Interesting Article on Breast Reconstruction & My Thoughts

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I have not had implants and if you have been following me you know I, myself, have not had breast cancer so do not have first hand experience with reconstruction. I have, however, been witness to my mothers journey with it and prior to her getting cancer in her liver and bones 5 1/2 years later we went through quite a bit with her reconstruction.

The first thing I can say is, ALWAYS check out the surgeon you have chosen. Ask them for references of patients willing to share their experience. Whether you are getting your surgery done with the NHS or privately you certainly have the choice and don’t let them tell you otherwise. I learned through my mothers experience the price we pay for making a hasty choice. My mother did not do any research and chose the very first surgeon on the list. This later turned out to be a massive problem. That surgeon was very bad at his craft and proved to make the implant look considerably different than the natural side, notable even when wearing her clothes.

When my mother called me sobbing uncontrollably about being ‘deformed’ I thought she was being dramatic but when I arrived to her home a few days later (I lived 9 hours away and needed to arrange leave from my military job as an aircraft mechanic) I realised that she was very accurate in her description. My mum later described it as having a water balloon on one side and a natural breast on the other. So if you take away anything from this post, please make your decision carefully and look for these surgeons on a Google search. You’d be surprised how much you can find out about a surgeon gone wrong that way!

I am posting a link to an article by my, of late, a popular article writer:
St George’s Hospital, The Princess Grace Hospital. He has written some very helpful articles on breast health and surgery. Have a look at this article: http://www.totalhealth.co.uk/clinical-experts/professor-kefah-mokbel/reconstructive-surgery-following-mastectomy-breast-cancer

He has a very simple way of explaining and I like that. I work with breast cancer survivors one to one helping them regain confidence after having been through mastectomy. At any stage during or after. Please feel free to comment, share or even contact me if you would like to speak further about my offering. I am very very focused on helping women to feel confident and vibrant again. Have a wonderful day!

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New Skin Sparing Mastectomy!

Really exciting new technology going on around skin-sparing mastectomies. See the article Professor Mokbel has written below and the link to his site and referencing the article is below. I find this new technique to be very interesting and his article is thorough. See what you think and please comment below, and share if you would like.

Introducing skin-sparing mastectomy

Article written by
St George’s Hospital, The Princess Grace Hospital

Both immediate and delayed breast reconstruction provide enormous benefits for women undergoing mastectomy for breast cancer. Skin-sparing mastectomy (SSM) has become a valid option for women who are undergoing mastectomy and immediate breast reconstruction for early breast cancer. The reason for this is that conventional non skin-sparing mastectomy (NSSM) often results in prominent scars on the new breast and a paddle of skin that is of a different colour and texture to the natural skin. With SSM most of the natural skin envelope is preserved during the immediate breast reconstruction leading to a much better aesthetic outcome. It also reduces the need for surgery on the other breast, which may otherwise be required to give a symmetrical appearance.

Is it safe?

Compared to NSSM the procedure of SSM seems to be safe for women undergoing mastectomy for invasive breast cancer smaller than 5cm in size and non-invasive breast cancer (known as DCIS), or risk reduction. However with more advanced cancers, there is probably less of a role for SSM due to the high probability of the need for post-mastectomy radiotherapy and the lack of medical data covering this.

Can the nipple be saved during mastectomy?

The nipple can be saved during skin-sparing mastectomy in selected cases. If the tumour is more than 2cm away from the nipple and the tissue behind the nipple is free from tumour then it is safe to save the nipple.

Radiotherapy after skin-sparing mastectomy

Most women undergoing mastectomy for breast cancer do not require radiotherapy following their surgery. However, patients with several positive regional lymph nodes and/or large tumours are offered radiotherapy in view of the proven reduction in recurrence and improved survival that it gives. The use of post-mastectomy radiotherapy has recently been on the increase and this has raised questions concerning both the effects of radiotherapy on a reconstructed breast and also the potential for the reconstructed breast to interfere with radiotherapy delivery. There are currently a lack of medical trials concerning the use of radiotherapy after SSM and immediate breast reconstruction and the published data that exist are based on very small numbers and vary quite considerably. It is accepted however, that radiotherapy following immediate breast reconstruction is associated with a higher rate of complications. The other concern regarding radiotherapy in the reconstructed breast is related to the use of implants. The scar tissue in particular often causes subsequent shrinkage of the reconstructed breast around the implant. One medical study compared 39 patients who received radiotherapy following implant and reconstruction, with 338 non-radiotherapy reconstructions and found that there was a significant negative impact on the reconstructive outcome with implants. The main complications were shrinkage and pain. Shrinkage results in poor appearance and sometimes requires further surgery. This has led some surgeons to recommend that immediate breast reconstruction be avoided if it is known that a patient is likely to require post-operative radiotherapy.

