Thoughts on Keeping Your Breast

I know that many women choose to have a mastectomy as they were originally performed, and I would never argue with a woman's choice to just have the breast taken off and be done with it. Everyone's situation and attitude is unique. The majority prefer to keep their breast and carry on with some semblance of their former bodies. We should never be ashamed to go after what we want when it comes to such a personal part of our bodies. I know I felt a little guilty at paying so much attention to the 'reconstructive' part of the cancer that I was dealing with. But I had the luxury of doing this because my cancer was early, and getting rid of it was a given from the very beginning. I suppose I would have been far more concerned about just surviving, were my cancer more advanced. So I am grateful that I could concentrate on keeping as much of the normalcy to my breast as I could.

There are many personal reasons for a woman to choose to just have the breast removed. Many women are older and really don't care whether they have a breast anymore. Perhaps they are widowed or divorced and plan to be alone for the foreseeable future. Others may feel strongly on principle that it shouldn't matter if one has a breast or not, and they want to accept what life has brought them. I respect those decisions, and the thoughts below are not intended for those ladies.

However, I know there are some out there who may be debating about whether to have reconstructive surgery, and they are considering avoiding it because they don't want to face the many difficulties involved, and for no other reason.  I have an approach to decision-making that may help those ladies.

Here it is:

I try never to use short-term criteria to make a long-term decision.

The difficulties are there, for sure, and they are many -- no way to sugar-coat that. But all of the pain and suffering you will experience is short-term, and you will come out the other side pretty quickly all-in-all. Now, over a year later, I hardly remember the hard parts. And when it's over you have a breast that behaves pretty normally -- it fits into a bra or swimsuit, it looks natural in clothes, it feels more or less as it did before, although pretty numb, at least for a while. So, I guess I am saying that some short-term discomfort will result in a long-term outcome that you may find easier to live with. I can't promise that you will be entirely happy with the results (I haven't been) but it may be preferable to not having your breast at all. Only you can decide that.

And certainly, if you have a man in your life, consider how he feels. Most supportive husbands and significant others will, of course, say that it is up to you and they will love you no matter what. Nevertheless, they are human, and it may be difficult for them to face a major change to your body, if you choose to go without your breast. It may be impossible to get this brutally honest information out of them, but only the most angelic man would not be affected at all by this. Take their human-ness into account in your decision, and consider how it might impact your romantic life -- whether it be his reaction to the New You, or your self-consciousness about the big change, regardless of how supportive he is to you as you make your decision.

When making your decision, remember that choosing to give up your breast entirely may mean some long-term issues, especially if you are going to want to look as you did before in clothing. Prosthetics are available, but they do have their issues, so you may want to talk to someone who has chosen to use them, and get their input. The medical center where you get your cancer care may be able to help put you in touch with someone. Most have wonderful support departments. Going without prosthetics has its own considerations that must be addressed.

And you should give some thought to how you will feel seeing yourself without a breast for a long time after surgery. Yes, you can always choose to have reconstructive surgery later, although keep in mind that this means another entire surgery, and the skin will have to patched at that time -- only with immediate reconstruction can you generally keep all the skin.

You may sense that I am encouraging you to keep your breast, and I guess I am, if you are not otherwise philosophically opposed to keeping it for any reason. I hope my remarks do not offend anyone. I know there are many, many ways of living life and making these kinds of difficult decisions, and no one can truly walk in the shoes of another.

Thoughts on Keeping Your Nipple

If you are newly-diagnosed with breast cancer, and this post is one of your first reads on the subject of reconstruction, you may be surprised to know that keeping the nipple is not standard in breast reconstruction. I know I was shocked to learn that the nipple has always been removed as a matter of course, even with a 'skin-sparing' mastectomy. I had always imagined that the breast would just be scooped out like a melon, and new 'filling', whatever it may be, put in. Learning that I would probably lose my nipple came as devastating news to me, I don't mind saying. That was the point at which I became pretty depressed about my situation.

Indeed, for many of us who face mastectomy, losing the nipple seems to be the most disfiguring part of the surgery. This fact is finally starting to percolate among surgeons who have been taking a harder look at the true risks associated with keeping the nipple. For a long time since breast conservation surgery became standard, it was thought that the nipple area would always be at higher risk for harboring cancer cells, since all the ducts in the breast lead to the nipple. But as surgeons actually began listening to their patients who wanted to keep their nipple, they looked harder at the data to see if this was really true, and it was found that for most women who don't have cancer near the nipple, or Paget's disease, the nipple could often be kept with little risk of cancer recurrence in that area. Some surgeons, in fact, completely hollow out the nipple area, leaving a hollow cone that can be refilled with other tissue.

Many surgeons are learning just how much keeping the nipple improves the quality of life for a woman, and may greatly improve her morale post-op, especially if she ends up facing an ongoing battle with cancer . Sometimes the small things really do matter. I remember sitting in one reconstructive surgeon's office and he said to me, "Mastectomy is such a harsh term. We prefer to say, "Gland Replacement Therapy". I appreciated that statement, because when all of the breast skin, including the nipple, is kept, then it really is just a matter of replacing the mammary tissue and fat in the breast with something else. You still have your breast, although there may be little to no feeling. This is, indeed, a far cry from classic mastectomy, where a woman is left with no breast, and only a scar running across the flattened area. As far as I'm concerned, anything that brings one closer to having the breast they used to (or in some cases an even better breast) is a blessing!

Nipple sparing mastectomy (NSM) is newer, but it is slowly becoming the gold standard for reconstructive care, and will continue to be. More and more practices around the country are offering this option, so seek them out. Below is a short list of those bigger names that offer NSM. There is certainly nothing to lose if your surgeon feels you are a candidate, and the worst that will happen is what happened to me -- the nipple will not do well, and you'll end up having some reconstruction. Personally, I comfort myself, knowing that I tried.

A simple search for any of these names, along with the terms 'nipple sparing' will probably take you where you need to go.

Cleveland Clinic (I believe the procedure was pioneered here)

University Hospitals, Cleveland (I find Cleveland to be a hub for many advanced medical procedures. You lucky Ohioans!)

Sloan-Kettering, NYC

Robert Allen practice, NYC

Mayo Clinic

Paoli Hospital, Paoli, PA

And here is a wonderful thread on breastcancer.org with many names from all around the country, along with personal recommendations.

http://community.breastcancer.org/forum/44/topic/750056?page=1

Good Luck!

Breast Cancer Vaccine in the Relative Near Future

In case you missed this in the news, here is some important new information on the prevention of breast cancer! Wouldn't it be great? Then I could delete this blog someday, with great pleasure.

Breast Cancer Vaccine Article