Previvors: Family History and Breast Cancer Risk

Abby recently found out that she has a family history of breast cancer — she has a cousin and a grandmother who have both been diagnosed at different stages. Abby is 37 years old and doesn’t have breast cancer, but the idea that she might have a higher risk of getting the disease because of her family history concerns her. She has decisions that she has to make about her health and what she needs to do to reduce her risks. Abby is known as a Previvor.

According to FORCE, Facing Our Risk of Cancer Empowered, a Previvor is an individual like Abby who may have a predisposition to cancer but who hasn’t actually had the disease. This includes people who carry a hereditary mutation, a family history of cancer, or some other predisposing factor.

In 2010, Congress passed the first-ever National Hereditary Breast and Ovarian Cancer (HBOC) Week and National Previvor Day to help raise awareness about hereditary cancer.

How do you know if you have a hereditary or higher risk for developing breast cancer?

 

Uncover your family history

 

To find out if you have a hereditary risk of being diagnosed with breast cancer  – start by taking a full health history of your own family. If any of your family members have battled breast cancer, find out how old they were when they were diagnosed, the type of breast cancer and the stage. And find out what age they were if they unfortunately succumbed to the disease. This family history should be as complete as possible and go back for as far as you can.

 

Your risk of getting breast cancer may increase if you have a first degree family member — mother, father, sister, or daughter — or multiple family members on either your mother’s or father’s side of the family who have had breast cancer.

According to the Centers for Disease Control, hereditary cancer syndromes are caused by mutations (changes) in certain genes passed from parents to children. In a hereditary cancer syndrome, certain patterns of cancer may be seen within families.

 

Genetic testing

 

The most publicly recognized breast cancer susceptibility genes are BRCA1 and BRCA2 but there are others. If you have a personal or family history of breast cancer, you can undergo BRCA genetic testing. A negative BRCA test result means that you do not have a detectable mutation in BRCA1 or BRCA2.  Some families have a BRCA mutation that is missed by this test, or another gene (s) that might explain the cancer in the family.  If you test negative for a BRCA mutation previously found in another family member, then you may have a true negative result.  A variant result means there is a variation in your genetic code, but it is unclear if it is the cause of the cancer in your family.  If you undergo genetic testing it is strongly recommended that you seek genetic counseling to understand the results and what the options are for your health.

 

Calculate your risk 

 

Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer. 

Benefits of Autologous Reconstruction vs. Implant Reconstruction

When considering breast reconstruction, a woman is faced with a few options — she can

choose autologous reconstruction — which is the use of her own skin and tissue to

create a breast mound, implants, or go flat.

Recently, the recall of certain breast implants has made the news, as the FDA reported

their connection to 573 rare cases of anaplastic large cell lymphoma and 33 patient

deaths. As a result, the FDA asked Allergan to recall its BIOCELL textured breast

implants and tissue expanders and they obliged.

We are sure that this news is upsetting and leaves questions in the mind of patients

who wonder about implants and their safety, as well as the choice they should make for

their own breast reconstruction procedure.

At The Center for Natural Breast Reconstruction, we educate our patients on the

differences between all types of procedures and their risks, but our emphasis has

always been on autologous reconstruction. Here’s a little about each autologous

procedure that we do:

DIEP flap: This is the most popular type of perforator flap reconstruction due to its high

success rate and its ability to reconstruct the breast without the patient having to

sacrifice much needed abdominal muscles. In addition to reconstructing the breast, the

contour of the abdomen is often improved – much like a tummy tuck.

GAP flap: Similar to the DIEP, tissue is taken from the buttock area instead of the

stomach.

PAP flap: The Profunda Artery Perforator Flap (PAP) utilizes the tissue of the upper

thigh just below the buttock to reconstruct the breast following mastectomy.

So now that you know the difference between each procedure, why should you choose

autologous reconstruction over implants?

● Autologous reconstruction lasts a lifetime: Breast reconstruction using tissue

from someplace else on your body will last a lifetime. There is nothing synthetic

that can break or cause illness or other major issues. On the other hand,

implants will normally have to be replaced between 10 and 20 years.

● Breasts made by autologous reconstruction feels more natural: When your

breasts are reconstructed, you want them to feel just like your old breasts.

Implants do not always feel real, but since the tissue on your belly, buttocks, and

upper thighs is very similar to your breast tissue, it makes for a good, more

natural substitute.

Deciding what kind of procedure is best for you is a big decision. The best thing to do is

to gather all of your facts, talk with your doctor and your surgeon and weigh all of the

pros and cons before deciding on what’s right for you.

Woman to Woman

 

When you’re going through something big in your life, there isn’t anything more comforting than talking to someone who has been through it before.

For women who are having breast reconstruction surgery, a doctor is certainly available to answer many of your questions, but it’s also helpful to hear from another patient who has had the same surgery. What should you expect? How should you prepare at home? How will you feel when you wake up after surgery? What clothes are best to wear? When will you feel like yourself?

