& so much more
A bi-monthly podcast where we share the stories of our Caregivers, patients and community.
& so much more
From Diagnosis to Reconstruction, with Dr. Canzoneri and Erin Hagen
A routine mammogram set off a chain of decisions Erin Hagen never expected to make at 40. What the radiology report called DCIS felt both urgent and confusing, and the days that followed were a blur of consults, terminology and timelines. We sit down with Erin and Dr. Christina Canzoneri from Centra’s plastic and reconstructive surgery team to unpack how you move from a diagnosis to a plan you can live with.
We walk through choosing a bilateral mastectomy, weighing immediate versus delayed reconstruction and confronting the fear of anesthesia and drains more than the incisions themselves. Dr. Canzoneri breaks down what breast reconstruction really involves, tissue expanders, fills, implants, healing windows, and addresses the biggest misconceptions, including insurance coverage that’s federally required after mastectomy, symmetry procedures on the other breast, and why “elective” doesn’t mean “cosmetic.”
Erin shares the practical wins that eased the hardest days: a nurse navigator who translated options, local appointments five minutes from home, and a surgical team that showed up with skill and small kindnesses, even holding her hand as the anesthesia set in.
If you’re navigating DCIS, early breast cancer, or simply deciding when to book your first mammogram, this conversation offers clear guidance and grounded hope. You’ll hear how to ask better questions, what to expect from recovery, how follow-ups with expanders work and how to coordinate care across surgery, oncology, radiation, genetics and imaging. Most of all, you’ll hear why proximity, transparency and trust can transform a scary season into a path back to normal life.
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Hi, and welcome to Anne So Much More on Centures Podcast. I am here with Dr. Christina Canzoneri, and she is a part of our plastics team. She does plastic and reconstructive surgery. And we're here because we have a patient, Erin Hagen. She's just gonna share her story, her journey, starting with breast cancer, but also ending with breast reconstruction surgery. And I almost gave away your first surgery, but I'm gonna let you say that. So we'll start with you. Introduce yourself. Tell us a little bit about yourself.
Erin:Yeah, my name is Erin Hagen. I have two little ones, a nine and six-year-old. Been living in Lynchburg now for 25 plus years. So yeah.
Cami:Makes you a local now.
Erin:It does make me a local.
Cami:Yep. And then Dr. Canzoneri, you want to tell us a little bit about yourself and how you came to Centra.
Dr.Canzoneri:Yeah, absolutely. So I um I don't know if I count as a Lynchburg native yet, but I've been here for a year. I started at Centra uh just last week was my one-year anniversary. I'm so happy. Yeah, things have been going great so far. Um, but I am from Texas originally and came to Virginia for the first time for my training, which I did plastic and reconstructive surgery residency um in Carillion, Virginia Tech Carillion um in Roanoke. So that's what brought me to the area. Stayed because I loved it here and I love taking care of patients in this in this kind of neck of the woods.
Cami:So well, we're so lucky to have you, especially because when you came, I feel like it breathed new life into our plastics program here because now we can have conversations like this, and patients have this at their disposal, which is so important, I think, not just for women, but specifically for women as we're talking about your story. And so you received a diagnosis how long ago?
Erin:It was right about a year ago. So um early September 2024.
Cami:Okay. So briefly tell us about that side of your journey, the cancer side of your journey.
Erin:Yeah, so um, as many 40-year-old women do, I started to get annual mammograms and something showed up on my annual mammogram. So fast forward several weeks, um, and the diagnosis came back uh DCIS, which is ductal carcinoma institute, um, which I was very fortunate it was that diagnosis because it had not become invasive yet. Um, and so once I receive the diagnosis, as I assume most women in this journey will experience, you have a lot of appointments that you are going to. There's still a lot of imaging that happens. Um then once you really know what it is you are dealing with, that's when the conversations with um treatment begin and surgeries and reconstruction. And so I had met with my general surgeon here in Lynchburg, um, and we had made the decision for me to go ahead and move forward with a bilateral mastectomy. And so um I think that was a Tuesday, and the very next day I had a consultation with Dr. Canzoneri. And so um you just receive a diagnosis. The the bilateral massectomy was my first surgical procedure ever. So that was a lot that I was trying to um absorb. And then, you know, you're you're being asked the very next day, do you want to do reconstruction? And so um it's a lot of information um and a lot of decisions um in a very short amount of time. And so um it was just it was a lot to process, um uh, but you wanted to do it quickly because they wanted to, you know, get the surgery started and see if there had to be any further treatment. So um that's what led me to Dr. Cansoneri.
