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Andrea Colton, MD, MPH, breast surgical oncologist at Lexington Clinic

LEXINGTON In the third grade, Andrea Colton, MD, MPH, wrote a book titled “My Grandpa’s Open-Heart Surgery,” chronicling the observations and lessons she’d gained at Cleveland Clinic visiting her grandfather while he recovered from a heart attack and subsequent surgery. The book was even replete with hand-drawn illustrations of her grandfather recuperating in his hospital bed and an anatomical representation of the heart.

Of the experience, Colton says, “I got to see him hooked up to all the different machines in the ICU and they explained that this was ‘keeping grandpa alive.’ About the surgery, they actually explained, ‘We connected this artery to this artery and this artery to this artery.’ And, so from that experience, I decided I wanted to be a surgeon.”

After attending the University of Kentucky and achieving a BS in dietetics, Colton received her medical degree and master’s of public health from St. George’s University in Grenada.

Colton states that her interest in public health came from her desire to have an impact on a larger patient population in addition to her surgery patients. “Working with one person helps that one patient, but public health helps a larger population,” she says. She remembers a fellow church-goer who had put off getting a mammogram until a lump was found in her breast. “I felt that by encouraging people to do small things for their health, they could have better outcomes and that spurred my interest in public health.”

Colton did her general surgery internship at Einstein Medical Center in North Philadelphia in Pennsylvania and a five-year general surgery residency at Conemaugh Memorial Medical Center in Johnstown, Pennsylvania. While there, she was exposed to a variety of different types of surgery—vascular, cardiothoracic, plastic, endocrine, cancer, colorectal—but was having trouble finding a specialty that suited her personality. After working with Patti Anne Stefanick, MD, who headed a breast surgery private practice, Colton knew she had found the right fit.

Of watching Stefanick with her patients, Colton says, “I remember going in, and she was holding their hands and talking to them, easing their fears and just reducing their anxiety levels. It made a really big impact on me. From that mentorship, I applied for a fellowship for breast surgical oncology.”

From Texas to the Bluegrass

Upon completing her fellowship at the University of Texas Southwestern in Dallas, Colton decided to return to Kentucky and join Lexington Clinic. This decision was largely based on the fact that Colton wanted a say in how her practice was set up and her patient protocols, particularly the amount of time allotted for each encounter. She states, “Breast surgery is not something that you can just say, ‘Hey, you’ve got appendicitis, and we need to take it out. And here’s how we’re going to do it.’ Our job is to explain all the different options, with the risks and benefits, and allow the patient to make the decision that is best for them. And that ultimately requires some time. It’s a lot more complex than you can discuss in a few minutes.”

Colton cares for both malignant and benign breast disease and performs excisional biopsies, nipple sparing mastectomy, skin sparing mastectomy, and partial mastectomies with oncoplastic techniques, optimizing cosmetic results as a Hidden Scar-trained surgeon. The vast majority of her patients are middle-aged and above women, though she occasionally encounters younger women and men with breast disease.

Advanced Technology for Improved Results

With breast cancer, across the board, technology has vastly improved the surgeon’s ability to make certain that tumors are removed with adequate margins. Two, in particular, have elevated efficiency: radio-frequency identification (RFID) tags and 3D mammography within the OR.

Colton explains, “If we cannot feel the malignancy within the breast, we use a localization called a radio-frequency ID tag. This is essentially a microchip that we place in the breast. Then, I am able to tell exactly how far away I am from the microchip.” A large area of calcifications may require multiple RFIDs placed in different areas to indicate the margins.

The 3D mammogram machine allows the surgeon to see one-millimeter slices of the specimen to evaluate exactly how close they are to any of the edges to determine whether further tissue needs to be taken to prevent additional surgery at a later time.

Breast cancer surgery has also advanced in its aesthetic abilities. Oncoplastic surgery, in which tumor removal and reconstructive surgery occur at the same time for breast conservation, allows for much better cosmetic outcomes. Two options are the Goldilocks mastectomy option and the Hidden Scar technique.

Colton explains the Goldilocks method: “If a patient has a good amount of subcutaneous tissue, then it facilitates us being able to remove all of the breast tissue in a pattern, which is very similar to a breast reduction. The tissue that is left in place is subcutaneous tissue, which is not at risk for breast cancer. And so that subcutaneous tissue is rearranged in a way that makes a full or small mound that resembles a breast.” Oftentimes, this breast contouring results in surgery being undetectable while a patient is clothed.

“The biggest thing I want women, or anyone with breast cancer, to know, is they have a lot of options.”— Andrea Colton, MD, MPH

The Hidden Scar procedure, which she currently performs on 95% of her patients, strives to make individuals more comfortable with their breast surgery results while unclothed. This technique involves hiding the incision around the areola, in the inframammary fold along the bottom of the breast, or in the axilla. Colton states, “I have patients that come back, and they say, ‘Oh my gosh, my doctor couldn’t even find your incision. It was so small and so hidden.’”

For more complete or complex cases requiring an implant, reconstruction is performed by a plastic surgeon who places a tissue expander or an implant at the time of the initial surgery, after Colton has removed all the breast tissue.

Ultimately, beyond actually performing their surgery, Colton sees her job as empowering the patients to be able to make an educated decision. On that note, there is something important Colton says in closing: “The biggest thing I want women, or anyone with breast cancer, to know, is they have a lot of options and they need to feel comfortable with whom they’re working with. Most women don’t really understand that they have the ability to choose whether you remove all your breast tissue or whether you get reconstruction or whether you have a small or large surgery. The vast majority have a lot of options that they don’t realize they have.”

From observing open heart surgery to performing breast reconstruction, Colton has followed her passion, and her patients are better for it.