Posts Comments

You are here: Home / 2019 / Archives for May 2019

Archives for May 2019

Q&A #2: May 2019

May 27, 2019 by

Q:
I had a bilateral mastectomy in October 2016. I finished radiation on the right side in January 2017, and underwent bilateral latissimus flap reconstruction in August 2017. I had capsular contracture (when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant) on the right side and the implant changed out in March 2018. Once again, I have capsular contracture on the same side. What do I do? They are absolutely not even close to symmetrical. I am only 46. I am kind of thinking that I should just forget reconstruction even though I don’t really want to go flat.

A:
Without knowing all of the details about your situation, I think there is a reasonable chance you have some good options left. Here are a few potential ones:
1. We have reconstructed more than 1,800 breasts with natural tissue alone (no implants) using the abdomen or buttocks. If you have any tissue in those areas, that is our most frequently used option.
2. We have, on several occasions, reconstructed breasts with latissimus flaps alone, with added free-fat grafts, which can sometimes double (or more) the size of the latissimus flap, and make implants unnecessary.
3. For the last 4 1/2 years, we have done all of our implant reconstructions exclusively in front of the muscle, using a full Alloderm (specially preserved donor skin) wrap. This has completely changed our outlook on implant breast reconstruction, and has on occasion produced surprisingly good results – even in radiated breasts. I have converted several “implant-behind-the-muscle” patients (some who already had latissimus flaps) to in-front-of-the-muscle, and they all feel that it is a significant improvement. Free-fat grafting can also be added to implant-based reconstruction to improve shape, size and overall naturalness.
There is absolutely nothing wrong with going flat if you are sure that is what you want to do, but it might be premature for you to decide to do that only because you don’t think you have any other options. I would be delighted to discuss your situation in more detail by phone, if you wish, or see you in person for a consultation.
Thanks for your question! We look forward to hearing from you.

Best,
Dr. Richard M Kline JR MD

Filed Under: Ask the Doctor Tagged With: , , , , , , ,

Overcoming ‘Scanxiety’: 5 Tips to Keep Your Wits for Your Next Breast Scan

May 22, 2019 by

Even though you won’t find the word in any dictionary — yet — scanxiety is real. Just ask any breast cancer patient. Scanxiety is the anxiety you feel when your next scan — mammography, ultrasound, PET scan or other major test — approaches. You’re nervous, restless and tense, your heart is pounding and you may have trouble sleeping or eating. You’re constantly worried about what the test will find.

These tests can determine if your cancer is in remission or if you still need additional treatment. For some, the scanxiety over these tests can start days, weeks and even months before the actual test occurs and continue while you take and wait for the results. And even those who have received good news from scans in the past still suffer from scanxiety leading up to their next one, hoping that they will hear those same results again.

There have not been many medical studies done on the impact of scanxiety, but one small study done on lung cancer patients was published in the October 2016 edition of Lung Cancer. It showed that scanxiety can mimic the symptoms of post-traumatic stress disorder (PTSD), including distressing thoughts, difficulty concentrating, anxiety, insomnia and irritability. The study showed that scanxiety can actually impair your quality of life.

Fortunately, there are steps you can take to help reduce or even eliminate the symptoms of scanxiety:

  1. Meditation: Whether you do it in a group or by yourself, meditation has been found to settle thoughts and help reduce stress and improve concentration. According to the Mayo Clinic, there are several ways that you can meditate:
  • Guided meditation: Led by a teacher, you are guided to conjure mental images that you find relaxing.
  • Mantra meditation: repeating a calming word or phrase that will be used to prevent distracting thoughts from entering your mind.
  • Mindfulness meditation: This is increased awareness and acceptance of living in the present moment. “I took a mindfulness course which I firmly believe kept me from completely going off the rails,” said one triple negative breast cancer patient in an online support group.
  1. Support Groups: Speaking of support groups, there are many in-person and online support groups that you can join to help you get through these difficult times. Your cancer center may have a supportive care department that is staffed with doctors, social workers and psychiatrists or psychologists. Here you can express your concerns about your upcoming scans. Others who may have also experienced the same symptoms can share additional coping mechanisms. Sometimes, just letting it out can help.

There are Facebook groups for breast cancer patients as well as patients with specific conditions, such as Triple Negative Breast Cancer. The best thing about online support groups is that they are available 24/7, so you can let people know what you’re going through even if it’s the middle of the night.

