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Originally published January 27, 2026
Last updated January 27, 2026
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A breast cancer diagnosis can be particularly emotional for many patients, not just because of the cancer itself but because of the links between breasts and fertility, self-image and sexuality. Deciding whether or not to proceed with breast cancer surgery can be a complex decision for most patients. As their doctor, it can be difficult to know how to set expectations around breast cancer treatment, surgery and results after surgery.
“The primary strategy here is to create a level of trust and understanding with the patient,” says Maria Nelson, MD, a surgeon and the director of breast, endocrine and soft tissue surgery with USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC. “To do this requires a lot of listening, understanding where a patient is coming from, and patient education on the many different ways to tackle treating breast cancer.”
With breast cancer, and any cancer, it’s important to create a partnership where you are listening to your patient; identifying their goals, wants, needs and concerns; and forming a plan that addresses all these priorities, Nelson says.
“Some people are very clear: they want the breast out and gone,” she says. “But other people want to preserve their breast and also keep the shape, so that can be a very different treatment strategy, with very different expectations that you have to manage.”
There are a lot of emotions surrounding a breast cancer diagnosis — for both the patient and their loved ones.
“It’s deeply personal, and you quickly learn each patient’s individual preferences,” she says. “Sometimes a partner or family member is present in an appointment as well, and it’s important to be attentive to their reactions while discussing surgical options.”
When discussing treatment expectations, it’s important to provide patients with realistic information in a way they can process and understand. Often, both the physician and the advanced practice provider — whether a nurse practitioner or physician assistant — work together during the same appointment to reinforce key details.
“This collaborative approach allows us to slow down the discussion, offer visual aids such as photo books and ensure the patient has time to absorb and revisit the information,” Nelson says.
Helping patients understand their specific disease can be instrumental in setting realistic treatment expectations, Nelson explains. It’s not uncommon for someone with a small, early-stage tumor to assume that a double mastectomy is necessary. In these situations, it’s important to realign their perspective.
“I often reassure them that because their cancer was detected early and is small, a more extensive surgery would not provide any additional survival benefit,” she says. “Patients are often relieved to learn they can successfully treat their cancer while preserving their breast. And, in some cases, they might even be able to achieve an improved cosmetic result, such as a lift or reduction. These are moments that help patients see their situation in a more hopeful light.”
The most favorable outcomes in breast cancer surgery are those that achieve cancer-free results, successful healing and as few surgical steps as possible, Nelson explains. “That said, healing can sometimes be a process, and patients may not reach their final result after a single procedure,” she says. In these cases, it’s essential to educate patients about the overall treatment plan so they feel prepared and informed every step of the way.
“I approach every patient encounter as if I were caring for myself or a loved one,” Nelson adds. “I always ask, ‘How would I want to be treated?’ And the answer is simple: with gentleness, kindness and respect.”
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