Breast Cancer Surgery
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She was sitting in the McAllister’s parking lot, pregnant and crying when she called her brother in New Orleans and broke the news. Doctor Kandice Ludwig’s mom was diagnosed with lung cancer in 2013. She died two years later.
Dr. Ludwig had been in practice about six years at the time. She was a mother, a daughter, a sister, and a wife. She could relate to her patients. But that moment when she viewed her mother’s scans, her sensitivity was heightened.
“When I was thrown into that daughter role, I understood the urgency and the waiting for test results and seeing the side effects of treatment,” said Dr. Ludwig. She also saw firsthand the impact on the spouse as she watched her dad navigate the rough waters of losing a loved one.
“I had a conversation with a women yesterday who has had a string of bad news. When I called her with more bad news she was preparing to get a port for her chemo. She said she feels bad for her fiancé because he has to sit around and watch her go through infusion,” said Dr. Ludwig. “I told her, ‘he can drive you to infusion, he can sit with you through infusion, and he can help fix you meals. He has a purpose. I think I’m a better doctor for experiencing that with my parents.”
At 41, Dr. Ludwig is the youngest of three and the only daughter in a family raised in New Orleans by a mother who was a biology teacher and father who was a police officer. One of her brothers is an orthopedic surgeon and her husband, Aaron Ludwig, is a urologist. Together they have a daughter, Harper, 6, and a son, Nolan, 4.
“I don’t think I practice differently now from before I was a mother, but because I’ve practiced for 10 years, I’ve always had a special place in my heart for young patients – the young survivors who are trying to get their kids to soccer practice, continue working, and maintaining a home, and will do whatever it takes to beat cancer,” said Dr. Ludwig.
Many of those young moms find support through groups like the Young Survival Coalition (YSC), an organization founded in 1998 by three young women who were under the age of 35 when diagnosed with breast cancer. One of the things Dr. Ludwig likes the best about her role with IU Health is working with the breast care team to help connect patients with resources and support.
“I had a woman I operated on last week and she looked at me through tears and said, ‘are any of your patients happy to see you?’ said Dr. Ludwig. “I said, ‘yes, at some point these visits will be social and we will talk about our kids, our vacations, and our families.’”
The road traveled to that point often seems endless for some patients.
About one in eight women are diagnosed with breast cancer at some point in their life. Today there are more than 2.8 million breast cancer survivors in the United States.
“Breast cancer is such an emotional disease,” said Dr. Ludwig. “Most other types of cancers don’t come with choices. With breast cancer it is fortunate that we often can offer patients choices – different types of surgery - and allow them to be a partner in their plan.”
The cancer that begins in the breast tissues may form cancer masses or tumors. It can advance to other tissues and spread to lymph nodes and metastasis to other parts of the body. In cases where surgery is needed, the choice patients may face are a lumpectomy (where a lump is removed through an incision, preserving the shape of the breast) or a mastectomy (removal of one or both breasts). Women may opt for breast reconstruction to rebuild the breast after surgery.
The main goal of reconstruction is to preserve a woman’s femininity, said Dr. Ludwig. “If a woman just wants to look symmetric, we can do that with bras and clothing, but if she wants to look symmetrical in a bathing suit then we are fortunate at IU Health to have some amazing plastic surgeons who can create new breasts. Our practice across the board is to try to save nipples whenever we can. It matches the other side more likely and saves them additional surgery. Taking the nipple would be a third operation,” said Dr. Ludwig.
How is it determined if a patient needs a mastectomy?
A lot depends on the size of the tumor. In other cases, there are patients who can’t have radiation maybe because their cancer is a reoccurrence or because they have an autoimmune disease, said Ludwig. Then there are the patients who carry genetic mutations and doctors discuss with them that they may be at risk for reoccurrences.
Since she began practicing, Dr. Ludwig said there has been both a local and national trend of women increasingly opting for mastectomies. The reason?
“Historically we only had the ability to test for two genes. Now that technology has become commercially available we can test up to 20 genes at the same time. We are also adding MRIs when women are initially diagnosed to better identify small hidden cancerous areas,” said Dr. Ludwig.
One of the hardest things for patients is making that choice – that final decision.
“Everyone approaches it differently. Some women feel betrayed by their body and their breasts. Others suffer with their loss of femininity,” said Dr. Ludwig.
“The majority of our patients who are candidates for lumpectomy who choose mastectomy are doing it for a psychological peace of mind. We tell them that removing those extra breast tissues does not extend their life, but they still want to take that chance. They are focused on living out their lives – watching their children on the soccer field, seeing them graduate and enjoying their grandchildren.”
Breast care team members help each patient navigate every aspect of treatment – from securing transportation to resolving financial issues.
“One of the most humbling things for me is that sometimes I only see a patient once before surgery so there is that quick and deep development of trust,” said Dr. Ludwig. And when they do meet her, they often ask a heartfelt question: “What would you do if it were your mother?”
-- By T.J. Banes, Associate Senior Journalist at IU Health.
Reach Banes via email at T.J. Banes or on Twitter @tjbanes.