David Raubach: I want to thank you for joining us on today’s episode of The Cancer Project Podcast. We have Dr. Stephanie Taylor with us. She is one of the best breast surgeons in the state of Oklahoma. We’re going to learn about everything about her practice and also why she chose to go into the medical profession. So, Stephanie, thank you for joining us.

Stephanie Taylor: Well, you’re welcome. Thank you for having me.

David Raubach: Um so, before we get started, why don’t you tell us what you do on a day-to-day basis? I said breast surgeon, but what does that actually mean? What does your practice look like?

Stephanie Taylor: It’s a lot. Okay. So, a lot of both clinic and operating room. So, mostly take care of breast cancer patients, although there’s some benign breast disease also. And so, um I would say half of my time is spent in the clinic talking to patients and their families and making a plan for what their options are for how to treat their breast cancer. Just so many different um things that go into deciding whether they should have lumpectomies or mastectomies or chemo or radiation. And so, I spend about half of my time doing that and the rest of the time in the operating room. And so, in the operating room is just kind of where I get to do the art of being a surgeon and help come up with, you know, good cosmetic outcomes, good cancer outcomes first. Um and it’s where I just kind of get to be me. It’s a lot of fun.

David Raubach: So, lumpectomy or mastectomy — describe the difference between those two.

Stephanie Taylor: So, for smaller breast cancers, patients can often times save their breasts. They often don’t have to lose their whole breast. And so, if you do a lumpectomy, then that’s a partial mastectomy or part removing part of the breast. And we do a lumpectomy and most of the time that those patients have radiation. So, if you’re going to save your breast, you do a lumpectomy and radiation. Or, you can do a mastectomy and remove the whole breast and just depending on the size of the tumor and whether lymph nodes are involved or not, you can have a mastectomy and sometimes no radiation.

David Raubach: What led to you becoming a breast surgeon? Why did you want to be a breast surgeon?

Stephanie Taylor: I originally started um medical school thinking I was going to be like pulmonary critical care. And so, I worked in respiratory when I was in high school and college um at the Children’s Center here in Bethany. And so, um I liked that kind of thing. And then, my first clinical rotation in medical school was surgery. And it was a big giant belly surgery.

Stephanie Taylor: I loved it. I loved you know, operating, being inside of people. So cool. You could see the bowel peristalsing. It’s really good. So, that’s actually where I started. And so, I’m actually trained in general surgery and trauma. And then, I went into a small practice um in Yukon. So, I kind of was catching the western Oklahoma people. And just little by little um women started, you know, coming to me for breast cancer or other problems. And you kind of know, women once women have a problem and then they share with their friends and then they friends share with their friends. And it just grew into this practice that really is almost exclusively breast now.

Stephanie Taylor: Okay. Um and and I love it. And so, and I would say when I was young, the thrill was in the crazy surgeries. Right. Um and the adrenaline rush. And now it’s in watching these women and families make a plan and come to a cure and survive and they’re not just old women. A lot of my breast cancer patients are young women with young children and um so just getting to spend time with them and get to know them has been great.

David Raubach: Has that changed over time? Have you noticed more younger women getting breast cancer or has that kind of stayed the same over the last 10 or 15 years?

Stephanie Taylor: I don’t know what the right answer to that question is. So, for me, for my practice, I definitely have a lot more younger women now than I did 10 years ago. And but that may be the nature of my practice, right? I may again, they young women in town seek out the other young woman who have it and I do some different types of reconstruction with special plastic surgeons and other things and I may just be part of my practice. But, yes, I would tell you I think they’re a lot younger.

David Raubach: Well, I think um we have seen that cancer incidence overall has been increasing in the younger population and there’s lots of theories behind that. Is it environment? Is it diet? Is it better screening? We catch things earlier, too.

David Raubach: Talk a little bit about that relational aspect of what you do because it is something that, you know, when somebody gets diagnosed with cancer, it is very kind of it’s a big upheaval in their life and a lot of what you’re doing is something there’s the physical element, but there’s this like emotional element that you’re helping these patients and their families navigate through.