However, more recently, in an analysis that my colleagues carried out to evaluate unilateral postoperative chest wall radiotherapy in patients who had bilateral tissue expander/implant reconstruction, it was observed that in most patients although the shrinkage was higher on the irradiated side, overall symmetry, appearance and patient satisfaction remained high. In only 10% of the patients was shrinkage of the irradiated breast clinically significant. These observations are consistent with our experience, and support the notion that immediate breast reconstruction using tissue expansion and implants is an acceptable option for women undergoing mastectomy for breast cancer. Moreover, any clinically significant scarring around the implant known as capsule formation can be treated with surgery.

Despite the higher incidence of complications associated with post-mastectomy radiotherapy, most patients remain highly satisfied with immediate breast reconstruction. In addition, the adverse effects of radiotherapy on skin-sparing mastectomy and immediate breast reconstruction can be minimised by optimising radiotherapy delivery and by placing a saline filled tissue expander under the pectoral muscles in the chest in order to help delayed revision of reconstruction using an implant. This new concept, known as immediate-delayed reconstruction, can avoid the aesthetic and radiation delivery problems that can occur after immediate breast reconstruction.

We have recently conducted a study to evaluate the clinical outcome and patient’s satisfaction in approximately 100 women who had SSM and immediate reconstruction at The London Breast Institute. Our study confirmed the safety of this technique and showed a very high level of patient’s satisfaction (average score 9.5 out of 10). The complication rate was low and post-mastectomy radiotherapy did not compromise the high level of patient’s satisfaction.

Conclusions

The current evidence suggests that post-mastectomy radiotherapy is an acceptable option with skin-sparing mastectomy and immediate breast reconstruction in the multi-disciplinary setting. Although post-mastectomy radiotherapy is associated with a higher rate of complications, a satisfactory cosmetic outcome can be achieved in most patients.  However, until better methods of radiotherapy delivery are developed to minimise complications, women at high risk of requiring post-mastectomy radiotherapy can be safely offered skin sparing mastectomy and immediate breast reconstruction using a saline-filled tissue expander and this can be replaced with a permanent prosthesis or converted into a flap reconstruction after the completion of the radiotherapy. Any scarring tissue formation around the implant can be surgically treated at this stage. This new concept, known as immediate-delayed reconstruction, can avoid the cosmetic and radiotherapy delivery problems that can occur after immediate breast reconstruction. Furthermore, prior radiotherapy does not represent a problem to skin-sparing mastectomy and immediate breast reconstruction, it does however increase the incidence of complications.

http://www.totalhealth.co.uk/clinical-experts/professor-kefah-mokbel/skin-sparing-mastectomy-breast-cancer

Timing Critical in Breast Cancer Surgery

Another really interesting article I read on Cancer Active’s website. Link is included. Next up I’ll have an article about the UK’s top reconstructive surgeons as voted by the people! Loving the input we are finally getting in the press!

Enjoy!

http://www.canceractive.com/cancer-active-page-link.aspx?n=1255&Title=Timing%20Critical%20in%20Breast%20Cancer%20Surgery

Dr Paul Layman wrote to us to clear up an error in the Tony Howell interview. Paul writes, “An eighteen year study on the protective effect of natural progesterone has recently been confirmed. The oestrogen receptor status of breast cancer is now thought to be of significance in recurrence rates, but the Imperial College study seemed to suggest that the timing of breast surgery was more important than receptor status“.

 

And he is perfectly correct. Choosing the correct point in your monthly cycle to have a breast operation can increase your 10-year survival chances by two thirds! Every woman and their doctor should know this fact.

 

The Imperial Cancer Research Fund (Cancer, 15 Nov 1999) states clearly that “Women having breast tumours removed during the follicular phase of their cycle (that is days 3-12 when their oestrogen is high) have a 10-year survival rate of only 45 per cent, compared to a 10-year survival rate of 75 per cent for women having surgery during the luteal phase (when progesterone is high).”

 

Indeed the research also showed that oestrogen receptor positive and progesterone receptor positive tumours had the highest survival rates if surgery was performed in the second half of a woman’s cycle.

 

This work confirmed an earlier study from Guy’s Hospital by Cooper, Gillett, Patel, Barnes and Fentiman in August 1999 and yet earlier work by Hrushesky et al (Lancet 1989).