Currently only 30% of breast cancer patients are informed of their breast reconstruction options before mastectomy or lumpectomy.
New legislation is being proposed in Texas that aims to significantly improve that abysmal statistic for breast cancer patients. Texas House Bill 669 would mandate that doctors inform all breast cancer patients about their breast reconstruction options BEFORE having surgery for breast cancer. The bill was drafted based on similar legislation in the state of New York.
PRMA Plastic Surgery is proud to announce that a former patient, Tammy Carrington, is the team leader behind this Bill. She proactively sought out her state representative, James White, to begin drafting proposals. The Bill was drafted and submitted January 14, 2011. If approved, this statute will take effect the following year.
Tammy Carrington knows firsthand what it’s like to be diagnosed with breast cancer and receive limited treatment options. After being diagnosed in June of 2009, Tammy was given two options: a lumpectomy with radiation or a unilateral mastectomy. Tammy didn’t want either.
Tammy wanted to decrease the risk of breast cancer in the future in the other breast too. After intensely researching her options on her own she learned she could have bilateral mastectomies and immediate reconstruction. Ultimately she traveled to PRMA in San Antonio and underwent bilateral mastectomies with immediate DIEP flap breast reconstruction using her own abdominal tissue. All the procedures were covered by her health insurance.
Not surprisingly, Tammy feels very strongly about this Bill since she so easily could have chosen something she feels would have been the wrong option for her.
"My nature is to research things completely so that I can make informed decisions. I am the mom to a severely brain injured little boy… I’ve spent lots of time over the years looking for information on how to help him get better… After getting over the shock of hearing the 'C' word,... I went into research mode”, Tammy recalls.
“HB 669 isn’t mandating any particular treatment. It's not mandating any surgery. It's just mandating education. Women have the right to be told about their options so they can make truly informed decisions about their own health. Unfortunately, right now only 30% are even told breast reconstruction is an option”, she says.
PRMA Plastic Surgery is proud to support HB 669 and is calling on breast cancer patients, physicians, and all those touched by breast cancer throughout the state of Texas to offer their support by calling their representatives.
Please call your State Legislator and urge them to co-author HB 669. Your state representative’s contact information can be found HERE.
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PRMA Plastic Surgery in San Antonio, Texas, specializes in advanced breast reconstruction using the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap. We are In-Network for most US insurance plans. Patients are routinely welcomed from across Texas, out-of-state, as well as from outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery
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Showing posts with label breast cancer reconstruction. Show all posts
Showing posts with label breast cancer reconstruction. Show all posts
Wednesday, February 2, 2011
Monday, August 3, 2009
Breast Cancer Reconstruction And Health Care Reform - What Does It Mean For You?
By Sharon Lacey
What does health care reform mean for patients with breast cancer and how will it affect you?
Well, it could mean...
Even though you or your loved one could benefit from advanced breast reconstructive surgery after mastectomy (like the DIEP flap procedure for example), your plastic surgeon might well have to say “no”.
While this may sound extreme to many of you, this would happen if comparative-effectiveness research rules that the benefits of the surgery for the average patient just don't justify its price tag, especially when compared with yesterday's treatments (like tissue expanders for example).
Unfortunately, medical advances and "cutting-edge" procedures do come at a price. Though this does mean certain procedures are more expensive, it has also ensured the United States has stayed at the leading edge of health care in the world, at least until now.
In an enormous break with tradition, such cost considerations based on averages will be factored into medical practice guidelines. These will function as an invisible hand that puts a brake on the more expensive procedures even though they benefit certain patients.
Standardized practice guidelines will be evident everywhere, even embedded into your doctor's government-certified computer: as described in the Obama budget, computer pop-ups will appear to help your doctor make decisions. (And through the same systems, his or her choices can be monitored for consistency with the guidelines.)
More uniform care will certainly improve weak performing doctors, but many experts worry about intruding on the seasoned judgment of the good physician. It remains to be seen how government micromanaging—if not rationing—of care, driven by reasons other than patient well-being, will go down,… particularly when that patient has a face.
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Keep up to date with the latest news in breast reconstruction at The Breast Cancer Reconstruction Blog. Also follow us on Twitter.
