Understanding The Zone To Be Reconstructed
Up until the 1980 s, it was not considered safe to reconstruct a breast until 2 years after the original mastectomy . Nowadays however, there is a wealth of evidence supporting immediate reconstruction and the oncologic safety thereof. Reconstruction may be immediate, delayed-immediate , or delayed . As a departure from Halsteds radical mastectomy of the late 1800 s , the trend of nipple sparing mastectomy and skin sparing mastectomy has brought reconstruction from general to plastic surgery. Some retrospective studies suggest that NSM does not correlate with cancer recurrence , while some recommend extreme caution . As for SSM, skin sparing varies from patient to patient, making it difficult to apply a standard to retrospective literature . However, it was reported that 0 of 44 patients with ductal carcinoma in situ relapsed upon SSM, while 10 out of 177 with invasive ductal carcinoma presented relapse within 10 years . When it does occur, DCIS relapse with SSM has been correlated with the young age of the mastectomy patients .
Treatment Of Recurrent Breast Cancer
For some women, breast cancer may come back after treatment sometimes years later. This is called a recurrence. Recurrence can be local , regional , or in a distant area. Cancer that is found in the opposite breast without any cancer elsewhere in the body is not a recurrenceit is a new cancer that requires its own treatment.
What Are Risk Factors For Breast Cancer Recurrence
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.
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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. It’s 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.
How Can You Cope With Negative Feelings
New fears and disappointment about this setback to your health, anger about the unfairness of your situation or being envious of healthy people are all perfectly natural reactions and are nothing to feel bad about. In the long run, however, it might be better for your general wellbeing to learn how to deal with negative feelings and thoughts so that you still have space for other things as well.
Many women say that it comes as a relief to accept feelings of anxiety, worries and despair and to talk about them with people close to them. As well as talking to your partner, family and friends, professional counseling might also help. Religious organizations and hospitals also offer pastoral or spiritual support. Sharing your experiences with other women in a self-help group is another option.
It can sometimes help to put anxieties and worries aside for a while. Concentrating on pleasant things or activities can help reduce fears and tension to a manageable level.
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Evidence For Breast Cancer Relapse After Flap Reconstruction
There is long standing evidence for immediate reconstruction post mastectomy with flaps and the related absence of relapse. Specifically, myocutaneous flaps ) are quoted as safe bloc transplants in a post cancerous setting . Immediate primary reconstruction with LD flaps in 51 patients were followed out for almost 45 months, with relapse showing in 4/51 . Similar findings were reported in 2013, where immediate reconstruction via SSM and transverse rectus abdominus muscle flaps showed 55 of the 249 patients relapse, 33 with lung metastases . Even in late stage patients, early reconstruction with flaps is lauded as an oncologically safe procedure . Due to excessive donor site morbidity, the DIEP is preferable to the TRAM . In a comparison with the older TRAM flap, the DIEP has not exhibited greater cancer recurrence . Recurrence with DIEP flaps has been reported on the ipsilateral side rather than contralateral, 35 years post reconstruction . Importantly, in a combination therapy of delayed DIEP and lipofilling, there was observed no significant increase in relapse between DIEP/fat grafting and delayed DIEP alone . Myriad other free flaps exist as reconstructive options for breast cancer; involving the gracilis muscle , abdominal , and fascio-cutaneous infragluteal , but are rather under-described in terms of cancer stimulation during reconstruction.
Family History Genetic Test For Gene Mutations
The researchers asked study participants about the type of treatment they had, as well as the clinical indications for double mastectomy, including the patients family history of breast and ovarian cancer, and the results of any genetic testing.
Women with a family history of breast or ovarian cancer, or with a positive genetic test for mutations in the BRCA1 or BRCA2 genes, may be advised to consider having both breasts removed, because they are at high risk of a new cancer developing in the other breast. This represents about 10 percent of all women diagnosed with breast cancer. Women without these indications are very unlikely to develop a second cancer in the healthy breast, according to the researchers.
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Adipose Derived Stem Cells In Grafted Fat
CAL has been shown in vivo to elicit regenerative effects via vascularization of the fat graft in a situation of radiation therapy . Studies have shown that ASCs in fat have the ability to withstand the initial hypoxic environment of the graft, and remain viable to recruit new vasculature. This is critical in avoiding necrosis of tissue and involution of grafted fat, both of which would defy the purpose of fat grafting . However, it is the same mechanism for which CAL earns skepticism in planning cancer reconstruction. A more recent study examined the paracrine impact of ASCs on co-grafted breast cancer cells in vivo. Tumors were artificially created in mice by co-injection of breast cancer cells with ASCs, the latter of which had been harvested from human fat and passaged in vitro . Cancer cell to ASC ratios ranged from 1:1 to 1:3, with larger tumors resulting from the increasing ratio. Tumors excised and lysed for chemokine analysis showed tumors had high levels of CXCL1 and CXCL8. The mechanism was elucidated further using shRNA to knock out CXCL1/8 in the supplied ASCs; a co-injection which resulted in a smaller, less vascularized tumor . This type of targeted research is a step in the right direction when considering the safety of CAL in cancer patients.
How Do Surgeons Use Tissue From A Woman’s Own Body To Reconstruct The Breast
In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a womans body and used to rebuild the breast. This piece of tissue is called a flap.
Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.
Depending on their source, flaps can be pedicled or free.
- With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
- With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.
Abdominal and back flaps include:
Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who dont have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.
