by Ann M. Geiger and others
Is this for me? If you have been diagnosed with breast cancer in one breast and are considering having the other breast removed to reduce your risk of developing a new breast cancer or having the cancer coming back, you might want to read this article.
Background and importance of the study: If you have been diagnosed with breast cancer, your risk of developing a new cancer is higher than that of a woman who has never had the disease. The size of this risk varies from person to person, because each person has different risk factors. For the average woman who has had breast cancer, the risk of developing a new and different breast cancer in the other breast (not a recurrence of the first one) is about 1% per year. This means a risk of about 10% over 10 years. Put differently, out of 100 women who have a personal history of the disease, about 10 will get a new breast cancer on the other side within 10 years.
The risk of a new breast cancer is higher for women who have additional risk factors. If you've been diagnosed with breast cancer and also have a strong family history of the disease, your risk is likely to be higher than 1% a year. If you have a proven genetic abnormality, your risk is even higher. If you have both a strong family history of breast cancer AND a known breast cancer gene abnormality, on top of a personal history of breast cancer, the risk is higher still. The range of higher risk is about 2% to 5% per year, depending on all of these factors, plus other things that might affect how an abnormal gene behaves. Over 10 years, this translates to a risk that ranges from 20% to 50%.
If you have a personal history of breast cancer plus other risk factors for a new breast cancer, it's important for you to help reduce your risk. You may want to seriously consider extra preventive measures, including lifestyle changes, medications, and surgery.
Preventive surgery to remove the other breast is a serious option with real benefits and side effects. While removing the breast can substantially reduce your risk of breast cancer, it involves permanent changes that can change your quality of life. The higher your risk of breast cancer, the more likely you are to benefit from preventive surgery. Removal of the breast can decrease the risk of a new breast cancer by about 90%. That's a big reduction. If your risk is estimated to be 80%, it could be lowered to about 8% by preventive breast removal. If your risk is 10%, it could be lowered to 1%.
The surgical option of breast removal is called "prophylactic," which means "preventive." If you take this step, you are doing something that will significantly reduce your risk for cancer in the future (although there is no guarantee). This option is permanent and irreversible.
Earlier studies have shown that for women with a personal history of breast cancer and other strong risk factors, preventive removal of the other breast (called contralateral mastectomy) reduces their risk of developing a new cancer and is associated with improved survival. Up to this point, however, no one had looked at how happy or satisfied women were with their choice.
In this study, the researchers asked women how content they were with their choice to have or not have preventive mastectomy.
Study design: In this study, the researchers asked 772 women who had preventive mastectomy and 105 who didn't have preventive mastectomy how content they were with their choice.
All the women had been diagnosed with breast cancer in one breast between 1979 and 1999 at one of six Cancer Research Network health care system centers in the United States. The women were aged 18 to 80.
To determine how content women were with their preventive mastectomy choice, the researchers mailed them a survey that asked questions about:
1) quality of life,
2) satisfaction with the surgery,
3) body image,
4) sexual satisfaction,
5) depression,
6) breast cancer thoughts, and
7) health perception.
About 73% of the surveys were returned, from 519 women who had preventive mastectomy and 61 women who didn't. Of those 61 women, 30 had single mastectomy and 31 had lumpectomy.
The research was funded by the National Cancer Institute.
Results: Of the 519 women who had preventive mastectomy, 86.5% were satisfied with the procedure and had no second thoughts about it, and 76% were very content with their quality of life.
Similarly, of the 61 women who did not have preventive surgery, 75% were very content with their quality of life.
There was no association between women reporting having a lower quality of life and having had preventive mastectomy or breast reconstruction, or with the women's age, race, education, or body mass index. But a lower quality of life WAS linked to:
1) poor perception of one's own general health,
2) possible depression,
3) unhappiness or self-consciousness about appearance,
4) unhappiness with sex life, and
5) feeling the need to avoid thoughts of breast cancer.
The results also showed that almost 75% of the women who didn't have preventive mastectomy were concerned about breast cancer, compared to 50% of the women who had the preventive surgery.
Conclusions: The researchers concluded that most women who have preventive mastectomy are satisfied with their choice and report having a good quality of life. The women who had preventive mastectomy were less likely than the other women to be concerned about breast cancer.
Women who reported having a lower quality of life were more likely to have poor body image, be unhappy with their sex life, possibly be depressed, feel the need to avoid thoughts of breast cancer, and have a poor general health perception.
Take-home message: If you have been diagnosed with breast cancer in one breast and are considering a preventive mastectomy, this study offers strong support that no matter which decision you make, you are likely to be content with that decision later.
More than 75% of women in each group were very content with their quality of life. The adage "whatever decision you make will be right for you" seems to carry truth for women grappling with this decision.
Of course, you need to balance the potential benefits of preventive surgery against the side effects. Every woman is unique. How you balance the benefits and side effects in your own situation is very personal.
In general, factors that might make you more likely to choose preventive mastectomy are:
1) a strong family history of breast cancer,
2) a serious diagnosis of breast cancer in the other breast,
3) being very fearful of another cancer,
4) lacking confidence in the power of early detection, and
5) feeling determined to never go through cancer therapy again.
This wasn't a randomized study, in which women are assigned to different groups. Every woman made her own decisions, and the women who chose preventive surgery are probably different in many ways from the women who chose not to have this procedure. As a result, comparing the two groups has limited value.
You probably know that we all need to believe in the big decisions we make—particularly important decisions about our health. But even when we get used to a big decision, it's normal to have mixed feelings. Although mastectomy can give women more peace of mind, it's also normal for women to have concerns about their body image and to miss their breast.
Also remember that no procedure—even surgery—totally eliminates the risk of cancer. Even when a breast has been removed, cancer can still develop in the area where the breast used to be. Close follow-up is necessary for all women, even after preventive surgery.
You have time to decide. The decision to have preventive surgery is not an emergency. Of course, the decision to have preventive surgery at any age requires much thought, and must be made in consultation with your health care team.
Learn about surgical options for breast reconstruction here.
SOURCE: Journal of Clinical Oncology; breastcancer.org
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Showing posts with label breast cancer blog. Show all posts
Showing posts with label breast cancer blog. Show all posts
Thursday, March 20, 2008
Friday, February 15, 2008
Breast Cancer patients may benefit from picking own breast surgeon
Women with breast cancer who are involved in the process of selecting their surgeon are more likely to be treated by more experienced surgeons and in hospitals with established cancer programs, according to a study published in the Journal of Clinical Oncology.
Surgeon and hospital characteristics can influence the outcomes of cancer treatments, the authors explain, but little is known about the factors that influence how referrals are made.
Dr. Steven J. Katz from the University of Michigan, Ann Arbor, and colleagues used survey data from women recently diagnosed with breast cancer and their attending surgeons to determine how surgeons are selected, and if there is any association between the referral process and characteristics of the surgeon and hospital.
Most women were referred to their surgeon by another doctor or by their health plan. They chose their surgeon for a number of reasons -- the surgeon's reputation, the institution's reputation, the recommendation of family or friends, or convenience of the location.
The investigators found that 54.3 percent of women were referred and did not select their surgeon; 21.9 percent were referred, but were also involved in selecting their surgeon; 20.3 percent selected their surgeon and were not referred by a provider or plan; and the rest of the patients had a prior relationship with their surgeon.
Women who selected their surgeon by reputation were twice as likely to have a surgeon who performed many procedures (high-volume surgeon) and to be treated at a cancer center designated by the National Cancer Institute or a program approved by the American College of Surgeons, the team reports.
Patients referred by another doctor or health plan were less likely to be treated by a high-volume surgeon or in hospitals with approved cancer programs, the researchers note.
Previous studies have shown that surgical patients often have better outcomes if they are treated by highly experienced surgeons and at hospitals that perform many similar procedures each year.
More research is needed to investigate the implications of the different referral patterns in this study, Katz and colleagues point out. "In the meantime, women with breast cancer should be aware that provider-based referral might not connect them with the most experienced surgeons or the most comprehensive practice setting in their community."
"Patients might consider a second opinion," the researchers suggest, "especially if they are advised to undergo a particular procedure without a full discussion of treatment options or a clear medical rationale for the recommendation."
SOURCE: Journal of Clinical Oncology; breastcancer.org
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Surgeon and hospital characteristics can influence the outcomes of cancer treatments, the authors explain, but little is known about the factors that influence how referrals are made.
Dr. Steven J. Katz from the University of Michigan, Ann Arbor, and colleagues used survey data from women recently diagnosed with breast cancer and their attending surgeons to determine how surgeons are selected, and if there is any association between the referral process and characteristics of the surgeon and hospital.
Most women were referred to their surgeon by another doctor or by their health plan. They chose their surgeon for a number of reasons -- the surgeon's reputation, the institution's reputation, the recommendation of family or friends, or convenience of the location.
The investigators found that 54.3 percent of women were referred and did not select their surgeon; 21.9 percent were referred, but were also involved in selecting their surgeon; 20.3 percent selected their surgeon and were not referred by a provider or plan; and the rest of the patients had a prior relationship with their surgeon.
