Surgery and your breasts…

No one truly plans to get cancer.  

Did you know more than 80% of breast cancer is sporadic, with no history of the disease in family members.  

So, it is a significant shock when a woman is told they have breast cancer. Unfortunately, it's a shock that more and more Australian women will have to experience.  Since 2019, the Australian Institute of Health and Welfare has reported that 1 in 7 women will develop breast cancer by the age of 85.  This means one in seven women will have to negotiate the myriad of management options for breast cancer. 

But firstly, pretty much universally, a woman will be struck by a stream of thoughts and fears. These thoughts can appear obtrusively and repeatedly.…. 

“Am I going to die?”

“What will happen to my family?”

“Will I need chemotherapy?”

“Will I lose my breasts?”

My hope is that when you come to see your breast cancer surgeon, you can start to make sense of all these questions, regain control of your thoughts and the feel more confident about the path ahead.  

With a careful conversation between yourself and your doctor, you should come to understand the management options that are available to you and begin to make choices that align with your values. 

To get back to basics - there are four big components of breast cancer management: 

Surgery – of the breast and the lymph nodes and what most people are familiar with. 

Oncology - including chemotherapy and targeted therapy; used for tumours with certain receptor profiles or more advanced disease.

Radiotherapy - This can be to target the breast or lymph nodes and may depend on other management decisions.

Endocrine therapy - Used when breast cancers express an oestrogen receptor, reduce the chance of recurrent or future disease.

Most women ultimately will have surgery for the management of breast cancer.   We operate on the breast to remove the tumour, as well as the axilla (the armpit) to check the lymph nodes.   The type of surgery each woman has is slightly different – as each woman is different.   We assess the breast, as well as the tumour, plus explore with you other impacting factors, so we can make the best decisions together, for now and the long term. 

You may not have thought much about your relationship with your breasts up to this point, or conversely, they may form part of your identity.   They may have bought a sense of joy and womanhood, or perhaps provided nourishment to your children.   

It's important to remember that every woman’s relationship with their own breasts is unique. I have heard the full range of remarks about breasts.  I've had 20-year-old women request mastectomies because they never want to have to worry about cancer, whilst I've had 80-year-old ladies articulate that they do not want their breast removed as they are enmeshed with their identity.    For so many reasons, women care for and value their breasts. 

I like to remember the journey each woman has been on with her breasts over a lifetime - from tiny breast buds as a child, to that initial growth spurt in puberty, which is often the first indication of that inevitable journey into womanhood.  

They may have been a source of pride or disquiet.  Perhaps they’ve already been enhanced or reduced.   They may affect how we dress, how we interact with others, how we exercise.  They may attract a partner and be a source of joy and happiness.  

It would be minimalist to dismiss the impact they have on a woman’s individual experience. 

So, it is understandable that the thought of surgery on the breast may fill some women with anxiety.  I want my patients to understand that I am cognisant of this when we come to plan your treatment.  I want to help as best as I possibly can to both remove the cancer and provide all options available for treatment of the breast.

Sometimes, we may not be able to find a suitable way to remove the tumour and preserve the breast.  For these patients, a mastectomy (complete removal of the breast tissue) may be necessary.  It's important to understand however, that in 2021 a simple mastectomy is not all that is available.  A ‘Total skin-sparing mastectomy’ or a ‘Skin-reducing mastectomy’ may be available to preserve the skin envelope as best as possible, on the path to reconstruction. 

For some women, using more advanced surgical techniques, a reshaping of the breast may be available.   This can achieve a clear and wide removal of the tumour combined with a reshaping and resizing of the breast and it’s covering skin.   I am dedicated to giving my patients every opportunity to keep this important part of their body, should they wish.  

I believe it's very important that patients feel comfortable and confident to discuss these issues with their surgeon.  Many women have never had to deeply explore their relationship with their breasts.  But by taking the time to understand a patient’s true values and beliefs, we can achieve the right outcome from cancer surgery of the breast.    

Fear of the effects of surgery on your body and physical appearance can be overwhelming and difficult to articulate. By writing this here, I hope I can make my patients feel more comfortable to enter into this conversation, so together we can define the priorities and opportunities and get the best outcome in what is a distressing time.