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Breast Cancer Awareness Month: celebrating brave women fighting the good fight

Sunday, October 7, 2012



Exploring the Different Types Of Breast Cancer Breast cancer is a universal term to describe several different cancers that form in and around the breast. Breast cancer types are generally categorized based on where the illness begins, most often in the ducts or lobules, the parts of the female anatomy responsible for producing breast milk. About 226,870 new cases of invasive breast cancer in American women will be diagnosed in 2012, while more than 22,000 Canadian women will be diagnosed with breast cancer over that same time period. The National Breast Cancer Foundation lists seven different types of breast cancer. Here’s a look at them. I Ductal carcinoma in-situ (DCIS): This is an early form of breast cancer that refers to the presence of abnormal cells inside a milk duct in the breast. This type of cancer is generally found during mammograms and is considered non-invasive. This means it hasn’t spread yet. This makes treatment for DCIS easier than for other forms of breast cancer. I Infiltrating ductal carcinoma

(IDC): Also known as invasive ductal carcinoma, this is the most common type of breast cancer. According to, roughly 80 percent of all breast cancer cases are IDC. This cancer starts in the ducts, but “infiltrating” means that it spreads to the surrounding breast tissue. Over time, IDC can spread to the lymph nodes and possibly to other areas of the body. I Medullary carcinoma: This is a less common form of breast cancer. It is a type of IDC, but it gets its name from the color of the tumors, which are close to the color of brain tissue, or medulla. Medullary carcinoma is quite visible during mammograms because the cancer cells are large and form a barrier between healthy tissue and tumors. I Infiltrating lobular carcinoma (ILC): The American Cancer Society says that one in 10 women will be diagnosed with ILC, which originates in the milk-producing glands of the breast. In ILC, abnormal cells inside the lobule begin to divide and break through the wall of the lobule to invade the surrounding connecting tissues.

I Tubular carcinoma: This is a common cancer for women ages 50 and older. When viewed under the microscope, tubular carcinoma cells have a distinctive tubular structure. There is a 95 percent survival rate for tubular carcinoma. I Mucinous carcinoma (Colloid): This is a rare condition in which the breast cancer cells within the breast produce mucus. The mucus and the cancer cells join together to form a jelly-like tumor. The tumors may feel like bumpy water balloons, but some are too small to detect with the fingers. I Inflammatory breast cancer (IBC): This is a rare and very aggressive type of breast cancer that causes the lymph vessels in the skin around the breast to become blocked. The cancer gets its name from the appearance of a swollen, red and inflamed breast. Women are advised to get a baseline mammogram in their mid30s and then annual mammograms starting at age 40. Early detection is generally vital for any form of cancer and is especially so for breast cancer.





About This Issue:

Symptoms of Breast Cancer

Supplement and Cover Design/Layout Martha J. Henderson, Special Sections Editor Photography: Hannah Sharpe and John Eastman Contributing Writers Ted M. Natt Jr., Deborah Salomon and John Eastman For advertising information, contact Pat Taylor at (910) 693-2505 or email

Breast Cancer Awareness Month: celebrating brave women fighting the good fight

Sunday, October 7,


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Breast cancer is a disease that claims the lives of so many people. Although many deaths cannot be prevented due to the severity and late stage of breast cancer, early diagnosis goes a long way toward improving mortality rates and sending individuals into remission faster. Knowing the symptoms of breast cancer can help women and men improve their chances of surviving the disease after diagnosis, as the earlier the disease is diagnosed, the better a person’s chances for survival. Not every person experiences symptoms of breast cancer. That’s because, in its very early stages, breast cancer may not exhibit any symptoms or, if a tumor is present, it may be too small to detect during a breast self-exam. Furthermore, there are different types of breast cancer, each of which may have its own distinct symptoms. Some of these






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Girl Talk

This Oncologist Relates to Breast Cancer Patients, Woman-to-Woman This article was originally published in the Oct. 23, 2011, edition of The Pilot.


reast cancer changes the lives of women. Breast and other cancers are the life of Dr. Ellen Willard, the oncologist whose practice at FirstHealth Cancer Center in Pinehurst includes a significant number of women diagnosed with the disease. Willard is the only female oncologist in Moore County — and probably the world’s only oncologist to win a statewide 4-H sewing contest. Her entry: a pin-tucked, ruffled, two-piece flowered cotton dress, a country mile from starched white lab coats. She is high-energy, breezy, opinionated, plainspoken — a humanist with short, spiky hair. You know when Ellen Willard’s in the room, a colleague said.



