Reframing the Discussion for Surgical Options After Breast Cancer

[00:00:00] Adam Walker: From Susan G. Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.

After undergoing a mastectomy, women can either proceed with a reconstruction or go flat, but today’s guest says the correct decision is what’s best for the patient. As an Oncoplastic breast surgeon at City of Hope Chicago, Dr. Carolyn performed surgical procedures for patients with breast malignancies ranging from the earliest to advanced stage of disease.

Dr. Bhakta works closely with her patients to understand their cancer needs and goals, to identify the most appropriate surgical options and to heal patients both physically and emotionally. When it comes to breast cancer surgery, there are no wrong decisions, only personal decisions here today to discuss the very personal choice that some women make to go flat and help change the narrative. Surrounding it is Dr. Carolyn Bhakta. We are honored to have you on the show. Welcome. 

[00:01:10] Dr. Carolyn Bhakta: Oh my goodness. Thank you so much for having me. This is so exciting. And thank you for bringing attention to this very important topic. 

[00:01:18] Adam Walker: Yeah, I mean we, I think I maybe talked about this one other time, but I feel like it’s really important to kind of explore that there are other options in this area. And I don’t think we talk about it enough. So I appreciate you coming on the show to talk about this. So let’s start today by telling listeners a little more about you and your practice. What can you tell us about Oncoplastic surgery and how did you realize that this was something you wanted to specialize in?

[00:01:43] Dr. Carolyn Bhakta: Yeah, so I think ultimately the reasons that brought me into this, specialty to begin with were my desire to improve women’s health and my interest in breast cancer surgery and treatments. So, breast cancer treatment is not only getting better and better but we’re able to cure more women than ever before.

So, what I do is breast cancer surgery. I perform surgeries to excise breast cancer tumors, and I also perform lymph node surgery as well. Oncoplastic surgery is the combination of breast cancer surgery with plastic surgery techniques and principles so that not only do I remove the tumors but I’m able to put the breast back together while making it look nice and pretty, so there’s no dent or holes where the original tumor is located. We essentially rearrange the tissue so that we can reform the breast shape. And in fact, my goal is to actually leave the breast looking even better than when I started. 


[00:02:50] Adam Walker: That’s a great definition.

I appreciate you making that accessible to those of us that are not medical professionals. So, like, walk me through what typically happens when a woman comes to you for their initial appointment. Like, what does that look like? 

[00:03:04] Dr. Carolyn Bhakta: This is such a great question. I think before I see any patient in the office, I definitely do my homework and I review all the necessary records prior to our consultation. It’s a little like playing detective, kind of putting all the pieces together. And so when I finally get to meet the patient sort of face to face; this is the chance that I get to hear from the patient themselves, what their journey has been like, how they’re processing their diagnosis. And you know, getting a sense of where you know their preferences are and where their heads at. And so when I gather all these pieces of information, then it’s really only then that I can start making an individual and personalized treatment plan for that patient. So, ultimately I tell the patients when we’re in our consultation that we have two goals. So, one is we’re gonna get rid of your cancer, and number two is that we’re gonna make sure it doesn’t come back.

So, anything that we suggest or recommend for treatment plans really falls within those two. Goals. And as a surgeon, I’m usually part of the getting rid of it part and we perform surgery and so the remaining treatments sometimes that are involved in breast cancer care, like radiation or medicine, they’re really kind of geared toward the prevention of recurrence or making sure cancer doesn’t come back.

So I think the one thing too that I remind patients, while we’re in our conversation is that every tumor and every breast cancer is different, and so no two cancers are alike. And also that means that their journeys and their treatments may look very different from another family members or friends.

So I think that’s really important. 

[00:04:49] Adam Walker: Yeah. Yeah, that, I mean, that is important I think, because a lot of times we sort of say like breast cancer as if it’s this uniform thing that happens exactly the same way to everyone. And obviously that is, that could not possibly be further from the truth. So you mentioned that every case is different. You mentioned you do your homework before that initial consultation. What are some of the most common surgical options and how do you go about educating your patients about those options? 

