Photo courtesy of rgbstock.com / xymonau
My Thoughts On Angelina Jolie, Prophylactic Mastectomy and Genetic Predisposition
Angelina Jolie’s heart-rending choice to have a double mastectomy has certainly created a storm of controversy this week among breast cancer circles and my friends and subscribers have asked my opinion on the whole matter, hence today’s post.
First of all, please read her personally written article which appeared in the New York Times Opinion Page. Eloquent. However…
Two Lines Of Thought
There are those who applaud her decision and her courage for making it (because it had to be a tough one to make), while others believe it was incredibly stupid because she didn’t have breast cancer, just a strong family history. I’m hovering somewhere in between those two lines of thought. Mostly I just feel incredibly sad for her, because it’s apparent that Ms Jolie fell prey to fear, to overzealous medical providers who must have played a rather large part in that fear, and to the cancer industry as a whole.
Please allow me to share some of my thoughts on the matter.
Surgery Has Risks
In explaining her own choice to have this surgery, Ms Jolie does not mention the many side effects and risks of this type of surgery. Surgery always comes with risks and side effects. To complicate matters, breast implants are considered “high risk” by the FDA (not that I concern myself overmuch with what the FDA thinks). The current statistics indicate that 4 out of 10 women who have had a mastectomy and implants will require additional surgery within 3 years of getting their implants.
More than a few of my subscribers have shared with me that had they known reconstruction surgery (whether flap reconstruction or implant reconstruction) was going to be so painful, so bothersome and such a disruption to their lives they would never have chosen it. I truly feel for them.
Genetic Predisposition Vs Epigenetic Factors
As far as the genetic predisposition part of the story, an excellent article has been written by Sayer Ji, the founder of greenmedinfo.com, a website resource that I trust and often refer to because it always contains well-researched and well-written information on all sorts of health issues. The article is titled Did Angelina Jolie Make a Mistake By Acting On The ‘Breast Cancer Gene’ Theory? Do yourself a favor and click on the link and read that article.
I particularly appreciated the author’s assertion that “even in those in which a BRCA mutation is identified, the genes, in and of themselves, do not alone make the disease.“ I have been endeavoring to teach that particular line of thinking via my posts on this site. In June, 2012 I wrote an article Cancer Genetics: BRCA1 and BRCA2 Are NO Cause For Concern! wherein I shared some information from the book “The Biology of Belief”, by Dr Bruce Lipton, a cell biologist, whose research and studies clearly indicate that many other factors are at play in health and disease than merely genetics.
To quote again from the greenmedinfo article, “…we must now accept that factors beyond the control of the gene, known as epigenetic factors, and largely determined by a combination of nutrition, psychospiritual states that feed back into our physiology, lifestyle factors, and environmental exposures, constitute as high as 95% of what determines any disease risk.“
Did you get that? Epigenetic factors (factors beyond the control of our genes) constitute as high as 95% of what determines disease risk. Our bodies are incredibly smart. They have the ability to prevent and heal all disease if they are given the right conditions!
Human Genes Should NOT be Patented
The thing that bugs me the most about all of this is that Ms Jolie’s decision is going to persuade thousands of other young women to do the same – to needlessly lose a valued part of their anatomy. Not every woman with a mutation will develop breast cancer! And Myriad Genetics, the patent-holders of the BRCA1/BRCA2 genes, are profiting. According to a Yahoo Finance report dated May 14, 2013, Myriad Genetics’ shares rose 4% after Angelina Jolie announced her mastectomy surgery.
I support an activist group called Breast Cancer Action, who in 2009 joined researchers, genetic counselors and cancer patients in a lawsuit to overturn Myriad Genetics’ patent on BRCA1 and BRCA2 genes. The case is currently before the U.S. Supreme Court and a ruling is expected this summer. Please visit this page on the Breast Cancer Action website for more information.
