American Medical Association Family Medical Guide - American Medical Association [580]
Biological therapy
Newer medications called aromatase inhibitors are starting to replace tamoxifen or be given after the 5-year course of tamoxifen in the treatment of postmenopausal women who have late-stage breast tumors. Aromatase inhibitors such as letrozole, anastrozole, and exemestane block the action of an enzyme that is necessary for the body to produce estrogen. These drugs may also be effective in shrinking tumors before a woman has breast cancer surgery and in preventing breast cancers from recurring. Side effects can include hot flashes and night sweats and an increased risk of osteoporosis.
Breast Reconstruction Surgery
Today, just about any woman who loses her breast because of cancer can have a new breast created through reconstructive surgery, although the best candidates are those women whose cancer has been completely eliminated by breast removal. New surgical techniques have given surgeons additional ways to create a breast that closely matches a natural breast. Reconstruction is now possible right after breast removal in many cases. If you have been diagnosed with breast cancer and your doctor has recommended breast removal, discuss your options for surgery with the doctor so you can work together to come up with the best alternative.
Reconstructive breast surgery usually requires more than one operation to insert a breast implant or form a breast using tissue from another part of the body and then to reconstruct the nipple and surrounding areola. Sometimes the surgeon also recommends reducing or enlarging the other breast to create better symmetry. Your surgeon will describe the different reconstructive options, including:
Skin Expansion
After your mastectomy, the surgeon will place a device called a balloon expander under your chest muscle. Over several weeks, he or she will inject a salt solution (saline) into the expander to gradually fill it. As the expander gets larger, the skin over your chest will expand enough to hold a permanent breast implant, which will be inserted in a subsequent operation. Some women do not need skin expansion before getting an implant.
Flap Reconstruction
In flap reconstruction, the surgeon makes a skin flap out of skin, fat, and muscle taken from another part of the body, such as the back, abdomen, or buttocks. The skin flap becomes either the pocket into which the implant is inserted, or the new breast itself. There are two types of skin flap surgery—a pedicle flap and a free flap. For a pedicle flap, the surgeon tunnels the borrowed tissue (usually from the abdomen), which retains its own blood supply, under the skin to the chest. For a free flap, the surgeon removes the tissue from the site of the graft and transplants it to the chest, connecting it to a new source of blood. Flap reconstruction is more complex than skin expansion and requires a longer recovery time.
Breast reconstruction using an implant
Following a mastectomy, a saline implant may be inserted under the chest muscle to create a breast or to add bulk to a breast that has been reconstructed with a tissue flap taken from the back or abdomen. The nipple may be reconstructed using tissue from the woman’s inner thigh.
After Surgery
The risks of reconstructive breast surgery include bleeding, excessive scar tissue formation, and infection. As with any surgery, smokers face a longer healing time and more noticeable scarring. Some women experience capsular contracture, a tightening of the scar tissue around the breast implant, which causes the breast to feel unnaturally hard and may require corrective surgery. For now, out of uncertainty over the safety of silicone gel-filled implants, the Food and Drug Administration approves only saline-filled