No one is ever prepared to hear the words, “You have breast cancer.” Yet, it is the most common type of cancer in women, making up around 25% of all cancer cases every year. The diagnosis is scary and overwhelming, but you do have options. At Bedford Breast Center, we are committed to helping you navigate the diagnosis, treatment, and reconstruction process, ensuring you have all the information you need to make the best decisions for your health and body.
The first step after a breast cancer diagnosis is to simply breathe. Give yourself time to collect all the details of your diagnosis and information about your choices moving forward. When you are armed with the facts, you can be ready to take charge of your treatment plan.
Treatment Timetable
It is not unusual to want to head into surgery soon after your diagnosis to remove the newly discovered cancer as quickly as possible. However, this is typically not the most prudent path for patients or surgeons. It may be much more effective to take a few days—or even weeks—to create a treatment plan that is precisely tailored to your specific situation. Most patients wait 3-6 weeks before undergoing surgery, ensuring sufficient time to consider the diagnosis, undergo additional testing, and create the treatment plan that will be the most successful for you from both a medical and a cosmetic standpoint.
Keep in mind that most breast cancers take 3-5 years to form, so time is on your side in most cases. Scheduling surgery immediately does not typically improve outcomes and may not give you or your surgeon the necessary time to create the most successful treatment plan. While we understand it is difficult mentally and emotionally to wait, prepare to spend a few weeks planning for your surgery.
Know Your Options
There are many options in breast cancer treatment today, and it is critical to weigh all of them when designing the best plan for you. This includes the order of the treatments as well as the specific treatments performed. The best plan will be dependent on the characteristics of the cancer cell rather than the size or location of the lump.
Rest assured that we can treat any breast cancer, regardless of its specific location. There is no more difficult or easier place to have breast cancer. Even cancer close to the nipple or skin can be treated. The goal is to eradicate the cancer while maintaining your skin, nipple, and femininity as much as possible.
WHAT ABOUT CLINICAL TRIALS?
Consider clinical trials when creating your breast cancer treatment plan. Trials provide you access to some of the latest treatment options while reducing your overall costs. Many of these treatments can only be performed before surgery, so begin researching your choices as early as possible. Our staff is happy to help you locate clinical studies that might relate to your specific situation.
Testing 101
Testing is a vital step in the process because it provides a profile of the cancer and can tell us which treatment will be best for you. Much of the testing occurs after the initial biopsy, using tissue taken from the cancer tumor.
Testing can provide you with extensive information about your cancer, as well as what your body might need to fight the cancer most efficiently. We design treatment plans around this information, which might include:
- Size and grade of the cancer
- Hormones present
- Cancer cell characteristics
- Cancer stage (whether it has spread to other areas of the body)
- How fast the cancer might spread
Preliminary pathology reports offer a variety of information, some of which can be obtained as early as 24-72 hours after the biopsy. Other data may take additional days or even weeks to receive. We will compile all the information necessary to ensure you have the most effective treatment plan possible. Other testing might include:
- Genetic Testing – There are nearly 40 genes we routinely look at to determine whether patients have an increased risk for breast cancer and other cancers as well. While testing for the BRCA1 and BRCA2 genes are the most well-known, PALB2 and PTEN genes also provide helpful information about a woman’s risk factors. These tests are frequently recommended for women who have a family history of breast or ovarian cancer
- Cancer Assay Testing – there are many types of assay testing, including the following:
- Oncotype – looks at specific genes to see how likely the cancer is to grow and spread
- MammaPrint – identifies specific genes to determine the likelihood of whether the cancer might return after treatment
- Breast Cancer Index – analyzes seven different genes to predict the return rate of the cancer after 5-10 years, helps to determine how long patient should remain on anti-hormone therapy
It can take anywhere from one to three weeks to get results from some of these tests, which can help determine the type of treatment you need following your breast cancer diagnosis and steps that you might need to take in the future to lower your recurrence risk.
Breast Cancer Treatment: Beyond Surgery
Many women might undergo additional treatments before or after their breast surgery. Chemotherapy and radiation therapy are the most familiar to most patients, but another common treatment option is anti-hormone therapy.
This treatment targets the estrogen receptors commonly found in breast cancers. Anti-hormone drugs block these receptors to prevent the cancer cells from reproducing. Patients typically remain on the anti-hormone drugs for five years, but women with a higher risk of recurrence may take the medications for 10 years.
CHEMOTHERAPY VS. RADIATION
If you require one or both of these treatments, it is helpful to understand what they involve and when they are recommended and performed.