My best advice is to do three things:
1. Sign up for my free newsletters to find out how best to reduce your risk of breast cancer;
2. Sign up for the free newsletters offered by greenmedinfo.com (use this link);
3. Donate funds to Breast Cancer Action (use this link), help them to continue their good work, compelling the changes necessary to end the breast cancer epidemic.
Hyperbaric Oxygen Chamber
I’ve been asked to do some research on Hyperbaric Oxygen Therapy (HBOT) as it relates to breast cancer but what I’ve been able to find is not particularly promising, at least as far as it relates to breast cancer.
What Is Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy (HBOT) involves the breathing of pure oxygen while you are in a sealed chamber designed to hold either a single person, or a group of up to 12, that has been pressurized at 1-1/2 to 3 times the normal atmospheric pressure. At the end of the session, which can last from 30-120 minutes, technicians slowly depressurize the chamber.
HBOT is the best treatment for decompression sickness — known as “the bends” — a very painful and potentially lethal condition that hits deep sea divers who come to the surface too quickly. HBOT also helps in cases of carbon monoxide poisoning, arterial gas embolism (bubbles of air in blood vessels), skin grafts and flaps that are not healing well with normal treatment, gas gangrene, soft tissue infections in which tissues are dying, crush injuries where there is not enough oxygen to the tissues, burns, delayed radiation injury, blockage of the retinal artery (blood vessel in the back of the eyeball), traumatic ischemia injuries like frostbite, and certain bone or brain infections.
You may recall that Michael Jackson was fond of sleeping in a hyperbaric oxygen chamber. I guess he didn’t have claustrophobia.
The Buzz Around Cancer Circles…
Why I have been asked to research HBOT is because there has been a bit of a buzz about HBOT in cancer circles. If you understand that cancer thrives in an anaerobic environment (meaning without oxygen) it only stands to reason that an oxygen-rich environment would stop or at least slow its growth. According to the American Cancer Society, “There is no evidence that HBOT cures cancer.” There is just currently no scientific evidence to support HBOT as a cure for cancer at this time, at least I wasn’t able to find any. If I’m wrong, I hope someone will set me straight.
By the way, are you aware that the FDA has Oxygen listed as a drug? So I guess we’re all guilty of taking drugs every time we take a deep breath in. Ridiculous…
The Research That Has Been Done On HBOT
As far as breast cancer is concerned, there is a 2011 study done by some researchers at the Department of Plastic, Reconstructive and Aesthetic Surgery, Maltepe University, Istanbul, Turkey that revealed the use of HBOT following irradiation could be an effective tool to reduce the “capsule reaction of the implanted area and the tissue damage seen in radiodermatitis.” The researchers postulated that since implant-based breast reconstruction has such a high rate of complications such as capsular contracture and poor aesthetic outcome, due to adjuvant radiotherapy, that HBOT could be of assistance. They only worked with 15 rats over a period of 9 weeks, but they did find that HBOT following the radiotherapy did reduce tissue damage. It remains to be seen whether it would be helpful for human patients who have had breast reconstruction, but it looks promising.
The most promising and heart-warming article I read was offered up by my own city’s paper, The Denver Post. It seems HBOT is being used with extremely good results for returning war veterans. I was distressed to learn that in 2012, we were losing an average of one soldier per day to suicide – more than to actual combat. So many are returning with traumatic brain injuries (TBIs) and their symptoms include headaches, memory loss, balance problems, and cognitive difficulties that can severely impact their quality of life. The Denver Post reported “While many mild TBIs self-heal, others result in chronic pain.” HBOT has been helping these veterans with TBIs, read the whole article here.
It appears that a lot more research needs to be done on Hyperbaric Oxygen Therapy – at least at it relates to cancer – and anyone wanting to use it for healing from cancer would be well-advised to pair it with all treatments recommended by their medical practitioners, both conventional and alternative or complementary.
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). It is my honor to help you through this.
