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 nobody realizes 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.
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.
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.
“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
Another 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.
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.
“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.
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.
© 2005 HealthNewsDigest.com