Breast Cancer: Treatment by Stage

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GALEN PERDIKIS: So there's a lot

of information that's been

thrown at patients when they've

got the new diagnosis

of early breast cancer.

And it's just overwhelming

sometimes.

The first decision

that the patient is going

to need to make

with a surgical oncologist

before they even meet us

is whether the patient will need

a mastectomy versus just

a partial mastectomy

or lumpectomy, cause that's

a very different discussion.

Once they've decided, though,

to have a mastectomy, there's

a very real option

to do nothing.

People sort of underplay

that option a little bit.

We've got reasonable data that

shows that a lady after 12

months of undergoing just

a mastectomy and going flat,

that they get back

to a new normal

and manage that appropriately.

But I will say that the majority

of ladies

are opting for reconstruction.

And there are lots of benefits -

physical, psychosocial -

that data supports

for the benefits of breast

reconstruction.

That is where

the whole discussion is

important with regard

to the plastic surgeon.

The surgical oncologist

and the patient serve a triad.

And so there's multiple issues.

One is radiation.

So if a patient's going to get

radiation, the plastic surgeon

generally will be talking

in a more delayed reconstruction

mode.

And that doesn't mean

the patient doesn't get

an expanded place at the time

of the mastectomy

just as a temporizing mechanism.

But the final reconstruction

is generally delayed

for after the radiation.

So that's the first thing.

Second aspect

for delayed reconstruction

would be in a lady that's

got lots of medical problems,

significant diabetes,

is a smoker, is very overweight.

Those are three examples

of where the surgeon, again, may

just use a temporizing expander

and then

do the final reconstruction

at a later stage.

Overall, if there's

an opportunity

to do immediate reconstruction,

then we like to do

immediate reconstruction.

Not everyone is a candidate.

And we have to evaluate everyone

based on their background

medical history.

And we're all in

with our patients.

We want them to get

reconstructed.

And so it is sometimes

difficult to have a conversation

where we say, "Look,

we're going to probably have

to delay your reconstruction

or look at other options."

When you're talking

to plastic surgeons,

make sure they chat with you

about all your options.

I think that's really important

if I'm speaking

as a patient advocate.

I think it's critical to have

a surgeon that wants your best

interests

and will discuss

every single surgical option.

Even if you don't offer all

those options

I think

a fair and unbiased discussion

about all the options

is critical for patients

to get the full story.