Oct 30, 2017

Double Mastectomies and Breast Reconstruction

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By: Chelsea Campbell

Breast cancer is one of the leading killers of women, and self-exams and frequent screenings are early cancer detection strategies that can save lives. Genetic screening to test for the presence of the “breast cancer gene”, BRCA, has become increasingly popular as a way to determine one’s predisposition to the disease.  For some women, preventative measures are paramount, with some even electing to get both breasts removed in order to cut their risks. How effective is this? Can the removal of healthy breasts save lives?

What is a Mastectomy?
When a lump or other sign of cancer is detected in a breast, a woman has several options for treatment. Some typical surgical options are a lumpectomy, which removes the lump, or a mastectomy, which is the removal of the entire breast. A mastectomy is usually resorted to when a lumpectomy would not be sufficient to prevent the spread of the disease. A double mastectomy is the removal of both breasts. Mastectomies can be total (also known as “simple”) by removal of the whole breast, or they can be nipple-sparing, whereby the breast tissue is removed, but the nipple is preserved.

Double Mastectomies Increase
Although mastectomies are an effective way to treat a cancerous breast, voluntary double mastectomies are becoming increasingly popular, increasing sixfold as evidenced by a study in 2011. Many women who have been diagnosed with cancer in one breast decide to have a double mastectomy in order to prevent any future instances of the disease in the other breast. On the other hand, some women who do not have cancer in either breast, but are carriers of the BRCA gene, are also opting to undergo a double mastectomy for preventative purposes.

Interestingly, the survival rate isn’t actually any higher for women who have mastectomies versus lumpectomies. And as far as removing both breasts when cancer is only present in one,  “A March 2016 study by researchers at the Duke Cancer Institute looked at about 4,000 women who had breast-cancer surgery and found that removing both breasts did not markedly improve a woman's quality of life,” says Time magazine.

So what is influencing this surge in invasive treatments? The study says that it’s largely due to the recommendation of doctors. A study published in JAMA Surgery found that doctors are more likely to recommend double mastectomies for patients’ peace of mind, and not necessarily to boost survival or to reduce the chance of cancer recurrence. Most doctors do discourage voluntary removal of breasts, also known as contralateral prophylactic mastectomy, or CPM, for women who are at average risk of cancer. But for those who are carriers of the BRCA gene, it may be a lifesaving option, and more and more doctors are putting this choice on the table for their patients.

While a double mastectomy is an invasive treatment, it is very often the most successful way to prevent the spread of breast cancer and can be a viable option for BRCA carriers. If a double mastectomy is what you have chosen to undergo, you may be interested in breast reconstruction to rebuild the shape and appearance of the breast. After undergoing a serious surgery like a mastectomy, some women may want to avoid unnecessary operations, especially while recovering from cancer.

Others want to enjoy wearing bathing suits or their favorite clothing styles with confidence. While no woman should feel pressured to reconstruct her breasts after a mastectomy, it may help boost self-confidence. It is a highly personal choice.

There are two main options for reconstruction of breast shape: breast implants or using fat grafting or your own body tissue (known as a tissue flap procedure). Many patients also get nipple and areola tattooing in order to help make the reconstructed breast look more realistic.

If you opt to have reconstructive surgery, make sure you ask the appropriate questions during the consultation with your surgeon. Breast reconstruction usually entails more than one operation. Knowing how much pain and discomfort will be involved, the recovery time, risks involved, costs, and what is involved for follow-up can help you make an informed decision about whether this type of surgery is right for you.

Double mastectomies can undoubtedly be life-savers, but this cancer treatment is a major decision and should be discussed at length with your doctor. Make sure that you feel comfortable and confident with your doctor’s recommendation and that you are given a variety of options for the treatment or prevention of breast cancer based on your individual circumstances.

Keywords: breast cancer, mastectomy, double mastectomy, lumpectomy, reconstructive surgery, breast reconstruction, tissue flap, breast implants, breast cancer prevention, BRCA gene

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