Category Archives: Breast Cancer Surgery

Post Mastectomy Pain Syndrome – It Is Real and What To Do About It

http://MarnieClark.com/post-mastectomy-pain-syndromePost Mastectomy Pain Syndrome – It Is Real and What To Do About It

If you have had a mastectomy or lumpectomy and are experiencing some ongoing pain and discomfort that has nothing to do with the normal recovery period for surgery – we’re talking pain and burning that lasts months and even years after surgery – it is VERY real, it has a name, and in this article I’m going to give you some suggestions for what to do about it.

It is a reasonable expectation that pain can be experienced after major surgery like a mastectomy or lumpectomy, although there are ways to minimize this kind of pain. See my article Your Breast Surgery Recovery – Using Arnica to Minimize Brusing and Swelling. But pain which persists beyond a normal period of healing is considered to be chronic and is a whole different thing altogether. There is a term for it, Post Mastectomy Pain Syndrome, and despite the title, it can happen after lumpectomy surgery as well.

What is Post Mastectomy Pain Syndrome (or PMPS)?

PMPS is categorized as chronic pain that occurs after surgery for breast cancer including lumpectomy, mastectomy, and axillary lymph node dissection (this involves removing lymph nodes in the underarm area) and persists beyond what could be considered a normal period of healing.

A number of my coaching clients are experiencing PMPS and it, quite simply, is driving them nuts. The pain and discomfort experienced from PMPS can be any of the following:
• a shooting pain
• a burning sensation
• a stabbing pain
• an electric shock type of pain that accompanies a constant burning and aching feeling
• a throbbing, aching pain

There are a number of studies on PMPS and they indicate that anywhere from 20 to 68 percent of breast cancer survivors who have had mastectomy, lumpectomy or axillary clearance experience PMPS. That’s a huge number! PMPS typically begins in the period immediately after surgery, but it can also wait up to several months after surgery to appear and persist for a number of years. For some, the condition goes away on its own, but for others the pain is constant, and it wears away at their normally good nature, making them feel tired, despondent, depressed and grouchy.

What Causes PMPS?

There are several different things which can cause PMPS:

1. During lumpectomy surgery, mastectomy surgery, and/or axillary lymph node dissection, sometimes a patient’s intercostobrachial nerve (see photo below) and/or other sensory nerves in the underarm and breast areas are injured. Removal of a tumor located in the upper, outer quadrant of the breast (near the underarm) also increases risk of PMPS because the nerves in this region are more easily damaged.

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2. Formation of scar tissue from the surgery can also be a cause for PMPS. Interestingly, studies have shown that PMPS occurs more often after lumpectomy than after mastectomy.

3. Treatment with radiation or chemotherapy after surgery can also cause PMPS.

Symptoms of PMPS

Survivors typically complain of pain in the upper arm, the underarm, the shoulder and even the chest wall (all are areas enervated by the damaged intercostobrachial nerve). The pain experienced can range from mild and manageable, to being severe enough to interfere with daily activities. It can cause impaired movement of the affected arm, and can lead to not only pain but stiffness, and a condition referred to as “frozen shoulder”. These symptoms can be fairly continuous or intermittent. One client said hers was the intermittent kind, she would feel better for a few days and think it was finally gone, only to have it return full force for no apparent reason. The pain of PMPS can worsen by doing seemingly simple things such as household chores or even gentle stretching.

Easing the Symptoms of PMPS

It is important to carefully manage PMPS – not only for relief of the aggravating pain and other symptoms, but also to reduce the negative impact it can have on your quality of life. Here is a list of things that can help:

1. Essential oils – using pain relieving and anti-inflammatory essential oils like wintergreen, marjoram, peppermint, copaiba, ginger and a few others topically on the area of pain or other sensations can help to relieve the pain, inflammation, and settle the nerve down until it can repair. I would try this avenue first. Please ensure you use therapeutic grade essential oils from a reputable supplier.
2. An anti-inflammatory diet is highly recommended to ease the attendant inflammation in the body. See my article Anti-Inflammatory Foods That Help Fight Breast Cancer for some recommendations.
3. Nonsteroidal anti-inflammatory drugs. While it isn’t recommended to use these daily over a long period of time, the occasional use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen can help to relieve chronic pain and inflammation.
4. Deep tissue massage therapy is beneficial in management of PMPS because it can help to ease inflamed tissues, reduce scarring and adhesions, and restore movement to the affected limb. Indeed, one Korean study reported in 2014 found that trigger points that had developed in two particular shoulder muscles in post-mastectomy patients were responsible for their pain syndrome and injecting the trigger points with ultrasound relieved that pain. [1] A well-trained deep tissue massage therapist will know how to do this manually, without the need for ultrasound, but both can be helpful.
5. Pulsed, high intensity laser therapy. One small 2015 Egyptian study with 61 women found that treatment with pulsed, high intensity laser therapy increased range of motion of the affected shoulder, as well as quality of life for the women who underwent this form of therapy. [2]
6. Nerve block. A small study published in Cancer Research in 2013 found that a nerve block employing a combination of bupivacaine (an anaesthetic) and dexamethasone (an anti-inflammatory corticosteroid) was an effective potential treatment option for chronic neuropathic pain after mastectomy. 75 percent of patients receiving this nerve block injection reported persistent relief after one injection. [3]