Women who selected their surgeon by reputation were twice as likely to have a surgeon who performed many procedures (high-volume surgeon) and to be treated at a cancer center designated by the National Cancer Institute or a program approved by the American College of Surgeons, the team reports.
Patients referred by another doctor or health plan were less likely to be treated by a high-volume surgeon or in hospitals with approved cancer programs, the researchers note.
Previous studies have shown that surgical patients often have better outcomes if they are treated by highly experienced surgeons and at hospitals that perform many similar procedures each year.
More research is needed to investigate the implications of the different referral patterns in this study, Katz and colleagues point out. "In the meantime, women with breast cancer should be aware that provider-based referral might not connect them with the most experienced surgeons or the most comprehensive practice setting in their community."
"Patients might consider a second opinion," the researchers suggest, "especially if they are advised to undergo a particular procedure without a full discussion of treatment options or a clear medical rationale for the recommendation."
SOURCE: Journal of Clinical Oncology; breastcancer.org
******
Sunday, January 27, 2008
Breast Cancer Gene Testing Less Likely Among Blacks
NEW YORK (Reuters Health) - African American women are generally less likely than white women to pursue genetic testing for BRCA1 or BRCA2, the gene mutations associated with an increased risk of break cancer, researchers report. However, African American women with a recent diagnosis of breast cancer are much more likely to do so, according to the article in the Journal of Clinical Oncology.
"Everybody deserves consideration for testing if their clinical and family history situation warrant it," Dr. James P. Evans, from the University of North Carolina at Chapel Hill, told Reuters Health. "Regardless of race, one has to approach genetic testing as an important option and explain the pros and cons to the patient."
Evans and associates examined race and the timing of breast cancer diagnosis and the frequency of BRCA1/2 genetic testing among women attending the UNC Cancer Genetics Service.
Among 768 women diagnosed with breast cancer who were offered BRCA1/2 testing, the rates of testing among African American and white patients did not differ, authors report.
Overall, African American women were 46 percent less likely than white women to undergo BRCA1/2 genetic testing, the author report.
Women who were diagnosed recently had a higher odds of pursuing testing than did women diagnosed more than 1 year before genetic evaluation, the investigators say, but this difference was statistically significant only for African American women, who were almost three-times as likely to undergo genetic testing.
Why a recent breast cancer diagnosis increases the use of BRCA1/2 genetic testing so "dramatically" among African American "could contribute to a better understanding of racial disparities in genetic testing and medicine," the authors conclude.
"We continue to aggressively try to find avenues for women who need testing but can't afford it, Evans said."One of the most interesting (and distressing) features of our study in my mind is that almost half of the patients who could benefit from testing can't get it...either because they had no insurance or their insurance was inadequate. Only through our special program were we able to provide it for all those patients."
Maximizing the use of BRCA1/2 testing requires "good genetic counseling and a personalized attentive approach on the side of the medical team," Evans advised. "We try to take a lot of time to explain the nuances to women and why testing can be of help to them and their families. I think this is especially important with African American patients where there is traditionally a lower level of trust in the medical profession (understandably)."
SOURCE: Journal of Clinical Oncology, January 1, 2008; breastcancer.org
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"Everybody deserves consideration for testing if their clinical and family history situation warrant it," Dr. James P. Evans, from the University of North Carolina at Chapel Hill, told Reuters Health. "Regardless of race, one has to approach genetic testing as an important option and explain the pros and cons to the patient."
Evans and associates examined race and the timing of breast cancer diagnosis and the frequency of BRCA1/2 genetic testing among women attending the UNC Cancer Genetics Service.
Among 768 women diagnosed with breast cancer who were offered BRCA1/2 testing, the rates of testing among African American and white patients did not differ, authors report.
Overall, African American women were 46 percent less likely than white women to undergo BRCA1/2 genetic testing, the author report.
Women who were diagnosed recently had a higher odds of pursuing testing than did women diagnosed more than 1 year before genetic evaluation, the investigators say, but this difference was statistically significant only for African American women, who were almost three-times as likely to undergo genetic testing.
Why a recent breast cancer diagnosis increases the use of BRCA1/2 genetic testing so "dramatically" among African American "could contribute to a better understanding of racial disparities in genetic testing and medicine," the authors conclude.
"We continue to aggressively try to find avenues for women who need testing but can't afford it, Evans said."One of the most interesting (and distressing) features of our study in my mind is that almost half of the patients who could benefit from testing can't get it...either because they had no insurance or their insurance was inadequate. Only through our special program were we able to provide it for all those patients."
Maximizing the use of BRCA1/2 testing requires "good genetic counseling and a personalized attentive approach on the side of the medical team," Evans advised. "We try to take a lot of time to explain the nuances to women and why testing can be of help to them and their families. I think this is especially important with African American patients where there is traditionally a lower level of trust in the medical profession (understandably)."
SOURCE: Journal of Clinical Oncology, January 1, 2008; breastcancer.org
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Bif Naked Fighting Breast Cancer By Making Music
Bif Naked, Canadian punk rocker, 36-year-old newlywed, vows to keep working on two new albums while in treatment for breast cancer. Bif, born Beth Torbert, found the breast lump herself while doing a regular breast self-exam. Bif is known for her healthy lifestyle, strict vegan diet, dedicated workout routine, and regular yoga sessions.
"I have never been one to give up when an obstacle is placed in front of me. I am in the fight of my life, and I'm lucky to have the support of my husband Ian and many friends and family members," said Bif. She plans to continue work on her sixth album, as well as a new project with Spanish-born, death-metal guitarist La Machina, to be called Jakkarta.
Bif Naked's treatment will include surgery, radiation and chemotherapy.
Source: breastcancer.about.com
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"I have never been one to give up when an obstacle is placed in front of me. I am in the fight of my life, and I'm lucky to have the support of my husband Ian and many friends and family members," said Bif. She plans to continue work on her sixth album, as well as a new project with Spanish-born, death-metal guitarist La Machina, to be called Jakkarta.
Bif Naked's treatment will include surgery, radiation and chemotherapy.
Source: breastcancer.about.com
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Wednesday, January 9, 2008
Breast Reconstruction Often Not Discussed
By Megan Rauscher
NEW YORK (Reuters Health) - Women with breast cancer faced with treatment decisions are often not told by their surgeons about the possibility of breast reconstruction after a mastectomy, a study confirms. When these conversations do occur, many more women choose mastectomy, researchers found.
In a survey of 1,178 women who had breast cancer surgery, only 33 percent reported that their surgeon had discussed breast reconstruction with them during the surgical decision-making process.
"We found it surprising that very few patients were informed about their options for breast reconstruction, and that information regarding reconstruction was more likely to be given to younger women who were more educated," Dr. Amy K. Alderman of the University of Michigan Medical Center, Ann Arbor, told Reuters Health.
The survey, posted online Friday by the medical journal Cancer, also indicates that women who had these discussions with their surgeon were four times more likely to have a mastectomy compared to women who did not discuss reconstruction.
"Women need to be fully informed about all of their surgical options for breast cancer: lumpectomy, mastectomy and mastectomy with reconstruction," Alderman said. "All are great options with the same long-term survival."
Breast reconstruction, continued Alderman, "is a personal decision for each woman that is influenced by her body image, sexuality, fear of recurrence, etc. Women should be educated consumers of their healthcare."
She concluded: "We, as physicians, need to make sure that all women, regardless of the patients' education and socioeconomic status, are fully informed of their surgical choices for breast cancer care."
SOURCE: Cancer, February 1, 2008
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NEW YORK (Reuters Health) - Women with breast cancer faced with treatment decisions are often not told by their surgeons about the possibility of breast reconstruction after a mastectomy, a study confirms. When these conversations do occur, many more women choose mastectomy, researchers found.
In a survey of 1,178 women who had breast cancer surgery, only 33 percent reported that their surgeon had discussed breast reconstruction with them during the surgical decision-making process.
"We found it surprising that very few patients were informed about their options for breast reconstruction, and that information regarding reconstruction was more likely to be given to younger women who were more educated," Dr. Amy K. Alderman of the University of Michigan Medical Center, Ann Arbor, told Reuters Health.
The survey, posted online Friday by the medical journal Cancer, also indicates that women who had these discussions with their surgeon were four times more likely to have a mastectomy compared to women who did not discuss reconstruction.
"Women need to be fully informed about all of their surgical options for breast cancer: lumpectomy, mastectomy and mastectomy with reconstruction," Alderman said. "All are great options with the same long-term survival."
Breast reconstruction, continued Alderman, "is a personal decision for each woman that is influenced by her body image, sexuality, fear of recurrence, etc. Women should be educated consumers of their healthcare."
She concluded: "We, as physicians, need to make sure that all women, regardless of the patients' education and socioeconomic status, are fully informed of their surgical choices for breast cancer care."
SOURCE: Cancer, February 1, 2008
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Wednesday, December 12, 2007
Dieting reduces lymphedema after breast cancer
By David Douglas
NEW YORK (Reuters Health) - Weight loss appears to be an effective way to reduce breast cancer-associated lymphedema of the arm, according to UK researchers.
