After a mastectomy, a patient may wish to have breast reconstruction, which involves multiple steps to prepare for implants. Until now, implants were only available for average-size breasts. Now, a new Food and Drug Administration-approved option is available for larger sizes. Norton Plastic & Reconstructive Surgery providers performed the first implant procedure in Kentucky using MENTOR MemoryGel Enhance silicone implants.

“Despite being a standard part of post-mastectomy care, reconstruction options have not kept pace with the diverse needs of today’s patient population,” said Brian P. Thornton, M.D., plastic and reconstructive surgeon with Norton Plastic & Reconstructive Surgery, who performed the first procedure with the new implant. “Patients who require a larger-volume implant than what was previously available now have an option that helps them feel whole again.”

The American Society of Plastic Surgeons reports that 157,740 women underwent breast reconstruction in 2023. However, many more did not have access to a reconstructive implant that would restore their breast size to what it once was.  

Silicone implants are desired by many patients because of their natural look and feel. Often, they also are lighter weight.

“We want every woman to have an option to feel like themselves again after undergoing a mastectomy,” Dr. Thornton said. “Until now, this was not possible and made a breast cancer diagnosis that much more traumatic.”

Breast reconstruction after mastectomy is available through Norton Healthcare’s Breast Health Program, accredited by the National Accreditation Program for Breast Centers (NAPBC). The program offers comprehensive services, from screening through diagnosis, employing several patient navigators to make the patient journey seamless and as comfortable as possible.

“Patients who must undergo a mastectomy often have decreased self-confidence, concerns about their physical appearance and even feelings of loss,” Dr. Thornton said. “It’s important for every person needing this part of the healing process to have options and a path forward.”

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Oaks Day honors women who have survived or are in treatment for breast or ovarian cancer. You’ll see this year’s 151 honorees walking the turf track in the Survivors Parade prior to the running of this year’s Oaks race.

This day also is an opportunity to talk about prevention and early detection of these cancers that affect nearly 300,000 people a year in the United States. Breast cancer alone is one of the top causes of cancer death in women — second only to lung cancer — according to the American Cancer Society. The Centers for Disease Control and Prevention show Kentucky’s rates of breast and ovarian cancer as similar to those of the entire nation: More than 133 women out of 100,000 women are expected to receive a new diagnosis of breast cancer in Kentucky this year, and 10 out of every 100,000 will get ovarian cancer.

Thankfully, high-profile events such as the Kentucky Oaks help call attention to these issues. However, they do more than that: They raise funds critical to bringing down these statistics. Churchill Downs will donate to two organizations, one of which is Norton Cancer Institute, the leading provider of breast cancer care in Louisville and Southern Indiana. Funds specifically benefit the Derby Divas Breast Health Center. In fact, Churchill Downs has donated more than $1 million in support to charities over 16 years to fund cancer screenings and care for underserved women.

We know that the breast cancer death rate has been on the decline since 1989. While there are constant innovations in cancer treatment, awareness and screenings have increased thanks to events such as the Kentucky Oaks — and the funding it raises.

If you’re taking a trip to Churchill Downs for this year’s Oaks, enjoy your day. But also be sure to recognize the importance of the pink (and teal) that you will wear. And know that just by being there, you are part of saving lives.

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Rewind to spring 2022, Rachel felt a lump in her breast. She talked to her health care provider, and they recommended to take a wait-and-see approach, primarily because she was so young and did not have a family history of breast cancer. As the months went by, the lump remained, so it was time to take action. By September, Rachel started the process of having a mammogram, ultrasound, biopsy and even an MRI — making sure her health care team had a good understanding of the tumor and could develop a treatment plan specifically tailored to her. The diagnosis was official: She had triple-positive breast cancer, and treatment would start right away.

Fortunately for Rachel, her care team was close to home. She consulted with Matthew Golden, M.D., general surgeon at Norton King’s Daughters’ Health, about the lumpectomy. Together with Ajay K. Kandra, M.D., medical oncologist with Norton Cancer Institute – Madison, the team established a treatment plan for Rachel. She would start with chemotherapy in an effort to shrink the tumor and it did.

“My scans showed the tumor shrinking after the first dose of chemo,” Rachel said. “And by the sixth and final dose there had been such a radical response, the tumor was reduced to scar tissue.”

“This type of response is called complete pathological response, and can be seen in patients with HER2-positive breast cancers with the right combination of chemotherapy and targeted therapy” Dr. Kandra said. “Patients with this type of response typically have the highest cure rates.”

