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Meet Dr. Amanda Woodworth

Amanda M. Woodworth, MD Amanda M. Woodworth, MD, is a breast surgeon and the director of Drexel’s Breast Health & Wellness Center. Dr. Woodworth specializes in innovative breast surgery procedures that include nipple-sparing mastectomy and reduction pattern lumpectomies. She is a leader in the holistic approach to breast cancer management. Dr. Woodworth is also a faculty member in the Department of Surgery at Drexel University College of Medicine.

For those of us who simply know you as Dr. Woodworth, can you tell me a little bit about your life before medicine?

I’m originally from Michigan. My mom was a medical technologist in a primary care office. I don’t have any physicians in my family, so she was my closest link to medicine. When I was really young, if I couldn’t go to the babysitter, I would go to work with my mom. While I was there, I’d see her draw blood and I’d follow her around the primary care office. I remember deciding at four years old that I wanted to be a doctor. If kids in the office were scared to have their blood drawn, I’d have her show them it didn’t hurt by doing it on me first. I also loved taking things apart and putting them back together. I just always wanted to be a doctor from a young age.

Did you know what type of medicine you wanted to practice?

During undergrad, I did the typical pre-medical track that focused on biomedical sciences, but I also became fascinated by people’s behaviors, so I picked up a second major in biopsychology. I joke that I feel like I use that second major more than my initial undergrad major. Studying human behaviors just fascinates me. Coming out of undergrad, I had actually thought that I was going to be a psychiatrist.

What changed your mind about psychiatry?

When I was in medical school, I still didn’t know exactly what I wanted to do. I knew by the time I worked at the Red Cross that I wanted to have patients and I could touch them, unlike psychiatry, so I crossed that off my list.

What did you do for the American Red Cross?

After completing undergrad, my first goal was to get out of Michigan. My second goal was to go to medical school. I took a year off before applying to medical school, and during that time, I moved to Albany, New York. I spent some time during that year trying to figure out what I wanted to do. I was applying to all these lab jobs and getting them, but I realized it wasn’t what I wanted to do. I eventually found a job as a donor specialist at the American Red Cross. I went on the interview and they told me that I’d get to take histories and do physicals and venipunctures. As a donor specialist, you basically take care of the donor throughout the process of donating blood. It was kind of like a clinical experience for me. I would get up at 4:00 a.m., get in a cold van, drive all over upstate New York and I absolutely loved it. I couldn’t get enough. That let me know I was heading in the right direction.

Had you questioned your decision to be a doctor before that?

The dream of a four-year-old can be very different from the reality of an adult and you have to check yourself along the way to make sure it’s what you want. Another moment that cemented my decision to go to medical school happened during high school when I was working as an aide in a nursing home. That was my first hands-on experience with caring for people. That was also my first encounter with death. One of the defining moments of my life happened during that time. One day I was helping run linens to another wing of the facility and this elderly lady wheeled out of her room and said that she wanted to go to bed. She asked if I could help her to bed, so I turned her around and helped her out. I tucked her in and she said to me, “You have such a kind heart; never lose that.” Unfortunately, she passed that night, but it was so powerful to me that I was the last interaction she ever had on this earth. It made me realize how important our interactions are with other people and how deeply it can affect other people. That was just helping someone to bed. Imagine the difference I could make as a physician.

Why did you choose surgery?

The first person to ever talk to me about being a surgeon was my anatomy professor. I told him that I thought surgeons were mean, and he laughed at me. One of the deans at my medical school was a pediatric surgeon, and he had a sign-up sheet for first-year medical students to observe him in the operating room. I was really eager and excited the first time I went. Like I mentioned, I don’t come from a big family of physicians, so this was very new and raw to me. The fact that I could be in the room at that moment was so powerful. I also loved watching the interactions between the anesthesiologist, the nurses, and the surgeon in the operating room. The dean saw how excited I was, and he eventually told me I could come by whenever I wanted. I started making it a habit to observe his first case before my classes started. It was in the stars for me as far as surgery. I loved being in the operating room, but I also loved that interaction with the patient and feeling like I made a big difference.

Did you always want to be a breast surgeon?

If you would have asked me early on, I would have said that I loved trauma, but I eventually realized that I’d rather get my adrenaline from exercise and other areas of my life instead of treating gunshot wounds. More and more, I saw the patient interaction as the most important thing. I started watching the breast surgeons I worked with and it was just different. They had a different relationship with their patients.

A diagnosis of cancer is one of the worst points in someone’s life, so these interactions are extremely important. Some surgeons did it very well and some did it very poorly. I knew this was an area I could succeed in and it would bring together my love for surgery with my love for working with people.

What is oncoplastic surgery?

Oncoplastic surgery is when you use a plastic surgery procedure to remove cancer. I was very privileged to learn this technique from Dr. Melvin Silverstein at the University of Sothern California. Dr. Silverstein is a pioneer in the field. His favorite surgery, which is now my favorite surgery, is called a reduction pattern lumpectomy. For a reduction pattern lumpectomy, we take out the cancer by using the same type of incision that is used for a breast reduction. I’ve found this can help women not only look the same after surgery, but maybe even better. Why leave a woman with a big dent if you don’t have to?

Another procedure that’s become more prevalent is the nipple-sparing mastectomy. When you do a mastectomy, you just need to remove the breast tissue. In the old days, breast cancer surgeons would remove the muscle, all the lymph nodes under the arm, and all the skin over the top. That’s called a radical mastectomy, and we don’t do that anymore. It was a big change when they started leaving the muscle, but they found it was safe to do. Slowly they started playing with the idea of leaving the skin for reconstruction, and it was found to be a safe thing to do. Finally, they looked at if you could leave the nipple. We do remove the milk ducts going right up to the nipple, but from a cancer standpoint, if the skin or nipple aren’t involved, it’s safe to leave them.

