Preparing for Cancer Surgery
- Katie Thurston is preparing for her late April double mastectomy (removal of both breasts), coordinating the surgery with pauses in certain medications while continuing hormone‑suppression therapy that remains central to her treatment.
- After earlier tumor shrinkage allowed her to delay surgery, she says she’s ready to move forward, noting that “removing the tumor” will be an important step in her ongoing fight against metastatic breast cancer.
- Thurston’s type of cancer is marked by the presence of hormones estrogen receptors (ER), progesterone receptors (PR), and HER2. This combination accounts for just 5–10% of all breast cancer cases and typically requires a layered treatment plan involving chemotherapy, HER2‑targeted therapy, and hormone therapy.
- Thurston previously shared that her treatment regimen includes ribociclib, a targeted therapy taken with endocrine therapy. Lleuprolide, a hormone therapy, and Letrozole, which is an aromatase inhibitor that reduces the body’s estrogen production, are commonly used in postmenopausal women with hormone-sensitive breast cancer.
Before breast cancer surgery, patients typically weigh several factors, including which procedure is most appropriate based on their cancer type and stage. For Thurston, the decision also involves coordinating around medications that are already playing a key role in her treatment.
Read MoreView this post on Instagram
“As a breast surgeon, my job is to help patients understand that their long‑term survival with a mastectomy is equivalent to that with a lumpectomy followed by radiation,” says Dr. Sarah Cate, Chief of Breast Surgery at Stamford Hospital.
WATCH: What Type of Breast Cancer Surgery Is the Right Choice?
Many women request the removal of both breasts, believing it offers the best protection against recurrence, but that isn’t always true. The most appropriate surgery depends on several factors, including tumor size, genetic markers, and the patient’s family history.
“Because of the timing of my medication break and liver recovery and the date of my surgery, which also requires pausing Kisqali, I’ll continue to pause treatment for another two months.”
She added that her hormone‑suppression therapies, such as Lupron and letrozole, “do a lot of the heavy lifting” in her treatment and will continue uninterrupted.
Late last year, Thurston told supporters her tumor was “still shrinking,” calling the update “really good news” for a six‑month check‑in. That progress allowed her to postpone the mastectomy at the time. Now, with surgery just days away, she says she’s ready to move forward.
“Removing the tumor will also be beneficial to my fight against cancer,” she said.
Stories like Thurston’s and McKeon’s are at the heart of SurvivorNet’s Breast Cancer Dialogues series, which fosters a space where women feel seen, supported, and empowered to share their experiences, from diagnosis and treatment to relationships, recovery, and everything that comes with the journey.
Expert Resources for Breast Cancer Patients Considering Surgery
- For Breast Reconstruction After Mastectomy, Women May Choose ‘Now,’ ‘Later,’ or ‘Never’
- Implant Reconstruction After a Mastectomy: The Options
- Is a Preventative Mastectomy Right for Me?
- Should I Have a Lumpectomy or Mastectomy?
- The Last Frontier: The Promise of Restoring Sensation After Mastectomy
- To Reconstruct or Not: After Mastectomy, Two Women Take Very Different Paths
- What is Nipple-Sparing Mastectomy?
- What Happens During a Double Mastectomy?
Katie’s Ongoing Breast Cancer Treatment Journey
When it comes to breast cancer surgery, there’s no one-size-fits-all approach. Choosing between a lumpectomy and a mastectomy is a deeply personal decision—one that depends on a range of medical and emotional factors.
“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,” says Dr. Sarah Cate, Chief of Breast Surgery at Stamford Hospital.
Still, many women request a double mastectomy (removal of both breasts), believing it offers the best protection against recurrence. But that’s not always the case. The size of the tumor, its genetic profile, and a patient’s family history all play a role in determining the most appropriate surgical path.
WATCH: Decisions Surrounding Breast Reconstruction
“Mastectomy has very specific indications,” Dr. Cate explains.
“Some of the things that would predict a mastectomy are things like a large tumor size to breast ratio, or having cancer in more than one area of the breast, or having a genetic mutation.”
