Where Can I Buy Suitable Bras After Breast Surgery
Any bra is suitable after breast surgery providing it is well-fitting and follows the points above. You can buy mastectomy bras from specialist suppliers that are specifically designed for women who have had their breast removed. Mastectomy bras are also available from many high-street shops, which can often be a cheaper option.
Superior And Inferior Gluteal Artery Perforator Flap Reconstruction
Gluteal artery perforator flap procedures use skin and fatty tissue from the buttocks to reconstruct the breast.
- The superior GAP procedure uses skin and fatty tissue from the upper part of a buttock.
- The inferior GAP flap procedure uses skin and fatty tissue from the lower part of a buttock.
Because no buttock muscle is used in either procedure, athletic ability after surgery is rarely affected .
S-GAP or I-GAP flap reconstruction may be a good option for women with more fatty tissue in their buttocks area than in their abdomen . However, it leaves a large scar across the buttock area.
If the GAP procedure leaves the buttocks noticeably different in size, liposuction can be used later to remove fat from the opposite buttock to create a more even look.
As with the DIEP flap, GAP flap procedures are more complex than other types of flap procedures and require a microvascular surgeon.
They take longer than other types of tissue flap surgeries , which may increase the risk of surgical complications .
If an S-GAP or I-GAP flap procedure isnt successful, it can be repeated using tissue from the opposite buttocks .
Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
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Breast Implants And Anaplastic Large Cell Lymphoma
Dr. Jones: So what did the FDA identify as a possible association between breast implants and a rare non-breast cancer?
Dr. Agarwal: Over the past decade and a half, the FDA, the medical societies, and doctors in general have been paying very close attention to the outcomes of their patients that have had breast implants placed. And so, over the past number of years, we found that there is a very small but significant incidence of a rare lymphoma, and it appears that it’s associated with a specific type of breast implant, whether they’re placed for reconstructive purposes or cosmetic reasons. And that’s ALCL, an anaplastic large cell lymphoma.
Dr. Jones: That’s a new one to me.
Dr. Agarwal: Yeah. Most people haven’t heard it.
Dr. Jones: Right. Very rare.
Dr. Agarwal: And it’s not a breast cancer as we think of breast cancers. It is a lymphoma. It’s typically found in the capsule, the scar tissue that surrounds a breast implant. But again, I want to emphasize that it’s exceedingly rare.
Dr. Jones: If there’s an increased risk, what kind of numbers are we talking about?
Dr. Agarwal: We’re talking about really low risk. It appears that patients with breast implants have about a one in 3,800 to one in 30,000 risk of developing this type of lymphoma. To put that in a broader context, you can think that the average woman in the United States, one in eight women will develop breast cancer.
Dr. Jones: In their lifetime, yeah.
Dr. Agarwal: That’s correct.
Whens The Best Time To Have Breast Reconstruction
The timing is based on what you want to do, your medical conditions, and your cancer treatment. You can have it done during the operation to remove the breast, or you can have it months or years after a mastectomy.
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Breast Implants After Radiation Carry Increased Risks
Dr. Kronowitz reviews and synthesizes recent research on breast reconstruction using implants for patients receiving radiation therapy. To reduce the risk of recurrent breast cancer, increasing numbers of women are being treated with radiation therapy after mastectomy . Radiation has toxic effects on tissues that can cause problems with healing.
Reconstructive surgeons agree that breast reconstruction results after radiation therapy tend to be better when the patient’s own tissue is used. However, in some situations implants may be the preferred option for reconstruction, or the only choice. The goal of the review was to analyze the best available evidence on the use of breast implants after radiation therapy.
Dr. Kronowitz identified 19 studies, of varying quality, evaluating the results of implant-based reconstruction in patients receiving PMRT. He writes, “In general, radiation increases the risk of complications and poor aesthetic outcomes of implant-based reconstruction.”
In one of the largest studies performed to date, the risk of major complications was about 45 percent for women receiving implants with radiation therapy, compared to 24 percent in patients not exposed to radiation. Complications were more common when radiation was given before versus after implant-based reconstruction: 64 versus 58 percent.
Cancers Linked To Treatment With Tamoxifen
Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.
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Other Free Flap Reconstructions
There are some other reconstruction techniques using flaps from other areas of the body. The following types of free flap reconstruction use tissue from the buttocks or thighs.
