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The Road to Recovery
Breast Reconstruction
Reconstruction timing
Reconstruction options
No reconstruction (prosthesis)
Reconstruction with implants
Reconstruction with body tissues
Nipple and areola reconstruction
Life After Breast Cancer
Physical aspects of recovery
Emotional aspects of recovery
Developing and maintaining healthy habits
Follow-up exams and breast cancer awareness
Recommendations for Family Members
The Search for a Breast Cancer Cure
Causes of breast cancer
Genetic studies
Chemoprevention
New imaging methods
Emerging surgeries and treatments
Breast Cancer Support Groups and Organizations
Selected breast cancer references

No matter where you are in the process of breast cancer treatment, the time will come when it's over. The scars will heal. The last dose of chemotherapy or radiation therapy will be delivered. And the time will come to move forward with a new lease on life.

The Road to Recovery

Moving forward after breast cancer surgery and treatment is a process of learning and renewal. On the one hand, there are clear-cut physical stages for which you can prepare, with the aim of resuming life as usual. On the other hand, life after breast cancer isn't quite the same for most women. It's as though a new life-chapter has begun.

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Breast Reconstruction

Choices about breast reconstruction after a mastectomy are personal ones. Some women don't want reconstruction; they want to avoid any more surgery than is necessary. Others definitely do want reconstruction to restore their self and body images. Who's to say which is right? It's important to realize, though, that reconstruction techniques have improved vastly over the years. Today, almost every woman can have breast reconstruction with great aesthetic results.

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Reconstruction timing

Breast reconstruction done at the time of mastectomy is called immediate reconstruction. If it's done at a later date it's called delayed reconstruction. Either way, it's critical to select a surgeon with lots of experience in reconstructive breast surgery and one who's a board-certified specialist. Have your breast cancer surgeon refer you to the best available specialist. Or contact the American Society of Plastic Surgeons for a list of qualified specialists in your area.

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Reconstruction options

There are three main reconstruction options. Of course, the first is no reconstruction at all. The second uses synthetic implants to create the shape of a breast. And the third uses a patient's own tissue—transplanted from another part of the body. For both reconstruction options, the goal is to create a breast shape and texture that matches the other breast. To do so, a minor procedure such as a breast lift might be required on the remaining breast.

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No reconstruction (prosthesis)

Many women who choose not to have reconstruction use a breast form (prosthesis) instead. These come in many sizes, shapes and colors. Some fit into a special bra, while others attach to the chest with a special adhesive. Some are inexpensive foam inserts. Others are custom-molded and have a realistic color and texture to closely match the natural breast. Breast forms help provide a nice, symmetrical appearance. They can also be useful in relieving strain on posture by balancing weight distribution.

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Reconstruction with implants

The most common breast reconstruction options involve synthetic implants. These tear-shaped pouches—which are made of silicone and filled with saltwater or silicone gel—are inserted under the breast tissue to recreate the shape of a breast. The implant will be chosen to match the other breast. If it's a small implant, the surgeon can insert it without overstretching the skin and muscles of the chest. But if it's large, the surgeon will use a temporary expander, which is inserted and filled with a little saltwater (saline solution). Each week a little bit more saline will be injected into the expander to help the skin and muscle stretch. When they have stretched enough, the expander is removed and the permanent implant is inserted.

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Reconstruction with body tissues

Breast reconstruction also can be done using tissue from another part of your body. This tissue transfer is called a flap. The use of flaps eliminates or reduces the use of synthetic materials in the body and often produces a more natural look and feel. But all flap reconstructions are complex and involve certain risks. Discuss the pros and cons in detail with your surgeon.

TRAM (Transverse Rectus Abdominis) Flap—This is one of the most common flaps. It uses one of the rectus abdominis muscles or abs. The muscle, fat and skin are separated from their attachments, pulled up under the skin to the breast area and then shaped to match the other breast.