Dr. Ellen Willard says treating cancer is all about a “team effort” that stems from the nurses and social workers at the Cancer Outpatient Center at the Pinehurst Medical Clinic. Willard (center) looks over a patient chart with Angel Swann, LPN (right) and Barry Baber, RN (left). And while a patient should not choose her doctor by gender, sometimes the comfort zone matters. “This is a sensitive area,” says Courtney Williams, RN/oncology case manager at FirstHealth Moore Regional Hospital. “If I had breast cancer, I’d rather talk to someone who knows how it feels, to explain why it’s breaking my heart. They’re not just boobs, you know. They are about feeding our babies, about loving our husbands. Dr. Willard is awesome.” Willard shrugs off the praise. “I’m a farm girl, from down a dirt road,” she says with a Piedmont twang. Willard’s father raised tobacco and hogs in Davidson County, near High Point. “My sister and I did some field work and chased pigs,” she says. Willard participated enthusiastically in 4-H activities, including quilting and sewing — not only the prize-win-

ning ensemble but, years later, her own wedding dress. The medical bent originated with Willard’s mother, a nurse. “She was my patient care model,” Willard says. “I loved science from junior high school, seeing structures and how they relate.” Medicine became her goal, early on. The UNC zoology major chose Wake Forest University School of Medicine in part because of a smaller class, and also because of “how they treated people.” An internal medicine residency led to hematology, gateway to oncology. She is board certified in internal medicine, hematology, medical oncology, hospice and palliative care, which qualifies her as medical director of the new FirstHealth Hospice House in Pinehurst.

see WILLARD, page 5


Willard From Page 4 Dealing With Cancer

Cancer, that dreaded beast, fascinated Willard, beginning with blood cancers (lymphomas). “You don’t just treat a single organ system,” since cancer attacks throughout the body. Medical oncology, she discovered, is pure whole-patient care using a team approach. Lay people still equate cancer with death. What kind of physician wants to toil in that vineyard? Willard protests. “The stories that make the newspaper are the true tragedies,” she says. “People who look at only the depressing miss the patient interaction, the success stories.” Some days, she says, resemble the thrill of victory, others the agony of defeat. Because, Willard continues, “Medicine is all about curing and healing and victory. But there are still things we can’t cure. As we make progress, cancer patients live much longer. We’ve made strides in understanding who needs to be treated aggressively.” Some strides are societal. In the mid-1950s, The New York Times refused to print the words breast and cancer. Now they appear on cereal boxes, T-shirts, kitchen implements, magazine covers. They are the subject of films, plays, books, TV specials, athletic events. October, once black and orange, has turned National Breast



ing the importance of a good doctor-patient match. Cancer Awareness Month pink, a noble and successful “The toughest part of my job is when family dysfunceffort that elicits varying opinions. tion plays out in the lives of my patients,” Willard says. Willard calls the effort a mixed bag: “Increased awareShe has witnessed extreme situations, like stealing pain ness prompts patients to be screened.” Yet, she continmedication and bickering about an ues, “Other cancers get the short inheritance. When family members shrift (money-wise). They don’t have disagree over treatment, she, as whole months. Lost in the dynamic is patient-advocate, gathers them in a that lung, not breast cancer, is the room and talks it out. most common cause of cancer death.” “But when families are united Willard provides these statistics: around a patient, they are wonderful,” Breast cancer is responsible for 30 she says. percent of cancers in women, but only Willard recognizes why some 15 percent of cancer deaths. women prefer a female provider Conversely, lung cancer is responsible when discussion turns to body image, for 14 percent of cancers in women, reconstruction and intimacy. but 26 percent of cancer deaths. Patients have already been According to the U.S. Department of diagnosed when she sees them. Some Health and Human Services, heart are fearful, others in fight mode, a disease is still the No. 1 cause of death few resigned. Most come armed with among women. information, not always complete or “If people really want to do someHANNAH SHARPE/The Pilot appropriate. thing for breast cancer patients, try to Dr. Ellen Willard is the only female “The biggest problem with the glut be intentional about it. Find out what oncologist in Moore County. is sorting it out, where it comes from, the money is going for,” Willard says. what is relevant to the patient’s She mentions FirstHealth situation,” Willard says, then shakes her head. “They Foundation CareNet, which addresses practical needs expect me to have heard what was on TV that day.” like wigs for women undergoing chemotherapy. Her method is to look a woman in the eye and tell the truth. Treating the Disease Breast cancer assumes many forms. Treatment may last for months or years and involve the family, increassee WILLARD, page 7

