Nipple Sparing Mastectomy - Breast Cancer Options

A nipple sparing mastectomy is one method of performing this surgical procedure. The surgical term "mastectomy" is used for several variations of the procedure. It may involve removing one or both breasts, portions, or incising regions in the armpits in order to take out the lymph nodes. These operations are done to get rid of breast cancer in the early or later stages. This disease often begins in the milk ducts and is then called ductal carcinoma. Although certain risk factors point to an increased chance of developing this disease, doctors aren't really sure why some women get it and others don't. Here are some different types of mastectomies:

- Nipple sparing: This operation entails removing tissue but leaving the skin, nipple and areola. The chest wall muscles are often left, as well. Biopsies of the lymph systems may be performed simultaneously and the bosom is reconstructed right away.

- Skin sparing: In this version, which is appropriate for small tumors, the nipple and areola are removed as well as tissue but the outer skin is left intact. With this technique, reconstruction would be done at the same time.

- Total: A total or simple version is when the entire breast is removed. Biopsy would be done at the same time in order to examine the sentinel lymph region.

- Modified radical: This is one of the more complete variations of this operation. A surgeon would remove all skin, tissue, nipple, areola, chest muscles and even part of the wall. Lymph systems in the armpits would also be targeted.

Each of these operations would be done in patients who have been diagnosed with breast cancer. This disease is now considered the most common of cancers in U.S. women besides skin cancer. Other treatments that are often performed simultaneously include chemotherapy and radiation. While a plastic surgeon would perform a nipple sparing mastectomy and reconstructive operations, different doctors would oversee the chemotherapy and radiation. An oncologist is the chemo prescriber and the radiologist would oversee the radiation. Some reconstruction possibilities include:

- Implants: A plastic surgeon can reconstruct the region with medical devices called implants. These are filled with either silicone or saline solution. They may be placed immediately or in a later surgery after an expander has been used to stretch the skin.

- Flap surgeries: There are various flap methods that surgeons use to move skin and tissue from one region to the chest to create mounds that resemble breasts. There are DIEP, TRAM and Latissimus flap procedures. The regions where tissue is brought from may be the abdomen or the back.

- Nipple reconstruction: If the nipple wasn't spared, there are ways to recreate a nipple and areola after the original operation has healed. A doctor may take a tuck with a suture or cut a star-like incision in the area. A tattoo in a deeper skin tone would be applied to create the areola.

When a patient has breast cancer, there are various options for treatment. One of them is the nipple sparing mastectomy; others are more radical. The operation that is chosen will be an individual decision depending on the patients' need.

A nipple sparing mastectomy is a great option for women who would like to retain as much of their original anatomy as possible. If you would like to learn more about this procedure: http://www.breastcenter.com/.

Original article

Breast Reconstruction After Lumpectomy or Mastectomy: Woman's Legal Right To Psychological Recovery

About one out of every eight women will develop some form of breast cancer within their lifetime. In 2010 approximately 207,000 cases of invasive breast cancer were diagnosed, with another 54,000 non-invasive cases diagnosed. Although breast reconstruction is an optional process after mastectomy, with over 2.5 women who have beat this disease, more and more women are choosing to have breast reconstruction as a part of breast cancer treatment. In fact, over 93,000 breast reconstruction procedures were performed in 2010, an increase of almost 20% from the year before (1). In fact, breast reconstruction has been seen as being so critical to a woman's recovery that in 1988, the Women's Health and Cancer Rights Act (WHCRA) was passed. This law actually requires all insurance companies who offer mastectomy coverage to also provide for reconstructive surgery, including any adjustments to the opposite breast to achieve symmetry and revision surgeries to refine the breast shape and recreate the nipple.

For most women, the treatment of breast cancer really consists of three parts. The first part of treatment is Physiological and involves the physical surgical removal of the tumor. A general surgeon performs either lumpectomy surgery, which removes the tumor and a small amount of surrounding tissue, or a mastectomy, which removes all breast tissue from the chest. Sometimes radiation therapy is used in combination with lumpectomy or mastectomy to treat any cancer cells that potentially remain. The choice of either surgery is usually determined by the size of the tumor, the size of the breast, and the patient's personal choice. The use of radiation is determined by the size of the tumor, tumor characteristics on biopsy, and what type of surgery is performed.

The second part of treatment is Pharmacological and includes chemotherapy in IV and/or pill form. Medications that modulate hormones are also sometimes used to reduce the risk of recurrence. This portion of the treatment can take anywhere from a few months to a year depending on chemotherapy drug choice, and tumor characteristics.

The final component of treatment is Psychosocial and includes all activities and treatments that help women to deal with their cancer and recovery. Studies have shown that breast reconstruction is important to helping women cope with cancer[2]. Because of this fact, breast reconstruction is a legally protected optional third part of treatment chosen by many women every year in the United States.