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Sunday, September 14, 2008
Christina Applegate Mastectomy Calls Attention To Need For Team Approach To Breast Cancer Reconstruction
Actress Christina Applegate’s public disclosure of her breast cancer, her decision to have a double mastectomy, and plans to go forth with breast reconstruction surgery, calls attention to the need for a medical “team” approach in the treatment and recovery from breast cancer.
“A decision to have breast reconstruction is a decision to have plastic surgery. And, that ought to be done by a plastic surgeon. This is what we train for and do everyday. Plastic surgeons have pioneered and refined all of the state-of-the-art techniques in breast reconstruction including implant approaches and autologous tissue (natural) transfers,” said Richard D’Amico, MD, president of the American Society of Plastic Surgeons (ASPS).
The methods for treating women with breast cancer have evolved and we are seeing scientific advancements in the treatment of this disease. These improvements can be attributed to a strong collaboration between medical specialties, in particular radiologists, pathologists, psychologists, general oncologic surgeons, medical oncologists, and plastic surgeons.
The ASPS says breast cancer patients should insist that their treatment be handled by a “team” of physicians, including plastic surgeons, with the appropriate expertise for each procedure and level of care. This, in turn, gives the breast cancer patient the best chance for positive outcomes.
“ASPS Member Surgeons are carrying out the cutting-edge research for constant outcomes improvement. Our members have the foremost training, education and experience in breast reconstruction, and should be a part of every breast care team,” said Dr. D’Amico.
Patients should not assume that anyone other than a board-certified plastic surgeon affiliated with an accredited facility is qualified to perform breast reconstruction. While technology has made breast cancer diagnosis, treatment, and reconstruction better than ever, it does not negate the need for medical expertise within each area.
According to a recent breast reconstruction study published in the Journal of Plastic and Reconstructive Surgery, 98 percent of elective mastectomy patients would have breast reconstruction again.
“That’s a success and satisfaction rate that should not be compromised,” said Dr. D’Amico.
According to ASPS statistics, more than 57,000 breast reconstruction procedures were performed in 2007.
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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 Cancer Reconstruction Blog.
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“A decision to have breast reconstruction is a decision to have plastic surgery. And, that ought to be done by a plastic surgeon. This is what we train for and do everyday. Plastic surgeons have pioneered and refined all of the state-of-the-art techniques in breast reconstruction including implant approaches and autologous tissue (natural) transfers,” said Richard D’Amico, MD, president of the American Society of Plastic Surgeons (ASPS).
The methods for treating women with breast cancer have evolved and we are seeing scientific advancements in the treatment of this disease. These improvements can be attributed to a strong collaboration between medical specialties, in particular radiologists, pathologists, psychologists, general oncologic surgeons, medical oncologists, and plastic surgeons.
The ASPS says breast cancer patients should insist that their treatment be handled by a “team” of physicians, including plastic surgeons, with the appropriate expertise for each procedure and level of care. This, in turn, gives the breast cancer patient the best chance for positive outcomes.
“ASPS Member Surgeons are carrying out the cutting-edge research for constant outcomes improvement. Our members have the foremost training, education and experience in breast reconstruction, and should be a part of every breast care team,” said Dr. D’Amico.
Patients should not assume that anyone other than a board-certified plastic surgeon affiliated with an accredited facility is qualified to perform breast reconstruction. While technology has made breast cancer diagnosis, treatment, and reconstruction better than ever, it does not negate the need for medical expertise within each area.
According to a recent breast reconstruction study published in the Journal of Plastic and Reconstructive Surgery, 98 percent of elective mastectomy patients would have breast reconstruction again.
“That’s a success and satisfaction rate that should not be compromised,” said Dr. D’Amico.
According to ASPS statistics, more than 57,000 breast reconstruction procedures were performed in 2007.
******
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 Cancer Reconstruction Blog.
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Sunday, August 3, 2008
98% Of Mastectomy Patients Would Have Reconstruction Again, Study Says
Satisfaction Rate 94% - 100%
Women who have breast reconstruction after an elective mastectomy are satisfied with their decision, have low complication rates and 98 percent would do it again, reports a study in July’s Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). In addition, breast reconstruction after preventive mastectomy was as safe as or safer than reconstruction in women with breast cancer and had excellent cosmetic results.
