“Of course They are Fake, Her Real Ones Nearly Killed Her”

“Of course They are Fake, Her Real Ones Nearly Killed Her”

response to The NY Times Jan 29, 2017
“After Mastectomies, an Unexpected Blow: Numb New Breasts”
by Roni Caryn Rabin
Beth Baughman DuPree, MD, FACS, ABIHM

Breast Cancer Surgeon and V.P. Surgical Services

Holy Redeemer
William L. Scarlett, DO, FACS, FACOS

Reconstructive Surgeon

Holy Redeemer


Have a listen to our recorded response to the NY Times article Jan 29, 2017

“After Mastectomies, an Unexpected Blow: Numb New Breasts”
Jan 29, 2017 by Roni Caryn Rabin

We were taken aback by the focus of the article on numbness and loss of sensation after a
mastectomy when we, as a breast cancer surgeon and a reconstructive surgeon, are
striving to decrease the physical and psychological trauma of breast cancer in every
patient we treat. Nipple-sparing mastectomies and Oncoplastic surgery are replacing
other forms of more disfiguring breast cancer operations that were accepted for decades
as “the norm”. Remember, we are not augmenting a breast. We are reconstructing a
diseased breast or one at risk for cancer.
Numbness and loss of normal sensation after breast cancer surgery are just a couple of
the concerns we discuss with our patients before any type of breast cancer operation;
whether it is breast preservation, skin sparing mastectomy, or most recently, nipple sparing mastectomy. For more than one hundred years – until the 1970’s – women didn’t
worry about numbness or loss of nipple sensation in their reconstructed breasts. Women
often had their entire breast, chest wall muscles and lymph nodes removed, often without
their knowledge, for diagnosis of breast cancer. They were simply not offered immediate
reconstruction or breast conservation. It was not an option.
In the thirty years that we have practiced breast surgery, there has been a major shift to
preserve the breast whenever possible, and when a mastectomy is chosen or required, to
try and preserve the nipple areolar complex. Preserving the nipple and skin envelope are
purely for cosmetic reasons and are far more technically challenging cases than the
previously-performed radical mastectomy or skin sparing mastectomy. The prior
reconstructions would require nipple areolar creation with surgery and/or tattooing. There
is no chance of maintaining nipple sensation when the nipple is in the pathology lab.
No one dies of breast cancer in the breast; they die when it spreads to other areas of the
body. Therefore, the “local treatment” (breast and lymph nodes) has made major strides
in working to preserve the physical appearance of the breast while adequately treating the
“There’s such a strong cultural gaze at women’s breasts,” Dr. Pitts-Taylor said. “It does
raise the question: Who is breast reconstruction for?” Breast reconstruction is for the
woman who had breast cancer; women who want to look in the mirror in the morning and
feel at peace with their appearance after a traumatic breast cancer experience.
Breast cancer is a diagnosis that is an emotional emergency, not a surgical emergency.
Risk-reduction surgery for women who are identified as carriers of high-risk deleterious
genes is an elective procedure. There is time to gather information, learn about all options
and gain a true understanding of the potential risks, benefits and long-term consequences
of the surgical decisions. We are no longer exclusively performing breast cancer surgery
on individuals with cancer. Genetic testing has come so far that we are identifying
women who have a higher probability of getting cancer, that can then choose to have
their breasts removed and reconstructed.
Let’s reframe the perspective on risk-reduction surgery. Women choose this operation
electively to decrease their risk of getting breast cancer from 50–87 percent to 1–4
percent. In 2008, when data on genetic risk revealed that some deleterious genes carried a
60–70 percent chance of cancers being triple negative (ER-, PR-, Her 2 neu-) the number
of women opting to reduce this chance by removing their breasts sharply increased.
Should we deny women the best aesthetic outcome, which can be achieved with a nipple sparing mastectomy? While we can not police what surgeons do in their practice, we can
educate them about the importance of fully and sincerely informing their patients. We can
empower and educate women to ask the right questions and demand the answers, and for this reason I am thankful that the New York Times has raised the issue.
If you are contemplating risk-reduction surgery, if your cancer requires a mastectomy or
if you are choosing a nipple-sparing mastectomy, remember that your grandchildren will
not care whether they are hugging “fake” reconstructed breasts. They are simply thrilled
to be hugging you.
Here are some of the most important questions to ask before any reconstructive surgery:
• If I choose or need a mastectomy, what are my reconstruction options?
• Can I choose to have implants? Can I use own tissue? If I choose to use my own
tissue, does reconstruction happen immediately or does it need to be delayed?
• How do chemotherapy and radiation therapies affect my reconstruction choices?
• Where will my incision be located?
• Can I preserve my nipple, and if not, why?
• Will my preserved nipple have sensation or contractility?
• Will my chest wall and arm pit have sensation? If so, when?
• If I choose to remove my nipples, can they be reconstructed?
• If I need tissue expanders, what will they feel like and how long will I have them?
• What are the possible complications in reconstruction?

Surgeons can not remove a breast or breast cancer without interrupting nerves, blood
vessels and your body’s lymphatic system. Long-term effects can occur, and no one can
predict the significance of these effects, but to not be fully informed of all possible
outcomes is unacceptable.

If you feel you have not been fully informed by your breast or reconstructive surgeon,
“vote with your feet,” and get a second opinion.

