Your Breast Cancer Journey

Authored By Lisa Cassileth MD, FACS

Trust Nation’s Leading Breast Specialists During Your Breast Cancer Journey

Getting the right kind of mastectomy is critical. The best results are achieved with a nipple/areola-sparing mastectomy or, if necessary, a skin-sparing mastectomy. We work very closely with our breast cancer surgeons at Bedford Breast Center, who perform the mastectomy through the smallest incision under the breast, and have the lowest risk of any surgeons for mastectomy flap or nipple necrosis while removing all the breast tissue. 

Four steps of the Breast Cancer Journey

Detect -> Diagnose -> Remove -> Reconstruct


​Suspicion of breast cancer is raised by:

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


You will visit with a  surgeon who specializes in breast cancer. 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 or ultrasound, you may choose to undergo a biopsy guided by mammogram or ultrasound.

If the biopsy does turn out to be cancer, then the surgeon will want to know if it has spread to the lymph nodes. Detection of abnormalities of the lymph nodes is performed by radiological studies, such as an MRI.


Based on the results of the biopsy, your surgeon may advise you to undergo lumpectomy or mastectomy. Your surgeon will discuss these options with you and help you to make an informed decision about how to proceed. For simple cancers, lumpectomy with radiation is equivalent in cure to mastectomy. For patients with widespread DCIS, multifocal disease, large cancers, or inherently increased risk, mastectomy may be a better option than lumpectomy.


In the event that you must undergo mastectomy or a large lumpectomy, you will visit with a plastic surgeon to discuss your options for reconstruction. Depending on where your cancer is located, you may be a good candidate for Cassileth One-Stage Breast Reconstruction, or the SWIM breast reconstruction.


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

  • Patients who have large breast cancers,
  • Patients who have multifocal breast cancer, or
  • Patients who 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.

*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.

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.


After the mastectomy, breast reconstruction is performed to restore your breasts. Our surgeons use a variety or methods of reconstruction, but we have develop and exclusively specialize in the Cassileth One-Stage Breast Reconstruction. and the Goldilocks mastectomy with SWIM reconstruction.  With both surgeries, 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.


For more information about understanding breast cancer please visit:

Helping women that are touched by cancer become mothers:

Local cancer support groups for you and your family:

To learn more about your options with breast reconstruction, contact Cassileth Plastic Surgery to set up a consultation with Dr. Killeen by calling (310) 278- 8200 or by requesting an appointment online.

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