What I Wish Breast Cancer Patients Knew About Mastectomies, As A Surgeon & Survivor

In this op-ed, Dr. Anne Peled, MD, a board-certified plastic surgeon practicing aesthetic, reconstructive, and breast cancer surgery in San Francisco, discusses how the prospect of breast numbness after a mastectomy can prevent patients from seeking this life-saving treatment — and how there are new techniques to help preserve sensation.

One out of every eight women and about one out of every 800 men in the U.S. will develop breast cancer in their lifetime, according to the National Cancer Institute. Many people diagnosed with breast cancer opt for a mastectomy, as will many people who know they are at high risk for breast cancer in the future due to their family history or genetic mutations and want to reduce this risk. And while mastectomy is a life-saving measure, few people talk about the after-effects, especially the psychological ones. Through my work as a breast cancer and reconstruction surgeon, as well as having gone through breast cancer treatment personally, the one thing I continue to be struck by is how a mastectomy can negatively affect a person’s sense of self and relationship to their body — and how there are new treatment options to minimize these effects.

At the time of a breast cancer diagnosis, considering treatment options can be very overwhelming. The initial, understandable urge for many people is to just “get the cancer out,” without as much consideration for the potential impact that the treatments may have on them later. Fortunately, we have come a long way in providing many different treatment options for patients. Many breast cancer patients are now offered newer breast reconstruction options and nipple-sparing mastectomy (NSM) approaches, and while these procedures provide excellent aesthetic outcomes, they also unfortunately come with a major downside: loss of breast and chest sensation.

Most people making the decisions around mastectomy don’t realize that the procedure will leave them with little, if any, sensation in their breast or nipple skin after surgery. In one 2018 study, only 2% of women gained full sensation in their breasts after a mastectomy. While this fact is sometimes discussed during surgical consultation, many people are surprised to find out that they have lost sensation after surgery, and are then even more shocked to find out it’s often permanent.

It’s difficult to be numb in any part of your body, but breasts may play a big part in a person’s life, from intimacy with their partner, to their sense of femininity. Studies of people who have undergone breast cancer treatment show a significant decline in overall sexual health, with specific studies looking at women who have undergone mastectomy showing it to be associated with a sense of disfigurement and conflict between sense of self and body. I've heard patients voice hesitation or fear about undergoing a life-saving mastectomy because they are concerned about permanently losing feeling in their breasts, and question how that will affect them for the rest of their lives.

When I was diagnosed with breast cancer at age 37 in December 2017, it came as such a huge shock on so many levels, especially as a surgeon who spends every day treating the same disease I’d just been diagnosed with. Once I started thinking about my treatment options, I realized that the thought of losing sensation after a mastectomy, especially so young, played a large role in my decision-making around what type of surgery I chose. I ultimately chose to have a lumpectomy, which is when the tumor is removed with clean tissue around it but the rest of the breast is left intact, primarily to avoid facing a lifetime of chest numbness and the many ways that would impact my life. Fortunately, I had the choice of either lumpectomy or mastectomy based on the size and type of cancer I had, but for many people, mastectomy is the only option. This is especially the case for people with genetic mutations that significantly increase their future breast cancer risk, who are strongly recommended to consider having mastectomies.

It’s equally important to understand the potential long-term impact breast cancer treatment can have on patients.

From this experience, my husband, Dr. Ziv Peled, who is a peripheral nerve and plastic surgeon, and I began to discuss ways in which we could prevent people undergoing mastectomy from losing sensation after the surgery. We developed a new technique for preserving sensation during mastectomy and implant reconstruction that combines the latest advances in breast oncologic, reconstructive, and peripheral nerve surgery. This procedure introduces the concept of nerve preservation and grafting for restoration of sensation following immediate implant breast reconstruction as a viable option for breast cancer patients.

We have been so excited to see our patients keeping their sensation after mastectomy and implant reconstruction, making it a much more attractive option for people who have been diagnosed with cancer and those who are considering preventive mastectomies, or “previvors.” We hope that as more and more people become aware of the prospect of numbness they will likely face after a mastectomy, breast cancer patients and previvors will seek out the option of sensation-preserving mastectomies, encouraging more surgeons to become trained in these techniques.

We should continue to raise awareness about breast cancer and support these patients who have battled this disease through fundraising, events, and research support. However, it’s equally important to understand the potential long-term impact breast cancer treatment can have on patients. While loss of sensation can be truly daunting, evolving options can help patients move past their breast cancer and continue to thrive.

Studies referenced:

Chirappapha, P., Srichan, P., Lertsithichai, P., Thaweepworadej, P., Sukarayothin, T., Leesombatpaiboon, M., … Kongdan, Y. (2017). Nipple-Areola Complex sensation after nipple-sparing mastectomy. The Breast, 32. doi: 10.1016/s0960-9776(17)30390-9

Oberguggenberger, A., Martini, C., Huber, N., Fallowfield, L., Hubalek, M., Daniaux, M., … Meraner, V. (2017). Self-reported sexual health: Breast cancer survivors compared to women from the general population – an observational study. BMC Cancer, 17(1). doi: 10.1186/s12885-017-3580-2

Sun, L., Ang, E., Ang, W. H. D., & Lopez, V. (2017). Losing the breast: A meta-synthesis of the impact in women breast cancer survivors. Psycho-Oncology, 27(2), 376–385. doi: 10.1002/pon.4460