Dr. Elmer Hoffman, a retired Baltimore surgeon who had been a pioneer in breast cancer surgery and immediate reconstruction and was also an advocate of the use of "super cold surgery" to ease the pain of the terminally ill, died Monday of complications from an infection at Sinai Hospital.
The longtime Pikesville resident was 92.
"We were pioneers and collaborators in Maryland of breast cancer surgery and immediate reconstruction," said Dr. Stanley A. Klatsky, a retired Owings Mills plastic surgeon. "Elmer was an excellent technical surgeon who was always at the top of his field."
The son of Harry Hoffman, a Beth Tfiloh congregation cantor, and Ida Pressman Hoffman, Elmer Hoffman was born and raised in Baltimore.
After graduating in 1937 from City College, he earned his bachelor's degree in 1941 from the Johns Hopkins University, where he had been a member of Phi Beta Kappa.
He earned his medical degree in 1944 from the Hopkins School of Medicine, and completed a residency in surgery at Sinai Hospital in 1952.
Dr. Hoffman was commissioned a lieutenant in 1941 in the Army Reserve and was called to active duty four years later with the Air Force, where he served as chief of surgery at Wright Patterson Regional Hospital in Ohio. He had attained the rank of captain at the time of his discharge in 1948.
He began his career in 1952, and in addition to maintaining a private surgical practice, Dr. Hoffman was an assistant professor of surgery at the Hopkins medical school.
He also served on the staffs of Johns Hopkins Hospital; Northwest Hospital, where he had been chief of surgery from 1993 to 1994; Sinai Hospital; Greater Baltimore Medical Center; and Franklin Square Medical Center.
Dr. Hoffman and Dr. Klatsky pioneered in Maryland the use of the all-in-one mastectomy and immediate reconstruction technique, which is done at the time of the mastectomy, reported The Evening Sun in 1985.
After the breast is removed, an inflatable balloon filled with salt water — a tissue-expander — is inserted, which is used to create a pocket under the chest muscles. The procedure takes about six to eight weeks.
A prosthesis of silicone gel is then permanently placed in the pocket, reported the newspaper.
"Unlike other techniques, this reconstruction does not use flaps from the stomach or the back, minimizing scarring and eliminating large interventions in other parts of a woman's body," reported The Evening Sun.
"We started doing this procedure in the early 1970s, and it was very controversial in those days, and now it is very common," said Dr. Klatsky. "It was a departure from routine breast cancer surgery and hadn't really been accepted."
Dr. Klatsky described his friend not only as a surgeon but as a "scientist-clinician."
"He was very bright and as a scientist liked to challenge the norm. He was always open-minded to new techniques, such as the nutritional aspect of wound healing," he said.
Dr. Hoffman was also an outspoken advocate and practitioner of what is called "super cold" surgery or cryotherapy, which is used for relieving pain and discomfort in terminally ill cancer patients.
The procedure, performed with a mild anesthetic or sedative, uses liquid nitrogen. It is then fed from a container through a tube to a copper-tipped probe placed next to the lesion, creating an ice ball.
"This 'super cold' kills the tissues, which are eventually sloughed off," reported The Baltimore Sun in a 1973 article.
Dr. Hoffman explained in The Sun interview that the procedure was used only when conventional surgery and drugs were no longer options for patients.
Dr. Hoffman was also known for his caring demeanor.
"He had a wonderful bedside manner when it came to caring for his patients," recalled Dr. Klatsky. "He had an outstanding work ethic and cared for his patients personally, and would only delegate this if he felt the other person was up to his level. He was very meticulous when it came to patient care."
At Northwest Hospital, Dr. Hoffman was the physician adviser for quality assurance.
"This was in the area of clinical care review, and he was the best that I've ever worked with," said Erik G. Wexler, former president of the hospital.
"He had a passion about the clinical care that our patients received. He would dissect reports that sometimes took weeks. He wanted to improve what we do and how we do it. He wanted to ensure good patient care," he said. "At Northwest, he was an institution unto himself and was beloved by all who knew him."
In addition to clinical surgery, Dr. Hoffman wrote 95 articles and was editor-in-chief of the Sinai Medical Journal from 1958 to 1962. He also lectured widely and served on the editorial boards of the Maryland Medical, Contemporary Surgery Journal and Infections in Surgery Journal.
He had received the award for Distinguished Service Medal in Medical Journalism in 1961 from the American Medical Writers Association.
Northwest Hospital established an annual lectureship in Dr. Hoffman's honor at the time of his retirement in 1994.
In 1984, Dr. Hoffman and Thomas F. Mullan III established the Mount Wilson Limited Partnership, which purchased the old Mount Wilson Hospital Center for $3.54 million and redeveloped the site as the North Oaks Retirement Community near Owings Mills.
Dr. Hoffman was a member of Har Sinai Congregation.
Services for Dr. Hoffman will be held at 11 a.m. Thursday at Sol Levinson & Bros., 8900 Reisterstown Road.
Dr. Hoffman is survived by his wife of 60 years, the former Sherry Koplon; two sons, Robert A. Hoffman of Lutherville and Richard A. Hoffman of Cambridge, Mass.; a daughter, Jo Anne Helman of Cockeysville; and five grandchildren.