Surviving the Carnage

I SURVIVED BREAST CANCER. WHAT NOW? 

After Breast Cancer Surgery

Subsequent to the surgery, you should report any changes in the breast area operated on or in your other breast to the doctor. Tell your doctor about any health problems, such as pain, loss of appetite or weight, changes in menstrual cycles, unusual vaginal bleeding, or blurred vision. Other chronic changes that should be reported are breathing and digestive problems. Such problems may arise months or years after treatment. It is of the utmost importance to share your concerns with your doctor so that problems can be diagnosed and treated as soon as possible.

It is important to go for regular check-ups with your doctor after the surgery. Check-ups will usually include an examination of the neck, underarm, chest, and breast areas. Breast self-examination (BSE) and clinical breast examination (CBE) should be routinely performed after all types of breast cancer surgery. 

Regular mammograms are also indicated to detect the re-emergence of cancer in either breast. The guidelines for mammography and imaging of the breasts after breast cancer surgery varies according to the type of surgery performed. Usually, screening mammography is continued on the unaffected breast on a yearly basis (or at an interval recommended by your physician). Annual mammograms of the unaffected breast are very important, since women who have had cancer in one breast are at higher risk of developing a new cancer of the other breast.

Regaining Your Bosom

1. Breast prosthesis

Breast prosthesis is an artificial breast that can be worn after the breast has been surgically removed. There are several different types of prostheses. Most are weighted so that they feel the same as the remaining breast (if only one breast has been removed). Some adhere directly to the chest area while others are made to fit into pockets of post-mastectomy bras. If a woman chooses to wear a breast prosthesis that does not adhere directly to the skin, she will need to wear a special post-mastectomy bra with pockets for the breast form.

Different types of prostheses may also have different features, such as a mock nipple or special shape. In many cases, a woman will be fitted for prosthesis so that it can be custom-made for her body. Partial prostheses, called equalizers or enhancers, are also available for women who have had part of their breasts removed.

•   Silicone Breast Prostheses

Silicone breast prostheses comes the closest to imitating breast tissue in weight and drape. A good prosthesis will also have some movement similar to your real breast. Although the weight of this kind of prosthesis can prevent shoulder muscle aches, it can also feel heavy or leave you feeling hot if you're outdoors a lot or participating in sports. Silicone prostheses can be custom-made so that you can be perfectly symmetrical, though they are the most expensive.

•   Non-Silicone Breast Prostheses

Non-silicone breast prosthesis may be made of foam rubber, fiberfill or cotton. These are lighter in weight than silicone prostheses, and can be worn as soon as you would like after a mastectomy. If you are physically active, this kind of prosthesis may be for you. A non-silicone breast prosthesis doesn't have the weight and drape of a real breast, but it is cooler to wear and less expensive than silicone.

•   Partial Breast Prosthesis

If you feel unbalanced after a surgery which removes a part of one breast, you can use a small, partial breast prosthesis or "equalizer" to help fill out your bra on your surgery side. These are made of silicone, foam rubber, or fiberfill. Partial breast prosthesis can be tucked into your regular bra, or into the pocket of a mastectomy bra.

•   Attachable (Contact) Breast Prosthesis

An attachable prosthesis does not require you to wear a post-mastectomy bra. These have prosthesis adhesive strips or Velcro tabs allow you to attach your prosthesis directly onto your body. This kind of prosthesis will move with you, and it can be worn with a regular bra.

•   Adhesive Nipples

Not everybody has nipple reconstruction after a mastectomy. So, there is a choice of adhesive nipples that you can use to complete your reconstructed breast. Latex nipples are held in place with fluid adhesive which are easy to remove and reusable. Silicone nipples come in different colours and don't require any "glue" to keep them in position. Either kind of nipple can be custom-made to match your own.

Before you begin wearing your prosthesis, physician will usually recommend that you wear a camisole (sleeveless undergarment made of soft material) with a non-weighted breast prosthesis first after your surgery until the surgical site is completely healed. This typically takes between four to eight weeks but may be longer or shorter depending on the individual situation. After the chest area has healed, a woman may be fitted for a weighted external breast prosthesis.

There are many advantages and disadvantages to wearing breast prostheses. Breast prostheses confer the following benefits:

• Balance and normalize your appearance. 
• Protect your chest area and surgical scar.
• Prevent your bra from moving around.
• Balance the weight on your shoulders and preventing back or neck pain and sagging shoulders

Some women find that their prosthesis feels heavy at first since they are not used to wearing it. However, in time, most women feel comfortable with their prosthesis.

You may be thinking, “How much does these all cost?” The prices of prostheses vary significantly and a higher priced prosthesis may not be the most comfortable one for you. The following are approximate prices of breast prostheses and post-mastectomy bras in the United States.

Product Type	Price Range
Silicone Prostheses Non-Silicone Prostheses Equalizers and Enhancers Post-Reconstructive/Surgical Bras Post-Surgical Camisoles Post-Mastectomy Bras	$180-$400 $30-$80 $80-$200 $30-$50 $65-$80 $36-$60

2. Breast Reconstruction


Several types of operations can be done to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. A tissue flap is a section of your own skin, fat, and muscle which is moved from your tummy, back, or other area of your body to the chest area.

• Implant procedures

The most common implant is a saline-filled implant. It is a silicone shell filled with salt water (sterile saline). Silicone gel-filled implants are another option for breast reconstruction. They are not used as often as they were in the past because of concerns that silicone leakage might cause immune system diseases.

There are some important factors for you to keep in mind if you are thinking about having implants:

·        Implants may not last a lifetime. You may need more surgery to replace them later.

·        You can have problems with breast implants. They can break (rupture) or cause infection or pain. Scar tissue may form around the implant (capsular contracture), or you may not like the way the implant looks. 

·        Tissue flap procedures

These procedures use tissue from your tummy, back, thighs, or buttocks to rebuild the breast. The two most common types of tissue flap surgeries are the TRAM flap (transverse rectus abdominis muscle flap), which uses tissue from the tummy area, and the latissimus dorsi flap, which uses tissue from the upper back.

These operations leave two surgical sites and scars, one where the tissue was taken and one on the reconstructed breast. The scars fade over time, but they will never go away completely. There can also be problems at the donor sites, such as abdominal hernias and muscle damage or weakness. There can also be differences in the size and shape of the breasts. Because healthy blood vessels are needed for the tissue's blood supply, flap procedures are not usually offered to women with diabetes, connective tissue or vascular disease, or to smokers.

In general, flap procedures behave more like the rest of your body tissue. For instance, they may enlarge or shrink as you gain or lose weight. There is also no worry about replacement or rupture. 

o   TRAM (transverse rectus abdominis muscle) flap

o   Latissimus dorsi flap

o      Gluteal free flap

The gluteal free flap or SGAP (superior gluteal artery perforator) flap is a newer type of surgery that uses tissue from the buttocks, including the gluteal muscle, to create the breast shape. It is an option for women who cannot or do not wish to use the tummy sites due to thinness, incisions, failed tummy flap, or other reasons. The method is much like the free TRAM flap. The skin, fat, blood vessels, and muscle are cut out of the buttocks and then moved to the chest area. A microscope (microsurgery) is needed to connect the tiny vessels.