Lymphedema is common, chronic condition that often develops after breast surgery, in which excess fluid collects in the lymph nodes and vessels in the armpit. Treatment for this condition has usually "centered on skin care, external support and compression, exercise and movement and simple lymphatic drainage," lead investigator Dr. Clare Shaw told Reuters Health.
"This is the first time that weight reduction has been shown to influence the size of a lymphedematous arm," the researcher points out.
Shaw of the Royal Marsden National Health Service Foundation Trust, London, and colleagues note that obesity is a risk factor for lymphedema of the arm as well as for poor response to treatment.
To investigate whether weight reduction might benefit in these patients, the researchers studied 21 obese women with breast cancer-related lymphedema. Their average body mass index (BMI) was 32. BMI is the ratio of height to weight used to estimate if individuals are overweight or underweight. People with a BMI of 30 or greater are considered obesity.
The patients were randomly assigned to receive specific dietary advice aimed at cutting out 1,000 kcal per day or to receive an information booklet on healthy eating.
After 12 weeks, the intervention group had lost an average of 3.3 kg (7.3 lbs), their BMI was reduced by an average of 1.3, and excess arm volume fell from 25 percent to 15 percent. There were no changes in weight or in arm volume in the control group.
"Weight management should become an integral part of the management of breast cancer-related lymphedema," concluded Shaw. Overweight patients should be given information on the potential benefits of weight reduction and support to help them achieve it.
SOURCE: Cancer, October 15, 2007.
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NEW YORK (Reuters Health) - Weight loss appears to be an effective way to reduce breast cancer-associated lymphedema of the arm, according to UK researchers.
Lymphedema is common, chronic condition that often develops after breast surgery, in which excess fluid collects in the lymph nodes and vessels in the armpit. Treatment for this condition has usually "centered on skin care, external support and compression, exercise and movement and simple lymphatic drainage," lead investigator Dr. Clare Shaw told Reuters Health.
"This is the first time that weight reduction has been shown to influence the size of a lymphedematous arm," the researcher points out.
Shaw of the Royal Marsden National Health Service Foundation Trust, London, and colleagues note that obesity is a risk factor for lymphedema of the arm as well as for poor response to treatment.
To investigate whether weight reduction might benefit in these patients, the researchers studied 21 obese women with breast cancer-related lymphedema. Their average body mass index (BMI) was 32. BMI is the ratio of height to weight used to estimate if individuals are overweight or underweight. People with a BMI of 30 or greater are considered obesity.
The patients were randomly assigned to receive specific dietary advice aimed at cutting out 1,000 kcal per day or to receive an information booklet on healthy eating.
After 12 weeks, the intervention group had lost an average of 3.3 kg (7.3 lbs), their BMI was reduced by an average of 1.3, and excess arm volume fell from 25 percent to 15 percent. There were no changes in weight or in arm volume in the control group.
"Weight management should become an integral part of the management of breast cancer-related lymphedema," concluded Shaw. Overweight patients should be given information on the potential benefits of weight reduction and support to help them achieve it.
SOURCE: Cancer, October 15, 2007.
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Sunday, November 18, 2007
Double Mastectomies To Prevent Breast Cancer Increase
From 1998 through 2003, the rate of double mastectomies among women in the United States who had cancer diagnosed in only one breast more than doubled, according to a report in the Journal of Clinical Oncology.
"Many surgeons had noticed that more women were requesting double mastectomy for treatment of the cancer in only one breast. So, we weren't surprised by the overall trend, but we were very surprised by the magnitude," lead author Dr. Todd M. Tuttle said in an interview with Reuters Health.
What is driving this trend will require further studies, added Tuttle, from the University of Minnesota in Minneapolis. In the meantime, he advised, it is critical that physicians be aware and inform their patients that "although there may be sound reasons for undergoing double mastectomy (avoidance of future mammograms and preventing a new cancer), the procedure does not improve breast cancer survival."
The new study involved an analysis of data for 152,755 women who were diagnosed with cancer in one breast between 1998 and 2003 and entered in the Surveillance, Epidemiology, and End Results (SEER), the US National Cancer Institutes' database.
Overall, 4,969 patients elected to undergo preventative mastectomy in the other breast. The rates of the operation were 3.3 percent among women who had any surgery, including those who underwent single mastectomy or only had their tumor removed, and 7.7 percent among mastectomy patients.
The overall rate of double mastectomy - that included removal of an unaffected breast climbed from 1.8 percent in 1998 to 4.5 percent in 2003, the report indicates. Among mastectomy patients, the rate rose from 4.2 percent to 11.0 percent. These trends were noted for patients at any cancer stage and were still apparent at the end of the study period.
Characteristics of the women who underwent double mastectomy included younger patient age, non-Hispanic white race, lobular breast cancer type, and a prior cancer diagnosis, the researchers found. Large tumor size was associated with an increase in the overall rate of the procedure, but with a decrease in the rate among mastectomy patients.
"The main unanswered question from this research is: why are more women choosing to undergo double mastectomy?" Tuttle said. "For our next research project, we will interview breast cancer patients before and after surgery to determine what factors influenced their surgical decisions. We will also interview patients' surgeons to determine their advice."
AUTHOR: Anthony J. Brown, MD
SOURCE: Journal of Clinical Oncology, October 22, 2007 online.
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"Many surgeons had noticed that more women were requesting double mastectomy for treatment of the cancer in only one breast. So, we weren't surprised by the overall trend, but we were very surprised by the magnitude," lead author Dr. Todd M. Tuttle said in an interview with Reuters Health.
What is driving this trend will require further studies, added Tuttle, from the University of Minnesota in Minneapolis. In the meantime, he advised, it is critical that physicians be aware and inform their patients that "although there may be sound reasons for undergoing double mastectomy (avoidance of future mammograms and preventing a new cancer), the procedure does not improve breast cancer survival."
The new study involved an analysis of data for 152,755 women who were diagnosed with cancer in one breast between 1998 and 2003 and entered in the Surveillance, Epidemiology, and End Results (SEER), the US National Cancer Institutes' database.
Overall, 4,969 patients elected to undergo preventative mastectomy in the other breast. The rates of the operation were 3.3 percent among women who had any surgery, including those who underwent single mastectomy or only had their tumor removed, and 7.7 percent among mastectomy patients.
The overall rate of double mastectomy - that included removal of an unaffected breast climbed from 1.8 percent in 1998 to 4.5 percent in 2003, the report indicates. Among mastectomy patients, the rate rose from 4.2 percent to 11.0 percent. These trends were noted for patients at any cancer stage and were still apparent at the end of the study period.
Characteristics of the women who underwent double mastectomy included younger patient age, non-Hispanic white race, lobular breast cancer type, and a prior cancer diagnosis, the researchers found. Large tumor size was associated with an increase in the overall rate of the procedure, but with a decrease in the rate among mastectomy patients.
"The main unanswered question from this research is: why are more women choosing to undergo double mastectomy?" Tuttle said. "For our next research project, we will interview breast cancer patients before and after surgery to determine what factors influenced their surgical decisions. We will also interview patients' surgeons to determine their advice."
AUTHOR: Anthony J. Brown, MD
SOURCE: Journal of Clinical Oncology, October 22, 2007 online.
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Thursday, October 18, 2007
High Risk of Breast Cancer: 4 Factors
Breast cancer has struck within my family, and when it did I was worried not only for my relative (she's fine now, thank goodness), but also for myself.
After her diagnosis, when I asked my doctor if I should do anything beyond the norm to safeguard my health, the doctor's answer was, "Many more women who have no known relatives with breast cancer get the disease than do those who have a family history."
This was her way of reassuring me, and I've continued to live healthy by getting the usual screenings and not worrying constantly that I will be diagnosed. Every year I schedule my mammogram, and every so often I do a self exam, and I tell other women to do the same. These are the best cancer-fighting aids we have: awareness, action, and advocacy.
To get a quick snapshot of your own risk, based on your family history, Therese M. Bevers, M.D., medical director of the Cancer Prevention Center at The University of Texas M. D. Anderson Cancer Center, suggests you ask yourself the four following questions:
1. Do you have at least two blood relatives who were diagnosed with breast cancer before menopause?
2. Do you have a blood relative who was diagnosed with breast cancer before menopause and a blood relative who developed ovarian cancer at any age?
3. If you have a family history of breast cancer, were any of the diagnosed relatives male?
4. Is your family of Ashkenazi Jewish descent?
If you answered yes to 1, 2 or 3, or to 4 along with any other question, your family history of breast cancer implies a genetic predisposition, says Dr. Bevers.
Talk with your doctor about whether you should consider seeing a genetic counselor, who can give you a much more complete assessment of your risk. (You can also find a genetic counselor yourself at the National Society of Genetic Counselors.
If you learn that you are indeed at high risk, organizations like FORCE, Facing Our Risk of Cancer Empowered, can provide additional information and support.
One more very important point: The American Cancer Society now recommends that certain women who have a higher-than-average risk of breast cancer get a breast MRI along with their mammogram; and depending on the details of your family history, you may need to start screening as early as age 30 or sooner.
