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

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.

Q&A #1: May 2019

 

 

 

 

 

 

 

 

 

 

 

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

Why Keeping a Breast Cancer Journal Is Good for Recovery


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.

Ask the Doctor: Q&A

 

Q:

What is the success rate for someone with:
• a bilateral mastectomy with immediate reconstruction in 2011;
• encapsulation in 2016 with several fat graft attempts;
• failed implant on radiated left breast site, removed in December 2016; and
• removed right implant in February 2017?
I am now am searching DIEP options.

Thanks,

C

A:

Hi C,
I am sincerely sorry you have had so much trouble. Fortunately, none of your prior problems affect the success rate of DIEP flaps in our practice.
We recently tabulated and presented our 15-year flap experience. After 1,362 DIEP flaps, the overall survival rate was 99 percent. Neither radiation nor previous failed implant reconstructions affects the flap survival rate. Many, many, many patients with a history of radiation and multiple implant failures have gone on to have successful DIEP flap reconstructions.
I would be happy to meet with you and review your options, or chat with you by phone, just let us know how we can help.

Sincerely,

Richard M Kline Jr MD

Ask the Doctor: Q&A

Q:

I had a mastectomy in 2008 with implant reconstruction. I had the implants exchanged during additional procedures to help improve the look of the breast. I am very unhappy with how I look as it is very unnatural. I am not opposed to a procedure with another implant if done correctly. Is this something you do? Otherwise I may need to consider alternatives as I feel so uncomfortable in my own skin.

Thanks,

V

A: Hi V,
Thanks for your inquiry.
We frequently revise implant reconstructions to improve patient satisfaction. For several years, we have done essentially all of our implant-based reconstructions in front of the pectoralis muscle, which confers a number of significant benefits in terms of comfort, appearance and naturalness (compared to behind-the-muscle). I also have converted a number of patients with older behind-the-muscle reconstructions to modern in-front-of-the-muscle reconstructions, and they all feel the result is much nicer.
If implant reconstruction still proved unacceptable to you, using your own tissue is another powerful option. We have completed more than 1,800 natural tissue reconstructions – many in women who previously had unsatisfactory implant reconstruction – with great success.
I would be happy to see you in consultation, or discuss your situation in more detail by phone, if you wish. Please let us know what works for you.
Best,

Richard M. Kline, Jr., MD

When is the Ideal Time for Reconstruction Surgery?

Some breast cancer patients require a mastectomy, the removal of a breast affected with cancer. Many choose to then have reconstruction surgery in an attempt to rebuild the breasts back to a normal look and shape. But when is the best time to have this surgery – at the same time you are having your mastectomy or at a later time?

Well, it depends on a variety of factors.

During the Mastectomy

Ideally, reconstruction begins at the same time that you have the mastectomy. This is especially important for earlier stage breast cancers. There is an advantage to having immediate reconstruction: Breast cancer patients do not have to wake up to the stark change of a removed breast. Instead, the reconstructed breast is already in place. This often helps with the breast cancer patient’s self-esteem and recovery.

Months After the Mastectomy

However, breast cancer patients who must undergo chemotherapy or radiation may choose to delay their breast reconstruction. Breast reconstruction cannot be performed until around six months after a patient’s final radiation treatment. However, chemotherapy varies. Some women have mastectomy and reconstruction immediately and do not start chemotherapy until after that is completed. Some women have to do chemotherapy first and then have mastectomy and reconstruction. Others have their mastectomy, have chemotherapy and wait to have reconstruction. Planning and timing is based on the type of cancer, pathology, oncology recommendation and the patient preference.

You might also decide to have reconstruction at a later time because, as a breast cancer patient, you are also dealing with a lot and may just want some time to make this decision and prepare for the surgeries.

Preparing for a Delayed Reconstruction

For those who do choose delayed reconstruction, the surgeon can put expanders in during the mastectomy that will help to keep the skin preserved to accommodate an implant or autologeous breast flap at a later time.