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Early detection of breast cancer can improve survival rates and lessen the severity of treatment options. Routine mammograms are essential to catching signs of breast cancer early on but so can home-based breast exams. Over the years there has been some debate over whether a breast self-exams, or BSE, is effective. Different breast cancer organizations have different views on the subject. Some studies have indicated that a BSE is not effective in reducing breast cancer mortality rates. Some argue that these exams also may put women at risk — increasing the number of potential lumps found due to uncertainty as to what is being felt in the breast. This can lead to unnecessary biopsies. Others feel that a BSE is a good practice, considering that roughly 20 percent of breast cancers are found by physical examination rather than by mammography, according to The American Cancer Society takes the position that a BSE is an optional screening tool for breast cancer. For those who are interested in conducting self-exams, here is the proper way to do so.  Begin with a visual inspection of the breasts. Remove clothing and stand in front of a mirror. Turn and pivot so the breasts can be seen at all angles. Make a note of your breasts’ appearance. Pay special attention to any dimpling, puckering or oddness in the appearance of the skin. Check to see if there is any change in symmetry or size of the breasts.  Continue the examination with hands placed by the hips and then again with your hands elevated overhead with your palms pressed together.

 Next you will move on to a physical examination. This can be done either by reclining on a bed or the floor or any flat surface. The exam also can be done in the shower. To begin examining the breasts, place the hand and arm for the breast you will be examining behind your head. Use the pads of your pointer, middle and ring fingers to push and massage at the breast in a clockwise motion. Begin at the outer portion of the breast, slowly working inward in a circular motion until you are at the nipple. Be sure to also check the tissue under the breast and by the armpit.  Do the same process on the opposite

breast. Note if there are any differences from one breast to the other. If you find any abnormalities, mark them down on an illustration that you can bring to the doctor. Or if you can get an appointment immediately, draw a ring around the area with a pen so that you will be able to show the doctor directly where you have concern. It is a good idea to conduct a BSE once a month and not when you are menstruating, when breasts may change due to hormone fluctuation. Frequent examinations will better acquaint you with what is normal with your breasts and better help you recognize if something feels abnormal.

October is Breast Cancer Awareness Month. Digital mammography is the most effective method for the detection, diagnosis and treatment of breast cancer. FirstHealth encourages you to take advantage of this lifesaving measure. Schedule your digital mammogram as a self-requesting patient or with a referral from your provider by calling 715-2778. Saturday appointments are available. Soft touch Mammopads® are available for a more comfortable mammogram. Working Together, First in Quality, First in Health

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Willard From Page 5 “She’s amazing with spot-on impressions of who might need counseling during cancer care,” says Beth Dietrich, a licensed clinical social worker at FirstHealth Cancer Center. “She assesses a patient’s coping skills during the consultation.” “This is a patient-intensive business. You can’t do this job if all you think about is the science,” Willard says. “By the time I retire, I’ll be a qualified minister and social worker. As you talk to patients, you get a sense how they will handle information. We all say cancer is not a curable illness. But breast cancer is extremely variable; women can live for years with Stage 4 disease. It has to be the fastest changing medical sub-specialty. Some patients bond with a nurse; others will only talk to their physician. Everyone needs reinforcement.” And compassion. Willard’s empathy is colored by personal experience. Her grandmother was diagnosed with earlystage breast cancer at the age of 80.

Surgery halted its spread. Her father, however, died of lung cancer three months after diagnosis. “He was a smoker. I knew what the outcome would be from the first phone call. That’s hard — knowing too much,” Willard says, visibly moved.

