Episode 7 Trailer- Breast Care Nurse Deb Scott

Deb Scott:

I introduce myself as a breast care nurse and I just listen to them, try to reassure them that this is not a death sentence. That we can cure this through surgery.

Wendy Squires:

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 oncoplastic, which involves removing cancers with pleasing aesthetic results for patients, after training in both plastic surgery and general surgery. Dr. Yaps 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 renowned experts in the field in Paris and Leon.

Wendy Squires:

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 & Scientific Committee. She is also Pink Hope expert advisor and vice president of the Medico-Legal Society of Victoria.

Wendy Squires:

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. Dr. Yap, before we get into your work, I’d love to introduce your breast care nurse, Deb Scott, who’s kindly come in today to talk to us. Thank you, Deb. We’ll talk to you in a moment. I’d love to talk to you about, why the breast? I know that you’ve studied quite extensively. Why the breasts? It came out of tragedy, didn’t it?

Dr Nicole Yap:

Yes. My very close friend Tina, Tina Hussey. She developed breast cancer during pregnancy and it was treated at the time when she was in Perth, this is before I knew her. And then she came across to live in Victoria and was always very concerned when she went for her annual checkups. And I hadn’t really got into why or the whereabouts of what happened when she was in Perth, as far as her management was concerned. But I do recall we used to go to the gym and one day, just after she’d been examined, she said, “I think they think it’s okay.” And then in the mirrors in the gym, we were doing a class and I said to her, “Have you got a lump on your neck?” Because I could see it in the mirror. And that’s when we diagnosed the metastatic cancer. And she fought with that for about five years, but succumbed, leaving behind three children, two of whom were still at school.

Wendy Squires:

That’s just awful. So that’s what made your mind up then that you would under specialize in the breast?

Dr Nicole Yap:

Yes. First of all, I want to make sure that all my patients get the full treatment, which I found that she hadn’t quite received because she was pregnant at that stage and then it had been forgotten after the birth of her child. Secondly, she was a very attractive woman and she was always sort of lopsided. And especially in her gym gear, she’d always be complaining it wasn’t quite right. And I thought, why do we have to put up with this? Just because the traditional approach was, “Well, you should just be lucky you’ve got over your breast cancer and you are alive.” You have to look at the whole person and if you’re going to stay alive for a long time, which is what the aim is and the intention after treating breast cancer, then we want someone to be psychologically fully apt and with it and feeling good about themselves as well.

Wendy Squires:

Exactly. You have studied internationally. Can you tell me what you learned over there that you couldn’t learn in Australia? Because traditionally in Australia we just had breast surgeons and we had plastic surgeons and the two very rarely met.

Dr Nicole Yap:

Yes. Well they did try, but the problem is that… well, I know this because I trained in both disciplines. But the issue about that is how do you put it together? So you need to know, one, oncologically where to put the incision and how to approach the cancer for good oncological result. Then you have to also decide where can I hide these incisions at the same time so that the patient doesn’t feel like they’ve had a cancer operation? And it’s all very well being you wear clothes on the outside and it looks okay, the contour looks great, but when you take them off and you might be maybe at the beach and you’re wearing more revealing bathers or your partner, or you might not even have a partner, do you really feel like going out there and revealing yourself to a new partner when you have these scars?

Wendy Squires:

Well, exactly. I mean, breast cancer is hard enough without feeling scarred as a result or wearing your impediment really. So the oncological approach is so important, isn’t it?

Dr Nicole Yap:

Yes. And Deb sees this as well. She sees the patients that are psychologically impaired by just the diagnosis, and is forever getting calls 24/7, I don’t get that. But she gets them and reports back, “Oh, this person is at the end of their tether because I think that they look so terrible.” I say, “Don’t worry, we’ll fix it. We’ll fix it and you know that the results can be quite nice, so.”

Deb Scott:

Absolutely.

Wendy Squires:

How is that for you, Deb? It must be a very specialized sort of nursing that you do in regards to this.

Deb Scott:

It is. It’s very rewarding. I mean, obviously when a woman first gets diagnosed with breast cancer, it’s shock for them. And they don’t know what to say, they don’t know what to think. So I introduce myself as a breast care nurse and I just listen to them. I listen, I try to reassure them that this is not a death sentence, that we can cure this through surgery and life goes on after breast cancer. So I’m here to provide resources and to make that cancer journey a little bit easier for them.

Wendy Squires:

I guess it’s not just their health concerns of the cancer, is it? Do you experience that it is the aesthetic or the horror of what could happen to them in regards to hair loss and things like that, that they are worried about as well?

Deb Scott:

Absolutely. So if they are requiring chemotherapy, unfortunately hair loss is a side effect from that. So obviously a lot of women feel very self-conscious knowing that they’re going to lose their hair. So I let them know where they can get a wig and let them know that their private health fund can reimburse them for wigs. There is also beautiful turbans and headscarves that they can wear. So I show them what they can get and where they can get it from. And a lot of women are not aware that they are able to get these resources. So they find the information I give them really useful and it helps them along their journey.

