Breast Cancer Risk Factors

What is a Risk Factor?

A breast cancer diagnosis can seemingly come out of nowhere for many patients. However, many things that could have made this diagnosis (or any potential diagnosis) far more likely for some patients than others. These little details in lives are known as risk factors. Some factors are a part of your lifestyle and can be controlled in your day to day life. Others are beyond a given person’s control, like things built into the DNA. It’s important to note that none of these factors will cause breast cancer. Any one of these risk factors is not a cause for breast cancer. They will only bring about higher risk.

Risk Factors You Can Affect

  • Taking hormones–Some forms of hormone replacement therapy (HRT), including estrogen and progesterone, in menopause can increase the breast cancer risk.
  • Using oral contraceptives–Some birth control pills have been found to raise breast cancer risk.
  • Reproductive history–A few factors relating to childbirth can vary your risk level. Having your first pregnancy after the age of 30, not having children, never having a full-term pregnancy, or not breastfeeding can increasing your breast cancer risk.
  • Being physically active–Women who are more active will decrease their risk of getting breast cancer.
  • Being overweight after menopause–Older women with obesity have an increased risk as opposed to those at a healthier weight.
  • Alcohol–The more alcohol someone drinks, the higher the risk of breast cancer. For example, a woman who has 2-3 alcoholic drinks a day will have a 20% higher risk than a woman who does not drink.
  • Diet–There is some debate about what diets increase or decrease the risk of breast cancer. However, a healthy diet with plenty of fruits and vegetables and minimizing animal fats has many health benefits.
  • Smoking–Smoking can increase a person’s risk of breast cancer.
  • Night shift/light at night–Routinely working night shifts can bring about a higher risk of breast cancer, possibly due to light exposure at night.

Risk Factors You Cannot Affect

  • Sex–A woman is far more likely to get breast cancer than a man due to the increased exposure to estrogen and progesterone. Because these are the hormones used in hormone replacement therapy for transgender women, this increased risk includes them. While men can certainly get breast cancer, the risk is not as high.
  • Race–White and black women are most likely to develop breast cancer. Black women tend to have the highest risk before 45 and are more likely to die from the disease.
  • Ashkenazi Jewish heritage–Jewish women also have a higher risk of breast cancer, likely due to a high occurrence of the BRCA1 and BRCA2 gene mutations in those of Ashkenazi Jewish descent.
  • Inherited genes–Several genes that can act as risk factors for breast cancer.
    • BRCA1 and BRCA2
    • ATM
    • BARD1
    • BRIP1
    • CDH1
    • CHEK2
    • NBN
    • NF1
    • PALB2
    • PTEN
    • RAD51C and RAD51D
    • STK11
    • TP53
  • Age–As you get older, your risk of breast cancer increases. Most diagnoses occur after the age of 50, and by the time a person is 60, the risk of breast cancer is 1 in 29.
    Breast History–If someone has previously been diagnosed with breast cancer or another breast disease like lobular carcinoma in situ or atypical hyperplasia, they have a much higher risk of breast cancer in the future.
  • Family History–Women who have a family history of breast cancer, especially when it is a first-degree relative (mother, sister, daughter) previously diagnosed. The risk of breast cancer also increases with multiple family members diagnosed, and a family history of ovarian cancer can also indicate an increased risk.
  • Radiation Exposure–Previous exposure to ionizing radiation in the chest area is a risk factor for breast cancer. Radiation is often used for treating Hodgkin’s disease. The risk is greater if the radiation was applied as a child.
  • Age at First Period–Starting menstruation early, before ages 11 or 12, can raise the breast cancer risk factor by bout 15-20% over those who started to get their periods at 15 or older. This is due to more prolonged exposure to estrogen and progesterone, which, as mentioned above, increases risk.
  • Age Starting Menopause–Women who start menopause after 55 have an increased risk of breast cancer by approximately 40% compared to those who start at age 45 or younger. Like with the earlier start of menstruation, this is due to more prolonged exposure to progesterone and estrogen.
  • Breast Density–Breast density comes from having more connective tissue than fatty tissue. This denser tissue can make it very difficult to read a mammogram accurately, sometimes increasing the risk of missing a potential diagnosis. Breast density can come from high estrogen levels, indicative of a risk factor rather than one on its own.
  • History of Diethylstilbestrol (DES)–DES was a drug given to some pregnant woman between the 1940s-1950s to prevent miscarriage. Those women and those whose mothers took it all have a high risk of breast cancer.
  • Birth Weight–Women born with a higher birth weight have an increased risk of breast cancer, particularly before menopause.
  • Blood Androgen–Androgens are hormones important to sexual development (including testosterone). An increased amount of androgens in a woman’s blood can increase her breast cancer risk.
  • Bone Density–High bone density can be a breast cancer risk factor. Someone with high bone density can have up to 60-80% higher risk than those with lower density.

