Before Breast Cancer Strikes
Breast cancer is responsible for one of every three cancer diagnoses. According to the American Cancer Society, it is the second leading cause of cancer death in women. Some women who have relatives stricken by breast cancer and other risk factors are surgically removing nature’s own and having new breasts reconstructed by plastic surgeons. Studies on various aspects of preventive mastectomy and breast reconstruction are springing up during October -- Breast Cancer Awareness Month.
(PRWEB) October 14, 2004 -- Deborah Barnes, a 53-year-old paralegal in Glen
Ridge, New Jersey, was terribly worried about the breast cancer in her family.
Her grandmother died of cancer in the 1960s and, more recently, her mother and
sister both suffered from the dreaded ailment. Eventually, alas, cancer
developed in one of Deborah’s breasts.
“The hardest phrase you’ll ever
hear is when a doctor says: ‘You have breast cancer,’” Deborah told
CosmeticSurgery.com. “Your whole world stops.”
But she did not settle for
removing only the cancerous breast. After studying her options and the risks for
yet more cancer, she opted for a double mastectomy to rid herself of the breast
that showed no symptoms – yet.
While she was still on the table, surgeons
rebuilt breasts from tissues in her abdomen and from other areas of her body.
It’s known as IBR, or, immediate breast reconstruction.
“I’m now
cancer-free and even the clerks in fitting rooms helping with bathing suits
don’t realize I have reconstructed breasts,” Deborah says.
Prophylactic
mastectomy is not as widely done as breast reconstruction, a procedure performed
on some 70,000 women in 2003, according to the American Society of Plastic
Surgeons (ASPS.)
But more women are taking a look at the rates of breast
cancer among their female relatives and wondering if, or when, the Big C will
strike them.
Guidelines for preventative mastectomy aren’t carved into
stone, but women with histories of pre-cancerous cells, relatives with breast or
ovarian cancer or mutations in several breast cancer genes – revealed through
genetic testing – often opt for more counseling, watchful waiting, soul
searching and, sometimes, prophylactic mastectomy.
The dagger aimed at
the heart of such women seems to be deadliest when several close relatives
develop the disease before age 50, if she is a smoker, (especially if she
started as a teenager or young adult,) and if she has been on hormone
replacement therapy.
“Women whose fathers have had breast cancer are at
an even greater risk than if their mothers had it,” says Loren Schecter, M.D., a
plastic and reconstructive surgeon near Chicago.
Mourene Tesler in
Denver, Colorado, knew her mother had three episodes of breast cancer while her
sister suffered two.
“My doctor figured my odds of getting breast cancer
again were about 80 percent,” Mourene says. “So the decision was sort of made
for me. I had three children at home and the doctor capped his discussion by
advising: ‘If you’ve got the guts, have the operation (preventative
mastectomy.”)
She had the procedure, received implants right after the
double mastectomy and says she has received no complaints from her husband of 40
years during the last 17 years.
However, Mourene’s sister did not have a
preventative mastectomy, developed breast cancer in 2000 and died of ovarian
cancer shortly afterwards.
“The doctors told us both: ‘By the time we
find cancer in your breasts, it will have spread to other organs,’” Mourene
recalls.
At the highest risk:
the woman who has already lost one breast to cancer and has a female relative
with the ailment. That patient stands about a 50 percent chance of developing
cancer again. Overall, about one in 500 women carry the gene mutations that
usually lead to breast (or ovarian) cancer. The bugbear genes – known as BRAC 1
and 2 -- are present in at least one of every ten breast cancer patients under
age 40.
About all the National Cancer Society can say about preventative
mastectomy is the procedure lowers chances of developing still more cancer by 90
percent for high risk women. The good news is, plastic surgeons can build bosoms
anew, using the body’s muscle and skin.
Surgeons favor rebuilding the
breasts immediately after the mastectomy so the patient doesn’t wake and
discover missing breasts; the shock can last a lifetime. Moreover, the imbalance
created by a missing breast can affect the patient’s spine. In many cases, it is
medically necessary to wear prosthesis to make sure the upper torso remains in
balance.