The test is able to spot changes that the X-ray might miss (though be warned that means a higher chance of an unnecessary biopsy). Who exactly should consider it? Women who have tested positive for a BRCA mutation; those who have a first-degree relative with a BRCA mutation; women who had radiation to the chest between the ages of 10 and 30 and those whose lifetime risk is 20 percent or higher.
If you said no to all of the questions listed above, or yes only to number 4, you are likely at average ris, which is probably lower than you think. A woman who has no family history has just a one in 13 chance of developing breast cancer in her lifetime, according to large study published in The Lancet.
****
Author Bio: Lucy Danziger is the editor-in-chief of SELF magazine. In 1991, SELF founded the Pink Ribbon to raise awareness and funding for breast cancer research. Each October, SELF produces a Breast Cancer Handbook feature. The 2005 handbook won a National Magazine Award for Personal Service. Danziger lives in Manhattan with her husband and two children.
****
After her diagnosis, when I asked my doctor if I should do anything beyond the norm to safeguard my health, the doctor's answer was, "Many more women who have no known relatives with breast cancer get the disease than do those who have a family history."
This was her way of reassuring me, and I've continued to live healthy by getting the usual screenings and not worrying constantly that I will be diagnosed. Every year I schedule my mammogram, and every so often I do a self exam, and I tell other women to do the same. These are the best cancer-fighting aids we have: awareness, action, and advocacy.
To get a quick snapshot of your own risk, based on your family history, Therese M. Bevers, M.D., medical director of the Cancer Prevention Center at The University of Texas M. D. Anderson Cancer Center, suggests you ask yourself the four following questions:
1. Do you have at least two blood relatives who were diagnosed with breast cancer before menopause?
2. Do you have a blood relative who was diagnosed with breast cancer before menopause and a blood relative who developed ovarian cancer at any age?
3. If you have a family history of breast cancer, were any of the diagnosed relatives male?
4. Is your family of Ashkenazi Jewish descent?
If you answered yes to 1, 2 or 3, or to 4 along with any other question, your family history of breast cancer implies a genetic predisposition, says Dr. Bevers.
Talk with your doctor about whether you should consider seeing a genetic counselor, who can give you a much more complete assessment of your risk. (You can also find a genetic counselor yourself at the National Society of Genetic Counselors.
If you learn that you are indeed at high risk, organizations like FORCE, Facing Our Risk of Cancer Empowered, can provide additional information and support.
One more very important point: The American Cancer Society now recommends that certain women who have a higher-than-average risk of breast cancer get a breast MRI along with their mammogram; and depending on the details of your family history, you may need to start screening as early as age 30 or sooner.
The test is able to spot changes that the X-ray might miss (though be warned that means a higher chance of an unnecessary biopsy). Who exactly should consider it? Women who have tested positive for a BRCA mutation; those who have a first-degree relative with a BRCA mutation; women who had radiation to the chest between the ages of 10 and 30 and those whose lifetime risk is 20 percent or higher.
If you said no to all of the questions listed above, or yes only to number 4, you are likely at average ris, which is probably lower than you think. A woman who has no family history has just a one in 13 chance of developing breast cancer in her lifetime, according to large study published in The Lancet.
****
Author Bio: Lucy Danziger is the editor-in-chief of SELF magazine. In 1991, SELF founded the Pink Ribbon to raise awareness and funding for breast cancer research. Each October, SELF produces a Breast Cancer Handbook feature. The 2005 handbook won a National Magazine Award for Personal Service. Danziger lives in Manhattan with her husband and two children.
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Sunday, April 8, 2007
Young, Black Women at Higher Risk of Aggressive Breast Cancer
Young, Black Women at Higher Risk of Aggressive Breast Cancer
These tumors lack hormone receptors that make ideal treatment targets, researchers say
By Alan Mozes
HealthDay Reporter
MONDAY, March 26 (HealthDay News) -- U.S. breast cancer patients with a particularly deadly form of the disease are more likely to be poor, black or Hispanic, and under 40 years of age, new research shows.
Patients diagnosed with "triple-negative" breast cancer lack three key hormonal cancer markers that are present in most other forms of the disease, experts explain.
The absence of these cell receptors deprives doctors and patients of critical diagnostic information and prime targets for treatment, reducing a patient's therapeutic options and undercutting her expected survival.
"The paradox is that while African-American and Hispanic women have a lower overall risk for breast cancer, they have a higher mortality, which is probably due to the higher incidence of triple-negative [disease]," said study co-author Dr. Vincent Caggiano, research medical director of the Sutter Cancer Center at the Cancer Surveillance Program in Sacramento, Calif.
"So, in addition to the usual surgery that all women undergo, these triple-negative women are not eligible to receive any hormonal therapy," he added. "This leaves them with only chemotherapy to treat a very aggressive form of breast cancer. And although triple-negative patients respond well to chemotherapy, they relapse and their survival is shortened."
The findings are published in the May 1 issue of Cancer.
According to the American Cancer Society, breast cancer is the second most common cancer among women, after nonmelanoma skin cancer. Women living in North America are subject to the highest rate of breast cancer in the world, and nearly 180,000 new cases of breast cancer will be diagnosed in the United States this year alone.
In most cases of breast cancer, the presence of hormonal receptors in tumor tissue allows for the use of highly effective and narrowly targeted endocrine treatments --collectively known as "hormone adjuvant therapy" -- which have been developed in recent years as an alternative to systemic chemotherapy.
Hormone receptors are specialized protein molecules that can be located outside or inside either normal or cancerous cells. Such receptors attract and draw in particular hormones, such as estrogen or progesterone. As hormones "lock up" with hormone receptors, the effect is like flicking on a switch for certain cellular activities, including cancer cell growth.
Recognizing that no two cancers are alike, newer drugs -- including aromatase inhibitors and herceptin -- target hormone receptors specific to the patient's cancer cells.
But about 15 percent of patients have so-called "basal-like" breast cancer, which includes all triple-negative cases. In such instances the tumor lacks hormone receptors for either estrogen (ER), progesterone (PR), or human epidermal growth factor receptor 2 (HER2).
To identify those women at highest risk for basal-like breast cancer, Caggiono and his team analyzed the demographics of 6,370 California women diagnosed with a primary case of triple-negative breast cancer between 1999 and 2003. The women were identified through the California Cancer Registry.
They next compared outcomes for women with triple-negative disease against those of more than 44,700 patients with breast cancers that carried the hormonal markers.
Triple-negative patients were significantly younger at the time of their diagnosis than were other breast cancer patients, the researchers found. Whereas about 63 percent of triple-negative cases were uncovered before the age of 60, less than half of other breast cancers were diagnosed in women under 60.
Women 40 years of age or under were over one-and-a-half times more likely to have triple negative breast cancer than were patients between the ages of 60 and 69, the team found.
Race was also a major risk factor. While nearly 25 percent of the black patients had triple-negative malignancies, only about 11 percent of whites, 12 percent of Asians, and 17 percent of Hispanics were similarly diagnosed.
In terms of income, richer patients were less likely to be triple-negative than poorer breast cancer patients, although the very poorest did not appear to have a significantly greater risk, the team says.
Triple-negative patients were also more likely to be diagnosed with larger tumors and at a more advanced stage of disease, the study found.
As suspected, survival was worse for triple-negative patients than for other patients. Three out of four (77 percent) of patients with triple-negative cancers survived five years post-diagnosis compared with 93 percent of other breast cancer patients.
Non-Hispanic black patients with triple-negative disease fared worst of all, having just a 14 percent five-year survival rate. By comparison, patients with other forms of late stage disease had five-year survival rates of between 36 and 49 percent.
Why such disparities? Caggiano's team say biological differences probably play a big role. But they also suggested that other factors, such as lack of health-care access and resulting differences in treatment could pay a role in the higher incidence of triple-negative cases among non-white patients and the poor.
"What's important to note is that breast cancer is not a single disease and even young women can get it," said Caggiano. "Why African-American and Hispanic women get this very aggressive form more often we really don't know. It may be due to genetics, socioeconomic status, or in part due to barriers to treatment. It's probably an interaction of all of them. It's clearly an area for further research."
Emily White, a researcher with the Fred Hutchinson Cancer Center in Seattle, said that "studies like this are worthwhile, and help us understand risk factors more clearly. But it's also an issue of debate whether estrogen and progesterone receptors and HER2 are fundamental [unchanging] characteristics of a tumor, or whether their status actually changes and they lose their ability to respond over time."
The notion of cancer cell change could help explain the socioeconomic disparities uncovered in this study, she said.
"If you say some tumors are simply destined to be negative from the start then you have to point to some genetic predisposition to explain it," said White, who is also professor of epidemiology at the University of Washington. "But, if you think tumors can change with time then it could be that certain socioeconomic groups get diagnosed with a more aggressive type of cancer simply because of diagnosis delays, due to health-care barriers. Whether or not this is so is not yet really understood."
More information
For more on triple-negative breast cancer, head to Breastcancer.org.