ABSICON 2016 “Celebrating India’s Breast Care”


Humbled and honored to be an invited international faculty member for the 4th ABSICON Conference. 1-3 July 2016 was a wonderful opportunity to share knowledge, culture and friendship in Bangaluru, India. Dr P Raghu Ram is the president of the ABSI and I had the great fortune to meet him in 2006 when he was completing his training in the UK. A diagnosis of breast cancer in his mother prompted his unplanned return to India to start a breast center so that other women could have access to exceptional breast care. Raghu is a dear friend and invited me to participate in the Congress teaching breast ultrasound, demonstrating nipple sparing mastectomy techniques, live and on video ( Huge Thank You to Medtronic Advanced Energy) as well as lecturing on an integrative approach to breast cancer. Dr Raghu Ram had the idea to begin the society upon his return to India and in 2011 he and his fellow surgical colleagues founded the society to further breast care in all of India.

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My travels from the USA to Bangaluru India were uneventful and the accommodations at the ITC Bangaluru were nothing short of perfection. Huge gratitude to Dr. Somasheker S P who, with the guidance of his talented wife who happens to be a pediatric surgeon, put together an amazing program.


Each floor had a theme and no surprise there were dragon fly’s on my floor with a message for me the minute I walked off the elevator.


There were many moving parts to this congress and multiple opportunities for things to go haywire, but somehow they pulled off a complex schedule without a huge ancillary staff. So literally surgeons were in charge and we all know that without our scrub techs and circulating nurses, we are practically useless in the OR!!

In India ceremony is part of everything and we, the international faculty, were all overwhelmed by the honors bestowed to us from the ABSI committee.


Humbled and Honored

Dr Hiram “Chip” Cody, past president of the ASBrS and attending breast surgeon from MSKCC presented a talk on “Axillary node staging:the beginning or the end”. Chip is an amazing surgeon incredibly humble for an academic surgeon who is known around the world not as “A” breast cancer expert but as one of “THE” breast cancer experts. He was again honored by the committee during his talk.

I presented two well received lectures to the general session. The first was a video of my nipple sparing mastectomy technique and the second on an integrative approach to breast cancer care. The doctors were thirsty for the knowledge and I needed 2 hours not 12 minutes to present all of the information that I had to share. ( it gives them a reason to bring me back to complete the full lecture!)

Dr Andrew Baildam , breast consultant from the UK gave the keynote to end all keynotes to surgeons. “Excellence in Surgery: Hubris and Humor”.  Every physician, whether a surgeon, radiation oncologist or medical oncologist, at The ABSICON conference in Bengaluru India was deeply touched by his words. In the pursuit of excellence as surgeons we must all remember to use courage, communication and compassion in all we do. I feel privileged to call him a colleague and a friend.

He received a much deserved standing ovation!!


Nothing seems to happen quickly in India, but we were successful in a quick spice run with the help of Dr Sumohan Chatterjee‘s cousin/sister Sumana and her husband. When I asked my eldest son what her wanted from India, her requested spices and spices he will receive.

Bollywood night was another experience all together. These doctors know how to thorw a party.


Raghu and Som deserve a standing ovation for their tireless work along with the entire Association of Breast Surgeons of India for putting on a fantastic conference.The ABSI has only just begun and the shift in breast care in India is palpable.

Their hospitality did not end with the conference as they made sure that we saw the sights of Bangaluru and the surrounding area. A young surgical oncologist in training, Dr Rohit Kumar, not only guided us through his country, he renewed my faith in the youngest generation of surgeons as he possesses, Dr Andrew’s triad Courage, Compassion and Communication!! We were given VVIP treatment at the ISCKON Temple where we learned that they feel hundreds of thousands of children in public school daily. The program was started in 2000  and has grown to supply endless children nutritious meals daily at school. We were given a tour of the kitchen and you could eat off of the floor, it was so clean.

We visited endless temples, The Mysore Palace, Mysore Chamundai Temple where a movie was being filmed The Mysore Zoo and were nourished ourselves with  amazing South Indian foods at what once was the Summer palace of the royal family.



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The monkey was drinking bottled water!!


Beth Rohit and Andrew on our city tour

As I type this post I am preparing to depart India. My plane leaves in 6 hours for the USA where it is currently the

4th of July!!!

What I know to be true after my breast cancer update in India, is that we are so fortunate to have the resources for our patients in the USA where breast cancer affects 1 in 8 women.  These amazing physicians and surgeons in India are treating the same disease I am treating in America and are doing it at a high tech level with a fraction of the resources where their incidence is 1 in 25 and rising. They have created Indian solutions to Indian problems in healthcare delivery and are tirelessly working to continually raise the bar to provide comprehensive care to women throughout their country. We are all facing the same problem as breast cancer is affecting younger women in both countries. This is where we can all work together to get to the source and not simply treat the symptom of breast cancer.

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We need to remember to focus on the “whole” as we target the tumor

 Happy 4th of July 2016 !




Screening mammograms aren’t killing women, BREAST CANCER is!

 Enough with the FEAR and UNNECESSARY BIOPSIES already!

They told us to wear PINK in support of their fearless leader! We always take things to a new level

They told us to wear PINK in support of their fearless leader! We always take things to a new level

The ACS’s recent recommendations for breast cancer screening that were released this week may state they interpret statistics, but as a breast surgeon, my partners and I look into the eyes of these young women who’s lives have been saved by early detection and they are not statistics!

Thankfully we now have advanced imaging in 3 D Tomosynthesis mammography, automated whole breast ultrasound and MRI when appropriate. Clinical breast exams  and breast self exam are important to identify the 20% of cancers that are not found on imaging!

The Facts about screening mammography speak for them selves.

