Better Surgical Options for Breast Cancer Help Survivors Return to Normal

Strides in treatment for breast cancer in recent years have helped more women regain a sense of normalcy after facing down the disease. Over 90 percent of breast cancer patients will become survivors, who will in turn need to deal with the physical, emotional and psychological effects of losing confidence that one won’t be betrayed again by one’s own body.

Dawn Johnson Leonard, M.D., breast surgeon and medical director of the Herman & Walter Samuelson Breast Care Center at Northwest Hospital, helps women decide upon their best course of breast cancer treatment. Compared to the past, there is a stronger awareness among the medical community that breast reconstruction is a critical part of the recovery process. Leonard also explains that, in recent years, the standard of practice has become to stage breast procedures as much as possible to reduce the number of surgeries a woman must face to remove the cancerous cells and reconstruct the breast.

“If you live in or can travel to a community that has plastic surgery capabilities, you will have more options when it comes to breast surgery,” says Leonard. It is now common for a breast surgeon to operate alongside a reconstructive surgeon so that both procedures can be done under the same anesthesia session.

“What used to take four surgeries can now sometimes be accomplished in just two: one to remove the tumor and the first stage of breast reconstruction, and the other to perform the second stage of reconstruction,” she says. For women desiring a more natural-looking breast, sometimes a third, optional procedure to reconstruct the nipple is performed; and others have a nipple added by tattooing –- technically not a surgical procedure. Leonard also keeps cosmetic factors in mind when she operates to remove areas affected by cancer, making incisions in places where they will leave the smallest, least noticeable scars.

Thanks to the Internet, some of Leonard’s patients come in already educated about the latest treatments for breast cancer. However, their online learning can never replace the value of sitting down and meeting with their cancer doctors. Leonard says that some of her patient meetings to discuss surgical plans have lasted up to three hours.

“The standard of care is now to let women know what all their options are,” says Leonard. “However, not all surgical options will work for every woman. One of my patients wanted to treat her breast cancer with a lumpectomy, but because she already had had a lumpectomy plus full breast irradiation, she was ineligible for that kind of treatment,” she says, noting that patients cannot receive radiation in the same area twice. Other factors that may influence what specific breast reconstructive procedures are performed include a woman’s body size, her medical history, whether or not she smokes or has smoked, and previous abdominal or back surgery.

To learn about all their options and choose the form of treatment that is best for them, those who are facing a breast cancer diagnosis should meet, if possible, with a multidisciplinary team of cancer experts, including a medical oncologist, a radiation oncologist and a breast surgeon. In addition to meeting with patients one-on-one, Leonard lends her expertise to these multidisciplinary meetings at the Samuelson Breast Care Center.