Episode 1 – Oncoplasty with patients Ayda Hornak and Diane Appolis

Wendy Squires (00:10):

Welcome. My name is Wendy Squires. And I’ve been a journalist for more than 30 years, covering women’s health issues, which is why I have the great pleasure of introducing Dr. Nicole Yap, a highly respected breast doctor and surgeon.

Dr. Yap is a specialist in oncoplasty, which involves removing cancers with pleasing aesthetic results for patients, after training in both plastic surgery and general surgery. Dr. Yap’s techniques were refined whilst working in the European Institute of Oncology in Milan, at the Royal College of Surgeons in London, and working with world-renown experts in the field in Paris and Lyon.

Amongst her many accolades, Dr. Yap was the Deputy Chair of the Victorian branch of the Royal Australasian College of Surgeons, and its representative on the Cancer Council, Victoria Medical and Scientific Committee. She is also Pink Hope Expert Advisor and Vice President of the Medico-Legal Society of Victoria.

Today, Dr. Yap is known for providing bespoke breast care. In other words, individually catering, not only to patient’s medical issues, but also how they want to look and feel after treatment, as she is adamant that one size doesn’t fit all when it comes to breasts.

Today, I’m here with Dr. Yap and two of her patients, Ayda Hornak and Diana Polis. And we’re going to be talking about the relatively new field of oncoplasty. It’s a very big word, Dr. Yap. Can you explain what oncoplasty is?

Dr Nicole Yap (01:43):

Well, if you bring it down to onco and plasty, onco stands for oncology, so that’s the art of removing a cancer adequately, gold standard. And plasty is part of plastic, so using a synthetic surgery to help close everything up and produce a pleasing result.

Wendy Squires (02:03):

Which is very much your goal, isn’t it, with patients? It’s not just the cancer removal, it is the finished result?

Dr Nicole Yap (02:10):

I think the finished result is highly important. Just both for the patient as far as the oncology is concerned, of course. But also, because for their psychology. So they don’t feel like they’ve had a cancer operation forever more, because I expect my patients to live a long life. So they have to live with these results.

Wendy Squires (02:32):

That’s why you do the bespoke breast care really, which is because every single patient, it’s different, isn’t it?

Dr Nicole Yap (02:37):

That’s right.

Wendy Squires (02:38):

Well, that’s a pretty good cue then to go to some of your patients.

Dr Nicole Yap (02:41):

Yes. So, Ayda. Ayda presented with what would otherwise be a simple breast cancer, and she made a few choices. What did you choose to do, originally?

Ayda Hornak (02:54):

Yeah. I decided at the start, I just had a lumpectomy because unfortunately, I didn’t have the insight in what a bilateral mastectomy and reconstruction could result in. So I had to make a quick decision, and we did the lumpectomy. But then after I went and did my research, I decided that a bilateral mastectomy was the way to go to reduce potentially another cancer, the risk of another cancer.

Wendy Squires (03:21):

So, can you explain to anyone out there that doesn’t understand what that involves? What is a bilateral mastectomy?

Ayda Hornak (03:26):

So bilateral mastectomy is the removal of all your breast tissue, in both your breasts.

Wendy Squires (03:26):

Okay.

Ayda Hornak (03:31):

So I felt that I wanted that peace of mind of risk reduction, because I presented at 41. So, relatively young.

Wendy Squires (03:40):

Mm-hmm (affirmative).

Ayda Hornak (03:42):

So yeah, I went down that path and worked with Nicole to go through the whole reconstruction process.

Dr Nicole Yap (03:50):

Yes, we did a bit of reconstruction, because [crosstalk 00:03:54]

Wendy Squires (03:53):

Can you tell us what it entailed?

Dr Nicole Yap (03:57):

Well, so Ayda, first of all, had a lot of negativity from the oncology team, because she did have to have chemotherapy. And while she was having the chemotherapy, which was how long did that go for?

Ayda Hornak (04:11):

12 weeks.

Dr Nicole Yap (04:11):

Okay. So during that period of time, she was talking about risk reduction surgery to the people there. And I think people don’t understand that if you can fix someone and put them into remission for a long time, from the age of say 40, then there’s at least 30, 40 years ahead of you, during which time you could potentially get a new breast cancer, not the old one.

Wendy Squires (04:40):

What are the statistics around that, about it coming back?

Dr Nicole Yap (04:43):

Well, it’s a lot higher than one in seven. And one in seven is the current primary, low risk statistics for women. So if you have it any higher than that, it’s significant.

Wendy Squires (04:58):

Yeah, the odds aren’t great.

Dr Nicole Yap (04:59):

Well, especially the longer you live.

Wendy Squires (05:01):

Of course.

Dr Nicole Yap (05:01):

If you’re 80 when you get it, it’s unlikely. But if you’re 40, then you have that higher chance. And Ayda has gone through chemotherapy, which is not very pleasant.

Ayda Hornak (05:12):

No, it’s not fun.

Dr Nicole Yap (05:14):

No, there was another issue there.

Ayda Hornak (05:15):

Yeah. So when I was speaking with the oncologists and they said that my decision to have a bilateral mastectomy was an extreme one, because they caught the cancer so early, they said they’ll monitor me as we go, so I don’t need to have a bilateral mastectomy. Because if a new cancer was to form, they’d be able to get it very quickly.

Dr Nicole Yap (05:34):

Yeah, but not early enough to not have chemotherapy.

