The word mastectomy conjures up deformity and permanent disfigurement. While it is true that a mastectomy removes the breast tissue, it is not true that an unsightly deformity is left behind. The majority of women in our area choose to have immediate reconstruction after a mastectomy. In most instances, we can save the nipple and skin and simply replace the inside contents. Part of the decision making process will include a consultation with a breast surgeon and a reconstructive surgeon.
There are a variety of techniques that we can use for reconstruction, but implant-based reconstruction is the most common. In this setting, the breast surgeon performs that mastectomy, and the reconstruction/plastic surgeon will then step in and repair the breast either with a temporary implant (to be exchanged with a permanent implant at a later date) or a permanent implant. Another method for reconstruction involves using your own (autologous) tissue. This may come from the abdominal wall (like a tummy tuck), from the back, or from the thighs.
The discussion about which option is best for you will take into account other treatments that you may need to treat your breast cancer (such as chemotherapy or radiation) as well as your lifestyle and body composition. This decision is made in conjunction with your team of physicians including your breast surgeon and reconstructive surgeon. Additionally, breast reconstruction is covered by insurance. In most cases, procedures performed on the opposite breast for symmetry are also a covered benefit.
If you decide not to have immediate reconstruction, you may decide to wear a prosthesis (a breast form) or not. There are special bras and fittings that can be done to achieve a natural appearance. Bras and prostheses are also a covered insurance benefit.
All decisions regarding breast Surgery and reconstruction will take each individual into account. We will work as a team to best meet your needs and the needs of your family.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy may be used after surgery to destroy breast cancer cells that remain in the area.
Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:
Hormone therapy may also be called anti-hormone treatment. If lab tests show that the tumor in your breast has hormone receptors, then hormone therapy may be an option. (See Lab Tests with Breast Tissue.) Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.
Options before menopause
If you have not gone through menopause, the options include:
In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Others are irregular menstrual periods, thinning bones, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Serious side effects are rare, but they include blood clots, strokes, uterine cancer, and cataracts. You may want to read the NCI fact sheet Tamoxifen.
Options after menopause
If you have gone through menopause, the options include:
Chemotherapy uses drugs to kill cancer cells. The drugs that treat breast cancer are usually given through a vein (intravenous) or as a pill. You’ll probably receive a combination of drugs.
You may receive chemotherapy in an outpatient part of the hospital, at the doctor’s office, or at home. Some women need to stay in the hospital during treatment.
Some anticancer drugs can damage the ovaries. If you have not gone through menopause yet, you may have hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. You may become infertile (unable to become pregnant). For women over the age of 35, this damage to the ovaries is likely to be permanent.
On the other hand, you may remain able to become pregnant during chemotherapy. Before treatment begins, you should talk with your doctor about birth control because many drugs given during the first trimester are known to cause birth defects.
Some women with breast cancer may receive drugs called targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells. (For information about HER2, see Lab Tests with Breast Tissue.)
Trastuzumab (Herceptin®) or lapatinib (TYKERB®) may be given to a woman whose lab tests show that her breast tumor has too much HER2: