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Breast Cancer After Double Mastectomy

Beyond The First 5 Years

Is Sensation Possible After a Double Mastectomy for Breast Cancer Prevention? One Woman’s Story

The risk of breast cancer recurrence is highest during the first 2 years after the initial diagnosis. As time passes, the risk of recurrence steadily decreases. Many survivors celebrate their 5-year cancer-free date because it is well known that the vast majority of patients who have not had a recurrence by that time have a relatively low risk of recurrence at all.

A late recurrence of breast cancer is one that recurs after the 5-year milestone. Since the likelihood of recurrence is so low at this point, we must ask ourselves:

  • Who experiences a late recurrence?

  • What factors contribute to their risk?

  • Why do seemingly cured patients, like my mother, have to face their cancer again?

Doctors, scientists, and researchers have identified factors that are related to the potential risks for late recurrence of breast cancer. Generally, these factors relate to the patients age, the cancers stage at diagnosis, hormone receptor status, genetic information, and lymph node involvement. Overall, the risk of a recurrence after 5 years is low, but breast cancer survivors with a higher risk of late recurrence are:

  • Survivors with the following receptor statuses

  • Estrogen receptor-positive tumor

  • Tumor larger than 2 centimeters

  • High number of involved lymph nodes

  • Postmenopausal survivors who are younger than 60 and had

  • Tumor larger than 2 cm

  • High number of involved lymph nodes

  • Postmenopausal women who are older than 60 and had

  • High number of involved lymph nodes

  • How Can You Decide What’s Right For You

    Be sure to give yourself time to think through both the medical facts and how you feel about your choices. This is a very personal decision. Your feelings are as important as any other factor.

    No one else can tell you what’s right for you. But it may help to discuss your choices with people who know you well.

    If you’re thinking about breast reconstruction, it’s a good idea to meet with a plastic surgeon. You can ask to see photos and talk to women who’ve had the surgery.

    It might also help to ask yourself some questions, such as:

    • Can I take time for a longer recovery? Or do I need to get back to my life as soon as possible?
    • Can I accept the small chance of a new cancer in my healthy breast? Or would I rather have my breast removed to help make this risk as low as possible?
    • Do I want to keep the natural look and feel of my healthy breast? Or is it more important that my breasts match as well as possible?
    • Do I have the information I need to make this decision? Or do I need to know more before I can make up my mind?

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    In fact, Boughey was the first author on two 2016 consensus statements by the American Society of Breast Surgeons that drew a similar conclusion. Essentially as a society, the American Society of Breast Surgeons came down and said for the average risk woman, we should not routinely be doing contralateral prophylactic mastectomy, Boughey said. One document included a bulleted list of facts about double mastectomy all surgeons should cover with patients considering the procedure.

    But surgeons still vary in how they talk about surgical options with their patients. For example, Boughey gives the pros and cons of all possible options, whereas Hughes tends to only discuss double mastectomy as an option if a patient brings it up. Both, however, focus their conversations on understanding what a patient wants and why, and providing accurate information to support her as she makes a decision.

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    Limit Or Avoid Alcohol

    Studies show that there is a link between moderate and heavy alcohol use and breast cancer. Alcohol is known to raise estrogen levels in your blood. This makes it more likely for you to get cancer again. If youâre a cancer survivor, itâs best to avoid alcohol altogether.

    If you do choose to drink, make sure to limit it to only one drink a day to lower your chances of your cancer coming back.

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    Will I Need Chemotherapy After A Total Mastectomy

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    A total mastectomy is the surgical removal of the entire breast to treat breast cancer. A physician may recommend this treatment on its own or in combination with another therapy, such as chemotherapy. When chemotherapy is provided after surgery, it is called adjuvant chemotherapy. Whether or not chemotherapy is recommended following a total mastectomy will depend on many different factors, including the patients overall health, age and medical history as well as the type, stage and nature of the breast cancer.

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    Can Triple Negative Breast Cancer Come Back After A Double Mastectomy

    Triple-negative breast cancer recurrence after mastectomy This treatment protocol can reduce an individuals risk of recurrence and improve their survival rate. However, according to a 2021 study , cancer recurrence rates are the same for those who had lumpectomy or removal of a lump and mastectomy.

    How Is A Local Breast Cancer Recurrence Or Metastasis Found

    Breast cancer that recurs at the original site is called a local recurrence. Breast cancer that returns and spreads to other parts of the body is called a distant recurrence . This is metastatic breast cancer and may also be called stage IV or advanced breast cancer.

    A local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm.