“Breast cancer is a terrible diagnosis and decisions regarding treatment are never easy. This study shows that women with cancer in one breast who choose to have their other breast removed as a preventive measure are happy with their decision and a high percentage would do it again,” said Scott Spear, MD, study co-author and past ASPS president. “More remarkable is the 100 percent satisfaction level, as well as the 100 percent willingness to have breast reconstruction again, for the women who chose to have both breasts removed.”
The study examined 74 women who had preventive mastectomies and subsequent breast reconstruction between 2000 and 2005. Forty-seven patients had breast cancer in one breast and elected to surgically remove their other breast (unilateral prophylactic mastectomy). Twenty-seven patients did not have breast cancer, but chose to surgically remove both breasts due to a high-risk of developing breast cancer (bilateral prophylactic mastectomy). The cosmetic outcome was scored by 14 surgeons who looked at post-reconstruction photos and evaluated the result on a 1 to 4 scale (4 being an “excellent” result).
The study found that women who had a bilateral prophylactic mastectomy were 100 percent satisfied with their breast reconstruction and 100 percent of them would have the surgery again. Ninety-four percent of women who had unilateral prophylactic mastectomy were satisfied with their reconstruction and 96 percent of them would have reconstruction again.
The complication rate for reconstruction in women who had bilateral prophylactic mastectomy was 3 percent and 10 percent for those who had unilateral prophylactic mastectomy. Additionally, the study noted the cosmetic assessment for all patients was a score of 3 out of 4.
“These women look and feel the same or better and their risk of cancer has been taken off the table,” said Dr. Spear. “For women who know they are at risk, this option gives them the opportunity to be active about their health and appearance rather than reactive. They can have excellent cosmetic results, low surgical risk and a high level of satisfaction with their breast reconstruction. This is empowering for women.”
According to ASPS statistics, more than 57,000 breast reconstructions were performed in 2007, up 2 percent since 2006.
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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery. He is a breast reconstruction surgeon offering all types of breast reconstruction surgery after mastectomy for breast cancer. 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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Women who have breast reconstruction after an elective mastectomy are satisfied with their decision, have low complication rates and 98 percent would do it again, reports a study in July’s Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). In addition, breast reconstruction after preventive mastectomy was as safe as or safer than reconstruction in women with breast cancer and had excellent cosmetic results.
“Breast cancer is a terrible diagnosis and decisions regarding treatment are never easy. This study shows that women with cancer in one breast who choose to have their other breast removed as a preventive measure are happy with their decision and a high percentage would do it again,” said Scott Spear, MD, study co-author and past ASPS president. “More remarkable is the 100 percent satisfaction level, as well as the 100 percent willingness to have breast reconstruction again, for the women who chose to have both breasts removed.”
The study examined 74 women who had preventive mastectomies and subsequent breast reconstruction between 2000 and 2005. Forty-seven patients had breast cancer in one breast and elected to surgically remove their other breast (unilateral prophylactic mastectomy). Twenty-seven patients did not have breast cancer, but chose to surgically remove both breasts due to a high-risk of developing breast cancer (bilateral prophylactic mastectomy). The cosmetic outcome was scored by 14 surgeons who looked at post-reconstruction photos and evaluated the result on a 1 to 4 scale (4 being an “excellent” result).
The study found that women who had a bilateral prophylactic mastectomy were 100 percent satisfied with their breast reconstruction and 100 percent of them would have the surgery again. Ninety-four percent of women who had unilateral prophylactic mastectomy were satisfied with their reconstruction and 96 percent of them would have reconstruction again.
The complication rate for reconstruction in women who had bilateral prophylactic mastectomy was 3 percent and 10 percent for those who had unilateral prophylactic mastectomy. Additionally, the study noted the cosmetic assessment for all patients was a score of 3 out of 4.
“These women look and feel the same or better and their risk of cancer has been taken off the table,” said Dr. Spear. “For women who know they are at risk, this option gives them the opportunity to be active about their health and appearance rather than reactive. They can have excellent cosmetic results, low surgical risk and a high level of satisfaction with their breast reconstruction. This is empowering for women.”
According to ASPS statistics, more than 57,000 breast reconstructions were performed in 2007, up 2 percent since 2006.