Reducing Risk

  • Breast Cancer Screening–Go for regular breast screening to keep an eye on your breast health. For most, a mammogram is sufficient for checking breast health. A Breast MRI (Magnetic Resonance Imaging) may be better for those of higher risk. Speak with your doctor to establish the best course of action for the frequency and type of screening for you.
  •  Breast Self-Exam–Monthly, you should check your own breast health. While it won’t necessarily catch every sign of breast cancer, it can find many, and it is an excellent way to keep yourself familiar with your breasts. By checking your breasts’ appearance, feel, and textures regularly, you will be more likely to notice any changes should they come. If anything does change, bring it to the attention of your doctor.
  • Breast Feeding–Breastfeeding can help reduce the risk of breast cancer, particularly in those pre-menopause.
  • Lifestyle Changes–As mentioned above, some breast cancer risk factors that can be reduced through your own lifestyle choices. By doing what you can to handle these risk factors, such as alcohol intake and physical activity, one can reduce their risk of breast cancer by a great deal while also keeping themself healthy in general.

Speak With Your Doctor

If you are ever concerned about your risk of breast cancer, you can speak with your doctor. While some risk factors are easy to determine for yourself, some must be tested for–blood androgen levels, inherited genes, etc.–which your doctor can help you get access to and understand. Once you and your doctor are familiar with your breast cancer risk level, you can set up a plan for your next steps. These will include recommendations for breast cancer screening–how often and what type–as well as possible medical preventative steps if your risk of breast cancer is high enough.

Dr. Gorman at Texas Breast Cancer is always available to help with any questions about breast cancer risk, preventative steps, and the process should a breast cancer diagnosis be given. She is an advocate for the informed patient, always providing her patients and those who could potentially become patients with the information they need.

If you have any questions about breast cancer or breast cancer risk factors, please feel free to contact Dr. Gorman or her team at Texas Breast Cancer.

 


Breast Cancer Recurrence: What and Why?

When breast cancer comes backs, it is called recurrence. While those who have a recurrence are not in the majority, they are certainly not a rarity or an impossibility. Recurrences typically happen within the first five years after treatment but can occur at any time and have a few ways of returning. To help ease some of the worries of these first few cancer-free years, we want to give some clarity and explanation into what breast cancer recurrence is and what to look for.

Causes

Breast cancer recurrence occurs when cells from your original breast cancer manage to escape being treated and begin growing again. This process can sometimes take years. The cancer cells will lay dormant until something kick starts them into growing again.

Risks

Many of the recurrence risk factors are determined by the original tumor and cancer, though the patient determines some. These risk factors include:

  • A large tumor–A larger tumor increases the risk of cells being left behind.
  • Close or positive tumor margins–During surgery, when the surgeon removes the cancer, they will remove a small amount of healthy tissue around it. The tissue is then examined with a microscope. If it is clear of cancer, the margin is considered negative. However, if there are any cells left (considered a positive margin), risk or recurrence increases.
  • Lymph node infection–The risk of recurrence increases if cancer was found in lymph nodes at your original diagnosis.
  • No radiation treatment post-surgery–While most who undergo a lumpectomy choose to receive radiation therapy in the area of cancer afterward to reduce the risk of recurrence, some do not.
  • Inflammatory breast cancer–This type of breast cancer increases the risk of a local recurrence.
  • Specific cancer cell characteristics–Having triple-negative breast cancer or cancer resistant to hormone therapy can increase your risk.
  • No endocrine therapy–For certain types of breast cancer, not receiving endocrine therapy can raise the risk of recurrence in cancer patients.
  • Younger age–Those of a younger age during their initial breast cancer diagnosis, specifically under 35, have a higher risk of their cancer returning, despite generally older generally being a risk factor of cancer in general.
  • Obesity–Increased body mass index increases the risk of breast cancer coming back.