Stephanie Taylor: I think that’s a huge part of my job. So, I think that I’m often the first doctor that they see after their diagnosis. And so, just sitting down with them and truly um breast cancer is a pretty treatable disease. And and it can be it can be a lot, you know, some of the different types of cancer, um, require a year of chemotherapy and radiation. Um, but in general, it’s very treatable. And so, starting with, um, “This is going to be okay. We’re really going to be here to help you figure out the best both oncologic treatment and physical outcome treatment.” And women are funny, you know, two extremes, right? So, some women come in and they’re like they have teeny teeny tiny breast cancers and they say, “Take them both off. Take them both off.” Right? And other women come in and don’t want to lose their breast at all. So, working through, you know, what their right treatment is and what long-term is going to be best for them.

Stephanie Taylor: It’s interesting, but in breast cancer, at least for the smaller breast cancers, there’s no survival difference between a lumpectomy with radiation and a mastectomy.

David Raubach: Oh, okay. Interesting.

Stephanie Taylor: Right? And women often times come in and think, “Well, or maybe if you take off my breast, then I won’t have to do chemo.” And so, explaining to them that there’s really if you need chemo, it’s because of the tumor characteristics. And there’s really no surgery you can do to take that need away if you need it.

David Raubach: And talk about the different types of breast cancer because we kind of use this term breast cancer, but there’s actually a lot of different types of breast cancer. So, how should women think about what are the different types of breast cancer? How is breast cancer categorized?

Stephanie Taylor: So, in two basic groups, there are like ductal cancers and lobular cancers. And so, your breast is made up of glands. They’re glands and they have, um, lobules that make milk and ducts that drain the milk to the nipple. And so, you can get breast cancer in either one of those two areas. And and whether or not it’s lobular or ductal doesn’t necessarily make a difference on how we treat it. How we treat it is based more on these receptors. So, every breast cancer is tested. Is it fed by estrogen or progesterone? You see um commercials on TV about hormone sensitive breast cancer or hormone — so that’s estrogen and progesterone. And the last thing we check is HER2. It’s a protein. And so, um but certain breast cancers, triple negative breast cancers, we know they’re more aggressive breast cancers.

Stephanie Taylor: HER2 positive breast cancers are more aggressive. So, those patients always get chemotherapy. Almost no matter how — even if it’s a 5 mm tumor, um they get chemotherapy. And and that’s to prevent those cancers from showing up somewhere else in their body. That’s more about preventing metastatic disease than um treating their local cancer at the time.

David Raubach: So, there’s the type of cell, I guess, that is malignant, and then there’s the genetic makeup of that cell. Those are kind of the two different categorizations.

Stephanie Taylor: Correct.

David Raubach: And then what about the staging? You hear about stage one or stage two or stage three. What does that mean?

Stephanie Taylor: So, your staging of breast cancer is based on the size of the tumor and the lymph node status, and then has it spread to anywhere else. And so, in general, like uh a stage four breast cancer, just like with any other cancer, when it’s stage four, um it’s probably it’s already spread somewhere. And breast goes typically to bone. So, bone, brain, those are the most common places that breast goes. Um but a stage zero breast cancer is what we call ductal carcinoma in situ. And so those are cancers that don’t grow as a mass. They grow as these um scattered cells down the duct. And so they can be larger tumors um but they don’t break through the cell wall or basement membrane or um get to the point where they can — so they stay local right there. They’re not going to shift out and go to your lymph nodes.

David Raubach: Okay.

Stephanie Taylor: And then anything invasive um so a one, two, or three that can um go to your lymph nodes. And so it’s kind of how staging a stage one breast cancer would be a small cancer that hasn’t gone to your lymph nodes yet. Ranging to a stage four where it’s gone to your lymph nodes and then to other places in your body.

David Raubach: Okay. And so that staging element — how do cancers get staged? Like what’s the actual process where you figure all of this out? What does that look like?

Stephanie Taylor: In breast cancer typically you um you would do a surgery first, a lumpectomy or a mastectomy with a lymph node. And so if I check your lymph node and there’s cancer in your lymph node, then that means there’s potential that your cancer has gone other places in your body. So it has to go from your breast to your lymph node before it can go anywhere else. And so in somebody that we suspect is early stage, we take out the lymph node and if the lymph node has disease in it, then that’s where a PET scan would come in or there’s a bone scan, there’s some other options, but in general a PET scan is kind of what we think of as the test to make sure it hasn’t spread.