  1. Breast cancer is the single leading cause of death for women ages 40-49 in the United States[1] So why would we delay a baseline mammogram and annual screening to women over 45?
  2. There are some aggressive breast cancers (the minority) that will occur between screenings (that’s why breast exams do matter). We call these cancers interval cancers as they often occur in the interval between mammograms and can grow rapidly. They are the triple negative breast cancers and the Her2 neu positive breast cancers. These cancers can both be treated and cure is possible, but that require aggressive chemotherapy and often radiation therapy.
  3. A benign diagnosis from a breast biopsy is not an “unnecessary” biopsy; it is fortunate for that patient that she does not have cancer. Many aggressive breast cancers mimic benign growths in the breast such as fibroadenomas and complex cystic masses. It takes a minimally invasive breast biopsy to tell them apart.
  4. According to the AACR (American Association of Cancer Researchers) , the total number of breast cancer cases in the United States is forecast to be 50% greater in 2030 than it was in 2011 (that is an increase from 283,000 in 2011, to 441,000 breast cancers diagnosed annually in 2030 ) Mostly ER+ tumors which are related to lifestyle choices. (the ones we find on screening mammography) [2] I ASK WHY CUT BACK SCREENING NOW?
  5. In a 20 year mammography screening study, Laszlo Tabar found that women aged 40–49 years, who were offered screening mammography compared to women not being screened there was a significant 48% reduction in death from breast cancer.[3]
  6. >75 % of all breast cancer is found in women without a family history! The notion that women with a family history should have access to higher levels of screening is insane as all women are at risk and the majority of breast cancers will occur in women without a family history.
  7. We finally have a tool for screening dense breasted patients with automated whole breast US. If you are told that your breasts are dense, insist on an ABUS. An automated whole breast ultrasound is a specific screening tool for women woth dense breasts and there is no radiation exposure with this test. There is legislation in place to inform you if your breasts are dense when you receive a screening mammogram so read your letters carefully. A standard hand held US done on both breasts is not the same as an ABUS. Be an informed consumer.
  8. We need more dedicated breast imagers who specialize in advanced breast imaging. These are  specialists who dedicate their career to early detection and diagnosis of breast cancer. They can decrease unnecessary biopsies  and call backs when they have the latest technology and fine the cancers at an early stage.
  9. What they did get right is stopping screening in the nursing home bound elderly who have a life expectancy < 10 years

Just the facts!

sporting the Pink Hair in Aupport of our patient

Suzanne was 44 and her 3 D Tomosynthesis mammogram found her tiny cancer. Under the new guidelines, she wouldn’t have been diagnosed for another year! Had they not had her prior mammograms to compare with, they may have put her in line for a 6 month follow up.

So what can you do as an educated empowered woman to decrease your risk of breast cancer?

Fear paralyzes and knowledge empowers so go forth with knowledge. There are modifiable risk factors and non- modifiable risk factors.

  1. The first  and greatest risk factor is having been born a woman. (Cannot change that)
  2. DO NOT SMOKE (Do I really have to remind you in 2015?)
  3. We cannot change our family history! But you need to ask you relatives if there are family members who have had breast cancer. (Ask at what age they were diagnosed and do not forget, men get breast cancer too so be specific) In addition a family history or ovarian cancer, colon cancer, melanomas and pancreatic cancers may place you family at higher risk for known genetic mutations, so be informed. (Ask your doctor if you qualify for genetic testing or visit https://www.myriad.com/patients-families/disease-info/breast-cancer/)
  4. Have your first child before the age of 30
  5. Breastfeed your babies. (Particularly if you have your first child over the age of 30 as it can help to decrease your risk!)
  6. Avoid alcohol particularly before you have your first child. The data is clear that it increases your risk, the more you drink the higher the risk, and we just need to get the word out! (This holds true for ER+ and ER- tumors!)Nutrition News.
  7. Maintain a healthy BMI. < 25!! Obesity is linked to an increased risk of breast cancer and an increased risk of recurrence of breast cancer in someone who already had breast cancer. (Fat is the building block of estrogen!)
  8. Exercise 30 minutes a day
  9. Eat a healthy diet viverhealth.com
  10. Sleep matters. (Lack of sleep and poor interrupted sleep is linked to an increased risk of breast cancer.)
  11. Risks of Poor Sleep 
  12. Huffington Post

Screening Recommendations

  • Baseline between 35-40 and if you have a family history, ask your doctor if you need to do anything earlier
  • Begin screening mammography at 40 and annually thereafter
  • Know your breasts. There may not be enough data for the ACS to say the breast self exam and clinical breast exams reduce the risk of dying of breast cancer, but since 20 % of breast cancers are not found easily with screening studies, and some cancers grow rapidly breast exams matter. So become familiar with your breasts and if you feel something don’t panic, see your doctor.
  • Ask if a 3 D Tomosynthesis mammography is right for you?
  • If your breasts are dense, request an automated whole breast ultrasound ( ABUS)
  • If your doctor calculates your risk of breast cancer and it is > 20% in your lifetime you should qualify for breast MRI for screening. http://www.hughesriskapps.com/

The take home message is to be aware of your personal risks and modify those that you can. Live consciously, eat clean, exercise regularly, limit yourself to 4 oz. glass of wine 5 X per week (or it’s equivalent) after you have had your first child and get enough good quality sleep. In addition, screening matters and don’t be afraid of a cancer your mammogram my find, instead, if your mammogram finds a cancer at an early stage, be thankful that that mammogram may have saved your life!

Finding Peace in your Heart

Whatever you do in life fine PEACE in your heart!




Follow me on twitter @drbethdupree

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[1] https://consensus.nih.gov/1997/1997BreastCancerScreening103html.htm

[2] http://www.ascopost.com/ViewNews.aspx?nid=26587

[3] Laszlo Tabar, et al. THE LANCET Vol 361 • April 26, 2003 • http://www.thelancet.com

The Bees are Buzzing

Checking the hive

Checking the hive

The winter of 2014-2015 was particularly hard on the bee population in Pennsylvania. As a backyard beekeeper, I was saddened when I checked my hives in March to find that only a very small number of bees had survived. I did in fact order new bees as I was not convinced that my bees would make it through the winter.

