Patients of Courage! Our patients are an inspiration to us and to women everywhere. Read their stories here. Alice C – Age 31 Since her first visit to our office in March 2008 she has never ceased to amaze us with her drive, determination, optimism and above all her courage dealing with a life-altering experience at such a young age.

Your Breast Cancer Journey

Every breast cancer patient has a unique journey, and at Dr. Cassileth’s office, we are here to help you in any way we can during this difficult time. Hopefully the information below can help you understand the steps in the process of treating your breast cancer and restoring you to health.

Breast Cancer Detection

Suspicion of breast cancer is raised by:

1. A radiologist performing a screening exam such as a mammogram or MRI;
2. A patient feeling a lump on self examination; or
3. A physician performing a breast exam.

Diagnosis with Your Oncological (General) Surgeon

You will visit with an oncological surgeon (general surgeon) who specializes in breast surgery. The surgeon will first want to know if the lump is truly malignant or not, and if it is, how big it is and if any lymph nodes are involved.

In order to get a true diagnosis, a sample of breast tissue is obtained. There are different ways to do this. For example, if the area that is suspicious can be easily felt, the surgeon may perform a needle biopsy. If the area can only be seen on mammography imaging, you may choose to undergo a biopsy guided by mammogram.

If the biopsy does turn out to be cancer, then the surgeon will want to know if it has spread to the lymph nodes. This is usually done initially by radiological studies, such as an MRI.

Discuss Breast Reconstruction Options with Your Plastic Surgeon
Visit with a plastic surgeon to discuss your options for reconstruction. Depending on where your cancer is located you may need more than one surgery for complete breast reconstruction.

Surgery - Mastectomy

Mastectomy (surgical removal of the breasts) is recommended for:

1. Patients who have large breast cancers,
2. Patients who have multifocal breast cancer, or
3. Patients that have an underlying either genetic condition or pathology that makes them more likely to get a new cancer in the future.

For the latter group, this includes patients who have BRCA (gene) mutations, and who have LCIS on pathology (lobular carcinoma in situ). Patients with extensive ductal atypia may also want to consider mastectomy.

No decision is made on the basis of pathology alone, however. Every patient has different feelings about the loss of a breast and the risk of future cancer.

Surgery - Breast Reconstruction

After the mastectomy, breast reconstruction is performed to restore your breasts. Dr. Cassileth’s standard of care is Cassileth One-Stage Breast Reconstruction. Your breasts will be reconstructed during the same surgery as your mastectomy surgery by placing silicone implants, so when you wake up from surgery, you will have your new breasts.

If your nipple/areola were removed (this is determined by the location of your cancer) you may later have a second surgery to reconstruct your nipple/areola. Often fat grafting to the breasts is performed at this time to enhance your overall aesthetic result.

Useful Links

For more information about understanding breast cancer please visit:
BreastCancer.org
Susan G. Komen for the Cure - Los Angeles County

Helping women that are touched by cancer become mothers:
Fertile Action

Local cancer support groups for you and your family:
weSPARK Cancer Support Center - Sherman Oaks
Cancer Support Community - Redondo Beach
Cancer Support Community - West Los Angeles

BRCA Definition: The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited (from a family member) mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer compared with the general population. Often women that test positive for the BRCA gene opt to have bilateral mastectomies and breast reconstruction to prevent possible future breast cancer.