SOURCES: Vincent Caggiano, M.D., research medical director, Sutter Cancer Center, Cancer Surveillance Program, and Sutter Institute for Medical Research, Sacramento, Calif.; Emily White, Ph.D., researcher, Fred Hutchinson Cancer Center, and professor, epidemiology, University of Washington, Seattle; May 1, 2007, Cancer
******
These tumors lack hormone receptors that make ideal treatment targets, researchers say
By Alan Mozes
HealthDay Reporter
MONDAY, March 26 (HealthDay News) -- U.S. breast cancer patients with a particularly deadly form of the disease are more likely to be poor, black or Hispanic, and under 40 years of age, new research shows.
Patients diagnosed with "triple-negative" breast cancer lack three key hormonal cancer markers that are present in most other forms of the disease, experts explain.
The absence of these cell receptors deprives doctors and patients of critical diagnostic information and prime targets for treatment, reducing a patient's therapeutic options and undercutting her expected survival.
"The paradox is that while African-American and Hispanic women have a lower overall risk for breast cancer, they have a higher mortality, which is probably due to the higher incidence of triple-negative [disease]," said study co-author Dr. Vincent Caggiano, research medical director of the Sutter Cancer Center at the Cancer Surveillance Program in Sacramento, Calif.
"So, in addition to the usual surgery that all women undergo, these triple-negative women are not eligible to receive any hormonal therapy," he added. "This leaves them with only chemotherapy to treat a very aggressive form of breast cancer. And although triple-negative patients respond well to chemotherapy, they relapse and their survival is shortened."
The findings are published in the May 1 issue of Cancer.
According to the American Cancer Society, breast cancer is the second most common cancer among women, after nonmelanoma skin cancer. Women living in North America are subject to the highest rate of breast cancer in the world, and nearly 180,000 new cases of breast cancer will be diagnosed in the United States this year alone.
In most cases of breast cancer, the presence of hormonal receptors in tumor tissue allows for the use of highly effective and narrowly targeted endocrine treatments --collectively known as "hormone adjuvant therapy" -- which have been developed in recent years as an alternative to systemic chemotherapy.
Hormone receptors are specialized protein molecules that can be located outside or inside either normal or cancerous cells. Such receptors attract and draw in particular hormones, such as estrogen or progesterone. As hormones "lock up" with hormone receptors, the effect is like flicking on a switch for certain cellular activities, including cancer cell growth.
Recognizing that no two cancers are alike, newer drugs -- including aromatase inhibitors and herceptin -- target hormone receptors specific to the patient's cancer cells.
But about 15 percent of patients have so-called "basal-like" breast cancer, which includes all triple-negative cases. In such instances the tumor lacks hormone receptors for either estrogen (ER), progesterone (PR), or human epidermal growth factor receptor 2 (HER2).
To identify those women at highest risk for basal-like breast cancer, Caggiono and his team analyzed the demographics of 6,370 California women diagnosed with a primary case of triple-negative breast cancer between 1999 and 2003. The women were identified through the California Cancer Registry.
They next compared outcomes for women with triple-negative disease against those of more than 44,700 patients with breast cancers that carried the hormonal markers.
Triple-negative patients were significantly younger at the time of their diagnosis than were other breast cancer patients, the researchers found. Whereas about 63 percent of triple-negative cases were uncovered before the age of 60, less than half of other breast cancers were diagnosed in women under 60.
Women 40 years of age or under were over one-and-a-half times more likely to have triple negative breast cancer than were patients between the ages of 60 and 69, the team found.
Race was also a major risk factor. While nearly 25 percent of the black patients had triple-negative malignancies, only about 11 percent of whites, 12 percent of Asians, and 17 percent of Hispanics were similarly diagnosed.
In terms of income, richer patients were less likely to be triple-negative than poorer breast cancer patients, although the very poorest did not appear to have a significantly greater risk, the team says.
Triple-negative patients were also more likely to be diagnosed with larger tumors and at a more advanced stage of disease, the study found.
As suspected, survival was worse for triple-negative patients than for other patients. Three out of four (77 percent) of patients with triple-negative cancers survived five years post-diagnosis compared with 93 percent of other breast cancer patients.
Non-Hispanic black patients with triple-negative disease fared worst of all, having just a 14 percent five-year survival rate. By comparison, patients with other forms of late stage disease had five-year survival rates of between 36 and 49 percent.
Why such disparities? Caggiano's team say biological differences probably play a big role. But they also suggested that other factors, such as lack of health-care access and resulting differences in treatment could pay a role in the higher incidence of triple-negative cases among non-white patients and the poor.
"What's important to note is that breast cancer is not a single disease and even young women can get it," said Caggiano. "Why African-American and Hispanic women get this very aggressive form more often we really don't know. It may be due to genetics, socioeconomic status, or in part due to barriers to treatment. It's probably an interaction of all of them. It's clearly an area for further research."
Emily White, a researcher with the Fred Hutchinson Cancer Center in Seattle, said that "studies like this are worthwhile, and help us understand risk factors more clearly. But it's also an issue of debate whether estrogen and progesterone receptors and HER2 are fundamental [unchanging] characteristics of a tumor, or whether their status actually changes and they lose their ability to respond over time."
The notion of cancer cell change could help explain the socioeconomic disparities uncovered in this study, she said.
"If you say some tumors are simply destined to be negative from the start then you have to point to some genetic predisposition to explain it," said White, who is also professor of epidemiology at the University of Washington. "But, if you think tumors can change with time then it could be that certain socioeconomic groups get diagnosed with a more aggressive type of cancer simply because of diagnosis delays, due to health-care barriers. Whether or not this is so is not yet really understood."
More information
For more on triple-negative breast cancer, head to Breastcancer.org.
SOURCES: Vincent Caggiano, M.D., research medical director, Sutter Cancer Center, Cancer Surveillance Program, and Sutter Institute for Medical Research, Sacramento, Calif.; Emily White, Ph.D., researcher, Fred Hutchinson Cancer Center, and professor, epidemiology, University of Washington, Seattle; May 1, 2007, Cancer
******
Saturday, November 18, 2006
Breast Reconstruction Not as Safe For Obese Patients
Significantly obese women may wish to consider delaying breast reconstruction following mastectomy until they achieve a healthier body weight. According to findings presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco, women who are significantly obese are at higher risk for complications and have a lower satisfaction rate than do normal and overweight patients.
“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”
The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.
“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”
The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.
“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”
For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
“Just because someone is overweight doesn’t mean they should not be entitled to undergo breast reconstruction after mastectomy,” said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. “Feeling ‘whole’ can be an integral part of recovery from cancer, yet significant concerns have been
raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.”
The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.
“We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight,” said Dr. Beahm. “We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight.”
The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.
“While it’s very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern,” said Dr. Beahm. “We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition.”
For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Immediate Breast Reconstruction After Mastectomy is Safe, ASPS Study Says
Debunking the myth that women with locally advanced breast cancer must wait until after chemotherapy to have their breast reconstructed, a study presented today at the ASPS/PSEF/ASMS 71st Annual Scientific Meeting in San Antonio found that immediate free flap reconstruction for women with breast cancer is safe and psychologically beneficial.
The study, which followed 170 patients with locally advanced breast cancer, found that immediate reconstruction did not delay post-operative chemotherapy, prolong recovery or hinder the diagnosis of local cancer reoccurrence.
"Losing a breast is traumatic," said ASPS Member James Watson, MD, and participating surgeon in the study. "As a board-certified plastic surgeon, I wanted to ensure that immediate breast reconstruction was safe for my patients and would make the healing process easier. The findings in this study will allow women to start healing sooner psychologically, knowing that their decision will not impede their physical progress against breast cancer."
The paper states that women participating in the study were pleased with their immediate reconstruction experience, indicating an immeasurable emotional benefit patients gain by having the reconstruction right away.
According to the findings, the majority of patients were either satisfied or very satisfied with their reconstruction and, if they had to, would have it done immediately after their mastectomy again. Also, the majority of women agreed they would recommend immediate reconstruction to a friend or colleague.
Through the study, Dr. Watson found that immediate free flap reconstruction - where a section of muscle, fat and skin are removed from the abdomen, buttocks or thigh regions and reattached in the breast using microsurgical techniques - resulted in similar complications and delays of post-operative chemotherapy to patients who delayed reconstruction. The most common postponement for patients was waiting for the wound to heal. However, the maximum delay was only three weeks, which did not have significant oncological impact on their post-operative therapy.
Also, while there were local reoccurrences of the cancer, physicians were able to diagnose the cancer's return quickly, resulting in no delay for additional treatment. Most local reoccurrences were located at the mastectomy scar or in the mastectomy flaps, which could be diagnosed by a physical exam and biopsy.
"An added benefit to reconstructing the breast immediately is that it's easier for the oncology surgeon to complete the mastectomy. Often, the breast cancer is so large or involves so much skin that the surgeon has to remove additional skin in the region, making it difficult to reserve enough tissue to close the wound," stated Dr. Watson. "With immediate reconstruction, the oncologic surgeon can eliminate more breast skin to ensure the cancer is removed and use the skin from the free flap procedure to close the wound."
Last year, more than 190,000 women were diagnosed with breast cancer. More than 80,000 women opted for breast reconstruction following a mastectomy, according to ASPS 2001 statistics.
Access to breast reconstruction following a mastectomy has increased due to the passage of the Women's Health and Cancer Rights Act 1998, proudly supported by ASPS, which mandated insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.