Breast reconstruction can be performed immediately after mastectomy or in a delayed manner, even months or years after mastectomy. There are several methods that can be used to reconstruct the breast, but they all fall under two main types - Flap reconstruction, which uses tissue from another part of the body, and Implant reconstruction, which uses a breast implant to recreate the breast. Sometimes a combination of both methods is used to get the best result possible.

Flap reconstruction uses muscle and fatty tissue from the back, tummy and occasionally other areas to create the breast mound. Skin can be transferred along with the other tissue when the chest skin has been damaged by infection, radiation, or a superficial tumor. Flap surgery requires a hospital stay of 3-7 days, leaves scars both on the breast and where the tissue was borrowed, and full recovery can take 2-3 months. Flap surgery has the benefit of avoiding an implant, but for patients who are very overweight or whose health is in poor condition, flap surgery may not be safe. Many women like that borrowing the tissue from the tummy is almost like having a tummy-tuck and that using tissue from the back can remove excess tissue that hangs over the bra straps.

Implant reconstruction has typically required two stages. During the first stage, a temporary implant (called a tissue expander) is inserted under the chest muscle. It is gradually filled with saline (IV fluid) after surgery through a needle that's inserted into a special part of the expander. In order to get more fluid into the expander at the time of the first surgery, tissue grafts called Allografts are sometimes sewn to the bottom of the muscle to make more room. The allograft also provides more coverage for the bottom of the implant. Complications of implant reconstruction with radiation are almost 50%, and the allograft can decrease some of these complications ( capsular contracture, exposure of the implant, and wound healing problems).

Using the allograft, sometimes an implant can be placed at the time of surgery (single stage reconstruction). This can only be done if the skin is in good condition after mastectomy. If the blood flow to the skin is poor, the traditional technique of slowly inflating the implant will need to be used.

If radiation is going to be needed, tissue expanders can be placed followed by flaps or implants, depending on how the skin recovers from radiation.

For more information the Author can be contacted by using this link.

[1] Report of the 2010 Plastic Surgery Statistics. Annual SASPS Procedural Statistics represent procedures performed by ASPS member surgeons certified by The American Board of Plastic Surgery® as well as other physicians certified by American Board of Medical Specialties-recognized boards. ©ASPS, 2011

[2] Rowland, Julia H. "Psycological Impact of Treatments for Breast Cancer", Surgery of the Breast, 2nd Edition, p. 382, 2006

Dana M. Goldberg M.D. is one of the fastest growing cosmetic plastic surgeons in West Palm Beach Florida. Dr. Goldberg was trained at the Ohio State university in plastic and reconstructive surgery. After completing her training she moved to Florida to create the thriving medical practice she enjoys today. Dr. Dana works with patients throughout the world, and is happy to answer questions for patients.

Original article

Breast Reconstruction Surgery Immediately Following A Mastectomy

Many women diagnosed with breast cancer will undergo a surgical procedure, called a mastectomy, to remove one or both breasts. After the mastectomy, some women will choose to undergo reconstruction surgery to rebuild the shape and appearance of the breast. Often, breast reconstruction surgery can be performed immediately following the mastectomy. This procedure occurs during the same operating room visit as the mastectomy so that the patient does not need to come back for more surgery.

With a mastectomy, all of the breast tissue and often, some surrounding tissue, are removed. Sometimes both breasts are removed, often as a preventive surgery for women who are at high risk for developing breast cancer. Losing one or both breasts can be both physically and emotionally devastating to the patient. Fortunately, many women are able to undergo reconstructive surgery to give them the pre-surgery appearance they desire.

Women who want reconstruction can choose to have it done while they are still under anesthesia from the mastectomy. Recent studies have concluded that immediate reconstruction does not delay post-operative chemotherapy, increase recovery time or hinder the diagnosis of local cancer reoccurrence. Many women choose to have reconstruction immediately after mastectomy so that the entire process is complete with one surgical experience.

Breast reconstruction helps to restore symmetry to the patient who has lost a breast to a mastectomy. In addition to rebuilding the lost tissue, the remaining breast may undergo a lift, reduction or augmentation to improve the symmetry of both breasts. Your surgeon will be able to make recommendations for a natural and balanced look that will help you feel confident and secure.

During this procedure, the surgeon may use skin and fat from your abdomen and back to reconstruct the breast mound. A saline or silicone gel implant may be used in combination with this technique. The method used will often be determined by your anatomy, desired results and personal preferences. It is important to note that the patient will not have the same sensation in the reconstructed breast as a natural one. It will feel different or unnatural, depending on the implant used. The patient will notice visible incision lines from the mastectomy and reconstruction.