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What Can I Do To Reduce The Chances Of Breast Cancer Recurrence
The best thing you can do following your breast cancer treatment is to take care of yourself. Dont smoke, and try to exercise and maintain a healthy diet as best as you can. You should also be sure to follow your schedule for follow-up appointments closely, and continue to perform monthly self-exams on your own. If anything seems out of the ordinary, dont be afraid to consult with your physician. As with other cancers, breast cancer recurrence is best treated when caught early.
In the event you do experience breast cancer recurrence, we invite you to come to the Don & Erika Wallace Comprehensive Breast Program at Moffitt Cancer Center, where our physicians will develop a treatment plan that is tailored to meet the challenges of your unique cancer. Other reasons to come to Moffitt for breast cancer treatment include:
- The unparalleled knowledge and experience of our multispecialty team
- Our robust clinical trials program
- Our supportive care specialists
If you are experiencing breast cancer recurrence after receiving a total mastectomy, you can schedule a consultation to speak with a Moffitt physician by calling or submitting a new patient registration form online.
What Can You Do For Your General Wellbeing
It’s important for women with breast cancer to take good care of themselves. Here are some ways to actively enhance your treatment and to do something good for yourself:
- Get regular exercise, if possible
- Eat things that agree with you and that you enjoy
- Find the right balance of activity and relaxation
- Get as much restful sleep as you can
- Generally do things you enjoy
A personalized exercise program is another way to reduce exhaustion and improve sleep, lightening your mood and seeing your body in a more positive way again. You can also take part in special sports activities offered as part of follow-up care after cancer treatment. It’s important to enjoy exercise, feel good while you’re doing it, and avoid overdoing it.
Many people think that certain diets can prevent cancer or speed up recovery. But reliable research on how nutrition influences breast cancer hasn’t yet found any direct effects on the risk of getting it or on how it progresses.
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Next Steps For Breast Cancer Survivors
Following a diagnosis of breast cancer, I always tell my patients to pace themselves. The journey after treatment can be long and challenging. The late, great Maya Angelou gave sage advice when she stated, My mission in life is not merely to survive, but to thrive, and to do so with some passion, some compassion, some humor, and some style.
These 5 steps can help you thrive in your overall health and cancer survivorship:
Take care of yourself emotionally. Seeking social support, developing strong personal relationships, accessing mental health services, and having a solid spiritual foundation are effective steps to manage lifes stressors and especially those unique to cancer survivorship.
Eat a healthy diet. Good nutrition supports overall health, such as eating a diet rich in fresh fruits, vegetables, and lean meats.
Maintain a healthy weight. Research shows that maintaining a healthy weight through a healthy diet and moderate physical activity lowers the risk of developing diabetes, high blood pressure, and other cancers and chronic diseases.
Stick with your follow-up care and other health screenings. Your routine oncology appointmentis a good time to talk about any concerns. If you notice any changes or new symptoms before your scheduled appointment, be sure to alert your health care provider. Also, take care of your entire body, including other recommended health screenings, such as Pap tests, general blood tests, blood pressure checks, and colonoscopy.
Local And Regional Recurrence
Breast cancer that comes back in the treated breast, chest or scar is called a local recurrence. Having a local recurrence does not mean the cancer has spread.
Breast cancer that comes back in the;lymph nodes;in the armpit, close to the breast bone, or lower neck, is called a regional recurrence. If cancer cells are blocking the lymph nodes in the armpit, fluid can build up in the arm and cause;lymphoedema.
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Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic — the cancer has come back not in the breast , but elsewhere in the body as well. That’s a much more serious situation . Or, it may have come back much as the first time you were diagnosed, as a “new” cancer, and is treated as such.
Be aware that many people talk about recurrence and metastasis in the same breath. But they are not the same thing. If you have had a local recurrence, when the cancer remains confined to your breast, the good news is that your prognosis is not necessarily any worse than it was the first time.
“Whether it’s a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume we’re dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation,” says Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York.
If, for example, you finished treatment for breast cancer seven or eight years ago, any recurrence or new cancer would be treated largely as an entirely new problem.
“That woman will not only undergo surgery, but may well receive additional therapy that doesn’t ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent,” says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.
How Is A Local Recurrence Or Metastasis Found
Breast cancer can recur at the original site . It can also return and spread to other parts of the body .
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 symptoms are reported to a provider.
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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Who Is At Risk Of Breast Cancer Recurrence
Everyone who has received a breast cancer diagnosis is at risk of recurrence, however the risk differs markedly depending on a number of factors listed below. Some breast cancers, when diagnosed very early when small and without lymph node involvement, have an excellent prognosis and are very unlikely to recur. On the contrary, larger cancers, with lymph node involvement or with a more invasive behaviour, are unfortunately at a higher risk of recurrence.
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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What Is The Breast Cancer Recurrence Rate After A Total Mastectomy
While being told you are in remission following your total mastectomy is undoubtedly a reason to celebrate, chances are theres still one thing on your mind recurrence. Its frustrating and scary to think that even if youve had your entire breast removed, your cancer might still come back. So, how likely is it that your breast cancer will recur? The truth is that its impossible to know, but experts believe there are some factors that put a woman at a higher risk of breast cancer recurrence. One indicator is lymph node involvement. The more lymph nodes that had cancer at the time of the mastectomy, the greater the chance of recurrence. Experts also believe that those who were initially diagnosed before the age of 35, those who had inflammatory breast cancer or those whose breast cancer did not respond to hormone therapy may also be at a higher risk for recurrence. However, having one or more of these risk factors isnt a reason to panic. Just like there was no way to know that you would develop breast cancer in the first place, theres also no way to tell if you will have a recurrence, and many survivors never experience a relapse.