HER2 is a protein that makes cancer fast-growing but also more responsive to treatments that attack the protein.

The successful response to chemotherapy made the lumpectomy, the next step in Rachel’s treatment plan, somewhat easier. Dr. Golden was able to remove the scar tissue along with a sampling of lymph nodes that would be tested to see if the cancer had spread. It had not, and Rachel was ready for the next step in her care plan. She started radiation, which would be followed by hormone therapy. The extended plan is to continue with a total of five years of hormone-blocker, a pill she takes, while continuing to undergo scans looking for any traces of the cancer returning. Coupled with the other therapies for Rachel, Dr. Kandra feels this will give her the best chances of remaining cancer-free.

A celebration like no other

Rachel has a tribe of support all around her. Her large family includes three brothers and three sisters who stepped in to help her with chores, treatment and moral support. She also had the support of a best friend who “never stopped showing up,” according to Rachel. Taylor Cruz and Rachel have been friends for nine years. Taylor, a registered nurse, was with Rachel at many doctors’ appointments and chemo treatments.

“She helped me celebrate every step and every little victory,” Rachel said. “I asked her to walk with me in the parade. So I can’t wait to celebrate the Oaks Survivors Parade with Taylor.”

The two are looking forward to the Oaks Day festivities. They have selected outfits —including hats —and are looking forward to meeting other survivors and hearing their journey too.

But for all of Rachel’s tribe and support system, the celebration truly began in November 2023 when she completed her final round of active treatment. After 17 infusions, she was finally done and got to ring the bell, a rite of passage for patients completing their active cancer treatment journey.

“It was a scary journey, but I got to meet so many amazing people and do so many wonder things along the way,” Rachel said.

A journey that kept her close to home

For many people, comprehensive cancer care could mean having to drive hours to receive treatment. For Rachel, everything was right in her hometown.

“Rachel received the best level of care at Norton King’s Daughter’s Health, including cutting-edge radiation therapy, chemotherapy and targeted therapy,” Dr. Kandra said. “Having those resources close by is important to the overall health and wellness of the patient. It improves tolerance for the treatment and ability to complete all the recommended treatments.”

Rachel felt a strong connection to so many of the people on her care team and remembers small gestures that really made an impact on her. For example, one time Parag R. Sevak, M.D., radiation oncologist with Norton Cancer Institute, stayed late at the clinic in Madison to make sure all of her questions were answered and she was comfortable after enduring a radiation treatment.

“It was that kind of attentiveness and compassion that helped carry me through this journey,” Rachel said.

Oaks Survivors Parade

This is the 16^th year for the Kentucky Oaks Survivors Parade featuring survivors of breast and ovarian cancer. Survivors, including men, submit their names and are chosen at random to participate. The Norton Healthcare Foundation, along with Horses and Hope of the Kentucky Cancer Program, is a charitable sponsor of the Kentucky Oaks Survivors Parade. Churchill Downs Foundation donates funds to support Norton Cancer Institute through the Norton Healthcare Foundation.

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Breast self-awareness is a way to improve overall breast health and make it more likely you will notice if something changes that could be a reason to talk to your primary care provider.

“It is so important for women to be aware of their breasts to know if there are any concerning changes that could be a sign of breast cancer.” said Laila S. Agrawal, M.D., a breast medical oncologist with Norton Cancer Institute.

About half of all cases of breast cancer in women 50 and older, and almost three-quarters of breast cancer cases in women under 50 are detected by women themselves, according to the American College of Obstetricians and Gynecologists.

Looking for changes in your breasts includes checking under each breast, underneath each arm and under the nipples. Breast tissue extends from armpit to armpit and from the collarbone to the top of the abdomen.

Breast self-awareness is important for women who aren’t old enough or at high enough risk for screening mammograms.

How to check for breast cancer

In the mirror

To check your breasts, stand in front of the mirror with your shirt and bra off and your hands at your side.

• Look for any breast change — size, shape or symmetry.
• Check the skin for redness, soreness or itchiness, for puckering or dimpling of the skin, for the nipple pulled inward, and for nipple discharge or scabbing over the nipple.

Raise your arms over your head with your palms pressed together and look for the same things. Put your hands on your hips and flex your chest muscles and look one more time.

In the shower

Next, do a manual check in the shower, using the pads of the middle three fingers of the left hand to check the right breast, and the vice-versa. Use a circular motion about the size of a quarter, varying pressure to feel breast tissue at different depths. Take your time and make sure to hit every spot.