The least exciting treatment option, but sometimes helpful for some patients in cases where pain is severe, is the use of anti-depressants and opioids to relieve neuropathic pain. These drugs must always be prescribed by a doctor and carefully monitored.

For some survivors, just knowing that the pain they are experiencing is real and not imagined can be comforting. Many have been told by their surgeons that there is no apparent reason for the pain they are experiencing and are sent on their way. If you’ve been told that, march down to your surgeon’s office with this article and have him/her read the research links below.

References:

[1] Application of ultrasound-guided trigger point injection for myofascial trigger points in the subscapularis and pectoralis muscles to post-mastectomy patients: a pilot study – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990076/

[2] Long-term effect of pulsed high-intensity laser therapy in the treatment of post-mastectomy pain syndrome: a double blind, placebo-control, randomized study – http://www.ncbi.nlm.nih.gov/pubmed/26115690

[3] Abstract P3-10-03: A simple intervention to relieve chronic neuropathic post-mastectomy pain – http://cancerres.aacrjournals.org/content/73/24_Supplement/P3-10-03.abstract

Post-mastectomy pain syndrome: incidence and risks – http://www.ncbi.nlm.nih.gov/pubmed/22377590

Prevalence of post-mastectomy pain syndrome and associated risk factors: a cross-sectional cohort study – http://www.ncbi.nlm.nih.gov/pubmed/24144570

Clinical and neurophysiological evaluation of persistent sensory disturbances in breast cancer women after mastectomy with or without radiotherapy – http://www.ncbi.nlm.nih.gov/pubmed/27456370

GET MY BEST TIPS on getting through breast cancer and preventing recurrences by signing up for my free e-newsletters and e-books on the right.  You can also “like” me on Facebook (Marnie Clark, Breast Health Coach) to get my inspirational snippets, news and updates.  I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.  

Essential Oils For Nausea After Surgery: The Research

Image source: freedigitalphotos.net / africa
Image source: freedigitalphotos.net / africa

Essential Oils For Nausea After Surgery: The Research

After undergoing surgery for breast cancer, it is pretty common to experience nausea, usually caused by a reaction to the anesthesia used.  It may be considered common, but it definitely is not nice when you are going through it.  I will share with you a couple of things that will help you through this.

Essential Oils For Nausea – The Research

Fortunately, essential oils are being studied a good deal more and the research coming to light is not only helpful but often fascinating.

One such study caught my eye recently, published in 2013 and titled Aromatherapy As Treatment For Postoperative Nausea: A Randomized Trial 1.  Researchers used aromatherapy with 301 adult patients who were having trouble with nausea in the post-anesthesia care unit of one surgical center.  The patients were given one of these four things on a gauze pad and asked to breathe in deeply three times:

1. Placebo (saline); or
2. Ginger essential oil; or
3. A blend of ginger, spearmint, peppermint and cardamom essential oils; or
4. Isopropyl alcohol

Nausea was then measured again in five minutes. The patients could also subsequently request anti-emetics (drugs which help to control nausea) if they needed them.

The researchers reported that the change in nausea level was significant for the essential oil blend and the ginger essential oil but not for the saline or the alcohol. No surprise!  I feel sorry for the people who received saline or isopropyl alcohol!  Also, the number of anti-emetic medications required after the aromatherapy treatment was significantly reduced.  The researchers noted “Aromatherapy is promising as an inexpensive, noninvasive treatment for postoperative nausea that can be administered and controlled by patients as needed.”

Ginger has been used for centuries for nausea, it is a well-known anti-emetic and quite often the basis for many natural remedies for seasickness. Cardamom is a member of the ginger family and is also considered quite helpful for queasiness and nausea. Spearmint and peppermint have been used throughout history for digestive complaints including nausea.

