. . My Own Story -- The Long Journey Back to Normal
I was diagnosed with DCIS breast cancer at 49, during a routine mammogram. After a large lumpectomy, we found that the area was bigger than previously thought, and the pathology report showed that my cancer was the nastiest kind -- '9' on the Bloom-Richardson scale of 1-9-- the highest possible rank for aggressiveness and likelihood of recurrence. Lucky me. So, although DCIS is usually treated with a simple lumpectomy followed by radiation, it was recommended that I have a mastectomy to keep the chance of recurrence low. So in December 2008, I had a left mastectomy and reconstruction. Some say that this procedure is one of the most grueling and painful to go through, and I would have to agree--this was by far the the hardest thing I've been through. But I am so grateful that we live in a day when we don't have to die of breast cancer if it's caught early.
I'm fortunate to have a quizzical mind, and through it all, I stayed very near the web. I love having information of all kinds just a keyboard away. I spent about two months searching the web for information -- the best doctors, the latest techniques, the latest breast cancer advances, as much as I could find -- it was painstaking work ferreting out all this information, which was all over the place. As I went, I bookmarked anything that looked interesting. I realized lately that having this information all in one place could be a tremendous help to others, so I am compiling it here for you! I also plan to continue to seek out the latest, and pass it along when I have it. It is likely that you're here because you or a loved one are also battling breast cancer. If so, know that you have a comrade-in arms. Over time there will be a lot of information gathered here, so please take a look at the archives, as well, and poke into all the corners.
See the archive below to navigate through the posts.
Welcome, and I hope you will find some answers here.
Saturday, March 16
The Future of Breast Reconstruction
For decades, cutting chunks of fat out of other parts of the body and suturing them into place on the chest has been the gold standard of breast reconstruction after mastectomy. This was because attempts to simply inject fat cells into an area failed -- most of the fat cells would just die. In 1987, the American Society of Plastic and Reconstructive Surgeons determined that fat grafting for breast augmentation could make cancer detection more difficult, and several studies around that time reported severe complications with the procedure. So for many years, most doctors did not use fat grafting for any treatment on the breast.
As the years passed, fat grafting in small quantities was used for other applications, but with limited success due to the large percentage of fat cells that would die. A few years ago, Cytori Therapeutics developed a device that could safely extract fat cells without damaging them, and mix them homogenously with the stem cells found naturally in fat, in preparation to inject them into other areas of the body. A high rate of survival of fat cells was achieved with this method, which meant that larger amounts of fat could be grafted successfully. This paved the way for the use of fat grafting in breast augmentation.
Then some studies were done to verify the true danger of using fat grafting as a means of rebuilding the breast after mastectomy, with some success. The results of one of these studies can be found here. The process is longer, taking months, rather than one procedure. Layers of fat are laid down one at a time, starting at the chest wall and building outward over time. But the benefits are obvious -- no long incisions and subsequent scars at the donor site, only a series of small incisions made to facilitate the suctioning of fat. And believe me, this is huge. The abdominal (or other donor site) surgery is the most difficult part of a breast reconstruction, in terms of pain and recovery.
So there is a resurgence of interest in using fat grafting to rebuild the breast, and there is one doctor in Miami offering the procedure. I have not come across any others, but if you find any, please post them in the comments section.
With today's technology, your options are usually either lumpectomy and mastectomy. I had asked my reconstructive surgeon about a quadrantectomy, which is the removal of larger part of the breast than lumpectomy, but less than removing the entire breast. It was a procedure that he did not offer, due to how much it disfigured the breast. I also asked several surgeons that I consulted why they could not just take a smaller flap of fat to fill in the area after a quadrantectomy, but got no satisfactory answer from any of them. I was left presuming that it would be hard to tailor a fat flap to fit an oddly-shaped gap in the breast. So we're left with either having a lumpectomy that is not large enough to disfigure the breast too much, or a mastectomy with a mound-shaped flap of fat or other mound-shaped filler to rebuild the breast.
With fat grafting, another option that will undoubtedly open up for breast cancer patients is the ability to fill in odd gaps after lumpectomy or quadrantectomy. Doctors will be able to remove larger areas of the breast without concern, when they can simply inject fat into those oddly-shaped areas to fill them in. For those having lumpectomy, this could mean the ability to have a larger lumpectomy to achieve larger margins around the cancer. In borderline cases, (like mine was, where a lumpectomy large enough to get rid of the cancer would seriously disfigure the breast, indicating mastectomy instead) a quadrantectomy could be offered instead of mastectomy, possibly conserving enough breast tissue to retain the natural nipple and sensation in the breast. It's all my conjecture at this point, but who knows?
I have been told that, due to my PCOS, I am at greater risk to develop cancer in the other breast. If that happens, I may be able to take advantage of this new technology, and after all I have been through so far, I would certainly give it a try. But let's hope it doesn't come to that.
Wiki info about Cytori
Cytori's information about breast reconstruction using their procedure
About.com article outlining the procedure
Blue Cross analysis of fat grafting to the breast
Article about fat grafting for breast augmentation, but much of the info crosses over to breast reconstruction.