In February, through a Facebook synchronicity, my friend Steve was intrigued by the bee boxes in direct view from my kitchen window. He was introduced to a new bee keeping technology created by Flow Hive a company out of Australia who created a technology to harvest honey without disturbing the honey making process. It has the potential to revolutionize the honey industry.

We went on line for the companies pitch to get funding for their start up and with in a few hours not only did they raise the 70 K they were looking fro but raised millions for their endeavor. Happy to report that Steve and I were in the early wave of investors and my Flow Hive is in transit from Australia as I type.

Backyard bee keeping has many advantages for the individual bee keeper as well as the planet. Having your own supply of local honey is advantageous for those with seasonal allergies. A tsp per day during the high pollen season can help alleviate the seasonal allergies. ( Not working so well today form my son who is working in the yard, but he has not been taking the tsp of honey daily.)

Stay tuned to the Buzz for updates on this years honey.

Sweet Dreams!!

bees to send-23 bees to send-24 bees to send-25

CRISIS IS OPPORTUNITY:The State of Breast Cancer Care in China


Shanghai China

 Crisis is Opportunity

I had the great fortune to be asked to write the introduction for my dear friend Susan Apollon’s new book An Inside Job: Healing Wisdom for your Cancer Journey. I was able to read this amazing manuscript on my recent flight to Shanghai China. She talks in the book about the irony that in the Chinese characters for “Crisis” and “Opportunity” share a symbol. I have always believe that through adversity we have the opportunity to grow spiritually and apparently the Chinese are in agreement.


Four hours after take off from Newark, NJ the wheels of United Airlines Flight 86 touched down at Pudong International Airport Shanghai China. I left the USA on a Wednesday at eleven AM and touched down in China 14 hours later Thursday at 2:30 PM. Fast way to lose a day. I awoke half way through the flight and checked our flight path to find that we were over the northern most regions of Russia and the temperature outside was -90 degrees Fahrenheit. By the time I opened my IPad to snap a pic the temperature increased by a whole degree. We flew over the Arctic Circle who knew?

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The 13th Chinese Breast Cancer Conference and The 9th Shanghai International Breast Cancer Symposium took place over a three-day period. There were in excess of two thousand breast cancer physicians in attendance. I was honored and humbled to be one of several invited speakers from around the world. I was quite surprised to find that minimally invasive biopsies for diagnosis and treatment of breast disease were not the standard of care in China. It has been over 6 years that I have given a lecture specifically on the benefits of vacuum assisted biopsy to diagnose breast cancer.


If your eyes are really good you can read my name on the main event roster!


I was one of a handful of speakers from the “West” our names are obvious


2000 Chinese Breast Cancer Physicians in Shanghai China


I met my interpreter the evening before my talk, as she would have to know what I was going to say to simultaneously translate during the conference. On my last trip to Beijing China in May, I lectured on the technique of nipple sparing mastectomies. I would speak and then wait for the translation live that was done by a Chinese surgeon. That method required me to speak slowly in complete sentences and not use any slang!


My lecture for this conference was on minimally invasive vacuum assisted biopsy to diagnose breast cancer. This is a technique that has been the standard of care in the USA for the last 10-15 years.


The incidence of breast cancer is on the rise globally particularly in recently industrialized nations. China has one of the fastest growing breast cancer rates. The western diet and “western ways” are thought to be the major part of the problem. Chinese women are also delaying child baring, have higher incidence of abortions as there is a limit to the number of children that they can have and the out of control pollution are all felt to play their part. That being said, women are still taken to the operating room to make the diagnosis of breast cancer for the most part. With the numbers of breast cancers on the rise, the shift to minimally invasive biopsies seems imminent.

The dynamics of the conference itself was interesting in comparison with conferences in the USA. The room was jam-packed with attentive eager to learn physicians waiting to ingest the latest information and cutting edge treatments from around the world. I think that I was the only blonde at the entire conference so I stuck out like a sore thumb.


The meeting ran from 8 AM to 12 noon breaking only briefly for lunch and resumed at 1 PM and ended at 6 PM. The audience was glued to their seats not wanting to miss a morsel of information being shared from around the world. I have to admit that the lectures given in Chinese, i.e. the majority of them were difficult to comprehend, but I was amazed at the amount of information I could surmise from the slides alone with the disease free survival curves and overall survival curves being the easy ones to understand.

Dr. Robert Carlson, the head of the NCCN, National Comprehensive Cancer Network, spoke about the recent changes in the guidelines in the hour before my lecture. His content was a great transition into minimally invasive biopsies for cancer diagnosis as it is one of the quality standards in the USA for attaining accreditation from the NAPBC (National Accreditation Program for Breast Centers). It was during his lecture that I realized that they were doing real-time interpretation. Suddenly my lecture seemed short, as I had planned the half hour to include the translation time. Fear not, as I can always elaborate on any topic and I would also have time for questions.


I remembered to speak slowly and in simple sentences so that my Chinese surgical oncology fellow, my interpreter, could easily translate in real time. That means that she has to listen, interpret and as she is speaking listen for the next thought process, clearly she drew the short straw getting this gig. (We traveled to Russia a few years ago and our tour guides were two neurosurgery fellows. My husband, Joe, joked with them, “ So who did you bump off that you are stuck being our tour guides!” They didn’t understand his humor and as it turns out, being the tour guide to the visiting surgeon from the USA was an honor for them!)