There are many decisions to make when you are undergoing breast cancer treatment and possible reconstruction. Patients and their team must consider timing and which reconstruction procedure is best. The patient can choose from implants or autologous breast procedures. Autologous breast reconstruction uses the patient’s own body tissue to recreate the breast. The tissue can come from the belly, buttocks or thigh.

It is important to note that if radiation therapy is indicated it’s best that occur before undergoing autologous breast reconstruction. Whether you decide to have autologous breast reconstruction or implant reconstruction will also depend on several factors, including your age, health status, location of the tumor, previous surgeries and the availability of extra tissue in your body. There are pros and cons of each procedure, so it’s important to talk to your doctor about which one is best for you.

The Center for Natural Breast Reconstruction believes in good health for everyone. If you or someone you know is in need of breast reconstruction, contact them at NaturalBreastReconstruction.com or toll-free at 866-374-2627.

Know the 5 Steps of Breast Reconstruction Before Your Mastectomy

 

If you’ve been diagnosed with breast cancer and will have a mastectomy, your doctor has probably discussed what comes next. Often, if you choose breast reconstruction, the process starts at the time of your mastectomy, but it can also be done at a later time – even years later.

Once the reconstruction process starts, it’s typically two or three stages – restoring the breast, refining the shape of the reconstructed breast and then reconstructing the nipples if desired. But every breast reconstruction procedure should start with a consultation with your physician.

Step One: Consultation with Your Team
Not every woman chooses to have reconstruction after mastectomy, so it’s important to weigh your options with your team, which should include your breast surgeon, plastic surgeon, radiation oncologist, medical oncologist and anyone else who is part of your treatment.

If you do choose reconstruction, your physician should discuss whether you will have your procedure at the same time you are having your mastectomy or at a later time. Your physician may recommend delaying your breast reconstruction based on the course of your treatment. Sometimes chemotherapy and radiation can delay the ability to have immediate reconstruction. Your surgeons should discuss the risks and benefits associated with all breast reconstruction procedures to allow you to make the choice that is best for you as well as helping you understand when the right time is for you to successfully complete the procedure of your choice.

Step Two: Mastectomy and Reconstruction

Choosing immediate reconstruction, at the time of mastectomy, is a great choice if it’s possible for the patient to do so. Those who opt to have breast reconstruction at a later time and have their mastectomy completed first can still choose from the wide variety of breast reconstruction procedures offered to all patients. At the time of mastectomy, tissue expanders can be inserted to help preserve the shape of the breast and conserve breast skin should definitive reconstructive surgery be scheduled for the future.   

Step Three: Restoring the Breast

Now it’s time to rebuild your breast. The two most common reconstruction procedures are autologous breast reconstruction and implant reconstruction. During autologous reconstruction, a plastic surgeon uses your own tissue, skin and fat from another place on your body – typically from your buttock, abdomen or thigh – to recreate your breast mound. Should you choose implant reconstruction, our surgeons at The Center for Natural Breast Reconstruction utilize the most state of the art techniques to achieve the most natural result. Direct to implant and above the muscle implant reconstruction with acellular dermal matrix are examples of the procedures we offer. 

Step Four: Refinement
Sometimes the shape of the reconstructed breasts need to be refined a bit, so another surgical procedure might be necessary. Some patients also choose to have the unaffected breast modified to achieve even closer symmetry, and that can be done at this stage.

Step Five: Nipple Reconstruction

If you have chosen to have a nipple-preserving mastectomy, you may only need one or two stages of surgery to complete the restoration process. However, if you need nipple reconstruction, it can be done either during Stage Two or Three. We typically like to wait at least three months between all procedures if possible to allow for healing before making further modifications. A few months after the nipples are reconstructed, you may also undergo a tattooing procedure to add more natural coloring to the nipple. Some women choose only 3-D tattooing as their definitive choice for nipple reconstruction.

Recovery time will vary from patient to patient. Your individual surgery timeline may also differ depending on your particular needs.

The Center for Natural Breast Reconstruction believes in good health for everyone. If you or someone you know is in need of breast reconstruction, contact them at NaturalBreastReconstruction.com or toll-free at 866-374-2627.

