It’s a paralyzing diagnosis that no one ever wants or expects to hear from their doctor; “I’m sorry, but the biopsy came back as breast cancer.” Right away, an explosion of emotions and a feeling of impending doom engulfs the unprepared patient. Her entire world will now be consumed with various doctor appointments, an overload of information, and many choices that have to be made rather quickly. I’ve seen more families dealing with this medical crisis than I want to remember. However, I sleep well at night knowing that our involvement as surgeons and the instant family bonds we create during this difficult time really help people understand what options they have in restoring their health and rebuilding their appearance as we navigate this road together. The typical consultation with a family going through this may take an hour or more, so I would never be able to sum it up concisely here, but hopefully this will help answer some initial questions:
Q1: What should I do right now?
A1: One in Eight female patients (12%) will be diagnosed with breast cancer at some point in their lives. Yes, although shocking to hear, this is not a rare cancer. However, like many forms of cancer (cervical, colon, skin, etc.), breast cancer can be caught early, prevented, and cured with early diagnosis. So the two most important things you can do are know your family history and make sure your doctor knows it too, and get mammograms at age 40 if you don’t have a family history or earlier than that if you do. The rule of thumb is to have a mammogram five years before your youngest immediate family member is diagnosed.
Q2: Why does my family history matter?
A2: There are familial or genetic forms of breast cancer. In these families, the incidence of breast cancer can be as high as 86%! Therefore, for patients with close family members with breast cancer, it may be possible to test your genes (BRCA1 and 2, for example) and determine your risk before you ever get diagnosed with cancer. For gene-positive patients or patients categorized as very high risk, performing prophylactic mastectomy can decrease your chances of getting breast cancer to less than one percent.
Q3: If I have been diagnosed with breast cancer, where do I start?
A3: If you have not already met with an oncologic (cancer) surgeon, this is where you need to start first. Your GYN or Primary physician could likely refer you to a good one locally. This surgeon is an expert at dealing with breast cancer, and based on the characteristics of the tumor (type, location, size, grade, stage) and your overall health, will be able to recommend your best options in treating this tumor. There is much to factor into this decision, but he/she will help facilitate your decision. If the choice is mastectomy, then this surgeon will be able to refer you to a plastic surgeon who will help with the reconstruction options.
Q4: What will the reconstruction cost me? I want to look and feel normal again.
A4: Breast reconstruction is medically necessary and, therefore, an insurance-covered procedure by law. Reconstruction has come a long way in recent times, and now there are several good options to help restore a woman’s body and self-confidence. Depending on the type of cancer operation chosen, plastic surgeons have many tools available to aid in rebuilding the affected breast, as well as improving the unaffected breast to match. All of these procedure are covered by medical insurance. Medical studies performed to evaluate female patients with breast cancer have shown much higher quality-of-life scores for those who chose to have breast reconstruction after mastectomy.
Q5: What are the most common ways to reconstruct a female breast?
A5: After mastectomy, most women opt for a silicone implant to restore the fullness of the breast. Sometimes, a temporary spacer, called an expander, will be placed first, and other times women with small tumors may go straight to a silicone implant. Your own fat can also be used as a secondary option to help soften and improve the look of the breast. If implants are not desired or radiation has caused damage to the skin of the chest, then free fat and muscle grafts can be taken from the abdomen to rebuild the breast mound. The opposite breast can be improved to match any option available to the patient, ie. Lift, implant, reduction, fat grafting, etc. The reconstruction plan and recovery will be discussed in detail with your plastic surgeon.
Erez Sternberg, MD
Ponte Vedra Plastic Surgery
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