[00:05:13] Dr. Carolyn Bhakta: Yeah. So kind of, going back to yeah, that everything is different and personalized, is that the common things that I hear are sometimes you know, coming from a patient, they’ll say, well, my friend had this done, or my family member had this treatment; she told me I need this too. And so, it’s a little difficult because we really have to, acknowledge the fact that yeah, you know, they have these experiences. They’re only trying to help. But again, every patient’s different. And so that’s why when we go to the drawing board, we really have to do our education so that we understand what some of our options are. For me, I really try and break this part down more simply because I consider myself as a guide. I am one of the patient’s treatment members. I am not, trying to overlook, telling them what they need to do. I really try and be a part of that decision -making process. I am part of the team and the patient is just as important as I am in this team.

Generally, when I start talking about surgery and the options, we generally break it down into two parts. So the first thing is that we focus on the breast itself and getting the disease out that, exists within the breast. So there’s generally two ways to do this, and I kind of explained that, back 30 or 40 years ago. We didn’t have fancy technology. If you got diagnosed with breast cancer, you got a mastectomy surgery and that is the removal of the breast. There were no other options. And so today we’re finding, you know, with our screening techniques and our newer technology, we’re finding smaller and smaller cancers. So it makes no sense now to remove the a person’s entire breast for maybe cancer that’s the size of a pea, for instance. 

[00:07:06] Adam Walker: Right. 

[00:07:06] Dr. Carolyn Bhakta: So that’s where the idea of lumpectomy was really born was because, someone thought, well, what if we just cut out the area of the cancer and leave the normal tissue behind?

Is that gonna be safe? Is it gonna be okay? And we know that through research and everything else. The answer is yes, it is safe, it is okay. So what’s nice about that option is that it allows women to be cancer free, they save their normal non disease parts of the breast, and in essence they can, preserve sensation and they can still feel sometimes in a lot of ways whole.

Okay. Yeah, I think not all women are eligible for, these different surgical options and it all depends on how much disease is there, how much reserve of breast tissue they have. So it depends on what their size is to begin with and whether or not we feel like once we remove that tumor can we rebuild the breast using the remaining tissue or is it just not gonna look good enough? Because we do care about the cosmetics and healing. We want them to heal well and heal without complications, or that we don’t want any wounds or breakdowns of the incisions, things like that. So we, there is a lot that goes into that kind of planning. But I think when you start to get a better feel for what people’s preferences are, then we can start guiding them toward what might be the best option for that patient for them.

So, yeah, so you mentioned like women will come in and I’ll say, oh, my, my friend had this, or my family member had this. They already kind of come in with a preconceived notion of sort of what they think they need. Are they surprised to realize that there are like a lot of different options and how do they typically respond to that?

Yeah, I think it sometimes, it depends. I think some patients come in to start to hear all their options. They’re a little nervous about doing their own research cause they’re not sure who to trust or what websites to trust. And so when they come in to see me, I think they’re surprised that there is more than one option. And I think they’re thankful for that actually. They’re pleasantly surprised in some ways. I do have other patients though that really do their homework and research before they even come to see me. So they’re in some ways they’ve had a little bit more background and so they, they already can maybe have a notion of what maybe they like.

However, I’ve definitely had, experiences where a patient will come in and think they want one thing, and then we really talk through the pros and the cons of each sort of decision. And when we do that, then sometimes patients are like, “oh, well maybe I think I want this.” And it’s okay to change your mind. I tell them there’s, you don’t have to make any, permanent decisions today. This is the background, this is the info session. This is just the starting off point. And we can easily kind of go from there to, figure out what’s gonna be best for you because ultimately it’s their decision, but also they’re gonna have to, going forward into the future, they have to be comfortable with that, with the decision they have to be okay with that decision. 