Ask the Doctor: Q&A

Q:

I am interested in DIEP and live in N.C., but before I go any further, I have questions. I’m a healthy, 43-year-old female; married with children; I work, and I’m a non-smoker. I was recently diagnosed with multi-centric DCIS in my right breast. MRI enhancing revealed a left breast lesion, and a biopsy will be scheduled soon. Genetic testing came back negative. A local plastic surgery consult indicated sufficient abdominal tissue to create a breast mound. My first question — who are the breast surgeons that your office works with? Would they do a sentinel node biopsy as my surgeon has recommended? Second, could the mastectomy and DIEP occur during a single surgery? Third, do you coordinate care with my current breast surgeon? I anticipate that if the lesion on the left is also DCIS, I would opt for a lumpectomy and radiation on that side since the area is small, and do it locally with my current breast surgeon. Finally, how would I start the process of moving forward with a consult with your office for DIEP?

A:

Hi, Kay,

Thank you for your question, I am sorry you have to go through surgery. It seems you have already gotten a lot of good information about your possible treatment and reconstruction. Our practice has specialized in breast reconstruction using natural fatty tissue and procedures such as the DIEP flap since 2002. My partner and I have performed nearly 2000 breast reconstructions using natural tissue with an overall success rate of 99%. We work with several breast surgeons who we collaborate with on every patient. We are also accustomed to patients having to travel to us from out of state and have had patients come from 48 of the 50 states. We understand the difficulties associated with what you are going through and our mission is to help people in your situation. You have some excellent questions so I will answer them in list format. 

1. Who are the breast surgeons that your office works with?

We work with multiple breast surgeons who we are familiar with and collaborate with to offer our patients the options that are best for each individual situation.  Drs. Megan Baker, Jennifer Fiorinni, and Jennifer Beatty are excellent breast surgeons who we work with. Would they do a sentinel node biopsy as my surgeon has recommended I have done? Yes, they would and frequently do prior to mastectomy to determine if radiation is needed after mastectomy.

2. Could the mastectomy and DIEP Flap occur during a single surgery?

Yes, absolutely! We feel this is very important to get the best result and to minimize the number of surgeries needed.

3.  Do you coordinate care with my current breast surgeon? I anticipate that if the lesion on the left is also DCIS that I would opt for lumpectomy and radiation on that side since it is a small area and would do that locally with my current breast surgeon.

Yes, we coordinate with our patient’s home breast surgeons. For what treatment is best we also rely on the opinion of the breast surgeon here. In your situation it may be best to consider possibly having both breasts removed and then reconstructing both at the same time with the same technique. That approach allows us to achieve better symmetry between the breasts. Sometimes after a lumpectomy and radiation, the breast can develop an abnormal shape that is not desirable and difficult — if not impossible — to match with the opposite breast. The problems might not surface until after radiation and are then nearly impossible to repair. When we use the DIEP flap, it is often available for each breast and therefore makes for a great match. We can discuss this more if you like.

4. How would I start the process of moving forward with a consult with your office for DIEP?

Just let me know if you would like to see me for a consult in person or make an appointment to talk over the phone. Most of the time, we can plan and answer questions before an actual visit in person. My staff can contact you to schedule an appointment and gather additional information.

I hope that I have answered your questions, let me know if you have other questions.

Thank you,

James Craigie, MD

CNBR

Finding the Right Surgeon

5 Key Attributes to Look for in a Plastic Surgeon

 

You’ve been diagnosed with breast cancer and had a mastectomy. Now you’ve made the important decision to have reconstructive surgery to rebuild your breast. Your next important decision is to make sure you have the right plastic surgeon to do the job.

Finding the right surgeon isn’t always easy. But you need to put the same time and effort into it that you would put into hiring a real estate agent to find you a home or finding the right school for your children. After all this is your health we’re talking about and you deserve the best.

So what should you look for when choosing a surgeon?