Meet Shirley. She’s a patient at The Center for Natural Breast Reconstruction who had a double mastectomy, followed by DIEP breast reconstruction surgery. She wanted to have a ‘girl-to-girl talk’ with other patients, so she wrote a 31-page booklet filled with raw, honest tips and advice that could help others. “No offense to the medical team that put together a technically comprehensive document, but boy did they leave out a lot of information that would have been helpful!” she wrote. “The kinds of things that, really, only a patient would know.”

Here is just a sampling of her tips and advice:

It’s a process, not a procedure:After the initial surgery, Shirley reminds patients that they will have one or two more minor procedures for final “sculpting.” “It’s important that you look at your reconstruction as a process, not one procedure and it’s done,” she writes. “Some healing is required between steps, and so there will be months between each step.”

Be vigilant at following instructions: Shirley made sure she followed her doctor’s instructions completely. That means that she ate a high-protein diet, made sure to exercise and took her vitamins. “I wanted to do whatever necessary to make sure everything went smoothly,” she writes. “Getting in shape prior to surgery will set you on a path to stay in shape, which will preserve your new body! Now that I have a flat tummy and perky “girls,” I’m more motivated than ever to stay fit.”

Go shopping before your surgery: It’s not just about retail therapy that will make you feel better. Shirley is advising patients to find specific clothing that will help with recuperation. “I would recommend that you get a very good idea of where your incision line will run and try to find some clothing that will be comfortable and not hit right on it for when you get home,” she writes. “And have large shirts at hand so that your drains will fit under. They need to button up the front, too, because it will be uncomfortable to raise your arms at first.”

Arrange help: “Another thing about showers — you have to dry off with a towel. So, here I was with limited arm movement juggling four drains and trying to dry all of my pieces and parts,” she writes. “I wasn’t supposed to be alone for showers the first couple of days. Dizziness and lightheadedness are common. My husband stayed with me and even helped me towel off, dress me and blow dry my hair. Naps usually followed showers.” If you don’t have a spouse, a trusted family member or friend should be available to help you.

Paint your toes:“Everyone will see your feet,” she writes. “I got so many comments on how pretty my toes looked. For some reason, that was comforting to me.”

Shirley also provides a day-to-day synopsis of her recovery, including her challenges such as sitting up after surgery and her accomplishments. Her booklet is helpful and inspiring to other patients who also may be struggling with finding the “light at the end of the tunnel.”

From one woman to another, Shirley gets you there.

The Center for Natural Breast Reconstruction would love to send Shirley’s book to anyone who like to receive it! Requests can be made via email, Facebook message, website chat, or phone at 843-849-8418. 

July Q&A #2

I would like to learn more about liposuction or non-surgical liposuction around my abdomen and my thighs.
– Harmony

Hey Harmony,

Depending on your personal goals, both are great options for body contouring.

Trusculpt iD is a non-invasive option that offers fat dedication and skin tightening with minimal downtime. It’s Monopolar Radio-frequency platform tailors to patients’ individual needs and features Real-Time Temperature Control for clinically proven results, safety, and patient experience. In 15 minutes, truSculpt iD treats the entire fat layer, resulting in an average of 24% fat reduction.

Surgical liposuction is a more invasive method, with 1-2 weeks of downtime. It reshapes specific areas of the body by removing excess fat deposits and improving your body contours and proportion. Anesthesia is required for this procedure, but it is also safe and effective.

I would like to discuss this in more detail. If you’re interested please call 843-849-8418 to schedule a consultation. I am sure we can tailor a plan to meet your specific needs.

Thank you for reaching out. Hope to hear from you soon!

Dr. Lindsey Weaver, FNP-C

July Q&A #1

Q.I’m waiting to have surgery to take a cancer lump from my left breast. Then I will be taking radiation treatment. Will my breast be disfigured from this and will I be suitable to build my breast appearance with reconstruction surgery?
Judi

A.Hi Judi, Sorry you’re having to go through this. Management of a lumpectomy defect can be more complicated than reconstructing an entire breast after mastectomy. If you are sure you want to have a lumpectomy instead of mastectomy, then it may be best to have a plastic surgeon do reconstructive surgery on your breast at the same time as your general surgeon does the lumpectomy, before radiation, as the radiation will make any subsequent surgery to improve the shape of the breast much, much riskier (particularly regarding wound healing problems). If you would like to discuss your situation in more detail by phone, I would be happy to speak with you.