Photo courtesy of rgbstock.com and jazza
In the time I have been a breast cancer blogger, I have met many wonderful women who did not want reconstruction surgery. For them, it just didn’t make sense. I celebrate their right to choose.
We don’t HAVE to have breasts! If we have lost one or both breasts to this disease, who says we have to replace them? Even my own mother-in-law chose against reconstruction surgery (she’s in her 80′s after all, and says “Who’s going to look at my chest besides me?”).
There is no simple answer to this dilemma. Many factors influence the decision and each woman must evaluate those factors for herself. Sometimes however, it helps to hear from other women about why they made the choices they made, and how they feel down the road.
Researching this article was really interesting. There are quite a few websites or blogs written by survivors who really didn’t want to deal with breast reconstruction and they had a myriad of good reasons why they didn’t wish to.
Here are some of their reasons or concerns.
Some Good Reasons to Choose Against Reconstruction
- They didn’t want another operation which they felt was unnecessary;
- They were unhappy with having an implant or ‘foreign object’ in their body or using muscle from another part of the body to create a breast form;
- For some, distance from the hospital or doctor performing the surgery was a big problem;
- Some felt have reconstruction surgery might bring risks of further complications (like infection) and after battling cancer, they just didn’t want to risk it;
- Several younger women with children said that caring for their children was their main concern and because reconstructive surgery would involve a long operation and recovery, they would not have the time and energy they’d need to care for their children after coming out of the hospital. A couple women chose to wait until their children were older;
- Several women said they were comfortable with how they looked — they didn’t want any more surgery and preferred instead to wear a breast form;
- Many older women in their 70′s and 80′s chose against reconstruction because it just didn’t worry them not to have a breast (or both) missing. They were completely at peace with their decision and their body shape.
For those of you considering a breast form, here’s a little information for you.
Breast Forms
A breast form (prosthesis) is worn either inside a bra or attached to the body. It has the appearance and feel of a natural breast. For women who have had a mastectomy, breast forms can be an important alternative to breast reconstruction. Most of these forms are made from materials that mimic the movement, feel, and weight of natural tissue. A properly weighted form provides the balance your body needs for correct posture and anchors your bra, keeping it from riding up.
Prices vary considerably for prostheses and a high price doesn’t necessarily mean that the product is the best one for you. Take your time to shop for comfort, good fit, and a natural appearance in the bra and under clothing. Your clothes should fit the way they did before your mastectomy.
Many women feel Amoena is a good brand. Here’s a good article from cancer.net about choosing a breast prosthesis.
The advantages of having a breast prosthesis are (1) they may give you a more natural shape under clothes, (2) they may give a more “balanced” look, (3) they do not require surgery, and (4) if your natural breast size changes, you can buy a new prosthesis.
There are a few disadvantages, however – (1) you may be less comfortable in revealing clothes than if you had reconstructive surgery, (2) it may be less convenient to do certain things, such as playing active sports, than if you had reconstruction (one swimmer I know had her prosthesis fall out during a competition and that embarrassed her terribly), (3) a prosthesis may be heavy, feel hot, and move around inside the bra, (4) it’s hard to scratch an itch underneath a prosthesis.
The Art of Doing Nothing
There is an art to choosing not to have breast reconstruction. You will, at some point, feel the need to explain your decision to curious friends or family members. I suggest you come up with an answer you are comfortable with and then just stick by it. Everyone will respect your decision – or most will, and if they don’t that’s their problem, not yours!
Here are a few options for doing nothing:
- If you have no breasts, no problem – you don’t need a bra. If you still have one, however, and you wish to support it, you will still need to buy a bra that fits well. Just stuff the other side with padding that won’t fall out if you want a balanced look.
- Wear a bandeau style bra if you have a surviving small breast – they are comfortable and will still provide you with support.
- One woman I know who had a single mastectomy wears a sports bra that’s very stretchy and provides her one breast with sufficient support and the other side clings to her body just fine. She doesn’t care about appearing lop-sided.