Cami:Wow. So, so much that I want to touch on that you just shared. First and foremost, please get your mammogram. Please get your mammogram. Start if you're 40. Um, if you have family genetic history, go early, find out what insurance covers, get yourself hooked up with the mamm van. If your insurance doesn't cover there's details on our website, please get your mammogram. So that's just a very important message. And I love that that they found that. Was this your first mammogram?
Erin:No, this was my third um mammogram, but I had never had a concerning one. Um, and I do not have breast cancer in my family. They did do all the genetic testing after my diagnosis. So um, you know, I didn't have any genetic component um to it. And so um and actually the guidance I'd been given was because I hadn't had a concerning one. I could go every five years.
Cami:Oh wow.
Erin:Um, thankfully I did not. Had I not, we would probably be in a different um situation. Yeah.
Cami:So you mentioned that there were so many conversations, so many decisions that had to be made. Um, what was that like? What was what was the support that you received? Tell me about that journey.
Erin:Yeah, so once um, you know, we were really starting down this path. Um, I was very thankful in that one of my good friends is a nurse navigator here at the cancer center. And so um she was able to walk alongside me and really explain everything, no different than how I assume they do with any patient that is brought to them. So, right off the bat, that was a huge blessing and just helping me understand what I was going to be facing, some of the decisions I had to make, um, but also encouraging me to get different consultations, um, you know, staying local, maybe UBA or Duke. And so all of that, you know, we were really trying to work through quickly because we we knew we needed to have the surgery, but who was gonna do the surgery right was the biggest thing. And so um, you know, after after we decided to to stay local, um I'll be honest, the the decision for the mastectomy was probably the easiest for me. That was that was yep, if that's gonna reduce my risk, go for it. It was actually the reconstruction piece, um, because I'm like, man, I don't I don't want more surgeries. Do I do I want to go through it? Um, and so that's where I really struggled the most, I think, to to work through all the information and and really make a decision there. But yeah, once again, getting to to sit with Dr. Canzanari and and and have her walk it through with me was unbelievable.
Cami:So I'm sure it's different for every patient. Absolutely. But tell me a little bit about that conversation that you have when a woman comes in, and and in your case, it's the day after. And so there's a lot of emotions that are happening. That's a lot on your plate. So you're you're more than just a provider here. You are having to really, you know, step in and provide that clarity and that comfort. So tell me about that conversation.
Dr.Canzoneri:It's a big conversation. Yeah. I know that Erin, I'm sure you remember this. I tell people it's okay to be emotional during this visit. You're going through a lot. And it's so true what you're saying that when you're thinking about needing surgery to reduce your risk to cure your cancer, that's an easy choice, right? It's it's pretty laid out for you that this is what we need to do for your overall health status. But when making the decision about breast reconstruction, which is, I mean, really considered an elective procedure, right? It's not cosmetic, it is reconstructed, it is covered by insurance, but it is elective, it's not necessary for your overall health. Um, that can be a really big choice. The visit itself, we always block off at least an hour for that conversation because it's a big conversation to have, and it is such a good, I'm so glad you brought your husband to that visit because it is it is great to have an emotional support person there with you, but it's also great to have somebody who can just help you remember the information. Because that's a great point. I feel so bad for these women, obviously, because of their recent diagnoses and what they're going through, but also because I essentially talk at them for about 45 minutes about what breast reconstruction is, how long the process takes, you know, what their options are that are, I mean, it's really different for every woman based off of her diagnosis, based off of her imaging, her overall body habitus, whether she needs radiation. So there's a lot of factors that go into it, and it can be a lot of information to retain. So it's a big visit. The good news is though that after that initial conversation, if we do move forward with surgery, there is a second visit before any surgery takes place so that we can go over all your questions and concerns again and just kind of neatly tie that all up in a little bit a bow before the morning of surgery.
Cami:So, what are some of the most common like misconceptions or fears that or questions that are brought to you in those either one of those meetings?
Dr.Canzoneri:Yeah, absolutely. Well, I think that there are a lot of things that I just say right off the bat for every single patient to try to address some of those misconceptions or fears. A lot of women are concerned just about paying for it. You know, will insurance cover this? And so I like to tell everybody up front, once you've had a mastectomy, insurance is actually required federally to pay for any reconstructive procedure on the breast that has been removed, but also on the other breast, if it needs to be changed in some way, if it needs to be reduced in size or augmented in size with an implant, your insurance will cover that as well. So that's a big thing that we cover on that first day. Um, but also that you know there's no rush to this. If somebody wants to decide to just move forward with a mastectomy first, heal from that, and then consider to, you know, can continue to consider their options, that certainly is something that we can start reconstruction in a delayed fashion, where maybe three, six months down the line we can focus on starting the reconstructive process. So um I really think it's such an individualized thing based off of each individual patient that really, if you have any questions about reconstruction, just come in and I will break down based off of all of your individual patient factors, really what you would even be a candidate for.