You are feeling for lumps, thick spots, or other changes.

Lying down

Finally, check your breasts lying down. With a pillow behind your right shoulder and your right arm behind your head, use your left hand to check your right breast. When you’re done, switch the pillow to your left shoulder and repeat the process with your left breast.

A breast check should be done at least once a month. If you menstruate, choose a time in your cycle when your breasts are the least tender, usually a week after your period ends. Women who are postmenopausal should check their breasts on the same day of each month.

What to do if you feel a lump

If you feel a breast lump, do not panic. Eight out of 10 lumps are not cancerous.

Don’t ignore it either. Call your provider if you feel or a lump or other change in how your breast feels, if there is dimpling, redness or swelling on the skin, if there are changes in the direction of your nipple, or if there is irregular or bloody discharge from your nipple.

Inflammatory breast cancer, which is rare, can cause redness, swelling, dimpling and changes to the nipple. The cause of the symptoms can be the result of cancer cells blocking the lymph vessels and making them appear inflamed.

Breast self-awareness does not replace visits to your health care provider or an annual breast cancer screening. Screening mammography usually can detect breast cancer before it can be felt.

The American Cancer Society no longer recommends self-exams as a screening method because there is no evidence they reduce overall deaths from breast cancer, but many breast cancer survivors say they discovered their breast cancer themselves.

Knowing your risk

Risk factors for breast cancer, according to the Centers for Disease Control and Prevention, include

• Aging. Breast cancer risk increases with age, and most breast cancers are diagnosed after age 50.
• Inherited genetic mutations. Changes to certain genes such as BRCA1 and BRCA2 are associated with higher risk for breast and ovarian cancer.
• Menstrual history. Starting menstruation before age 12 and starting menopause after age 55 increases exposure to hormones, increasing breast cancer risk.
• Dense breasts. Having more connective breast tissue than fatty tissue — dense breasts — increases likelihood of breast cancer. Breast MRI screening may be appropriate for some people with dense breast tissue.
• Personal history of breast cancer. New breast cancer diagnosis — not a recurrence of a previous diagnosis — is a risk in women who have had breast cancer previously.
• Family history. Having a mother, sister or daughter with the disease increases risk for breast or ovarian cancer, as does having multiple family members on either your mother’s or father’s side who have had breast or ovarian cancer.
• Radiation therapy. Radiation treatment on the chest or breasts before the age of 30 increases the risk of breast cancer.
• Exposure to diethylstilbestrol (DES). This drug was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage. Women who took the drug and their daughters are at higher breast cancer risk.

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Heather had experienced this once before. A small lump discovered in 2015 during a routine mammogram resulted in a lumpectomy. Fortunately, the cancer was stage 0 and no further treatment was needed. In November 2021, she discovered a new lump in her breast. She recalls thinking, “Here we go again.”

“I was getting in the shower and noticed a lump when my hand grazed the side of my breast,” Heather said. “I wasn’t sure. I remember checking again, and again, even later in the day checking again hoping it was a mistake or something different.”

Heather contacted Gigi L. Girard, M.D., OB/GYN with Associates in Obstetrics & Gynecology, a Part of Norton Women’s Care. Dr. Girard, a breast cancer survivor herself, had Heather come in immediately.  

“With her history, Heather is at increased risk for developing cancer, and any lump needed to be evaluated quickly,” Dr. Girard said.

After an in-office breast exam, Dr. Girard wanted to get Heather in for diagnostic testing that same day.

“I remember telling her, ‘I have a lot of meetings today,’ and Dr. Girard’s response was, ‘You don’t anymore,’ and we walked directly from her office to get the mammogram and ultrasound,” Heather said.

The staff at the Derby Divas Breast Health Center at Norton Women’s & Children’s Hospital jumped into action, getting a mammogram and ultrasound for Heather quickly. And within a day, Heather had her diagnosis of breast cancer. There was a large tumor in the left breast and smaller spots in the other. She would need a double mastectomy and to start a medication, tamoxifen, an estrogen blocker that would help treat her cancer.

Feeling the embrace of care

Throughout her treatment, Heather felt the embrace of care, support and hope from everyone she encountered at Norton Cancer Institute.

“I felt it for myself; I witnessed it in the interactions with others around me,” Heather said. “It was a part of who they (the care team) are in every interaction.”

Heather appreciated the compassion, and she felt more than just support for her clinical care.

