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Published on October 08, 2019

Treating the Unseen Effects of Breast Cancer

Hidden Scar Surgery

Losing a breast to cancer can lead to a myriad of emotions for a woman, according to Hyannis breast surgeon Kathryn H Dalton, DO, FACS.

“Our breasts are a symbol of womanhood…of motherhood, and our ability to nurture another human being,” she said.

For that reason, she tries to dissuade patients from having double mastectomies unless they carry a genetic predisposition. The BRCA1 and BRCA2 mutations dramatically raise the lifetime risk of developing large or multiple breast or ovarian cancers, according to the National Cancer Institute.

“Ninety percent of mastectomies (in the U.S.) aren’t medically necessary,” she said. “Patients are requesting them out of fear.”

Dr. Dalton, who specializes in breast cancer surgery at Cape Cod Hospital, said she works to minimize surgical damage to breast appearance. She uses techniques to spare the nipple and surrounding areola, when possible, and works to hide scars in natural body folds. In some cases, particularly with older women, she performs a breast lift.

Patients seeking or needing mastectomies may not realize the effect breast removal may have on them and their relationships, she said. They will be facing a body that looks different, perhaps with a smaller or scarred breast, or missing one or both breasts.

According to the American Cancer Society, it’s common for women to feel less attractive after breast surgery. Some become self-conscious during sex, may not want their breast or scar area touched, or lose sensitivity there.

Radiation treatment after surgery may result in skin burns, and chemotherapy can cause lack of energy, temporary hair loss, stomach upset, and weight loss or gain, according to the American Cancer Society. Hormone treatment can bring on symptoms of menopause: hot flashes, vaginal dryness and changes in menstrual cycle.

These post-surgical challenges can be difficult for patients and their partners to face, Dr. Dalton said.

She advocates for patient’s health and their quality of life and, for that reason, she doesn’t wait for patients to bring up any concerns about sexuality and self-image.

“I always break the ice,” she said. She tries to maintain that open communication through annual visits.

Many Options

There are many options to improve the lives of breast cancer patients, Dr. Dalton said. They may include referral to a plastic surgeon for breast reconstruction, getting them fitted for breast prosthesis, and working with their oncologist to reduce ill effects of radiation and chemotherapy.

Some patients are reluctant to ask for a breast reconstruction, but Dr. Dalton said she sees no difference in the need for a prosthetic leg for an amputee and a breast reconstruction for one of her patients. Reconstruction can improve appearance and help clothes fit better. Patients who are not interested in breast reconstruction can be fitted for breast prosthetics.

Other patients tell her that they feel vain asking for reconstruction after breast cancer surgery.

“It’s giving back what we took away,” Dr. Dalton said. “It has nothing to do with vanity.”

Nor does it have to do with age. Dr. Dalton said her oldest reconstruction patient was a 102-year-old who had undergone a double mastectomy.

For patients and their partners struggling emotionally with the aftermath of surgery, she will recommend individual or couples therapy.

A number of women’s cancer and breast cancer support groups exist on Cape Cod, including Better Together, a group for young women, Dr. Dalton said. There is also Cape Wellness Collaborative, which provides free integrative wellness therapies, such as massage, yoga and nutritional counseling, to Cape and Islands residents with cancer. Dr. Dalton is the nonprofit organization’s medical director.

“The mind-body-spirit is very important to me,” she said.

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