Prevention

There are methods and steps you can take to reduce your risk of recurrence of breast cancer, many in your initial treatment.

  • Chemotherapy–Those with an increased chance of recurrent breast cancer have been shown to have a decreased risk when treated with chemo.
  • Hormone therapy–If you have receptor-positive breast cancer, taking hormone therapy in your initial treatment can reduce your risk. This treatment method can sometimes continue for five or more years.
  • Targeted therapy–If your cancer produced additional HER2 proteins, targeted drug and treatment might reduce your risk.
  • Radiation therapy–A previous breast cancer patient with a large tumor, a breast-sparing operation, or inflammatory cancer would have reduced risk if treated with radiation treatment.
  • Bone-Building–Bone building medications can reduce the risk of recurrence taking place in bones, otherwise known as bone metastasis, for those with a high risk.
  • Healthy Diet–To decrease your risk of breast cancer recurrence, be sure to include plenty of fruits, vegetables, and whole grains in your diet, as well as limiting alcohol to one drink a day.
  • Exercising–Exercising regularly may help reduce your risk.

Kinds of Recurrence

Recurrent breast cancer can take one of three forms, defined by where it appears in reference to the primary cancer and treatment. The three types are local, regional, and distant recurrence.

Local

A local recurrence occurs when cancer cells grow in the same area as your previous cancer. If a lumpectomy was used for treatment (rather than a full mastectomy), cancer might start to regrow in the breast tissue that remains. If a complete mastectomy were performed, the tissue along the skin or chest wall would hold the recurring breast cancer.

Some signs that local recurrence is occurring are:

  • One or more painless lumps, nodules, or irregular areas of firmness under the skin
  • Newly thickened areas along mastectomy scars
  • Changes to the skin (inflammation, redness, changes in texture)
  • Nipple discharge

Many of the signs of a local recurrence are similar to those of initial breast cancer. After treatment, it does not hurt and may help to continue self-breast exams to keep an eye out for any changes, just in case.

Regional

Regional recurrence also happens rather close to the original site of infection. However, the difference between regional and local recurrence is a matter of lymph nodes. In regional recurrence, the local lymph nodes, such as those under the arm, will be infected with cancer.

Signs of regional recurrence cancer may include a lump or swelling in lymph nodes, so continue your self-checks in these areas:

  • Under the arm
  • Along the neck
  • Near and in the groove above the collarbone

This kind of recurrent breast cancer can almost be considered a subset of local recurrence and can many times be found by being familiar with your own body. Regular self-breast checks are just as necessary after breast cancer treatments as they are before.

Distant

Distant recurrence is when cancer recurred somewhere in the body away from the original site. This can include other organs such as the lungs or even bones. In this case, the patient is generally treated much in the same way as those diagnosed with stage IV breast cancer. However, treatment can vary from standard stage IV treatment based on the responses to previous treatments.

Treatment

Treatment, many times, is determined by the kind of breast cancer recurrence found. Local will be treated differently from regional will be treated differently from different.

Local Treatment

Local breast cancer recurrence is, if possible, treated with surgical treatment. If a lumpectomy and radiation were used previously, then a mastectomy would be the first choice treatment. If a mastectomy was performed prior, the tumor would be removed, and the patient will be treated with radiation therapy if not already received.

Either way, both of these plans are likely to be accompanied by chemotherapy, targeted therapy, hormone therapy, or some combination to ensure a full recovery.

Regional Treatment

Sometimes breast cancer will come back in the lymph nodes. This can be treated by removing the lymph nodes themselves, followed by radiation in the surrounding area, if not already received. Systemic (targeted, hormone, or chemotherapy) treatment after surgery may be discussed on a case-by-case basis to ensure that any remaining cancer cells are eliminated.

Distant Treatment

The primary treatment for distant recurrent breast cancer will be a form of system treatment (hormone, targeted, or chemotherapy) based on how your cancer has responded before. You and your doctor can create a treatment plan that serves you well, knowing what has worked with these breast cancer cells previously and what has not.