Stephanie Taylor: Um if I know from the beginning that it’s in your lymph node, say your tumor was bigger or when they were working it up, they biopsied a lymph node because they could see it. Then before I operate, um we make sure it hasn’t spread because there’s no reason to do a big surgery on your breast if your cancer is other places in your body because that’s what’s the most important. In general, I like to tell patients that what we’re doing is all about, you know, you don’t want your cancer somewhere else in your body, right? The cancer in your breast is pretty easy to take care of.

David Raubach: Yeah. So then uh is surgery always first or would sometimes a patient get chemo first?

Stephanie Taylor: Yeah, so in these HER2-positive cancers or triple-negative cancers — those are the more aggressive cancers — those patients often get chemotherapy first. It’s based on the size of the tumor. So if your tumor is bigger than 2 cm or you have a positive lymph node, then you would do chemotherapy before you have surgery. If it’s smaller than that, you don’t have to. Um you can do the surgery first, but you’re still going to have to do the chemo. So um I think sometimes you can do less chemo if you have surgery first if you have a small tumor. So there’s a benefit to that.

Stephanie Taylor: And then these estrogen-fed cancers they can be big and chemo doesn’t necessarily make a difference, right? So they could be 3 or 4 cm, but I wouldn’t necessarily give chemotherapy to try to shrink it because it probably won’t respond. And so they’re just — I think of um the more aggressive the cancer is, the better the chemo works. I wouldn’t want to do chemo if I had a low-aggressive tumor. If I could avoid doing the chemo, that would be my goal.

David Raubach: Well, and because the chemotherapy is more systemic — it’s treating the potential for these lesions to have spread to other parts of the body as well, right? So it’s not just treating that local tumor.

Stephanie Taylor: That’s correct. So I think of surgery and radiation as local treatment. And then in breast cancer chemotherapy and hormone blockers, so so these estrogen tumors that are bigger that might not need any chemo, um they still go on an estrogen blocker and that’s their best preventative tool for their cancer showing up somewhere else — is this um estrogen blocker.

David Raubach: And so like what are the estrogen blockers, what are some of those specific drugs?

Stephanie Taylor: Tamoxifen is for premenopausal women and aromatase inhibitors are for postmenopausal women, so Arimidex or letrozole.

David Raubach: Okay. And so then uh talk about the screening process and how women should think about that because part of what you’ve talked about earlier was the fact that we’re doing a better job of catching cancer earlier and if we catch it earlier, we catch it before it’s spread out of the breast or spread beyond just maybe a single lymph node. There’s we can do a little bit better job treating it or at least it’s uh there’s more of a chance of getting all of the cancer.

Stephanie Taylor: There’s definitely a survival benefit to catching cancer early, right? The earlier you catch it, the better off you’re going to be.

David Raubach: So what is what’s the latest and greatest on cancer screening guidelines for breast cancer? How should women be thinking about that?

Stephanie Taylor: You need to be starting your mammograms. If if you don’t have any family history, you’re not at high risk, you need to start your mammograms at 40. And screening mammograms are still at 40 and they’re once a year. Yep. And when you get your screening mammogram and just about everywhere in town does this, but when you get your screening mammogram, we’re going to calculate a risk score. We’re going to fill out a little questionnaire and we’re going to be able to say to you, you know, your lifetime risk of getting breast cancer is 12%. Or your lifetime risk is 25%. And so, at the age of 60, your lifetime risk should be about 12%. At the age of 80, it’s 20%. It goes up.

Stephanie Taylor: And so, um so in the average just general population, if you’re Tyrer-Cuzick is what it’s called, if it calculates out at above 20%, then you need to be in a high-risk screening program. So, those women need to have alternating mammograms and breast MRIs every 6 months. And that way, again, there’s a survival benefit to catching it early. And so those are the first steps. So, if you have an abnormal screening mammogram, then, you know, sometime that day, somebody’s probably going to call you and say, you know, there’s we need to we need to look around. We call it a BI-RADS zero. And so, it’s an inconclusive study and you need more imaging. And so, then that leads to diagnostic imaging. And sometimes that is diagnostic mammograms where you get additional views, tighter, you know, areas um with bigger magnification, so we can really look at those areas. And then, if it’s mass-like, then you would also get an ultrasound. And so and diagnostic mammogram and ultrasound um are then what leads to biopsies, right?