These techniques are mainly used when other types of reconstruction arent suitable. They may be appropriate for women who are too slim for tissue to be taken from their abdomen or who have scarring from previous surgery to their abdominal or back area. Only a few surgeons in the UK offer these techniques and you may need to travel to another centre if you need this type of surgery.
As with all types of flap reconstruction, these techniques are generally not suitable for women who have diabetes, are heavy smokers or are very overweight.
SGAP flap and IGAP flap
SGAP and IGAP use only fat and skin taken from the upper or lower buttock to create a new breast . This involves microvascular surgery, which is the process of joining blood vessels together. Where tissue has been removed from the buttocks, there will be a scar and an indentation.
TMG flap or TUG flap
The tissue removed in this procedure is taken from the upper inner thigh and consists of skin, fat and a small strip of muscle .
The procedure may be suitable for women with small- or medium-sized breasts. The inner thigh fat feels soft and is therefore similar in texture to the breast fat. Microvascular surgery is needed to join the blood vessels.
This film shows the SGAP and IGAP, TMG and TUG techniques.
Mammograms After Breast Reconstruction
You will still be offered regular mammograms on your natural remaining breast, and to check any remaining tissue in your reconstructed breast if only part of your breast tissue was removed.
If youve had an implant in your natural breast to match the reconstructed breast for size, tell the radiographer in advance so the Eklund technique can be used if appropriate. This takes an additional image of the breast during screening. It involves easing the breast tissue forward away from the implant so that it can be seen more clearly. The radiographer should explain the technique and explain why they think it is suitable for you.
Bras after surgery
Sometimes you may be advised to wear a bra during both the day and night initially after your surgery.
Many women are concerned about finding comfortable and well-fitting bras following breast reconstruction. Initially after surgery your surgeon will advise what bra to wear depending on your type of reconstruction.
Our booklet Breast prostheses, bras and clothes after surgery provides practical information about bras and clothing for women who have had breast surgery.
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Common Misconceptions About Breast Reconstruction After Breast Cancer
First, I want to make some important points in addressing a few common misconceptions patients often have surrounding breast reconstruction.
Transverse Rectus Abdominis Myocutaneous Flap Reconstruction
The transverse rectus abdominis myocutaneous flap uses skin, fat and muscle from the lower abdomen to reconstruct the breast . It creates a natural-looking breast.
A TRAM flap usually doesnt require an implant as long as theres enough excess skin and fatty tissue in the lower abdomen. If you dont have excess abdominal tissue or youve had abdominal surgery in the past, you may not be a candidate for a TRAM flap reconstruction.
The TRAM flap has some drawbacks:
- Once a TRAM flap has been done, it cant be repeated.
- The surgery leaves a large scar across the lower abdomen.
The loss of an abdominal muscle can cause weakness in the abdominal area. Although a mesh is used to reconstruct the area of the missing muscle, there may be a risk of hernia or bulge. This risk may be greater in bilateral breast reconstruction procedures for double mastectomy. If youre active, talk with your plastic surgeon about this drawback.
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Summary Of Surgery Timing
Though we don’t have a solid answer on how soon surgery should be done after a diagnosis of breast cancer , it would seem earlier surgery is ideal .
Delaying for a lengthy period of time can be dangerous, with studies finding that those who delay over six months are twice as likely to die from the disease. This is important to keep in mind for those who have breast lumps they are “observing” without a clear diagnosis. Any breast lump needs to be explained.
Making An Informed Choice
Each person is unique. Your breast cancer treatment, your body, your breast shape and your lifestyle affect not only your reconstruction options, but also the pros and cons of your options.
Your plastic surgeon will help you choose the type of reconstruction that will give you the best results and fit your lifestyle, while minimizing the risk of complications.
Study your options and make a thoughtful, informed choice after carefully considering the pros and cons of each option.
Although this decision may seem overwhelming, it may help to know most women whove had breast reconstruction dont regret the method they chose .
If youre a good candidate for a procedure, there are fairly few complications with any of the current techniques .
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Types Of Breast Reconstruction
The two primary categories of breast reconstruction after mastectomy are implant-based reconstruction and autologous reconstruction. For each category, surgeons may use a variety of specific techniques to perform the reconstruction.
