Breast reconstruction after mastectomy: recent advances

Article Abstract:

For many years, the only method of treating breast cancer was radical mastectomy. One unfortunate consequence of this surgery is that the patient must deal with the psychological aspects of disfiguring surgery at the same time she is dealing with the emotional consequences of a potentially fatal illness. In the past 20 years, however, advances both in the treatment of breast cancer and in its early diagnosis have made breast conserving surgery possible. When this is an appropriate alternative, breast conserving surgery is as effective as mastectomy. However, not all breast cancers are amenable to breast conserving treatment, even when diagnosed early. For these women mastectomy remains the only possible treatment. Advances in cosmetic surgery have made it possible, however, to reconstruct a natural-looking breast to help alleviate some of the effects of losing this psychologically important symbol of femininity. The author describes the current techniques for breast reconstruction. In some patients, particularly those with early Stage I cancer, reconstruction may begin at the time of mastectomy surgery. More often, however, breast reconstruction will begin several months after the end of adjuvant chemotherapy; this practice may result in better healing. Reconstruction of the breast is accomplished in several steps; often the first is the implantation of an inflatable device to expand the overlying skin and provide a skin area comparable to the unaffected breast. For women with particularly large or droopy breasts, a tissue expander is inadequate and flaps of skin must be transplanted. Next, the silicone implant may be put into place. The last step is the creation of a nipple and areola, which can be color-matched by judicious choice of transplanted skin or by the use of injected tattoo dyes. It should be emphasized that breast reconstruction should not be considered as an afterthought; planning must be integrated into the initial treatment plan. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Surgery, Breast implants

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Symptoms and rehabilitation needs of patients with early stage breast cancer during primary therapy

Article Abstract:

The needs of the breast cancer patient are not limited to surgery and adjuvant treatment. The breast cancer patient also requires a great deal of supportive and rehabilitative care. The author provides a detailed discussion of the nursing requirements of the breast cancer patient. These begin immediately after diagnosis, when the needs of the patient for information and psychological support predominate. The psychological difficulties of the breast cancer patient will continue into the treatment phase, regardless of whether mastectomy or breast-conserving surgery is chosen as the method of treatment. The effects of surgery and irradiation of the breast will include breast soreness, fatigue, and skin changes; these will resolve over time. Of course, adjuvant chemotherapy will produce the symptoms commonly associated with cytotoxic drugs: nausea and vomiting, and hair loss. Chemotherapy also affects normal ovarian function and is likely to produce menopausal symptoms. The side effects of adjuvant chemotherapy are regarded as mildly to moderately distressful by most patients. The author emphasizes that an important part of successful management of the breast cancer patient is effective communication among patients and health care providers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Care and treatment, Cancer patients

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