is cancer present in a specimen of tissue. It is not uncommon for women to bring their pathology slides done at another facility for a second opinion. On occasion the Hopkins pathology faculty discover abnormalities including finding breast cancer which was overlooked in the initial findings reported from an outside facility. Knowing the type of breast cancer you have and special factors about it is critical to selecting a treatment plan that will provide a woman her best opportunity for defeating this disease. The pathology staff have extensive experience in evaluating and accurately classifying breast tissue specimens so that the breast center team have the information they need to make the best medical decisions for that patient.

Preoperative Physical Therapy and Occupational Therapy Program
It is true that an ounce of prevention is worth a pound of cure. This is why we instruct patients on range of motion exercises before their surgery is done. It gives them an opportunity to practice, receive instruction and demonstrations prior to surgery. This is also the ideal time for the physical or occupational therapist to evaluate the patient's current arm strength and physical mobility. This provides accurate baseline information for measuring and monitoring the patient after surgery to ensure she has returned to her baseline physical capabilities. It most importantly helps the patient to prepare for the post-operative routine that she will be expected to perform, thus preventing her from complications related to frozen shoulders and other orthopedic problems that can occur without proper monitoring and care. This program is especially designed for women undergoing breast reconstruction and/or will be having drains in place post operatively due to nodal dissections.

Lymphedema Prevention and Management Program
The Breast Center offers the latest treatments available for management and monitoring of lymphedema which occurs with a small number of patients who undergo lymph node removal as part of their breast cancer surgery. An occupational therapist who is certified in lymphedema management and prevention provides this special clinical program. Hopkins is one of the few hospitals in the country who offers a lymphedema prevention program for their patients. Our goal is to prevent lymphedema from occurring and our low rate of occurrence confirms we are successful at accomplishing this. When there are problems with arm swelling and fluid retention in the arm which lymphedema can cause we have the necessary resources and skill to treat it effectively.

Patient Satisfaction Surveys
In addition to the surveys randomly conducted by the hospital to measure patient satisfaction with both inpatient and outpatient care, the Breast Center also conducts focused surveys routinely, measuring all aspects of the patient's experience. This include their initial contact with the center for their first appointment, tests and procedures they had, skill of the health care team, time spent by the doctors and nurses on the team, home health care they received, and compassion of the faculty and professional and clerical staff. Our survey tool, as well as the results over many years, are available online. We encourage patients treated elsewhere to also complete the survey so that we can use this information aggregately for benchmarking purpose. Focused groups are also conducted to help establish priorities for new services desired. Most importantly, the data results are used to determine what improvements can and will be made to better serve future patients seen and treated in the breast center. (Survey Results)

Radiation Oncology Services:
This state of the art comprehensive program has several full time physicists dedicated to ensuring that the patient receives the very best radiation treatment based on their specific diagnosis, recommended dosage, and targeted body area warranting radiation therapy. The patient satisfaction scores for this area reflect the outstanding services being provided which includes educating the patient about this type of adjuvant treatment and having them participate in the decision making about choosing this mode of treatment for breast cancer.

Medical Oncology
As one of the few comprehensive cancer centers in the country patients are afforded opportunities to be part of various clinical trials that offer the maximum potential for long term survival. The adjuvant therapy program offered through the Hopkins Breast Center provides for close monitoring of the patient's condition every step of the way as she completes her treatment transforming her from victim to survivor.

Access to Participate in Clinical Trials:
Johns Hopkins is one of the few fully accreditated comprehensive cancer centers in the country and the only one in ourr geographic region. Because of this special status we are able to offer patients a variety of clinical trial programs that can provide the latest advancements in clinical care and treatment for breast cancer. Often times patients associate clinical trials solely with chemotherapy regimens. This is not the case however. For example the ability to provide most women the options of having breast conservation surgery rather than mastectomy was a directly result of a clinical trial. Everyday new advances are being achieved in the area of breast cancer and Hopkins is able to provide their patients with these advancements whenever possible. (Clinical Research Highlights)

Breast and Ovarian Screening and Surveillance (BOSS)
With BOSS, The Johns Hopkins Breast Center offers special services for individualized breast and ovarian cancer risk assessment; evaluation and testing for genetic cancer susceptibility; instruction in breast self examination; individualized breast and ovarian cancer screening recommendations and recommendations for breast and ovarian cancer prevention. Johns Hopkins has offered this special service since 1989 and the BOSS team of physicians, genetic counselors and nurse practitioners is always up-to-date on the latest research results in breast and ovarian cancer risk assessment, detection, prevention and genetic susceptibility. BOSS is also actively involved in clinical research related to these issues.