Stephanie Taylor: So, if you have an abnormal diagnostic mammogram or biopsy or ultrasound, then you have a biopsy. And then, if that’s a cancer, then, based on your, you know, density, your age, you probably will get a breast MRI. And that is looking for additional disease, either on the same side or the other side. And so there’s so many more things to that.

David Raubach: But that’s a good summary. So if I’m going to see if I can repeat that back to you. Okay, let’s do it. Let’s see if I remember. So, screening should start at 40 if you have no family history. Like that’s just the baseline. Think of — I turn 40, big celebration, birthday party, hire a band, have a great time, go to Vegas, go on a cruise, whatever, but also schedule your mammogram.

Stephanie Taylor: Exactly.

David Raubach: Uh if you have a family history, which means maybe you’re higher risk, it’s potential that you should go and talk to a doctor about starting screening earlier. What’s the youngest that somebody might — let’s say somebody’s very high risk. Both of their mom, their grandmom, sisters have all had breast cancer, genetically they’re at high risk.

Stephanie Taylor: That’s what I think that’s the key, right? So, it probably not before 30. Um and some some people would say not before 35. Maybe think about how old your closest relative was, your youngest close, right? So, if your mom was 35, then the first thing we’re going to do if your mom was 35 is do genetic testing and just make sure you don’t have a breast cancer gene. Because patients with a breast cancer gene, um they need to be having not mammograms, but breast MRIs just kind of as soon as we figure out that’s what’s happening. And it’s not uncommon for that to be in their late 20s is kind of a common age for families who have breast cancer genes to start figuring it out. And so, in those patients, I really just counsel those patients. Um so, we sit, we talk, we wait to figure out whether or not, you know, are they going to have any more kids? What kind of where are they in life? When are we going to be ready?

Stephanie Taylor: Um and and those patients with genes typically we like to do prophylactic mastectomies.

David Raubach: Oh, okay.

Stephanie Taylor: So, yeah. And that way, there is definitely a survival benefit. The one patient population who has a survival benefit from doing prophylactic mastectomies are these families that have BRCA mutations or PALB2 mutations, other mutations that we know cause breast cancer.

David Raubach: Okay. So I’m going to simplify this a little bit in my mind. So there’s two groups of people. There’s two groups of women. There’s groups of women that have some type of mutation that puts them at higher risk for breast cancer. And then there’s women that don’t have any of those mutations. So therefore they’re probably lower risk.

Stephanie Taylor: That’s correct. Yep, it is. And there are definitely families that don’t have the mutation. You have lots of women in them who have breast cancer. Yep. And those families we do, you know, again, alternating mammograms and breast MRIs and try to watch them. Um we know that increased breast density leads to those patients have increased risk of breast cancer.

Stephanie Taylor: And I thought for a long time that those patients had increased risk of breast cancer not necessarily because of risk but because I felt like they were hidden, right? That breast density was so dense that we just — it was hard to even see the cancer. But it turns out that that’s actually a risk factor. Um and so we have this other imaging modality that we can do that’s called a contrast-enhanced mammogram. And so some people um really don’t like to lay in an MRI machine. So in case you didn’t know, so for a breast MRI, you lay on your belly in a very loud machine and it runs you through. And it’s definitely the best study we have.

David Raubach: Yep. Um but some people do not like that. It can be a little claustrophobic sometimes, too.

Stephanie Taylor: Yeah, exactly. And so we have contrast-enhanced mammograms now. And I would say that’s probably the, you know, most recent development in breast care that, you know, breast radiologist and the surgical society are supportive of. Um, but same, you get a mammogram, it’s the same mammogram machine, but give you IV contrast before um you get your mammogram and it actually is very, very good at picking up on early breast cancers. Shouldn’t be replaced, shouldn’t replace the MRI, but it’s a good substitute for people who need it.

David Raubach: So, you’ve said dense breasts a couple times. How would somebody know that they had dense breasts? What does that mean?

Stephanie Taylor: You’re actually not going to know unless you have a mammogram. So, on your mammogram um your breast just look white. So, I know I don’t have a mammogram with me, but a normal mammogram would be like kind of black and fluffy cloudy and then you could see a a white spot and the white spot might be the potential for a cancer or a mass or some calcifications that would show up as little white dots that would be those are areas we’re going to target and check more into. But when women have really dense breasts all of their breast looks white. And if all of your breast looks white, you can’t see a white mass or white calcifications. And those are dense breast. And that’s where you might want to do an MRI.

