Breast Treatment Associates Blog

Dr. Cross Reports Positive Findings from Use of 3D Marker in Breast Cancer Treatment

FAYETTEVILLE, Ark. – A research study by local surgical oncologist Michael Cross, M.D., F.A.C.S., concluded that use of the BioZorb® surgical marker appears to provide better cosmetic outcomes and may be associated with an increased use of breast-conserving surgery in his practice.

The study found that more than 90% of patients who received the implant as part of their surgery experienced either excellent or good cosmetic results, as rated by both patients and their physicians. Dr. Cross has been using the FDA-cleared marker since 2012.

His scientific poster was presented at the 2017 American Society of Breast Surgeons annual meeting. Dr. Cross has in previous studies also reported a trend toward shorter courses of radiation therapy in cases where patients were treated through breast-conserving lumpectomy surgery.

“If we can deliver less overall radiation with better cosmetic results and just as good survival rates, then it’s a win-win-win scenario,” said Dr. Cross.

This observational, retrospective study encompassed a total of 1,115 patients who underwent breast cancer surgery between 2011 and 2016. The use of lumpectomy in Dr. Cross’s practice increased by 27.7% during the study period.

In 2011-2013 — the period before the marker was used routinely in the practice’s breast surgeries – Dr. Cross performed 540 breast cancer surgeries and the lumpectomy rate was 37.7%. During 2014-2016 when the device was consistently used, he performed 575 breast cancer surgeries and the lumpectomy rate was 48%.

Because Dr. Cross’s data is from a single practice with a largely rural patient population, he said further research was needed to see if his results are generalizable to other practices that serve patients with different characteristics.

The unique BioZorb implant is sutured into the tumor site and is the first device that identifies where the breast cancer tumor was removed in a fixed, three-dimensional manner. After lumpectomy surgery, the implant helps the radiation oncologist plan treatments more reliably and determine where to aim the radiation in a more targeted fashion.

The implant consists of a framework made of a bioabsorbable material that holds six titanium clips. The framework of the device slowly dissolves in the body over the course of a year or more while the small marker clips remain at the surgical site and can be viewed for long-term monitoring such as mammograms. Studies have reported the rate of complications such as infection (2-3%) is virtually the same as for lumpectomy surgery without the implant.

Breast cancer can be treated by mastectomy (breast removal) or by lumpectomy. With lumpectomy, a small amount of tissue containing the tumor is removed. In addition to the surgery, it is important to add radiation treatment to “clean up” any microscopic cancer cells that might remain behind in the breast. The addition of radiation allows surgeons to safely conserve the breast tissue, while decreasing the chances of cancer recurring in the same location.

The favorable cosmetic results with the device are due in part to its advantages for oncoplastic surgery (OPS), Dr. Cross said. OPS emphasizes both cancer control and a better cosmetic outcome. It reconstructs and reshapes the breast to avoid deformities that can occur after healing from surgery and radiation.

“Because of the BioZorb’s shape, it helps me use the patients’ own tissue for reconstruction at the time of lumpectomy – so I like to use the term ‘reconstructive lumpectomy’ when I explain what the surgery will entail,” Dr. Cross said. “In my practice, this is now the routine standard with appropriately selected patients.” The marker enhances oncoplastic surgery because it helps fill the space left by the tumor removal, while also providing a sort of scaffold for the breast tissue as it heals.

In addition, the implant clearly delineates the tumor’s previous location. This enables follow-up radiation therapy to be delivered more precisely, according to previous studies of the device. Better-targeted radiotherapy can have a positive impact on cosmetic outcomes and can help protect healthy body structures such as the heart and lungs from radiation exposure.

Dr. Cross said the ability to deliver shorter, hypofractionated radiation therapy provides a substantial benefit for his patient population. This shorter course of radiation allows women to receive their radiation therapy over three to four weeks, instead of the usual five to six weeks.

Many of his patients live far from Fayetteville and have to travel several hours to the city. Patients who receive hypofractionated radiation therapy have to travel far less often for treatment. The ability to get a shorter course of radiation may lead more women to choose breast-conserving surgery (BCS) instead of a mastectomy. (BCS is usually followed up with radiation therapy, while a mastectomy normally is not.)