The lecture went well from my perspective and there were several excellent questions so I know that al least three people understood what I was trying to get across to the conference. Performing minimally invasive biopsies, with ultrasound, stereotactic or MRI guidance, is the standard of care in the USA and allows us to obtain a diagnosis and construct a treatment plan with out patients. We use vacuum assisted biopsies (www.mammotome.com ) to accomplish accurate minimally invasive diagnosis so that we can create a care plan to treat our patient’s cancers.

I am hopeful that my lecture will open the door for positive change in a country that is facing a breast cancer “crisis” as the average of a woman obtaining a diagnosis of breast cancer in China is 10 years younger than in the USA. China does not have wide spread screening to date and that is another opportunity for early detection.

There was a time in the not too distant past that being a woman in Asia conferred a benefit as they had a low incidence of breast cancer. There are several theories as to why the shift in incidence and why the lower age at diagnosis. The Western influence has had its blessings and curses. (I would like to think that my trip and educational opportunity is a blessing and not a curse)

In a 2001 lecture from The University of Pittsburgh

Jesse Huang, MD, MHPE, MPH, MBA黄建始

Professor of Epidemiology

Assistant President
Chinese Academy of Medical Sciences

Peking Union Medical College Medical Center of Qing Hua University

Presented an overview of proposed causes of this shift.

Breast Cancer in China

  • Breast Cancer in China is increasing rapidly
  • This increase resulted mainly from metropolitan female at reproductive age
  • Highest risk age group at 40-49, which is earlier than that in developed countries (50-79 yrs)
  • Highest risk (40-49) age group’s characteristics:
  • High educational level
  • Engaging in scientific research
  • Depression
  • High BMI
  • High protein intake
  • Disharmonious marital life/divorce
  • Induced abortion
  • Late age at first pregnancy
  • Oral contraceptive use
  • Lack of lactation
  • Benign breast disease
  • Family history of BC
  • Late menopause
  • Passive smoking

Many of these factors are modifiable and should be a lesson to the entire world. Since China jumped so rapidly in breast cancer incidence and lifestyle and gestational history are huge factors, we should take notice and begin to truly embrace lifestyle modification around the world before breast cancer becomes an epidemic.

Traveling to China this year has been amazing!

The culture of Asia, the hospitality of the people, the history a nation and breathtaking sites were worth every second of travel.  Being able to potentially influence breast care in China is PRICELESS! 

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FOcal Point of the Shanghai Evening Skyline

The TV Tower

The Breast Cancer Crisis is our Opportunity to change the factors in our lives and the lives of young women around the world that are modifiable.


  • Regular exercise is essential to maintain our breast health and overall health (3-5 hours per week)
  • Nutrition is key and we are what we eat ( viverhealth.com)
  • Maintain a healthy BMI ~25 (lean muscle mass matters)
  • Young women should limit alcohol before their first pregnancy
  • Alcohol in moderation after childbearing
  • Do not delay childbearing
  • Breast feed
  • Meditation and stress reduction
  • Obtain adequate sleep

Be aware of your personal and family risk factors.

Traveling to China this year has been amazing

But when it comes to HealthCare


God Bless Americagiphy

Double Harvest Sewing Seeds of Life


At Double Harvest Haiti, Blue Sky Surgical was able to find a home in Haiti.


The Medical Clinic

Sowing seeds

Signed by the TEAMS that have come before us

There are 64 individual stories that I could share about the people we operated upon. Each individuals journey is compelling and many stories are heart wrenching. For each of the people who were fortunate enough to have surgery this week whether life saving or life changing, there were countless others that we evaluated that we were unable to help.

The children we could not help

A young boy with a cutaneous venous malformation that we are unable to remove.

A tongue issue we could not help

A young child with a cyst of the tongue

Some surgeries were beyond our capabilities and others were ones that require surgical sub-specialties that may come to Double Harvest in the future. It still breaks my heart when we had to turn them away. We can tried to arrange for an evaluation with a team of specialists in the future.

There is always hope and it is so beautifully illustrated but the story of Daniel Smith. Tony created opportunities for Daniel’s life to change in a way that he never thought possible. Daniel is the future of Haiti, he just needed the helping (healing) hand from his USA family. He visited Dr. Tony this week as Tony has changed the course of Daniels life for ever.

You can read about his journey in the Philadelphia Inquirer.


Daniel before his jaw surgery


Daniel after surgery and his guardian angel Dr. Tony
Making a difference one patient at a time

It is the demeanor of the Haitians that is so special. Their eyes are soulful and with a simple glance, they can see directly into your soul.

Our patients may have been monetarily or materially poor, but they are all spiritually wealthy beyond belief. Over and over again this week patients would awaken from anesthesia and say  “May God Bless you and your TEAM”, “ May God bless your hands” and they truly meant it.

 Just take a look at a snapshot of the amazing people of Haiti.

A happy patient Heria patient who spent the night Showering in the street USA preop Dress in her best fro surgery Strabismus family cindy loo hoo Soulful Eyes tude Darius  Balance A different kind of balance in their life Yvons brother visits

For those of you have never received an email from me then you do not know my favorite quote. For those of you who do receive emails then bare with me again.