******
Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery. He is a breast reconstruction surgeon offering all types of breast reconstruction surgery after mastectomy for breast cancer. 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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Thursday, May 1, 2008
Fat-Derived Stem Cell Enhanced Breast Reconstruction for Lumpectomy Repair
Article by Pam Stephan
Cytori Celution Improves Soft Tissue Transplantation
A lumpectomy is less drastic than having a mastectomy, but it leaves you with a scar and a dimple where a smooth, full curve used to be. The breast can also end up much smaller causing significant breast asymmetry in some women. This asymmetry is often exacerbated by the contraction (shrinkage) caused by the radiation therapy that usually follows lumpectomy. An investigational breast reconstruction technique is being studied that uses your own fat and stem cells to repair the shape of your breast. This technique is called Cell-Enhanced Reconstruction, and was presented at the 2007 San Antonio Breast Cancer Symposium.
A Technique for Partial Breast Reconstruction
Women who have had breast-conserving surgery (lumpectomy, partial mastectomy) currently do not have any options for breast reconstruction. Mastectomy patients can choose from implants and tissue flap procedures for recreating a lost breast, but lumpectomy patients have been left behind - until now.
Japanese Investigational Study
Dr. Keizo Sugimachi, of Kyushu Central Hospital in Fukuoka, Japan, has used this new fat graft procedure on 21 patients, 79% of which said they were pleased with the results. His colleague, Dr. Kitamura, who led the Japanese study, said, "The investigational procedure offers hope to partial-mastectomy patients who have limited options," said Dr. Kitamura. "Unfortunately the concept of 'breast conserving therapy' can often times be misleading, as even minimally invasive resections can result in defects that leave patients dissatisfied with the cosmetic outcome."
Stem Cell Enhanced Breast Reconstruction
Cell-enhanced reconstruction uses your own fat tissue (adipose) that is a rich source of stem and regenerative cells. These stem cells are not the controversial embryonic stem cells. Soft tissue transplants have been done for many years, but this new procedure uses a special process to ensure that the transplanted cells will live and adapt to the transplantation site. The process was developed by Cytori, and uses a machine called CelutionTM System EU.
Stem and Fat Cell Liposuction and Injection
Cytori Celution System is used to remove fat and stem cells. These cells are processed to create a mixture of concentrated stem cells combined with fat cells. This concentrated mixture is injected into your lumpectomy area in 3 places, to fill out the missing tissue. Your breast won't immediately look like it has been repaired; it will need about a month for the transplanted cells to settle into position and fill out the lumpectomy cavity.
The Reconstruction Technique:
1: Standard liposuction removes fat, regenerative, and stem cells from abdomen.
2: Cells go into the Cytori Celution processing system
3: Celution system separates regenerative and stem cells from fat cells. The regenerative and stem cells are then washed and concentrated.
4: The concentrated stem cell mixture is combined with the fat cells.
5: The final mixture is injected into the lumpectomy area, where it fills in and replaces tissue volume.
One Surgical Procedure
Fat cells (adipose tissue) can be extracted from your abdomen, thighs, hips, or lower back. Only one surgical procedure is required for this breast reconstruction technique. In the Japanese study, patients were followed for up to 18 months after the procedure, with no loss of tissue volume and no recurrence of breast cancer.
Planned Clinical Studies
Women who participate in a clinical trial of cell-enhanced reconstruction must be recovered from their breast conservation surgery and any follow-up treatments, and must be recurrence-free for at least two years. There will be two clinical trials in Europe during 2008, which will involve about 90 patients. If approved, clinical studies will begin in the United States after 2008.
Sources:
1) Kitamura K, et al "Stem cell augmented reconstruction: a new hope for reconstruction after breast conservation therapy" Breast Cancer Res Treat 2007; 106 (Supp1): Abstract 4071.
2) Medpage Today. Medical News from SABCS: San Antonio Breast Cancer Symposium Meeting. Fat-Derived Stem Cells Used for Breast Reconstruction. Published: December 17, 2007.
3) Cytori Therapeutics. Cytori Therapeutics Receives FDA 510(k) Clearance for the Cytori Fat Transfer System. Published: December 12, 2007.