The BioZorb device is now widely used by breast surgeons and general surgeons throughout the U.S.

The data was presented as a scientific poster at the annual meeting of the American Society of Breast Surgeons annual meeting held April 26-30 in Las Vegas.

Focal Therapeutics, which makes the BioZorb device, provided writing and research support for Dr. Cross’s presentation.

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  • Blog
  • January 20, 2017

Breast Treatment Associates Awarded with NAPBC Accreditation


After a huge two year task, the American College of Surgeons’ National Accreditation Program for Breast Centers (NAPBC) has awarded us with Three Full Year Accreditation. This accreditation formally acknowledges our commitment to providing the highest quality evaluation and management of our patients. Read the NAPBC Accreditation Report here and visit for more information on NAPBC.

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  • Blog
  • December 13, 2016

The School of Oncoplastic Surgery, 2017, Training Surgeons in Oncoplastic Breast Surgery Techniques

The School of Oncoplastic Surgery focuses on a multidisciplinary and practical “hands-on” approach to training surgeons in oncoplastic breast surgery techniques. It is the first and is the only oncoplastic surgery educational program in the U.S. that incorporates a full-day anatomy lab as well as a full day of didactic lectures led by world-renowned pioneers in oncoplastic surgery.

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  • Blog
  • November 2, 2016

Dr. Cross Summarizes Findings From BioZorb Study

The first study, a peer-reviewed article appearing in the World Journal of Surgery, outlines how the three-dimensional, bioabsorbable marker provides more accurate targeting of the cancer tumor bed for radiation treatment when implanted during surgery. Read more…


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Dr. Cross Featured in ASC Focus Article

ASCs today are adapting to multiple shifts in the health care and financial environments. Among the many challenges they face as this evolution continues are changing reimbursement, more knowledgeable patients who evaluate their health care options with that knowledge in hand and increased competition from hospitals that purchase physician practices.

Our North Hills Surgery Center in Fayetteville, Arkansas, faces many of these challenges, but innovative approaches to both infrastructure and clinical care have helped us to remain viable and continue to serve our community. One of the clinical care innovations that we have adopted is our approach to breast cancer treatment.

Continue to the full feature: ASC Focus article

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  • Blog
  • November 23, 2015

Dr. Cross to Speak at School of Oncoplastic Surgery

Dr. Cross will be speaking alongside other faculty at the 2016 School of Oncoplastic Surgery. The School of Oncoplastic Surgery (SOS) provides an opportunity for surgeons to immerse themselves in knowledge alongside world-renowned pioneers in oncoplastic surgery.


Visit 2016 SOS’s Website to Learn More.
View the 2016 Marketing Materials.

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  • Blog
  • October 21, 2015

Dr. Cross Appears in CitiScapes Feature

Local surgeon’s pioneering work improves care for breast cancer patients.

Three years later, Kathey Rhoads still remember exactly what it was like when she felt the lump in her breast. “It was one of those moments I’ll never forget.”

Continue to the full feature: Oct 2015 Citiscapes feature on Cross-Rhoads

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  • September 22, 2015

Research Finds Surgical Marker Helps Cut Cost of Breast Cancer Treatment

Breast cancer research conducted by two Fayetteville medical groups highlights their success in pioneering use of an absorbable, three-dimensional marker used during treatment for breast cancer. Their cost analysis, to be presented at an international breast cancer conference this week, showed that by helping to shorten the course of radiation treatments, the surgical marker contributed to a 25% cost savings per patient.

Breast surgeon Michael Cross, M.D. of Breast Treatment Associates and colleagues at Highlands Oncology Group compiled three years of data on use of the BioZorb™ marker, as part of improvements in treating breast cancer. They concluded that this unique device assisted with the targeting of radiation treatments, which are usually needed after breast cancer surgery.

The surgeon sutures the marker directly to the area that needs radiation. With the marker providing greater confidence in targeting, the doctors said they were able to use shorter courses of radiation – an approach that is often referred to as “hypofractionated” therapy.

Hypofractionated radiation treatments typically can be given over three to five weeks, compared to the usual five to seven weeks required for standard radiation therapy.

