“Women with breast cancer who undergo autologous fat grafting following post-mastectomy breast reconstruction want a breast that looks and feels more natural and say it makes life better psychologically, emotionally, and sexually, according to researchers.
“Results from the ongoing Mastectomy Reconstruction Outcomes Consortium (MROC) study now show that fat grafting is effective and safe and that it does not increase risk for breast cancer recurrence or intervene with breast cancer screening.”
“After learning she had a high genetic risk for breast cancer, Dane’e McCree, like a growing number of women, decided to have her breasts removed. Her doctor assured her that reconstructive surgery would spare her nipples and leave her with natural-looking breasts.
“It did. But while Ms. McCree’s rebuilt chest may resemble natural breasts, it is now completely numb. Her nipples lack any feeling. She cannot sense the slightest touch of her breasts, perceive warmth or cold, feel an itch if she has a rash or pain if she bangs into a door.”
“Vivien Foldes says she does not regret having her breasts removed five years ago after she was found to have an early-stage cancer.
“But there are things Ms. Foldes, a 58-year-old accountant from Woodmere, N.Y., wishes she had known when she chose a double mastectomy, like the fact that the process of reconstruction would drag on for five months and leave her forever unable to sleep on her stomach. Or that it would leave her with no sensation ‘from the front all the way to the back in the entire bra area,’ she said. ‘Nothing. Zero. Zip.’
“Ms. Foldes says there are days that she asks herself, ‘Should I have done it?’ But, she said, her mother had two types of cancer, and she wanted to be proactive: ‘I didn’t want to be waiting for the other shoe to drop.'”
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“Ann Partridge, MD, MPH, breast medical oncologist, Dana-Farber Cancer Institute, discusses optimal local therapy for women with breast cancer. Partridge says that while studies have shown that lumpectomy followed by radiation is the equivalent of having a mastectomy, there continues to be a growing epidemic of women getting a bilateral mastectomy for unilateral breast cancer. These surgeries include women who are not at high-risk.
“Partridge says these bilateral mastectomies should be better explained to women who opt to have them. She adds that the common misconception is that once both breasts are removed, a patient is cancer free and “the hard part” is over. Partridge says the complications for women who opt to reconstruct their breasts after a bilateral mastectomy still poses significant health risks.”
“Among the various guideline-concordant local therapy options available for women with early-stage breast cancer in the United States, mastectomy plus reconstruction had the highest complication rates and complication-related costs for both younger women with private insurance and older women on Medicare and was the most expensive option for younger women, according to data presented at the 2015 San Antonio Breast Cancer Symposium, held December 8–12 in San Antonio, Texas (Abstract S3-07).
“ ‘Women with early-stage breast cancer have several local therapy options. Although there’s nuance as far as what treatment is best for which patient, there is a large group of patients for whom most, if not all, of these treatment options are considered guideline-appropriate,’ said Benjamin D. Smith, MD, Associate Professor and Research Director of the Breast Radiation Oncology Section in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center.”
“The public’s awareness of reconstructive breast surgery options were boosted following media coverage of Angelina Jolie’s hereditary disposition to breast cancer and preventive double mastectomy in 2013. The results of a prospective, public survey were published earlier this week in Cancer.
“Significantly more women were aware of reconstructive breast surgery options after mastectomies for breast cancer. About 20% of the 205 women polled communicated that their awareness and interest in breast cancer stemmed from the media coverage of Angelina Jolie. The survey results suggest that media coverage can improve the health IQ of the public.
“ ‘The results underscore the importance of a media-related impact for professionals in the health care sector, which can serve as a tipping point for raising awareness and improving knowledge concerning a specific disease among the general public,’ wrote David Benjamin Lumenta, MD, of the department of surgery at the Medical University of Graz in Austria, and colleagues.”
“Women undergoing mastectomy with immediate reconstruction were at twice the risk for surgical site infections than women undergoing mastectomy alone, according to researchers from Washington University School of Medicine.
“Although the National Healthcare Safety Network (NHSN) estimates the incidence of surgical site infections (SSIs) following breast operations in the United States to be around 1% to 2%, SSI rates vary widely across institutions. According to Margaret A. Olsen, PhD, MPH, and colleagues, this may be due to ‘the type of breast operation, definitions used for infection, surveillance methods to identify infections, and the length of postoperative follow-up.’
“The researchers examined the incidence of infection in a much larger population of women treated at numerous facilities. Participants included 18,085 women with private health insurance who underwent 18,696 mastectomy procedures with and without immediate implant or flap reconstruction from 2004 to 2011.”
The gist: Women who do not have breast reconstruction after mastectomy may have less cancer-related distress than women who start breast reconstruction more than one year after mastectomy. Women who have mastectomies have three choices: no reconstruction, immediate reconstruction started during the mastectomy surgery, or delayed breast reconstruction. Researchers recently compared women who had no breast reconstruction with women who started reconstruction more than one year after mastectomy. The women who had delayed breast reconstruction had higher levels of distress and obsessiveness than women who did not have reconstruction.
“In women who have undergone mastectomy, those who underwent delayed breast reconstruction experienced greater cancer-related distress over the long term compared with women who underwent mastectomy alone, according to a prospective study by Metcalfe et al in the Journal of Surgical Oncology…
“Metcalfe and colleagues conducted a prospective study to examine the psychosocial outcomes in women who had mastectomy alone compared to those who underwent breast reconstruction more than 1 year postmastectomy. Psychosocial functioning was assessed according to levels of total distress, obsessiveness, and cancer-related distress…
“According to the investigators, psychosocial functioning improved over time in patients treated with mastectomy in the long-term breast cancer survivorship period, which may be related to the effect of time posttreatment and not whether or not these women chose to undergo delayed breast reconstruction. Over the course of the study, the investigators did not observe any statistically significant differences in changes in quality of life over time as a result of having mastectomy alone or delayed breast reconstruction.
“ ‘It is critical for health-care providers to recognize that women who seek out delayed breast reconstruction may have higher baseline levels of distress and body image issues postmastectomy, which may persist after delayed breast reconstruction,’ the authors said.”
“Misconceptions may be keeping many women from getting breast reconstruction after a mastectomy, even though the procedure can help improve quality of life for cancer survivors, according to a new review.
” ‘Anything we can do to increase awareness of reconstruction and the relative risks and benefits will empower more women to make an informed decision,’ said lead author Dr. Lisa Schneider, a surgeon at the Institute for Advanced Reconstruction at the Plastic Surgery Center in Shrewsbury, New Jersey.
“Schneider and her coauthor, Dr. Babak J. Mehrara, a plastic surgeon at Memorial Sloan Kettering Hospital in New York, reviewed previous studies of breast reconstruction to understand what influences women to opt out of the procedure.
“In the U.S., less than 40 percent of women who have a mastectomy for cancer treatment undergo immediate breast reconstruction, the authors point out in the Journal of the American College of Surgeons.”