David Raubach: Yeah. And is there anything that — if a woman has dense breasts, you’re saying that doesn’t necessarily make them higher risk for cancer or they are actually higher risk?

Stephanie Taylor: They are actually higher risk. They are. So, that’s something that you should be aware of. That’s right. So, that is yeah. Okay. We’re not just increasing with the MRI because we want to see better, although that is huge. Um, we also know that you’re at increased risk and we want to make sure we catch it.

David Raubach: And is that something you’re just born with? You either have dense breasts or you don’t or is there like lifestyle factors that impact that?

Stephanie Taylor: Like I just squirmed. Definitely some lifestyle things, too, right? So, we I mean, patients who are on long-term estrogen, although that doesn’t — we don’t necessarily think that leads to breast cancer, it definitely contributes to breast density, and so makes mammograms harder to read in general. The older you get, the easier your mammogram should be to read because of less estrogen stimulation and just time. You should have fatty replaced breasts as you get older instead of glandular breasts.

David Raubach: Okay. Yeah. Um all great things to talk to your doctor about.

Stephanie Taylor: All great things to talk to your doctor about.

David Raubach: Uh are there things that people can do to reduce their risk of breast cancer?

Stephanie Taylor: Well, yes. And so, just in general, um we know that obesity is one of the highest risk factors. We know that drinking alcohol, um consistent heavy use of alcohol, leads to increased risk of breast cancer. Smoking. Um so, there are definitely lifestyle changes that are good for all of us. So, the fat cells in our body make estrogen or convert other chemicals to estrogen, and that’s why even postmenopausal women with breast cancer, if it’s fed by estrogen, we still put them on hormone blockers, this aromatase inhibitor. Um and so, we know that all of those um just lifestyle things are helpful.

David Raubach: Yeah. What about — so those are the big three. So, obesity, alcohol, smoking. Anything else? What about diet? Does that play a role? I’ve heard rumors around, you know, sugar feeding cancer. Is that a real thing? What’s your thoughts on that?

Stephanie Taylor: My thoughts are we’d all be better off if we weren’t um eating sugar and processed foods. I really do feel that way. Do I know that those things lead to cancer? Uh no, not necessarily. Um do I eat like that, no sugar and no processed foods? No. [laughter] Do as I say, not as I do. Right. But if you really ask me if I felt like it makes a difference, maybe. Maybe.

David Raubach: I think that uh — do you think it makes a difference? Well, here’s how I would think about it. There’s definitely new research that’s come out over the past 5 or 10 years where there’s suggestions around um inflammation being correlated with cancer, stress being correlated with cancer, and so forth, right? But then, you know, you’ve got these factors cuz people that are stressed also can tend to drink more. So, is it really the drinking that’s causing it, or is it the stress? So, like, correlation versus causation, right? That’s the question, right? Um I do think there’s some very compelling research tied to colon cancer and diet.

Stephanie Taylor: Yeah. Because colon cancer — absolutely.

David Raubach: There, you know, where it presents is directly impacted by the food that is or the substances that are going through your body. And so, if you have highly processed foods that are causing more cell mutations, which we know that highly processed foods cause more cell mutations in the gut, the chances of you getting cancer go up. That’s just like — just makes sense.

Stephanie Taylor: That makes obvious sense. In the breast, it’s harder to say if that’s the case or not.

Stephanie Taylor: When a patient says, “How should I adjust my diet now that I have breast cancer?” — which they do. I mean, patients ask me that all the time. My statement is always the same. Do I feel like it would be better for us if I didn’t eat all that stuff? I do. Can I tell you that that’s really going to change anything? I don’t know that it will.

David Raubach: Well, the other thing to think about, too, is that, you know, cancer is a disease. And so, your body’s immune system is going in as you’re going through treatment or as you’re going through anything where there’s this uh you know, something foreign that’s identified inside your body. So, these cells that are mutated, which is what cancer is, your body’s immune system is kind of working in overdrive, and you want your immune system to be as strong as possible as you’re going through that. And then uh something like chemotherapy is going to suppress your body’s immune system, which is going to make you susceptible to other diseases. And so, you hear about patients that don’t necessarily do as well clinically, and maybe it’s not even directly the cancer or it’s the chemotherapy, but it’s because they got a horrible case of pneumonia because their body’s immune system was suppressed and couldn’t fight off this other thing that they were exposed to. So, it all kind of like works together.

