Breast Reconstruction & Reduction -- October 29, 2012 -- Dr. Lau - NewsChannel5.com | Nashville News, Weather & Sports

Breast Reconstruction & Reduction -- October 29, 2012 -- Dr. Laura Lawson, Dr. Chad Robbins

Saint Thomas Health's Medical Mondays
Monday, October 29, 2012
TOPIC:  Breast Reconstruction & Reduction
Laura Lawson, MD | breast surgeon
Chad Robbins, MD | plastic surgeon
BAPTIST HOSPITAL

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:

226,870 new cases of invasive breast cancer (includes new cases of primary breast cancer among survivors, but not recurrence of original breast cancer among survivors).

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:

• Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
• A mass or lump, which may feel as small as a pea.
• A change in the size, shape, or contour of the breast.
• A blood-stained or clear fluid discharge from the nipple.
• A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed).
• Redness of the skin on the breast or nipple.
• A change in shape or position of the nipple
• An area that is distinctly different from any other area on either breast.
• A marble-like hardened area under the skin.

What Are the Types of Breast Cancer?

The most common types of breast cancer are:

• Invasive ductal carcinoma. This cancer starts in the milk ducts of the breast. Then it breaks through the wall of the duct and invades the fatty tissue of the breast. This is the most common form of breast cancer, accounting for 80% of invasive cases.
• Ductal carcinoma in situ (DCIS) is ductal carcinoma in its earliest stage (stage 0). "In situ" refers to the fact that the cancer hasn't spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is often curable.
• Infiltrating (invasive) lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues or other parts of the body. It accounts for about 10% of invasive breast cancers.
• Lobular carcinoma in situ (LCIS) is cancer that is only in the lobules of the breast. It isn't a true cancer, but serves as a marker for the increased risk of developing breast cancer later. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.

In addition, there are several other less common types of breast cancer.

What Are the Stages of Breast Cancer?

• Early stage or stage 0 breast cancer is when the disease is localized to the breast with no evidence of spread to the lymph nodes (carcinoma in situ).
• Stage I breast cancer: The cancer is 2 centimeters or less in size and it hasn't spread anywhere.
• Stage IIA breast cancer is a tumor smaller than 2 centimeters across with lymph node involvement or a tumor that is larger than 2 but less than 5 centimeters across without underarm lymph node involvement.
• Stage IIB is a tumor that is greater than 5 centimeters across without underarm lymph nodes testing positive for cancer or a tumor that is larger than 2 but less than 5 centimeters across with lymph node involvement.
• Stage IIIA breast cancer is also called locally advanced breast cancer. The tumor is larger than 5 centimeters and has spread to the lymph nodes under the arm, or a tumor that is any size with cancerous lymph nodes that adhere to one another or surrounding tissue.
• Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes (located beneath the breast and inside the chest).
• Stage IIIC breast cancer is a tumor of any size that has spread more extensively and involves more lymph node invasion.
• Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to places far away from the breast, such as bones, lungs, liver, brain, or distant lymph nodes.

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.

• Local treatments are used to remove, destroy, or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments.
• Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy; hormone therapy such as tamoxifen; aromatase inhibitors such as Arimidex, Aromasin, and Femara; and biologic drugs such as Herceptin, Perjeta, and Tykerb are systemic treatments. A patient may have just one form of treatment or a combination, depending on her needs.

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:

1. Annual screening mammography starting at age 40 or 50. Breast cancer experts don't agree when women need to begin getting mammograms. Ask your doctor.
2. Women in high-risk categories should have screening mammograms every year and typically start at an earlier age. MRI or ultrasound screening can also be given in addition to mammograms. Discuss the best approach with your doctor.
3. Have your breasts examined by a health care provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can complement mammograms.

BREAST RECONSTRUCTION

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.