The use of CO₂ lasers in breast cancer survivors

Scott Kober talks to Dr. Lesley Clark-Loeser, a board-certified dermatologist at Precision Skin Institute in Davie, FL. Dr. Clark-Loeser explains how she uses the versatile CO₂RE laser to effectively treat scars left by breast cancer surgery, and how the procedure can help both the physical and mental well-being of patients. 

Scott: My name is Scott Kober with Dermatology Times and today we’ll be talking about the use of CO₂ lasers in breast cancer survivors.

I’m happy to be joined today by Dr. Lesley Clark-Loeser, a board-certified dermatologist at Precision Skin Institute in Davie, FL. Dr. Clark-Loeser is a consultant and speaker for Candela.

Scott: When you first started considering the acquisition of a fractional CO₂ laser for your current practice, what sort of vetting process did you go through to determine the best fit?

Dr. Clark-Loeser: I’ve been using fractionated CO₂ devices for just over 10 years, initially as an associate at a private practice before going out on my own a little less than 3 years ago. My last laser before I started my practice was Candela’s QuadraLASE, the predecessor to the CO₂RE System, so I had familiarity with the brand. When it became time to purchase a fractional laser for my new practice, the first laser I looked at was the CO₂RE System. It basically seemed to be the next stage in the evolution of the Candela platform and was a perfect fit for what I was looking for.

The CO₂RE laser allows me to truly tailor treatments to the individual needs of my patients due to the various modes of use. In addition, the fractional mode of the CO₂RE System really cuts down on the amount of time it takes to complete certain procedures. That makes me more efficient and makes my patients happier because they are in and out of the office faster.

Scott: How long would you say it took before you were able to operate all the various components of the CO₂RE laser?

Dr. Clark-Loeser: It is such versatile technology that, two and a half years after I acquired the laser, I’m still learning different applications and incorporating them into my practice. That’s one of the things I like most about the CO₂RE System – Candela does a great job of putting you in contact with other healthcare professionals who may be using the device in a different manner than you are, and it allows you to learn new techniques and broaden the number of services you can offer your patients.

Scott: Let’s transition into talking specifically about one specific use of the CO₂RE laser – repairing surgical scars in breast cancer survivors. How do you utilize the CO₂RE System in that very specific subset of patients?

Dr. Clark-Loeser: One of the most useful features of the CO₂RE System is its ability to help remodel tissue. There are many scenarios when patients have scarring that leads to abnormal collagen and connective tissue, and this is a tool that allows us to remodel that abnormal tissue.

Specifically, in regard to breast cancer survivors, many of them come to see me after having extensive reconstructive surgery where there may be skin flaps and removal or movement of tissue. The finished appearance following surgery is never 100 percent perfect no matter how great the surgeon – you can always tell by the naked eye that the patient has had an extensive procedure. The scarring can also be emotional as well as physical in nature.

With the CO₂RE System, it gives you the ability not only to improve the appearance of the scars, but also address the fact that these scars are associated with uncomfortable symptoms such as pain, restricted movement, itching, and burning.

Scott: Is there anything different from a procedural perspective when you are repairing a surgical scar of a breast cancer survivor versus a patient who had a surgical scar from a repair procedure of a different sort?

Dr. Clark-Loeser: If the patient has required radiation in the area of the scar, that can impact the quality of the skin and will alter some of the parameters you need to set during the repair procedure with the CO₂RE System, but that shouldn’t even prevent the use of the laser.

Scott: What do you tell breast cancer survivors to expect from the scar repair procedure with the CO₂RE laser?

Dr. Clark-Loeser: The majority of the breast cancer survivors who I see have been referred to me, often because they are aware that they will be treated at no cost to them. It’s important for me to give back to my community by taking away the possible financial burden of this procedure for these women who have already been through so much.

With that taken off the table right from the start, I’m able to focus more quickly on what the patient is looking to improve about their surgical scars. Are they concerned about the look or feel of the scars? Are there any symptoms that have become burdensome due to the scars?

Patients need to understand that there is no written recipe that will absolutely predict how their scars are going to look after the procedure. It’s important that they understand that we’re entering into a journey together whose end goal is to get the patient to feel better about the way they look and/or to improve any symptoms they may have related to the scarring.

Once we have baseline expectations squared away, I will typically evaluate the pigmentation of the patient’s skin to see if that might be an issue. While you can use the CO₂RE laser in patients with most skin types, if I have a patient with extremely dark skin, I’ll usually opt for a different device. I have four devices that I use for these procedures depending on the patient – the CO₂RE laser, the Vbeam Perfecta pulsed dye laser, the Picoway ultrashort laser, and a Sublative fractionated radiofrequency. With those four tools at my disposal, I can typically accomplish my procedural goals with just about any patient.

Scott: What happens on the day of the actual procedure?

Dr. Clark-Loeser: To some degree, it depends upon the laser that we’re going to utilize and how much scarring the patient has. If we’re going to be using the CO₂RE laser, I always ask the patient if they have a history of viral infection, and specifically herpes simplex virus. If they do, I treat them prophylactically to suppress herpes outbreak.

In all patients, I begin by having them apply a topical anesthetic an hour before the procedure, which they can do before they arrive in the office so they aren’t just sitting here waiting for the effects to kick in. The laser procedure itself can then take anywhere from 10 to 30 minutes.

After the initial treatment, I typically have patients come back to the office at regular 1-to-2 month intervals to assess improvement and determine next steps.

Scott: What do you tell patients to expect as far as improvement following the laser procedure?

Dr. Clark-Loeser: Depending upon the nature of their scars, patients should see or feel something different in their scars at one month.

The healing process from the actual laser procedure takes about a week. During the procedure, you are creating sub-microscopic wounds in the skin, and there is some basic wound care that patients need to take care of. I liken it to a painless red burn where the skin has been abraded. Within 3 days of the procedure, patients should see small scabs start to form around those abraded areas and a few days later, those scabs should start to slough off.

The hope is that underneath where those scabs appear, we’ve been able to deliver a significant amount of energy underneath the tissue and that collagen remodeling is beginning to take place. There should also be some tissue contraction occurring due to all of those tiny holes that have been created. The combination of these effects will then hopefully reduce the size and intensity of the original scarring.

Scott: How would you characterize the overall degree of patient satisfaction that you’ve seen in breast cancer survivors who have undergone surgical scar repair with the CO₂RE laser?

Dr. Clark-Loeser: There is certainly a high level of gratification. I had a recent one patient tell me how she was self-conscious of her body. To me, that shows the impact of what we can do for our patients. Remember, though, that we are just one small piece of the healing journey for breast cancer survivors, and there is much more that these women will need to help them heal.

Scott: Great. I think this has been a terrific discussion regarding the impact that CO₂ laser repair can have in this unique patient population.

Please click here for more information about the CO2RE laser.