    Metastasis is usually found when new and persistent symptoms are reported to a health care provider and follow-up tests are done.

    If you have a local recurrence or metastasis, its not your fault. You did nothing to cause it.

    Learn about follow-up care after breast cancer treatment.

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    What Are The Types Of Breast Cancer Recurrence

    If you develop cancer in the opposite, untreated breast , you receive a new breast cancer diagnosis. This isnt the same as breast cancer recurrence.

    When breast cancer returns, it may be:

    • Local: Cancer returns in the same breast or chest area as the original tumor.
    • Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit or collarbone area.
    • Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.

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    A Swollen Arm Or Hand

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    You might have some slight swelling in your arm or hand after your operation. This should settle soon after your surgery.

    Tell your doctor or nurse as soon as possible if the swelling does not settle or if you have pain or tenderness in your arm or hand.

    You are at risk of long term swelling in your hand and arm after surgery to remove your lymph glands. This is swelling caused by lymph fluid that can’t drain away. It can happen any time after surgery.

    Once you have lymphoedema it cant be cured but early treatment can help to control it. Your nurse will talk to you about ways of preventing lymphoedema.

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    When Would You Need A Mastectomy

    A mastectomy may be recommended if:

    • the size of the cancer is large in comparison to your breast
    • there is more than one cancer in your breast
    • cancer has returned to the same breast
    • you have previously had radiotherapy to the same breast.

    A mastectomy usually takes one-to-two hours, with up to a week or more for recovery depending on individual circumstances.

    Mammograms After Breast Cancer Surgery

    Nearly all women with breast cancer will have surgery at some point as part of their treatment. There are many different kinds of breast cancer surgery. The type of surgery you have had will affect if you need to get mammograms in the future:

    • If you have had breast-conserving surgery , you will still need to get mammograms of the treated breast.
    • If you have had a mastectomy, you most likely wont need a mammogram of that breast.

    However, if you had surgery on only one breast, you will still need to get mammograms of the other breast. This is very important, because women who have had breast cancer have a higher risk of developing a new cancer in the other breast.

    While the American Cancer Society does not have specific guidelines for mammograms or other breast imaging in women who have been treated for breast cancer, there is information available about what these women will probably need to do.

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    Where Does Breast Cancer Form

    Breast cancers may develop in the glandular tissue of the breast, specifically in the milk ducts and the milk lobules. These ducts and lobules are located in all parts of the breast tissue, including tissue just under the skin. The breast tissue extends from the collarbone to the lower rib margin, and from the middle of the chest, around the side and under the arm.

    In a mastectomy, it is necessary to remove tissue from just beneath the skin down to the chest wall and around the borders of the chest. However, even with very thorough and delicate surgical techniques, it is impossible to remove every milk duct and lobule, given the extent of the breast tissue and the location of these glands beneath the skin.

    Survivorship Care After Local Or Regional Recurrence Treatment

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    Because of treatments theyve received, many breast cancer survivors have a higher risk of developing other diseases as they age, including high blood pressure, heart disease, and osteoporosis. To make sure breast cancer survivors are regularly screened for these and other, experts have developed the idea of survivorship care planning.

    Survivorship care plans are written documents made up of two parts.

    The first part is a treatment summary, a record of all the breast cancer treatments youve received.

    The second part is basically a roadmap of what you can expect in the years after treatment, including any late or long-term side effects you might have, and a schedule of how youll be monitored for these side effects and other health conditions. This part of the survivorship care plan usually includes:

    • the tests youll have

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      which doctors will order the tests

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      a schedule of when the tests will be done

    • resources, if you need more information

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    Talking To Family And Friends About Your Illness

    Women who have breast cancer are often concerned about how the disease will affect their relationship with their partner and if they are mothers their children. The stress of treatment often makes sexual needs a lower priority for a while. It can affect your daily routine and require a lot of decisions and planning. All this can give rise to conflicts. Its important to keep talking to your partner. If you have reached your limits you can get psychological counseling or support, either individually, or as a couple.

    Whether children are still very young or already grown up, many mothers find it difficult to talk to their children or grandchildren about their disease. It might stir up memories of the first time they were diagnosed and the same fears may resurface, along with new worries as well. But even if you would rather protect your children from this situation, children do sense when something is wrong. So it is a good idea to speak openly with them about the cancer coming back and about the fact that there may be more treatment to come, and that you may once again need to rest more often.