Chemotherapy
Chemotherapy is a treatment that uses special medications to destroy cancer cells or to stop them from growing. In addition to targeting cancer cells in and around the tumor, chemotherapy addresses cancer cells in other areas of the body. Chemotherapy is frequently used for patients who have early-stage invasive cancer to destroy the remaining cells after surgery. It can also be recommended for advanced-stage breast cancer, destroying and stopping as many cancer cells as possible.
It is becoming more common to use chemotherapy before breast surgery, as this approach can shrink the tumor to improve both medical and cosmetic outcomes. Patients often have a port placed to easily inject the medication at each treatment session, which can be placed on the chest or in the armpit. Patients are often hesitant to undergo chemotherapy due to fear of hair loss, but this side effect can be effectively mitigated in many patients if steps are taken at the beginning of the process.
Radiation
Radiation is another treatment that destroys cancer cells, using a high-energy beam that targets the malignant cells and leaves healthy cells intact. At Bedford Breast Center, we recommend a consultation with a radiation oncologist to our patients who have indications for radiation treatment. This is most often recommended for those who undergo lumpectomy, as well as a few who undergo mastectomy.
Prepare for Surgery
It is wise to get a few opinions before undergoing any kind of breast surgery. Keep in mind that what one doctor considers and prioritizes may be very different to another doctor. We want you to have a team of doctors that shares your same goals and understands your concerns. The right team will develop a well-rounded plan that works best for you.
Consider two patients with identical cancer situations. One of these patients might have personal experience with friends or family members and have an incredible amount of anxiety about the possibility of recurrence or follow up. For this patient, bilateral mastectomy is the best option, taking into account her highest concerns that are simplifying future surveillance and respecting the anxiety she may have about the possibility of recurrent disease.
The second patient may have misgivings about more complicated surgery and may have strong feelings about retaining as much of her own natural tissue as possible. She may be comfortable with monitoring going forward as she understands this is still a wonderful treatment option that is considered safe as well. For this patient, her best choice may be a lumpectomy.
If a doctor does not offer you all possible options or tells you what you want to do is impossible, ask why. It may be that you have fewer options than other patients with breast cancer for a variety of reasons, but it’s important to understand why certain doors may be closed to you if your physician recommendations are out of line with your expectations. Be sure that your voice is heard and that you are fully comfortable with your treatment plan.
If you’re comfortable with what your doctor says, you may not need to worry about getting a second opinion. However, if you feel uncomfortable or unhappy with what you hear, it might be beneficial to get another opinion.
For example, many patients come to us who have been told it is unsafe to perform nipple-sparing mastectomy, but we can almost always meet this need. Other patients have been told that they must have multiple surgeries in order to have reconstruction after mastectomy, but we have had consistent and beautiful results with performing direct implant-based reconstruction after our nipple and skin sparing mastectomies. We are even comfortable with placing the implants on top of the muscle to avoid disrupting the natural anatomic movement of your arms and chest. This is especially important for our most active patients.
We are often surprised by the number of patients who were told that certain techniques are unsafe, are not recommended, or are even “impossible”, when we are able to achieve fantastic results with these techniques.
CANDIDATES FOR LUMPECTOMY
A lumpectomy is a surgical procedure that removes the tumor and surrounding tissue while leaving the majority of the breast intact. Incisions are placed discreetly to minimize visible scarring afterward. Candidates for lumpectomy typically have either small tumors or large breasts. We will assess your specific situation to determine whether lumpectomy is the most appropriate option for you.
Some patients may be able to retain their breast tissue and have their cancer removed but require additional specialized plastic surgery techniques called oncoplastic reconstruction To ensure the most feminine and natural brush profile along with symmetry between the breasts. We will help guide you through this process as well if it is best suited for you.
CANDIDATES FOR NIPPLE-SPARING MASTECTOMY
Nipple-sparing mastectomy involves removal of cancerous breast tissue, while leaving the skin and nipple intact. This procedure allows for a more natural breast reconstruction, increasing a woman’s confidence in her appearance after cancer treatment, while ensuring a low risk of recurrence because at Bedford Breast Center, we cancel cancer, not beauty.
While this procedure is more complex than traditional mastectomy, Dr. Heather Richardson and the other surgeons at Bedford Breast Center are considered experts in this technique and can perform it on 95% of women who do not have cancer in the nipple. We do not compromise safety for cosmetic results—survival is our top priority. Women undergoing nipple-sparing mastectomy with us can rest assured this approach does not negatively impact their cure or recurrence rate.
Choices in Breast Reconstruction
Breast surgery to remove cancer is only one part of the equation for many women. In order to feel whole once again, breast reconstruction becomes a vital step in the process. When and how this step is performed will vary, depending on the unique circumstances of each patient. Like the rest of your cancer treatment, there are choices in reconstruction that allow us to work together to customize your plan to your precise needs and goals.