[00:10:13] Adam Walker: That’s right. That’s right. And so I mentioned this in the intro and I want, so I wanted to make sure I asked about it sort of during our conversation. Can you talk a little bit more about kind of the growing trend of going flat and how do you think through that or talk through that with a patient?

[00:10:31] Dr. Carolyn Bhakta: Yeah. So, I mean, what you’re basically referring to is when we start talking about mastectomy surgery. 

[00:10:39] Adam Walker: Right. 

[00:10:39] Dr. Carolyn Bhakta: So, once we start talking about mastectomy surgery and removing the breast, generally you have two options. One is once we remove the breast, we do nothing. We actually just kind of close up the skin, and that is called going flat. It’s basically using your own. Skin to sort of make an incision and close it over the chest wall, and the remaining form is such that it’s almost like a flatness to the chest wall. The second option, I would say, is a option for reconstruction of the breast. So there’s different ways to reconstruct a breast and reform a breast bound, and that’s when we start involving some of the extra team members, like plastic surgeons who do some of these very complex reconstructions. But maybe that option isn’t, basically for everybody. It, you know, it, it involves extra surgery, it involves extra healing time and the potential, we’re introducing the potential for complications even more so if we’re doing more surgery. For some women that’s a risk that they may not want to take. And that’s okay. I mean, going flat is a very personal decision and so, we kind of talk about what that looks like too after, when we’re talking about this, we want them to really understand what they’re sort of signing up for, but what some of the options are after going flat. Because going flat doesn’t necessarily mean they have to go without, and I think that’s the common misconception because we actually have available. In multiple areas in the state and in the country where they’re starting to build these boutiques that are just for breast cancer patients, and they sell basically prosthetics, bras, wigs, all kinds of different breast cancer attire. And so, they even have swimsuits that are specifically built for women that have had mastectomy surgery or breast surgery. And so it’s getting to be a little bit more normalized, but also at these specialized stores, they’re fitting these garments specifically for the patient. It’s not a one size fits all. It is personalized and really kind of made for that body type so that when they wear clothes, no one can tell. 

[00:12:56] Adam Walker: That’s fantastic. I did not know that these boutiques existed. That’s really kind of encouraging. So, so you mentioned the nature of the decision, it’s a very personal decision.

It’s a very sort of difficult decision. I wonder if you could talk through how do you walk your patients through that decision making process? 

[00:13:14] Dr. Carolyn Bhakta: Yeah. Some of the hesitation of maybe, “going flat.” Might be because that patients feel like they might be looked at differently. And I think also we can’t ignore the fact that sexually too, that might be something that is very important to a patient and something that can’t just be overlooked. Sometimes it’s part of individuality and so everybody thinks about their own body differently. So until society has really embraced the differences in body types and that women’s bodies may take on different shapes and forms, I think we’re still gonna see some bias. So I think talking about it is the first step. But then also acknowledging that these are some of the, maybe fears or limitations that people have, but really kind of, preparing them for what that looks like after surgery. Also, kind of mentioning these things that they can do afterwards to still have it and feel like they have a shape underneath clothes. But also too, at the end of the day, their doors are completely closed. Sometimes they can still even be eligible for reconstruction of the breast. Down the road should they change their minds. So it’s not something that may be completely permanent and that’s it. It is something that if they do kind of, go through and say, “you know what, actually I think I would like a reconstruction,” but I can do it on my own time because now I’m not, faced with the timeline of getting rid of cancer. Now I have the freedom to really do this when I’m ready. And that’s also an option too. 

[00:14:56] Adam Walker: Oh, okay. I did not realize that. I appreciate you sharing that. So, I wonder related to like the question of going flat, like could it, like, from your perspective, do people sometimes just sort of need the validation that it’s okay to make that choice because it’s just not really talked about a lot?

[00:15:13] Dr. Carolyn Bhakta: Yeah. Sometimes, and I think all of these options, again they’re very personalized, but I think, you know, when I mentioned that they’re not alone and that many patients are actually choosing this and they don’t feel like they’re the only person that’s doing this, right. 

[00:15:31] Adam Walker: Yeah. 