“The Norton Cancer Institute Resource Center set me up with a social worker who helped me with applying for Medicaid. Being self-employed, my insurance benefits were terrible, and I was so afraid of accumulating unending debt from the medical expenses. It was a process, and I had lots of questions along the way, but the social worker helped me and I was on Medicaid before I had my surgery. It was such a relief.”

A social worker is just one aspect of the support available through the Norton Cancer Institute Resource Centers. The five centers provide personal attention to address patients’ physical and emotional needs before, during and after cancer treatment. The centers’ offerings range from support groups to monthly classes and seminars to therapies such as reiki, tai chi, art and music — even pet therapy. Heather was particularly fond of the art therapy and the opportunity to use art to work through her emotions.

Being enrolled in Medicaid before her surgery in January 2022 helped with the financial burden ahead of Heather. The Norton Cancer Institute Resource Center social worker played a huge role in assisting Heather with the process. And by end of that same year, Heather’s cancer was considered in remission. She and her doctors will continue to monitor for any cancer closely over the next five years, a time that is considered critical for all cancer survivors.

The honoree and what it means

Over the past 17 years Derby Divas has transformed from a small gathering of 20 or so to more than 400 people raising money and awareness for breast cancer detection. To date, the Derby Divas event has raised more than $1.78 million for Norton Cancer Institute in support of breast health initiatives. This includes funding a new Norton Prevention & Wellness Mobile Prevention Center and providing mammograms and health screenings for underserved areas of our community. Every year they select an honoree, this year was Heather.

“Derby Divas is enabling women of all walks of life the ability to get their mammogram,” Heather said. “The work and dedication this group of women puts into raising money and awareness of breast cancer screenings just amazes me.”

The annual event is presented by Churchill Downs and supported by Brown-Forman, The Diaz Family Foundation, Myriad Genetics and Northern Trust.

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As a medical assistant at Norton Cancer Institute Women’s Cancer Center, Rikka helps care for patients who have breast cancer and some who are in palliative care. According to Rikka, she wants to be there for every step of a patient’s cancer journey. She supports patients, prays for them and advocates for them when they are going through possibly the worst time in their lives.

For Rikka, faith is her guiding light.

“My motivation is God first,” Rikka said. “He’s head of my life. I wake up in the mornings and I pray, and he guides me in a positive direction.”

In her 10 years as part of the caring team at Norton Cancer Institute, Rikka has been a guide for her fellow employees and a faithful patient advocate. Above all else, Rikka approaches every situation she faces with love and patience.

It’s not surprising that Rikka’s faith also guides her to get involved in her community. She volunteers within Norton Healthcare for various events and activities and participates in Synergy, Norton Healthcare’s African American employee resource group. Outside of work, she is a member of the Order of the Eastern Star, a Masonic group guided by faith to serve the world.

To Rikka, Black History Month is a time to celebrate the past and look forward to the future.

“It’s an opportunity to uplift our Black voices and acknowledge our people who made sacrifices to make a difference in our culture — to honor our Black leaders who were historically oppressed, yet still gave us hope and lifelong lessons that are still relevant today,” Rikka said. “I wouldn’t want to rejoice and reflect in any other way.” In her free time Rikka enjoys dancing, listening to jazz and R&B, and spending time with her grandchildren.

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First diagnosis

In 2008, when she was 46, Wanda felt lumps in her breasts. Having just lost her job, she had no insurance coverage. So she made an appointment for a mammogram with the Norton Prevention & Wellness Mobile Prevention Center, which offers community screenings for breast health in locations around Greater Louisville.

“They called to say that yes, I had cancer,” Wanda said. “I had to call them back. I needed time to process that information.”

Wanda was diagnosed with stage 4 breast cancer. Her cancer also had spread to her lymph nodes, as well as her lung and chest wall.

After the initial shock, she said to herself, “I’ve got to fight to be here. I’m going to be here for my daughter.”

That daughter, Wynika Anderson, then 26, was there for her mother — driving her to appointments, praying with her and being her biggest supporter.

Wanda’s care team at Norton Cancer Institute included oncologist/hematologist Laila S. Agrawal, M.D., who guided Wanda through a single mastectomy surgery, chemotherapy and radiation.

“Having Dr. Agrawal there for me really helped,” Wanda said. “She was there with empathy, understanding and information. For example, she explained all the potential side effects for anything we did.”

The journey was not easy, but with the expertise of the team at Norton Cancer Institute and the love and support of her family, Wanda’s cancer has been in remission for five years.