Ultimately, the choice is yours. It’s your body and only YOU can choose what makes sense for you. Talk to your doctor, talk to your family, and then be at peace with your decision.
I send my love to everyone taking this journey right now. If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey… and beyond.
Photo courtesy of Johns Hopkins Medicine
Following on my series of articles about the different types of reconstruction surgery, today I’m discussing expander implants after mastectomy.
What Is Tissue Expansion?
A tissue expander is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman’s natural appearance.
A tissue expander is a temporary device that is placed on the chest wall under the pectoralis major muscle. This may be done immediately following a mastectomy, or it can be done later. The tissue expander’s purpose is to create a soft pocket to contain a permanent implant. Tissue expanders come in a variety of shapes and sizes.
According to PlasticSurgery.org tissue expansion is a “relatively straightforward procedure that enables the body to ‘grow’ extra skin for use in reconstructing almost any part of the body. A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow.” It is a staged approach.
Most expanders have a fill port that is built into the front of the device, and this is accessed with a needle through the skin. Expansion only takes about a minute, and the amount of fluid that is placed in it is limited by the tightness of the patient’s skin. A typical volume for each expansion procedure is 50 cc’s of saline (about 10 teaspoons).
Once Tissue Expansion Is Achieved…
Once expansion of your tissue is completed and you are cleared for another operation (about one month after finishing chemotherapy), the second stage of reconstruction is performed. This is an outpatient procedure that involves exchanging the expander for an implant, and creating a more refined breast shape. The initial tissue expander placement, and subsequent exchange for an implant, each take about 1 hour in the operating room.
Advantages and Disadvantages of Tissue Expanders
The good part about the procedure is that tissue expansion offers a very good to near-perfect match of color, texture, and hair-bearing qualities, also because the skin remains connected to the donor area’s blood and nerve supply, there is a smaller risk that it will die. In addition, because the skin doesn’t have to be moved from one area to another, as it does with the various flap surgeries I’ve written about lately, scars are often less apparent.
The disadvantage of the procedure is that it takes rather a long time to grow additional skin. Depending on the area to be reconstructed, tissue expansion can take as long as three to four months.
Also, the procedure requires repeated visits to the surgeon for injection of the salt water that inflates the balloon. And from what I’ve learned from those enduring this procedure, IT’S DAMNED UNCOMFORTABLE, I don’t care what the surgeons say. I’ve heard the complaints – they discuss the discomfort of having these foreign objects in their chests that are regularly inflated so that it feels like their breasts are going to explode, the necessity for sleeping in a recliner chair because they can’t roll onto their sides or stomachs for at least two months, the drains going from the surgical sites drive them nuts, healing sometimes takes a long time…
I’m not saying don’t have this – just be aware of the pitfalls. Make sure you discuss this procedure thoroughly with your surgeon and ensure it’s the best one for you and your particular needs before you proceed.
Reference Articles:
http://www.breastreconstruction.org/TypesOfReconstruction/ExpanderImplant.html
breastcancer.org discussion forums
http://plasticsurgery.org
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Photo courtesy of freedigitalphotos.net and duron123
When I first decided to write about all the different types of reconstruction surgery, I had no idea how many types there were! Even in the eight years since I had breast cancer, this type of surgery has come a long way and I certainly did not have as many options back then as there are today.
Deciding which type of reconstruction surgery to have will be quite difficult for some, so I’m hoping that this series of articles assists someone in making that decision.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
The GAP, IGAP, SGAP Flap
This type of breast reconstruction is generally utilized when a patient does not have sufficient tummy fat to have TRAM or DIEP flaps. The GAP (gluteal artery perforator) uses skin and fat from your tushy (buttocks) and depending on whether your surgeon uses the upper portion (SGAP = superior gluteal artery perforator) or the lower portion (IGAP, inferior gluteal artery perforator) will be a decision that you either make together, or solely by your surgeon in the operating room.