Latissimus Dorsi Flap—Also called a lat flap, this procedure involves an incision under the shoulder blade. Part of the lat muscle from the upper back is then pulled through a tunnel under the skin to the breast area. If the lat muscle isn't large enough to match the other breast, a synthetic implant is added.

Free Flap—A portion of muscle, fat and skin is removed from the abdomen or buttocks and transplanted to the breast. The original blood supply to the flap is cut and then reconnected to new ones in the breast. This procedure requires a doctor skilled in microsurgery, since it involves sewing together tiny blood vessels under a microscope.

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Nipple and areola reconstruction

Women who want the reconstructed breast to look as natural as possible can also have nipple and areola reconstruction. It's usually done a few months after the breast reconstruction so the breast has time to settle in place. Small flaps of skin on the reconstructed breast are raised and brought together into the shape of a nipple. The surrounding areola then is created either from skin or by tattooing.

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Life After Breast Cancer

Once breast cancer surgery and treatment are over, the road to recovery still lies before you. It's a road many women have traveled before. So many of the physical and emotional hurdles you might face are predictable.

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Physical aspects of recovery

After a larger lumpectomy, mastectomy or lymph node dissection, your arm may feel numb and tingly due to nerve damage. Somewhat later, you might feel shooting pains caused by the nerve growing back. Decreased range of motion and weakness in the shoulder also are to be expected. But don't worry—these conditions rarely are permanent. Your medical team will help you regain arm strength and motion. Following the exercise schedule closely will help you recover quicker. And make sure also to follow your medical team's recommendations about reducing the risk of lymphedema.

Many side effects after treatment are temporary. For example, radiation therapy can make breast skin more irritable. After chemotherapy or radiation therapy, most women feel fatigued. But some side effects can endure. For example, chemotherapy and hormonal therapy are almost certain to stop your periods. If you are young, your periods are more likely to return than if you're approaching menopause. Chemotherapy can also reduce testosterone in the body, which is responsible for female sex drive. Talk to your doctor if you think this might be going on.

For younger women, fertility is a big consideration. Just having breast cancer doesn't mean you won't be able to have children. Many breast cancer survivors do. But talk the matter over in advance with your medical team. And, after surgery and treatment, have them review all the details of your case to make sure it's safe for you to get pregnant.

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Emotional aspects of recovery

Breast cancer diagnosis has a way of affecting a woman's self-esteem, self-image, sexuality and whole perspective on life. Many breast cancer survivors feel that life is never the same again, so there's a heartfelt sense of loss. The only way forward seems to be to go through a grieving process, which is really a kind of healing.

After facing breast cancer, who wouldn't feel anxiety and depression? The key is to know the difference between feelings you can cope with on your own and those requiring professional help. Every women undergoing cancer treatment will go through sad times called reactive depression. Most women can get through it with help from their support team. But there's a form of depression that doesn't go away so easily. It involves round-the-clock feelings of sadness, worthlessness and guilt along with great fear of the future and lack of interest in intimacy. This is called clinical depression and requires help from trained professionals. By all means, ask for professional help if you feel these things. It's a sign of wisdom, not weakness.

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Developing and maintaining healthy habits

Having had breast cancer can be a big incentive to set new priorities in life. Often this includes adopting a healthier lifestyle all around. That's one of the best decisions any woman can make. Evidence suggests that good nutrition helps speed healing after surgery and chemotherapy. Plus, a diet with the right balance of proteins, fats, carbohydrates and vitamins can help you feel younger and stay healthier. You'll already be doing arm exercises as part of your recovery. But why stop there? A regular exercise program for your whole body can help you stay stronger and feel younger and also improves your immune system.

Remember too that breast cancer survivors are at increased risk for other types of cancer. That's a perfect reason to quit smoking and always use sunblock when you're in the sun. Any lifestyle change or complementary therapy that promotes relaxation or lowers stress seems to be a real bonus as well.

