When someone is told they have been diagnosed with breast cancer, many thoughts go swirling around in their head. “Am I going to die?” This question is quickly followed by “what am I going to look like during and after my treatments?”
The (old) Halsted radical mastectomy was standard of care 50 years ago. As long as there are women alive today to tell the horror stories of what the 1970s’ breast surgery looked like, there will be women who fear breast cancer solely because of the fear this will be their surgical outcome. Granted, it did reduce mortality from 91% down to 6% for Dr. William Halsted’s patients who he performed it on, with the same results for those he surgically trained, but it remains a horrific image and story that is told.
Indeed, the procedure was quite disfiguring. It involved removal of the breast and much of the breast skin (up to the clavicle and down to below the bando elastic of her bra), both pectoralis major and minor muscles, and every lymph node (levels 1, 2 and 3) from the underarm. It guaranteed to develop lymphedema within a month, and patients would deal with serious disfigurement for a lifetime.
Therefore, it is important to discuss with your breast cancer patient upfront what her concerns are. This may include hair loss if she will be receiving chemotherapy, so make sure she gets fitted for a wig before she experiences hair loss so a facsimile can be provided to her. This way, only those she chooses to tell about the alopecia would likely know.
Weight gain is another issue. It is common for women to gain weight during chemotherapy and hormonal therapy. Power walking and steering clear of high fat/high calorie foods are smart approaches. She needs to tell family and friends who offer to bring meals to her to not bring cakes and pies and other items destined to land on her hips and never leave.
When it comes to surgery, don’t assume that she will be fine with her body image if she is having a lumpectomy. The cosmetic results will be impacted depending on the location of the scar, how much breast volume needs to be removed, and how her breasts currently look. She may look fine in a bra, but she needs to live with herself out of a bra, too. Photographs of before and after pictures of lumpectomies, mastectomies, and mastectomies with reconstruction are helpful. For those who need mastectomies and are not candidates for reconstruction, encourage her to think this way—“when you look down, don’t see that your breast is gone; see instead that the cancer is gone.”