The GAP blood vessels are not located within muscle, so your gluteus maximus will be undisturbed during this procedure except for an incision which your surgeon makes to tease the perforator vessels out of the gluteal muscle to create the blood vessels for the transplanted tissue.
Most women have enough tissue in their gluteal area to create a new breast, however, if there is not enough tissue, a small implant can be placed to fill out the size of the new breast.
This type of flap can be taken from one buttock, or can be harvested from both buttocks for bilateral breast reconstruction. Flap elevation is completed while the patient is sleeping (under anesthesia, of course) face down, and then the patient is turned over for the flap to be attached to the chest.
This is another procedure which requires a high degree of proficiency from your surgeon – it’s microsurgery. Please ensure that your surgeon has the requisite experience and skills.
Length of Surgery: for one breast, 5-7 hours, for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-4 days (ask your particular surgeon for more information as this varies between hospitals and surgeons)
From A Practical Point of View…
Because no muscle is moved during this operation, most women said the recovery period wasn’t too bad. One who had had the IGAP (taken from the lower buttock) mentioned she couldn’t sit down comfortably or wear jeans for quite a few weeks.
Expect to be off your feet for 3-4 days while you are in the hospital and the surgical donor site on your tush heals.
The SGAP scar lies in the upper buttock and is “easily hidden in a French cut bikini or in underwear” (according to The Center for Microsurgical Breast Reconstruction). The IGAP scar lies within the lower buttock crease.
If you choose to have reconstructive surgery, please read my articles Tips For Surgery – Useful Items to Take With You and My Top Favorite Things to Promote Surgery Recovery.
Have you had the GAP surgery? Perhaps you’d like to comment below on what it was like for you personally so that my readers will have some more good feedback. Thanks!
References:
http://breastreconstruction.org/TypesOfReconstruction/OtherFreeFlaps.html
http://breastcancer.about.com/od/reconstructivesurgery/tp/sgap_flap.htm
breastcancer.org forums
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). You can depend on me to help you through this.
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Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The SIEA Flap
The SIEA flap type of breast reconstruction is a relatively new style of reconstruction and requires microsurgery. The SIEA flap is somewhat similar to the DIEP flap in that both techniques use skin, fatty tissue and blood vessels from the abdomen, but the DIEP flap utilizes tissue from the upper abdomen, while the SIEA flap uses tissue from the lower abdomen to reconstruct a natural, soft breast following mastectomy. Also, the SIEA blood vessels are not located within muscle, so your abdominal muscles never have to be disturbed during this procedure.
The SIEA flap is more technically difficult to perform. Please ensure that your surgeon has the requisite experience and skills. Having said that, I read that the SIEA flap procedure has a less than 1% failure rate.
The SIEP flap is apparently used less frequently since the arteries required are generally too small to sustain the flap in most patients. According to PRMA – Center for Advanced Breast Reconstruction: “Less than 20% of patients have the anatomy required to allow this procedure. Unfortunately, there are no reliable pre-operative tests to show which patients have the appropriate anatomy. The decision as to which type of reconstruction to perform is therefore made intra-operatively by the plastic surgeon based on the patient’s anatomy.”
You would NOT be a good candidate for the SIEA flap if there is not enough tummy fat (for instance if you are very thing or have had a tummy tuck already), or if you are an active smoker — your abdominal scar will heal slowly, and your fat tissue is more likely to turn into scar tissue.
The SIEA flap can be used for reconstructing one or both breasts. Since you will have two surgical sites, you will have two scars.
Length of Surgery: for one breast, 5-7 hours, for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-4 days (ask your particular surgeon for more information as this varies between hospitals and surgeons)
From A Practical Point of View…
One of the things that bugs me about my latissimus dorsi flap reconstruction is that I have a lot of numb areas on my breast and back. With the SIEA flap, sensory nerve reconstruction can also be performed in most patients and this can really improve long term sensation in the reconstructed breast.