Stephanie Taylor: It does. I think of just generally being healthy, you’re going to do better during treatment, you’re going to do your recovery is going to be a little bit better.

David Raubach: Yeah. I agree. Um there’s no magic bullet. Right. For sure. Um so, what would you say is the hardest part of your job, Stephanie?

Stephanie Taylor: When I um when I can’t tell patients in good conscience that what they want to hear or how they would like to be treated is the right thing. When I have to really, you know, redirect and say to you, I am so sorry. I did this this morning. Right? So, this patient has had a lumpectomy and radiation already. We can’t really do a lumpectomy and radiation again. Right. Um in most situations, we don’t radiate the breast the same spot twice. Right. And so, now ma’am, I’m sorry, but you should have a mastectomy. That’s the right thing to do.

Stephanie Taylor: So, the first question is, well, can I have reconstruction? Um well, there’s lots of things that go along with that. And so, if she’s — if you smoke, you can’t have reconstruction. If your BMI or body mass index is over about 35, plastic surgery doesn’t want to offer you reconstruction. And that’s not — that is not plastic surgery being mean. That’s we want you to have a good outcome. We know that a previous history of radiation, smoking, and obesity all three lead to wound healing problems. And you don’t want to do a giant surgery while you’re trying to be treated from your cancer, only to have a breast implant have a lot of problems and need multiple surgeries. And so, we just don’t offer that to patients.

David Raubach: Okay. That’s pretty devastating to some women, right? Women want to think, “Oh, I have cancer, and if a mastectomy is what I need, then I should just be offered reconstruction.”

Stephanie Taylor: And so, those are some of my hardest conversations is not not, you know, “You’re going to need chemotherapy, but your option for reconstruction is gone.” Yeah. And some of it is because of your lifestyle, you know?

David Raubach: Well, and that’s uh yeah, we want we want the cancer journey to be this nice clean linear path where it’s like, “Okay, well, you have cancer, and now here’s step one, two, three, and four, and here’s the — yes, it’s going to be a tough journey, but there’s going to be this kind of clean, neat outcome at the end.” And a lot of times that’s not the case.

Stephanie Taylor: Correct.

David Raubach: And having those conversations, I have to imagine is really yeah, really really challenging.

Stephanie Taylor: Yeah.

David Raubach: So, on reconstruction, um cuz you’re a surgeon, and you work very closely with reconstructive surgeons as well. Describe that process. Like, what is actually — so, if a if a woman’s getting a mastectomy, and then she does a reconstruction, kind of walk through what that looks like.

Stephanie Taylor: Yeah. When we can, we like to do it at the same time. And so, um and there two kind of distinct groups of reconstruction, right? Two different types. One, we take your own tissue um and do what we would call a flap, some type of flap. So, it can be your belly, take the skin and fat from your belly, or from your thigh, or wherever, um but typically from the abdomen. And um use the blood vessels that supply that mound of skin and fat and attach them to the blood vessels inside your chest.

David Raubach: Oh, okay. Wow.

Stephanie Taylor: And so, right. So, just like it’s like doing a transplant, right? It’s an autologous transplant. That’s our favorite. That’s my favorite. And so, you take the skin and fat from the belly and build a breast out of it. And we like to do that at the same time. Where you can see, so that’s probably a 5-to-6-hour surgery. Why it’s so many things are critical. But, you can’t smoke because that causes small blood vessel disease. And here we’re sewing these small vessels together. Um but that particular type of reconstruction is really good for patients who have already had radiation. So, if they needed radiation, maybe from a previous lumpectomy, or maybe they had a positive lymph node, for whatever reason that they needed radiation, when we take your skin and fat and build a new breast out of it, we don’t have to stretch your skin.

Stephanie Taylor: And so, if on the flip side, um patients who don’t need any radiation, um one of two things. We can um do a mastectomy and go directly to a breast implant. If um again, if they’re not smokers, if they’re not too um overweight, those are things that are good. Um those are good candidates. And so, that can be done at the same time or if I’ve already done a mastectomy and we’ve just decided the right thing to do for this particular patient is to treat their cancer first. I do the mastectomy and then you know, if they never need any radiation, then they can go back, plastics will go back at any point when they’re a good candidate um and they could put in an expander and stretch their skin back out.

