Treatment Considerations For White House Chief of Staff Susie Wiles, 68, After Her Early-Stage Breast Cancer Diagnosis

RELATED: Facing Breast Cancer Today, You Have Choices: Making Better-Informed Decisions After Active Treatment

The Florida-based Republican strategist opened up about her diagnosis with the following statement, as per the New York Times, “I am grateful to have an outstanding team of doctors who detected the cancer early and are guiding my care, and I am encouraged by a strong prognosis.

“I am also deeply thankful for the support and encouragement of President Trump as I undergo treatment and continue serving in my role as White House Chief of Staff.”

RELATED: Huge Number of Early-Stage Breast Cancer Patients Over Treated, New Study Shows Current Aggressive Treatment Is No Better Than Active Surveillance

Understanding Early-Stage Breast Cancer and What Comes Next

Early-stage breast cancer means the tumor is small and hasn’t spread to nearby lymph nodes. According to Dr. Elizabeth Comen, a medical oncologist at NYU Langone Health’s Perlmutter Cancer Center, who previously spoke with SurvivorNet, the first step is usually surgery to remove the cancer. This may involve a lumpectomy, where only the tumor and surrounding tissue are removed, often followed by radiation therapy to reduce the risk of recurrence.

However, treatment isn’t one-size-fits-all.

When it comes to deciding on treatment, factors like age, tumor size, family history, and personal preference may influence whether radiation is needed or if a patient chooses a more aggressive approach, such as a mastectomy—removal of the entire breast.

After surgery, a pathologist examines the tissue under a microscope to help determine the next steps in treatment.

WATCH: Understanding Early Stage Breast Cancer

Diagnostic testing plays a critical role in shaping your care plan. If a mammogram or clinical breast exam reveals something abnormal, your care team may recommend:

• Diagnostic mammogram and breast ultrasound to get a closer look at the breast and nearby lymph nodes
• MRI scans for additional imaging detail
• Biopsy of suspicious areas, including lymph nodes, to confirm cancer
• Tumor marker testing to identify hormone receptors and proteins that influence treatment options
• Additional imaging to check for any signs of metastatic disease

Once all this information is gathered, your cancer is staged—based on tumor size, lymph node involvement, and whether it has spread.

Staging helps guide treatment decisions, while hormone receptor and protein marker tests reveal how the cancer behaves and which therapies may be most effective.

Your healthcare team will consider all of these factors—alongside your personal health, values, and goals—to create a treatment plan tailored to you.

Finding a Balance Between Screening and Treating

Depending on several factors, including the stage of your cancer, your overall health, if and how much the cancer has spread, and the specific characteristics (biology) of your tumor, your doctor may suggest any of the following treatment options, or a combination of multiple:

• Surgery
• Chemotherapy
• Radiation
• Hormone therapy

Deciding On Surgery

If Wiles’ treatment plan calls for a mastectomy, Dr. Ann Partridge, an oncologist at Dana-Farber Cancer Institute, says there are a number of factors to weigh when considering a mastectomy, chief among them is whether breast-conserving surgery (or lumpectomy) is possible.

Your doctor will look at the size and features of your tumor as well as your family history in order to make a recommendation.

“When I talk to a woman who comes to me and she has breast cancer, I evaluate what the standard options for treatment for her are, which typically include cutting out the cancer– which is either a lumpectomy if you can get it all with just a little scooping around of the area that’s abnormal or a mastectomy for some women meaning taking the full breast because sometimes these lesions can be very extensive in the breast,” Dr. Partridge explains.

If you’ve had a mastectomy, breast reconstruction is one of the major issues to consider. There are several options available. The reconstruction process can happen at the time of the surgery to remove the breast, or later on in the case of implants. Some women opt for no reconstruction, but decide later on that they want reconstruction to restore a sense of self, or simply get back to the way they used to look.

WATCH: Breast Reconstruction: Regaining Your Sense of Self

“Breast reconstruction is about restoring both a woman’s form and her sense of self,” explains Dr. Andrea Pusic, Chief of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital. It’s a deeply personal decision, and today’s surgical options can create breasts that look natural and real.

Immediate reconstruction can produce better results than delayed reconstruction, resulting in fewer surgeries. However, it may require a more extended initial hospitalization and recovery time. This long surgery may also have a higher risk of complications, such as infections, than two separate surgeries.

It may be worth noting that “Delayed reconstruction has fewer complications than immediate reconstruction,” Dr. Terry Myckatyn, a plastic surgeon specializing in breast reconstruction, told SurvivorNet.

When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). During reconstruction, one can also take one’s own tissue (usually from the belly area) and transfer it to the breast area.

After breast cancer surgery, women diagnosed with early-stage breast cancer may also need chemotherapy, radiation, or hormone therapy.

