By Dr. Constance M Chen
The ancient Egyptians described breast cancer in papyrus writings as far back as 1600 B.C. Over the following centuries, many causes were suggested – from imbalances of bodily fluids to compression from tight clothing – and treatments ranged from cauterization to opium to arsenic. It was not until the 18th century that breast cancer came to be understood as a localized disease whose spread could be contained by isolating and removing the affected cells, giving rise to what we know today as mastectomy. The American surgeon William Halsted pioneered the radical mastectomy in the late 1800s, removing not just the breast tissue and adjacent lymph nodes but the underlying chest muscles down to the ribs as well in an aggressive attempt to control the spread of the disease. Halsted and other surgeons of his time did not believe in breast reconstruction. They feared that any intrusion at the surgical site could adversely affect the progression of the disease or hide a recurrence. So while the first attempts at reconstruction were made in the 1890s, it was not until the mid-20th century when radical surgery gave way to equally effective but less aggressive treatments that interest in breast reconstruction soared.
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By Andrea Smith
A diagnosis of breast cancer turns a woman's life upside down. Despite roiling emotions, she must make crucial decisions about treatment and figure out how to manage her life in the face of a new reality. Not least among her concerns are the financial ramifications of her illness, particularly if she will need a mastectomy. Will her insurance cover reconstruction? The surgeon, the anesthesiologist, the hospital, the lab? Procedures on the healthy breast to ensure symmetry? What if she elects to have reconstruction at a later date? What if her preferred surgeon is not in her insurer's network? The most important information is that all insurance policies will cover – in fact, must cover – breast reconstruction if it covers mastectomy.
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By Dr. Constance M Chen
Pregnancy and breastfeeding take a toll on women's breasts. So does extreme weight gain and loss, smoking, aging, and excessive sun exposure or eating a nutrient-poor, high-fat diet. Extreme fluctuations in breast size due to pregnancy and weight changes combined with the natural effects of gravity over time, however, are the primary culprits in causing breasts to lose their youthful appearance. Breast tissue is made up of collagen and elastin, which break down as we age. The skin loses elasticity, sometimes stretches irreversibly, and the remaining breast tissue falls to the bottom of the breast, leaving the top looking flat and deflated. No cream, bra, or exercise can correct droopy breasts, but there are surgical options that can restore lift and fullness and create a more youthful contour.
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By Dr. Constance M Chen
Pregnancy, childbirth, and breastfeeding often brings great joy but it can also alter a woman's body so much that sometimes she feels like she no longer recognizes herself. During pregnancy and breastfeeding, the skin of the breasts and abdomen stretches and loses elasticity, sometimes leaving stretch marks and loose skin. The breasts may sag and be deflated after breastfeeding is over. And the abdominal muscles may separate after childbirth in a way that causes physical discomfort and stress on the back muscles as well as a permanent bulge that is not correctable by weight loss.
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By Dr. Constance M Chen
Every year, hundreds of thousands of women in the United States receive breast implants, either to reconstruct a breast lost to cancer or for cosmetic purposes. But three out of four reconstruction patients will experience at least one complication and many will be unhappy with the way their implants look and feel. Women who have had cosmetic implants also suffer complications and are often dissatisfied; almost 30,000 of them had implants removed in 2016.
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By Dr. Constance M Chen
In the midst of the emotional turmoil of realizing that she has cancer, women are faced with critical decisions about treatment. For a woman who must undergo mastectomy, the predicament is further complicated by the array of options available and the decisions she must make about whether, when and how to have breast reconstruction. There are two types of breast reconstruction and multiple options for each: implants and reconstruction that uses the body's own tissue, known as autologous tissue reconstruction. Either type can be performed immediately, or months or even years later.
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By Dr. Constance M Chen
According to the National Cancer Institute, the risk of breast cancer is approximately 12% for women in the general population, which means that one in eight women will develop breast cancer at some point in her life. But the risk is considerably greater for women who inherit a mutation in the BRCA1 or BRCA2 gene that prevents the gene from performing its proper function, which is to produce proteins that help suppress tumors. That risk is 60% for those with a BRCA1 mutation and 45% for those with a BRCA2 mutation. As more women become aware of these risks, those who test positive for the harmful mutations face the difficult decision of whether to reduce their risk by undergoing bilateral prophylactic mastectomy – preventive removal of both breasts.
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By Dr. Constance M Chen
Many women with very large, heavy breasts suffer years of physical and social discomfort – neck, back, and shoulder pain, rashes under the breasts, difficulty finding clothes that fit, unwanted attention. Breast reduction surgery, or reduction mammoplasty, effectively addresses these problems and improves appearance. Breast tissue and breast skin is resected and the nipple-areola complex is repositioned higher on the chest wall, creating a smaller and more youthful breast.