Dr. Gorman

Dr. Valerie Gorman and the Texas Breast Center are aware of the risks of recurrent breast cancer and the chances that your breast cancer may come back. This is why she and her team stay with you through your personalized treatment and long after to make sure you know that you always have a support system, whether you need it or not.

Dr. Gorman specializes in surgical oncology and surgical diseases of the breast. She serves as the Medical Director of Surgical Services at Baylor Scott & White Medical Center as well as the Chief of Surgery.


Breast Density FAQs

After a mammogram, some women find out they have dense breasts. They come to me with questions about what that means, how it affects their risk for breast cancer, and what they should do differently. Here’s how I answer the questions I hear most often.

 

What does it mean to have dense breasts?

It’s common for women to have dense breasts. Your breasts are made of fatty tissue, which is not dense, and supportive tissue, milk glands, and milk ducts, which is. The parts of your breast made up of dense tissue show up as white on a mammogram, so it can be harder to spot signs of breast cancer in those areas.

 

How do I know if I have dense breasts?

The radiologist who reviews your mammogram assigns a grade to your breast density based on how much of your breast tissue is dense. You might see something on your mammogram report called Breast Imaging Reporting and Data System (BI-RADS). There are four levels of breast density:

  • A is almost all fatty tissue, found in about 10 percent of women
  • B is more nondense than dense, found in about 40 percent of women
  • C is more dense than nondense, found in about 40 percent of women
  • D is almost all dense, found in about 10 percent of women

If you fall into the C or D categories, your mammogram report may indicate that you have dense breasts. If it doesn’t say, ask your doctor.

As you can see, about half of all women have dense breasts. You’re more likely to have dense breasts if you are younger, have less body fat, and/or take hormone therapy for menopause.

 

How does my breast density affect my risk for breast cancer?

Since it’s harder to spot breast cancer on dense breasts, you have a higher chance of cancer not being detected on a mammogram. Separately from that, women with dense breasts also have a higher risk of breast cancer.

 

What should I do differently if I have dense breasts?

You should talk to your doctor about your other risk factors for breast cancer and work together to come up with a breast cancer screening schedule that works for you. For my patients with dense breasts but no additional risk for breast cancer, I recommend an annual mammogram beginning at age 40. Depending on other risk factors for breast cancer, I might also recommend:

  • A breast MRI, which uses magnetic forces to image your breast
  • A 3D mammogram, which combines images of your breast taken from different angles
  • Breast ultrasound, which uses sound waves to investigate areas of your breast that might be concerning
  • Molecular breast imaging, which uses a radioactive tracer to look for cancerous areas

The Cost of Breast Cancer Treatment: What are the Contributing Factors?

In a recent survey of patients diagnosed with early-stage breast cancer, 38% said they were worried about finances due to their treatment. 14% said that their breast cancer cost them at least 10% of their household income. 17% said that they had spent even more than that 10% on out-of-pocket medical expenses.

When doctors, surgeons, and radiation oncologists were asked about how their offices handle financial discussions with their patients, 50% of medical oncologists reported that someone in their practice “often or always discusses financial burden” with their patients. 43% of radiation oncologists said they did as well. Only 16% of surgeons reported the same.

Furthermore, no one seems to know, going in, just how far a diagnosis of breast cancer is going to set them back financially. It is difficult to find answers about the cost of treatment, whether for surgery, radiation, or other medications. We are taking this chance to clear the air between doctors and patients; we can give the answers that so many have been looking for and help to start the conversation so you can be prepared should this diagnosis ever come your way.

Total Costs

In 2010, breast cancer was the highest-costing cancer in the United States. Nationwide, it cost a total of $16.5 billion. By 2020, this is expected to increase to $20.5 billion. The American Cancer Society estimates that over $180 billion is spent on health care expenses and lost productivity every year due to cancer.

Of course, each person’s case is unique. Their access to insurance must be taken into consideration. Different stages of cancer are harder to treat than others, which can affect overall treatment costs. Not to mention that disease takes root differently in each person, so it must be treated differently. And with no one-size-fits-all treatment, there is no one-size-fits-all price tag. All of these factors must be considered.

