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Breast Cancer & Breast Reconstruction

In the month of October, we celebrate Breast Cancer awareness. We also pay tribute to the brave women and men who have been, or currently suffering from breast cancer. Breast cancer remains the most common form of cancer in South African women of all races. According to the National Cancer Registry, women have a lifetime risk of 1 in 25 to develop breast cancer.

What are the risk factors for breast cancer?

  • Being female
  • Increasing age (especially women older than 50 years of age)
  • A personal history of breast conditions
  • A personal history of breast cancer
  • A family history of breast cancer
  • Inherited genes that increase cancer risk i.e BRCA genes
  • Radiation exposure to your chest
  • Obesity
  • Beginning your period at a younger age
  • Beginning menopause at an older age
  • Having your first child at an older age (> 30 years)
  • Having never been pregnant
  • Postmenopausal hormone therapy i.e Estrogen treatment
  • Smoking and drinking alcohol

How do breast cancer present?

Most of the times as a lump or thickening of the breast.

But it can also present in the following ways:

  • Change in the size, shape or appearance of a breast
  • Changes to the skin over the breast, such as dimpling
  • A newly pulled in nipple
  • Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  • Redness or pitting of the skin over your breast, like the skin of an orange
  • Bloody or discloured nipple discharge

How can I prevent or reduce my risk for breast cancer?

  • Ask your doctor about breast cancer and when to begin breast cancer screening, for example self-breast examination and imaging like a mammogram or ultrasound
  • Become familiar with your own breasts through self-breast examination at least once a month.
  • Drink alcohol in moderation
  • Maintain a healthy weight and exercise
  • Choose a healthy diet
  • Limit postmenopausal hormone therapy

When do I see a doctor?

If you find a lump or change in your breast – even if your mammogram was reported as normal.

How do you diagnose breast cancer?

  • Breast examination by your GP, Gynaecologist or Specialist Breast Surgeon
  • Mammogram: Special xray of the breast
  • Ultrasound: Especially in younger women with denser breast tissue
  • Removing a sample of breast cells, better known as a biopsy
  • Breast MRI: In cases where the mammogram or ultrasound is inconclusive or when you have breast implants

What do I do if my doctor suspects or confirms that I have breast cancer?

You must be referred to a Multidisciplinary Breast Unit consisting of the following specialists:

  1. Specialist Oncological Surgeon – usually a General surgeon specialized in breast cancer treatment
  2. Specialist Reconstructive Surgeon – usually a Plastic Surgeon specialized in breast reconstruction
  3. Oncologist – specialized in adjuvant breast cancer management i.e. radiation & chemotherapy
  4. Radiologist – specialized in breast cancer imaging
  5. Geneticist – specialized in inherited cancer genetics
  6. Therapist – specialized in post-surgical scar management and lymphedema treatment
  7. Dietician – specialized in providing and maintaining a healthy lifestyle and diet

What treatment options are there for breast cancer?

Surgery remains the mainstay of treatment. Depending on the size, location and type of breast cancer, as well as the patient’s age and health status, either a mastectomy (removal of the entire breast tissue) or a lumpectomy (removal of the tumour only) will be required. This can include removal of the lymph glands in the axilla as well. Depending on the characteristics of the breast cancer, a nipple-sparing or skin skin-sparing mastectomy can be performed, providing a more suitable tissue envelope for breast reconstruction. Prior or after your surgical treatment, adjuvant therapy might also be required in the form of radiation or chemotherapy. Your treatment plan will be individualized by your Breast Unit.

Can I have breast reconstruction after breast cancer surgery?

Breast reconstruction can be offered to all women undergoing breast cancer surgery, unless the cancer is extensive or the patient’s health status is not optimal for additional surgery.

Breast reconstruction can either be done at the time of the cancer surgery (immediate) or at a later stage (delayed). Both immediate and delayed forms of reconstruction has been shown to be safe.

What type of breast reconstruction options are there?

Breast reconstruction can either be implant-based, autologous (your own) tissue or a combination thereof.

Implant-based reconstruction is the placement of a permanent implant (mostly silicone) or the temporary placement of a saline implant (tissue expander) that can expand the skin envelope, followed by a permanent silicone implant. Advantages of implant-based reconstruction are: Shorter duration of surgery, less downtime and length of hospital stay, less scaring and additional donor site problems. Disadvantages include possible implant related complications like malposition and capsule formation and the need for additional surgery to replace or exchange the implants at a later stage.

Autologous reconstruction is the transfer of your own tissue from a donor site, like your abdomen, thighs or back to reconstruct your breast. Advantages included: more natural appearing and feeling breast, no implant related complications, will mature and act more as a normal breast. Disadvantages include: Longer duration of surgery, longer hospital stay, additional donor sites and wounds and possible autologous tissue loss due to blood flow problems.

Combination procedures is the use of both implants and autologous tissue to reconstruct a breast. An example of this procedure would be to have a permanent implant placed at the time of the cancer surgery followed by fat grafting or lipofilling to correct the contour and add volume. The fat used for lipofilling will be harvested from your abdomen or thighs by liposuction.

Your reconstructive surgeon will guide you in deciding on the best reconstruction procedure for you.

Will breast reconstruction influence my future breast cancer screening or follow-up?

Not at all. You must continue with your annual follow-up examinations and imaging like a mammogram or ultrasound. In cases where imaging with either mammogram or ultrasound are inconclusive or difficult, a MRI will be required.

Is breast cancer curable?

Yes, especially if breast cancer is diagnosed at an early stage. Women with breast cancer of all stages, have a 90% chance of 5-year survival when seeking treatment. Therefore prevention, screening, early detection and treatment by a multidisciplinary Breast Unit is paramount.

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