“You must be the change you wish to see in the world” Gandhi

Our future is in the hands of our youth


Dr. Peter Pierrot

Our future

Cate , Craig and Dean

Service is something that many individuals begin late in life. Cal sat in the “circle of trust” meeting our last evening and said that he had wished he had started serving earlier in life. I believe he served our country when he served in the military. (Although it was his job at the time, he chose to protect and serve our nation.)  He was particularly touched by his logistics work with Dean and Craig and the medical service of Cate and Dr. Peter. He sees  our youth as the future of change for Haiti and the world. (He loves the rest of us a respects our service, but he knows that serving on our surgical mission trip in Haiti is Life changing for our children )

Dean the man of few words

The earlier we engage our children  and help them to understand that we are all connected as souls on this journey of life traveling together, the earlier they will see what it means to serve. Despite living in different countries with different backgrounds we are all connected. In the USA we are blessed to be living in a country where you can receive treatment for an incarcerated hernia regardless of your ability to pay just by showing up in an emergency room. Remember Dr. Coletta’s first day in Haiti.  Tony, having been in the right place at the right time, kept a woman and her five children from being fatherless. (I call that divine intervention)

I feel blessed that Tony invited me to share in his passion for Haiti. I know that it was very hard for him to trust anyone else with the surgical care of the people that he loves so dearly.  My life, as well as all of my TEAM members lives, are richer because of these mission trips. Now my youngest son’s life will be forever changed. It is hard to believe that this years trip was more than last years trip, but we just keep working toward what Dr. Sauter has called HAITIAN SHIBUMI.

The seamless perfection of care for those in need



I wish I could report that our trip home was uneventful, but it was not to be so. On our flight from Port au Prince to Miami, there was a call for medical professionals. Simultaneously Tony, John, myself and another surgeon rang our call bells. An elderly gentle man with known end stage cancer arrested in the bathroom. Unfortunately despite our collective best efforts, he passed over into spirit. His wife and daughter were with him on the plane.

It was a vivid reminder that every moment in life is precious and we all need to remember this one small detail.

Be present in the moment as that is what you are guaranteed, none of us are guaranteed tomorrow.

We can change the world one person at a time.

Peter and our three young TEAM members are our future. The seasoned veterans will all return to Haiti when we can.

 “You must be the change you wish to see in the world”


Be the change

The necklace that I wore on our mission trip and the motto I live by!

Your passion my not take you to Haiti or even outside of your community. The reality is that you have a choice. You can be part of the problem or become part of the “SOULtion”.

“Success isn’t just about what you accomplish in your life,

It’s about what you INSPIRE others to do”

If you want to support our effort you can reach out to me at dupreehealingdoc@aol.com and I will let you know how you can support our future efforts

My hope is that Blue Sky Surgical mission trip Inspires you to make a difference in the world.


Our gift from God on our uneventful flight from Miami to Philadelphia

Sante se Richess “Our Health is our Greatest of Wealth”


Blue Sky Surgical has had an amazing week. 19 individuals came together with their new Haitian family of health care providers to care for so many men, women and children in need. We completed our week of 64 surgeries and countless clinic evaluations and we have all changed from the experience in a positive way.

Let me share want a typical day looks like. for Blue Sky Surgical.  For the DuPree family, it was a 5:45 wake up and out the door at 6 for a workout.  We always paused to watch the sunrise as best part of the AM workout is being up to watch the spectacular event.


Dean is training for winter track Pennsylvania State Championships. <Last year they took silver in the distance medley relay and they are going back to run the same race again> Dean would alternate sprint workouts with plyometric exercises. . Hopefully Mr. Rodgers, his coach, will see this BLOG to realize his level of commitment. ( Mr. Rob Rodger’s sister is Deb our nurse anesthetist’s best friend!)

6:40 Morning Devotional

Every morning at 6:40 the locals would congregate at the clinic and there would be a speaker and singing. Although we could not always tell what they were saying, we could all feel the energy that came from their songs.

Breakfast was served at 7 AM. It was always an adventure and the best mornings were the ones where we cooked with the Haitian cooks. These women put such love into our food that nourished our hearts and so many carbohydrates into our diet that went right to our butts!

Milk in the paint can

The Milk was fresh from the cow, Brought to us in an plastic acrylic paint bucket!

Our cooks

Our beautiful cooks

On Friday February 14 as we were all remembering to call and text our significant others, we celebrated the birthday of our Haitian interpreter and guide Pierre.

Waiting to be seen

Patients in the USA would not have the patience to sit i the hall and wait to be seen. Sometimes for hours!

By 730 we were headed down the stairs to the clinic or to the OR begin our day of surgery.

My Haitian office

Our office

Tony and I would alternate between the OR and the clinic. Shashi just kept operating all day long.

Tina and Elsie were an amazing TEAM. There was no us or them just WE!

TEAM work

The nurses would prep the patients in the PACU( post anesthesia care unit) and we were off to our day of surgery. They would prepare the patients with IV’s and fluids, check the charts and keep the schedule moving. They were priceless.
Dean and Craig at our service

Dean and Craig at our service

The Logistics guys were everywhere and anywhere they needed to be. They cleaned sterilized instruments. The packaged the appropriate insturments we needed for our cases. The moved the patients from the OR to the PACU. TRANSPORTATION was key. They cleaned the floors and when they weren’t doing that they were making a birthday candle for Pierre’s birthday cake! With Cal as their leader, they were a finely oiled machine. One of Cal’s favorite activities of the day was spending time with the locals.

Grandpa Cal

Cal and his new friend

Shashi had room #2 as his room and we tried to get the little children taken care of first so that they did not have to wait all day without eating and drinking. There was one small child, no more than 2 years old who had a hernia repair on our last day. When I came out between cases, I saw him asleep in what I thought was his mother’s arms.


Yvon then told me that it was his sister holding him as they both slept.

Yvon  shared their story.  Their mother had died this past  September. My heart gasped and my eyes filled with tears as I looked at them nestled in the chair. She was so protective of her little brother. Their father and the oldest daughter, unfortunately without their mother, were raising these 10 children.

            Her eyes speak volumes

Sister and son

Her soulful eyes

Every single person we cared for had a story and I learned each and every one of their stories that I could!