Recent studies have indicated this shorter course of treatment significantly lowers treatment costs and is just as effective in overall survival rates and preventing cancer recurrence. It also has been shown to lower toxicity and improve patients’ quality of life measures.

The ability to provide radiation with equivalent success in a shorter timeframe is an important and growing trend around the world. However, adoption of these methods has previously been hindered by the difficulty in confidently defining the surgical site needing radiation.

The Fayetteville researchers’ scientific poster, which will be presented at the 2015 Breast Cancer Symposium in San Francisco, summarized prospective research and clinical experience with 109 patients over three years.

BioZorb is a small coil, inserted into the breast by the surgeon at the time of tumor removal. It holds six tiny clips arranged in a three-dimensional array. This 3D array remains over time, while the coil holding the clips dissolves.

The marker helps clinicians visualize where the tumor was removed. It can also be used to help plan and target radiation treatments done after surgery, while marking the cancer site for follow-up mammograms and other imaging studies.

“This device helps us provide shorter courses of radiation, which means less travel and time commitment for patients and is therefore much more convenient for them,” Dr. Cross said. “We are also seeing better cosmetic outcomes using this device. Because it provides a structure for the breast tissue during the healing process, it supports regrowth of healthy tissue and helps preserve the natural contour of the breast after surgery.”

Dr. Arnold Smith, a radiation oncologist at Highlands Oncology Group who contributed to the research, said the marker “lets us clearly see where the surgeon removed the tumor, which is the spot with the greatest risk for cancer recurrence. This way, we can focus the radiation where it needs to be. That means more efficient treatment and better care for our patients.”

Scott Jones, M.S., D.A.B.R, the medical physicist at Highlands Oncology, said the device makes it easier during radiation treatment to use more sophisticated “field in field planning.” He said BioZorb also contributes to cost savings from a shorter course of radiation treatment by adding a level of confidence about the accuracy of where the radiation beam in each dose “fraction” should be aimed especially for partial breast or boost treatments.

“When you are delivering radiation with fewer fractions, you need to be sure you know exactly where the dose should be delivered, “ he said. “What BioZorb allows us to do with more confidence is to delineate the breast region more accurately within the field, to contour the dose in three dimensions, and deliver each treatment very accurately.” Jones is Director of Medical Physics and Dosimetry at Highlands Oncology Group.

Dr. Cross and his colleagues were the first in the United States to make the surgical marker available to patients. Their research on its use is the most extensive to date.

Their presentation at the upcoming 2015 Breast Cancer Symposium is titled “Implantable marker facilitates use of hypo-fractionated radiation in early breast cancer.” In addition to Drs. Cross and Smith and physicist Scott Jones, other poster authors were Joe Ross, M.D. and Thaddeus Beck, M.D. The Breast Cancer Symposium will be held in San Francisco, Sept. 25-27.

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  • Blog
  • April 14, 2015

New Breast Cancer Treatment Pioneered by NWA Surgeon

A Northwest Arkansas surgeon is the first in the country to pioneer the use of what’s being called ‘groundbreaking innovation’ in breast cancer treatment.

Dr. Michael Cross, North Hills Surgery Center and Highlands Oncology Group are now offering patients a new device that can help improve the treatment of breast cancer. The bioabsorbable surgical marker is called BioZorb and it’s inserted into the breast by the surgeon at the time of tumor removal. Dr. Cross is one of the leading researchers in the world to demonstrate the effectiveness of this unique device.

View full article on KNWA.

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  • Blog
  • March 19, 2015

Innovative Approach to Breast Cancer Treatment Being Pioneered

Local breast surgeon Michael Cross, M.D., F.A.C.S., North Hills Surgery Center and Highlands Oncology Group havepioneered a groundbreaking innovation that can be used during treatment of breast cancer.

A new bioabsorbable surgical marker called BioZorb is inserted into the breast by the surgeon at the time of tumor removal. Dr. Cross is one of the leading researchers in the world to demonstrate the effectiveness of thisunique device.

“This small, three-dimensional tissue marker provides a target for aimingradiation therapy precisely at the tumor site, which helps minimize any damage to remaining healthy tissue including the heart and lungs,” said Dr. Cross. “For patients who want breast-conserving treatment and a very good cosmetic outcome, this approach is an excellent option.”