Stages

The stage at which a patient’s breast cancer is discovered significantly affects how difficult it is to treat. A study was done recently and published in The American Health and Drug Benefits1 on the cost and frequency of some treatments based on the cancer stage and how long it had been since the diagnosis.

It was not much of a surprise to find that those patients with more advanced stages of breast cancer spent more on treatments. For those with stage 0 cancer, the average cost of treatment at twelve months after diagnosis was $60, 637. After twenty-four months, the price had jumped to $71, 909 per patient overall.

For those whose cancer had advanced to stages I-II, their medical costs were approximately $82,121 in the first twelve months of treatment. In the second twelve months, each patient still in the study brought the total average to $97, 066.

With breast cancer in stage III, the average cost in the first twelve months continued to rise to $129,387. After a full twenty-four months, the study reported that patients spent an average of $159,442.

At stage IV, the most difficult to treat, the average treatment costs were $134,682 at twelve months and $182,655 at twenty-four.

According to the study, patients were paying an average of $85,772 within the first twelve months of being diagnosed with breast cancer, despite their cancer stage. And within the first two years of their diagnosis, the study reported their treatment costs averaging $103,735.

Treatments

Another major factor that will contribute to the overall cost of breast cancer treatment is the kind of treatment a patient is receiving. Which treatment you receive depends on the location, cancer stage, and extent to which the disease has spread. Sometimes the procedures are combined to get the best results and return you to health quicker and more effectively. The same study mentioned above also explored the average amount spent on categories of treatments, and how common these kinds of treatments were within the given periods.

Surgery

Surgery is a standard treatment for a breast cancer diagnosis. If applicable, it is a way to remove cancer physically from where it has taken root. Altogether, surgical treatment accounts for an average of 20% of the cost of breast cancer care treatments within the first year after diagnosis, and 4% in the second year.

  • Inpatient breast cancer surgery accounts for 6% of the cost treatment in the first year, and 2% in the second year. In the first year of treatment, the cost of breast cancer surgery is, on average, $4,762, while in the second year after diagnosis, the cost is approximately $347.
  • Outpatient breast cancer surgery accounts for approximately 14% of the price of breast cancer treatment in the first twelve months, and 2% in the second. The cost of outpatient surgery in the first and second years were found to be, on average, $11,691 and $389 respectively.

Chemotherapy

Chemotherapy is another well-known treatment of cancer. It accounts for approximately 19% of breast cancer treatment in both the first and second year after diagnosis.

  • For general chemotherapy, the average cost (including all costs on the day of the treatment) in the first year is $15,113. As this accounts for 18% of the payment for treatment for breast cancer, this is particularly significant. In the second year post-diagnosis, the average cost for this treatment is $3,625. This makes up 16% of all breast cancer treatment costs.
  • Oral chemotherapy is far less conventional. It only accounts for approximately 1% of the costs of first-year treatment, and 3% in the second year. Patients are usually paying $432 in their first year and $636 in their second year for this treatment.

Radiation

Radiation is used to kill the tumors by damaging cancer cells’ DNA. It is often used in combination with surgery. It makes up 18% of diagnosis treatment costs in the first year and 3% in the second year. In the first year, it costs an average of $15,455, while in the second year, patients pay $638.

Medication

Hand in hand with these major treatments come medications. Medications make up for 3% of the first year’s medical payments, and 7% of the second year. That equates to approximately $2,258 and $1,510 respectively.

Other Treatments

There are, of course, other treatments. Smaller subcategories that don’t quite fit these above, including hormone therapy, additional inpatient or outpatient care, or professional or specialist care. They make up about 42% of potential treatment costs in the first year and 67% of costs in the second year. That equates to $35,762 in the first twelve months and $14,980 in the second.

Health Insurance

Another factor that contributes to the overall cost of breast cancer treatment is health insurance. Healthcare, the amount of coverage you have, and the type of coverage you have, are all essential to discuss with your doctor, oncologist, and surgical team to make sure you understand where you stand.

Researchers in North Carolina found that patients who received a cancer diagnosis and did not have insurance or Medicare paid $6,711 for medication, while those with insurance paid $3,616 and those with Medicare paid $3,090 simply because they do not have the means to negotiate for a lower price.

