Podcast Summary

We Can Do Hard Things

Episode: Life-Saving Intel: Amanda's Breast Cancer Surgeon Dr. Lucy De La Cruz
Date: October 21, 2025
Hosts: Glennon Doyle, Abby Wambach, Amanda Doyle
Featured Guest: Dr. Lucy M. De La Cruz

Overview

This special episode, released for Breast Cancer Awareness Month, centers on Amanda Doyle’s decision to publicly share her breast cancer experience and the immense ripple effect of that transparency. The Pod Squad reflects on how sharing personal, tactical health information—rather than just increasing "awareness"—can literally save lives. The episode also features a deep-dive conversation with Dr. Lucy De La Cruz, Amanda’s breast surgeon, demystifying breast cancer detection, treatment decision points, and the urgent need for patients to advocate for themselves.

Key Discussion Points and Insights

The Power of Information Over “Awareness”

Amanda shares her frustration with the typical “awareness” activities, like pink shirts, preferring actionable information over symbolic gestures.
Theme: The massive gap between awareness (knowing the problem exists) and concrete, usable steps is what creates anxiety and helplessness.
Amanda: “Awareness without a plan is anxiety.” (05:44)

Listener Impact Stories (Voicemail Segment, [09:36]-[13:12])

Three Pod Squad members describe how Amanda’s episodes prompted them to push for extra screening, which led to life-saving early diagnoses—sometimes when mammograms had not detected anything.

Notable Quote:

“Because just sharing information does nothing ... What is so remarkable is the people who have heard the information and then gone to do something about it.”
— Amanda (03:38)

The Critical Issue of Breast Density (~[14:22]-[25:19])

Amanda explains the four categories of breast density (A, B, C, D), with a focus on why mammograms miss cancer in women with very dense breasts (Category D: 1 in 10 people with breasts).
Half the population falls into dense categories (C & D), yet they often aren’t told these categories specifically.
Key Fact: 50–60% of breast cancers in those with dense breasts may be missed by standard mammograms.
Advocacy Required: For dense breasts, especially Category D, MRIs—rather than ultrasounds or 3D mammograms—are crucial. Insurance may push back, so patients must insist and even use documentation/podcast episodes to advocate.
Mini-MRI Option: For those blocked by insurance, a mini-MRI (about $500 out of pocket) exists and is diagnostically effective.

Notable Quote:

“If you are category D, what you need to do ... is advocate for yourself to have the MRI ... It shouldn’t have to be the case. It’s bullshit that it is, but it is bullshit. So now we just have to advocate for ourselves.”
— Amanda (22:13)

Incredible Serendipity & Community: Finding the Right Surgeon ([26:29]-[29:35])

Amanda shares the emotional connection with a woman named Lori who found her way to Dr. De La Cruz after hearing the podcast, emphasizing the community impact of open sharing.

In-Depth with Dr. Lucy De La Cruz ([33:27]-[108:43])

Dr. De La Cruz’s Philosophy ([35:21]-[41:35])

Women deserve choices and honest, full information—every option should be named.
Informed consent isn’t real unless patients know their alternatives.
Prioritizing both oncological safety and cosmetic/psychological outcomes (“oncoplasty”).

Notable Quote:

“When women come to me, I want to make sure this ... is not a defining moment that makes them feel like they lost something. We all lose something through breast cancer ... but my job is to make sure when they’re done surgically, they still are able to recognize themselves.”
— Dr. De La Cruz (39:18)

Major Surgical Decision Points

1. Lumpectomy vs. Mastectomy ([48:24]-[56:23])

Lumpectomy: Removes only the tumor and part of the breast—frequent monitoring afterward is required; recurrence risk is 0.5–1% per year, compounding.
Mastectomy: Removes virtually all breast tissue—recurrence risk up to 8% over a lifetime; eliminates the need for long-term monitoring.
Personal Factors: Breast size, cancer-to-breast tissue ratio, patient’s comfort with ongoing risk/monitoring, peace of mind.
Psychosocial Impact: Symmetry, sexuality, and intimate relationships factor heavily in decisions.

2. Direct-to-Implant (Single Surgery) vs. Expanders (Two Surgeries) ([67:10]-[77:12])

Old Standard: Mastectomy + expanders; patient heals, then returns for reconstructive surgery.
De La Cruz’s Practice: Immediate ("direct-to-implant") reconstruction whenever feasible, requiring only one surgery and recovery.
Why Not Offered Everywhere: Some surgeons are not trained or comfortable with the technique; tradition lingers in older practice patterns.