"With the finding that reconstruction right after mastectomy is safe, women can maximize their opportunity to not only heal physically but also psychologically right away," said Dr. Watson. "Before, women had to wrestle with their changed body image after losing a breast while physically recovering from their battle with cancer. Now, they don't have to delay the psychological healing process of beating breast cancer and celebrating that victory."
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
The study, which followed 170 patients with locally advanced breast cancer, found that immediate reconstruction did not delay post-operative chemotherapy, prolong recovery or hinder the diagnosis of local cancer reoccurrence.
"Losing a breast is traumatic," said ASPS Member James Watson, MD, and participating surgeon in the study. "As a board-certified plastic surgeon, I wanted to ensure that immediate breast reconstruction was safe for my patients and would make the healing process easier. The findings in this study will allow women to start healing sooner psychologically, knowing that their decision will not impede their physical progress against breast cancer."
The paper states that women participating in the study were pleased with their immediate reconstruction experience, indicating an immeasurable emotional benefit patients gain by having the reconstruction right away.
According to the findings, the majority of patients were either satisfied or very satisfied with their reconstruction and, if they had to, would have it done immediately after their mastectomy again. Also, the majority of women agreed they would recommend immediate reconstruction to a friend or colleague.
Through the study, Dr. Watson found that immediate free flap reconstruction - where a section of muscle, fat and skin are removed from the abdomen, buttocks or thigh regions and reattached in the breast using microsurgical techniques - resulted in similar complications and delays of post-operative chemotherapy to patients who delayed reconstruction. The most common postponement for patients was waiting for the wound to heal. However, the maximum delay was only three weeks, which did not have significant oncological impact on their post-operative therapy.
Also, while there were local reoccurrences of the cancer, physicians were able to diagnose the cancer's return quickly, resulting in no delay for additional treatment. Most local reoccurrences were located at the mastectomy scar or in the mastectomy flaps, which could be diagnosed by a physical exam and biopsy.
"An added benefit to reconstructing the breast immediately is that it's easier for the oncology surgeon to complete the mastectomy. Often, the breast cancer is so large or involves so much skin that the surgeon has to remove additional skin in the region, making it difficult to reserve enough tissue to close the wound," stated Dr. Watson. "With immediate reconstruction, the oncologic surgeon can eliminate more breast skin to ensure the cancer is removed and use the skin from the free flap procedure to close the wound."
Last year, more than 190,000 women were diagnosed with breast cancer. More than 80,000 women opted for breast reconstruction following a mastectomy, according to ASPS 2001 statistics.
Access to breast reconstruction following a mastectomy has increased due to the passage of the Women's Health and Cancer Rights Act 1998, proudly supported by ASPS, which mandated insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.
"With the finding that reconstruction right after mastectomy is safe, women can maximize their opportunity to not only heal physically but also psychologically right away," said Dr. Watson. "Before, women had to wrestle with their changed body image after losing a breast while physically recovering from their battle with cancer. Now, they don't have to delay the psychological healing process of beating breast cancer and celebrating that victory."
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including DIEP flap reconstruction. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Breast Reconstruction Helps Cancer Patients Return to Normalcy, According to the American Society of Plastic Surgeons
"It's only a part of my body, not my life," said Lola Sawyers when she was diagnosed with breast cancer in October 1997. The diagnosis was not a shock to Sawyers as her mother had breast cancer.
Lynette Dilbert, whose sister died from breast cancer, was determined not to let the disease take over her life when she was diagnosed in August 2000. "I'm in charge of what I decide," explained Dilbert about her treatment.
Just eight months after Judy Tanner's husband died from a brain tumor in June 1998, she found a lump on her right breast while dressing. Devastated by her husband's death, the diagnosis of breast cancer was hard to bear, but like Sawyers and Dilbert, Tanner would not let the disease take her life.
Through research and discussions with physicians and breast cancer survivors, these women made a firm decision - after mastectomy they would undergo breast reconstruction.
This year, more than 175,000 women in the U.S. will be diagnosed with breast cancer. However, if diagnosed and treated the survival rate is greater than 90 percent. For those women, whose treatment includes either partial or full mastectomy, advances in breast reconstruction and breakthrough legislation helps make this devastating news easier to bear.
"Strength and determination are simple words, yet they are strong terms that truly describe Lola, Lynette and Judy," said American Society of Plastic Surgeons President Walter Erhardt, MD, Albany, Ga., about his patients. "Choosing breast reconstruction is a big decision when facing this life-altering disease, but as any plastic surgeon can tell you, after breast reconstruction, survivors have a renewed sense of self-esteem and confidence.
"After breast reconstruction, no one can tell I had cancer," explained Dilbert. Tanner noted that she felt like a whole woman again. "I'm looking better than I did before," she said. "Even my co-workers have noticed a positive change in me."
Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992. The passage of the Women's Health and Cancer Rights Act of 1998 has aided this increase. The law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone mastectomy. The law applies to women with group health insurance or a health insurance plan purchased through a health insurance company.
Discussion about breast reconstruction can start immediately after diagnosis. Typically, plastic surgeons make recommendations based upon the patient's age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants, or flap reconstruction.
"Breast reconstruction gives patients the ability to feel whole again," said Dr. Erhardt. "As a plastic surgeon it's rewarding to see my patients develop a renewed confidence and love of life."
When confronted with breast cancer, Sawyers, who is known as the lemonade lady in her community because she's taken life's lemons and made lemonade, reminds woman to look at all the options. "Make reconstruction a personal choice based on what you believe and what you know," she says. "Let the final decision be yours."
"Loosing a breast is not the end of the world," said Dilbert who is active in her community's breast cancer advocacy programs. "I constantly remind women to schedule their mammograms."
Tanner strongly advises women to ask questions when choosing reconstruction. "Find out all you can about the surgeon's credentials, talk to other patients and do your homework," she reminds.
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Lynette Dilbert, whose sister died from breast cancer, was determined not to let the disease take over her life when she was diagnosed in August 2000. "I'm in charge of what I decide," explained Dilbert about her treatment.
Just eight months after Judy Tanner's husband died from a brain tumor in June 1998, she found a lump on her right breast while dressing. Devastated by her husband's death, the diagnosis of breast cancer was hard to bear, but like Sawyers and Dilbert, Tanner would not let the disease take her life.
Through research and discussions with physicians and breast cancer survivors, these women made a firm decision - after mastectomy they would undergo breast reconstruction.
This year, more than 175,000 women in the U.S. will be diagnosed with breast cancer. However, if diagnosed and treated the survival rate is greater than 90 percent. For those women, whose treatment includes either partial or full mastectomy, advances in breast reconstruction and breakthrough legislation helps make this devastating news easier to bear.
"Strength and determination are simple words, yet they are strong terms that truly describe Lola, Lynette and Judy," said American Society of Plastic Surgeons President Walter Erhardt, MD, Albany, Ga., about his patients. "Choosing breast reconstruction is a big decision when facing this life-altering disease, but as any plastic surgeon can tell you, after breast reconstruction, survivors have a renewed sense of self-esteem and confidence.
"After breast reconstruction, no one can tell I had cancer," explained Dilbert. Tanner noted that she felt like a whole woman again. "I'm looking better than I did before," she said. "Even my co-workers have noticed a positive change in me."
Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992. The passage of the Women's Health and Cancer Rights Act of 1998 has aided this increase. The law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone mastectomy. The law applies to women with group health insurance or a health insurance plan purchased through a health insurance company.
Discussion about breast reconstruction can start immediately after diagnosis. Typically, plastic surgeons make recommendations based upon the patient's age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants, or flap reconstruction.
"Breast reconstruction gives patients the ability to feel whole again," said Dr. Erhardt. "As a plastic surgeon it's rewarding to see my patients develop a renewed confidence and love of life."
When confronted with breast cancer, Sawyers, who is known as the lemonade lady in her community because she's taken life's lemons and made lemonade, reminds woman to look at all the options. "Make reconstruction a personal choice based on what you believe and what you know," she says. "Let the final decision be yours."
"Loosing a breast is not the end of the world," said Dilbert who is active in her community's breast cancer advocacy programs. "I constantly remind women to schedule their mammograms."
Tanner strongly advises women to ask questions when choosing reconstruction. "Find out all you can about the surgeon's credentials, talk to other patients and do your homework," she reminds.
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Breast Cancer and Reconstruction: Exploring the Options, Procedures and Perceptions
By Lisa Barclay
Breast cancer. It is the leading cancer diagnosed in women in America. This year, it will affect the lives of more than 180,000 women for the first time – and end the lives of 40,000 more. Thanks to proactive efforts like National Breast Cancer Awareness Month celebrated in October, the disease doesn't automatically mean a death sentence. However, the impact breast cancer has on the lives of its victims is arguably life altering – and not easily erased.
In this article, we will share the experiences of five women who have survived the disease, as well as the expertise of several American Society of Plastic Surgeons (ASPS) members who specialize in breast reconstruction after breast cancer. It is our hope that the information presented in this article will serve as a valuable resource in your journey through breast cancer treatment and recovery.