******
Cytori Celution Improves Soft Tissue Transplantation
A lumpectomy is less drastic than having a mastectomy, but it leaves you with a scar and a dimple where a smooth, full curve used to be. The breast can also end up much smaller causing significant breast asymmetry in some women. This asymmetry is often exacerbated by the contraction (shrinkage) caused by the radiation therapy that usually follows lumpectomy. An investigational breast reconstruction technique is being studied that uses your own fat and stem cells to repair the shape of your breast. This technique is called Cell-Enhanced Reconstruction, and was presented at the 2007 San Antonio Breast Cancer Symposium.
A Technique for Partial Breast Reconstruction
Women who have had breast-conserving surgery (lumpectomy, partial mastectomy) currently do not have any options for breast reconstruction. Mastectomy patients can choose from implants and tissue flap procedures for recreating a lost breast, but lumpectomy patients have been left behind - until now.
Japanese Investigational Study
Dr. Keizo Sugimachi, of Kyushu Central Hospital in Fukuoka, Japan, has used this new fat graft procedure on 21 patients, 79% of which said they were pleased with the results. His colleague, Dr. Kitamura, who led the Japanese study, said, "The investigational procedure offers hope to partial-mastectomy patients who have limited options," said Dr. Kitamura. "Unfortunately the concept of 'breast conserving therapy' can often times be misleading, as even minimally invasive resections can result in defects that leave patients dissatisfied with the cosmetic outcome."
Stem Cell Enhanced Breast Reconstruction
Cell-enhanced reconstruction uses your own fat tissue (adipose) that is a rich source of stem and regenerative cells. These stem cells are not the controversial embryonic stem cells. Soft tissue transplants have been done for many years, but this new procedure uses a special process to ensure that the transplanted cells will live and adapt to the transplantation site. The process was developed by Cytori, and uses a machine called CelutionTM System EU.
Stem and Fat Cell Liposuction and Injection
Cytori Celution System is used to remove fat and stem cells. These cells are processed to create a mixture of concentrated stem cells combined with fat cells. This concentrated mixture is injected into your lumpectomy area in 3 places, to fill out the missing tissue. Your breast won't immediately look like it has been repaired; it will need about a month for the transplanted cells to settle into position and fill out the lumpectomy cavity.
The Reconstruction Technique:
1: Standard liposuction removes fat, regenerative, and stem cells from abdomen.
2: Cells go into the Cytori Celution processing system
3: Celution system separates regenerative and stem cells from fat cells. The regenerative and stem cells are then washed and concentrated.
4: The concentrated stem cell mixture is combined with the fat cells.
5: The final mixture is injected into the lumpectomy area, where it fills in and replaces tissue volume.
One Surgical Procedure
Fat cells (adipose tissue) can be extracted from your abdomen, thighs, hips, or lower back. Only one surgical procedure is required for this breast reconstruction technique. In the Japanese study, patients were followed for up to 18 months after the procedure, with no loss of tissue volume and no recurrence of breast cancer.
Planned Clinical Studies
Women who participate in a clinical trial of cell-enhanced reconstruction must be recovered from their breast conservation surgery and any follow-up treatments, and must be recurrence-free for at least two years. There will be two clinical trials in Europe during 2008, which will involve about 90 patients. If approved, clinical studies will begin in the United States after 2008.
Sources:
1) Kitamura K, et al "Stem cell augmented reconstruction: a new hope for reconstruction after breast conservation therapy" Breast Cancer Res Treat 2007; 106 (Supp1): Abstract 4071.
2) Medpage Today. Medical News from SABCS: San Antonio Breast Cancer Symposium Meeting. Fat-Derived Stem Cells Used for Breast Reconstruction. Published: December 17, 2007.
3) Cytori Therapeutics. Cytori Therapeutics Receives FDA 510(k) Clearance for the Cytori Fat Transfer System. Published: December 12, 2007.
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Monday, April 14, 2008
DIEP Flap Reconstruction And Breast Cancer Recurrence
Can DIEP flap breast reconstruction prevent detection of breast cancer recurrence? This is a very important issue that is often not discussed.