Losing one or more breasts to cancer can be a very emotional experience. Often, a woman's breasts are closely related to her self-esteem and sexual confidence. With immediate reconstruction, the woman does not have to worry with breast prostheses or other devices that give the illusion of breasts. Reconstruction ensures that the woman has the shape and figure that will allow her to wear the clothes she wants and feel confident with her appearance.

Not all cancer centers have qualified surgeons that are able to provide reconstruction in conjunction with a mastectomy. You will need to talk with your cancer specialists about your desire for this procedure to determine what options are available for you. Your physician will be able to go over the risks and benefits of reconstruction immediately following a mastectomy.

Breast cancer treatment can have a big impact on a woman's emotional and physical health. It is important that you get the care and treatment you require to fight this disease and to live as a survivor. Breast reconstruction is one way to help women feel better about their post-cancer body and improve their quality of life.

Laura Mims is a writer for FirstHealth Moore Regional Hospital, which specializes in oncology, cancer care and cancer treatment in Pinehurst, North Carolina.

Original article

What Is Prophylactic Mastectomy?

Meaning of prophylactic mastectomy: It is the surgical removal of a non-cancerous breast with the intention of preventing onset of breast cancer in that breast.

The question of prophylactic mastectomy comes in two clinical situations:

1. Those women who have been diagnosed with cancer in one breast and who are concerned of a new cancer coming up in the opposite breast and thus explore the possibility of removing this breast as prevention. This is called contra-lateral prophylactic mastectomy (the word contra meaning the opposite side).

2. Those women who do NOT have a diagnosis of cancer but who have high risk factors for developing breast cancer. Such patients may explore the possibility of removing both breasts to prevent the onset of cancer. This is called bilateral prophylactic mastectomy (the word bilateral meaning both sides).

Let us consider the first situation of contra-lateral prophylactic mastectomy in women already diagnosed with cancer in one breast. The following are some of the situations where this decision may be appropriate.

1. Diagnosed at age 45 or younger, regardless of family history.

2. Diagnosed at age 50 or younger and EITHER of the following:

- at least one close blood relative with breast cancer at age 50 or younger.

- at least one close blood relative with epithelial ovarian, fallopian tube, or primary peritoneal cancer.

3. Diagnosed with two breast primaries (includes bilateral disease or cases where there are two or more clearly separate ipsi-lateral primary tumors) when the first breast cancer diagnosis occurred prior to age 50,

4. Diagnosed at age 60 or younger with a triple negative breast cancer.

5. Diagnosed with two breast primaries when the first breast cancer diagnosis occurred prior to age 50.

6. Personal history of ovarian, fallopian tube, or primary peritoneal cancer.

7. Close male blood relative with breast cancer.

8. Women of Ashkenazi Jewish, Icelandic, Swedish, Hungarian, or Dutch descent.

9. Development of invasive lobular or ductal carcinoma in the contra-lateral breast after electing surveillance for lobular carcinoma in situ of the ipsi-lateral breast..

10. Lobular carcinoma in situ confirmed on biopsy.

11. Lobular carcinoma in situ in the contra-lateral breast.

12. Diffuse indeterminate micro-calcifications or dense tissue in the contra-lateral breast that is difficult to evaluate mammographically and clinically.

Bilateral prophylactic mastectomy may be considered in women who have the following situations:

1. Those with confirmed BRCA1 or BRCA2 genetic mutation.

2. Those with close blood relative with a known BRCA1, BRCA2 mutation.

3. First or second-degree blood relative meeting any of the above criteria for individuals with a personal history of cancer.

4. Third-degree blood relative with two or more close blood relatives with breast and/or ovarian cancer (with at least one close blood relative with breast cancer prior to age 50).

5. Those with a history of treatment with radiation to the chest.

6. Those with atypical ductal or lobular hyperplasia, especially if combined with a family history of breast cancer.

7. Those with dense breasts that are difficult to evaluate through mammograms and breast exams. Those with several prior breast biopsies for abnormalities with a strong concern about breast cancer risk.

The decision to proceed with prophylactic mastectomy should be taken very seriously because of its irreversible nature and its major implications on the physical and psychological welfare of these women. There are a number of non-surgical options that are available to lower the risk of breast cancer in the situations outlined above. It is strongly urged that women exploring this difficult decision discuss with expert physicians regarding less radical, non-surgical options.

Dr. Kumar is a board certified Radiation Oncologist who is co-founder of a private practice group in Florida. He has over 17 years experience dealing with cancer patients including several members in his own family who have been afflicted by this disease.

His philosophy of managing patients is through a unique holistic approach that takes into account the wishes and needs of patients and their families. He believes that any battle is won at the level of the mind first before the body goes into action to win the war. His website http://curingcancerofthemind.com/ reflects this philosophy.

He is always available to help any patient with questions regarding cancer and radiation therapy and can be reached at 772 293 0377.

Original article