‘Do the Best You Can’ Rachel Yates has experienced cancer and Dr. Ellen Willard from both sides. Yates, a retired RN/surgical assistant, is a breast cancer survivor, owner of Hope Cottage in Aberdeen (a boutique for cancer patients) and has been Willard’s patient for eight years. “Ellen is direct but compassionate. She tells you the truth and then helps you handle it your way. She respects and listens to your ideas; she’s willing to explore other things,” Yates says. “She is the most intelligent woman and doctor I have ever known.” Beth Dietrich adds, “It’s an honor to work with her.” After 20 years in practice, Willard retains a freshman enthusiasm for

outdoors relieve stress. “My husband, Ken, is a huge part of how I can do my job,” Willard says. “He makes me laugh.” Death comes hard to these physician-warriors, male and female, old-school and contemporary, whose final service is to support cancer patients whentreatment has run its course. “You do the best you can. You always see patients as people and you’re faithful to them,” Willard says. “Death is a process, not an event. Patients decline — there’s an element of anticipatory grief. Some deaths hit harder than others. Certain days are awful; you don’t feel defeated, just sad. But I can handle it.” Looking back, Willard half-heartedly wishes she had been attracted HANNAH SHARPE/The Pilot another specialty. During a break in her day, Dr. Willard stops to catch up by“Now I can’t imagine doing with Beth Dietrich, a licensed clinical social worker at the anything else,” she says. Cancer Outpatient Clinic at Pinehurst Medical Center. Ellen Willard, MD: Carolina girl, born and educated. Not your oldfit, youthful doctor says. “People are time hen medic. A real piece of work. surprised to see me in the grocery store, Contact Deborah Salomon at but I have to eat, like everybody else.” Exercise, cooking, sewing and the

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Rachel Yates opened her shop, Hope Cottage, in Aberdeen, four years ago.

At Hope Cottage, Empathy and Service Abound This article was originally published in the Sept. 5, 2012, edition of The Pilot.

BY TED M. NATT JR. Business Writer


Rachel Yates helps Anne Steidinger, one of her regular customers, try on a head scarf.

Cancer survivor Rachel Yates knew there had to be a better way after she was fitted in a stock room for a breast prosthesis right out of a box. “It’s a very traumatic thing for a woman to have a breast, or both, removed,” said Yates, 73, who had a mastectomy nine years ago. “It’s very hard for women to adjust to it. They just need a little tender loving care. I know I did.” So, four years ago, Yates opened Hope Cottage, in 1,400 square feet of space at Magnolia Square in Aberdeen. The specialty shop has products and services dedicated to helping women on their journey through cancer treatment and recovery. “There was nothing here like this,” Yates said. “We’re the only free-standing cancer boutique for many, many miles. The closest one is in Greensboro. We have everything a woman needs to get through this journey. “We needed something more dignified, more private. I’ve been there, so I know what women need.”

SUNDAY, OCTOBER 7, 2012 But perhaps more important than the products and services is the compassion Yates brings to the job. “Many customers walk into the store angry at their situation and often project that anger on Rachel,” said her husband, Bob, who runs the back of the house. “But Rachel turns them around completely by listening to their story and empathizing. When the customers leave, they’re giving her all kinds of hugs and kisses.” Yates, a retired nurse, said listening to customer stories helps her assess their needs. “Most women diagnosed with cancer are initially terrified and can become paralyzed,” she said. “You’re wondering, ‘What’s going to happen? Am I going to die?’ So, it’s very much a step forward when women come here. They’re looking ahead.” Hope Cottage carries a wide variety of breast prostheses and mastectomy bras, as well as post-surgery camisoles. There are also plenty of hair-loss alternatives, including wigs, scarves, hats, caps and turbans. “We are sensitive to each person’s feeling about changes in body image and hair loss, and know how to address those changes,” Yates said. “We want to improve their quality of life by providing exceptional service and quality products to meet their personal needs.” While Yates relies on a couple of large suppliers for many of her products, she also sells specialty products made by fellow cancer survivors. Jackie Lawson, of Pinebluff, makes reading pillows and does other sewing for Yates. “Being a survivor, you really need someone who can understand what you’re going through. Rachel makes you feel very comfortable when you go into her shop,” Lawson said. “It’s relaxing, and you can’t find that anywhere else around here. She just has a true passion for what she does.” Lawson, who also sells her pillows at craft fairs, said she doesn’t keep track of annual production. “I have no clue. I just make them and sell them,” she said. “It’s just enjoyable for me to be in the sewing room.” Yates and her husband bankrolled the start-up of Hope Cottage and have never taken a salary. “It all goes back into the business so we have all that we need for our customers,” Yates said. Added Bob, “The best way to stay in business is to take care of your customers first, not yourself.” Hope Cottage currently has more than 800 customers between the ages of 11 and 94, most of whom come from about a dozen counties in North Carolina and South Carolina within a 60-mile radius of Aberdeen. “My customers have taught me an awful lot about survival,” Yates said. “Opening this shop has been one of the most rewarding things I’ve ever done. I’ve enjoyed every minute of it.” Hope Cottage recently received its second three-year accreditation from the American Board for Certification in Orthotics, Prosthetics and Pedorthics, an independent, nonprofit organization that has been providing facility accreditation since 1948. The store was recognized for achievements in organizational management, patient care standards, quality assurance, supplier compliance, and facility and safety management. “We are extremely pleased to have achieved this designation for the second time,” Yates said. “Accreditation is a rigorous process, but one that we welcome as a continual quality improvement mechanism.”