A Diagnosis of Cancer
Fear. Shock. Denial. These are just a few of the emotions women experience upon learning they have breast cancer. Jayne Siebold, of Hinsdale, Ill., was 49 when she was diagnosed with the disease and explains her initial reaction to the news. "When the doctor confirmed it was cancer, I remember thinking, 'They can't be talking about me, this must be a mistake.' Then the fear kicked in."
Barbara Taylor of Dallas went into physical shock. "Everyone I had ever known or heard of who had the disease died from it. So the fear I experienced initially was completely overwhelming, virtually crippling."
When Sue Kocsis of Omaha, Neb., was diagnosed she was 34 years old and the mother of three little girls. "The entire process was extremely overwhelming. It took visits to five different physicians before the cancer was actually diagnosed, so in the beginning I was relieved to know just what I was dealing with – but felt a tremendous amount of anger toward the doctors who kept telling me it was just fibrocystic disease and nothing to worry about."
The treatment of breast cancer involves a physical change to the body. As a result, it can have a profound psychological impact. "A woman's breasts are deeply rooted in her sense of femininity...her role as mother and nurturer, " says Jack Bruner, M.D., of Sacramento, Calif. "Therefore, facing the loss of one or both breasts can be very traumatic." Dr. Bruner recommends that every women diagnosed with breast cancer request information about reconstructive options from their general surgeon and seek the opinions of several plastic surgeons prior to surgery.
Reconstructive Solutions
Almost any woman who loses her breast to cancer can have it rebuilt through reconstructive surgery. And discussion about reconstruction can start immediately after diagnosis. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
There are several reconstructive options available after mastectomy. Typically, your plastic surgeon will make a recommendation based upon your age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants or flap reconstruction.
Flap reconstruction is a more complex procedure than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed site, and recovery time is longer than with an implant. However, when the breast is reconstructed with one's own tissue, the results are generally more natural and concerns related to implants are non-existent. Recovery times for both procedures range from six months to one year, or longer, depending on individual circumstances.
Skin Expansion
This common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your plastic surgeon will insert a balloon expander beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has been sufficiently stretched, the expander is removed in a second operation and a more permanent implant – either saline or silicone – will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and dark skin surrounding it – called the areola – are reconstructed in a subsequent procedure.
Flap Reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the abdomen, back or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of skin, fat and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.
Making the Choice
Breast cancer affects women differently depending on their age, marital status and self-image, as does their attitudes about reconstruction. No matter how they feel about it, Glenn Davis, M.D., of Raleigh, N.C., stresses that "every woman should be afforded the choice of undergoing reconstruction as part of her breast cancer treatment, and provided adequate facts to make an informed decision.
Unfortunately, many women are not given the option or the information they need to make an informed decision about reconstruction. According to Christine Horner-Taylor, M.D., of Edgewook, Ky., the women who don't undergo reconstruction procedures after losing a breast to mastectomy have many reasons for doing so. "Many women have told me the reason they didn't have breast reconstruction was because their general surgeon didn't recommend it or didn't mention that it could be done at the same time as the mastectomy. If the women are older, their surgeon may have decided they don't really need to go through it," she says.
Other reasons women pass on reconstruction include their unwillingness to have any more surgery than is absolutely necessary and an inability to weigh all the options available while they're struggling to cope with a diagnosis of cancer.
When Reconstruction May Not Be an Option
Not all women are good candidates for breast reconstruction. According to Dr. Horner-Taylor, "Women who have had a mastectomy or Lumpectomy with radiation are typically not strong candidates for skin expansion reconstruction. Radiation changes the characteristics of skin tissue, causing a variety of complications ranging from excessive scar tissue development, to blood supply and overall healing problems."
Dr. Davis feels that while radiation does present some difficult challenges, it doesn't automatically rule out the possibility of reconstruction. "While each circumstance is different, I strongly believe that if there is enough good tissue to work with, reconstruction remains a viable option for most women," he says.
Dr. Bruner notes that patients that are emotionally unstable should probably postpone reconstruction. "Coping with the reality of breast cancer is an extremely overwhelming process. If a woman cannot understand the risks and limitations of reconstruction prior to her mastectomy surgery, I would recommend she wait."
Managing Misconceptions
Misconceptions abound regarding breast cancer reconstruction. "Most misconceptions are fueled by a lack of information," says Dr. Bruner.
Common misconceptions include having to wait up to one year to safely undergo reconstruction, reconstruction makes it difficult to identify cancer if it recurs, and reconstruction interferes with cancer treatments, such as chemotherapy.
"Wrong on all counts," says Dr. Horner-Taylor. "Reconstruction can take place immediately following mastectomy with little complication. In the case of implants, reconstruction may take longer if the patient has to undergo chemotherapy, but otherwise doesn't interfere with the process."
Managing Expectations
Managing patient expectations is one of the most important aspects of breast cancer reconstruction. It is important for women to remember that the goal of reconstruction is improvement, not perfection. "Be sure to discuss your expectations candidly with your plastic surgeon, and expect nothing less than total honesty from him or her in return," says Dr. Horner-Taylor. "It's always smart to get the opinions of several plastic surgeons before moving ahead."
To ensure reconstructive surgery has the desired outcome, breast symmetry procedures – surgery to the other breast – is usually also part of the reconstructive process. "Symmetry procedures either reduce, lift or reshape the remaining breast to ensure a better match to the reconstructed breast," says Dr. Bruner. He goes on to note that symmetry procedures can be an ongoing process, with periodic adjustments necessary to correct the affects of the aging process. ASPS is currently pushing for legislation to ensure women have access to symmetry procedures as part of their reconstruction treatment after breast cancer.
Dolores Glover, Siebold and Kocsis all decided to undergo reconstruction procedures – Siebold at the same time as her mastectomy, Glover 10 years later and Kocsis one year later. Glover and Siebold opted for skin expansion with implants. Kocsis decided to go with flap reconstruction.
"Breast reconstruction was the number one motivation that got me through the most difficult times of my treatment," says Siebold. "The breast reconstruction, although excellent, will never look or feel the same as a natural breast. However, not having to stuff my bra with fillers is a great relief, and I truly feel like a complete woman again."
Glover was never given the option of reconstruction at the time her cancer was diagnosed and her mastectomy performed. She was 38. "I was so busy being a mom to my two children and a wife that I didn't think about reconstruction initially. I also didn't want to endure any more pain or surgery, although my oncologist strongly recommended it," she says. However, every time she caught a glimpse of herself in the mirror, she was reminded of her disfigurement. "I felt deformed, and that feeling never went away until I had reconstruction. I eventually did use a prosthesis, but still wasn't happy with the results." Ten years after her mastectomy, Glover finally decided to have breast reconstruction. "I'm glad I had it done. It helped me to find closure and feel normal again."
For Kocsis, breast reconstruction was a completely mind restorative process. "The day I had my reconstructive surgery was the day I took my life back," she says. She first learned about flap reconstruction through a local support group and decided to undergo the procedure one year after her diagnosis. "I liked the idea of using natural tissue for the reconstruction, and once I made the decision to have surgery, I actually looked forward to having it done." The reconstruction was a success and Kocsis is thrilled with her results. "I really feel great about my decision and the end result. In fact, my family and I celebrate the date of my surgery every year as my re-birthday." Kocsis is now active in public education efforts for breast cancer and reconstruction, writing articles, conducting interviews and giving presentations.
Davis decided not to undergo reconstruction, although she was prepared to go through with it until the day before her mastectomy. "I just decided that I didn't want to be under anesthesia or on the operating table that long," she says. And five years later, she's confident she made the right decision. "It was more important to me to focus on treating the cancer. My breasts are not that important to me, they don't define who I am as a person."
Making An Informed Decision
The decision to undergo breast reconstruction is an intensely personal one. All of the ASPS members interviewed for this article agree that the decision should be made by the patient, not by treating physicians. "It really is a quality of life issue," says Dr. Davis. "And it doesn't matter how old the patient is or if they're married or single. All women should have the option, if they want it."
The most important tool available to women coping with breast cancer is information. "Women need to get as much information as they can, from doctors, cancer organizations, support groups and other women," says Dr. Bruner. "And they shouldn't be afraid to ask the tough questions, as many as necessary to increase their comfort level with their treatment and aid in their recovery process."
To learn more about your breast reconstruction options CLICK HERE.
For more information about breast cancer, call any of the following toll-free numbers:
American Cancer Society
1-800-ACS-2345
Cancer Care, Inc.
1-800-813-HOPE
Cancer Research Foundation of America
1-800-227-2732
National Alliance of Breast Cancer Organizations (NABCO)
1-800-719-9154
National Cancer Institute's Cancer Information Service
1-800-4-CANCER
Y-ME National Breast Cancer Organization
1-800-221-2141
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
Breast cancer. It is the leading cancer diagnosed in women in America. This year, it will affect the lives of more than 180,000 women for the first time – and end the lives of 40,000 more. Thanks to proactive efforts like National Breast Cancer Awareness Month celebrated in October, the disease doesn't automatically mean a death sentence. However, the impact breast cancer has on the lives of its victims is arguably life altering – and not easily erased.