Often, clinical appointments are more costly, as well. Where an insured patient might pay approximately $65-246, a patient without insurance coverage would pay around $129-391.

Ask Questions/Dr. Gorman

Getting a diagnosis of breast cancer is near impossible to imagine, and even harder to plan for. But if you ever find yourself in that place, you have a little more knowledge about what to expect. One should always be prepared for the unexpected, and it never hurts to have a little money saved up for emergencies. But breast cancer treatment costs will require more than just a bit of your savings. However, with communication with your team and laying out your healthcare terms and concerns as you discuss your health plan, everyone can be on the same page and do what they can to work within your needs.

Dr. Valerie Gorman knows about the financial burden that comes with breast cancer. She is dedicated to offering her patients a personalized approach to breast surgery and the treatment of breast cancer. She and her team will help to create a treatment plan that best meets your needs, and most fits your lifestyle. Because of the experience and breadth of our specialists, a multitude of treatment options exists which can be tailored to your situation.

There is no need to panic when you hear the word cancer. We have walked alongside many people who have been diagnosed and understand your fears and concerns. It is our privilege to walk with you and help you through this difficult process.

 

 

 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/#idm139828318640480title

 

 


FAQs About Mastectomy

What are the types of mastectomy?

 

  • Simple/Total Mastectomy–The entire breast is removed; lymph nodes and muscle are not removed.
  • Radical Mastectomy–The entire breast is removed, this time including the pectoral muscles and lymph nodes extending under the arm. This is rarely done today.
  • Modified Radical Mastectomy–Removes the entire breast including the lymph nodes;
  • Double Mastectomy–Both breasts are removed.
  • Lumpectomy/Partial Mastectomy–Part of the breast is removed, namely abnormal tissue or cancer, rather than the whole breast, just removing the lump.
  • Nipple-Sparing Mastectomy–The breast tissue is removed, but the nipple and skin are left unscathed.
  • Skin-Sparing Mastectomy–The skin is left intact while the breast tissue, areola, and nipple are removed.

 

Mastectomies are recommended for those who have large tumors or tumors that affect multiple areas of the breast. They can also be used as a preventative measure for those who carry the BRCA1 or BRCA2 gene or other genetic mutations that increase your risk of breast cancer. The skin- and nipple-sparing mastectomies are newer surgeries. These are optimal for minimal scarring and reconstruction.

What is recovery like for a mastectomy?

Your stay in the hospital after a mastectomy will vary depending on the kind of mastectomy you had, your reactions to the anesthesia, and whether or not you had reconstruction done at the time. However, it can be guaranteed that after surgery, you will be taken to a recovery room until the nurses are sure you are stable and (mostly) alert. At this point, you will be wheeled along to your hospital room where you will stay approximately 1-2 days.

Then, once you are home, you must keep the incisions clean. Your surgeon will give you instructions on how to do so, as well as how to care for your drainage tube, which you will only have with you until your follow up exam.

Your doctor should prescribe you medication for your pain, though the levels vary depending on the location, type of mastectomy, and amount of tissue taken. Follow your doctor’s instructions for approved medication intake.

It usually only takes a few weeks to be back to normal activities, though anything that uses your arms a lot or seems strenuous to your body should be approached cautiously for a while. If you’re ever unsure, you can always check with your doctor. It’s better to be safe than sorry. But soon enough you’ll be back on your feet and facing the world again.

What are mastectomy recovery tools?

While you are recovering, there will be many things you will have directly on your mind. There will be drains to empty and keep untangled, pain medications and antibiotics to keep track of, what will be waiting at home after your stay in the hospital, and your life at large to consider. But there are some tools to help you stay comfortable while you heal. And some people have been patients before you. They have tips to recommend based on their experience.

Some tools that many find helpful are drain belts or robes and mastectomy pillows. There are variations on both of these tools, but both offer support and work to simplify your recovery.

