Vacuum Assisted Excision Biopsy
You may be offered a vacuum assisted excision biopsy to remove the intraductal papilloma.
After an injection of local anaesthetic, a small cut is made in the skin. A hollow probe connected to a vacuum device is placed through this. Using a mammogram or ultrasound as a guide, breast tissue is sucked through the probe by the vacuum into a collecting chamber. The biopsy device is used until the area being investigated has all been removed. This may mean that an operation under a general anaesthetic can be avoided. The tissue removed is sent to a laboratory to be examined under a microscope.
This procedure can cause some bruising and pain for a few days afterwards.
Which Women Might Consider Having Surgery To Reduce Their Risk Of Breast Cancer
Women who inherit a deleterious mutation in the BRCA1 gene or the BRCA2 gene or mutations in certain other genes that greatly increase the risk of developing breast cancer may consider having bilateral prophylactic mastectomy and/or bilateral prophylactic salpingo-oophorectomy to reduce this risk.
In two studies, the estimated risks of developing breast cancer by age 70 years were 55 to 65 percent for women who carry a deleterious mutation in the BRCA1 gene and 45 to 47 percent for women who carry a deleterious mutation in the BRCA2 gene . Estimates of the lifetime risk of breast cancer for women with Cowden syndrome, which is caused by certain mutations in the PTEN gene, range from 25 to 50 percent or higher , and for women with Li-Fraumeni syndrome, which is caused by certain mutations in the TP53 gene, from 49 to 60 percent .
Other women who are at very high risk of breast cancer may also consider bilateral prophylactic mastectomy, including:
- those with a strong family history of breast cancer
- those with lobular carcinoma in situ plus a family history of breast cancer
- those who have had radiation therapy to the chest before the age of 30 yearsâfor example, if they were treated with radiation therapy for Hodgkin lymphoma
Reconstruction Using An Implant
Implant breast reconstruction involves restoring the shape and volume of the breast using a breast implant. Breasts reconstructed in this way tend to be close to a natural breast shape, but are firmer and move less naturally than those using your own tissue. This can mean its more difficult to get a natural shape when one breast, rather than both, is being reconstructed.
The reconstructed breast will not droop with age and may look higher than the other breast, particularly as you get older. If you lose or gain weight, this will affect the natural breast but not the reconstructed breast, causing a difference in shape and size. At some point you may need more surgery to the reconstructed breast, or to the other breast, for a better match.
Implant reconstruction is often recommended for women with small and firm breasts, as it avoids the need for more extensive surgery using tissue from another part of the body.
With any type of reconstruction there is a risk of infection or other problems. If this happens with implant reconstruction, the implant may need to be removed.
There is no set lifespan for a breast implant but it will usually need to be replaced at some point and further surgery will be required at this stage.
This film shows techniques that use a breast implant and those that use your body tissue to reconstruct the breast including the LD flap where tissue is taken from your back.
Immediate reconstruction using an implant
Delayed reconstruction using an implant
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What Is A Preventive Mastectomy
Women who have a high risk of breast cancer may choose to have a preventive mastectomy, also called prophylactic mastectomy.
Studies show that women with a high risk of breast cancer may be as much as 90% less likely to get the disease after preventive mastectomy.
Usually, doctors recommend a total mastectomy. In some cases, women have both breasts removed. This is called a double mastectomy.
Some women who’ve had breast cancer in one breast will have the other one removed to lower the chance of cancer coming back .
If you plan to have breast reconstruction, it can be done at the time of the preventive mastectomy or later on . During breast reconstruction, the surgeon may use synthetic implants or tissue flaps from another part of your body to create a breast.
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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What Factors Can Affect The Choice Of Breast Reconstruction Method
Several factors can influence the type of reconstructive surgery a woman chooses. These include the size and shape of the breast that is being rebuilt, the womans age and health, her history of past surgeries, surgical risk factors , the availability of autologous tissue, and the location of the tumor in the breast . Women who have had past abdominal surgery may not be candidates for an abdominally based flap reconstruction.
Each type of reconstruction has factors that a woman should think about before making a decision. Some of the more common considerations are listed below.
Reconstruction with Implants
- Enough skin and muscle must remain after mastectomy to cover the implant
- Shorter surgical procedure than for reconstruction with autologous tissue little blood loss
- Recovery period may be shorter than with autologous reconstruction
- Many follow-up visits may be needed to inflate the expander and insert the implant
For Women At Very High Risk Of Breast Cancer
For women in this group, removing both breasts before cancer is diagnosed can greatly reduce the risk of getting breast cancer.
