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Surgery Services

Doctor in Scrubs Reading Notes

New Diagnosis of Breast Cancer

Having a new breast cancer diagnosis can be scary. The good news is that most cancers are currently diagnosed in early stages and highly curable. At least 8 world-wide randomized trials have documented mortality reduction for women who are regularly screened with mammography. Ideally, women should consider having annual mammograms at age 40, and in some cases even earlier if there is a family history of early age breast cancer. Cancers that are detected through screening mammography are generally smaller in size and have a better prognosis, often requiring lesser surgical procedures to manage and less intensive other treatments. Breast cancers are only rarely painful, and breast pain is more often indicative of a benign condition. Suspicious findings for cancer include a palpable mass or thickening, bloody or watery nipple discharge, prominent redness or thickening of the skin, or pulling in of the nipple or breast skin. If you have any of these symptoms or findings, it is advisable to get an evaluation.

Image by National Cancer Institute

Treatment for Breast Cancer

The treatment for breast cancer is multi-disciplinary, meaning that providers from different specialties give input regarding care: medical oncology, radiation oncology, physical therapy, and plastic surgery. Generally, this input is given during a weekly care conference called a Tumor Board. A very important principle of medical ethics affirms your right to determine your response to medical recommendations (patient autonomy). Although recommendations will be made, with consideration of options as well, the final decisions will be yours to make. No surgery or treatment is completely risk free, so an honest discussion of benefits and risks (informed consent) is standard prior to surgery or initiation of any treatment. You are always encouraged to seek a second opinion if you think that will help you make your best decision. Also, you are free to choose your cancer care providers (although Dr. Smith generally works with a selected team of providers).

Surgical Lights

Surgery for Breast Cancer

The surgical treatment for breast cancer frequently involves an outpatient procedure either removing the tumor as a lumpectomy, or for larger tumors, mastectomy. Targeted lymph node removal is also included in the surgery if there is invasive disease present. Reconstruction after mastectomy is always an option either with implants or tissue. This is a procedure that is performed by the plastic surgeon. If you ultimately need to have surgery, you will receive detailed pre-op and post-op instructions. We will discuss options for surgery locations. The incision(s) will be closed with dissolvable sutures, and care is generally straightforward. For mastectomy patients, there can be an overnight stay. We want your whole experience to be as smooth and easy as possible. You are encouraged to call immediately if you have any questions or concerned after surgery.

Preparing for your Appointment

Appointments typically last 30 minutes and can be in office or via tele-health:

  • Prior to your appointment, we request that you review the video link so that you understand the basics of genetic testing

  • Also, prior to your appointment, we request that you try to get an accurate cancer family history including cancer types and age of first diagnosis.

  • Most insurers will cover genetic testing with very little out of pocket for the patient. The lab does insurance pre-authorization. We recommend that each patient review billing details with the lab at the time of testing. Medicare will not typically pay for genetic testing unless the patient has a personal history of cancer. For patients who do not have insurance, the cost of testing is $250.

  • Results are typically available via a secure patient portal in 2-3 weeks.

  • For patients who have an identified genetic mutation, the lab provides a formal consultation with a certified genetic counselor, which is included in the cost of the testing.

  • Follow up appointment when results are back is included in the initial consultation fee. This follow up appointment is important for each patient so that a care plan can be established, including decisions related to testing for other family members.

HELPFUL LINKS

Risk assessment (PDF)

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Clinical Management tools for mutation carriers:

Gene Table

Medical management & guides


Patient Resources for mutation carriers:

facingourrisk.org

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