  1. Support System: Often scanxiety gets worse if you feel like you’re going through the tests alone. Will someone be with you when you go to the test or get the results? Having that person to hold or talk to can often reduce scanxiety.
  2. Fun Things: It might sound simple, but distracting yourself with some fun activities may help to reduce your scanxiety. A good book or a good movie, dinner with friends, or a weekend getaway can keep your mind occupied.
  3. Medication: Sometimes, patients need help keeping anxiety under control. Before taking anti-anxiety medication, such as Lorazepam, discuss these options with your physician to find the right one for you.

Most importantly, don’t ignore your scanxiety symptoms. Treating them allows you to live a better quality of life while you’re going through these very important tests.

Filed Under: Health and Wellness, Recovery Tagged With: , , , ,

Q&A #1: May 2019

May 13, 2019 by

 

 

 

 

 

 

 

 

 

 

 

Q:

I had bilateral mastectomy on May 11, 2018, as a result of inflammatory breast cancer. I did have a tumor, but I also had a complete response to chemo and clear margins at surgery, followed by six weeks of radiation. A 5mm metastasis to one lymph node and a total of two lymph nodes were removed. I do have scar tissue and some swelling on the affected side, but I control it with OT and exercise. I am 61 years old, and otherwise healthy. Am I a candidate for reconstruction and, if so, how long should I wait? I currently see my oncologist yearly and my surgeon every six months for a vascular ultrasound.

Thank you!

A:
You are absolutely a candidate for reconstruction with your own tissue, and we would be happy to help you any way we can. I feel it is rarely, if ever, necessary to wait more than six months after radiation for reconstruction, and you are well past that. Also, your history of radiation, fortunately, has no impact on our ability to reconstruct you successfully using your own tissue.
I would be happy to chat with you further by phone, or see you in consultation in our Charleston office. Please let us know what we can do to help.

Best,
Richard M. Kline, Jr., MD

Filed Under: Ask the Doctor Tagged With: , , , ,

Why Keeping a Breast Cancer Journal Is Good for Recovery

May 7, 2019 by


For many young girls, it’s a rite of passage to keep a diary filled with secrets, hopes and dreams. It feels good to have a private place to write down those things that are too difficult to share with another living soul. Looking back at it later in life, it allows you to discover details that have long since been forgotten. Unfortunately most of us stopped writing in those diaries that were locked away when we hit our teen or adult years.

For women who find themselves on the emotional journey that is breast cancer, it might be time to start journaling again. Studies have shown there are mental and health benefits to journaling. After all, journaling has been shown to improve your mental health, reduce stress and make you feel better physically. It’s also just a great way to document your recovery.

Although not many studies exist on the effects of journaling, WebMD.com suggests that writing can improve sleep, help fight feelings of fatigue, and provide an outlet for positivity.
Before starting a journal, here are five ideas to guide you:

1. Rule #1: No Rules
The only rule to keeping a breast cancer journal is that there are no rules. Treat yourself to a new notebook or pretty journal or download one of the many journaling apps that are available. Write for a few minutes or several times a day. You can draw, write your thoughts in poetry or take pictures and write captions about what you see. Anything goes.

2. Start Anywhere
It doesn’t matter where you are in your breast cancer journey, you can start a journal today. You can work backward on the path you’ve already walked and write down as much as you can remember or write going forward only.

3. Be Prepared for the Emotions
One breast cancer patient had big aspirations of writing in a journal throughout her journey. Unfortunately, writing about her tests and treatment brought out too many emotions and she put the journaling aside. Journaling can be emotional, but it can be therapeutic too. If it gets to be too much, stop for the time being, but make a date to pick it back up again and perhaps write in smaller chunks or skip a few days in between. Find what works best for you.

4. Make a Caring Bridge Journal
There are online websites that allow you to journal and share it with family and friends who want to keep up with your journey but who may not be able to see you. “Anne-Marie” started a CaringBridge account to share her journey. She wasn’t posting every day, but often enough that when she goes back now and re-reads the entries, she remembers details about things that she started to forget.

5. Use Your Phone
Maybe you prefer to use your phone to journal, which is probably with you all the time. If so, try a journaling app, such as Dabble.me, Day One, or Five Minute Journal. Some charge a fee for the download but can provide prompts to remind you to write.
Whatever you do, and however you do it, make sure it works for you. That’s really the ultimate test of any effort to deal with your breast cancer journey.

Filed Under: Breast Cancer Awareness, Health and Wellness, Recovery