No Essential Oils? Try Controlled Breathing

If you do not have access to essential oils, one smaller 2014 study indicated that just doing controlled breathing when experiencing nausea after surgery could be as helpful as the administration of peppermint essential oil 2.

Controlled breathing is a fairly specific way of using and focusing on the breath and here’s how it works. Fill your lungs and breathe in through your nose and out through your mouth using a steady, slow rhythm. Try to keep your mouth closed when you breathe in through your nose and as you breathe out, “purse” or pucker your lips (as if you were about to whistle or kiss). This helps to slightly restrict the outflow of air.  Try to make your “out” breath twice as long as your “in” breath. This technique helps to empty your lungs of old air, and to make more room in your lungs for fresh, oxygen-rich air.  You might find it helpful to count to two as you breathe in, and count to four as you breathe out. Try not to hold your breath between breathing in and out.  For some reason this technique helps to relieve some of the nausea after surgery quite well.

My Experience With Essential Oils For Pain Relief, Inflammation

While I did not experience nausea after surgery, I used peppermint essential oil post-surgery to help with pain relief, combining it with wintergreen.  Peppermint and wintergreen are an effective duo for pain relief and inflammation.  I just put a drop or two of each on the area of concern and never needed any of the morphine that was offered me. I considered that a big plus, I don’t do well with drugs and I know many others have that same problem. This might not work for everyone, but it certainly worked for me.

If you are about to undergo surgery, here are links to other articles on my website that may be useful for you:

Your Breast Surgery Recovery: Using Arnica To Minimize Bruising and Swelling

Tips For Surgery: Useful Items To Take With You

Research:

1. Aromatherapy as Treatment for Postoperative Nausea: A Randomized Trial – http://www.ncbi.nlm.nih.gov/pubmed/22392970

2. Controlled Breathing with or Without Peppermint Aromatherapy for Postoperative Nausea And/or Vomiting Symptom Relief: a Randomized Controlled Trial – http://www.ncbi.nlm.nih.gov/pubmed/24461278

GET MY BEST TIPS on getting through breast cancer and preventing recurrences by signing up for my free e-newsletters and e-books on the right.  You can also “like” me on Facebook (MarnieClark.com) to get my inspirational snippets, news and updates.  I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.

Facing Mastectomy? The Merits Of Having A “Breast Wake”

Image Source: rgbstock / sundesigns
Image Source: rgbstock / sundesigns

Facing a life-altering surgery such as mastectomy is never going to be easy, let’s face it.

Regardless of your age, your breasts have been a big part of your sexual identity, nurtured your children, and/or given your partner much delight (and hopefully you as well).  If  you are facing mastectomy because of breast cancer, the thought of losing one or both breasts is no doubt a huge shock.

There are many resources out there for you to help you make your decision – and more than a few on this website – but the purpose of today’s article is to share with you the merits of having a “breast wake” should you decide to go forward with mastectomy.

What is a Breast Wake?

The traditional wake, held when someone died, involved family members or friends who stayed awake with the body of the deceased to watch or guard it and/or have a prayer vigil until it was time for the church funeral and/or burial.

According to Wikipedia, a wake is often a social rite which highlights the idea that the loss is one of a social group and affects that group as a whole.

Why should the loss of a breast be any different?  I have a friend who held a wake for a much-beloved dog.  I really think that this kind of loss should be noted, either before or after the event, but preferable before and here’s why.

Why Have A Breast Wake?

When you have gathered your family and friends together to mourn the loss of your breast(s), this is an exceptional time to ask each of them to help you with that process, in some small way while you are recovering and even possibly after treatments begin (if any).

Whether it be cooking you a healthy meal and bringing it over, or just taking out your garbage, or occasionally scrubbing the sink, you will be surprised to discover how many people actually want to help you and are willing to do just that.  And you will need their help at some point, I promise you.

Helpful Hints

Mourning the loss of a breast doesn’t have to be a solemn occasion.  Put someone else in charge of all of this – your best friend, for example – if you don’t http://MarnieClark.com/facing-mastectomy-the-merits-of-holding-a-breast-wakefeel up to it.  Pull the carpets back and dance if you want to.  Have some great, healthy food with your friends and family.  Cry and laugh with them.  Propose a toast to your breast(s) and have others do the same.  Serve cupcakes that look like breasts.

Instead of having a guest book where people list their names, have a blank book for people to write in – a few of their favorite inspirational quotes (ask them to bring them along when you invite them) because at some point during this journey you will feel overwhelmed, scared and depressed.  Having a book like this to delve into can help you through these difficult times.