Ayda Hornak (05:37):

Correct. So when I asked the question, so do I need to go through chemo again if a new one forms, they’re like, “Yeah, but we’ll get it early.” Because chemo was so much fun. Why wouldn’t I want to do that? Crazy.

Wendy Squires (05:47):

No one would want to face chemo a second time in their lifetime.

Ayda Hornak (05:49):

No. Gosh, no. And that’s the cancer reason why I decided not to keep my other breast. I decided to go down the path of a bilateral mastectomy.

Wendy Squires (06:02):

Can I ask you, when you had the first breast down and then compared to the second, do you feel now more balanced? Are you happy with the result?

Ayda Hornak (06:12):

And that’s exactly what I was going to go to next. So there’s the medical reason and then there’s also the self-esteem, if you want to call it the self-esteem reason. I figured I’ve still got a lot of bikini days left in me, so I wanted to be able to look in the mirror and go, “Yes, there’s consistent-“

Dr Nicole Yap (06:27):

I’ve got lots of those photos.

Ayda Hornak (06:30):

“… there’s some consistency there.” They look the same, they feel the same. I’m not reminded of why I’ve gotten to that place. It’s not because it’s cancer. It’s because I made a decision to empower myself and say, “No, I’m going to take this negative and I’m going to turn it into something that I can work with and be happy with.”

Dr Nicole Yap (06:50):

And I have seen Ayda in frontless, backless dresses, all with the perky breasts.

Ayda Hornak (06:56):

No bra.

Dr Nicole Yap (06:56):

No bra?

Ayda Hornak (06:57):

No bra.

Wendy Squires (06:59):

No bra? Wouldn’t that be lovely? I think it was a very brave decision, but a very, very good one for you. And I think it’s very interesting, too, that you talk about self-esteem where a lot of people talk about aesthetics. It really is a lot deeper than that, isn’t it? It’s really about self-esteem.

Ayda Hornak (07:12):

Absolutely. As women, we identify with our femininity in the form of breasts, in the form of hair. So there was a stage where I had lost all my hair, removed my breasts and I’m looking in the mirror, going, “Who is this person?” I couldn’t relate to who I was. And I know it may sound shallow to some people because they’re only breasts, but it makes a difference in terms of your self-esteem.

Dr Nicole Yap (07:38):

I don’t think it sounds shallow to 50% of the population.

Ayda Hornak (07:42):

Yeah. Well, it certainly was important to me.

Wendy Squires (07:45):

Certainly doesn’t sound shallow to me, I can tell you that. This is probably a good time to talk to you, Diane, about your journey with Dr. Yap. What was the story? How did you end up being in her offices?

Diane Appolis (07:57):

Initially, I went to Dr. Yap for a breast reduction, because my breasts were becoming larger. I was having neck pain and back pain. So my GP referred me to Dr. Yap and Dr. Yap did some tests before we did the reduction. She first did the test to find out what was there and what she was having to deal with. She found a lump and it was benign. And I had some biopsies done, and I was sent away to decide when I was going to have the breast reduction done.

So I went back after it was about 18 months, wasn’t it? I went back to her because I could feel it. Something was not right. And it was painful. More tests done, which found the big lump there that was cancerous. So initially, when they told me, I said, “We’re going to have to sit down now,” because I was beginning to [inaudible 00:08:49].

Wendy Squires (08:48):

Oh, I can imagine.

Diana Polis (08:50):

So I said, “Well, we just have …” And I asked the doctor, “Am I going die now?” She said, “No, no. No, not yet. Not just yet. Not just yet. We’ll take it from there. We’ll see where we go.” So we just did one step at a time. And then Dr. Yap helped. I did it on my own with her, because I was living alone with my dog. [crosstalk 00:09:12] an elderly mother that I had to put into care. So yes, I was all on my own.

Wendy Squires (09:17):

Everything happens at once, doesn’t it?

Diana Polis (09:19):

Everything did.

Wendy Squires (09:20):

So Dr. Yap, what did you do with Diane?

Dr Nicole Yap (09:23):

Well, she now presents with a cancer and back pain from large breasts. So I thought, why not do two in one? So removed the cancer with adequate, very clear margins, biopsy the lymph node from the same incision, and then did a breast reduction technique. So she’s had everything done and fortunately, is doing extremely well from the cancer perspective.

Diana Polis (09:54):

Yes.

Wendy Squires (09:54):

Oh, that’s wonderful. So can I ask, as someone with large breasts, what size did you go from and where did you end up?

Diana Polis (10:01):

I was a size 20. I think it was H or something like that. And I’m now a 20D, so I’ve got my young, perky breasts again.

Wendy Squires (10:11):

How wonderful. And it sounds like you’re very, very happy with the results.

Diana Polis (10:15):

Yes, I am. Thank you. Yes.

Wendy Squires (10:17):

Your neck and back?

Diana Polis (10:18):

No pain. No, no stress on the neck or the shoulder blades. Nothing. It’s all gone.

Wendy Squires (10:24):

And cancer, too?

Diana Polis (10:25):

Cancer, too. Cancer free now.

Wendy Squires (10:28):

That’s so wonderful.

Dr Nicole Yap (10:29):

Yeah.

Wendy Squires (10:29):

Well, I thank you both for coming in and sharing your stories. I really appreciate it.

Ayda Hornak (10:34):

Pleasure.

Diana Polis (10:35):

Thanks.