In this article, we will share the experiences of five women who have survived the disease, as well as the expertise of several American Society of Plastic Surgeons (ASPS) members who specialize in breast reconstruction after breast cancer. It is our hope that the information presented in this article will serve as a valuable resource in your journey through breast cancer treatment and recovery.
A Diagnosis of Cancer
Fear. Shock. Denial. These are just a few of the emotions women experience upon learning they have breast cancer. Jayne Siebold, of Hinsdale, Ill., was 49 when she was diagnosed with the disease and explains her initial reaction to the news. "When the doctor confirmed it was cancer, I remember thinking, 'They can't be talking about me, this must be a mistake.' Then the fear kicked in."
Barbara Taylor of Dallas went into physical shock. "Everyone I had ever known or heard of who had the disease died from it. So the fear I experienced initially was completely overwhelming, virtually crippling."
When Sue Kocsis of Omaha, Neb., was diagnosed she was 34 years old and the mother of three little girls. "The entire process was extremely overwhelming. It took visits to five different physicians before the cancer was actually diagnosed, so in the beginning I was relieved to know just what I was dealing with – but felt a tremendous amount of anger toward the doctors who kept telling me it was just fibrocystic disease and nothing to worry about."
The treatment of breast cancer involves a physical change to the body. As a result, it can have a profound psychological impact. "A woman's breasts are deeply rooted in her sense of femininity...her role as mother and nurturer, " says Jack Bruner, M.D., of Sacramento, Calif. "Therefore, facing the loss of one or both breasts can be very traumatic." Dr. Bruner recommends that every women diagnosed with breast cancer request information about reconstructive options from their general surgeon and seek the opinions of several plastic surgeons prior to surgery.
Reconstructive Solutions
Almost any woman who loses her breast to cancer can have it rebuilt through reconstructive surgery. And discussion about reconstruction can start immediately after diagnosis. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
There are several reconstructive options available after mastectomy. Typically, your plastic surgeon will make a recommendation based upon your age, health, anatomy, tissues and goals. The most common procedures include skin expansion followed by the use of implants or flap reconstruction.
Flap reconstruction is a more complex procedure than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed site, and recovery time is longer than with an implant. However, when the breast is reconstructed with one's own tissue, the results are generally more natural and concerns related to implants are non-existent. Recovery times for both procedures range from six months to one year, or longer, depending on individual circumstances.
Skin Expansion
This common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your plastic surgeon will insert a balloon expander beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has been sufficiently stretched, the expander is removed in a second operation and a more permanent implant – either saline or silicone – will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and dark skin surrounding it – called the areola – are reconstructed in a subsequent procedure.
Flap Reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the abdomen, back or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of skin, fat and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.
Making the Choice
Breast cancer affects women differently depending on their age, marital status and self-image, as does their attitudes about reconstruction. No matter how they feel about it, Glenn Davis, M.D., of Raleigh, N.C., stresses that "every woman should be afforded the choice of undergoing reconstruction as part of her breast cancer treatment, and provided adequate facts to make an informed decision.
Unfortunately, many women are not given the option or the information they need to make an informed decision about reconstruction. According to Christine Horner-Taylor, M.D., of Edgewook, Ky., the women who don't undergo reconstruction procedures after losing a breast to mastectomy have many reasons for doing so. "Many women have told me the reason they didn't have breast reconstruction was because their general surgeon didn't recommend it or didn't mention that it could be done at the same time as the mastectomy. If the women are older, their surgeon may have decided they don't really need to go through it," she says.
Other reasons women pass on reconstruction include their unwillingness to have any more surgery than is absolutely necessary and an inability to weigh all the options available while they're struggling to cope with a diagnosis of cancer.
When Reconstruction May Not Be an Option
Not all women are good candidates for breast reconstruction. According to Dr. Horner-Taylor, "Women who have had a mastectomy or Lumpectomy with radiation are typically not strong candidates for skin expansion reconstruction. Radiation changes the characteristics of skin tissue, causing a variety of complications ranging from excessive scar tissue development, to blood supply and overall healing problems."
Dr. Davis feels that while radiation does present some difficult challenges, it doesn't automatically rule out the possibility of reconstruction. "While each circumstance is different, I strongly believe that if there is enough good tissue to work with, reconstruction remains a viable option for most women," he says.
Dr. Bruner notes that patients that are emotionally unstable should probably postpone reconstruction. "Coping with the reality of breast cancer is an extremely overwhelming process. If a woman cannot understand the risks and limitations of reconstruction prior to her mastectomy surgery, I would recommend she wait."
Managing Misconceptions
Misconceptions abound regarding breast cancer reconstruction. "Most misconceptions are fueled by a lack of information," says Dr. Bruner.
Common misconceptions include having to wait up to one year to safely undergo reconstruction, reconstruction makes it difficult to identify cancer if it recurs, and reconstruction interferes with cancer treatments, such as chemotherapy.
"Wrong on all counts," says Dr. Horner-Taylor. "Reconstruction can take place immediately following mastectomy with little complication. In the case of implants, reconstruction may take longer if the patient has to undergo chemotherapy, but otherwise doesn't interfere with the process."
Managing Expectations
Managing patient expectations is one of the most important aspects of breast cancer reconstruction. It is important for women to remember that the goal of reconstruction is improvement, not perfection. "Be sure to discuss your expectations candidly with your plastic surgeon, and expect nothing less than total honesty from him or her in return," says Dr. Horner-Taylor. "It's always smart to get the opinions of several plastic surgeons before moving ahead."
To ensure reconstructive surgery has the desired outcome, breast symmetry procedures – surgery to the other breast – is usually also part of the reconstructive process. "Symmetry procedures either reduce, lift or reshape the remaining breast to ensure a better match to the reconstructed breast," says Dr. Bruner. He goes on to note that symmetry procedures can be an ongoing process, with periodic adjustments necessary to correct the affects of the aging process. ASPS is currently pushing for legislation to ensure women have access to symmetry procedures as part of their reconstruction treatment after breast cancer.
Dolores Glover, Siebold and Kocsis all decided to undergo reconstruction procedures – Siebold at the same time as her mastectomy, Glover 10 years later and Kocsis one year later. Glover and Siebold opted for skin expansion with implants. Kocsis decided to go with flap reconstruction.
"Breast reconstruction was the number one motivation that got me through the most difficult times of my treatment," says Siebold. "The breast reconstruction, although excellent, will never look or feel the same as a natural breast. However, not having to stuff my bra with fillers is a great relief, and I truly feel like a complete woman again."
Glover was never given the option of reconstruction at the time her cancer was diagnosed and her mastectomy performed. She was 38. "I was so busy being a mom to my two children and a wife that I didn't think about reconstruction initially. I also didn't want to endure any more pain or surgery, although my oncologist strongly recommended it," she says. However, every time she caught a glimpse of herself in the mirror, she was reminded of her disfigurement. "I felt deformed, and that feeling never went away until I had reconstruction. I eventually did use a prosthesis, but still wasn't happy with the results." Ten years after her mastectomy, Glover finally decided to have breast reconstruction. "I'm glad I had it done. It helped me to find closure and feel normal again."
For Kocsis, breast reconstruction was a completely mind restorative process. "The day I had my reconstructive surgery was the day I took my life back," she says. She first learned about flap reconstruction through a local support group and decided to undergo the procedure one year after her diagnosis. "I liked the idea of using natural tissue for the reconstruction, and once I made the decision to have surgery, I actually looked forward to having it done." The reconstruction was a success and Kocsis is thrilled with her results. "I really feel great about my decision and the end result. In fact, my family and I celebrate the date of my surgery every year as my re-birthday." Kocsis is now active in public education efforts for breast cancer and reconstruction, writing articles, conducting interviews and giving presentations.
Davis decided not to undergo reconstruction, although she was prepared to go through with it until the day before her mastectomy. "I just decided that I didn't want to be under anesthesia or on the operating table that long," she says. And five years later, she's confident she made the right decision. "It was more important to me to focus on treating the cancer. My breasts are not that important to me, they don't define who I am as a person."
Making An Informed Decision
The decision to undergo breast reconstruction is an intensely personal one. All of the ASPS members interviewed for this article agree that the decision should be made by the patient, not by treating physicians. "It really is a quality of life issue," says Dr. Davis. "And it doesn't matter how old the patient is or if they're married or single. All women should have the option, if they want it."
The most important tool available to women coping with breast cancer is information. "Women need to get as much information as they can, from doctors, cancer organizations, support groups and other women," says Dr. Bruner. "And they shouldn't be afraid to ask the tough questions, as many as necessary to increase their comfort level with their treatment and aid in their recovery process."
To learn more about your breast reconstruction options CLICK HERE.
For more information about breast cancer, call any of the following toll-free numbers:
American Cancer Society
1-800-ACS-2345
Cancer Care, Inc.
1-800-813-HOPE
Cancer Research Foundation of America
1-800-227-2732
National Alliance of Breast Cancer Organizations (NABCO)
1-800-719-9154
National Cancer Institute's Cancer Information Service
1-800-4-CANCER
Y-ME National Breast Cancer Organization
1-800-221-2141
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.
******
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