Jana de Boniface

I am a general surgeon trained in Berlin and Västerås, today specialising in oncoplastic breast surgery. The seat of my clinical activities is Capio St Göran's Hospital, one of the three large Breast Centers in Stockholm. Born in Giessen, Germany, I moved to Humboldt University in Berlin after school and studied medicine as well as violin (Universität der Künste) until receiving my graduations in 1996 and 1999. I did my doctoral thesis on viral hepatitis C and psychological side effects of Ribavirin and interferon treatment and later continued with a PhD thesis on sentinel node biopsy in breast cancer at Uppsala University.

My research, through a position as senior researcher at Karolinska Institutet, is focussed on two main clinical areas: axillary surgery and oncoplastic breast surgery. In addition, we have recently started a randomized trial within exercise oncology.

Axillary surgery in breast cancer has undergone an enormous development since the 1990s. While we always performed an axillary clearance before that time, removing at least 10 lymph nodes from the armpit regardless of whether they were tumor-bearing or not, we today get more and more restrictive about the extent of axillary surgery. The reason for that if of course mainly the known risk of lymph edema, affecting about 20-25% of women after axillary clearance, and the fact that breast cancer is diagnosed earlier today, making is less likely that extensive axillary surgery contributes to any survival benefit at all.

In the 1990s, the sentinel node biopsy was introduced, identifying the first lymph node/s draining the breast and representing the remaining axillary nodes. It is established today that no axillary clearance needs to be performed in case of a negative sentinel node. There are, however, additional data questioning the benefit of further axillary surgery even in the event of a tumor deposit (metastasis) in the sentinel node. We therefore started a large randomised trial, the SENOMAC Trial, analysing the effect of the omission of axillary clearance in this situation, the first results have been presented in San Antonio in December 2023 and the publication on recurrence-free survival is in press. 

The next step of reducing axillary treatment is the randomized T-REX trial testing to reduce radiotherapy to the armpit, and the AXSANA study assessing how much axillary surgery we need to perform after preoperative chemotherapy.

Oncoplastic surgery is the use of plastic surgical methods in order to make breast cancer surgery less mutilating, maintaining the same safety that conventional methods provide. While I actively promote the knowledge and use of oncoplastic techniques through training courses and certification processes, the issues of oncological safety and quality of life are the focus of my oncoplastic research. Thereby I try to support the safe use of volume displacement methods as well as reconstructive options, but I am also involved in analyses on the reasons for regional differences and the patient-reported outcomes after such surgery, especially in patients irradiated after implant-based reconstruction.

Teaching oncoplastic breast surgery is a passion of mine as I believe that we can thereby provide tailored surgery to breast cancer patients. The complex assessment of tumor, stage, planned treatment, together with patient factors such as own desires and priorities, expectations, body shape and comorbidities are fascinating. To disseminate "oncoplastic thinking" and craftsmanship, I lead the annual national oncoplastic course in Sweden and have recently joined the Oncoplastic Breast Consortium.