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By Dr. Constance Chen
The body's reaction to surgery depends on many factors, including the type and location of the surgery, the aftereffects of anesthesia, and the patient's overall health. Beyond the variation from person to person, however, all surgery is trauma to the body – the entire body – and induces a common and predictable response beyond the immediate surgical site. Surgery induces a stress response that produces metabolic changes. Put simply, all the body's energies are redirected to repair and heal the damage at the surgical site leaving the rest of the body to fend for itself. So, for example, areas like the skin, hair, and nails may become thin, dry, and brittle as they lose the elements that normally support their constant building and replenishment.
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By Dr. Constance M Chen
Breast reconstruction after mastectomy is a very subjective experience. Different women who undergo the same type of breast reconstruction may have very different perceptions of newly reconstructed breasts depending on the starting point. In general, the best result in breast reconstruction today is achieved with natural tissue, in which the patient's own body, usually the abdomen or legs, is used to create a new breast that replaces the fat and skin that was lost to mastectomy. Since it is made from the patient’s own tissue, the restored breast is soft, warm, and reacts just like any other part of the woman's body, growing or shrinking as weight is gained or lost, for example.
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By Dr. Constance Chen
For all the joys that motherhood brings, pregnancy can also change a woman’s body in ways that can be physically and emotionally disorienting. For some women, exercise and weight loss will bring back their pre-pregnancy bodies. But sometimes the body has been stretched out so much that it cannot be restored with diet and exercise. The skin loses its elasticity and the abdominal muscles separate in a way that causes physical discomfort and extra stress on the back muscles. The 'mommy makeover' is a personalized combination of surgical procedures designed to restore a woman's body after pregnancy and enhance her physical and emotional health.
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By Dr. Constance M Chen
For many women, breast reconstruction is a process rather than a single procedure. Some women have experienced complications, particularly with implants, that require additional surgery. And many women are simply unhappy with the results of their breast reconstruction. The goal of breast reconstruction after mastectomy is to create a natural breast with the shape, softness and symmetry of the original. Sometimes follow-up adjustments are necessary to achieve that goal, and some women may need corrective surgery to reverse the effects of a failed reconstruction. It's important for women to know that with an individualized plan and advanced surgical techniques, we can often improve size, shape, and symmetry problems after the initial breast reconstruction to help a woman’s breasts look more normal again and to restore a sense of wholeness.
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By Dr. Constance M Chen
All women are at risk for breast cancer, particularly with advancing age. There are specific factors, however, that significantly increase the risk for women of all ages. As more women become aware of these factors, those at high risk can explore their options for reducing their risk. The most common risk factor is an inherited genetic mutation that greatly increases the odds of developing breast cancer. For some women, inherited genetic mutations can increase lifetime risks of developing breast cancer to greater than 86%. For women who have seen multiple family members die after struggling with breast cancer, the most common risk-reducing option is bilateral prophylactic mastectomy – the preventive removal of both breasts.
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By Dr. Constance M Chen
According to the American Society of Plastic Surgeons, about 400,000 women in the United States had breast implant surgery in 2016. About three-quarters of breast implants were placed for cosmetic breast augmentation and the rest for reconstruction following mastectomy. Studies by implant manufacturers, however, have shown that within seven years about half of all implants need to be removed.
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Andrea and I were so inspired to be standing in solidarity with Gloria Steinem, Judy Norsigian, Julie Childers, Carol Ciancutti and the incredible women of Our Bodies Ourselves. It was amazing to learn from the stories of diverse women from different backgrounds, and to share in the conversation about breast implants and natural tissue alternatives. At the end of the evening, we were all charged up as we look forward to working together to protect the health and well-being of every woman.
By Dr. Constance M Chen
More than 100,000 women have mastectomies in the United States every year. And, with surgical advances that promise a soft, warm breast that will look and feel like her original breast, more and more women now opt for breast reconstruction, either at the time of the mastectomy or later. But many of these women who undergo reconstruction discover that the natural “look and feel” of her restored breast refers to how the breast will look and feel to someone else. Often the breast does not feel at all natural to the woman herself and her reconstructed breast may lack all feeling and be completely numb to touch and sexual arousal.
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By Dr. Constance M Chen
Among breast cancer patients who opt for breast reconstruction, 80% undergo implant-based breast reconstruction. Studies by implant manufacturers, however, show that within three years, three out of four breast reconstruction patients with implants will experience at least one complication, such as pain, infection, hardening, or the need for additional surgery. Many women live with chronic implant problems, or else they undergo multiple operations to adjust or replace their implants with new implants in the hope of improving their implant-based breast reconstruction. There is a risk of cosmetic and health problems in the first few years, and the risks increase over time. Many women do not realize that implants are not expected to last forever. Most implants have a ten-year warranty, but many will have to be removed before that. That said, women should know that there are alternatives to replacing failed implants that will give them a more natural result and a lifelong solution.
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