Also because no muscle is moved during this operation, most women said the recovery period wasn’t too bad. Another plus is that there is little risk of developing an abdominal hernia later as there is with the DIEP flap.
One thing to note – if the SIEA flap reconstruction fails, the tissue flap may die and will have to be completely removed and you would not be a candidate to try it again for another 6-12 months.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you choose to have reconstructive surgery, please read my articles Tips For Surgery – Useful Items to Take With You and My Top Favorite Things to Promote Surgery Recovery.
References:
http://prma-enhance.com/breast-reconstruction/siea-flap
http://breastcancer.about.com/od/reconstructivesurgery/tp/siea_flap.htm
breastcancer.org forums
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Photo courtesy of freedigitalphotos.net and Apple’s Eyes Studio
Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The TUG Flap
The TUG flap is a relatively recent type of reconstruction surgery, it certainly wasn’t available 8 years ago when I went through breast cancer. It is recommended for women who, due to a slender body type, or due to previous abdominal surgery, can’t have the more utilized TRAM or DIEP flap procedures.
In the TUG flap procedure, your surgeon will utilize fatty tissue, muscle and blood vessels from the inner thigh to reconstruct your breast. TUG is an acronym for “transverse upper gracilis”.
The gracilis is a muscle on the inside of your upper thigh. It’s a relatively small muscle responsible for helping to move your leg closer to the center of your body. It is reasonably expendable and does not create any noticeable loss of strength, because other muscles exist which can compensate for its function. The skin and fat carried by the inner thigh flap can be a transversely oriented ellipse just below the groin and buttock crease, which allows the donor site to be closed similar to a thigh lift, resulting in a well concealed scar. Alternatively the incision can be extended vertically along the inner thigh to capture more tissue volume in a sort of fleur-de-lis design, and this allows larger breasts to be reconstructed with the inner thigh flap.
The TUG flap can be used for reconstructing one or both breasts. The scar runs along the inner upper thigh and is well hidden. An added benefit might be a leaner inner thigh similar to what you might receive after a thigh lift procedure.
Length of Surgery: for one breast, 2-3 hours, for both breasts, 4-6 hours (this may vary according to your surgical team).
Hospital Stay: 4-7 days (ask your surgeon for more info)
From A Practical Point of View…
After this surgery, it’s normal to have some wound healing issues because of the location of the incisions on the inside of the thighs. You will most likely need a compression garment for the inside of the thighs.
Most survivors mentioned that they needed to avoid sitting in a chair for any extended time during the first two weeks post-surgery, but that laying in bed, sitting in a reclining chair, or walking did not cause problems. Most complaints were just about the 4 drains they needed to carry around with them after surgery. That part was a little irritating, but most everyone seemed pretty pleased with this type of reconstruction.
This is microsurgery, a highly specialized field, so please ensure that your surgeon has the requisite experience and skills.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you choose to have reconstructive surgery, please read my article Tips For Surgery – Useful Items to Take With You. Another article that might be helpful: My Top Favorite Things to Promote Breast Surgery Recovery.
References:
breastreconstruction.org
breastcancer.org forums
http://www.hopkinsmedicine.org/avon_foundation_breast_center/treatments_services/reconstructive_breast_surgery/transverse_upper_gracilis_flap.html
http://prma-enhance.com/breast-reconstruction/tug-flap
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Photo courtesy of rgbstock.com and lusi
Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The Latissimus Flap
The latissimus flap is a pretty standard breast reconstruction method, first utilized way back in the 1970’s. Your surgeon will take a flap from your latissimus dorsi muscle (located on your back), with or without attached skin. The flap is elevated off of the back and brought around under the skin under your arm to the front of the chest wall. The main vessels remain attached to the body to ensure proper blood supply to the flap. The latissimus flap provides soft tissue to allow complete coverage of an underlying implant if one is utilized.
The latissimus flap is most commonly combined with a tissue expander or implant, to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone. Sometimes, for a thin patient with a small breast volume, the latissimus flap can be used alone as the primary reconstruction without the need for an implant.
