Saint Thomas Health's Medical Mondays
Monday, October 29, 2012
TOPIC: Breast Reconstruction & Reduction
Laura Lawson, MD | breast surgeon
Chad Robbins, MD | plastic surgeon
News notes via www.webmd.com
October is Breast Cancer Awareness Month
In 2012, it is estimated that among U.S. women there will be:
63,300 new cases of in situ breast cancer (includes ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS), of those, about 85 percent will be DCIS). DCIS is a non-invasive breast cancer and LCIS is a condition that increases the risk of invasive breast cancer. Learn more about DCIS and LCIS.
39,510 breast cancer deaths
Facts About Breast Cancer
Cells in the body normally divide (reproduce) only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign (not cancerous). If however, the cells that are growing out of control are abnormal and don't function like the body's normal cells, the tumor is called malignant (cancerous).
Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.
What Causes Breast Cancer?
We do not know what causes breast cancer, although we do know that certain risk factors may put you at higher risk of developing it. A person's age, genetic factors, personal health history, and diet all contribute to breast cancer risk.
Who Gets Breast Cancer?
Breast cancer is the most common cancer among American women after skin cancer. Today, about 1 in 8 women (12%) will develop breast cancer in her lifetime. Breast cancer is the second-leading cause of cancer death in women (lung cancer is first). The American Cancer Society estimates that in 2012, about 226,870 women will be diagnosed with invasive breast cancer and about 39,510 will die from breast cancer.
Only 5% to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are "sporadic," meaning there is no direct family history of the disease. The risk for developing breast cancer increases as a woman ages.
What Are the Symptoms of Breast Cancer?
The symptoms of breast cancer include:
What Are the Types of Breast Cancer?
The most common types of breast cancer are:
In addition, there are several other less common types of breast cancer.
What Are the Stages of Breast Cancer?
How Is Breast Cancer Diagnosed?
During your regular physical exam, your doctor will take a careful personal and family history and perform a breast exam and possibly order a mammogram or an ultrasound of the breasts. In certain women who are at increased risk for breast cancer, an MRI may be ordered.
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue.
After the sample is removed, it is sent to a lab for testing. A pathologist -- a doctor who specializes in diagnosing abnormal tissue changes -- views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is (ductal or lobular carcinoma) and whether it has spread beyond the ducts or lobules (invasive).
Lab tests such as hormone receptor tests (estrogen and progesterone) can show whether the hormones help the cancer to grow. If the test results show that hormones help the cancer grow (a positive test), the cancer is likely to respond to hormonal treatment. This therapy deprives the cancer of the estrogen hormone.
Breast cancer diagnosis and treatment are best accomplished by a team of experts working together with the patient. Each patient needs to evaluate the advantages and limitations of each type of treatment, and work with her team of doctors to develop the best approach.
How Is Breast Cancer Treated?
If the tests find breast cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis.
The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells and the stage or extent of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.
Breast cancer treatments are local or systemic.
What Happens After Treatment?
Following local breast cancer treatment, your doctors will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of hormone therapy or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
How Can I Protect Myself From Breast Cancer?
Follow these three steps for early breast cancer detection:
Breast reconstruction surgery for breast cancer is performed to replace skin, breast tissue, and the nipple removed during a mastectomy. The amount of missing tissue varies with each mastectomy. Factors contributing to the amount of tissue removed include the width, size, and location of the original tumor and its proximity to the armpit (called the axilla), from which the lymph glands are removed.
The ultimate goal of reconstruction is to restore symmetry between the two breasts.
Is Breast Reconstruction Right for Me?
When it comes to breast reconstruction, the choices that are right for one woman aren't necessarily right for another. That's because the long-term prospects of living without a breast or part of a breast affect every woman differently.
After your mastectomy, you may choose to wear external breast forms or pads, or you may choose to not alter your appearance whatsoever. Some women have breast reconstruction, using either breast implants or their own tissue.
Improvements in plastic surgery techniques offer better results today than ever before and make breast reconstruction an option for most women facing a mastectomy.
Many women believe that breast reconstruction not only improves physical appearance, but has psychological benefits as well. It's thought to promote a sense of wellness for the woman and her family.
The decision, however, is a personal one and is often not easy to make.
Is Breast Reconstruction Considered Cosmetic Surgery?
Restoring the breast through breast reconstruction is not considered cosmetic surgery. Operations performed to restore anatomy and symmetry, like breast reconstruction after a mastectomy, are considered reconstructive surgery. Since breast reconstruction after mastectomy is part of the treatment of a disease and not cosmetic surgery, according to the Women's Health Care Act, health insurance companies usually pay the major portion of the cost of the procedure. Contact your insurance carrier about your coverage for breast reconstruction.
When Is the Best Time to Have Breast Reconstruction?
Timing of breast reconstruction is based on the woman's desires, other medical conditions, and breast cancer treatment. Whenever possible, plastic surgeons encourage women to begin breast reconstruction at the same time they are having their mastectomy. For many women, immediate reconstruction reduces the trauma of having a breast removed, as well as the expense and discomfort of undergoing two major operations.
It is also possible to do breast reconstruction months or years after a mastectomy. For some women, this may be advised if radiation following mastectomy was or will be performed.
Your surgical team can help you determine the best time for your breast reconstruction.