Helping Women Learn Their Options After a Breast Cancer Diagnosis
- Actress Shannen Doherty, 52, who is living with advanced-stage cancer, is sharing what she would have done differently after her 2015 breast cancer diagnosis, and hoping to make women more aware of their options so they can make a more informed choice.
- On her Let’s Be Clear podcast this past week, the Beverly Hills, 90210 star said she wishes she would have had both breasts removed rather than undergoing a single mastectomy, but supporters (and survivors) jumped in on the comments to tell her she cannot beat herself up about decisions she made, as she did nothing wrong. Her guest, a prominent Beverly Hills plastic surgeon, said the same.
- However, encouraging women to learn their options and empower them to make their own decision is important, and Doherty raising this topic can be very helpful. Learning how much multiple opinions matter and getting to know your options.
On her Let’s Be Clear podcast this past week, the Beverly Hills, 90210 star said she wishes she would have had both breasts removed rather than undergoing a single mastectomy.
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While she considers it a “mistake,” it’s also important to not beat yourself up over health decisions, since there’s no telling what the outcome would have been otherwise.
Many fans and survivors expressed this view in the comments of the posted Instagram clip.
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“I had both removed and my cancer still came back almost 5 years later in my spine,” one person weighed in, while another urged, “There are no wrong decisions. You did what you were comfortable with.”
A third supporter noted she “had both removed at the same time and it traveled to my brain. But you did what was best for you at the time. This cancer shit is soo unpredictable. Much love to you ❤️.”
As many survivors know, it’s common to rack your brain and think of everything you potentially did “wrong” before, during or after your cancer diagnosis, but trying to let go of that guilt can be better off for your mental health.
Doherty’s guest on the episode, Beverly Hills plastic surgeon Dr. Jay Orringer, gently expressed that she did nothing wrong, that her thinking at the time was “very reasonable.”
But it is important for women — and men — to know their options.
Shannen Doherty’s Breast Cancer Diagnosis and Recurrence
After Doherty’s diagnosis, she had a single mastectomy as mentioned, along with chemotherapy, radiation and hormone therapy. In 2017, she achieved remission status, but the disease returned two years later in 2019. This time around, her breast cancer was metastatic, or stage 4.
Having metastatic breast cancer means the cancer has spread, or metastasized, beyond the breasts to other parts of the body. It often spreads to the liver and lungs, but can also spread to places like the brain and bones, which happened with Doherty.
(Photo: Instagram/theshando)
As a result, she’s undergone both radiation and surgery in the form of a craniotomy to improve her prognosis. According to Dr. Kimberly Hoang, a board-certified neurosurgeon at Emory University School of Medicine, a craniotomy procedure like Doherty underwent earlier this year is “a procedure to cut out a tumor” on the brain that may be particularly useful “if the tumor is causing symptoms or if it’s large.”
While treating advanced breast cancer, the goal of treatment is to keep you as stable as possible, slow the tumor growth, and improve your quality of life.
What Is a Lumpectomy vs. Mastectomy?
Depending on the stage of the cancer, the type of cancer, and whether or not you have a family history or are at higher risk genetically, you will either have a mastectomy or a lumpectomy, which is when just the tumor and any cancerous tissue is surgically removed without removing the breast or breasts.
RELATED: Recovering From a Lumpectomy, Also Known as ‘Breast-Conserving Surgery’
In some situations, either decision will be backed by your medical team, as many women will not need to have their breasts removed. For example, a woman without hormone-related cancer like triple-negative breast cancer, who has no family history, typically does not need to have full removal of their breasts if it’s earlier stage, therefore choosing what kind of surgery to have is a very personal choice. It’s of course important to get multiple opinions and weigh all options, but know that the decision is yours. Your providers can help educate you on what each decision can mean for you.
Should I Have a Lumpectomy or Mastectomy?
“As a breast surgeon, my job is (to help patients) understand that their long-term survival with mastectomy is equivalent to that with lumpectomy and radiation,” Dr. Sarah Cate, Chief of Breast Surgery, Stamford Hospital, previously told SurvivorNet.
Often women will request to have both breasts removed, believing it’s the best way to prevent the cancer from recurring. This is not always the case. The size of the tumor, its genetic markers, and the patient’s family history are all factors to consider when choosing which surgery to undergo.
More and more women who carry a higher risk for getting breast cancer, referred to as “previvors,” are choosing to have their breasts removed when they haven’t ever had cancer, and it’s important to know about that option as well.
Reconstruction After a Mastectomy
If you’ve elected to have implant reconstruction following a mastectomy, there are two options for the procedure: using a breast tissue expander which is a two-step process, or direct-to-implant reconstruction which is completed at the same time as the mastectomy.
With the tissue expander implant reconstruction, an expander is put in between the skin and chest muscle at the same time as the mastectomy surgery or afterwards, if you’re choosing delayed reconstruction. The expander has a small valve that will be filled gradually over time with saline every one to two weeks, stretching the skin until the area is ready for the permanent implant.
Implant Reconstruction After a Mastectomy: The Options
Only a minority of women are great candidates for direct-to-implant reconstruction, said Dr. Andrea Pusic, Chief of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital, that’s because it’s best for women with small breasts and/or women who are having no skin removed and preserving the nipple and areola. Women who are able to get this option can go home from a mastectomy with their breast reconstructed.
When survivor Laura Morton was told she needed surgery for breast cancer, she really wanted to try nipple-sparing surgery — which is when surgeons work to keep the nipple and areola intact during a mastectomy.
“I so wanted to have the nipple-sparing surgery, I wanted the best cosmetic outcome that I could have,” Laura shared in a prior interview with SurvivorNet.
Choosing a Plastic Surgeon Don’t be Afraid to Ask the Hard Questions
She visited a plastic surgeon’s office and spent some time looking through books of breast augmentations — she was almost sold on taking the nipple-sparing route. But when she visited another surgeon at a major cancer center, she got some really solid advice.
“She said, ‘I’m not selling you plastic surgery, I’m not giving you cosmetic surgery. I’m giving you back breasts, because you have cancer,’” Laura recalled.
That surgeon told Laura that she couldn’t promise the cosmetically beautiful results, but she could promise that they would do everything to get rid of her cancer. “I knew right there and then that she was the plastic surgeon for me,” Laura says.
RELATED: The Silver Linings—Author Laura Morton on The Aftermath of Breast Cancer Surgery
As much as it hurt to hear that she was not actually a good candidate for nipple-sparing surgery, Laura’s very happy that her surgeon was so honest with her. There’s value in asking your doctor the hard questions — and getting the hard answers.
Many women also choose to “go flat” and not get breast reconstruction. Some just want to be done with surgeries and move on with their lives or simply focus on fighting cancer. Others may want to simply “stick it” to conventional beauty standards.
Bottom line, it’s your body, you can do what you want with it, and never beat yourself up about the choices you make.
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