Breast Reconstruction - Implants & Nipple/Areola Tattoos

The Women's Health & Cancer Rights Act of 1998 says that if an insurance plan or coverage provides medical and surgical benefits for a mastectomy, then it must also include coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance, the prostheses (or breast implant), and any physical complications at all stages of mastectomy, including lymphedema.

After a mastectomy, many women choose to get breast implants. They help restore the psychological sense of being female as well as help clothing fit better, especially items that are fitted. Implants come in different diameters. Choose the diameter that fits your skeleton best. Implants come in different sizes, similar to cup sizes, but they are labeled according to how much fluid they can hold. The plastic surgeon should have some samples to see.

One type of implant is a saline implant. It has a clear silicone shell that looks like a balloon and is filled with a sterile saline solution (salt water).

Silicone implants are the other option. For several years they were off the market because of public concerns that the silicone gel inside might leak and cause immune system problems. Subsequent studies have shown that silicone gel implants do not increase the risk of immune system problems and so they are once again available.

There are two approaches to breast reconstruction:

1. One-Stage breast reconstruction can be done right after the mastectomy when the skin is preserved. After the surgeon removes the breast tissue, a plastic surgeon steps in and places the implant where the breast tissue used to be.


2. In Two-Stage reconstruction, the skin and chest wall are tight and flat after the mastectomy. First, a deflated "tissue expander" is put into place. Think of it as a temporary implant. It's job is to slowly stretch the skin, making it ready to receive the permanent implant. The expander has a tiny valve that the surgeon injects a little bit of saline solution into during several visits over time. Once the skin over the breast area has stretched enough, there is a second surgery to remove the expander and put in the permanent implant. Some expanders can be left in place as the final implant. Two-Stage reconstruction also allows for the option of waiting until after radiation treatment to begin reconstruction.

Things you should know about implants:

• Implants may not last a lifetime. They usually come with a "warranty" for a certain number of years but might need replacing in the future. That means surgery again.


• There might be complications from any surgery such as scarring, pain and infection.


• Contact sports and activities are no longer allowed because a blow to the chest can cause a break or leak to the implant.


• Capsular contracture (hard scar tissue around the implant) might occur. The plastic surgeon will show the patient massage techniques to counteract this during the healing process but it's not a 100% guarantee. Only a few people have this problem.


• The end result might not be the "beautiful breasts" that one dreams of. It's a reconstruction, not a recreation.

A word about nipples- believe it or not, new nipples/areolas can be tattooed on. Yes, the surgeon can do this! There is a little bit of post-operative care but it's easy.

Christina Applegate and Breast Cancer

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In 2008, the 36-year old actress and already established breast cancer advocate, Christina Applegate found herself being diagnosed with breast cancer with a very important decision to make. Her cancer was found during a routine breast MRI that's able to find cancer cells earlier than mammograms can.

Her mother, singer Nancy Priddy, fought breast cancer twice and carries the BRCA1 breast cancer gene. Christina chose a double mastectomy even though her cancer was found in only one breast because the statistics were against her. Luckily, chemotherapy and radiation were not necessary.

Returning to work and future reconstructive surgery are in her future. She says she looks forward to have "great boobs" when she's in the "old folks home." By then, I don't think she'll be alone in that physical attribute!

Now Christina is focused not only on breast cancer awareness, but also to encourage early detection and help women get the tests they need and finances to pay for them.

Not all health insurers cover breast MRI's which can be quite expensive, so Applegate created the "Right Action for Women" organization aka the Christina Applegate Foundation. Its goal is to help women who have a higher risk for breast cancer receive and pay for breast MRI's. One of her fundraising efforts is to auction off ribbon roses, made from the ribbons of Christina's get-well-soon bouquets while she was in the hospital.

Applegate appeared on The Tonight Show, stating "If I can just save one person. That’s why I am doing this.”