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Follow-up exams and breast cancer awareness

Even after treatment is complete, there's always a chance cancer can recur. True, the more time that passes without a recurrence, the greater your chance of staying cancer-free. But no one can ever say for sure the cancer is cured for good. That's why regular follow-up exams are vital. One doctor should be in charge of your follow-up care to keep track of all the facts. Usually, you'll be seen every few weeks right after treatment, but later this will trickle down to every six months or so.

Breast self-examination (BSE) is particularly important for women at higher risk for breast cancer, which includes every cancer survivor. Doctors also suggest a clinical breast examination (CBE) as part of your regular check-ups. The doctor or nurse will spend additional time examining the scars and areas under the arms and around the collarbones (where lymph nodes are found). In addition, every woman who's had breast cancer should have a mammogram once a year. Women who've had a mastectomy should have an annual mammogram on the remaining breast. For women whose breasts are dense or hard to diagnose with mammography, an MRI is advised. Chest X-rays, blood tests and bone scans might also be advised.

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Recommendations for Family Members

If you're diagnosed with breast cancer, the likelihood increases that your first-degree relatives will also develop it. That doesn't mean they'll get cancer for sure. But it does mean you need to encourage your daughters and sisters to practice early detection. This includes regular breast self-examination and clinical breast examination. It also means yearly mammograms starting either at age forty or at an age ten years younger than you were when diagnosed—whichever is earlier. MRI is advised for women whose breasts are not easily examined with mammography.

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The Search for a Breast Cancer Cure

All over the world, in-depth research is in full gear into the causes, prevention and treatment of breast cancer. No one claims we'll be able to cure all cases of breast cancer soon. But great strides constantly are being made.

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Causes of breast cancer

Many studies are examining lifestyle factors and habits that affect breast cancer risk. For instance, studies are looking into the affects of exercise, weight gain or loss and diet. Other researchers are trying to determine the best use of genetic testing for breast cancer screening. One large, long-term study known as the Sister Study aims to help find the causes of breast cancer. It's following 50,000 women for ten years or more to collect information about genetic, lifestyle and environmental factors that might cause breast cancer.

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Genetic studies

Doctors can't predict who will have a cancer recurrence. That's why almost every woman receives some kind of treatment after surgery (adjuvant therapy). To better determine who truly needs adjuvant therapy, scientists have linked certain gene patterns with more aggressive cancers. These cancers are the ones that are more likely to return and spread. This new research has also revealed that there are four basic types of breast cancers, each requiring a unique treatment pattern.

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Chemoprevention

Some research suggests that using chemotherapy drugs in advance, such as tamoxifen, taloxifene and others might lower breast cancer risk in some women. But many women are reluctant to use these medications because of the side effects. Newer studies also are looking at whether or not preventative use of aromatase inhibitors can reduce the risk of breast cancer in postmenopausal women.

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New imaging methods

Several new imaging methods show great promise for evaluating breast abnormalities, although they're still being researched:

Scintimammography—involves the injection of a radioactive tracer. The tracer attaches to breast cancer cells, which a special camera can detect. This technology might be useful for zeroing in on suspicious areas found in mammograms.

Tomosynthesis—is an extension of a digital mammogram that allows the breast to be viewed as many super-thin slices. It's still considered experimental but may provide an earlier, more accurate breast cancer diagnosis.

Thermography—analyzes patterns of heat radiation that come from various tissues and structures that lie within the breast. These patterns might give clues about early or unusual tumor formations.

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Emerging surgeries and treatments

Newer types of mastectomy

Newer approaches to mastectomy that deliver better cosmetic results are always being studied. These include skin-sparing mastectomy, subcutaneous mastectomy and nipple-sparing mastectomy. In each of these procedures, the breast tissue is removed, but if no breast cancer cells are found next to the skin layer—or nipple and areola—they can be reattached. This generally produces a more natural looking and feeling reconstruction.