A handful of studies have shown that breast reconstruction (with any reconstructive technique) does not impact local recurrence or long term survival in patients with early breast cancer (stage I and II). The rate of local recurrence and length of survival is the same in patients with stage I and II disease whether they undergo immediate breast reconstruction (ie reconstruction at the same time as mastectomy) or not. For this reason most institutions (including ours) offer breast cancer patients with early disease immediate breast reconstruction whenever possible.
Patients diagnosed with advanced disease are more likely to be candidates for delayed breast reconstruction once they have undergone mastectomy, completed their cancer treatment and remained disease free for several months.
Breast reconstruction (with a DIEP flap or any other method) does not encourage or enhance breast cancer recurrence or shorten long term survival in any way.
Dr C
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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.
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A handful of studies have shown that breast reconstruction (with any reconstructive technique) does not impact local recurrence or long term survival in patients with early breast cancer (stage I and II). The rate of local recurrence and length of survival is the same in patients with stage I and II disease whether they undergo immediate breast reconstruction (ie reconstruction at the same time as mastectomy) or not. For this reason most institutions (including ours) offer breast cancer patients with early disease immediate breast reconstruction whenever possible.
Patients diagnosed with advanced disease are more likely to be candidates for delayed breast reconstruction once they have undergone mastectomy, completed their cancer treatment and remained disease free for several months.
Breast reconstruction (with a DIEP flap or any other method) does not encourage or enhance breast cancer recurrence or shorten long term survival in any way.
Dr C
******
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.
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Thursday, March 20, 2008
Few Women Have Regrets When Choosing Preventive Mastectomy for Other Breast
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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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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Sunday, January 14, 2007
Will Insurance Pay For My DIEP Flap Breast Reconstruction?
"Will insurance pay for my DIEP breast reconstruction?"
This is a question I am repeatedly asked. The easy answer is "they should". However, some women have experienced difficulties with their insurance companies in terms of getting their DIEP breast reconstruction covered. Women must also be aware of "balance billing".
The good news is that there are a handful of plastic surgeons across the country that do routinely offer these advanced procedures and many of them accept insurance. Unfortunately most women will have to travel to gain access to them. We have posted an article on our website about finding a DIEP flap surgeon near you and which questions to ask.
Our group, Plastic, Reconstructive & Microsurgical Associates (PRMA) is located in San Antonio, Texas. We perform over 350 DIEP breast reconstructions per year, the vast majority of which are covered by insurance. We are in-network for most major US insurance plans and do not balance bill. We have insurance specialists on staff so our patients typically do not need to worry about the insurance side of things themselves.
Answers to more DIEP insurance FAQs can be found here.
Answers to more general DIEP flap FAQ's can be found here.
Dr C
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Dr Chrysopoulo, board certified plastic surgeon, PRMA Plastic Surgery, San Antonio, TX. Specializing in breast reconstruction surgery after mastectomy for breast cancer. Over 350 DIEP flaps performed yearly. In-network for most US insurance plans. Toll Free (800) 692-5565. www.prma-Enhance.com. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.
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This is a question I am repeatedly asked. The easy answer is "they should". However, some women have experienced difficulties with their insurance companies in terms of getting their DIEP breast reconstruction covered. Women must also be aware of "balance billing".
The good news is that there are a handful of plastic surgeons across the country that do routinely offer these advanced procedures and many of them accept insurance. Unfortunately most women will have to travel to gain access to them. We have posted an article on our website about finding a DIEP flap surgeon near you and which questions to ask.
Our group, Plastic, Reconstructive & Microsurgical Associates (PRMA) is located in San Antonio, Texas. We perform over 350 DIEP breast reconstructions per year, the vast majority of which are covered by insurance. We are in-network for most major US insurance plans and do not balance bill. We have insurance specialists on staff so our patients typically do not need to worry about the insurance side of things themselves.
Answers to more DIEP insurance FAQs can be found here.
Answers to more general DIEP flap FAQ's can be found here.
Dr C
*********
Dr Chrysopoulo, board certified plastic surgeon, PRMA Plastic Surgery, San Antonio, TX. Specializing in breast reconstruction surgery after mastectomy for breast cancer. Over 350 DIEP flaps performed yearly. In-network for most US insurance plans. Toll Free (800) 692-5565. www.prma-Enhance.com. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.
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