What is it?
Finding out that you have a mass in your breast can be a very scary experience, and can happen in different ways. Some women may feel a lump on a self-breast exam, others may be discovered by a doctor, or found on a mammogram. Women can have lumps or irregularities in their breasts for various reasons, and not all breast masses are cancerous. The first step to finding an answer is a good physical exam by a physician experienced in treating breast masses. Depending on your symptoms and findings, the next step is usually obtaining imaging to get a more detailed look at the mass. The type of imaging can vary depending on your age and history, but usually includes a mammogram, ultrasound, MRI, or some combination of the three. Generally, the imaging will point to whether the mass looks benign, suspicious, or very concerning. If the mass is anything other than obviously benign, a biopsy is usually required to obtain tissue for diagnosis. Depending on the circumstance, this may mean bringing you to the operating room to completely remove the mass, or it may mean having an interventional radiologist use a large needle to remove a sample under image guidance. Based on the results of the biopsy, your specialist can discuss specific breast cancer treatment options with you.
According to the American Cancer Society, it is estimated that among U.S. women alone, there will be approximately 316,120 new cases of breast cancer diagnosed in 2017. While mortality rates have substantially decreased over the last two decades due to early detection and improved adjuvant therapy, it still remains the most commonly diagnosed cancer in women worldwide. At Lift Plastic Surgery, we know it can be hard to find the silver lining once you've been diagnosed with breast cancer. The very core of our practice believes in helping our patients feel completely secure in their health, overall wellbeing and image, despite these unforeseen circumstances. We understand that, while having your cancer removed and remaining cancer free is the ultimate goal, it often results in additional challenges to overcome. While the initial surgeries themselves may be lifesaving, they can have a lasting impact on how you look, feel, function, and overall quality of life. If you, or someone you've loved, has been diagnosed with breast cancer, we understand the emotional and physical scarring that it can bring. No matter your gender or background, losing a breast can be emotionally, and physically, taxing. After diagnosis, patients are faced with an overwhelming amount of information, and a multitude of decisions to make in a short amount of time! This leaves many patients feeling frustrated and helpless - understandably so! It is our goal to streamline this process for you.
In the majority of instances, after breast cancer is diagnosed, a patient will be referred to a breast surgeon that will remove the tumor and work with an oncologist to treat the cancer, and a referral will also be made to a plastic surgeon who works with the breast surgeon to provide breast reconstruction. Unfortunately, some patients are never referred to a plastic surgeon, and have no idea that breast reconstruction is even an option. Lift Plastic Surgery is unique, in that it can provide all of these services for you. Dr. Patel and Dr. Wegge are both fully trained in general surgery and plastic surgery. By coming to us, your care can be simplified, as you have one team treating you from beginning to end, and providing all of your needs. It can be a comfort to know that your surgeon is invested in every part of your care, and knows your history, goals, and desires inside and out. Additionally, our plastic surgery skillset gives us the ability to plan your cancer removal in the most aesthetic way, taking into account future reconstruction that might be planned for the best possible final outcome.
What treatments are available?
Breast cancer varies significantly from woman to woman, and each treatment plan is based on specific tumor characteristics. Overall the topic is too expansive and complex to completely cover here. When you come to see us, we will have an in-depth conversation about what options are available to treat your cancer in the most successful way. If your cancer is small and in an early stage, it may be possible to perform a “lumpectomy”. This means removing the tumor with a rim of surrounding normal breast tissue. After a lumpectomy, radiation treatment is usually recommended to decrease the chance of a recurrence of cancer in that breast. A mastectomy would also be an option if you wished to avoid radiation therapy.
For larger or more aggressive tumors, a “mastectomy” is usually required. There are different types of mastectomies that can be performed, based on the specifics of the tumor, and whether or not the tumor has spread to the lymph nodes in the armpit. A “simple mastectomy” involves removing all of the breast tissue, as well as some skin and the nipple and areola. Usually this is combined with a “sentinel lymph node biopsy”, which involves removing usually 1-3 lymph nodes from the armpit to test whether or not the cancer has spread. A “modified radical mastectomy” removes the breast tissue and nipple/areola, as well as the fascia over the pectoralis muscle and the lymph nodes from the armpit. In select cases, where the tumor is small and far away from the nipple, or if the surgery is being performed prophylactically for a genetic diagnosis (BRCA), a “nipple sparing mastectomy” may be an option.
A nipple sparing mastectomy involves removing all of the breast tissue, while keeping the skin and nipple/areola intact for later reconstruction. The nipple and areola can be a sight of later cancer recurrence, so careful surveillance must be maintained. Additionally, the blood supply to the nipple/areola is decreased after all of the breast tissue is removed, and there is a possibility that some or all of the tissue may die after the mastectomy. Because of this, we often perform something called a “delay procedure”. This involves bringing you to the operating room two to three weeks before the mastectomy. At that time, the nipple and areola are separated from the underlying breast tissue, and a sheet of silicone is placed between the two. This forces the body to compensate by making the remaining blood supply to the area bigger and stronger. Later, when all of the breast tissue is removed, it is more likely that the nipple and areola will survive and do well. Additionally, it allows for a biopsy of the tissue behind the nipple which helps determine whether or not keeping the nipple and areola at the time of mastectomy is safe.
Treating your cancer will also involve working with an oncologist to help determine the most appropriate medical therapies based on the specifics of your tumor. This may or may not involve radiation therapy, chemotherapy or endocrine therapies.
Additionally, a small percentage of breast cancers can be linked to a genetic cause. If there is a strong family history of breast cancer, or a known familial BRCA gene, genetic testing may be a necessary part of the cancer work-up. Positive test results will specifically affect cancer treatment options and surveillance.
Additionally, breast reconstruction is often a very important part of a woman’s recovery after treatment for breast cancer. It can help recreate cleavage, projection, and soft contours relative to a woman's natural breasts. Research shows that reconstruction of the breasts can improve psychological well-being and quality of life by enhancing body image and self-esteem. Reconstructive breast surgery, for many, offers a chance to feel whole again, recover lost confidence, and sense of self. However, we also understand that each patient is unique and, for some, breast reconstruction may not be necessary or even desired. This is why we feel it is important to create an individualized treatment plan for each patient. Please see the specific breast reconstruction section of the website for more details.
Dr. Shitel Patel and Dr. Jackie Wegge believe that no one should have to go through this process alone, and take pride in being a part of you or your loved ones’ journey. Our doctors firmly believe that, regardless of life's circumstances, you deserve to feel comfortable and beautiful in your own skin. It's easy to feel overwhelmed and pressured in decision making after breast cancer diagnosis. At such a sensitive time, it is best to research all options regarding your health and well-being. Our Houston plastic surgeons are here to answer all of your questions, provide breast cancer support and help create a plan which best treats your cancer and you as a whole, so that, in the end, you still feel like yourself.