Contact Ted M. Natt Jr. at (910) 693-2474 or tnatt@




Breastfeeding With Breast Cancer? It Is Possible

Many mothers subscribe to the belief that breastfeeding is healthy for their children. Medical experts encourage breastfeeding for a period of at least one year so that the infant receives optimal nutrition and the antibodies necessary to start off life on a healthy track. But what of the mothers who have recently been diagnosed with breast cancer or previously undergone treatment? Although it may be challenging, breastfeeding might still be possible for women in such situations. Even under the best circumstances, many women find breastfeeding is challenging. Some babies do not take to it as easily, having difficulties latching on. As a mother, it may take a while to grow accustomed to breastfeeding or even for your milk to come in full force. Having breast cancer may make the process even harder. Stress can take its toll on the body, including causing physiological symptoms that can inhibit the production of milk or even make mothers feel less confident in their ability to breastfeed.

It is advisable for any woman thinking plan that is acceptable to all parties. If methods of detection can be used to about breastfeeding to enlist the help of a breast cancer is detected in lactating circumvent radiation-based methods of lactation coach or consultant. This breasts, there may be a temporary diagnosis, many of the treatments for can be especially beneficial to cancer involve cocktails of medications, women with breast cancer, as chemotherapy or even surgery — lactation coaches are knowledgeable all of which could affect breast milk. in how to express and store milk. It is important to discuss with your Once a woman has started physicians when your milk will be breastfeeding, she will need to safe again before returning to maintain her milk supply, which can breastfeeding. Chemotherapy and be problematic if she has to stop some types of radiation can leave breastfeeding for a period of time residual harmful chemicals in the due to cancer treatment. The body and breast milk. Surgery may consultant can guide you through damage milk ducts, causing a the proper procedures, which may compromised supply. Each case include a “pump and dump” varies and will have to be assessed by process. This will keep the milk the health professionals involved. coming, but you will be discarding The good news is that although milk that may have been breast cancer can temporarily derail COURTESY METRO CREATIVE Despite a breast ca compromised by treatment. breastfeeding plans, it doesn’t always ncer diagnosis, som CONNECTION have Women with a current cancer to mean weaning a baby from e women go on to successfully br eastfeed after treatm diagnosis or those who have had breast milk. Also, there is no evidence ent. treatment in the past should consult with that breast milk from a cancer survivor their obstetricians and oncologists as to interruption in the breastfeeding poses any risk to the infant. Many whether breastfeeding is advisable. The schedule. women go on to survive breast cancer and doctors may be able to work together on a Although needle biopsies and other successfully breastfeed.

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More than 500 people participated in this year’s second annual 1 in 8K Moore for the Cure event.

Run/Walk Raises More Than $32,000 for Breast Cancer BY JOHN EASTMAN Special to The Pilot

On Saturday, Sept. 8, 2012, the 1 in 8k Moore for the Cure was held in the village of Pinehurst. The 1 in 8k Moore for the Cure is a benefit run/walk that exists to raise funds to fight breast cancer, increase public awareness, and allow individuals to honor and support those who battle breast cancer. It is also the first feature event in the Fall Series of the Sandhills Race Series. Events included an 8k Run/Walk, a 1k Fun Run/Walk, a live concert by the band Ad Nauseam, and educational displays on breast health. This was the second year that the 1 in 8k was held. More than 500 people participated, and approximately 600 people were on hand for the events. The 1 in 8k Moore for the Cure raised more than $32,000 to benefit breast cancer treatment and research through Susan G. Komen for the Cure — North Carolina Triangle to the Coast affiliate. Many breast cancer survivors and their family and friends participated in this event. Businesses in the village of Pinehurst also participated in raising awareness and funds for breast cancer through the

