I have had many breast cancer patients over the years. When I first meet them, they have just received the diagnosis. “You have cancer.” A week ago they were a healthy 40 something woman whose biggest worry was should you buy organic milk for your kids? Now you have cancer.
When I meet you, I will remind you to take a step back. You don’t have to make all of the decisions today. It is overwhelming, particularly for my Bay Area women who are hypereducated. The internet is a wonderful source of information, but when you just find out you have cancer and you can’t sleep, you read too much… All through the night…. You are frazzled, overwhelmed, and for many of you, you need to “keep it together” for your families.
My advice?
Make what decisions you must now, and table the other decisions until later.
Decisions you need to make:
- Lumpectomy or mastectomy? This is something you should decide with your general surgeon. The decision rests on many factors: your age, size of tumor, is it invasive or in situ, do you have evidence of spread, do you have a strong family history/ BRCA or not, etc?
- If mastectomy, do you want reconstruction? This is a simple yes or no answer.
- If you do want reconstruction, do you want to do autologous (fancy way of saying using your own tissue) or a tissue expander/ implant reconstruction? For this answer, you should see a plastic surgeon. I have heard countless stories of women who didn’t do reconstruction because they didn’t like the first plastic surgeon they met. Many general surgeons have plastic surgeons they work with a lot. But if you don’t like the first one you meet with, meet with another one. As for autologous versus tissue expander/ implant, you may not be a good candidate for one or the other. If you are super skinny, you may not have enough fat for a TRAM. If you have had a mastectomy in the past and were radiated, your skin may not expand, so you may need to have autologous. As for exactly what kind of reconstruction, have your surgeon help you surf through the terms. Free flaps, DIEP flaps, pedicled flaps, etc etc. Textured implants, anatomic or shaped implants, gummy bears, silicone, etc. etc.
- Do you want to address the other breast? This could be with mastectomy and reconstruction, breast lift, breast reduction, breast augmentation. Insurance will cover the contralateral surgery. Consider this a little silver lining. If you always wanted to be bigger, smaller, lifted- here is your chance. Again your doctors can help you with your choice.
What you don’t need to decide right now is what kind of implant, or size, or shape you want. Or your nipple areola reconstruction- should I tattoo or skin graft? What about yadda yadda yadda. These are things you decide down the road.
Table it.
Distill down to what you need to do now. Make the other decisions down the road. Cancer chooses when you do the first surgery. It jumps out of nowhere and upsets your life and schedule. Most breast reconstruction surgeries have stages. You get to decide the timing of your next surgeries.
If you had a recent diagnosis and you are truly overwhelmed and can’t decide if you want reconstruction, then you shouldn’t. You can always do a delayed reconstruction down the road.
So take a step back.
Meet with your doctors. Bring someone with you who can take notes and help you remember what you hear.
And don’t forget to breathe.