The latissimus flap can be used for reconstructing one or both breasts. You will have a horizontal scar (although some doctors create vertical scars) running under your shoulder blade on the reconstructed side, approximately 5″ long.
Length of Surgery: for one breast, 2-3 hours (this may vary according to your surgical team).
Hospital Stay: 1-3 days
From A Practical Point of View…
After this surgery, it’s normal to have some restriction of range of motion of the arm on the affected side. Also, because you now have muscle tissue in your new breast, when you contract your latissimus dorsi muscle, you will feel your breast contract as well. This may annoy some women. I chose this type of reconstruction for myself and I’m used to the muscle contraction now – it’s a great party trick (lol).
Some survivors say they wish they had never chosen this surgery because they have suffered from a great deal of post-surgical back pain, presumably there was some nerve damage done. For myself, I have experienced no such problem. I have had to be extremely proactive with stretching and yoga to regain my muscle strength and range of arm motion, as well as a particular type of massage to reduce adhesions from scar tissue. Since I’m a massage therapist, I created a video to explain the procedure so others could get their massage therapists to do this for them.
One further thing I have noted – the area around the scar on my back is still numb, eight years later, and it itches sometimes. It’s also numb along the side of my body over the area where the tissue wraps around and I have a lot of loose, slack skin on the side of my body where the muscle wraps around. If I were younger and worried about such things, I might need a further surgery to correct that.
All in all, most survivors who chose the latissimus flap reconstruction were happy with their surgeries. Here’s an inspiring YouTube video of a woman who underwent this type of surgery.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you choose to have reconstructive surgery, please read my article Tips For Surgery – Useful Items to Take With You. Another article that might be helpful: My Top Favorite Things to Promote Surgery Recovery.
Reference: breastreconstruction.org, breastcancer.org forums
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Photo courtesy of freedigitalphotos.net and taoty
Deciding upon which type of reconstruction surgery to have after losing part of your breast (or all of it) to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The DIEP Flap
DIEP stands for “deep inferior epigastric perforator” which means that your surgeon will utilize lower abdominal skin and fat for the breast mound and does not remove any of the rectus abdominis muscle such as occurs with the TRAM flap. Instead, blood supply is provided through the perforator vessels that are separated out from the rectus abdominus muscle, using a muscle incision alone. Your surgeon decides in the operating room how many perforators are needed to provide sufficient blood supply for the DIEP flap to survive.
Once the DIEP flap is raised, a microscope is utilized to transplant the tissue to a set of blood vessels on the chest wall. The tissue is used to create a breast shape without having to be tunneled under the skin (as in the pedicled TRAM flap). In order to avoid using any muscle, it does take longer to harvest a DIEP flap than a TRAM flap. However, this results in the advantage of minimizing injury to the abdominal wall muscle, resulting in less pain, and a lower risk of hernia formation as compared with TRAM flaps.
This type of surgery requires a higher skill level from your surgeon – this is microsurgery and much more difficult to perform. The success rate in transferring tissue in this manner is very high in the hands of surgeons who perform microsurgery regularly. It is recommended that you inquire as to your surgeon’s expertise with this type of surgery, as well as to ask about the hospital where it will be performed because they will also need the necessary experience monitoring these kinds of flaps.
The DIEP flap can be used for reconstructing one or both breasts. You will have a horizontal scar running from hip to hip on your lower abdomen.
You would not be a good candidate for this type of surgery if you do not have enough lower abdominal tissue to create the flaps; if you have had previous abdominal surgical procedures such as abdominoplasty (a C-section scar is usually okay); or if you cannot tolerate anesthesia for long periods.
Length of Surgery: for one breast, 5-7 hours; for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-5 days
From A Practical Point of View…
After this surgery, it’s normal to have abdominal pain and tightness for several weeks, and that can last up to several months before you can return to a full range of activity. Even though no muscle is cut, the fascia covering the muscles is cut and that requires healing time, as do your incisions and nerves.