After the mastectomy, drains are left in the area to allow any access fluid to leave the body rather than pooling. The fluid follows a tube to a bulb that you empty regularly and record the amount in them. However, the tubes can quickly become an inconvenience with a risk of snagging. The easiest solution is to attach the drains to your clothes with the velcro attachment or clip them onto a lanyard. But other people have come up with more comfortable and convenient solutions. There are now drain belts, which are comfortable belts with holster-like pockets in which the bulbs can sit. There are drain robes that have pockets to keep the drains out of your way. And some companies produce adhesive pockets that will attach to whatever clothes you wear, making your pajamas into drain holders. Dr. Gorman’s surgical team will provide a bra for you post-operatively that includes rings to which you can attach your drains.

Mastectomy pillows are pillows that are shaped or placed in a way to help support you after your surgery. This can be anything from a regular pillow that is placed under your knees to raise your legs and increase blood flow to the armpit pillow–a rectangular pillow that lays over your chest with notches cut out for your arms. Some provide support for both breasts, while others go between the breast tissue of one breast and the other. Find the pillow that minimizes pain and discomfort and offers the support and comfort you will need. Volunteers in our community sew rectangular post-op pillows for Dr. Gorman’s patients. Each of Dr. Gorman’s patients receives one of these pillows in recovery immediately after surgery.

Previous breast cancer patients have made suggestions to make your recovery as easy as possible. First, stock up on food—at least two weeks’ worth–before your surgery. You will not want to go shopping while you are healing. And while you may not want to eat right away, you should try to find something light on the stomach so you can take it with your pain medication, such as yogurt or pudding.

When you take your first shower about two days after your surgery—or when Dr. Gorman clears you to do so—it’s generally best to do so sitting in a shower chair. You have been off of your feet and on medication since your mastectomy. It’s safest to sit while you clean yourself off.

Avoid housework. Think of this as an excuse to avoid your chores for as long as you can. You need to heal before you start expending that kind of effort. Similarly, don’t try to rush back to work. Many women recommend waiting at least three weeks before returning to your job. Returning too quickly could not only tire you out but could potentially cause complications. This advice is especially relevant to those who have reconstruction surgery, as well.

Dr. Gorman’s team provides a one-on-one education time for each patient that covers all of this information and more prior to a mastectomy.

What will my mastectomy scars look like?

The type or amount of scarring will differ based on the type of mastectomy you are having done. The total, radical, and modified radical mastectomies will leave a visibly large scar as a large amount of tissue/skin is removed. However, with partial/lumpectomies, skin-sparing, and nipple-sparing mastectomies, the scars are less noticeable. Skin-sparing mastectomies tend to leave behind a scar that is usually where the nipple was previously. The scar of the lumpectomy is small and linear and tends to be hidden away in the crease or around the nipple to avoid detection. Lastly, the nipple-sparing mastectomy generally leaves a scar under the breast, where it can be tucked away in the bra-line to avoid visibility.

The Texas Breast Center utilizes Hidden Scar™ Breast Cancer Surgery to help minimalize scarring in patients. Dr. Gorman works with each patient to make the right decision for them on the right kind of mastectomy, and from there to ensure the scarring will be minimal and where it will as minimally intrusive as possible.

How does breast reconstruction work?

Not everyone has breast reconstruction after a mastectomy. For example, those having lumpectomies do not necessarily need one, because a majority of the breast tissue is left alone in the breast. With a mastectomy, reconstruction is more likely as all the tissue was removed. However, it really is up to the patient. Talk to your surgeon about your preferences so that they can be informed when discussing your options with you

What are the risks of a mastectomy?

A mastectomy, like any other surgery, has its risks. There will be swelling in the area, as well as bruising for a while after the surgery. The breast will be sore and scar tissue will form and likely harden. Some patients experience phantom pain in removed breasts. More seriously, however, the incisions could bleed or become infected, or, more rarely, skin necrosis. There is a risk of lymphedema or swelling in the arm where lymph nodes were removed. Seromas (fluid filling the now-empty breast) can form. And not the least of the risks can be a change in self-confidence.

Dr. Gorman is aware of these risks and is there to help prevent them. If they can’t be avoided, she will support you through them and work with you on a plan to improve, step by step.

Should I have radiation or chemo with my mastectomy?

Chemotherapy is not used in all cases of breast cancer. And, if it is used, it is not always used in the same way. There are two primary ways it is used concerning surgery.