Notable Quote:

“If I had breast cancer tomorrow and needed a mastectomy, I would have direct implant. ... Why not?”
— Dr. De La Cruz (76:56)

3. Resensation (Nerve Grafting for Sensation Recovery) ([77:13]-[96:20])

Most women are not told they’ll lose all breast (and nipple) sensation with mastectomy; sexual and personal identity impacts are profound.
Dr. De La Cruz and a pioneering group now routinely add nerve grafting, greatly increasing the chance of meaningful sensation recovery (“It takes 15 extra minutes to give you a whole life of feeling”—95:03).
Insurance: Most major carriers now cover; remaining resistance requires advocacy.

Memorable Exchange:
Amanda, on default nerve loss: “Can you freaking imagine a world in which something was going to happen to men’s testicles ... and the standard of care was: we don’t even mention it?” (80:40)

4. Nipple-Sparing Mastectomy & Margins ([99:01]-[101:41])

Many women are told preemptively they must lose their nipples; Dr. De La Cruz advocates removing after pathology if needed—not before (“All nipples are innocent until proven guilty”).

5. Lymph Node Removal / Sentinel Lymph Node Biopsy ([103:15]-[108:18])

Past standard: always remove lymph nodes with mastectomy. Now: For stage 0 (DCIS), only if truly needed.
New technique ("Mag trace") allows identification and delayed removal if (and only if) invasion is proven, sparing 95% of women unnecessary surgery.

Dr. De La Cruz:

“I don’t want anything removed from my body if I don’t have to have it removed. … For DCIS with mastectomy, using the mag trace injection ... is practice changing.” (107:54)

Notable Quotes & Moments

Amanda, on mammograms missing 50%+ of cancers in dense breasts:
“It’s a flip of a coin. ... If you are category D, you absolutely cannot rely on your mammogram.” ([19:46])
Abby, on wanting to “report” doctors who gatekeep MRIs:
“It would be nice to have a place we could report doctors who don’t approve the MRI.” ([24:41])
Dr. De La Cruz, on training the next generation:
“Never stop learning. When you stop learning, it’s not just you who gets stuck, but your patients who don’t get the best of the best.” ([38:40])
Amanda, summarizing the episode’s purpose:
“You’re going to send this episode to every person you know who has breasts, as a gift to them.” ([30:39])

Timestamps for Key Segments

Opening Theme & Setting the “Awareness vs. Information” Debate: 00:10–06:00
Listener Life-Saving Voicemails: 09:36–13:12
Breast Density, Advanced Screening, and Advocacy Guidance: 14:22–25:19
Amanda’s Story of Community Impact: 26:29–29:35
Amanda & Dr. De La Cruz Deep Dive: 33:27–108:43
- Choices in Breast Surgery: 48:24–56:23
- Direct-to-Implant Insight: 67:10–77:12
- Resensation and Sensation Loss: 77:13–96:20
- Decision-Making about Nipples/Lymph Nodes: 99:01–108:18

Conclusion

This episode transforms breast cancer awareness into real, tactical, potentially life-saving action, advocating for self-advocacy and information-sharing. Dr. De La Cruz’s candor empowers listeners with vital questions and options they may not ever have been told exist. Above all, “We Can Do Hard Things” models how vulnerability, shared knowledge, and relentless advocacy—combined with wise, patient-centered medical care—can tangibly change and save lives.

Resources/Recommendations

Send this episode (and its show notes) to anyone with breasts.
Ask your healthcare provider:
- Your breast density category (A, B, C, D)
- Whether additional screening (MRI) is needed for Category C/D
- Surgical options and stats for any planned procedure (revision rates, nerve preservation, etc.)
For those denied advanced imaging: Consider a mini-MRI out of pocket; bring evidence and resources to appointments in writing.

Final Note:
For anyone at any point in the breast cancer “hullabahoo,” this episode provides both a map and a rallying cry: self-advocacy isn’t selfish—it's loving, vital, and often life-saving.

Podcast Summary

We Can Do Hard Things

Overview

Key Discussion Points and Insights

The Power of Information Over “Awareness”

Amanda shares her frustration with the typical “awareness” activities, like pink shirts, preferring actionable information over symbolic gestures.
Theme: The massive gap between awareness (knowing the problem exists) and concrete, usable steps is what creates anxiety and helplessness.
Amanda: “Awareness without a plan is anxiety.” (05:44)

Listener Impact Stories (Voicemail Segment, [09:36]-[13:12])

Three Pod Squad members describe how Amanda’s episodes prompted them to push for extra screening, which led to life-saving early diagnoses—sometimes when mammograms had not detected anything.