I do my incisions underneath the breast along the inframammary fold, so the incision is actually hidden. When you look at a woman who has had a nipple-sparring mastectomy with reconstruction, you don’t even see that scar. However, to have the procedure done that way, you have to be a good candidate. You have to have smaller breasts, and you have to be a non-smoker. It allows for some of the most beautiful reconstruction results that I’ve ever seen.

I strive to give my patients the best possible outcome, not just from a cancer perspective—we’re pretty good at treating breast cancer—but let’s also think about what we’re leaving behind. I believe it’s the best thing I can do for my patients, to leave them looking and feeling as good as possible.

Another unique service you provide is your holistic approach. What does that include?

The breast is a part of a person. It’s not a breast in a vacuum. People talk about being holistic and that can mean a lot of different things, but one of the biggest areas I focus on is diet. I try to talk to patients about eating healthy and staying away from processed foods. The food we put in our body has a direct impact on our health and how we feel in general.

With highly processed foods, we’re exposing our body to something we were never meant to eat. I try to look at it that simply. For example, a calorie is a form of energy that we get from food, so we shouldn’t feel tired after eating. If you feel tired after eating, that means your body is working very hard to process whatever you ate. It’s important to pay attention to your body. The right diet for me may not be the right diet for you. Our bodies are really smart. If you don’t feel well after eating, your body is probably telling you that you’re taking in things that you shouldn’t.

Another thing I talk to patients about is vitamin D. Low vitamin D levels increase your risk for breast cancer. The majority of people in the United States could benefit from some vitamin D supplementation since it comes from the sun and a lot of us sit inside working all day. Exercise is huge too. Studies show that exercising for at least three hours a week can reduce your risk for breast cancer by almost 20 percent. That’s huge! I’m also a believer in massage therapy. For breast pain, there’s a supplement that comes from cruciferous vegetables that I recommend. It’s called diindolymethane (DIM).

I look at my patients as a whole person. For me, it’s about more than just treating cancer. I try to educate my patients on every aspect of the disease, and I provide ways to help them live their lives afterwards.

What is stage zero breast cancer and how do you treat it?

Stage zero breast cancer is called ductal carcinoma in situ, or DCIS. Dr. Silverstein, my mentor, essentially wrote the book on DCIS, so it’s something I’m well-versed on. If a woman has DCIS, I do tell them that it’s a cancer. There’s some debate over treatment since it’s a cancer that’s stuck in the milk duct, meaning it’s non-invasive. However, if you are zoomed in on those cancer cells with a microscope, you can’t tell the difference between an invasive cancer and a non-invasive cancer until you zoom out. So from a microscopic standpoint, it’s cancer. Behavior is the important thing. Only about 20 percent of non-invasive cancers will break out of the milk duct. Unfortunately, we’re not really great at predicting who that will happen to, but if it does break out of the milk duct, it can become a big problem fast.

Ultimately, the treatment options for DCIS are pretty similar to invasive cancer with the exception of chemotherapy because the cancer cells are confined and they haven’t spread all over your body. They can’t even get into the lymph nodes. Our goal is to catch cancer at its earliest stage, or DCIS, because if you can catch it, you don’t have that risk of it going somewhere else. For treatment options, we look at mastectomy or lumpectomy with radiation. Some patients may be candidates for no radiation, but it has to be very well selected patients. For young patients, I would say you still need radiation just because of the chance of recurrence. Some people think a mastectomy for DCIS is a crazy thing, but if majority of your breast is involved by DCIS, then you need that.

How do you determine which procedure—mastectomy or lumpectomy—is best for a breast cancer patient?

It’s a case-by-case basis. I try to present both options: mastectomy and lumpectomy. Sometimes, unfortunately, I don’t have both options because of the size of the tumor. If somebody is really young and they qualify for genetic testing or they have a family history, we test for genetic mutations. If we find a mutation, their chances of developing a second breast cancer are over 60 percent, which is huge. In that case, I would recommend a bilateral mastectomy.

At the end of the day, it’s also up to the patient. I counsel them and help them understand what the options are, but they have a say in the treatment as well and I listen to that. Some feel very strongly one way or the other. They need to hear from me what makes sense from an oncological perspective, but after that, it’s largely up to the patient.

Do you do any type of advocacy work for breast cancer awareness?

Yes, I’m very in touch with the community. I’ve done countless community talks and try to go out to every possible group. I’ve done the Healthy Women’s Day up in Bucks County for a few years. There were over 400 women that attended that event, and I served on the panel and did some breakout sessions. Breast cancer awareness is so important. People need to know that we do still recommend annual mammograms starting at the age of 40. There’s a lot of information out there, and sometimes it helps to have a surgeon right in front of you to ask questions. I also speak to several support groups where I talk a lot about lifestyle changes.

Why did you decide to work at Drexel?

I’ve always loved to teach. In fact, most people who know me were surprised that I didn’t go right into teaching. When I decided that’s what I wanted to pursue, I started looking at institutions here in Philadelphia. I live in Northern Liberties, so I liked the idea of working in the community where I live.

Drexel is a strong institution, not just for medicine, but all of Drexel has an unbelievable reputation. When I met the surgery staff here, I felt a connection. Academic centers aren’t always quick to try new things, but Drexel embraces new ideas and they’re ready to build a great breast program and that’s what I’m here to do.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

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