What you should know about mastectomies

In recent years, celebrities have taken the brave step of going public about their diagnosis of breast cancer. From Olivia Munn, who detailed her cancer journey after her diagnosis in 2023, to Julia Louis-Dreyfus, who revealed her diagnosis shortly after receiving it the morning following her Emmy win for “VEEP,” their willingness to share personal details about the challenges of breast cancer have created awareness and helped thousands of women realize they are not alone in coping with the disease.

Munn and Louis-Drefus have also helped spotlight one of the procedures often performed as part of breast cancer treatment — a mastectomy, a surgery to remove the breast.

Treating cancer

“Breast cancer treatments often start with surgery to remove the cancer,” explains Dr. Noran Barry, a Sharp Rees-Stealy Medical Group breast surgical oncologist affiliated with Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns.

While a mastectomy is the removal of the entire breast, a lumpectomy is the removal of the tumor and only some of the tissue surrounding it, preserving the remainder of the breast. Following the surgery, particularly a lumpectomy, radiation therapy is customary to ensure all the cancer cells have been eliminated.

A doctor may recommend a mastectomy over a lumpectomy for several reasons, including:

• The tumor is particularly large

• There are multiple tumors within the breast

• A person wishes to avoid the radiation therapy that commonly follows a lumpectomy (though, radiation may also be advised following a mastectomy)

Sometimes, chemotherapy may be used before surgery to shrink the tumor to a size that allows for the option of a lumpectomy.

During a mastectomy, a doctor may also recommend removing the other breast, a procedure commonly called a double mastectomy. This is usually done for patients with a strong family history of cancer or other risk factors, which can be revealed through genetic testing.

“Some patients choose a double mastectomy to avoid those risks, though most patients who have breast cancer never do end up with it in the other breast,” Dr. Barry says. “You’ll want to talk that decision through with your care team to make sure you avoid an unnecessary procedure.”

Options following surgery

Just as chemotherapy may be used before surgery, it may also follow surgery to ensure all cancer cells have been eliminated. Another potential option following a mastectomy is breast reconstruction, a procedure performed by a plastic surgeon to restore the look of the breast.

There are three primary methods of breast reconstruction:

• Breast implants (filled with saline or silicone)

• Natural tissue flaps (using skin, fat, and sometimes, muscle from the patient’s body)

• A combination of the above two

“For some patients, breast reconstruction helps them feel more comfortable with their appearance after a mastectomy, though it’s important to note that reconstruction won’t exactly match the way the breast looked or felt before the surgery,” Dr. Barry explains.

Reconstruction is sometimes done at the same time as a mastectomy. This is known as immediate reconstruction. However, there are various factors that could require the procedure to be delayed.

“There are several decisions that need to be made when considering a mastectomy,” Dr. Barry says. “That’s why it’s important to feel comfortable with your care team, including your oncologist and surgeon, and have open conversations about your treatment goals to achieve the best outcome.”

Importance of screenings

Both Munn and Louis-Dreyfus chose to have double mastectomies. They are among the many celebrities who have used their experiences to raise awareness about breast cancer.

Munn has discussed the importance of understanding your cancer risk. She received additional screening beyond a routine mammogram after a risk assessment performed by her OB-GYN showed she was at high risk of developing breast cancer. It was this additional screening that revealed the presence of cancer cells.

Louis-Dreyfus also shared the importance of screenings. Additionally, she raises money to pay for breast reconstructions for patients who cannot afford the procedure.

“One out of every eight women in the United States will be diagnosed with breast cancer in their lifetime,” Dr. Barry points out. “So, it’s important to know your risk. Your primary care doctor or OBGYN will define your risk using the IBIS risk assessment tool — also known as the Tyrer-Cuzick risk assessment — to determine if you are eligible for additional screening in the form of an MRI.”

Talk with your doctor about your family history of breast cancer. And if you notice any changes in your breast or something feels “out of the ordinary,” Dr. Barry recommends seeking care.

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