Dr. Hazem Khout operates within a comprehensive Multidisciplinary Team (MDT) framework, recognizing that the optimal management of breast cancer extends beyond the operating room. Surgical success is intricately linked with coordinated adjuvant treatments, planned and executed by a team of specialists.

The Multidisciplinary Team (MDT) Approach

The MDT is a formal assembly of experts who review every patient's case collectively to determine the most effective and personalized sequence of care. This team ensures that all medical, surgical, and psychological aspects of treatment are considered.

Key MDT Members Include:

• The Oncoplastic Surgeon (Dr. Khout): Determines the optimal surgical approach (mastectomy, lumpectomy, reconstruction) and coordinates timing with other therapies.
• Medical Oncologist: Specializes in systemic therapies, including chemotherapy, hormone therapy, and targeted treatments.
• Radiation Oncologist: Plans and administers radiation therapy to target residual cancer cells and reduce recurrence risk.
• Pathologist: Analyzes tissue samples to determine cancer type, grade, and receptor status (e.g., ER/PR/HER2), which guides adjuvant treatment decisions.
• Breast Care Nurse / Clinical Nurse Specialist: Provides essential support, patient education, and coordination across all phases of care.
• Radiologist: Interprets all pre- and post-treatment imaging.

Integrating Adjuvant Therapies

Adjuvant therapy refers to treatment given after the primary surgery to eliminate micrometastases (tiny, undetectable cancer cells) and reduce the risk of the cancer returning. Neoadjuvant therapy refers to systemic treatment given before surgery, often to shrink large tumors or test cancer response.

1. Chemotherapy

Chemotherapy uses drugs to kill rapidly dividing cells throughout the body.

• Adjuvant Role: Typically used when cancer has spread to lymph nodes or is high-risk/aggressive (e.g., triple-negative breast cancer).
• Neoadjuvant Role: May be used pre-operatively to make the tumor smaller and allow for breast-conserving surgery instead of mastectomy.

2. Radiation Therapy (Radiotherapy)

Radiation uses high-energy rays to destroy cancer cells in a targeted area.

• Role: Almost always required after breast-conserving surgery (lumpectomy). It may also be used after mastectomy if the tumor was large or if certain lymph nodes were involved.
• Planning: The radiation plan is carefully mapped in coordination with Dr. Khout’s surgical plan to minimize damage to healthy surrounding tissues.

3. Endocrine (Hormone) Therapy

This treatment blocks hormones (like estrogen and progesterone) from fueling cancer growth.

• Eligibility: Only effective for hormone-receptor-positive cancers (ER+ or PR+).
• Duration: Typically taken for 5 to 10 years and is one of the most effective long-term strategies for preventing recurrence in this subset of patients.

4. Targeted Therapy

These drugs target specific abnormalities in cancer cells.

• Example: Drugs targeting the HER2 protein are highly effective for HER2-positive breast cancer.
• Role: Often given in conjunction with chemotherapy, tailored precisely based on the pathology report.

The Role of Coordination in Oncoplastic Care

Dr. Khout's oncoplastic philosophy relies on perfect timing. If a patient requires neoadjuvant chemotherapy, the reconstruction plan must be flexible and may be staged to occur after the systemic treatment is complete, optimizing safety and aesthetic results. The MDT coordination is the bedrock of this complex, multi-stage treatment pathway.