What is the difference between a prophylactic mastectomy and a therapeutic mastectomy?
Should breast reconstruction surgery be performed immediately after a prophylactic mastectomy?
Should breast reconstruction surgery be performed immediately after a therapeutic mastectomy?
Are the nipple and areola removed with the breast tissue?
What are the options for breast reconstruction surgery?
Will an immediate reconstruction after therapeutic mastectomy alter the ability of health care workers to detect cancer recurrence?
What are the benefits of breast reconstruction surgery after a mastectomy?
What are the risks associated with breast reconstruction surgery?
Are there any non-surgical options?
What is the difference between a prophylactic mastectomy and a therapeutic mastectomy?
Prophylactic mastectomies are those performed on women at high risk for developing breast cancer in the breast(s) they choose to remove. These women often have had family members diagnosed with breast cancer, have been diagnosed with breast cancer themselves, or have had genetic testing that confirmed the presence of the cancer-related genes BRCA1 or BRCA2. The removal of the healthy breast(s) is performed before cancer is found(1) (2) (3) (4)
A therapeutic mastectomy is performed on women diagnosed with breast cancer. The surgery removes the breast along with the cancer. Prophylactic and therapeutic mastectomies can be performed in a single surgery if a woman is diagnosed with cancer in one breast and decides to have both breast removed to prevent the development of cancer in the disease-free breast(1)
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Should breast reconstruction surgery be performed immediately after a prophylactic mastectomy?
Immediate reconstruction after a prophylactic mastectomy does not present any known health risks(5). Immediate reconstruction may allow the preservation of the skin surrounding the breast tissue. This may result in better symmetry and less scarring than if the skin was removed (3) (1)
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Should breast reconstruction surgery be performed immediately after a therapeutic mastectomy?
Immediate breast reconstruction after a therapeutic mastectomy poses more possible health risks than reconstruction after a prophylactic mastectomy. The radiation and chemotherapy used in cancer treatment may prevent the immediate reconstruction of the breast. Radiation and chemotherapy affect the body's wound-healing ability, including the healing that is needed after breast reconstruction. Other factors such as lymph node status and possible scarring are also taken into account when considering immediate breast reconstruction (1)(2)
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Are the nipple and areola removed with the breast tissue?
Nipple-areola preservation depends on the type of mastectomy. If the skin 'flap' of the breast is spared, the nipple-areola complex may be spared as well. Women whose surgeries left the nipple-areola intact do not show an increased risk of cancer recurrence, but many physicians still prefer to remove these structures during a mastectomy(1) (2)(5)
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What are the options for breast reconstruction surgery?
In general, there are two main types of breast reconstruction surgeries.
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The first type of surgery uses a saline or silicone gel-filled shell that is placed under the pectoral muscle. An expander implant is often used first in order to make room in the tissue in preparation of the final implant. The expansion greatly decreases possible implant problems.
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The second type of surgery uses skin, fat and muscle from the patient to rebuild the breast. The tissues may be obtained from several sites including the back, buttocks, thighs and abdomen.
The techniques can be used in combination on a single patient to achieve the best possible result(4) (6)
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Will an immediate reconstruction after therapeutic mastectomy alter the ability of health care workers to detect cancer recurrence?
No. Studies have shown that breast reconstruction has no effect on the ability of a physician to monitor breast health or possible recurrences. Additionally, no correlation has been found between breast reconstruction and increased cancer recurrence(7)
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What are the benefits of breast reconstruction surgery after a mastectomy?
The removal of one or both breasts can alter a patient's body image and cause psychosocial difficulties. These difficulties include anxiety, depression, altered body image and impaired sexual function. Studies have shown that breast reconstruction provides several beneficial results: Restoration of body image, improved vitality, improved sense of well-being, and increased quality of life. Breast reconstruction is not a necessary procedure and, over time, many women experience improved mental health without undergoing breast reconstruction. According to studies most women's mental and physical health return to normal levels about one year after surgery regardless of breast reconstruction (8) Do what feels right to you(4) (8)
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What are the risks associated with breast reconstruction surgery?
As with any other surgery, breast reconstruction poses possible health risks. The risks depend on the type of reconstruction. Risks associated with implants - Infection, poor positioning of the implant, scar tissue formation, wrinkling of the implant, and implant deflation.Risks associated with tissue-based reconstruction - Infection of the breast and/or donor site, bruising (hematoma), build-up of body fluids near the surgical wounds (seroma), deterioration of donated tissues, and the possible need to replace the skin 'flap' used to cover the new breast.
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Are there any non-surgical options?
For a variety of reasons many women do not have breast reconstruction. These women may choose to use breast prostheses. A prosthesis is a curved form made of soft silicone that can be slipped into a special pocket on bras, clothing, and swimsuits. For women missing one breast, a prosthesis provides symmetry and balance which helps maintain good posture. Prosthetic breasts can be custom-made and are often covered by health insurance.(6)
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