Dr. Terry Myckatyn, a breast reconstruction specialist at Washington University in St. Louis, emphasizes that the process is collaborative: “It’s a shared decision-making process between the patient and the physician. The patient needs to advocate for herself and make her goals clear. The physician needs to provide clear, logical, evidence-based explanations for their recommendations.”

WATCH: How some women may keep their breast size and shape in cancer surgery.

Plastic surgeons typically reconstruct breasts using either implants or tissue taken from another part of the body—such as the back, abdomen, or inner thigh. This tissue-based approach, known as a flap procedure, often produces breasts that look and feel more natural than implants and can change with your body over time, for example, with weight gain or loss.

However, flap procedures involve more extensive surgery, longer recovery, and additional scarring—both at the breast and at the donor site. They may also weaken muscles where tissue is taken, and not all patients are candidates. Women who smoke or have certain health conditions, such as poorly controlled diabetes, circulation problems, or connective tissue disorders, may not be eligible.

Implant-based reconstruction usually requires fewer surgeries, smaller incisions, and less scarring, allowing for a quicker return to daily life. The trade-off is that implants don’t adapt to body changes, which can make them look less natural over time. Implants also carry risks of leakage or rupture, which would require replacement.

Every surgical option comes with risks. Understanding those risks—and weighing them against your personal goals—is essential before making a decision.

Another aspect of breast cancer surgery involves the possibility of sparing the nipple.

WATCH: Understanding Nipple-Sparing Mastectomies

During a nipple-sparing mastectomy, doctors use special techniques to remove a woman’s breast, leaving the skin and the nipple intact. The idea is to maintain, as close as possible anyway, the natural look of the breast. After a mastectomy, a plastic surgeon will use either an implant or the woman’s own tissue to recreate the breast. When a woman’s own tissue is used, doctors typically take it from fat in the patient’s lower abdomen.

“Nipple-sparing mastectomy, or nipple-preserving mastectomy, differentiates itself from the traditional mastectomy where the nipple was not saved,” Dr. Irene Wapnir, a surgical oncologist and breast surgeon at Stanford University Medical Center, explains to SurvivorNet.

“It’s the ideal procedure for those women who choose to have prophylactic mastectomy who don’t yet have breast cancer, who will choose that route because they have a strong family history of breast cancer, or if they’ve been tested and are a carrier of a mutation, a gene mutation, that predisposes them to a much higher risk of developing breast cancer,” Dr. Wapnir explains.

Navigating the Emotional Journey of a Breast Cancer Diagnosis

A breast cancer diagnosis can be extremely shocking and deeply unsettling. However, it’s completely natural for emotions to fluctuate throughout the process. Psychiatrist Dr. Lori Plutchik notes that emotional responses often vary from day to day, sometimes surfacing as sudden waves of stress or uncertainty.

“The patient or person going through the stressful event should accept that emotions will be fluid,” Dr. Plutchik says. “You may feel fine one day and then feel a massive wave of stress the next. It’s also important for those you look to for support—whether that’s a therapist, friends, family, or both—to understand the fluidity of stress-related emotions.”

If your emotional well-being begins to feel significantly impacted, seeking mental health support may be beneficial. Options for care include traditional talk therapy, medication, lifestyle changes such as exercise and diet modifications, joining a support group, or other personalized approaches.

Here are a few ways to help manage the emotional toll of a breast cancer diagnosis:

• Lean on loved ones. Open up to your family and close friends, allowing them to step in and offer support. Many cancer survivors express a strong need for assistance but struggle to ask for help—encourage those around you to offer practical aid, whether it’s meals, transportation, or simply a listening ear.
• Keep a journal. Writing down your thoughts and emotions can be a powerful way to process feelings. A journal provides a safe space to express yourself and reflect on your journey.
• Join a cancer support group. Local and online groups offer an opportunity to connect with others who are facing similar experiences. Learning from others and sharing your story can provide comfort and strength on difficult days.
• Consider therapy. Speaking with a mental health professional can help you navigate fears and concerns in a safe, supportive environment. Sometimes, vocalizing emotions rather than keeping them inside makes a meaningful difference in coping with stress.

Although the journey may seem uncertain, having the right support network and effective coping methods can greatly influence your emotional and mental health. Remember, facing breast cancer is difficult, but you are not alone—healing comes in many forms, not just physical.

More on Breast Cancer Screening

The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives. For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.

Women with a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.

Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.

Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.

Family History & Breast Cancer Risk

Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:

• Older age
• Having a gene mutation such as the BRCA1 or BRCA2
• Added exposure to estrogen
• Having children after the age of 30
• Exposure to radiation early in life
• Family history of the disease

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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