With regard to the people who offer to help you, either you or a friend with good handwriting can write down the name and phone number of each person who offers help, along with what it was they offered to do.  Don’t be afraid to call them either!

Please do mark the occasion because it will help you in so many ways.  It will help your friends too.

If you would like to receive my best tips on getting through breast cancer and preventing recurrences, just  sign up for my free e-newsletters and e-books on the right, and/or “like” me on Facebook (MarnieClark.com). I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond. 

How To Relieve Pain From Tissue Expanders – Naturally

How To Relieve Pain From Tissue Expanders – Naturally

One of the things I hear most frequently from women going through breast implant reconstruction is their pain and frustration over those darned tissue expanders, so today I’m offering some information on how to relieve the pain from tissue expanders – naturally.

Tissue expanders are temporary devices implanted within chest muscles after a mastectomy, the main goal being to expand the tissues of the chest in order to accommodate an implant after removal of the patient’s own breast.  The point of the tissue expanders is to make room for a permanent breast implant, and it is the muscles that are being stretched that are the source of the pain and discomfort.

Depending on the elasticity of your skin, it can be a very painful and uncomfortable process.  This is not true for everyone and it should be said that the pain and discomfort are temporary.  But for those going through it, it can be pretty miserable, so here is some help for you.

There are certain essential oils that are very good for improving the elasticity of skin, the best ones being lavender, myrrh and geranium.  The essential oils of wintergreen, peppermint and copaiba can also help to relieve pain and inflammation – without the use of NSAIDS, opiates (Yes!  I know one doctor who prescribes Vicodin for this pain!) or other pharmaceutical drugs.

How to Relieve Pain From Tissue Expanders – Naturally

You will need:

1 small glass bowl

1 larger glass bowl

Organic, unrefined coconut oil

Essential Oils for Improving Skin Elasticity  – lavender, myrrh and geranium – make sure they’re high quality oils, I only use Young Living Essential Oils

Essential Oils for Pain Relief and Inflammation – wintergreen, peppermint, copaiba, clove

Step 1.  We will work on pain relief first.  Put about 1/2 tsp of coconut oil into the smaller glass bowl, set aside for a moment.

Step 1

Step 1

Step 2.  Pour boiling water into the larger second bowl.

Step 2

Step 2

Step 3.  Place the smaller glass bowl containing the coconut oil into the larger glass bowl.  The boiling water will melt and warm the coconut oil.  Once the coconut oil has melted, usually after a minute or two, just add 2-3 drops of each of wintergreen, peppermint and/or copaiba or clove (you can skip the boiling water and melting part of this if it’s a hot day and your coconut oil is already liquid!).

Step 3

Step 3

Step 4.  Now dip your fingertips into the bowl containing the oils and gently massage into the sore tissues of your chest that are being expanded.  Easy does it.  These particular oils really help relieve pain and inflammation, as will the gentle massage.  You could also do some gentle movement like yoga stretching.  A cold gel pack can help a lot with pain if you’re in a hurry.

For Improving Elasticity of Tissue

Just go through steps 1-4 above, only substitute 2-3 drops each of lavender, geranium and/or myrrh.  They all help to improve the elasticity of the skin, as will the warm coconut oil and gentle massage.

You can use this procedure as often as needed.

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I hope that helps!

If you would like to receive my best tips on getting through breast cancer and preventing recurrences, just  sign up for my free e-newsletters and e-books on the right, and/or “like” me on Facebook (Marnie Clark, Breast Health Coach). I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.  

The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional.  You should not use the information on this site for diagnosis or treatment of any health problem and please be sure to consult your health care professional when making decisions about your health.

Need A New Breast? Sure, Let Me Just Print One For You!

Photo courtesy of freedigitalphotos.net / Stuart Miles

Creating Body Parts With 3D Printers

Last week I was listening to a news report about 3D printers and how scientists are working towards creating body parts using a new science called biofabrication.  A scientist was holding up a model of a woman’s breast and they were describing how this new science worked.  

This is the next frontier – 3D printing, a very exciting technology with so much potential.  For breast cancer patients, the hope is that within the next 3 years, science will be able to create a new breast from a patient’s own cells.

No More “Flap” Surgeries Or Silicone Implants

Imagine this,  no more rearranging the muscles from our bodies – muscles that we need and want – to rebuild our breasts, and no more silicone implants!  Personally – speaking as a bodyworker – I feel that when they use muscles to rebuild a breast, it creates all sorts of imbalances in the body, I know that has certainly been the case for me.  Using this new biofabrication technology, your new breast will be made using your own cells!

