C (44:26)
I mean, I can't attest to that kind of recommendation from anybody because usually, you know, as a surgeon we all look at the imaging and we, I mean, I do tell patients you may lose your nipple. If I go in there and your margin is positive, we may have to go back and take it out. I have done enough of these that I feel like we have removed. I mean, in my past, you know, when I first started, when I was young and fresh and bushy's bright eyed and I wanted to do everything, you know, kind of like, you know, kind of what every, a lot of, a lot of other people were doing, which was removing nipples in the setting. And I would look at the final pathology and notice that the nipple was not involved. And I kind of felt like this is not right, this doesn't feel good. And so I was like, you know what, I rather remove it after because it's a smaller procedure. You can do it in an office. It's, you know, if you need it, then the discussion with you and I would have been a different discussion. I would have been like, Amanda, you need to have this nipple. And then you would have said, Lucy, you did everything I, you could. And I'm and that's usually the kind of response that I get from losing a nipple. Because they're positive, right? The patient will be like, you know what? At least we gave it a shot. And so I feel that in my mind there's no harm by doing that. We test it, we sample it, and like, you know, in the pathology department, the pathology comes back. My plastic surgeon will take you back a week later. And usually they'll either do it in the office or they'll do it in the operating room. But it takes like 15 minutes to remove that nipple that's been affected. It's really, you know, incredible how many young women are getting diagnosed with breast cancer. And I mean, I've been in practice for 12 years. And I remember when I went to medical school and I graduated in 2004, we learned that breast cancer was a disease of the aging. And I think the, the counseling today for women is a completely different counseling than maybe the one that my mom got as far as her breast surgery. And you know, she had a small tumor, she had a lumpectomy, she's 75. You know, the younger women who have a longer life expectancy, they want to reduce that risk of local recurrence, although there is no survival difference. Right. But they're always worried. They're like, well, I'm going to have to get an mri, a mammogram, am I going to have to do more biopsies? And a lot of the biopsies and a lot of, I mean, the mastectomies that we do are not really for oncologic reasons. They're really because the patients want peace of mind, patients want symmetry, and patients don't want to have a six month follow up with then followed biopsies and things like that. Because oncologically there's no difference. A lumpectomy and a mastectomy oncologically have the same survival. They have a slow, a lower recurrence rate. But the survival is not impacted by my surgery by doing bilateral mastectomy. Now, when we talk to younger, and we'll talk about that if you have, if you want to talk about it. But when we talk to younger women, what they want to do is if I'm going to have a surgery, I want to look symmetric. I want to be able to get naked and have intimacy without feeling like I have to explain myself or, or be unsure, be shy. I mean, you know, I remember when I got divorced, I was like, oh my God, how am I going to date again? You know, I just had Babies. My body's. I'm in my 40s. Like, my body's changing. Imagine going through that. And then also, like, having to make this decision, being single or being, you know, with. In a relationship and having, I mean, I don't know, just insecurities about your, like your sexuality after and dealing with all of that. These are things that we talk to patients about. And I significantly feel that that's one of the things that I thank my mentor for, because she brought that to light to me. She would talk to women about it. She would talk to me about it. She said, you know, we are touching women's lives and make sure that that touch that you do is the best touch that you will ever do, because it's the one touch that will be there in their lives forever. But if they have great outcomes, that's the biggest satisfaction and the biggest gift that I can do to a patient. To give that to them, you know, to be able to give them that opportunity to be cancer free, to look and feel good.
