Breast Cancer Surgery - Kim Reed, MD

Ask A Doctor
Kimberlee Reed, MD
Breast Cancer Surgery
 

Q: Is it better to have a mastectomy rather than a lumpectomy?
A: There is no difference in recurrence rates or survival between women who have a mastectomy for breast cancer and those who have breast conservation (which is a lumpectomy followed by radiation). This is only true if a patient having a lumpectomy has radiation treatment afterward; otherwise the risk of recurrence is much higher. So if a woman chooses to keep her breast and not have a mastectomy, the trade-off is that she needs to have radiation treatment.

There are a few situations in which a mastectomy is absolutely necessary--for example, a woman with more than one tumor in different areas of the same breast, or with a very large tumor, or a patient who cannot tolerate radiation treatments would not be a candidate for breast conservation. In the vast majority of breast cancer patients, however, there is no difference in outcomes whether one has mastectomy or lumpectomy, and the choice is really a personal one.

Q: How long is a typical recovery from lumpectomy versus mastectomy? If lymph nodes are also removed, does recovery take longer?
A: A typical recovery from a lumpectomy is quite short. Patients go home the same day, and may resume normal activities within a day or two. Usually they will be told to avoid strenuous activity involving the upper body for a few weeks.
A mastectomy can be done as an outpatient procedure, at least according to Medicare guidelines, but all of my patients spend at least one night in the hospital. After a mastectomy, the patient will have drains in place for about a week, and will usually benefit from some physical therapy so that they don’t develop a frozen shoulder. The usual lymph node biopsy done to stage breast cancer typically doesn’t add a lot of time or pain to the recovery.

Q: Are patients ever referred for physical therapy following breast cancer surgery?
A: I often refer patients for physical therapy after breast cancer surgery. After a mastectomy, patients are often timid about moving the arm on the side of the surgery, and the chest and shoulder muscles can become tight, limiting their range of motion. This can also happen after radiation to the chest wall. Physical therapy techniques can help prevent or reverse this problem.

Q: What is lymphedema? How can lymphedema be prevented?
A: Lymphedema is swelling, usually in extremity, due to a blockage or abnormality of the lymph drainage system. It is usually irreversible and can be quite disabling. Lymphedema can be caused by surgery to remove lymph nodes. In the past, breast cancer patients often underwent removal of most of the lymph nodes in the underarm area as part of their treatment; 40% of these women developed lymphedema of the arm on that side. Since the development of the sentinel node biopsy, a procedure in which only one or a few lymph nodes are removed, only about 5% of patients develop arm swelling.

Q: How do surgeons and oncologists work together? Who else is involved in the medical care of a breast cancer patient?
A: Treatment of breast cancer actually involves several different disciplines of medicine. Several physicians will work together to care for a single patient. Most often, the patient’s primary care physician or gynecologist will discover the cancer, or it will be found by a radiologist reading a routine screening mammogram. The surgeon will operate to remove the tumor, and to check for spread of tumor to the lymph nodes. Sometimes a patient will have the entire breast removed, and then have the breast reconstructed by a reconstructive surgeon. A pathologist will evaluate the tissues that are removed to help determine the type of cancer and the stage of the cancer, and look for any markers or receptors that may point out “weak spots” in the cancer that can be targeted with different medications. Once the main tumor has been removed, the patient will need to see a medical oncologist, who will treat any cancer that may have spread and help the patient reduce her risk of recurrence. The medical oncologist will often follow the patient for many years. If a patient needs to have radiation, she will also work with a radiation oncologist. Patients thought to be at risk for carrying the “breast cancer gene” may also meet with a genetic counselor.

Q: How do you know that all of the cancer has been removed?
A: When a cancer is removed during surgery, it is sent to the pathologist, who will study it extensively to determine the type of cancer, whether it has spread to lymph nodes, and various characteristics of the cancer that may help the medical oncologist and the patient choose the best method of fighting it and preventing a recurrence. The pathologist will also examine all of the edges of the tissue that has been removed, the “margins”, under a microscope, to make sure it doesn’t look like there is cancer at the edge of the specimen, which could indicate that some tumor was left behind.

Bio:
Kimberlee Reed, MD, is a general surgeon with Sierra Surgical Associates in Sonora and has treated hundreds of women with breast cancer.

She attended Central Catholic High School in Modesto and went on to Harvard University. She earned her medical degree from McGill University in Montreal and completed her seven-year surgery residency at UCLA in 2001. Following her residency, she practiced at Scripps Clinic in La Jolla and at UCLA Medical Center. She moved to Sonora in 2007.

Dr. Reed had a science teacher in junior high who encouraged her to consider medicine as a career. Taking her advice, Dr. Reed found three doctors in Modesto who served as mentors, telling her about their work and taking her on rounds.

Dr. Reed loves her work. “I can’t imagine any other job that would make a person feel so good inside,” says Dr. Reed. “I have the honor of being part of my patients’ lives at a time when they are really in need. It is truly a privilege and a blessing to be able to help people and be there for them.”