10 Things You Should Do Before Undergoing Breast Cancer Surgery
1. Stay Calm
The diagnosis of breast cancer strikes most women like a “crisis”. However, you should resist the urge to treat it as an “emergency”. Having the cancer removed quickly may help your anxiety, but “rushing” to surgery will not improve your chances of surviving breast cancer or avoiding a recurrence. For the best possible outcome, it is critical that you learn about all of your treatment options before going to surgery so that you do not deprive yourself of treatment options or make hasty decisions that might compromise your outcome. It is completely safe to take a few weeks to figure things out.
2. Avoid multiple unnecessary operations
Nearly 1 out of every 3 women who undergo lumpectomy for breast cancer requires more than one operation to successfully treat her breast cancer when only one operation is usually all that is necessary. Here are the three most common reasons that patients undergoing multiple operations: 1) the surgeon was surprised to find cancer after removing a lump that was thought to be benign, 2) incomplete removal of the cancer at the first operation, and 3) failure to evaluate the lymph nodes at the first operation in a woman with breast cancer. While it is not always possible for the surgeon to be successful in the first operation, following this “10 Things Guide” will greatly increase the chances that your first breast operation will be successful.
3. Consider a Second Opinion
Choosing a surgeon to treat your breast cancer is among the most important decisions you will make in your fight against breast cancer. This decision will not only influence how you emotionally handle your cancer diagnosis, it will also greatly affect the kinds of treatments you are offered, the success of your breast cancer operation, and the kinds of side-effects you will deal with after breast cancer surgery. Even if you are happy with your current surgeon, obtaining a second opinion will make you a smarter consumer and reassure you that you are on the right path to recovery. Second opinions may also help you identify more effective or safer options that might have not been offered to you. Don’t be ashamed to ask for a second opinion. It is your right as a patient.
4. Insist on a Needle Biopsy Before Surgery
If you have a new breast lump, abnormal mammogram, or abnormal ultrasound, please resist the urge to have it removed as the first step to finding out what it is—even if your surgeon recommends removal as the first step. Instead of surgery at the first step, please insist on a needle biopsy first to allow a portion of the abnormality to be removed for a diagnosis. Finding out what the abnormality or lump is before having it surgically removed will greatly improve the chance of successful removal, reduce the chances of unnecessary surgery, and provide you the opportunity to fully consider your treatment options (e.g., lumpectomy, mastectomy, reconstruction, lymph node biopsy, second opinion, clinical trials) before you burn any bridges that can’t be crossed again. Commonly, the only difference between successful cancer surgery and unsuccessful cancer surgery is whether or not a needle biopsy was performed first.
5. Ask Your Surgeon To Obtain Wide Surgical Margins
While the idea of losing extra breast tissue might seem unsettling, it is essential that your surgeon remove a generous rim of normal tissue along with your cancer. We call this rim of normal tissue the surgical margin or safety margin. The safety margin is important because cancers are often larger than they appear on mammogram or ultrasound. So the surgeon must remove the cancer with a safety margin (surgical margin) to increase the chances of successful removal in case the cancer is larger than expected. Even small cancers can be a challenge to remove because they cannot be felt. To aid removal of small cancers, surgeons usually have localizing wires or needles temporarily inserted into the breast by the radiologist prior to surgery to mark the location of the cancer. Although many surgeons use only 1 localizing wire inserted right through the center of the tumor, ask your surgeon to consider using 2 wires (one on either side of the tumor) to ensure removal of your cancer along with a wide surgical margin. While placing multiple localizing wires prior to surgery might be an inconvenience to you, your surgeon, and to the radiologists, it is not nearly as inconvenient as having to return to surgery a second time because the cancer was not adequately removed.
6. Ask Your Surgeon if He/She Performs Oncoplastic Breast Surgery
Oncoplastic (On-Co-Plastic) Surgery is a relatively new approach to managing breast cancer. Practiced by only a few breast surgeons in the country, oncoplastic surgery combines advanced cancer removal principles, state of the art breast imaging, and plastic surgery techniques to enable removal of breast cancers with wider safety margins. This ensures more effective cancer removal, lowers the risk of recurrence, and preserves the shape and appearance of the affected breast. Oncoplastic surgery may also improve the appearance of your breasts by combining cancer removal with a reduction or lift of both breasts if your breasts are larger or low-hanging. On the other hand, if you have smaller breasts, oncoplastic surgery may allow you to undergo cancer removal with improved cosmetic results compared to the standard lumpectomy.
7. Ask Your Surgeon If He/She Uses the “Z11” Protocol
There have been many recent changes in the way that lymph nodes are handled during cancer surgery. For most of the last 100 years, women with cancer spread to their lymph nodes (called “positive” nodes) were all treated with axillary node dissection, a procedure in which up to 30 or 40 lymph nodes are removed. This procedure is typically associated with underarm pain, impaired arm movement, and permanent arm swelling (lymphedema) in many women. Fortunately, axillary node dissection is no longer necessary for most women with breast cancer treated with lumpectomy and radiation therapy. This change is the result of a recently published study called “ACOSOG Z11”, which showed that even women with “positive” lymph nodes may be safely managed with the sentinel node biopsy alone, a procedure in which typically only 1-4 lymph nodes are removed. To avoid unnecessary side effects of lymph node surgery, make sure your surgeon uses the “Z11” protocol. If he/she does not, find one who does.
8. Request Breast MRI of Both Breasts
Mammograms and ultrasound are the standard tools used to diagnose breast cancer and to plan surgery. However, it is also known that these studies commonly under-estimate the size of cancer, sometimes resulting in multiple operations for removal of previously unrecognized cancer. Breast MRI can greatly aid in the planning of surgery by identifying areas of cancer that might not be seen on the mammogram or ultrasound. Breast MRI might also identify cancer in your unaffected breast that might not be detected by the mammogram and ultrasound. By obtaining an MRI of both breasts prior to surgery, the surgeon is better able to plan your breast operation and improve the chances that you will undergo the right operation the first time.
9. Ask About Intraoperative Radiotherapy (IORT)
Currently, most patients who undergo lumpectomy receive daily radiation treatment to their entire breast for 3-6 weeks to lower the risk of cancer recurrence. However, newer technology enables the entire course of breast radiation treatment to be given in a single trip to the hospital, completely replacing the 3-6 week course of daily radiotherapy. This treatment may be given during surgery (intraoperatively) immediately following lumpectomy, or may be given as a single treatment in the office setting within a month after surgery. The effectiveness of IORT was proven in a large international study that showed IORT to be equally safe and equally effective as the 3-6 week course of radiotherapy. In addition to saving time, IORT also avoids the fatigue commonly associated with breast radiotherapy and allows more rapid return to normal activities.
10. Ask About Clinical Trials
Many patients hesitate to participate in clinical trials due to concerns about “experimentation”. However, the truth is that participants in clinical trials usually receive more comprehensive evaluation, more complete follow-up, and more attentive care than patients who do not participate in clinical trials. Clinical trial participants are also the first to access newer treatments that are aimed at increasing the effectiveness and safety of cancer treatments. Regardless of whether your breast cancer is an early stage or late stage cancer, you might be able to participate in a clinical trial involving surgery, radiation, chemotherapy, or other aspects of care. Ask your doctors about clinical trials to find out if he or she has a clinical trial that’s right for you.