Cami:Yeah. Um, I was gonna ask you, you know, what are like what goes into that decision making, but that really kind of sheds a lot of light. First of all, I did not know that insurance covers this, and so that just goes to show you how important it is to just have the conversation, just ask the question. Um, let's not go in with a uh preconceived no when the answer could be yes. Um, and so I do want to touch on just that surgery experience. And so, because like you said, this was your first surgery, and and for a lot of women, like I mean, having big surgeries in our life is not a very common thing. And so, what is that experience like?
Erin:For me, there was um a lot of anxiety around it, not because of the procedure I was having, or I even think what the recovery was gonna look like. It was, I think, just the experience in general, having never been put under general anesthesia before. That was terrifying for me. Um, and I don't know why. Um, and so, you know, from the moment I stepped into Virginia Baptist um one, I mean, the nurses were fantastic. Um, Dr. Canzoneri comes and meets with you. My general surgeon uh came and met with me and you know, the anesthesiologist, and they just took the time to walk back through, okay, here's here's what we're doing. Um, you know, here's kind of the the process and the length of it. Um, of course, my husband was there the whole time as well. Um, you know, and then it's just one of those where they will you back and you don't remember a whole lot after that part, which is the fantastic part. Um, you know, thankfully I reacted very well to the to the anesthesia. I didn't have any adverse side effects, which once again was was my major concern. But um, you know, with with the bilateral massectomy, I did stay a night in the hospital. Um, so just so I could be monitored. Um, and then that next day, bright and early, Dr. Canzoneri was there making sure everything looked great. Um, and then you're sent home for recovery.
Cami:So and how long was recovery for you?
Erin:Um, I would say, you know, I had surgical drains. Um, and so I had those a little over two weeks of when I was able to get those drains out. So those those first two weeks, you're very limited in being able to move. Um, you don't want to overdo it because you really want those drains out as quickly as possible. As I was telling Dr. Canzoneri, I think every time I met with her. Um, but you have a lot of follow-up appointments too, which is one of the reasons I was so thankful that I chose to stay local. Um, because my house is five minutes away from Dr. Canzoneri's office. And so if I had a concern or if um it was just a checkup, I mean I was here. I wasn't driving two hours. So that part was great. Um, I would say by a month I was um released to start doing some like lower body exercises and you know, stuff like that, and starting to get back into the swing of things.
Cami:Yeah. So what is this like from the clinical side?
Dr.Canzoneri:Um, we get to know our patients really well, I would say. And so I, you know, this is one of my favorite things to do within my field of practice is to help take care of my patients with breast cancer, just because we do form such a relationship during the process. So, you know, for many women who choose to undergo implant-based breast reconstruction, um, that's at least two surgeries. And in between the two surgeries, you have tissue expanders, and those have to be filled periodically in the office. So you're coming in every two to three weeks to see us and our team and our nurse practitioner, Courtney. And so we get to know you really well, whether whether you want to or not. Like we're gonna be friends at the end of this. And so um, you know, I think from a clinical standpoint, I love doing this. Um, just because we do get to form that relationship and kind of see you from start to finish. And it can be such an emotional journey, um, particularly at the end, even when I say, Well, you know, it's been great treating you. See you around. Like, wait, I I just leave now. Yeah.
Cami:Wow. I mean, it's a season, it's a season of your life that is so drastically different, kind of, you know, a little pocket in the middle. Um, but what I love and what has been so encouraging to hear from both of you is that that care team that has come around you, um, you know, it that changes everything. It changes everything, especially when um it's your first experience, when there's family, when there's an it, there's just so much that goes into it. So understanding that care team approach that you know, I think most uh facilities would do. Um, how many people were on a care team for for Aaron, but for any given patient?
Dr.Canzoneri:Oh gosh, a lot. Well, I mean, just from you know, the plastic surgery standpoint, you know, you have kind of a whole team around you because it's you know you're going to see me, you're going to see um our nurse practitioner who does a lot of the tissue expander fills, but certainly you're interacting with lots of people in our office from nurses and surgery schedulers. Um but then certainly there's general surgeries involved, usually medical oncology will have an appointment with them. For many women, radiation oncology is is required if you require radiation following um your treatment, um, genetics, uh all the staff at the hospital. It's it ends up being an incredible number of doctors' visits and you touch so many different areas within Centra.