Katie Thurston, who recently shared her breast cancer journey publicly, is preparing for a double mastectomy. While this procedure is often part of treatment, it’s also used preventatively for women at high risk of developing breast cancer.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” says Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System.
“The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
WATCH: What Goes Into a Double Mastectomy
Today, most women choose to undergo some form of reconstruction, which can significantly extend the duration of surgery—especially when tissue is transferred from another part of the body.
“When you take tissue from another part of the body and transfer it to fill in the empty space where the breasts are, this is a very long operation,” Dr. Port says.
“It can take anywhere from six to 12 hours because it’s really like having a tummy tuck and then transferring the tissue and grafting the tissue, connecting the vessels, so those tissues have blood flow to live in,” Dr. Port adds.
For women with a strong family history or a known genetic mutation—such as BRCA1 or BRCA2—the decision to undergo a preventative mastectomy may be the most effective way to reduce their risk.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high risk for getting breast cancer,” Dr. Port explains. “For genetic mutation carriers, who are the ones at the highest risk, there’s unfortunately only one way to actually prevent breast cancer.”
WATCH: Getting a Preventive Mastectomy
Women who test positive for a BRCA mutation typically face two options.
“One is what’s called high-risk surveillance, which means we check them every six months or so—mammograms, MRIs—with the hope that if, God forbid, they develop breast cancer, we pick it up early,” Dr. Port says. “But that’s not prevention, that’s early detection.”
“Early detection is a goal, it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say, reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
Katie’s Ongoing Treatment
Thurston previously shared that her treatment regimen includes three key medications:
- Kisqali (ribociclib): Approved by the FDA in 2017, this targeted therapy is used in combination with endocrine therapy to treat HR+/HER2- breast cancer. It works by slowing the progression of cancer, offering a more tolerable alternative to traditional chemotherapy.
- Lupron (leuprolide): A hormone therapy injection that lowers estrogen levels in the body, helping to prevent the cancer from growing.
- Letrozole: An aromatase inhibitor that reduces the body’s estrogen production, commonly used in postmenopausal women with hormone-sensitive breast cancer.
Treatment Options for Advanced Breast Cancer
Metastatic breast cancer (also called stage 4) means cancer cells have spread from the breast to other parts of the body, which may include the bones, liver, lungs, brain, and beyond.
Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different body parts, where they grow as new tumors.
As the cancer spreads to other body parts, patients may experience additional symptoms depending on where the cancer has spread. Examples include:
- Bones: Severe bone pain or fractures
- Lungs: Difficulty breathing, chest pain, new cough
- Liver: Yellowing of the skin (jaundice), abdominal pain, nausea, and/or vomiting
- Brain: Headaches, memory loss, changes in vision, seizures
WATCH: Treatment options for metastatic breast cancer.
Although stage 4 breast cancer is not curable, several treatment options exist that can extend the life of patients. Treatment options depend on the stage, type of primary breast cancer, and whether hormone receptors are positive.
Treatment can include a combination of:
- Chemotherapy: Oral or IV medications that are toxic to tumor cells
- Hormonal therapies: Drugs that lower estrogen levels or block estrogen receptors from allowing the cancer cells to grow
- Targeted therapies: Drugs that target your tumor’s specific gene mutations
- Immunotherapy: Medications that stimulate your immune system to recognize and attack cancer cells
- Radiation: The use of high-energy rays to kill tumor cells and shrink tumors
- Surgery: To remove a cancerous tumor or lymph nodes (uncommon with stage IV; more common in stages I, II, and III)
- Clinical trials: Studies of new medications, treatments, and other therapies offer hope for better outcomes.
Questions to Ask Your Doctor
If you’re considering a mastectomy, it can be helpful to go into the conversation with your doctor prepared. Here are some key questions to ask as you weigh your options. SurvivorNet’s proprietary AI tool, “My Health Questions,” can also support you along the way by providing evidence‑based answers aligned with cancer treatment guidelines and informed by oncologists across multiple specialties.
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
- What should I know about implants?
- What will recovery look like after the procedure?
Learn more about SurvivorNet's rigorous medical review process.
