Radiation therapy after breast augmentation or reconstruction in early or recurrent breast cancer

Article Abstract:

An increasing number of women are opting for silicone breast implants to augment the size of their breasts. The incidence of breast cancer is sufficiently high that it is not uncommon to identify breast cancer in a woman with breast implants. This may be recurrent cancer in a woman who had implants after breast surgery, or it may be primary breast cancer occurring in a woman who had silicone implants for purely cosmetic reasons. In the past, a breast implant was removed during radical surgery, which could make reconstruction of the breast difficult. Since breast conservation is an important concern among women with breast cancer, a study was conducted to evaluate the effectiveness of conservative surgery and irradiation among women with silicone breast implants. From 1984 to 1989, 14 such cases were treated. Three women had primary breast cancer after periods from 5 to 13 years following cosmetic breast augmentation. Ten patients developed recurrent breast cancer after previous surgery for cancer and breast reconstruction. In one case, breast reconstruction had been performed after surgery for fibrocystic disease. All 14 cases were treated with local excision of the cancer, followed by irradiation of the affected breast; some patients also received radiation of the lymph nodes. Twelve patients are available for follow-up; a minimum two-year follow-up is available for nine of the women. Three of these nine cases developed encapsulation responses. This is a common occurrence after surgery; the body attempts to encapsulate a foreign body, in these cases, the silicone implants. Two of these patients underwent a procedure to release the encapsulation with excellent results. A case with injected silicone rather than gel implants did not fare so well, however. Fibrosis developed around individual silicone lumps, resulting in hard silicone granulomas, which prevented proper examination of the breast. For this patient, radical mastectomy was deemed preferable to the risk of overlooking cancer among the silicone lumps. The 14 cases illustrate that women with breast implants may be offered the option of breast-prosthesis conserving treatment for breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Surgery, Breast implants, Mammaplasty, Breast reconstruction

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Psychosocial adjustment in women with breast cancer

Article Abstract:

Breast cancer is exceedingly common, and may be expected to strike 1 in 11 women at some point in her life. As might be expected, there have been numerous studies of the psychological impact of breast cancer on the patient and on the ways in which the patient psychosocially adjusts to her condition. In an extensive critique of the psychological and sociological literature on this subject, the authors determine that few such studies meet rigorous standards of research methodology. For example, since the introduction of conservative management for early stage breast cancer, there have been numerous studies comparing the psychological effects of breast-conserving surgery with those of mastectomy. Most often, however, patients are recruited into such studies long after the surgery is complete. Furthermore, since the patients themselves determine which treatment protocol they prefer, there is a tremendous amount of bias in the selection of patients. There have been only two studies comparing breast-conserving surgery and mastectomy using a randomized prospective trial. It is worth noting that the overall psychological distress did not differ between the two groups. However, the women with breast-conserving surgery had superior body images and superior sexual experiences. Taken globally, the body of research on the psychosocial aspects of breast cancer, flawed though it may be, indicates that the majority of breast cancer patients do not experience long-term emotional distress. However, 20 to 30 percent experience functional disabilities and problems with social relationships. If the disease does not progress, psychosocial adjustment will often occur in time. This adjustment is strongly dependent on social support, but further research will be required to determine what aspects of social support are most important in contributing to psychosocial adjustment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Methods, Cancer patients, Adjustment (Psychology), Psychological research

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Psychosocial adjustment after mastectomy and breast-conserving treatment

Article Abstract:

A study was conducted to assess the postoperative social and psychological adjustment of women following mastectomy (removal of the breast) for surgical removal of breast cancer. Researchers compared disturbances of work, social and family life, marital adjustment, and the occurrence of anxiety and depression taking place among women who had breast-conserving treatment (removal of cancerous tissue from the breast) as opposed to women who had a mastectomy. The findings showed that a better body image was maintained when the breast was preserved, accompanied by improved sexual relationships in women who had conservative surgery than among the women who had mastectomy. Most of the findings in this study lack the statistical evidence to prove that women having breast-preserving treatment have a more favorable psychosocial prognosis than those women who have mastectomy. Previous studies, however, have shown that with breast-preserving treatment the patient is more pleased with the cosmetic result and has a more positive body image than if she had undergone mastectomy.

Social aspects, Body image, Mastectomy

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