Cancer Mythconception: I’m going to lose my breast with a cancer diagnosis
Telfair Breast Surgery Surgeon Dr. Susan Mahany discusses breast cancer surgical treatment options
As a breast surgeon, one of the first questions Dr. Susan Mahany is asked by breast cancer patients is, ‘Am I going to lose my breast?’
The answer is ‘not necessarily,’ Dr. Mahany replies.
It’s a common misconception that a breast cancer diagnosis automatically means a woman has to lose one or both her breasts.
“When I was training 30 something years ago, there were basically two treatments, and the majority of patients did get mastectomies back then because we were just starting to do lumpectomies,” Dr. Mahany says. “Now everything we do is specifically designed for the patient we are seeing.”
A mastectomy is the surgical procedure that removes the entire breast, while a lumpectomy removes just the cancerous tissue and a ream of surrounding tissue, Dr. Mahany explains.
Dr. Mahany is the medical director of Telfair Breast Surgery at St. Joseph’s/Candler. She’s also part of the multi-disciplinary breast cancer team at the Nancy N. and J.C. Lewis Cancer & Research Pavilion. The team, comprised of surgeons, oncologists, nurse navigators, genetic counselors and others, work on each individual patient case to determine the best course of treatment.
If you are diagnosed with breast cancer, your surgeon will go over all your options and help you make an educated decision for your treatment.
“Every patient is treated differently according to the tumor that they have,” Dr. Mahany says. “It’s more complicated than it used to be, but it’s much better for the patient.”
What is a lumpectomy?
A lumpectomy is a surgical procedure that removes the tumor and cancerous tissue but leaves the rest of the breast attached. Lumpectomies preserve much of the appearance and sensation of the breast. It’s also a less invasive surgery with a shorter recovery time than with a mastectomy, Dr. Mahany says.
About 75 percent of all breast cancer surgeries are lumpectomies.
So, when would a patient need a mastectomy?
Reasons to have a mastectomy could include:
- A gene mutation that puts a patient at higher risk of recurrence
- A large tumor that is not going to give a good cosmetic result with a lumpectomy
- The patient is unable to tolerate radiation therapy or does not have easy access to a radiation facility (radiation isn’t typically required following a mastectomy depending on the type of cancer)
- Patient’s choice – some women are adamant that they want to have one or even both breasts removed
A bi-lateral mastectomy removes both breasts during surgery whether there’s cancer in both or not. This is typically recommended for patients with a genetic mutation because their chance of developing breast cancer can be 65 to 80 percent over their lifetime, Dr. Mahany says. Really young breast cancer patients also may opt for a bi-lateral mastectomy to reduce their chances of recurrence.
Mastectomies do have disadvantages other than the permanent loss of the breast. Mastectomy patients also will lose sensation in the chest wall, Dr. Mahany says.
Additionally, patients who have mastectomies are often at more risk of lymphedema. Lymph is a thin, clear fluid that circulates throughout the body to remove wastes, bacteria and other substances from tissues. Edema is the buildup of excess fluid. Lymphedema occurs when too much lymph collects in any area of the body.
Chance of recurrence
Another misconception that Dr. Mahany often hears is that women think if they have a mastectomy there is zero risk of recurrence. Unfortunately, that’s not true.
There’s between a three to five percent risk of recurrence.
“Stage for stage, it doesn’t matter if I do a lumpectomy and they get adjuvant radiation, or if I do a mastectomy, the disease free survival is exactly the same,” Dr. Mahany says.
The exception is in younger patients. A 30-year-old who had a lumpectomy is at a slightly higher risk of local recurrence simply because she is likely to live longer than a 65-year-old who had a lumpectomy.
If a mastectomy is your best chance of curing your breast cancer and reducing the risk of recurrence, your surgeon will work with you on reconstructive surgery options or prosthetics, which are available through the LCRP’s Transformation Station.
Immediate reconstruction is offered to mastectomy patients if radiation isn’t required, Dr. Mahany says. If a patient needs radiation, for example a woman with inflammatory breast cancer, some surgeons prefer to wait until after radiation treatment to do reconstruction.
When is the last time you’ve had a breast exam?
More than 60 percent of breast cancers are diagnosed through mammography while the other 40 percent are found by self-examination or physician examination. And thanks in part to better screening and early detection, as well as advancements in treatment, the death rate from breast cancer has dramatically fallen to about 1.9 percent a year.
That’s why it’s so important for women to have annual check-ups with their OB/GYN and annual mammograms after the age of 40 or 10 years prior to a diagnosis in a first-degree relative.
St. Joseph’s/Candler has five area locations that offer mammography. Learn more here.
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