The choices after getting diagnosed with breast cancer can be overwhelming

One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.

You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the stereotactic biopsy on the spot, because it didn’t require outpatient surgery. If I had it to do over I would have chosen differently, but that’s a topic for another day. Your experience may be quite different; just be sure to ask about the pros and cons of each procedure.

Once breast cancer is confirmed, the choices start piling up. They vary depending on what type of cancer you have, your family history and your risk tolerance. You may find yourself on the borderline between radiation and chemotherapy, or between surgery and radiation like I was.

I had stage 0 ductal carcinoma in situ, which means the cancer was confined to the milk ducts and hadn’t become invasive (yet). The typical treatment course for DCIS is either breast-conserving surgery followed by radiation, or mastectomy.

I hoped to knock out the DCIS using breast-conserving surgery and radiation. But after two attempts didn’t get the clear surgical margins we hoped for, I decided to stop messing around and get the mastectomy. I opted for a single mastectomy although I know women who chose the bilateral. This is a highly personal choice and only you know what’s right for you.

Your next choices involve reconstructive surgery, with the first and biggest choice being whether you want it or not. I knew I wanted it, so I had to decide whether I wanted tissue transplant surgery or an implant to reconstruct the breast. I opted pretty quickly for an implant, which required choosing between saline and silicone implants. I preferred silicone but I know women who preferred saline, just as I know women who preferred tissue replacement.

The decision-making process doesn’t end there. You can leave the reconstructed breast as is, or you can have a nipple reconstructed and color tattooed in. I opted yes here as well but know women who decided not to take this last step.

And finally, since you may have lost symmetry, you may also choose to have the other breast worked on. I used to say mine resembled a bowling ball and bowling pin until I had the other one lifted so they’d match better. I had this done during the second-stage reconstruction on the mastectomized breast. I’m not sure what other countries do but in the United States, insurance has to pay for this additional cosmetic surgery if you’ve had breast cancer.

These choices can seem overwhelming so be sure to give yourself time to think. The key to making the right ones is to do what’s right for you and won’t keep you awake at night or second-guessing yourself down the road. I’ve never regretted any of my decisions and I wish the same for you.

Jackie Fox is the author of From Zero to Mastectomy: What I Learned And You Need to Know About Stage 0 Breast Cancer, and blogs at Dispatch From Second Base.

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  • Susan Alexander

    Amazing that our experiences are almost exact duplicates (I chose not to do the nipple) even to having the breast-conserving surgery done twice without clear margins before the mastectomy. I am grateful that the reconstruction options included the work on the healthy breast, too, as I would have been very uneven. It was a journey, but not really a bad journey because there was support at each step. Thanks for sharing your story.

    • jackiefox

      Thanks for your comment, Susan! It is interesting to hear the parallels and I’m glad to hear from someone else who had a positive experience. I’m not discounting anyone who wasn’t as lucky as we were, I know reconstruction doesn’t always go well but I’m pretty happy with the way mine turned out. That could be a result of being in my 50s and having the effects of gravity reversed, but all in all it went pretty well.

  • Michael A. Zadeh, MD

    Thanks for sharing that. I find that alot of patients aren’t given the full range of options when faced with such a life changing physical and emotional decision by their physician/surgeon. I provided the following as part of a brief guide for patients I come across who have been newly diagnosed with breast cancer. Perhaps it can be of some use to others in similar situations as yours.

  • Sri Vinati

    women should not succumb to the psychological depression after undergoing masectomy.Should not think about their beautiful figure but to think about their valuable life.You are the most valuable we don’t want to lose you..This is my message to the women who have undergone  masectomy.

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