Unfortunately theres no way to know for sure ahead of time if a woman will benefit from this surgery. For example, most women with a BRCA1 or BRCA2 gene mutation will develop breast cancer at some point. Having a prophylactic mastectomy before the cancer occurs might add many years to their lives. But not all women with BRCA1 or BRCA2 mutations develop breast cancer. For some women the surgery might not have been helpful. Although they might still get some important benefits from the surgery such as peace of mind, they would also have to deal with its aftereffects.
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Going Home After A Mastectomy
Be sure and arrange for someone to drive you home from hospital the day you are discharged.
We will advise you on suitable bras and inserts if you have not had reconstruction surgery. Be sure and clarify when you can begin to wear these before you leave hospital.
It can take a few weeks to recover from this surgery. You should allow yourself time to rest and recover. Rest when you are tired – fatigue is very common following a mastectomy.
Continue taking any pain medication as prescribed by your surgeon. You should not bathe or shower until any drains are removed. Take sponge baths until you are released to bathe normally.
Your stitches may be self dissolving or you may need to return to have them removed. You will receive instructions on caring for your scar.
Continue your gentle exercises to avoid stiffness. You should avoid any strenuous activity or chores until released by your surgeon. Be sure and discuss any return to work issues with your surgeon.
Most people recover from mastectomy with little or no complications. As in any surgery there may be complications:
- Numbness of the surgical area
- Tenderness of the surgical area
- Fluid collection under the scar
- Delayed healing of the surgical wound
Mastectomy With Breast Prosthesis
If you dont want to have breast reconstruction, you can get a breast prosthesis. This is a breast form made of silicone gel, foam or other materials thats fitted to your chest.
The form is placed directly on top of your skin or in the pocket of a special bra.
The surgeon will leave the area as flat as possible so the prosthesis can be comfortably fitted to your chest.
Your prosthesis can be properly fitted several weeks after your mastectomy surgery.
Your health care provider can discuss breast prosthesis options with you and help you choose the type that best fits your lifestyle.
If you have concerns about airline security screening, visit the TSA website.
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When Is A Mastectomy Recommended
A mastectomy may be recommended if:
- a few cancers are found in different parts of the breast
- the cancer is large
- the patient has a preference for it
- there are extensive suspicious findings on mammography
- there is an inability to obtain clear or negative margins of lumpectomy
- the patient is unable to have radiotherapy
Some women at high risk of breast cancer choose to have a mastectomy even when there’s no sign of cancer.
Breast Cancer And The Covid Vaccine: What You Need To Know
- Breast Cancer and the COVID Vaccine: What you Need to Know
Women who are being treated for breast cancer, were recently treated, or have survived the disease, should get the COVID vaccine as soon they can, according to Carla Falkson, M.D., leader of the breast cancer service line at the Wilmot Cancer Institute.
I cant emphasize enough that if we can build herd immunity, the coronavirus wont be able to divide and produce variants, Falkson said. I really believe we should all get the vaccine. Your close contacts, household members, anyone you interact with regularly, should also be vaccinated. We need to protect each other.
Falkson spoke to an audience of more than 200 people at a virtual community event organized by the Breast Cancer Coalition of Rochester on Feb. 24, 2021.
Here are the key messages she delivered about the COVID vaccine and breast cancer with a few caveats and explanations:
- The Pfizer and Moderna vaccines, which use mRNA technology, are definitely safe for our cancer patients, and are also safe while they are receiving chemotherapy, she said. Both vaccines have been approved by the U.S. Food and Drug Administration , and are available in New York state.
- Will the COVID vaccine interact with, or interfere with, hormonal therapies commonly prescribed for breast cancer, such as aromatase inhibitors? No. The vaccine is appropriate for these women.
- What about radiation therapy? Its okay to get the vaccine while receiving this treatment.
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What Is A Modified Radical Mastectomy
A less traumatic and more common procedure is the modified radical mastectomy . The doctor removes your breast, including the skin, breast tissue, areola, and nipple, and most of the lymph nodes under the arm. The lining over the large muscle in the chest is also removed, but the muscle itself is left in place. This way, you arenât left with a hollow area in your chest as with a radical mastectomy.
You might get breast reconstruction afterward.
Depending on the size of your tumor and whether the cancer has spread to your lymph nodes, your doctor might recommend that you have radiation after your surgery.
Getting Tattoo Ideas And Inspiration
If you would like some inspiration for a tattoo design you can read our blog Eight inspiring mastectomy tattoos. The US charity P-ink.org has a gallery of images that may give you some ideas.
You could also have a look at our online Forum and see if anyone has had a tattoo and where they had it done, or start your own thread.
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What Are The Risks Of Getting A Tattoo
For anyone getting a tattoo the biggest risk is from dirty needles that can spread diseases such as HIV and hepatitis. Tattoo artists should always use sterile equipment and fresh needles.
