Meet Dr. R -- The Breast Surgeon

After receiving the biopsy report that Dawn Ann was positive for breast cancer, we met with Dr. R, the breast surgeon the next day.

Dawn Ann dropped of the children at grandma’s house, then we drove together to the doctor’s appointment. As I mentioned previously, we were very grateful to get in to see Dr. R. We knew that she would be on vacation the following week, and that it might take 2-3 weeks after that to get an appointment with her. Fortunately there had been a cancellation, and they were able to fit us in the next day after getting the biopsy results. We consider this a great blessing from the Lord, for which we are extremely grateful.

The doctor’s office was extremely busy. Each of the doctors there specialized in cancer treatment of some kind. One of the other doctors specialized in melanoma. As I looked into the faces of the people waiting there, I knew that cancer had touched each one of their lives. You could see the worried looks on their faces.

Virtually no one was there alone. Whether they were there for melanoma, or for breast cancer they had a spouse or someone else with them. This is a very good thing. No one should have to face a this life-threatening disease themselves.

The going was slow in the waiting room. We arrived at 12:45 PM. Our appointment was at 1:00 PM, but we didn’t actually get back into an exam room until close to 2:30.

After we got to the exam room, a nurse came in and asked us if we knew the results of the biopsy. Apparently some patients are sent there with their radiology films and pathology reports, but without being told what the results were. I thought that was a little odd. I’m glad the Women’s Center let us know right away.

After waiting another half hour in the exam room, we finally met Dr. R. She is a slight woman, in her late forties to early fifties. We talked about the results of the biopsy.

The kind of breast cancer Dawn Ann has is called DCIS – or Ductal Carcinoma in Situ. We learned that of all the types of breast cancer one can have – this is the best one to get (as If there is a best kind of cancer to get!) You can see an example of DCIS microcalcifications here.

From the mammography, and the pathology report, it was determined that the cancer was present only in the milk ducts, and appears not to be invasive. That means that it likely has not spread outside the milk ducts into other parts of the breast, or to other parts of her body. If left untreated, this kind of cancer could eventually become an invasive, life threatening type of cancer.

The doctor reassured us that no one dies from DCIS – which was quite a relief. In our case, the pathology report indicated that the aggressiveness of the cancer cells were at a low-to intermediate grade – which is an indication of the risk of the DCIS turning into an invasive form of cancer.

As far as treatment options go – it appears that mastectomy will be required. Since Dawn Ann has DCIS in two different quadrants of the right breast, doing a lumpectomy would not be prudent. Two lumpectomies, on the two different DCIS spots, would remove too much of the breast tissue to save the breast.

During the surgery, a dye will be injected into the breast. The purpose of the dye will be to determine the location of the sentinel lymph node. The sentinel lymph node will be removed and biopsied to determine if any cancer cells have entered the lymphatic system. If no cancer cells are found there, then it will indicate that the cancer has not spread beyond the breast.

The good news is that if the diagnosis is correct, that mastectomy should get all the cancer. Radiation and/or Chemotherapy should not be required.

Of course, the final treatment plan will not be known until after the final pathology report after the mastectomy takes place. If the sentinel lymph node is clear, and if the breast tissue around the margins is free of cancer cells, then we believe that all of the cancer will be removed from her body with the mastectomy.

If cancer cells are found in the margins of the breast tissue, or if cancer cells are found in the sentinel lymph node, then further treatment will be required, such as radiation, or chemo.

I asked the doctor how soon we need to have this surgery performed. The surgeon replied that it doesn’t have to be done within the next few days, but that we have a few weeks to have further diagnostic testing performed, and to consider breast reconstruction options.

The doctor recommended that we get a Breast MRI screening. This will mainly be done to check out the left breast more thoroughly. The mammogram showed no cancer in the left breast, but the MRI can detect DCIS much sooner than is possible with a mammogram. The drawback to the MRI is that it has many more false positive results – meaning that it can pick up non-cancerous calcifications that might require further investigation or biopsies. The MRI may also reveal further information on the right breast, that we know has cancer cells present.

The doctor also recommended that we may want to meet with a genetic counselor to determine if Dawn Ann has the genetic markers that indicate a susceptibility to cancer.

Cancer does run in Dawn Ann’s family. Her mother was diagnosed with breast cancer (IDC) 8 years ago in 1999, at the age of 61. She had a lumpectomy, and both chemo and radiation treatments. So far she is still cancer free.

Both of Dawn Ann’s grandmothers died of cancer – although not from breast cancer. One grandmother died of ovarian cancer, and the other grandmother died of cancer of the throat and tongue.

All of these considerations need to be taken into account as we plan our treatment options. We need to decide if we need to have a single mastectomy, or a double mastectomy. Even if there is no cancer found in the left breast, we still have to consider the possibility of having the left breast removed also as a preventative measure.

The other big decision we need to make is with regard to breast reconstruction. We are studying various reconstruction techniques. We already have scheduled appointments to consult with two plastic surgeons. Dawn Ann wants to get more than one opinion on reconstruction. We have learned that different plastic surgeons go about reconstruction in different ways.

If we decide on reconstruction, then we could have the reconstruction begin at the time the mastectomy is performed. In this scenario, after the mastectomy has been completed by the breast surgeon, Dawn Ann would be turned over to the plastic surgeon to insert a tissue expander for a future implant. The surgeon would also leave some extra skin to accommodate the reconstruction.
Dr. R stated that we don’t have to do reconstruction right away, if we don’t want to. However, it would get the process underway as soon as possible.

There are also some financial implications involved here too. Our health insurance has a maximum out of pocket expense level – which we will surely pass this year. Once the maximum out of pocket amount has been reached, further surgeries and treatments will be covered 100% by insurance, through the end of the plan year – which ends on June 30, 2008. If we start the reconstruction right away, more of the treatments will be covered 100% since we will have surpassed the out of pocket limit. If we wait until future years, we will have to start the out of pocket expense over again.

I don’t want finances to be the driving force of our treatment options, however it is a reality that needs to be considered.

For now, our next steps are the Breast MRI, and consultations with plastic surgeons. We also may meet with a genetic counselor as well. After that we will meet again with the breast surgeon. Our follow-up appointment with the breast surgeon is on October 3rd. At that time we will make the final treatment determinations, and schedule the surgery.


It was so good to visit with Dr. R. She gave us some great information. It was good to know that Dawn Ann’s cancer has been caught at a very early stage. The good news that Dawn Ann’s DCIS as currently diagnosed, is 99.9% curable.

For now, that is our focus, to get the cancer out, and to preserve the life and health of my dear wife, and the mother of our children. We want to keep her around for a very long time to come.