How The Process Works

As far as I understand it, rather than using rearranged muscles or a silicone implant, an MRI or a laser scan of the patient’s healthy breast would be used to design what is called a breast scaffold.  You can see what the scaffold might look like in this article from the Brisbane Times.

The tissue is created by using modified printer cartridges and cells extracted from the patient, either from biopsies or stem cells.  Then the tissue is grown using already existing techniques – it is cultured in a growth medium and allowed to multiply.  Once the required amount of cells have grown, they are collected and formed into the desired shape and loaded into a cartridge to create what is called BioInk.  The BioInk is loaded into a bioprinter along with a cartridge of hydrogel, which is a water-based matrix used as scaffolding for creating layers of cells.  The printer prints a layer of the hydrogel, followed by a layer of BioInk cells, and so on. The layered calls naturally fuse together to create a scaffold.

Check out this quick YouTube video created by UMC Utrecht (one of the universities mentioned below) that shows how the process can be used to create osteochondral material in bone.  This will give you a better idea of how it works.

Just think – some of your healthy cells could be harvested, grown in a dish, the scaffold created, and in one single operation, your surgeon would implant the scaffold into your body, and *voila* you have a new breast.  From what I understand, in 2-3 years, the original scaffold will have degraded and disappeared.

Fascinating!

This technology is already moving along at a rapid pace – I read about a 2-year-old child in the USA who was born without a trachea and received one built with her own stem cells, this occurred last year (see link to story below). 

University Courses

An international masters degree in biofabrication is already going to be jointly offered by the Queensland University of Technology, the University of Wollongong, the University Medical Center Utrecht in the Netherlands and the University of Würzburg in Germany, the first of its kind.  Australian students would spend 12 months at one of the European universities and European students would spend 12 months at one of the Australian universities. 

Ethical Concerns

Of course, there are ethical concerns that this kind of technology will allow us to “play God” as never before, which makes a lot of people very uncomfortable.  There has already been an exposé on 60 Minutes about guns that have been created using 3D printers.  That one really made me nervous.  It will need to be well-regulated, no doubt.  But the applications for biofabrication are seemingly endless – new breasts, new bones, organ transplants.  18 people in the USA die every day while waiting in vain for transplants.  We could save some lives in a big way.  And get new breasts, with our own cells.  🙂

References

Brisbane Times article: 3D Printing Pushes Medical Boundaries

UK Telegraph: The Next Step: 3D Printing The Human Body

CNN: Toddler Gets New Windpipe From Her Own Stem Cells

CNN: The Next Frontier in 3-D Printing: Human Organs

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 and e-books on the right, and/or “like” me on Facebook (MarnieClark.com).  It is my honor and my goal to help you through this so that you emerge from breast cancer feeling better than before, thriving!

Your Breast Surgery Recovery: Using Arnica To Minimize Bruising and Swelling

 

Arnica Montana
Arnica Montana

Your Breast Surgery Recovery: Using Arnica To Minimize Bruising and Swelling

When I was anticipating my lumpectomy in 2004, I consulted a friend who was a trained naturopath and she strongly recommended that I start taking homeopathic arnica 2-3 days prior to my surgery and continuing for 5 days post-surgery to minimize the pain, bruising and swelling.  She said it also helped to recover from anesthesia.

I took her advice and was very happy I did.  I found arnica to be extremely effective for post-surgical bruising and swelling.  So was my plastic surgeon – in fact, he was so impressed, he thereafter began recommending it to his patients and had it sitting in a prominent place on his reception desk!

What Is Arnica?

Arnica montana is a perennial herb found (according to Wikipedia) widely distributed throughout North America, in Europe from southern Iberia to southern Scandinavia and the Carpathian mountains, and all the way to Siberia.  For some reason, it doesn’t grow in the United Kingdom, in Italy or in the Balkan region. 

Arnica’s favorite habitat is nutrient-poor meadows, moors and heaths and grows as high as 9,800 feet above sea level (3,000 metres).   The flowers and roots are used in herbal medicine and homeopathic remedies, typically in remedies applied directly to the skin.

How Arnica Helps

The active components of Arnica montana include sesquiterpene lactones and flavonoids which are known to reduce inflammation and ease pain. It also contains thymol, an infection-fighting essential oil, and carotenoid, a powerful antioxidant.