Stephanie Taylor: And once they get it to the size that they want to be, so the expander you put the plastic surgeon puts in and the patient goes in once a week and gets their expander filled and it stretches their skin out. And then when their skin pocket is the size that the patient wants to be, they go back to the operating room and take their expander out and put in an implant.

David Raubach: Yeah. Okay, interesting. And so the — you mentioned radiation a couple times that some patients get radiation and some patients don’t. So why would a patient get radiation or not get radiation?

Stephanie Taylor: Just about anytime you have a positive lymph node, you need radiation. So if I’m — so specifically right now let’s talk about mastectomies. So if a mastectomy patient has a tumor size greater than 5 cm or a positive lymph node, then they’re going to need radiation. And then sometimes it’s a margin thing. If their cancer, you know, was up against their chest wall, then maybe they’ll need radiation for that. So so in general, we like to think if you’re having a mastectomy, you can avoid radiation. But in more advanced disease, you can’t. So in locally advanced disease, you need radiation whether you do a mastectomy or a lumpectomy.

Stephanie Taylor: Cuz you get as the surgeon, you’re thinking — there are situations where I literally can’t cut everything out. It just would be — and so in those situations, if I meet the patient first and I look at that and I think I cannot cut this all the way out. Those patients need to have chemotherapy before they go to surgery. And I shrink it up, do the best that we can, but they still have to have radiation because anything that, you know, any cell that originally had cancer in it, if I’m not cutting it out, it has to be radiated.

David Raubach: I remember watching or there’s a there’s a book called The Emperor of All Maladies. Have you read this book?

Stephanie Taylor: No.

David Raubach: It’s a book written by a medical oncologist Siddhartha Mukherjee and it came out, I don’t know, maybe 15 years ago. And the book is all about the history of the treatment of cancer in the United States. And it got turned into a PBS documentary as well, but I remember part of what they talked about in this documentary and in the book was the fact that there was a point maybe in the 70s or 60s where the surgery with breast cancer — because they were so concerned, I mean, one there weren’t all of the options with radiation and chemotherapy that there are today. But there also was this — we didn’t fully understand why cancer spread, how it spread, what led to it spreading. And so they would sometimes go in and literally cut out bones. Like they were cutting out ribs and you’d see these surgeries and the like the entire chest is like caved in after the surgery.

Stephanie Taylor: Yes. And I still get patients, typically older patients, right? Who who ask me about stuff like that, you know, and just reassuring patients that — they might have had a parent that went through a surgery like that — that is not how we do it now, right? The the chances that we would call that — a modified I mean, we would call that a radical mastectomy. A radical. I maybe have done two in the last 10 years. We just don’t have to do that anymore. So that’s good.

David Raubach: Cuz you’re also focused on getting rid of the cancer, but you’re also focused on life after cancer. What do those cosmetic outcomes look like?

Stephanie Taylor: That’s exactly right. My, you know, obviously number one is the treatment of this cancer. But 5 years from now when this young lady is done and cancer-free, all she’s going to see is what she looks like now. So whatever bridge I can do, um and so I do feel like being part of a team, I have oncology, radiation oncology, plastic surgery, and me. And so if we have a patient come in that is a locally advanced or complex patient, we all meet with that um patient prior to anybody starting anything to make sure that we have a plan that’s going to work and and sometimes it’s it’s different. Sometimes it’s think out of the box, you know? I may know that you want and need a mastectomy, but if you do, this is a lot, but if you do your chemo first and then I do a little lumpectomy and let you go ahead and do your radiation, then we’ve radiated your intact breast and skin and I’ve been able to save all of that skin.

Stephanie Taylor: And so now we can go back and do a mastectomy directly to reconstruction because the radiation part is already done and your skin is preserved and those patients have a a little better cosmetic outcome. You don’t have to do it that way, but it kind of works out good for some of the women to get to go directly from mastectomy to implants.

David Raubach: Well, one of the things I’ve always been so impressed with you, Dr. Taylor, is that you make it a point to really understand all of those elements of care, um which is important because often, like you said, you’re the first physician uh or surgical onco — first oncologist of the radiation, surgical, medical oncologist, yeah, to meet with the patient. So you kind of do have to understand how everything works together, but you also do a great job working with the other doctors here in town to coordinate and sync up that care.