Some surgeons require that you stay in a “flexed” position for the first 3 weeks after surgery.
Some survivors say they have some abdominal discomfort of various kinds, many months or even years after surgery but that it is not debilitating, some described a muscle cramp kind of sensation, others just described tightness. What they all agreed on was that it was really important to increase your core muscle strength after this surgery – yoga and Pilates were extremely helpful.
All in all, most survivors were pretty happy with their DIEP flap surgeries.
A Warning
DIEP surgery is a fairly lengthy procedure, with potential for other complications such as total flap loss. You’ll want to make sure that your surgeon is very experienced with microsurgery and enjoys a high rate of success.
I’ve found a helpful YouTube video from a UK surgeon, Adrian Richards, explaining the difference between DIEP flap and TRAM flap. And here’s another one which has a lovely story within it, showing the entire procedure – but be warned, if you’re the least bit squeamish, you’d probably better not watch it: UCLA DIEP Flap Breast Reconstruction.
If you choose to have reconstructive surgery, please read my article Tips For Surgery – Useful Items to Take With You. Another article that might be helpful: My Top Favorite Things to Promote Surgery Recovery.
Reference: breastreconstruction.org
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Photo courtesy of freedigitalphotos.net and imagery majestic
Deciding upon which type of reconstruction surgery to have after losing part of your breast (or all of it) to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
TRAM Flap
The TRAM flap is the most common type of reconstructive surgery and utilizes the entire rectus abdominus muscle to create the new breast.
TRAM stands for “transverse rectus abdominus myocutaneous” which means that your surgeon takes the lower abdominal skin and fat up to the chest wall and a breast is then created using this tissue.
There are two methods of performing the TRAM flap procedure – one called “pedicle” flap and one called “free” flap. To find out more about these two types, click this link.
In order to transfer the flap to the chest, the muscle is tunneled under the upper abdominal skin. Many women choose this approach since the patient’s own body tissue is used and it feels like a pretty natural breast reconstruction. Another benefit is that often you also get a flatter tummy. The scar on the abdomen is low, and extends from hip to hip.
The TRAM flap can be used for reconstructing one or both breasts. In a patient undergoing a one-sided (unilateral) reconstruction, it’s felt that the TRAM flap can potentially offer better symmetry than using an implant.
To prevent the possibility of getting hernias somewhere down the track, most surgeons will use a synthetic mesh when closing the abdomen.
If you are a smoker, have diabetes or suffer from obesity, doctors do not advise having this surgery because of limitations in the flap blood supply.
Length of Surgery: for one breast, 4-5 hours; for both breasts, 5-7 hours (this may vary according to your surgical team).
Hospital Stay: 3-5 days
From A Practical Point of View…
After this surgery, it’s normal to have abdominal pain and tightness for several weeks, and that can last up to several months before you can return to a full range of activity.
Most patients report that it’s painful to cough or sneeze post-surgery (or even stand up straight) so if you find it necessary to do this, you’ll need to bend over at the waist to avoid pulling muscles.
Immediately after surgery, you’ll need to learn to roll over onto your side when getting out of bed, and then pushing yourself erect with your arms.
Some survivors recommend that you need to exercise as soon as you can post-surgery. Walking, swimming, yoga, Pilates, Wii Fit are all wonderful to strengthen your back muscles because your stomach muscles will now be much weaker. It’s very important to compensate for that by strengthening your back muscles.
One survivor mentioned that just standing still can be painful, it can make you feel tired much sooner than you might otherwise.
I’ve found a helpful YouTube video from a UK surgeon, Adrian Richards, explaining the difference between DIEP flap and TRAM flap.
If you choose to have reconstructive surgery, please read my article Tips For Surgery – Useful Items to Take With You. Another article that might be helpful: My Top Favorite Things to Promote Surgery Recovery
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
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