1. Make Sure the Plastic Surgeon Specializes in Your Procedure

Some plastic surgeons specialize in implants, while others do tissue flap procedures, such as TRAM or the newer microsurgical procedure, the DIEP flap. Perhaps you already had a reconstruction procedure and need it revised. You need someone who has extensive experience with revision surgery.  Ask how many procedures the surgeon has performed and the success rate for the specific procedure you are considering.

2. Make Sure They are Board Certified and Well Trained.

Plastic surgeons are certified by the American Board of Plastic Surgery (ABPS)  which means that they have completed residency training specifically in Plastic and Reconstructive Surgery at an accredited institution.  They have passed comprehensive written and oral examinations covering all plastic surgery procedures. You can visit the ABPS website to find out if your plastic surgeon is an up-to-date certified member.  Fellowship training in a specialized field such as Breast Microsurgery is desirable if you are considering muscle sparing autologeous reconstruction procedures such as DIEP, GAP, PAP etc.

3. Make Sure the Surgeon’s Record is Clean

There are licensing boards for each state where you can check a surgeon’s background for any malpractice judgments or disciplinary actions. Visit the Federation of State Medical Boards’ website for more information.

4. Make Sure You are Comfortable

Once you find a plastic surgeon that specializes in your chosen breast reconstruction procedure, make sure to meet and ask a variety of questions. For example, how many procedures have you performed? What is your success rate? What is your background? What will the surgery entail and what is recovery going to be like?

Even if you have done your research and know the answers, see if you are comfortable with how the doctor communicates with you during this meeting. Does the surgeon answer your questions thoroughly and address your concerns?  If the answers are off-putting or you feel uncomfortable in any way, that surgeon may not be the one for you.

5. Make Sure They Take Your Insurance

It might sound like an obvious thing to ask, but some surgeons will require that you pay out-of-network fees. You don’t want to be surprised with a big bill at the end of the procedure, so make sure that your plastic surgery procedure and the surgeon’s fees are covered at in-network rates by your insurance plan. Work with the surgeon and their staff to make sure everything is covered and you know all of the out-of-pocket costs prior to the procedure.

The Center for Natural Breast Reconstruction believes in good health for everyone. If you or someone you know is in need of breast reconstruction, contact them at NaturalBreastReconstruction.com or toll-free at 866- 374-2627.

Ask the Doctor: Q&A

Q: I had a lumpectomy and radiation for breast cancer. I would like to know if I can get reconstruction surgery.

Sincerely,

Ms. Jones

A: Ms. Jones,
Thank you for your question. You can absolutely get reconstruction after lumpectomy and radiation. Some of your options depend on the extent of deformity/radiation damage and asymmetry between breasts, and whether you want to proceed with a complete mastectomy.
If you are looking to just improve the appearance of your radiated breast, different things that can be done to adjust that breast to achieve a better cosmetic result and symmetry. Often modifying the non-cancer breast with a reduction and/or lift can create better symmetry.

With true breast reconstruction, you need a complete mastectomy for an implant or your own tissue to replace the breast mound. Implants are often not recommended for and do not work the best in a radiated breast, but it is not impossible. Having had a lumpectomy with radiation has no effect on your ability to have the breast reconstructed with your own tissue by using your abdomen, buttocks or thighs as the most likely donor sites.

We work with multiple excellent breast surgeons in our area who could do the mastectomy immediately followed by reconstruction in the same surgery. Depending on your overall risk and preference, you could also have the non-cancer breast removed and reconstructed, but we leave that decision up to you and your oncology team.

Our reconstruction procedures are most commonly a staged process that involves at least two surgeries to achieve something close to a satisfying result. We would be happy to meet you in the office for a consult with one of our surgeons, Dr. James Craigie or Dr. Richard Kline, to discuss your best options and give you more information on the different procedures. If you live out of town, we can often offer a phone consult first to help you better understand the process before you make a long trip here. We also can set up a meeting for you with a local breast surgeon on the same day as your consult with us if you are interested. Please let us know how we can best help you, and we look forward to hearing from you.
Sincerely,

Audrey Rowen, PA-C