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Advanced Breast Cancer: Managing Your Medical Care: Diagnosis To Treatment Decision

If A Mastectomy Is Recommended.

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Take time before making a decision

You do not have to make a decision in your first meeting with your cancer doctor. Instead, take the time to make the best treatment decision for you. Your cancer doctor can tell you how much time you have to decide.

How to make a treatment decision

Whether to have a mastectomy should be based on both the best medical information you can gather and what feels right to you. When it comes to your feelings, think about what it would mean to you to lose a breast. 

Emotions can be devastating. However, research has shown that reconstruction after mastectomy, very much like breast conservation, helps a woman to achieve a more positive self-image and increased sexual satisfaction. Studies have also shown that the type of surgery performed has a surprisingly small effect on a person's overall psychological health and ultimate sexual functioning.

Don't choose a mastectomy for the wrong reason

Some women choose a mastectomy "to get rid of as much of the cancer as quickly as possible." This is not a good reason because both a mastectomy and a lumpectomy accomplish this same purpose. 

Some women choose a mastectomy thinking that they will have a better chance of survival than with a lumpectomy. Studies show that women who choose total breast removal do not live longer than women who remove only  the cancerous lump and then have radiation. There are other reasons to choose a mastectomy, but this is not one of them.

Discuss options with your doctor

 If you are interested in breast reconstruction, discuss the subject with your surgical oncologist.

  • Benefits from reconstruction may be more than cosmetic. A survey of more than 600 women post-lumpectomy found that women with pronounced breast asymmetry were far likelier to have depressive symptoms than those with less asymmetry.
  • Include timing in the discussion. Reconcstuction can start as early as having it done at the same time as a mastectomy. On the other hand, it can also be delayed. Delay may be advisable if surgery is to be followed up with radiation.

Also discuss whether the mastectomy will spare your nipple. Keeping the nipple might allow cancer to recur.(Nipples can also be reconstructed).

If you decide to have the surgery:

  • Learn how to prepare for going into the hospital.
  • Learn how to stay safe and be comfortable in the hospital. For instance, even in world class hospitals, it is helpful to have a family member or friend stay with you as much as possible to act as a patient advocate. While you're at it, Survivorship A to Z also has information on how to save money in a hospital and how to make your room feel more friendly.
  • If you are not insured, or will have to pay part of the bill yourself, the document about hospitals in "To Learn More" covers those subjects as well.

If you are going to have reconstruction:

  • Consider doing it at the same time as the breast removal. A second operation is likely to still be required to construct a nipple, but at least you won't wake up and see the breast gone.
  • Start thinking about who to use as plastic surgeon. Look for someone who is board certified with special training and experience in plastic surgery and breast reconstruction.Your breast surgeon likely has the best referral for you. It is important to your surgeon that you be satisfied with the combined results of your mastectomy and reconstruction. If the reconstruction will be at the same time as the surgery, the plastic surgeon has to be authorized to operate in the same hospital and to be available at the same time as your surgeon.

Your insurance likely covers reconstruction if it covers the mastectomy thanks to federal Women's Health and Cancer Rights Act and to the laws of many states offsite link.

To learn more about reconstruction, see the website of the American Cancer offsite link

NOTE: For a discussion of a mastectomy vs. a lumpectomy, see the section above.

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