Notable Quote:

“Because just sharing information does nothing ... What is so remarkable is the people who have heard the information and then gone to do something about it.”
— Amanda (03:38)

The Critical Issue of Breast Density (~[14:22]-[25:19])

Amanda explains the four categories of breast density (A, B, C, D), with a focus on why mammograms miss cancer in women with very dense breasts (Category D: 1 in 10 people with breasts).
Half the population falls into dense categories (C & D), yet they often aren’t told these categories specifically.
Key Fact: 50–60% of breast cancers in those with dense breasts may be missed by standard mammograms.
Advocacy Required: For dense breasts, especially Category D, MRIs—rather than ultrasounds or 3D mammograms—are crucial. Insurance may push back, so patients must insist and even use documentation/podcast episodes to advocate.
Mini-MRI Option: For those blocked by insurance, a mini-MRI (about $500 out of pocket) exists and is diagnostically effective.

Notable Quote:

“If you are category D, what you need to do ... is advocate for yourself to have the MRI ... It shouldn’t have to be the case. It’s bullshit that it is, but it is bullshit. So now we just have to advocate for ourselves.”
— Amanda (22:13)

Incredible Serendipity & Community: Finding the Right Surgeon ([26:29]-[29:35])

Amanda shares the emotional connection with a woman named Lori who found her way to Dr. De La Cruz after hearing the podcast, emphasizing the community impact of open sharing.

In-Depth with Dr. Lucy De La Cruz ([33:27]-[108:43])

Dr. De La Cruz’s Philosophy ([35:21]-[41:35])

Women deserve choices and honest, full information—every option should be named.
Informed consent isn’t real unless patients know their alternatives.
Prioritizing both oncological safety and cosmetic/psychological outcomes (“oncoplasty”).

Notable Quote:

“When women come to me, I want to make sure this ... is not a defining moment that makes them feel like they lost something. We all lose something through breast cancer ... but my job is to make sure when they’re done surgically, they still are able to recognize themselves.”
— Dr. De La Cruz (39:18)

Major Surgical Decision Points

1. Lumpectomy vs. Mastectomy ([48:24]-[56:23])

Lumpectomy: Removes only the tumor and part of the breast—frequent monitoring afterward is required; recurrence risk is 0.5–1% per year, compounding.
Mastectomy: Removes virtually all breast tissue—recurrence risk up to 8% over a lifetime; eliminates the need for long-term monitoring.
Personal Factors: Breast size, cancer-to-breast tissue ratio, patient’s comfort with ongoing risk/monitoring, peace of mind.
Psychosocial Impact: Symmetry, sexuality, and intimate relationships factor heavily in decisions.

2. Direct-to-Implant (Single Surgery) vs. Expanders (Two Surgeries) ([67:10]-[77:12])

Old Standard: Mastectomy + expanders; patient heals, then returns for reconstructive surgery.
De La Cruz’s Practice: Immediate ("direct-to-implant") reconstruction whenever feasible, requiring only one surgery and recovery.
Why Not Offered Everywhere: Some surgeons are not trained or comfortable with the technique; tradition lingers in older practice patterns.

Notable Quote:

“If I had breast cancer tomorrow and needed a mastectomy, I would have direct implant. ... Why not?”
— Dr. De La Cruz (76:56)

3. Resensation (Nerve Grafting for Sensation Recovery) ([77:13]-[96:20])

Most women are not told they’ll lose all breast (and nipple) sensation with mastectomy; sexual and personal identity impacts are profound.
Dr. De La Cruz and a pioneering group now routinely add nerve grafting, greatly increasing the chance of meaningful sensation recovery (“It takes 15 extra minutes to give you a whole life of feeling”—95:03).
Insurance: Most major carriers now cover; remaining resistance requires advocacy.

4. Nipple-Sparing Mastectomy & Margins ([99:01]-[101:41])

Many women are told preemptively they must lose their nipples; Dr. De La Cruz advocates removing after pathology if needed—not before (“All nipples are innocent until proven guilty”).

5. Lymph Node Removal / Sentinel Lymph Node Biopsy ([103:15]-[108:18])

Past standard: always remove lymph nodes with mastectomy. Now: For stage 0 (DCIS), only if truly needed.
New technique ("Mag trace") allows identification and delayed removal if (and only if) invasion is proven, sparing 95% of women unnecessary surgery.

