Filling the Void
Twenty years ago the risk of breast cancer was quoted as
one in twelve women. Now the figure is closer to one in
eight. About one fifth of these tumors arise in women with
a positive family history. In other words, four out of five
women who develop breast cancer have no close relative with
the disease.
We are gaining ground. Educational programs stressing the
importance of monthly self-exams, routine use of screening
mammography, ultrasound and a heightened public awareness
of the disease and available treatments, allow for the identification
of tumors at an earlier stage. By finding new and more accurate
ways to identify smaller tumors, we can treat more breast
cancers without mastectomy and improve overall cure rates.
The radical type of mastectomy, which included the breast,
the muscles beneath the breast and the entire contents of
the axilla (armpit), is now all but forgotten. Studies have
shown that the muscles can be preserved without compromising
patient survival. The lymph nodes are now sampled more selectively
to decrease associated swelling of the arm without increasing
the risk of metastatic disease. Moreover, work is under
way to reliably identify and remove only a few sentinel
lymph node(s), without compromising either treatment or
prognosis.
For now, modified radical mastectomy (MRM) is still the
best treatment for many breast cancers. This involves removal
of the tumor with the normal breast tissue and sampling
of the lymph nodes in the axilla. Lymph node involvement
affects prognosis and may indicate the need for additional
treatment. Although MRM may be the best way to cure breast
cancer, it leaves a physical and emotional void.
Fortunately, there are options available for breast reconstruction.
I will preface this with the knowledge that reconstructed
breasts look and feel different than the native breast.
Symmetry is extremely difficult to achieve and is rarely
present in nature. There are many different ways to rebuild
the breast, because no one way is perfect or will work for
everyone. Breast reconstruction usually requires several
surgeries, but the magnitude decreases with each progressive
stage. Moreover, the psychological and physical benefits
out-weigh the risks for the vast majority of breast cancer
survivors.
Any of the options discussed below can be done immediately
or can be delayed. Immediate reconstruction is done in the
operating room right after the MRM. With this approach,
the breast mound is never absent.