David Raubach: Um so uh before we go, thank you. This has been super helpful. I’ve learned a lot. I actually do want to bring this up. I think this is important and maybe you can talk about this. Um we like to think of breast cancer is only impacting women and for the most part it does, but there is actually such a thing as male breast cancer. You’ve operated on male breast cancer patients. So, talk about that, screening for that, and risk of male breast cancer.

Stephanie Taylor: So, I probably at any given time have two males that I’m treating. Just kind of with the process of things and we treat it exactly the same. Well, back to me with radiation or mastectomy, um potentially no radiation. We don’t do, in general, screening on men. So, men have very little breast tissue and they can usually feel it. So, men typically present by feeling a mass. So, if you feel something, we need to know about it and you start with a mammogram, um just like a woman would. You start with a mammogram and ultrasound. Now, in these families that have breast cancer genes, um even though you’re a male, you should still be tested. So, if your mom or your sister or whoever has a breast cancer mutation, then the men in the family need to be tested as well.

Stephanie Taylor: So, the most um you know, so most most breast cancers are not genetically associated, right? Most breast cancers don’t have a breast cancer gene, but most male breast cancers, they more commonly do.

David Raubach: Oh, okay.

Stephanie Taylor: Most, but male breast cancers more commonly do. And so, those families, especially with BRCA2 mutations, um —

David Raubach: Was it also true, I don’t know if this is true or not, maybe you can opine on this. Is it true that if if there’s a breast cancer gene, that there’s a higher likelihood that the males in the family have some type of genetic mutation that might even be correlated with other types of cancers like prostate cancer or colon cancer?

Stephanie Taylor: Yeah, all yes. And so, and and I don’t know that they I think they’re at the same 50/50 risk of getting the gene, right? You get one from your mom, one from your dad. They’re at the same 50/50 risk of getting the gene. Um but we definitely see in these families that have genetic mutations, the men have the mutations also.

David Raubach: And I’ll mention this too. If somebody is interested in doing genetic testing, they can reach out to your practice or the Premier Breast Health Institute where you work and and help run that facility. Um and it’s a simple blood test.

Stephanie Taylor: It’s easy. When we’re talking about genetic testing, in case anybody’s wondering, it’s it’s a blood draw, gets sent off to a lab. And we actually there’s a QR code and I know that it’s just sitting around the breast center at different places, but I think it’s on the website, too. And so, you can scan the QR code and just answer a couple of questions and it will say you qualify for genetic testing. It doesn’t matter whether you’re a man, a woman, colon cancer, prostate cancer, you know, whatever it is. All of the different cancers have different genes associated with them. And if you fill out that little survey, it’ll say you qualify for genetic testing for whichever reason and we can we’re happy to help with that.

David Raubach: So, my last question today, I’ve asked you what the toughest part of your job is. What would you say is the most rewarding part of your job?

Stephanie Taylor: Oh, young women who um come through and getting to watch their families grow up and getting to watch them have good cosmetic outcomes and be happy and come back in. I mean, always the last visit is great. That visit where they say, “I’m done and and thank you.” and um I think we have good relationships with our patients.” And so, it’s always exciting to watch people move on.

David Raubach: Yeah. Well, we’re really fortunate to have you here in Oklahoma City. So, Dr. Stephanie Taylor — Partners of Oklahoma. So, if anybody listening has questions about breast cancer, breast surgery, um and you also have a couple of great general surgeons uh in your group as well. Um and so, if anybody has any questions, reach out to you or call Premier Breast Health. And thank you for your support and partnership with us here at Oklahoma Proton Center as well.

Stephanie Taylor: Well, thank you. I appreciate it.

David Raubach: Yeah. Thanks. The Cancer Project podcast is made possible by the Oklahoma Proton Center, a state-of-the-art cancer center where precision in treatment meets real compassion in care. We’re grateful for their support and for you for spending this time with us. If you’d like to learn more about the Oklahoma Proton Center, you can visit their website at the link below. And if something you heard today resonated, we’d love for you to stick with us. You can subscribe to the podcast and follow along on our socials link below for more conversations like this, honest stories, thoughtful perspectives, and the kind of support people don’t always know where to find, but do truly need. At the end of the day, this podcast isn’t just about cancer. It’s about what it means to be human inside of it and how we keep living, connecting, and moving forward together. We hope you leave each episode feeling a little bit more informed, a little bit more supported, and a lot less alone.