Other risks include:
- Infection see below
- Allergy to pigment this is very rare but some studios do offer a patch test before a tattoo
- its possible to get tattoos removed but its expensive and can be very painful. Theres also no guarantee that a tattoo can be completely removed.
- The colour fading the pigment will naturally fade over time. To reduce initial fading avoid swimming, sunbathing, using a sunbed or doing exercise that makes you sweat for two weeks after having a tattoo. You can use a high factor sunscreen on your tattoo to help reduce fading
The tattooed area will be swollen, red and may itch but this should go away over time. You may also have some bruising to the area.
If any redness or swelling doesnt go away and you develop a high temperature or feel feverish you may have an infection. If you think you have an infection contact your GP, nearest urgent care centre or A& E as soon as possible as you may need antibiotics.
What Can Women At Very High Risk Do If They Do Not Want To Undergo Risk
Some women who are at very high risk of breast cancer may undergo more frequent breast cancer screening . For example, they may have yearly mammograms and yearly magnetic resonance imaging screeningâwith these tests staggered so that the breasts are imaged every 6 monthsâas well as clinical breast examinations performed regularly by a health care professional . Enhanced screening may increase the chance of detecting breast cancer at an early stage, when it may have a better chance of being treated successfully.
Women who carry mutations in some genes that increase their risk of breast cancer may be more likely to develop radiation-associated breast cancer than the general population because those genes are involved in the repair of DNA breaks, which can be caused by exposure to radiation. Women who are at high risk of breast cancer should ask their health care provider about the risks of diagnostic tests that involve radiation . Ongoing clinical trials are examining various aspects of enhanced screening for women who are at high risk of breast cancer.
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Does Mastectomy Cure Breast Cancer
A mastectomy is usually one part of a breast cancer treatment plan. Your plan may also include chemotherapy, radiation therapy and/or hormone therapy.
Once youve beaten breast cancer, it usually doesnt return. But occasionally it does come back, even if youve had your breasts removed. There are many factors that can increase your risk of cancer returning, including whether the cancer has spread to your underarm lymph nodes. Talk to your healthcare provider about your risks.
Mastectomy With Breast Reconstruction
Some women choose to have breast reconstruction to help restore the look of the breast that was removed.
Reconstruction may be done at the same time as the mastectomy or later . In general, cosmetic results are better with immediate reconstruction.
Discuss your reconstruction options with your plastic surgeon before breast surgery.
Not all women choose to have reconstructive surgery. Some women choose to get a breast prosthesis. Others choose to go flat, with no reconstruction or prostheses.
Read our blog, Despite What Doctors Told Me, Ive Never Regretted My Decision to Go Flat After a Double Mastectomy.
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What Is A Mastectomy Tattoo
Some people consider having a decorative tattoo on their breast or chest after breast cancer surgery. This is sometimes referred to as a ‘mastectomy tattoo’, but could be after breast-conserving surgery, a mastectomy or breast reconstruction.
An example of a mastectomy tattoo
Decorative tattoos are different to nipple and areola tattooing which are usually carried out by a doctor or nurse who has had specialist training.
Surgeons Excited At The Prospect Of New Treatment Option
Sheldon Feldman, chief of breast surgery at Montefiore Health System, who is involved in the NCI trial said that now that drug treatments have become more advanced, “medical therapy works better the role of surgery is less and less.”
Kuerer hopes the trials will prove that going surgery-free is an option for some women with breast cancer. “I would be ecstatic if all of us would be put out of business,” he said.
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Outcomes Of Breast Cancer In Patients Who Use Alternative Therapies As Primary Treatment
This was a medical chart review by Chang et al, published in the American Journal of Surgery in 2006. It examined breast cancer patients who refused conventional chemotherapy, or delay its initiation, in order to use CAM. The authors calculated each patients prognosis at the time of diagnosis. In total, 33 women were included. The results were grim:
- Eleven patients initially refused surgery. Ten of these patients experienced progressive disease. Five ultimately had surgery. In the six others, the cancer had already metastasized, so surgery would have offered no benefit.
- Three patients refused to allow sampling of lymph nodes to evaluate disease spread. One of these patients developed recurrent disease in the lymph nodes.
- Ten patients refused local control of the tumor site. Two patients developed recurrences in the same location, and two developed metastatic disease.
- Nine patients refused chemotherapy, raising their estimated 10-year mortality from 17% to 25%
Consistent with the study above, the vast majority of breast cancer patients who refuse surgical intervention developed progressive disease. Even delaying surgery increased risks and overall mortality. Outcomes were better for patients that accepted surgery, but refused adjuvant treatments, like chemotherapy. However, even this strategy significantly raised 10-year mortality estimates.