Wine Walk that was held on the same day in the afternoon. Many businesses “Turned Pinehurst Pink” by offering a variety of items that were pink at a discount. Why an 8k? Sadly, statistics show that one out of every eight women will develop invasive breast cancer at some time in their lives. The 1 in 8k Moore for the Cure supports breast cancer awareness, screening and research by benefiting the Susan G. Komen for the Cure – North Carolina Triangle affiliate. All of the 1 in 8k proceeds go directly to the Triangle to the Coast affiliate, to which Moore County belongs. Within the past year, Moore County received a grant from the local Komen affiliate in the amount of $68,000 to provide free screening mammograms and follow-up treatment to women in Moore County who cannot afford such care. The 1 in 8k Moore for the Cure is a part of the Sandhills Race Series ( and is an annual event that will be held again next year on the Saturday following Labor Day. For more information on the race or the cause, go to the race website



Hey, Guys. Listen Up

Don’t Forget

Breast Cancer Is Not Exclusive to Women There are many people — male and There also are lymph nodes in the female — who are completely unaware breast region and under the arms. Cancer that men are susceptible to breast cancer. cells can travel through the lymph nodes With preventive mammograms and to other areas of the body. messaging largely geared toward women, Because men have considerably less men may not even think about the breast breast tissue than women, diagnosis of cancer risk to themselves. cancer can be easier. A lump in the breast Although less prevalent among men, is more noticeable on a man than on a breast cancer is not exclusive to women. woman. The American Cancer Society The American Cancer also lists a few other Society estimates that symptoms that could about 2,000 new cases be indicative of breast of invasive breast cancer: cancer are diagnosed I lumps in the in men each year, and nipples or chest approximately 450 muscle men die from breast I nipples turning cancer annually. Male inward breast cancers I skin dimpling or account for puckering around the approximately 1 nipple percent of all breast I redness or scaling cancer cases. of the nipple or breast The Canadian skin Cancer Society I discharge from reports that less than the nipple 1 percent of Canadian Benign growths can men develop breast be mistaken for breast COURTESY METRO CREATIVE CONNECTION cancer, and men over cancer. Also, men can Although rare, breast cancer can have a condition called the age of 60 are most likely to be diagnosed. affect men. gynecomastia, which To understand how is a noncancerous men get breast cancer, one must first breast tissue growth that may be know about the physical makeup of the mistaken for cancer. If any symptoms are male body. present, they should be brought to the Like women, men have breast tissue. attention of a doctor for further Before boys or girls enter puberty, they investigation. have similar breast structures, including If it is breast cancer, treatment methods breast tissue and a few ducts under the are largely the same among men and nipple and areola. women. A combination of chemotherapy, During puberty, female hormones radiation and surgery may be further develop the milk ducts and recommended depending on the stage and lobules, or milk-producing glands. For positioning of the cancerous tumors. males, testosterone levels increase during Although it is rare, breast cancer does puberty, stalling further growth of breast occur in men. Therefore, guys should be tissue. However, what was already there aware of their bodies and the breast area, remains, and in that tissue, cancerous and be on the lookout for any changes that cells can grow and multiply. could lead to problems. see us for an annual exam. It’s one of your best defenses against breast cancer. Our Women’s Care Center, our General and Bariatric Surgery Center and our Plastic Surgery Center are all in one convenient location. Together, they provide everything you need for comprehensive care of breast and breast diseases. U ˆ}ˆÌ> >““œ}À>«…Þ U *Ài«>Ài`‡Ìœ‡œÀ`iÀ ˆ>}˜œÃ̈Và U Û>Õ>̈œ˜ >˜` >˜>}i“i˜Ì œv i˜ˆ}˜ Ài>ÃÌ Concerns U ˜`ˆÛˆ`Õ> /Ài>̓i˜Ì vœÀ Ài>ÃÌ >˜ViÀ U ,iVœ““i˜`>̈œ˜Ã vœÀ -ÕÀ}ˆV> "«Ìˆœ˜Ã ˆ˜VÕ`ˆ˜} ,iVœ˜ÃÌÀÕV̈œ˜ U /Ài>̓i˜Ì >˜` >˜>}i“i˜Ì œv œ˜‡œ«iÀ>̈Ûi Conditions U œœÜ‡Õ« >˜` ˆvi‡œ˜} >Ài

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