Cami:And you mentioned your nurse navigator to you, who I imagine is extremely helpful in figuring out paths to take and what areas you are going to be interacting with.
Erin:Yeah, I mean, even the you know, the the radiologists who read my um, you know, mammogram, and and they're the ones who did my biopsy um as well. I mean, there were so many different departments and individuals um who are part of my my care team.
Cami:So one year later, you're celebrating your first full year here at Centra, but you're celebrating the year of this kind of coming to, I don't want to say to an end, but you know, coming to a close in the season. What are things like now? Post-recovery, like what is how has this impacted your life?
Erin:Yeah, well, I actually had my second surgery. Um, so that was when they took the tissue expanders out, put the implants in. So that was February. So it was probably right around three months after my mastectomy. Um, you know, and so you have to go through that recovery a little bit again. And then I think I had my last um appointment with Dr. Canzoneri, I want to say it was sometime in May. And that's when she kind of gave the, hey, it's been great, go live life, you know. I'm not an emotional person. Um, but I I mean I'm very I teared up because I'm like, man, I've had so many appointments. Like, what do you mean go live life? Um but it's it's it's been great. I've had no complications. Um, I've been um very happy, not only with the care um that I receive, but the results um as well. You know, I think once again, you're always, is it gonna, is it gonna be weird? Is it gonna feel different? Is it gonna look different? Um, and I can only say positive things um about my my experience, specifically with Dr. Canzoneri. And I'll give one example if I can. Um being wheeled into the second surgery, um, there's a ton of people in the operating room, right? And I think they tried to introduce you to everybody, but you've already been given something to where you're feeling very relaxed. And I'm like, I don't know, I'm not gonna remember this. Um, but I remember Dr. Canzoneri was right there, the nurse practitioner was right there, and they held my hand. Um, I think Courtney held my toe, and um, you know, and they're just okay, Erin, here we go. Like they're putting the stuff in, or you know, we're gonna see you on the other side. And I mean, I woke up and they were right there. And I'm like, just to have them there, that was huge. That was a huge blessing.
Cami:That's amazing. Yeah. So I want to hear from both of you on this last question, but what would your message be as a patient, as a survivor at this point to women who are watching this? Maybe in your shoes at the beginning, or maybe at the end, kind of like you are, and are like, what do you mean, just go live my life now?
Erin:Um, kind of what you emphasized at the beginning. Um, don't miss your annual mammogram. Um, I'm so thankful that I did not miss mine, um, because it would have been a different story. So I just encourage everyone to be consistent with that. Um, but ask questions. Um, ask, you know, it's your health, um, it's your body. Um, ask questions. Even if sometimes it's it's awkward and you feel like you might be offending the surgeon or you know, um, ask those questions because at the end of the day, you just want to have a piece with with the um operation and and I guess the direction that you're um you're choosing to go. And um, I know this sounds cliche. Trust the process. Um, it can be a long process and sometimes a frustrating process. Um, and thankfully, Dr. Canzoneri let me call and email. And is this normal? Can I send you a picture? Because I don't think, you know, and um she always took the time to to explain, Erin, it's normal. All of this is normal. Um, and so that was always just a huge, huge help and and blessing for me. I love it.
Dr.Canzoneri:Yeah, I mean, I definitely want to echo your message, especially as October is approaching with breast cancer awareness month. Please get your mammograms. It's so, so, so important. Um, but you know, certainly once you've got a diagnosis, just come talk to us in plastic surgery. I and also Dr. Jesse Payton, one of my colleagues, we both do breast reconstruction here. And we are so open and we're easy to talk to, and we want to talk to you about all the options that are possible. Whether that's something that we can accomplish for you here, maybe you, you know, better be served by some kind of autologous option that we know we can't do here, but we know all the people in the area who are really good at it, and we can help guide you on your path, whichever path that may be. And maybe the answer is not no reconstruction at all, and that's okay too. And you know, we we can still be here, you know, thinking about you and supporting you spiritually or or however through your process. But I come talk to us because any questions that you have about brush reconstruction, we are more than happy to answer.
Cami:Awesome. Thank you both for just being transparent and so kind, sharing your story, and then for giving us so much context into that snapshot of what it looks like from a clinical perspective. Um, for those of you who do have questions again, head to our website. Um, you can go to the plastics page, and you know, we also have our cancer page, which has so many details. Um, but then reach out to your provider and just start a conversation. So thank you guys. Thank you. And thank you all for joining us for that, and so much more.
