5 questions to ask a breast cancer surgeon

If you’ve been diagnosed with breast cancer, surgery will likely be a primary part of your treatment. You’ll want to choose a surgeon and cancer center with the tools and expertise to deliver the best outcomes for your survival — and your quality of life for years to come. Breast surgeon Jessica Young, MD, of Roswell Park Comprehensive Cancer Center explains the key points you should discuss with a surgeon before deciding where to have your cancer treatment.

1. What breast-conserving options do you perform?

Larger, more radical surgeries do not mean greater survival, don’t determine whether you need chemotherapy, and can greatly impact your quality of life. “We seek to provide tailored options for each patient and may be able to de-escalate or decrease the amount of surgery needed — and still maximize survival,” says Dr. Young. Options go beyond lumpectomy (removing just the tumor) and mastectomy (removing the entire breast). “We offer several breast-conserving options that aim to retain as much healthy breast tissue as possible, including partial mastectomy as well as nipple-sparing and skin-sparing procedures that can enhance breast reconstruction if a patient chooses. We also offer oncoplastic reduction, an option that can benefit large-breasted women, in which traditional lumpectomy is combined with breast reduction surgery.”

2. Should I have chemotherapy or other treatment before surgery?

For decades, surgery was traditionally the first line of treatment for breast cancer, but new advances in science and medicine are changing the landscape. Many people with breast cancer, especially with certain types of breast cancer, such as triple-negative or HER2-positive, may benefit from having chemotherapy or targeted therapy drugs before surgery. With newer innovative medications, this approach can shrink tumors before surgery, so that a patient can have a smaller, less radical operation. Patients who were initially recommended to have a mastectomy can sometimes have a lumpectomy instead. “This is why it’s important to be evaluated at a comprehensive cancer center before you undergo any treatment. At Roswell Park our surgeons and medical and radiation oncologists collaborate to weigh all potential options — and their most beneficial sequence of treatments for you.”

3. Do you offer radioactive seed localization?

This unique pre-surgical procedure is a huge benefit for patients undergoing lumpectomy. In preparation for breast cancer surgery, a breast radiologist will implant a tiny radioactive seed in the breast to mark the tumor’s exact location. (This painless 30-minute outpatient step can be performed up to two weeks before your cancer surgery.) Then, in the operating room, the surgeon uses a handheld radiation detection device to locate the seed and navigate to the tumor. The seed is removed with the tumor and no radioactivity remains. Roswell Park is the only center in the region that performs this type of tumor marking. “Radioactive seed localization aids a more precise removal of small tumors and a far better patient experience, replacing the old and uncomfortable method of having a wire protruding from the breast until surgery is performed.”

4. Can I have breast reconstruction surgery without implants?

Breast reconstruction surgeries that do not use implants are called autologous or flap reconstructions. These specialized surgical procedures that require high expertise in microsurgery use skin, fat, blood vessels and occasionally muscle tissue from other body areas, such as the abdomen, back, thighs or buttocks to recreate the breast. Roswell Park’s Plastic & Reconstructive surgeons perform several flap techniques that can result in a more natural breast appearance and feel. The type of reconstruction that’s best for you will depend on your cancer’s type and stage, as well as the type of surgery and other treatments that you undergo. An innovation in implant breast reconstruction available at Roswell Park involves placing the breast implant above the chest muscle rather than beneath it. Called prepectoral implant placement, this approach results in easier healing, reduced pain and discomfort from the surgery, and helps to avoid movement of the implant when the muscle contracts. Learn more about the full range of breast reconstruction options offered at Roswell Park.

5. Why does it matter to be treated at a National Cancer Institute-designated center?

Several studies show that patients treated at comprehensive cancer centers designated by the National Cancer Institute have better survival, by as much as 25% better. These better outcomes are the result of a comprehensive effort by a team of breast experts at every step in the cancer journey from diagnosis to highly skilled operations and medical management to survivorship. “At Roswell Park, everyone on the team is a breast expert. Right from the start, every patient has their imaging and pathology re-evaluated by our breast-specializing radiologists and pathologists and the breast surgeons and breast oncologists plan treatment in concert with these experts. You don’t get that kind of high-level multidisciplinary care anywhere else in the region.”