TIMING OF RECONSTRUCTION
We can initiate the reconstruction process at different times throughout your journey. Choices include:
- Immediate Reconstruction: Reconstruction is performed at the same time as the mastectomy, also known as direct-to-implant reconstruction.
- Delayed Reconstruction: Reconstruction is done after mastectomy, and possibly after other treatments like radiation or chemotherapy.
- Delayed-Immediate Reconstruction: This procedure involves the insertion of an expander at the time of the mastectomy to maintain the breast shape, with reconstruction at a later time.
Timing of reconstruction will depend on many factors, including your personal preference, other treatments you might need, and the type of reconstruction you plan to have. For some women, immediate reconstruction allows them to heal more effectively after breast surgery. Other women may need time to undergo treatment or mentally and physically prepare for the reconstruction process.
Many women ask us about the use of expanders. With reconstruction techniques that have been pioneered by our own breast surgeons at Bedford Breast Center, we have greatly eliminated the need for expanders by performing the reconstruction at the same time as mastectomy. However, women who choose to delay reconstruction may benefit from the use of expanders to prepare the breasts for reconstruction at a later time. If you choose to have reconstruction later and have not had expanders placed, we can still perform the procedure, but with some limitations.
Types of Reconstruction at Our Medical Center
There are different ways to perform reconstruction, whether using only your own breast tissue or adding implants to enhance the shape and size of the breasts after surgery. At our Beverly Hills medical center, we offer two primary reconstruction options:
DIRECT-TO-IMPLANT RECONSTRUCTION USING IMPLANTS
Our own breast surgeon, Dr. Lisa Cassileth, developed our direct-to-implant reconstruction process. First, Dr. Cassileth or another of our breast surgeons will perform your mastectomy, removing the cancer and surrounding tissue, while leaving the nipple and skin intact whenever possible. The surgeon will then place implants into the breast, using a collagen substance to create an internal bra to hold the implants in place. Direct-to-implant reconstruction can produce excellent cosmetic results that you can see immediately after your mastectomy.
GOLDILOCKS MASTECTOMY
Dr. Richardson developed the Goldilocks mastectomy with her colleague Dr. Grace Ma, to give women the best possible outcome without “going flat.” This procedure removes unhealthy tissue while saving healthy tissue and skin to create a smaller, but completely natural, breast. The Goldilocks mastectomy allows women to retain their breasts in a single procedure with the least amount of downtime and without the need for multiple surgeries. The breast is reconstructed without the need for expanders, implants, or tissue transfer from other areas of the body.
Choosing Your Implants
Women who opt for direct-to-implant reconstruction will also have implant choices. There are three basic types of implants used for this procedure:
SALINE IMPLANTS
Saline implants consist of silicone shells that are filled with sterile saline water after placement into the breast tissue. These were the first implants to be introduced and continue to be used today. Advantages to saline include smaller incisions and the ability to customize the size to the precise proportions and desired results of each patient. There is a risk of the implant leaking, which could change the appearance of the breast quickly and require replacement.
SILICONE IMPLANTS
Silicone implants also have silicone gels, but instead of salt water, they contain a silicone gel-like substance. They come pre-filled, but there are multiple shapes and sizes available to ensure women achieve a proportionate, balanced result. These implants tend to feel more like natural breast tissue.
COHESIVE GEL
The cohesive gel or form stable implants are a type of silicone implant that contains a thicker silicone substance. Also dubbed “gummy bear implants” due to their resemblance to the candy, these implants will hold their shape even if the shell breaks. While they still resemble natural breast tissue, they tend to be firmer than traditional silicone implants.
Your plastic surgeon will walk you through the reconstruction process to help you make the choices that work best for you. While some women will need to replace their implants at some point, others will be able to keep their implants indefinitely as long as no issues with the implants arise.
Studies have shown implants to be a very safe option for women undergoing breast reconstruction. Doctors recommend scheduling an appointment with a healthcare professional annually to ensure no problems arise.
Your Body, Your Story
Your breast cancer journey will be a unique experience unlike anyone else’s. Sometimes the same diagnosis for two different people still means different things. Even when your diagnosis sounds the same, you may have a different treatment plan to accommodate your specific needs. You will have your own path—just like every mother has a different labor story.
The journey is yours, but you won’t have to walk it alone. Our team of experts will be with you every step of the way. From understanding your diagnosis and treatment options to creating a customized reconstruction plan, we will be here to offer you the information, support, and compassion you need to overcome your cancer and move forward with your life. To learn more about our services or schedule an appointment, contact or call our medical center today at (310) 278-8590.
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