    Is A Preventative Double Mastectomy For Me

    A woman newly diagnosed with breast cancer will often say, when discussing her surgical options, Why not just take them both off? These patients often express a desire to never have to worry about my breasts again, particularly those women who have had difficulty with screening procedures in the past or have a history of multiple breast biopsies. Women in whom the primary cancer was initially missed often lose faith in mammography and other screening methods and may feel that the only way to be sure this will not happen to them in the future is to remove both breasts.

    Double mastectomies have been featured more in the mainstream media, increasing awareness of this option. Furthermore, the option of immediate reconstruction serves to make this route more appealing than in the past. But what is the real risk of developing a new cancer in the other breast? Do double mastectomies really save lives or improve quality of life? The answer is different for every woman. This article seeks to address these issues and assist individuals in making the most informed decision.

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    Who Should Consider Having A Preventive Mastectomy

    According to the National Cancer Institute, only those women who are at very high risk of breast cancer should consider preventive mastectomy. This includes women with one or more of the following risk factors:

    • BRCA or certain other gene mutations
    • Strong family history of breast cancer
    • Previous cancer in one breast and high risk of developing breast cancer in the opposite breast
    • History of lobular carcinoma in situ plus family history of breast cancer
    • History of radiation to the chest before age 30

    Preventive mastectomy should only be considered after you’ve received the appropriate genetic and psychological counseling to discuss the psychosocial impacts of the procedure.

    What To Expect From Recovery

    Breast cancer survivors share mastectomy scars for new campaign

    You can expect temporary soreness in your chest, underarm and shoulder, as well as possible numbness across your chest that may be permanent.

    The surgical drains that were inserted inside your breast area during surgery typically stay in for about one week to 10 days.

    While recovering from surgery, most people have some pain. Recovery times vary depending on the specifics of your double mastectomy.

    • After a mastectomy without breast reconstruction, it can take three to four weeks to feel mostly normal.
    • If you also have breast reconstruction, recovery can take six to eight weeks.
    • For some procedures, it can take months before you can return to being fully active.

    You’ll likely receive a written list of instructions about post-surgical care that includes:

    • How to care for the surgery site and dressings
    • How to recognize signs of infection
    • Tips for bathing and showering after surgery
    • When you can use your arm again
    • Arm exercises to prevent stiffness
    • Restrictions on activity

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    What Are The Pros And Cons Of Bilateral Mastectomy

    Bilateral mastectomy has some benefits. For example, with this surgery there is:

    • A lower future risk of cancer in the breast.
    • No need for follow-up mammograms or breast MRIs.
    • A better chance that the breasts will match if both are reconstructed at the same time.

    The surgery also has some downsides. Bilateral mastectomy:

    • Has no effect on the risk of cancer somewhere else in your body.
    • Is more complex than lumpectomy. It takes longer to recover. And there’s a higher risk of problems, such as infection.
    • Causes a loss of feeling in the chest. Usually the feeling doesn’t come back. And the surgery leaves scars that are permanent.
    • May mean that you need one or more other surgeries if you want breast reconstruction. Each surgery has risks and requires recovery time.

    What Do Experts Say About Bilateral Mastectomy

    Most experts do not recommend bilateral mastectomy for early-stage breast cancer. This is because:

    • Women who have both breasts removed don’t live longer than women who have lumpectomy plus radiation treatments.footnote 1
    • Bilateral mastectomy reduces only the risk of a new cancer in the breast. It doesn’t reduce the risk of a new cancer in another part of the body.

    The risk of a new cancer in the breast is already small. If a new cancer occurs, it’s more likely to appear somewhere else in the body.

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    Breast Cancer Recurrence After Mastectomy

    Breast cancer is one of the most common cancers among women nowadays. Many female patients that have been diagnosed with breast cancer decide to get a mastectomy. But what happens after the mastectomy can the breast cancer return? Here well discuss some important must-knows about breast cancer and mastectomies.

    Why Werent These Escaping Cells Identified The First Time The Cancer Was Treated

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    Although scans of the body can detect if there is obvious spread to these other organs, for women with early stage breast cancer there rarely is anything that shows up on a scan. There is a limit to what scans can tell us: they wont show extremely tiny spots of cancer, and they definitely cant show us if there are individual cells circulating in the body. Neither will any blood test, or any other test for that matter. So the first time around we perform our surgery and give our treatmentschemotherapy, hormonal therapy, radiationwith the hope that if microscopic spread has already taken place, the treatments will scavenge those cells and kill them before they take up residence someplace in the body.

    Unfortunately, these treatments dont work 100 percent of the time. So if cells have spread, and if the treatments we give dont affect them, the cancer cells can persist and take hold someplace, developing into metastases, or spread. This is why and how recurrence happens.

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