The proposed method of action is by stimulation of white blood cells and dispersion of fluids that accumulate around surgical sites.  The cumulative effect is a boost in immunity, acceleration of healing and anti-inflammation.  The thymol component also helps the body combat bacterial infection, which is important when you’re sitting in a hospital working on breast surgery recovery.

The Science

Several studies have found Arnica montana to be no more effective than a placebo in relieving pain, swelling, and bruising.  Maybe they were not using the proper strengths – who knows?

For myself, I found it to be extremely effective and everyone I’ve recommended it to felt similarly.  Homeopaths have used arnica for more than 200 years to treat injuries, in particular swelling and bruising, with great results.

I did find some positive studies:

(1)  In a 2007 study of 190 adults having their tonsils removed, scientists discovered that those taking a homeopathic dilution of arnica had a small but significant decrease in pain compared to patients assigned to a placebo.  Robertson A, Suryanarayanan R, Banerjee A. “Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial.” Homeopathy 2007 96(1):17-21.

(2) A 2002 study of 37 people undergoing surgery for carpal tunnel syndrome found that taking a homeopathic dilution of arnica and applying arnica ointment also produced a significant decrease in post-surgery pain.  Jeffrey SL, Belcher HJ. “Use of Arnica to relieve pain after carpal-tunnel release surgery.” Alternative Therapies in Health and Medicine 2002 8(2):66-8.

(3) A 2006 study of 29 patients undergoing face-lifts found that patients taking perioperative homeopathic arnica montana exhibited less bruising.  Seeley BM, Denton AB, Ahn MS, Maas CS. “Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial.”  Arch Facial Plast Surg. 2006 Jan-Feb;8(1):54-9.

Dosages

I strongly recommend that you consult a trained naturopath or homeopath to get the dosage correct for YOU.  Having said that, I do have a homeopathic protocol that comes highly recommended:

Homeopathic Arnica Protocol

  • Three days prior to surgery take one dose of Arnica 30C
  • Two days prior to surgery take Arnica 30C two times per day
  • One day prior to surgery take Arnica 30C three times per day
  • On the day of surgery take Arnica 30C four times before surgery commences.
  • Post-surgery take Arnica 30C every 15 minutes as soon as possible in recovery during the first hour.
  • After the first hour repeat Arnica 30C every hour for the duration of the day.
  • One day post-op take Arnica 30C every four hours for the duration of the day.
  • Day two post-op take Arnica 30C four times per day.
  • Day three post-op take Arnica 30C  three times per day.
  • Day four post-op take Arnica 30C two times per day.
  • Day five post-op take Arnica 30C one time per day and continue until full recovery.
As you will notice, the protocol increases the frequency of repetition of doses leading up to surgery and then after surgery, the repetition increases significantly, then starts to decrease as the body heals.  This protocol has been highly recommended, but please check with your health professional prior to commencement.
 
Check out my Useful Links page to buy arnica from recommended sources.
 
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.

My Thoughts On Angelina Jolie, Prophylactic Mastectomy and Genetic Predisposition

 

Photo courtesy of rgbstock.com / xymonau
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.

Can Hyperbaric Oxygen Therapy – or HBOT – Assist Breast Cancer?

Hyperbaric Oxygen Chamber
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.

Don’t Want Reconstruction Surgery? The Art Of Doing Nothing

http://MarnieClark.com/Dont-Want-Reconstruction-Surgery-The-Art-Of-Doing-Nothing
Image Source: rgbstock.com / jazza

In the time I have been a breast cancer blogger and coach, 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 for 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 of 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 (or both sides) 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.

Here’s a nice video by Megan, 58, who chose against breast reconstruction and is quite happy with her body shape.

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.  

Types of Reconstruction Surgery – Expander Implants

Types of Reconstruction Surgery Expander Implants
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.

Types of Reconstruction Surgery – the GAP flap (incl IGAP, SGAP)

Types of Reconstruction Surgery the GAP flap
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.

Here’s a great little YouTube video put out by Johns Hopkins to illustrate this type of flap procedure.

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.

Types of Reconstruction Surgery – the SIEA flap

Types of Reconstruction Surgery the SIEA flap
Photo courtesy of morguefile.com

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.

Types of Reconstruction Surgery – The TUG Flap

Types of Reconstruction Surgery The TUG Flap
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.

Types of Reconstruction Surgery – The Latissimus Flap

Types of Reconstruction Surgery The Latissimus Flap
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.

Types of Reconstruction Surgery – The DIEP Flap

Types of Reconstruction Surgery The DIEP Flap
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

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