Am I suitable for weight loss surgery?
Weight loss surgery, also known as bariatric surgery, is most effective for patients who demonstrate medical need for weight loss. This is usually determined through a measurement called the body mass index (BMI). The BMI is calculated using your height and weight and is frequently used as an indicator of the amount of body fat. Individuals qualify for weight loss surgery if they have a BMI greater than 40, or a BMI greater than 35 accompanied by other health problems (known as comorbidities). These include diabetes, high blood pressure, heart disease, arthritis, and high cholesterol. Calculate your BMI >
Successful weight loss is a continuous process that does not end at surgery. It involves dedication and a commitment to making sustainable lifestyle changes. As a result, we recommend that our patients have a good support system prior to weight loss surgery. Whether it be a family member, friend, or group of like-minded individuals, having the right support system improves the journey.
Does weight loss surgery last? Will the weight come back?
It is common for patients to regain some weight (about 5%) back following surgery. However, long-term studies demonstrate that most bariatric surgery patients are able to achieve and maintain sustained weight loss.
Patients experience an average excess weight loss of 66.5% after gastric bypass surgery. Most often, patients are able maintain this level of weight loss for 5 years. In some cases, the effects of gastric bypass surgery may last 15 years. For other procedures such as sleeve gastrectomy, studies have shown that patients are able to maintain their weight loss beyond 5 years after surgery, with the average excess weight loss remaining at greater than 50%.
To learn more, visit our Bariatric Surgery site.
What caused my breast cancer?
Breast cancer develops when cells in the breast begin to grow abnormally. Over the course of a lifetime, nearly 1 in 8 women (12%) will develop breast cancer. Researchers have identified hormonal, lifestyle and environmental factors that may put some woman at higher risk of breast cancer. Most of these are related to total estrogen exposure and include increasing age, early menarche (first menstrual period), late menopause, age at first childbirth, and use of hormone replacement therapy. Additionally, other environmental factors including radiation exposure, post-menopausal obesity, and lack of physical activity have been linked to increased risk of breast cancer. However, it is important to know that most women who develop breast cancer have no known risk factor other than being female.
In 5-10% of breast cancer cases, the breast cancer is caused by a genetic mutation passed through generations in a family. There are several mutations that researchers have identified that substantially increase the likelihood of developing breast cancer and the most well-known are BRCA 1 and BRCA 2. If you have a strong family history of breast or ovarian cancer in your family, especially if the breast cancer diagnosis was at a young age (<age 40-50), your doctor may recommend a blood test to check for mutations that are associated with developing breast cancer.
I’m being referred to a breast surgeon – does that mean I need an operation?
Not necessarily! While breast surgeons do operate, they are also experts in all forms of breast conditions, including benign changes (cysts, benign lumps and infections) as well as breast cancer. In addition, breast surgeons will commonly evaluate and monitor patients who are at high risk for developing breast cancer because of a family history of breast cancer, genetic mutations, or abnormal cellular changes on biopsy.
When should I start screening for breast cancer?
In general, annual mammography starting at age 40 is recommended for most women, though this may be individualized on patient risk factors and preferences.
Is mastectomy a safer treatment for my breast cancer compared to lumpectomy?
Mastectomy is when the entire breast on the side of the cancer is removed. In contrast, lumpectomy removes only the cancer and a small rim of normal tissue around the cancer. Lumpectomy is also called “breast conservation” and is the ideal treatment for many patients because it allows for preservation of the breast mound and nipple-areolar complex. In the case of mastectomy, the breast mound can be recreated using plastic surgery. However, it will never be the same as keeping your native breast. The survival outcomes after lumpectomy and mastectomy have been studied in thousands of patients with over 25 years of follow-up and the survival is the same regardless of which type of surgery is done. It is important to know there are many factors your surgeon may consider when recommending mastectomy or breast conservation, including the size of your tumor compared to your breast, tumor location, or if you have a genetic mutation that puts you at elevated risk for future cancers.
To learn more, visit our Breast Health site.
I have a thyroid nodule. Could it be cancerous?
Thyroid nodules are very common, especially in older women. The good news is that most thyroid nodules are benign (not cancerous). An ultrasound of the neck is the best way to evaluate thyroid nodules. Most nodules that are larger than 1 cm and have suspicious characteristics on ultrasound are evaluated with biopsy. This will determine whether the nodule is benign or suspicious for cancer.
I was recently diagnosed with thyroid cancer. Does my entire thyroid gland need to be removed?
Recent guidelines from the American Thyroid Association support either removal of half of the thyroid (thyroid lobectomy) or the entire thyroid (total thyroidectomy) for low-risk thyroid cancers. This includes papillary thyroid cancers that are up to 4 cm in size. The extent of surgery can now be individualized based on characteristics of the tumor and the patient. We carefully examine the tumor with ultrasound to look for any extension or break outside of the thyroid capsule and any spread of cancer to the lymph nodes in the neck (which would make a total thyroidectomy necessary). If these high-risk features are absent, removal of half of the thyroid may be appropriate in many cases.
My calcium level has been high in my blood test. What could be the cause?
The most common cause of high calcium is hyperparathyroidism (overactive parathyroid gland). This can be determined by checking the calcium and parathyroid hormone (PTH) levels, which are both high in hyperparathyroidism. Other causes of high calcium include cancers, inflammatory conditions such as sarcoid, and medications (such as certain diuretics).
To learn more, visit our Endocrine Center site.