Some kinds of chemotherapy–neoadjuvant chemotherapy–is used before surgery as an attempt to shrink the tumor to a more manageable size that requires less extensive surgery. Adjuvant chemotherapy is given after surgery to kill any possible remaining circulating cells that may have been left behind to prevent more tumor growth.

Radiation is often recommended after a mastectomy as a tool to prevent the recurrence of cancerous growth. Traditionally, radiation is administered for five to six weeks, up to five days a week. However, Dr. Gorman has experience with a method that only takes five days, with less waiting period between surgery and the radiation beginning for post-lumpectomy patients.

Can men get a mastectomy?

Breast cancer in men may be rare, but it is still very possible. Only 1% of breast cancer diagnoses are in men, but that still accounts for 1 in every 1,000 men. Invasive Ductal Carcinoma is the most common form of breast cancer found in men. Like in women, black men have a higher risk of getting breast cancer than those of other races. Take precautions and familiarize yourself with the breast area by firmly feeling over the breast tissue in the area for anything unusual.

If a man receives a diagnosis for breast cancer, there is a high chance surgery will be involved in treatment. The operation could be used to establish how far into the lymph nodes the cancer has spread (a sentinel lymph node biopsy, for example), to relieve symptoms of advanced cancer, or to remove as much of the tumor itself as possible (a mastectomy).

All of these and a few more can be performed on a man to help treat him for breast cancer. It is not just women who get this disease, and today’s treatments reflect that.

How do I take blood pressure after a mastectomy?

There is some question about where to have blood pressure taken and blood drawn from post-mastectomy; more specifically, patients ask whether it is safe to do these things on the same side of the body as the mastectomy. While you can have your blood pressure tested from either arm without causing any trouble to your healing process, there could be a (minimal) risk when it comes to drawing blood after breast cancer surgery.

After certain types of mastectomies–radical mastectomy, modified radical mastectomy, sentinel lymph biopsy, or any procedure when the lymph nodes are removed–there is a risk of lymphedema. Lymphedema is a swelling of the arm and usually stems from an infection of the arm. Because having blood drawn in a medical facility is done in a clinical environment with sterile equipment, the already small risk of infection becomes minimal. However, it is still recommended to take the ‘better safe than sorry’ route and instead have your blood drawn from the arm opposite your operation.

The same goes for vaccines and other injections. While the medication won’t cause any complications, it’s best to reduce the chances of introducing possible infections to the area soon after your breast surgery or years later.

What do I ask my surgeon?

You should always prepare a few questions when going into a procedure like this. Likely, a number of them will get answered simply through the surgeon’s explanation of the process, but it never hurts to be prepared. Here a few to get you started:

 

  • What are the risks of my type of mastectomy?
  • Will I need reconstruction? Can it be done in the same procedure?
  • How can I prepare my home for my recovery before the procedure?
  • How can I emotionally prepare for this?
  • What medicines/foods should I or shouldn’t I take on the day of the procedure?
  • Who will perform my breast reconstruction surgery?
  • How much breast tissue will be removed in my mastectomy?
  • Will I need radiation therapy?
  • How long will I stay in the hospital?
  • Will I need to return for additional surgery?

And remember, there really are no stupid questions. None. This is your surgery, you deserve to know about it, and Dr. Gorman is here to help you understand. Ask away and she will do her best to answer. She will help with your before questions, your after questions, and your it’s-been-a-while-but-this-just-occurred-to-me questions. Being informed is something she wants for all of her patients, and something she will do her best to ensure as she walks with you every step of the way.

Who performs a mastectomy?

A breast cancer surgeon will perform your mastectomy, and a plastic surgeon will perform your breast reconstruction should you have that done. When choosing your surgeon, Johns Hopkins recommends a surgeon who:

  • Specializes in breast cancer
  • Is recognized as a breast surgical oncologist
  • Performs many breast cancer surgeries each year

 

Looking at these qualifications, Dr. Valerie Gorman at the Texas Breast Center can be your breast cancer surgeon, and of course, is always ready to help. Her specialty is breast cancer surgery and its related topics. Her residency was in general surgery, though with a focus on detecting and treating breast cancer. She is also currently serving as the Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center, as well as board-certified by the American Board of Surgery.

At the Texas Breast Center, mastectomies and other breast cancer surgeries are what Dr. Gorman is known for, and she performs them year-round.