We had both OR’s running all day long and Tony spent this morning in clinic adding on cases were the children were NPO.  (remember nothing by mouth after midnight). My room had completed 5 cases by 11:30 and Shashi was on his 5th case as well.

My 5th case today was a simple lipoma, benign tumor of fat, on a gentleman’s forehead. The gentleman spoke minimal English and required Manny to translate during the beginning of anesthesia.

Jesus savior

Molly and our messenger from God


Mr Messenger

During induction of anesthesia , after the entire syringe of Propofol ( medicine that gives you amnesia and puts you to sleep very quickly) we had an amazing experience. The patient looked at Deb, the nurse anesthetist, and said to us in perfect English “ Jesus is in the room ” We were all taken aback. He then said “The Lord our Shepard is watching over us”. I had goose bumps, as did our entire team. We were in a state of disbelief as his English was flawless, his message profound, and he had enough of the medicine in his system to put him to sleep quickly. Dr. Sauter thought that we made up the story, but as you may be aware truth is often stranger than fiction.

Watching over us

Jesus watching over us

He asked for the name s of all of our team so that he could pray for us daily! WE SAID YES!

Darius, Beth ad Marjorie

Darius, Beth ad Marjorie

After this case, I went to clinic with our nurse Beth to see Marjorie the 39 year old mother of 5 children who had had modified radical mastectomy three

days earlier. She came to the clinic with her husband to have her drains removed. She brought her youngest son Darius with her. I looked at this child and quickly realized that she had gotten pregnant almost immediately after her lumpectomy in Feb of 2012. So not only did she not have the opportunity to have chemotherapy and radiation therapy, she had an estrogen storm from her pregnancy. Beth was there to hold her hand as I removed the drains and she saw her chest wall without her breast for the first time. It saddened me that I did not have a post surgical bra and prosthesis for her at this moment as she would have to wait until I can send them back to her in the appropriate size. She did very well with this visit despite the realization that her breast was gone.




Marjorie told us that she wanted to have her baby Darius rebaptized with “Tony”in his name. I think that’s the greatest thank you ever.

I hugged her goodbye until next year and made arrangements for her to return to see Dr. Peter and continue to take her Tamoxifen. I returned to the OR and was quickly summoned to go out to the street and meet her 5 children who she had brought along to meet me. She wanted me to know why she had to be OK.

Marjorie and Dean

Marjorie and Dean

Her children needed her and the surgery we performed and the Tamoxifen that was donated by Holy Redeemer are the one shot that she has. So Dr. Tony’s intervention two years ago and his insistence of continuity of care and his follow through with pathology and getting her back for follow up were instrumental in her getting her to us to perform her surgery.

The family!

The family!

I left this beautiful 39 year-old woman to operate on my 93-year-old gentleman who too had breast cancer. They were of the extremes in age and sex but both had breast cancer. This gentle soul has high blood pressure, and no funds to buy the medications to lower it. Dr. Sauter saw him on Tuesday and Dr. Peter gave him the medication to take for a few days to optimize him for surgery.


93 yo Felix looking good one hour after surgery.

He was clearly our highest risk patient of the week, but he clearly had angels as he walked out to the “bus stop” just 2 hours after his lumpectomy. What we were able to do for him was to remove the tumor so it would not erode through his skin and stop the pain he was having from its connection to his chest wall muscle. One patient at a time we were making a difference.

Feliz at the bus stop we hore

Felix and his daughter waiting for transportation with Barb. She would have followed him home to make certain he was OK!

Dr. Shashi and Tony were busy repairing children’s hernias. The faces of those we cared for were priceless and all we needed to know that we are doing God’s work. Having a pediatric surgeon along was a gift for the Haitian’s that Tony was able to provide. On our last trip we performed 17 pediatric cases, therefore we knew there was a need. Shashi rocks!


Pre op

post op

Post op

post op om

We closed up the OR with feelings of pride, accomplishment, and some sadness for leaving Haiti. We all shared a sense of peace as we had found a new home for Blue Sky Surgical TEAM.Under Dr. Anthony Coletta’s leadership, I an certain that we will continue to change lives one at a time. Not only is Tony changing healthcare in America, he is changing health care globally.

The members from Holy Redeemer ( missing from this picture are Randie Oberlander, Joe Benonis, Mike Laign and all of the other individuals who helped make our trip happen.

hr team

Dr Beth, Dean DuPree, Craig Bunting, Dr Shashi and Dr. Tony ( now with IBC but still part of our family)

Mainline Health System ( missing are all of those individuals that donated the time and materials form Lankenau and Bryn Mawr Hospitals as well as United Anesthesia Services)


Yvon, Deb, Cate, Leslie, Dr. Tony. Robin. Dr Sauter andBarb

We found out an amazing synchronicity on the last day. Shashi had actually performed a hernia surgery on Craig when he was six!

Craigs hernia

Shashi and Craig
His incision has healed 16 years later!

photo 2

Our workday was done and we joined each other on the roof, aka our Haitian beach, to laugh, share stories and just be! Manny and I made homemade chips with my left over corn tortillas and we a version of happy hour on the roof.

IMG_2350 IMG_2249

Our final dinner was a absolute feast. I was a fly on the wall watching as they lovingly prepared our dinner. The cooks out did them selves with Haitian meatballs, fried chicken, rice and beans (who knew there was garlic and cloves in there!), picklees (shredded cabbage and a lot of spice), Haitian macaroni and cheese, fried okra and fried bread fruit that tastes like a warm Philadelphia pretzels.


Amazing Rice and Beans with homemade french fries


We retired to the roof to watch the sunset as others packed for our return to the USA.


Our fearless leader

We had our final evening 7 PM meeting where we shared stories of the day, concerns for the next day in the OR  and our last evening we shared hope for the future of our work at Double Harvest.