Dr. Cross and North Hills Surgery Centerwere the first team in the U.S. to pioneer use of the FDA-cleared BioZorb device during surgery. Dr. Crosshas now treated over 100 patients using the surgical marker as part of the procedure.

Breast cancer can be treated by mastectomy (breast removal) or by lumpectomy. With lumpectomy,a small amount of tissue containing the tumor is removed. In addition to the surgery, it is important to add radiation treatment to “clean up” any microscopic cancer cells that might remain behind in the breast. The addition of radiation allows surgeons to safely conserve the breast tissue, while decreasing the chances of cancer recurring in the same location.

“During radiation treatment, the BioZorb marker provides much needed identification of the site where the cancer was,” said Dr. Arnold Smith, radiation oncologist at Highlands Oncology Group. “The marker more clearly defines the treatment area. That means we can even more confidently focus treatments that previously needed larger volumes to account for positioning uncertainty.”

Prior to the development of the surgical marker, radiation treatments usually had to be directed at the entire breast. “Now, because we can do a better job of directing the radiation exactly where the tumor is, we are able to safely reduce the amount of breast tissue receiving radiation,” Dr. Cross said.

“In over 51% of our patients, the total treatment time was significantly decreased as well. What used to take six weeks of radiation now can be delivered accurately in four weeks,” he said. “There’s no doubt that this is just the beginning of a major improvement in how radiation will be used in breast cancer treatment. What I love about BioZorb is its simplicity. It fits right into our routine, and we’ve seen the benefits in our patients.”

BioZorb is a small coil that holds six tiny clips arranged in a precise three-dimensional array. This 3D array remains over time, while the coil holding the clips dissolves. The precise marking of the tumor bed also makes it easier to do followup exams using routine mammograms.

One Patient’s Story

Kathey Rhoads has been familiar with cancer treatment for many years, having worked at Highlands Oncology Group since 1996. Even though Rhoads oversees the oncology center as its COO, she said, “I was one of those people who thought they would never get cancer themselves.” But when she found a lump in her right breast shortly after she was remarried in July 2012, a biopsyconfirmed that she had breast cancer.

She was familiar with Dr. Cross’s work and immediately chose him as her surgeon. After taking medication to reduce the size of the tumor, she had surgery at North Hills Surgery Center in November 2012.

Rhoads, who’s now 56, was one of the first patients in the world to receive BioZorb as part of her treatment, and she’s very happy with the cosmetic outcome. One advantage of the device is that it helps retain the natural shapeof the breast after surgery, by making it easier for surgeons to avoid the “dimpling” effect that can sometimes result from older lumpectomy techniques.

Rhoads also felt good about her role in helping to demonstrate the value of the new surgical marker. “As part of a medical oncology practice, I know how important new procedures are,” she said. “Unless we have participants willing to use the new technology, we can’t learn what the benefits are going to be.”

Dr. Cross has presented hisresearch findings at several scientific conferences, summarizing his clinical experiences with the BioZorb device. The most recent report on 65 caseswas presented at the 18th SIS World Congress on Breast Healthcare, Oct. 16-19, 2014 in Orlando, Fla.

Thanks to women like Rhoads and physicians like Dr. Cross, this improvement in breast cancer treatment is being made available to many more women. “The ultimate goal with breast cancer treatment is to have the breast look like it did before treatment. Sometimes that’s not as easy as it seems,” said Dr. Cross. “Now, in many cases, we have found that result is actually achievable.”

About North Hills Surgery Center

North Hills Surgery Center is a multispecialty practice in Fayetteville founded in 1998. It has approximately 50 physicians on staff and is affiliated with Washington Regional Medical Center. Designed for comfort, convenience and privacy, North Hills is dedicated to providing the highest quality healthcare in Northwest Arkansas. For more information, call (479) 713-6100 or visit

About Highlands Oncology Group

Highlands Oncology Group was formed in 1996 and has clinics in FayettevilleandRogers. The group’s mission is to provide comprehensive cancer care ensuring patient access tothe latest, most advanced technologies and research available. Patient education and patient support groups are some of the support services offered at Highlands Oncology Group as well as research through clinical trials. For more information, call (479) 587-1700 or visit


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