Breast Screening and Prevention Program
The Johns Hopkins Breast Center provides services to women who have breast health issues, not just breast cancer. One of the programs offered is a special screening program for women who have a possible breast abnormality or other breast health concern. This clinical service is provided by nurse practitioners who have expertise and training in this area. They also can make a rapid referral for additional assessment and treatment if the findings on clinical exams warrant it. Patient have found this service to be a valuable one for themselves as well as for other family members and friends.

Complementary Medicine offerings
We know for most patients being able to do help themselves along their road to recovery and to survivorship is important. They want to develop a healthier lifestyle than perhaps they have experienced before or want to improve upon that which they have already developed. Some women are interested in nutritional programs; others in stress management, acupuncture, or massage therapy for example. In recognition of a patient's desire to have access to these types of programs Hopkins offers programs in massage therapy for patients undergoing chemotherapy and individual counseling for stress management for all interested patients and family members. Acupuncture is also available by appointment. And educational material on a variety of topics is available through the breast center.

Women's wellness and fitness programs
Women have an opportunity to also schedule an appointment with Jasmine Demos for a "Wellness consultation" to review nutrition, life style habits that may influence health, and other women's health issues discussed. For an appointment call 443-287-2778. We also have partnered with several organizations to combat fatigue during treatment and promote overall fitness and wellness after treatment. These programs are available at: Johns Hopkins Physical Medicine and Rehabilitation (410-614-3234), Evolutions body Clinic in Annapolis at 410-224-7220 (which includes educational programs once a month on Wednesday evenings conducted by our faculty. www.evolutionsbodyclinic.com and Brick Bodies at all their locations! www.brickbodies.com 410-252-8058. During your breast cancer treatment you are eligible to take advantage of Brick Bodies services and programs for free. Just provide a note from your treating doctor.Yoga classes is a special service being offered at Brick Bodies at their Green Spring Station location for our patients. Tuesday afternoons. Call them for more details about this special program.

Breast Cancer Survivor Volunteers
Having the opportunity to talk and spend time with other breast cancer survivor volunters who have previously undergone the same treatment regimen a patient is about to begin is very important. We have a team of more than 80 survivor volunteers ranging in age from their mid 20's to mid 80's who make themselves available to be "matched" with newly diagnosed patients. They matching is based on their age at time of diagnosis, stage of disease, anticipated treatment plan and other demographic variables to help us achieve the best match for our patients. They provide a wealth of knowledge and emotional support for women now facing treatment. Several survivor volunteers also come onsite to provide support on busy surgery days, as well as in breast imaging, to support women having chemotherapy as well as radiation therapy.

Promoting Women's Health-During and After Breast Cancer Treatment
We want your treatment for breast cancer to go smoothly and for you to maintain your energy and activity level while undergoing treatment. Benefits have been scientifically demonstrated that prove exercise can help reduce side effects some women experience during breast cancer treatment. In addition, maintain a healthy lifestyle and weight may be beneficial to prevent recurrence of this disease.

To achieve both goals, The Johns Hopkins Avon Foundation Breast Center has established relationships with several organizations to support you in an active, healthy and enjoyable lifestyle. We also have a nurse practitioner, Jasmine Demos, who specializes in women's wellness and can provide you with a consultation to evaluate your overall health, wellbeing and life style habits that influence your health status. (To schedule a consultation in the Breast Center with Jasmine call 443-287-2778)

Listed below are fitness programs and services available to you, based on the area where you live or type of wellness program you prefer:

Brick Bodies-Building Partners in Breast Cancer Survivorship
Lynne Brick has created special programs just for you at her Brick Bodies Fitness Centers! She has named it "Supportive Healthy & Integrated Program" (SHIP). Starting October 2007 Bricks Bodies is now available at Green Spring Station. She is offering free services at her facilities for women while they are going through breast cancer treatment through a special program called the Patti Clark Memorial. (Just take a note from your oncologist or nurse practitioner in the Breast Center with you). In addition to having access to the Fitness Center, she is also offering Yoga classes taught by one of our own breast cancer survivor volunteers, Rosemary! we also are providing Educational Programs there, conducted by our faculty and nursing staff at the end of the yoga session ( Yoga on Tuesdays in October, 2:00pm-3:15pm ) For more information call 410- 825-0550 or visit www.brickbodies.com

Johns Hopkins Rehabilitation Medicine and Physical Therapy Program
During your treatment, you may want to have assistance from some of our specially trained therapist at Hopkins who are intimately familiar with the breast cancer surgeries we perform here (like DIEP flap breast reconstruction) or are interested in a fitness program that can be provided downtown while here for your regular visits or perhaps during your lunch time. Women having flap reconstruction will automatically be scheduled for a consultation prior to surgery for core strengthening exercise training. Please feel free to call 410-502-4239 for a consultation to discuss the types of programs that best serves your health needs today and for the future.