September 8, 2017

Jennifer McAlister, MD, FACS, Answers Some Common Breast Surgery Questions

One of the most difficult things a woman will undertake after being diagnosed with breast cancer is making sure they identify and ask the right questions about surgery. Should you consider a double mastectomy? What about post-surgery? Do you need chemotherapy? Jennifer McAlister, MD, FACS, with Regional Surgical Specialists, an affiliate of Mission Health, answers four common questions that may be on your mind.

Some points to consider:

  • Regardless of surgery type, lymph nodes may be checked in invasive breast cancers.
  • Regardless of surgical choice, the need for systemic treatments such as chemotherapy and hormonal therapy is a separate decision.
  • Perhaps the biggest point to consider, regardless of surgical type, for early breast cancers, the survival rate at ten years post operation is equal.

Do I need a mastectomy?

This decision is multifactorial and typically depends on the size of the cancer. Most women with early stage breast cancer are candidates for either a lumpectomy or a mastectomy. I discuss the pros and cons of both with them. Typically, it is the patient who decides which type of surgery they will have.

Do I need chemotherapy?

This depends on the size and receptors of the individual cancer. Sometimes the medical oncologist will order a test after surgery to assist in making that decision. The big take home point is that the surgical decision has no effect on the chemotherapy decision.

Should I have both breasts removed?

In most cases, no. The risk of breast cancer in the opposite breast is typically 3-5 percent over 10 years. The added risks of additional surgery usually outweigh the benefits in most cases. There are exceptions. Patients who have a genetic predisposition (only about 10-15 percent of patients) should consider bilateral mastectomy.

Why did I choose breast surgery?

I was a general surgeon in a rural location and therefore did all types of surgery and procedures. A significant portion of my work was breast related. This became my passion. There is a very different relationship that is formed between a breast cancer patient and her surgeon than say a gallbladder or hernia patient. In my eyes, the most important part of my job is to educate these patients about why different treatment options may or may not be available to them so that they feel like they have made good decisions for themselves.


Jennifer McAlister, MD, FACS, is a fellowship trained breast surgeon with Regional Surgical Specialists, an affiliate of Mission Health. (828) 252-3366


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