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    Can You Trust Your Mammogram?

    Reticence on Reconstruction continued...

    What you should do: "Ask your surgeon how your breast will look, how your clothing will fit," says Amy Alderman, M.D., M.P.H., an assistant professor of surgery at the University of Michigan. Even if you're sure you want breast-conserving surgery, you may want to consult with a plastic surgeon. Lumpectomy sometimes changes the breast more than women expect; a specialist can help you assess what might happen in your case. This is not vanity: Women who end up with extremely uneven breasts are more likely to be depressed and to worry that their cancer will return, a brand-new University of Michigan study found. Or you may want to seek out a breast surgeon who's experienced in oncoplastic techniques, which can improve the look of the breast.

    Thankfully, the days of "Doctor knows best" are behind us. But that means breast cancer patients have to work with their physicians to make tough choices. To do that, women must share their fears and desires. "The doctor only knows what's on your X-ray and pathology report," says Karen Sepucha, Ph.D., a senior scientist with the Health Decision Research Unit at Massachusetts General Hospital: "What you care about needs to get on the table."

    And you have to be the one who makes sure it does.

    More Ways to Get the Answers You Need

    Going for a Third Opinion
    Kim Friedrich, 37
    Mastic, NY

    Kim Friedrich was in shock. In February 2007, her left breast had a tumor one-and-a-half times the size of a golf ball; because it was so big and aggressive, the surgeon told her she needed to have that breast removed, as well as the other as a precaution. A second doctor agreed. "I kept seeing myself on my deathbed," Friedrich says. She'd look at her two daughters and seize up with grief — would they grow up without her? While she would have done anything to live, she wasn't convinced she had to lose her breasts. Neither doctor had taken much time with her, she realized. Friedrich began to do research and talked to everyone she could. When an acquaintance raved about her breast specialist, at a cancer center a three-hour drive away, Friedrich pressed for an appointment. The mastectomy recommendations did not surprise the doctor. "That's old thinking," he told her. His advice: a course of chemotherapy (which shrank the tumor down to the size of a pea), followed by a lumpectomy and radiation. It was very tough, but Friedrich has no doubt she chose the right treatment — and doctor: "I got two quick assessments, and felt like they were thinking, 'Let's just do what's fastest and move on to the next patient.'"

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