In one type reconstruction, known as tissue expansion, the
surgeon inserts an implant under the skin and, sometimes, the first layer of
chest muscle (pectoralis), after a pocket is created. The doctor then inserts a
balloon-like expander under the tissues and periodically injects a solution
through the skin into a tiny valve to pump up the device. After several
episodes, sufficient space is created for an implant.
“It’s just like
pumping up a car tire, little by little,” says Mourene Tesler.
More
positive things happened when surgeons found they could leave some muscle. And
then later, they found they could leave more skin.
“Many other
practitioners and health care specialists will examine a reconstructed breast
and not be able to tell it from the real thing,” says Valerie J. Ablaza, M.D.,
at The Plastic Surgery Group in Montclair, N.J
In another case, a
psychologist (who asked not to be identified) knew her mother, her aunt and both
grandmothers had breast cancer. At age 36, and with her family complete with
three small children, she saw a genetic counselor who found her BRAC 1 gene
showed a mutation meaning she, the psychologist, has a 90% chance of developing
breast cancer (and an 80% chance of developing ovarian cancer) sometime during
her lifetime. Two weeks later, she underwent a double mastectomy, followed by
skin expansion and implants.
One type breast reconstruction is known as a
TRAM (transverse rectus abdominis myocutaeous) and rebuilds a breast from
tissues in the patient’s abdomen. Other flap reconstruction procedures create a
breast using skin, fat and muscle from the patient’s back or buttocks. Surgeons
say the work includes a rebuilt nipple; the rebuilt breast and nipple are
virtually indistinguishable from the real deal.
In some procedures, like
the one had by a then 34-year-old Deede (who also asked not to be identified) of
Inverness, Illinois, the surgeon – working totally under the skin -- creates a
breast under her mastectomy scar by pulling part of her stomach muscle up into
the chest.
“When I awoke from anesthesia and found only one breast, my
first thought was happiness that it was gone,” says Deede. “I knew I could be
there for my little guy -- a 14-month-old son -- for at least the next ten
years.”
Some surgeons use a similar technique known as the DIEP (deep
inferior epigastric perforator flap,) a procedure that takes tissue from the
patient’s abdomen – but without sacrifice to the stomach muscles. Surgeons who
use the DIEP process say the operation creates a natural looking breast that
results in less pain and allows the woman to return to normal activities more
quickly.
Yet another reconstructive procedure, known as EARLi, uses
muscle from a woman’s back to rebuild a breast.
“Plastic surgeons have a
number of techniques for recreating realistic nipples,” says Richard Lopchinsky,
M.D., a clinical associate professor of surgery at Mount Sinai School of
Medicine. “Virtually all surgeons feel the nipple is a high risk area for
recurring cancer and remove it during the mastectomy.
The EARLi operation
harvests the muscle in the rib cage commonly referred to as ‘lats” (latissimus
dorsi.) Experts say that muscle is only necessary for those who want to be
Olympic class swimmers or those who do many chin-ups. Working under the skin,
the surgeon performs, not a mastectomy, but a lumpectomy to remove the tumor
while leaving the nipple intact. The latissimus dorsi muscles are then rolled up
to fill up the breast pocket.
Nobody seems to be tracking the numbers of
patients who opt for preventive mastectomy. But it’s becoming common enough that
more experts are studying patient outcomes, and reporting the generally
excellent results in professional journals.
But whatever technique is
used, more and more women are aware of the danger and use self exams and genetic
testing to guard against breast cancer.
For more information visit http://www.cosmeticsurgery.com
CosmeticSurgery.com
Staff Report
Medically Reviewed by Dennis J. Hurwitz, M.D., FACS (http://www.cosmeticsurgery.com/find/cosmetic-surgeons/Pennsylvania/r~73/dr~info/)
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Source : http://www.prweb.com/releases/2004/10/prweb167488.htm