"I'm going to face challenges, but you can't get any darker than where I've been," she said on Good Morning America. "So, just knowing that in my soul gave me the strength to just say, 'I've got to...I have to get out there and...and make this positive."

On the Oprah Winfrey Show, Applegate shared, "This is my opportunity now to go out and fight as hard as I can for early detection...there is this need and this desire to make every single day count...I used to say … 'Don't sweat the small stuff, not even the big stuff.' At the end of the day, none of it matters but your own joy, your own spiritual journey that you go on. God, your loved ones, your friends, your animals - these are the things you've got to cherish and love and embrace."

For more information of BRCA genes, click on http://breastcancerisabitch.blogspot.com/2008/12/genetic-hereditary-breast-ovarian.html#links

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GENETIC / HEREDITARY BREAST & OVARIAN CANCER

Every 1 in 9 people (men and women) will develop breast cancer at some point in their lifetime. This is about 200,000 people per year. Researchers and scientists suspect up to 25% of these cancers are hereditary mutations on our genes.

Scientists are naming these genes BRCA (BReast CAncer) with a number afterward. They have been nicknamed "broken genes." The BRCA1 gene was the first one to be discovered. It is on the 17th chromosome. A second one, BRCA2, was discovered on the 13th chromosome. Right now BRCA1 & 2 are suspected for causing about 0.2 percent of hereditary breast and ovarian cancers. They are the current "leaders" in cause by their share of percentage. Scientists feel upward of 25% of all breast cancers are genetic in some way and they are on the verge of identifying a BRCA3, also on the 13th chromosome.

If you have a "broken gene" you are not guarenteed to develop cancer. Your risk is just higher than that of the general popular so doing monthly self-exams, getting annual mammograms and clinical checkups are very important to catching it early, getting treatment right way, and perhaps saving your life. You can take medication which will cut your risk in half.

If you have parents, siblings or aunts/uncles with breast cancer then you are considered at "high" risk of having a genetic predisposition to breast cancer. If one of your parents has breast cancer, then your risk is 50/50. If you or your spouse has hereditary breast cancer or carry a broken gene, then each of your children have a 50/50 risk of developing it.

There is a simple (for you) blood test to see if you have the BRCA1 or BRCA2 gene mutation. Ashkenazi (Eastern European) Jews are 10 times more likely than the general population to have these two hereditary mutuations. If there is breast or ovarian cancer in your family tree, pressure your doctor to order the test. My insurance covered the cost (in full) which is good because it's several thousand dollars. My results were negative.

Don't rule out the men for developing breast cancer (1% of all breast cancers are men) or passing down a broken gene. Every year about 2000 men develop breast cancer and 450 will die from it. The famous "Shaft" actor Richard Roundtree has breast cancer. See this link for more on him: http://abcnews.go.com/Health/OnCallPlusBreastCancerNews/story?id=4028791. There is also a website for men and breast cancer. See http://www.menstuff.org/issues/byissue/breastcancer.html.

SOURCES:
National Institue of Health
National Human Genome Research Institute
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My Lumpectomy

The surgeon skipped doing a needle biopsy and went straight for a lumpectomy. I went to the hospital very early in the morning as an outpatient. The morning wait was long - one person had the operating room ahead of me and then there was an emergeny appendectomy. The doctor shook me to wake me to say it was cancer. I rolled onto my side, pulled my knees up in fetal position, and cried and cried. I don't remember thinking anything, no words. Just emotion. Later on I cried, thinking to myself my daughter is too young (10) for her mommy to die.

I would have to return in about a week to have the margins and lymph nodes checked. For now it's up to the lab to test the lump for the individual characteristics of my cancer.

My tumor was about 10mm. My scar is about 2 inches long.

Finding the Lump

I was just at the doctor for my yearly exam in November and do my self-checks several times a month. In April I scratched an itch and found a lump. I made an appointment with my doctor who ordered a mammogram and ultrasound and referred me to a surgeon and that set off the chain reaction that is now my life. One appointment, test, or surgery after another.