[00:15:31] Dr. Carolyn Bhakta: So sometimes, we have, what’s nice about our cancer center is that we have support groups and we have these patient groups that actually are aligning with some of these surgical options so that they don’t feel alone and they can start to talk to other women who have already had this type of surgery, and then they can sort of see what their experience has been. So we really try and, kind of, hook those patients up so that they can talk through it. Really kind of get a sense of, “is this really for me?” And then that’s how sometimes they can make their decision. But yeah, they feel like they’re not alone. The more we talk about it, the more they’re starting to say, okay “this is a valid option and this is okay.”

[00:16:16] Adam Walker: Yeah. It is, it’s a valid option. It is. Okay. And there are people that have been through it and that can support through it as well. So, so you speak about this with a lot of passion. I’m curious, like, where does the passion come from? Why are you passionate about this? 

[00:16:30] Dr. Carolyn Bhakta: Yes. I think one word is choice.

I think it’s just so important for patients to have a voice and to be able to choose their own path. Being able to make the right choices is also reliant on having the most accurate information. And there are some really good, reputable websites and resources out there, but then there’s some not so reputable resources and it’s hard to know who to trust or what to trust. I think finding a provider who is an expert on these topics is necessary to really guide patients through this sort of very complicated process. And so for me it means just, education is key. For my patients I really kind of lay all the cards on the table. I try to help them navigate. I give patients even information to take home so that once they are ready to process a little more, they can start reading through you know, some of these sort of booklets and handouts that I’ve provided. And then I give patients actually time to, to process too, and to speak with family members and friends. And then we sort of regroup. I think what’s really important, because at the end of the day it’s, it really has to, you have to give patients time to let things sink in and sort of really kind of feel like, you know, get their own feeling about things so that they can start really listening to themselves, their bodies, their preferences. And that may be that we talk with our patients several times throughout the process before they make a decision. I do a lot of telehealth and phone calls and things because, as we go along, new questions come up or, things they hadn’t thought about maybe in the past, they are now wanting to explore. So, we really do make this process something that is well thought out so that by the end, patients are more comfortable with their decisions. 

[00:18:29] Adam Walker: I mean, I really appreciate you sharing about how you give patients time to let their options sink in and to really make an informed decision. Because I think for some reason in my mind, like it was kind of this scenario where you sit down across the table from a doctor, they give you the options.

You just pick one right then, and then that’s your trajectory. And of course I’ve obviously never experienced anything like that but I, but that’s where my brain immediately goes. And I imagine I’m not alone in that. So I appreciate that, that this is a process that you’re walking patients through step-by-step so that they can make the right decision for themselves.

That was in incredibly helpful. So, alright, so, last question and this has been great. What final advice do you have for women that might be currently weighing their own surgical options? 

[00:19:15] Dr. Carolyn Bhakta: Yeah, so I think this can probably be best described in what I actually tell my patients whenever I see them. Is that number one, you gotta just listen to your heart and what your mind and body are truly telling you because only you can know what’s right for you and this is your journey and no one else’s. At the end of the day, our goal is to have people feel good about their decisions moving forward. And when you think back, you can be at peace at the choices that you’ve had to make at that time at very difficult time, a lot of times in people’s lives. And I think this is really the key part to overall wellness and ultimate healing. 

[00:19:57] Adam Walker: That’s great. That’s great advice! Well, Dr. Bhakta, I appreciate you coming on the show. Appreciate the work that you’re doing, how important it’s, and just your approach just seems so methodical, so kind, and so, well done. 

So thank you for joining us on the show today. 

[00:20:12] Dr. Carolyn Bhakta: Oh, thank you. It’s been a pleasure. 

[00:20:15] Adam Walker: Thanks for listening to Real Pink, a weekly podcast by Susan G. Komen. For more episodes, visit and for more on breast cancer, visit Make sure to check out at Susan G. Komen on social media. I’m your host, Adam. You can find me on Twitter at ajwalker or on my blog