She received the diagnosis on her daughter’s second birthday.
“It was kind of a stressful, shocking situation,” she said. “You have to relearn how to feel feminine. My husband and I were young, and it affected us.”
Smith knew she would need surgery and immediately sought advice on her options for breast reconstruction after the mastectomy. Initially, she met with a breast surgeon from another health-care organization who recommended she not be concerned with reconstruction so soon after her diagnosis.
But Smith knew paying attention to this part of the process was important, even at the outset. At the recommendation of her doctor, she met with Bruce Mast, MD, a plastic and reconstructive surgeon then working in private practice in Gainesville. Mast had worked as an assistant professor of surgery at UF from 1995 to 2000 before transitioning to private practice. He returned to UF in 2010 as chief of the department of surgery’s division of plastic and reconstructive surgery, five years after Heather Smith became one of his patients.
“I met him the day that I was diagnosed,” she said. “He came and closed his office down and met with me.”
Mast recommended Smith select Edward Copeland, MD, a Distinguished Professor of Surgery at UF, as the surgeon to perform the mastectomy. When she underwent the procedure, Mast was there to insert an expander, the first step in breast reconstruction.
After the mastectomy, Smith received chemotherapy treatments in an effort to kill all the cancer cells. Between rounds of chemo, she made visits to Mast, who inserted a needle through her skin and into a nozzle in the expander to enlarge it. By doing so, he made room under the skin for an implant.
“Dr. Mast was very helpful in helping us decide on the best course of treatment,” Smith said. “We went for the least invasive of all the reconstructions, because I wanted to be able to pick my daughter up still, and I wasn’t willing to be out of work for 6 and 8 weeks, which some of the other surgeries make you have to do.”
But before Smith could get the implant, she got more bad news. Genetic testing revealed she had a genetic mutation that greatly increased the chances of cancer occurring in her other breast.
“I had a 90 percent chance of a secondary cancer,” she said, “so we made the decision, my husband and I, to go ahead and just have a prophylactic” (preventive) mastectomy on the other breast.
Because Smith’s right breast did not yet show any signs of cancer, Mast performed the second mastectomy. He again inserted an expander to begin the reconstruction process.
In November 2005, Smith underwent yet another operation to receive breast implants in place of the expanders. It had been almost a year since her diagnosis and first surgery.
Throughout the whole process, she said, Mast and his staff were invaluable guides for her and her husband.
“I could call his office every day,” she said. He helped us with “any questions we had, any pictures we wanted to see, any discussions we felt the need to have.”
After Smith received her first set of implants, she had trouble adjusting to the new look they gave her.
“I’m really narrow and they just didn’t look right on my build,” she explained. “I didn’t know if it was possible to have anything better. Dr. Mast wasn’t happy with it and immediately said, ‘Nope, we’re going to fix this. We’re not going to stop till you’re happy with it.’”
After some adjustments, Smith felt better about her new breasts.
“Most people who didn’t know me then wouldn’t look at me in clothing and have any idea that I’ve had anything done, which is, I guess, the result that you look for,” she said.
Smith has undergone several additional procedures with Mast to adjust the look of her new breasts. She emphasized that she elects to have these procedures done, and says Dr. Mast does not push her into anything.
“I’m ready for them to look as natural as possible,” she said.
She anticipates undergoing another surgery this year, once a new, more natural-looking type of breast implant becomes available. For her, the payoff is worth it, she said, and the surgeries are less harrowing because of her trust in Mast.
“I do brag about him often,” she said. “I have nothing negative to say about him, or his staff. Every cancer patient that I know who has gone to him has felt the same way. He cares about his patients. It’s not just a job to him, and I think that’s important.”
Mast applauded Smith’s response to her cancer.
“Heather showed true courage and character throughout this process,” he said. “She has kept a wonderful perspective and attitude, even becoming involved in the community through fundraising and support groups.”
He also said his work with breast cancer patients is a very fulfilling part of his job.
“Treating women with breast cancer is a wonderfully rewarding experience. My efforts help them restore what cancer has taken away, not only physically, but emotionally as well. I continue to follow my patients indefinitely, which provides something even more rewarding: a long-term relationship that surgeons don’t often get with their patients.