Daughter follows in mom’s footsteps of strength and resilience

In 2021, Wynika felt lumps in her breast. Mom wasted no time in getting Wynika to see doctors at Norton Cancer Institute. They put Wynika on a course of chemotherapy. That treatment was supplemented with complementary therapies including art and music, and Norton Healthcare’s facility dog program.

Wynika continues to go to work at a retirement community, even after difficult treatments.

“I feel better when I’m with my residents,” Wynika said.

A consistent routine, care from her mom and son Kingston (now 11 years old), and her faith have been key to Wynika’s support system.

Though she sees her oncologist about every other week, Wynika’s prognosis is good, and she feels hopeful about her future.

Advice for the community

Wanda wants you to know that you need to care of your health.

“Even if you don’t have insurance, like I didn’t when I was first diagnosed, you have to check your own body,” Wanda said.

She acknowledges that statistics show that cancer rates are higher for the Black community than for other groups. This higher risk makes early detection and preventive care even more important.

Wanda spends time sharing her journey with other cancer patients and hopes to get the word out to her community that prevention is important, as is taking care of your health.

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While preparing for surgery, Sara discovered pillows designed for patients who have this surgery. Sara’s mom, Betty, is a retired home economics teacher and promptly created a version of the pillow for her daughter’s recovery.

“The pillow was a huge help on the car ride home from my surgery and during my post-surgery care,” Sara said. She learned that appropriate body position is very important post-surgery. Tissue expanders, which are placed in the chest to create more tissue for the reconstruction, can cause tenderness while healing.

Betty now makes and donates these recovery pillows for other patients.

“My mom was my rock during my time of need,” Sara said. She wants caregivers to know how important they are during recovery. Sara said, “Caregivers really step up when those of us who are going through it are down. They help fit the puzzle pieces [of our lives] back together.”

Sara’s aunt also had breast cancer and was a source of information and advice. Sara was surprised to learn that her aunt had championed insurance coverage for mammograms and other breast care services, including reconstruction.

Sara has felt inspired by her mom and aunt. She now volunteers with a nonprofit organization that provides research funding for metastatic breast cancer treatment and provides patient support. Reaching out to other people going through a difficult time is an activity that lifts Sara up.

Sara enjoys delivering recovery pillows, and the staff at Norton Cancer Institute Resource Centers appreciate Sara and Betty’s thoughtfulness. Sara feels a bond with her care team at Norton Cancer Institute after their support throughout her treatment. She appreciates her doctor’s guidance in choosing the best care plan for herself and her family.

“Norton is a great community for me. My services, whether it is an exam, or the screening mammograms I had before my diagnosis, the staff has always been caring. My doctor is always watchful. They understand that I am an individual. I have gained friendships through these experiences,” Sara said.

“I guess you have to walk through the rain to see the rainbows.”

Karen A. Allen R.N., BSN, OCN, is an oncology nurse navigator at Norton Cancer Institute.

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“I want other cancer patients to be as blessed as I am. I want them to have that little something special that they can use more than once,” Rhonda said.

It started when Rhonda’s sister was diagnosed with breast cancer over ten years ago.

Chemotherapy, radiation therapy or surgery can leave skin hypersensitive, especially in the breast areas. Rhonda’s mother made flannel washcloths that were very gentle on her sister’s skin.

Her sister shared the washcloths with other patients, who found them helpful during chemotherapy and radiation.

The family was surprised at how this simple gift was treasured and used by others. Now Rhonda’s mother handcrafts the cloths as well as cheerful, soft pillows for use after surgery. Rhonda brings them to the Norton Cancer Institute Cancer Resource Centers, where they are given to patients going through cancer treatment.

Rhonda also consults with other organizations that provide gifts to patients. She offers suggestions on items patients will find helpful such as mints, crosswords, seek-and-find puzzles and lip balm.

When asked what the biggest change in her journey has been over the years, she didn’t have to think for long – her answer was immunotherapy. Rhonda recently completed her immunotherapy at Norton Cancer Institute – Brownsboro. Immunotherapy was still experimental and in research at the time her sister was treated.

“I am so blessed with the whole Norton Cancer Institute staff. They are absolutely fantastic. Fantastic. There is not one person I have met who is not friendly, compassionate and kind. It’s been kind of wonderful. That is why I feel like I want to give back to other patients.”

Karen A. Allen, BSN, R.N., OCN, is an oncology patient navigator for Norton Cancer Institute.

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