Yvon sleeping during our meeting

Yvon more than occasionally fell asleep when we were meeting.

surrounding our Haitian Dr Peter

The girls surrounding our Haitian Dr Peter

We talked to Dr. Peter Pierrot and Henry Peters, the missionary, who is one of the caretakers of the facility. We thanked Henry for giving us the insiders’ tour of Double Harvest including the Tilapia fish runways, The Hydroponic farming, the chickens for eating and laying eggs. (Deb didn’t know that they had different function)


Henry Peters

The Diesel

The diesel tanks

The future fish

The Tilapia farm


The beautifully manucured fields

The Eaters

The eating chickens


The hydroponic farming

The Layers

The egg laying chickens


Plants ready for sale

IMG_2254 IMG_2127

Tony talked about how proud of his TEAM of 19 ( he forgot to count himself) and how well we performed. This week, John taught us the term Shibumi, which means seamless perfection. It takes Shibumi to take 19 individuals who haven’t worked together in the OR and perform 64 surgeries in 5 days, without any complications. Under the leadership of Dr. Tony we all had something to be proud of. We laughed, we teared up and mostly we were filled with the joy in knowing that we had made a difference in so many lives.

TEAM BS ( Blue Sky!)

We talked about our future trips and having so many young TEAM members gives HOPE to Haiti.

Our Surrounding Community in Haiti


The fresh water provided to the town by Double Harvest


Deb and her little friend



The Bank in the town


Dean and his buddy from the town. He walked with Dean arm iin arm for the 45 minutes we were there. His left arm had to hold his pants up as they were several sizes too big


This is the house of the man brings the steers outside of our compound daily


The girls are so cute and loved hanging around with us


Ivan made friends with this man and he invited us to see his house above


Craig jammed in the church that lost it’s roof in the earthquake


Dean’s buddy never left his side. They could not communicate with language but true friendship transcends that!


The sunset sky


Who would think that two strong willed surgeons could coexist and absolutely THRIVE in Haiti! WE can because we have the best TEAM


Bedtime big day in the OR tomorrow


One patient at a Time



So many of my friends and patients have asked me why I come on these trips. Several individuals have pointed out that the problems in Haiti are so massive that my individual efforts, all though admirable, can’t even begin to scratch the surface of the healthcare problems in Haiti.

My response: “ I can only take care of one patient at a time whether I am in the USA or Haiti. For that one patient, my being their surgeon, may change the course of their life. In Haiti it’s not that I am the surgeon that they choose, I am the chirijen ( that’s creole for surgeon)  that has been divinely guided to be in Haiti that  year, that month that week that moment. ”


We have completed four days of successful surgery. As a TEAM, which we truly have become, we have completed over 43 surgeries, numerous minor procedures and I personally have seen more hemorrhoids than I even want to admit! <Did miss my breast patients back in PA after a half day in clinic seeing general surgery patients>. If you don’t know this fact, surgeons love to be in the OR and often just tolerate the clinic. My clinic, or office hours as I call them at Comprehensive Breast Care Surgeons at Holy Redeemer are a cake-walk compared to  the clinic in Haiti.

Let me introduce you to Marjorie


She is a beautiful 39 year old Haitian woman who is a daughter, a wife and a mother. February of 2012, Dr. Tony performed and excisional biopsy of a left breast mass that turned out to be breast cancer. It was estrogen receptor positive. (We know this as Tony brought the specimen back to the USA for evaluation and that my friends is another customs story that is best told by Dr. Coletta himself)

Unfortunately, we were never able to get Tamoxifen, a medicine we give to treat estrogen receptor positive cancer, to her and therefore he breast cancer returned. ( Had she been treated in the USA she would have had her lymph-nodes sampled, had radiation therapy to her breast and would likely have had chemotherapy as well) She got the best care that she could with the resources that were available. Fast forward to 2014. Marjorie returned to see Dr. Coletta. Despite a change of clinic location by our team, she found him. Unfortunately her cancer recurred and she required a mastectomy. This news to this beautiful young woman was devastating. If we were n the USA, she would have access to reconstructive surgery and chemotherapy. In Haiti she had Dr. Coletta and me to care for her. We scheduled her for surgery on Tuesday morning. She did not show initially at her planned time and I was concerned that she had backed out as the psychological trauma of the mastectomy may have been too much.

She showed up a little late and a little scared. Her surgery went off with out a hitch. Dr. Coletta, myself and Manny our PA were able to complete her surgery and have her safely returned to the PACU. Not even an hour after surgery, her husband came in to be with her and in English she said to me. “ That man he is my life!” Pretty nice thing to say about her husband! ( Possibly an early Valentine’s gesture)I am certain that this transition will be difficult for her, not having her breast, but she has her husband, family and children to support her. She also has Tamoxifen in her hands thanks to Randie from Holy Redeemer’s pharmacy!

We cooked breakfast fro her as she stayed the night and she loved the French toast and SPAM.

(Thanks to Dean we had 4 cans of SPAM and the team loved it)




She came by the clinic this morning to say goodbye on her way home. She told me that she loved me and that she was so happy that I came to Haiti. I will see her tomorrow to remove her drains. Beth, our nurse who has also had a mastectomy,  will be with me when we take down her dressings and she sees what she looks like without her breast.  It is a difficult moment, but I am confident that Marjorie will be fine. I won’t goodbye just say see you next year.



When I get back home, I will be securing enough Tamoxifen for the year,  breast prosthesis of the appropriate color and surgical bras for her. Dr. Peter will bring them back to Haiti fro her in a month. Marjorie’s story is just one individuals life that was greatly impacted by our TEAM.


One patient a time we are making a difference