Richard M. Kline, Jr., MD

Coping after surgery

Surgery is a common method of treating breast cancer, but it can be overwhelming. There is so much to think about and you might be feeling scared, especially about how you will handle recovery. Here are some tips that we hope will help to make your recovery easier:

Prepare: Recovering from breast surgery really begins before you even have your surgery. It will take you a few weeks to recover, at least, so take time to brainstorm everything you do on a daily and weekly basis. What can wait to do until after you’ve recovered? What do you need help with on a daily or weekly basis? You will need assistance, but before you make any arrangements, figure out exactly what those needs are. For example, do you need someone to drive the kids to activities? Take the garbage out? Cook or clean for you? Help with laundry or taking care of your bandages?

Find support: Once you know what you need, it is time to create a support system. You might need someone to help you dress, undress and bathe until your doctors remove your drain, if you’ve had a mastectomy. Ask what your spouse can help with and see where there are gaps. Perhaps your children, a few close friends or relatives can alternate times to help you. Neighbors might offer to take your children to their activities, while your mom offers to cook and do the housework for you.

Stock up: Make sure to cook and freeze a few days or weeks worth of meals before surgery, so you have easy-to-grab foods and snacks. Eating healthy is important for your recovery too, so choose low-fat, highly nutritious options. Keep fruit, vegetables and water on hand as well.

Don’t forget that you may have an issue putting on your current clothes, so consider purchasing several shirts that are a little larger than what you currently wear and that button up in the front so they are easier to get on and off and do not rub against your incision.

Don’t overdo it: Everybody wants to get back to their regular routine after surgery, but it’s important for your recovery that you don’t overdo it. Get plenty of rest and sleep, especially in the first few weeks.

Follow post-surgery care: You will be given exercises to do after surgery, information on how to care for your skin and directions on what you can and can’t do. For example, you may not be able to shower for a week or go in a pool for several weeks. Make sure to keep your follow-up appointments too. To heal properly, be sure to follow all directions that you’ve been given.

Be observant:If you have a drain, keep an eye out for any excess blood, signs of infection or other problems. If you see something that doesn’t seem right, contact your physician right away.

Cool For Summer

Healthy lifestyle concept, clean food good health dietary in heart dish with sporty gym aerobic body exercise workout training class equipment, weight scale and sports shoes in fitness center

Making healthy changes at any point in your life can help you reduce your risk of a recurrence or new cancer, prevent additional health issues and keep your body strong as it recovers from treatment and surgery.

Consider these important 6 healthy living choices:

  1. Drop Excess Weight
    Those love handles might sound cute, but carrying around excess pounds can increase your risks for a variety of health issues, including heart disease and high blood pressure, high cholesterol, and Type 2 diabetes.

According to the Centers for Disease Control, the good news is that even a modest weight loss, such as 5 to 10 percent of your total body weight, can produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.

Losing weight prior to your breast reconstruction might also help to prevent surgical complications. One study published in the Journal of Reconstructive Microsurgery found that obese women were 2.29 times more likely to experience surgical complications.

Dropping pounds should be done gradually at a rate of 1 to 2 pounds per week.

  1. Eat Healthier
    If you skip breakfast, love sweets, douse your popcorn in a salt and butter, enjoy a double cheeseburger every day for lunch, and haven’t had a veggie pass your lips in years, you might want to consider a diet overhaul. Eating a healthy, balanced diet can prevent heart disease, diabetes, and certain cancers, keep your bones and muscles strong and help keep your weight down.

Start eating healthier by making small changes. According to the U.S. Department of Health & Human Services, you should incorporate at least six of these eight goals into your diet:

  • Make half your plate fruits and vegetables.
  • Make half your grains whole grains.
  • Switch to fat-free or low-fat milk.
  • Choose a variety of lean protein foods.
  • Compare sodium in foods.
  • Drink water instead of sugary drinks.
  • Eat some seafood.
  1. Get Moving
    Cancer treatment can tire out your body, but it’s important to get off that couch and get moving! It doesn’t matter how you do it either — whether it’s dancing to Usher’s latest tunes, walking a treadmill, hiking, or joining a weekly Zumba class, find something you enjoy and do it. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. Add moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) at least 2 days per week.

Exercise helps to lower your risk of heart disease, stroke, type 2 diabetes, high blood pressure, dementia and Alzheimer’s and several types of cancer. It also helps with depression and anxiety.

  1. Stop Smoking
    According to the American Cancer Society, about half of all Americans who keep smoking will die because of the habit. Each year more than 480,000 people in the United States die from illnesses related to tobacco use. This means each year smoking causes about 1 out of 5 deaths in the US More importantly, research shows that smokers have higher rates of wound complications after surgery, including healing after plastic surgery and breast reconstruction.

It’s hard to do, but quitting smoking can improve your health almost immediately. Quitting lowers your blood pressure and heart rate almost immediately and your risk of a heart attack declines within 24 hours.

  1. See Your Doctor
    You’re already seeing your doctor to treat your breast cancer, but have you had a general physical or other annual tests such as a colonoscopy or bloodwork? Staying on top of your health will help reduce the risks of getting sick and prevent other illnesses.

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.

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.

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.