Dr Nicole Yap:

I know because I get to see them in a variety of wigs. I say, “What have you been up to Deb?” So, one time I had a patient come in. She said, “Oh, I was caught out.” She’s in the great community and does a lot of events. And she said, “I was shopping in my short wig and these people saw me and said hi. That night I went to the same event as them and I had my long wig on. And they said, “What is happening?”” And she said, “I didn’t know what to say because they didn’t know I was suffering from breast cancer and was going through chemotherapy.”

Dr Nicole Yap:

Because that’s the other thing, too. If you make people feel good about themselves, which you can aesthetically through the sort of cancer surgery that I do, the oncoplastic surgery, they cope so much better in an environment which otherwise is detrimental to the psychology, which is like having chemotherapy and losing your hair. All of a sudden they can see the other side of it that we can look good in wigs or scarves. And some people look really good, don’t they?

Deb Scott:

Absolutely. Absolutely.

Dr Nicole Yap:

They get involved with their wigs.

Wendy Squires:

It sounds like you support them very much though, in that journey as well.

Deb Scott:

Absolutely. And there’s another service that the Breast Cancer Foundation provides. It’s the Look Good Feel Good program which is held in the city. And it’s a day where they can go and be pampered. And they get their hair done, they get their makeup done and they’re made to look beautiful again. So obviously with cancer and chemotherapy, they lose their facial hair as well, they lose their eyelashes, their eyebrows. So when they go to the Look Good Feel Good day, they get their makeup done and they look normal again. So it’s a great day for women. They can bring their significant other as well. And it’s very popular so they have to book in real early.

Wendy Squires:

My mother, when she was dying of cancer, went and had that treatment and it was one of her best days. And she met so many wonderful friends there that were great supports to her as well, right to the very end, which was… it’s a wonderful, wonderful offering actually. Dr. Yap, is it true that realistically after a woman has had to go through something as traumatic as breast cancer, that some of your patients walk away and they’re happier with their breasts than they were?

Dr Nicole Yap:

Oh, yes. So with these different types of ways of treating breast cancer, either removing the cancer, otherwise in layman’s term called lumpectomy, or you can have a full mastectomy, but keep your skin and your own nipple areola, if it’s oncologically safe. So with these types of patients, you might have a very large breasted woman, I had one who came in and she had a terrible relationship with her husband because she felt so bad about her image. And he was so supportive and he was there and she pushed him away. After I did a breast reduction technique and removed the cancer at the same time, she told me sometime later, she said, this is the best relationship she’s had with her husband for about 20 years and it was all because she was diagnosed with cancer, and thanks very much for the treatment she received, because it really helped her feel confident about herself.

Dr Nicole Yap:

And the other cases are people with small breasts and they might come in and you think, you can take a little cancer out. But do you want small breasts? I’m talking about A cup size, maybe B. And like, “Oh no, I always wanted to be like my sister or my mother or my friend. Could you make me a bit smidge bigger? So I can achieve that, remove all the tissue from both sides, so they have reduced to risk of recurrence and you make them look just a little bit bigger and more confident in themselves, and they’ll always have perky breasts.

Wendy Squires:

Which is a wonderful thing for women who have been through this process too, if they can come out feeling a little bit more confident after being through such an ordeal. I that’s an absolute wonderful thing.

Dr Nicole Yap:

Yes, it’s a way of making a negative into a positive.

Wendy Squires:

What are the common misconceptions around breast cancer that you see in patients, and what is the realities?

Dr Nicole Yap:

So patients tend to not present early because they’re afraid of dying. And my idea or my message across to patients is that if you present early, early detection saves lives. And don’t worry about the rest, that’s my job. So I can fix the rest. So if you present early, we can actually treat it. And in Australia it’s been… the figures are approximately 20,000 women in a year, this coming year, will be diagnosed with breast cancer. And a 1% of those will be male, roughly. And also of those about 6%, so 3000 will die from the disease. So we need more people knowing about this and presenting early, so we can reduce that number. So, it’s a smaller percentage and in fact, the survival rate at the moment, which is not just survival, but cancer-free rate for five years from the diagnosis, if treated appropriately is 91%, which is pretty good.

Wendy Squires:

Oh, that’s wonderful. Deb, do you find the same thing too? Is that a statistic that you tell your patients?

Deb Scott:

Absolutely. And I think most patients, they know someone who had a friend who died from breast cancer and they relate their own journey to the stories that they’ve heard. And I always say, you can’t compare your diagnosis with someone else’s diagnosis. That’s probably the number one thing I hear the most that people compare themselves to other people. And I always say to them, this is your own individual journey. And the first thing is we know about it. So, that’d be just the most important thing. And after that, they feel relaxed and now they realize that we work as a team and we’ve had great success and patients have been really happy.

Wendy Squires:

Which I think comes back to what you say about your practice, which is that you provide bespoke breast care. It seems to me that this is a big message to get out there, is that everybody’s journey is different and it needs to be catered for as such.

Wendy Squires:

Ladies, it’s been wonderful chatting with both of you. Thank you so much for coming in.

Dr Nicole Yap:

Thank you.

Deb Scott:

Thank you.