Talking With Your Doctor About Mastectomy
A mastectomy removes part or all of a breast. Doctors most commonly perform a mastectomy to treat breast cancer. People at high risk of developing breast cancer may opt to have a preventive mastectomy. This includes people who have a certain gene mutation, such as a BRCA1 or BRCA2 mutation, or a strong family history of breast cancer.
Your doctor can tailor your treatment plan to your specific breast cancer or risk of developing it. But individualized care starts with a conversation. Here are topics to bring up with your doctor that will help him or her decide the best course of treatment—for you.
Prepare for Your Conversation
How do you get the most of the talk with your doctor? Start by following these suggestions:
Do some homework. Learn as much as you can about mastectomy before you talk to your doctor. The more you know, the more comfortable you will be talking about it.
Make a list. Write down your specific concerns and questions so you won’t forget what to ask or say.
Don’t go alone. Bring a friend or family member to your appointment. Having someone else there to listen and take notes can help you understand and remember what the doctor says. Also consider recording the conversation. It will let you to listen to your doctor's answers as many times as you need.
Don't hold back. Remember to speak up if you’re not clear about anything your doctor tells you. It might help if you repeat key points back to the doctor to make sure you understand the information.
Explore Your Surgery Options
It’s helpful to know some basic facts in preparation for your doctor visit. The type of mastectomy you can have depends on the stage and type of your breast cancer. The greater the spread of cancer cells, the more breast and nearby tissue your surgeon will remove. The types of mastectomy procedures include:
Partial mastectomy—also called a lumpectomy or segmental mastectomy—removes the cancerous breast tissue and a small area of normal breast tissue around it. This conserves as much breast tissue as possible.
Subcutaneous mastectomy—also called nipple-sparing mastectomy—removes all or most of the breast tissue under the skin. It leaves the nipple, areola, underarm lymph nodes, and chest muscle intact.
Simple mastectomy—also called total mastectomy—removes the entire breast. This includes the breast tissue, nipple, areola, and skin. It leaves the underarm lymph nodes and chest muscle intact.
Modified radical mastectomy removes the entire breast. This includes the breast tissue, nipple, areola, skin and the underarm lymph nodes.
Radical mastectomy is the most extensive mastectomy. It removes the entire breast, including breast tissue, nipple, areola, skin, underarm lymph nodes, and chest wall muscles under the breast.
Subcutaneous and simple mastectomies are common choices for preventive mastectomy. Ask your doctor why he or she thinks a certain surgery is right for you. Ask about the risks and benefits of the surgery your doctor is recommending.
Talk About Reconstruction
Breast reconstruction isn’t right for every woman. It’s a very personal decision that you shouldn’t rush to make.
Talk with your breast surgeon and a plastic surgeon about your reconstruction options. Ask how many surgeries will be necessary and whether reconstruction can be done at the same time as your mastectomy. You need to understand how long it will take to return to your activities and if your reconstruction will require muscles from other body parts. Some women experience weakness at the muscle donor site. Also, ask your doctor to put you in touch with other women who have and have not had reconstruction. Hearing their experiences can help.
Having a plan may help you feel better. This is true even if the plan is not having reconstruction at all. This option offers you the ability to have reconstruction in the future should you change your mind.
Find Out What to Expect
Finding out what to expect with a mastectomy can help you and your loved ones prepare. Your recovery and the time you spend in the hospital will depend on your surgery choices. Ask your doctor about the specifics. You should also ask your doctor about the emotional issues you may have. Many women find comfort in talking with therapists, support groups, and friends and family about life after a mastectomy. Your doctor can refer you to local resources.
Get a Second Opinion
A second opinion can give you additional options that you hadn’t considered or it can reinforce your current decision. It can increase your confidence in your treatment so you aren’t left wondering if you made the right decision. A good doctor understands the value of a second opinion and should encourage you to get one. Some insurance companies even require them. Your doctor can refer you to another breast surgeon or plastic surgeon to discuss your mastectomy and reconstruction options.