Dr. De La Cruz:

“I don’t want anything removed from my body if I don’t have to have it removed. … For DCIS with mastectomy, using the mag trace injection ... is practice changing.” (107:54)

Notable Quotes & Moments

Amanda, on mammograms missing 50%+ of cancers in dense breasts:
“It’s a flip of a coin. ... If you are category D, you absolutely cannot rely on your mammogram.” ([19:46])
Abby, on wanting to “report” doctors who gatekeep MRIs:
“It would be nice to have a place we could report doctors who don’t approve the MRI.” ([24:41])
Dr. De La Cruz, on training the next generation:
“Never stop learning. When you stop learning, it’s not just you who gets stuck, but your patients who don’t get the best of the best.” ([38:40])
Amanda, summarizing the episode’s purpose:
“You’re going to send this episode to every person you know who has breasts, as a gift to them.” ([30:39])

Timestamps for Key Segments

Opening Theme & Setting the “Awareness vs. Information” Debate: 00:10–06:00
Listener Life-Saving Voicemails: 09:36–13:12
Breast Density, Advanced Screening, and Advocacy Guidance: 14:22–25:19
Amanda’s Story of Community Impact: 26:29–29:35
Amanda & Dr. De La Cruz Deep Dive: 33:27–108:43
- Choices in Breast Surgery: 48:24–56:23
- Direct-to-Implant Insight: 67:10–77:12
- Resensation and Sensation Loss: 77:13–96:20
- Decision-Making about Nipples/Lymph Nodes: 99:01–108:18

Conclusion

Resources/Recommendations

Send this episode (and its show notes) to anyone with breasts.
Ask your healthcare provider:
- Your breast density category (A, B, C, D)
- Whether additional screening (MRI) is needed for Category C/D
- Surgical options and stats for any planned procedure (revision rates, nerve preservation, etc.)
For those denied advanced imaging: Consider a mini-MRI out of pocket; bring evidence and resources to appointments in writing.

Life-Saving Intel: Amanda's Breast Cancer Surgeon Dr. Lucy De La Cruz

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Summary

Podcast Summary

We Can Do Hard Things

Overview

Key Discussion Points and Insights

The Power of Information Over “Awareness”

Listener Impact Stories (Voicemail Segment, [09:36]-[13:12])

The Critical Issue of Breast Density (~[14:22]-[25:19])

Incredible Serendipity & Community: Finding the Right Surgeon ([26:29]-[29:35])

In-Depth with Dr. Lucy De La Cruz ([33:27]-[108:43])

Dr. De La Cruz’s Philosophy ([35:21]-[41:35])

Major Surgical Decision Points

1. Lumpectomy vs. Mastectomy ([48:24]-[56:23])

2. Direct-to-Implant (Single Surgery) vs. Expanders (Two Surgeries) ([67:10]-[77:12])

3. Resensation (Nerve Grafting for Sensation Recovery) ([77:13]-[96:20])

4. Nipple-Sparing Mastectomy & Margins ([99:01]-[101:41])

5. Lymph Node Removal / Sentinel Lymph Node Biopsy ([103:15]-[108:18])

Top Questions Every Patient Should Ask (According to Dr. De La Cruz, [96:40]-[98:34])

Notable Quotes & Moments

Timestamps for Key Segments

Conclusion

Resources/Recommendations

Summary

Podcast Summary

We Can Do Hard Things

Overview

Key Discussion Points and Insights

The Power of Information Over “Awareness”

Listener Impact Stories (Voicemail Segment, [09:36]-[13:12])

The Critical Issue of Breast Density (~[14:22]-[25:19])

Incredible Serendipity & Community: Finding the Right Surgeon ([26:29]-[29:35])

In-Depth with Dr. Lucy De La Cruz ([33:27]-[108:43])

Dr. De La Cruz’s Philosophy ([35:21]-[41:35])

Major Surgical Decision Points

1. Lumpectomy vs. Mastectomy ([48:24]-[56:23])

2. Direct-to-Implant (Single Surgery) vs. Expanders (Two Surgeries) ([67:10]-[77:12])

3. Resensation (Nerve Grafting for Sensation Recovery) ([77:13]-[96:20])

4. Nipple-Sparing Mastectomy & Margins ([99:01]-[101:41])

5. Lymph Node Removal / Sentinel Lymph Node Biopsy ([103:15]-[108:18])

Top Questions Every Patient Should Ask (According to Dr. De La Cruz, [96:40]-[98:34])

Notable Quotes & Moments

Timestamps for Key Segments

Conclusion

Resources/Recommendations