Its beyond the scope of this article to discuss these techniques in detail, but if youd like to learn more about them, I recommend you go to the Types of Breast Reconstruction page of the American Society of Plastic Surgeons website.
Benefits Of Breast Reconstruction Surgery
Breast reconstruction can help you feel balanced, normal and feminine, as well as make you feel empowered by your body. Youll also feel better about wearing certain types of clothing with comfort and confidence.
There are many reasons why you might choose breast reconstruction:
- To regain your breast shape permanently
- To balance out the look of your breasts when you wear a swimsuit or bra
- To not need to wear an external prosthesis inside your bra
- To renew your confidence from implant reconstruction after radiation
According to clinical studies, Breast reconstruction doesnt cause your breast cancer to come back. If your cancer does come back, your reconstructed breasts shouldnt affect your radiation or chemotherapy treatment. Also, breast reconstruction after lumpectomy radiation is typically not a problem for most women.
Although this surgery might leave scars which may be visible when youre naked, over time they should fade. Scarring can be reduced through a number of newer techniques. Topical solutions can aid in reducing or eliminating the appearance of your scar while other gels and creams are also available on an over-the-counter or prescription basis. Some plastic surgeons offer scar treatments which can include but are not limited to surgical removal, cryotherapy, steroid injections and silicone sheets.
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How Do I Spot The Symptoms
It is important to know the symptoms of breast implant associated cancer. The most common symptom is swelling of a breast caused by fluid build-up around the implant, but in some cases it may appear as a lump in the breast or armpit.
As this is a rare disease, changes in your breast are unlikely to be breast implant associated cancer. For example, swelling immediately after your breast implant surgery is normal. But you should raise all concerns with your surgeon, including the possibility of breast implant associated cancer. If the surgeon or clinic which performed your original implant operation is no longer available, you should see your GP for referral to another surgeon.
Who Can Get Breast Implant Associated Cancer
All reported cases of breast implant associated cancer in Australia involve patients who have had a textured implant at some point in their life. Based on current evidence, experts do not think breast implant associated cancer is related to either the contents or shape of the implant.
Breast implant associated cancer is rare. The recent review by the TGA has found between one in 2,500 and one in 25,000 people with breast implants are diagnosed with the condition in Australia based on confirmed cases of BIA-ALCL where only one brand of implant had been used. The risk of developing BIA-ALCL increases with increasing texturing of the implant. Implants which have a smooth surfaced have not been associated with BIA-ALCL. Breast implant associated cancer can occur after either reconstruction or augmentation surgery, with 95% of cases occurring between three and 14 years after the insertion of an implant.
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Breast Reconstruction In A Private Hospital
You can choose to pay for treatment as a private patient even if you don’t have private health insurance. If you choose to have breast reconstruction surgery through the private health system, there can be considerable out-of-pocket expenses, even if you have a high level of private health insurance. Some women have told us that their out-of-pocket expenses have reached up to $15,000, while others report much less.
“I had private health insurance, but having said that, we were still out of pocket by more than $12,000.” — Lyn
Its important to ask your surgeon for a written quote before committing to any surgery. Some specialists are willing to negotiate their fees if you ask them. If you are not happy with the quote you receive, you can ask your GP or surgeon for a referral to another surgeon.
If you have private health insurance, you may like to ask your fund what is covered by your insurance and what the gap will be between how much you are charged and how much is paid by your fund. There can be a substantial gap between the cost of surgery and the amount you receive from your insurance fund that is not covered by Medicare. You can also ask your fund for the names of any plastic or reconstructive surgeons who have entered into gap cover agreements with them. If your surgery is provided by a surgeon who has a gap agreement with your fund, the surgeon will charge your health fund directly and there should be no out-of-pocket cost to you.
Its Covered By Insurance
Health care costs are often a primary concern for patients facing any surgical procedure. For breast reconstruction after breast cancer, it doesnt have to be. Federal law requires that breast reconstruction, in addition to other post-mastectomy benefits, be covered by medical insurance.
Reconstructive Surgery After Breast Cancer
This type of surgery requires not just a skilled and experienced surgeon but also a team of doctors and nurses who treat breast cancer. Johns Hopkins plastic and reconstructive surgeons specialize in complex breast reconstruction procedures and have successfully completed reconstructions for hundreds of women, restoring their self-image after cancer treatment.
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