Advancements in breast reconstruction

Although the number of women choosing breast-conserving surgery continually increases, some women still choose mastectomy for medical or personal reasons. More and more women who do also are choosing reconstructive surgery to restore the breast's appearance. Technical advances in microvascular surgery (reattachment of tiny blood vessels) have given rise to many new free flap procedures for breast reconstruction. These offer the potential benefits of shorter recovery time and less discomfort after surgery.

Radiation therapy advancements

For women who need radiation therapy after a lumpectomy, accelerated partial breast irradiation (APBI) offers a more convenient approach than traditional radiation treatments that take many weeks to complete. Several types of APBI are being applied and studied, including accelerated external beam radiation (higher doses in shorter time periods), intraoperative radiation therapy (delivery of high doses of radiation therapy during surgery) and intracavitary brachytherapy.

New chemotherapy regimens

Recent research suggests that giving chemotherapy every two weeks at the usual doses may work better in preventing recurrence than delivering it every three or four weeks. This is called dose dense chemotherapy. Because of the aggressive schedule, care must be taken to prevent low blood-cell counts. Also, because advanced breast cancers are hard to treat, researchers always are looking for newer and better drugs. One promising candidate is ixabepilone. It's been found to cause many breast tumors to shrink or stop growing, even in women who've had other types of chemotherapy.

Targeted drug therapies

Other new drugs take advantage of gene changes in cancer cells. Trastuzumab works by preventing the HER2/neu protein from promoting excessive growth of breast cancer cells and may also help the immune system fight the cancer. Lapatinib is FDA approved for use in women with HER2-positive breast cancer that's growing despite use of trastuzumab. Studies also have found that breast cancers surrounded by many new, small blood vessels are likely to be more aggressive. Bevacizumab is drug that can be used in combination with chemotherapy to stop these blood vessels from developing (anti-angiogenesis).

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Breast Cancer Support Groups and Organizations

By now you know you're not alone in your battle with breast cancer. In addition to your medical and personal support teams, many sources of help, information, referrals and programs are there for you. The list that follows is by no means exhaustive. But it will give you a good start.

Remember also that recovery can involve helping others. As you reclaim your strength, in body and mind, consider reaching out to other survivors. Some might be in earlier or tougher stages of recovery. Imagine what they could gain from your experience and guidance. Many organizations listed below need volunteers to help women in their breast cancer struggle. Giving to someone else just might be the greatest gift you can give yourself.

American Cancer Society
www.cancer.org
The ACS offers a wealth of cancer-related information and services. You can get answers to all your questions and receive support, information, training and other benefits. ACS programs are free and available in many languages.

CANCERLIT
www.cancer.gov/cancerinfo/literature
This site is the one to go to whenever you want to find any cancer articles published in scientific journals, books, meetings or reports.

Families USA
www.familiesusa.org
This nonprofit organization's mission is to achieve high-quality, affordable healthcare and long-term care for all Americans and to be a consumer watchdog for healthcare consumers.

Hospice Net
www.hospicenet.org
Geared toward the patient and her family, you can find answers to all your questions about hospice care. The site also shows you where to find a hospice and features a professional staff that provides answers to your questions via email.

National Alliance of Breast Cancer Organizations
www.nabco.org
This coalition of more than 370 breast cancer organizations is the leading nonprofit information and educational resource on breast cancer in the United States. It has links to almost anything you want to know about breast cancer.

National Cancer Institute
www.cancer.gov
Part of the National Institutes of Health, this federal government organization is responsible for funding cancer research. It's huge and has many divisions including:

Cancer Information Service
www.cancer.gov/cis
This is the place to go when you want someone to explain the latest research in simple to understand, non-technical language.

Clinical Trials
www.cancertrials.nci.nih.gov
Here you can search for clinical trials by state, city and type of cancer. This Website also provides information about the cost of trials and whether your insurance will cover it.

National Center for Complementary and Alternative Medicine
www.nccam.nih.gov
This center is one of the 27 Institutes within the National Institutes of Health. Its mission is to conduct research on complementary and alternative medicine (CAM), train practitioners in CAM, and educate the public on which methods work and which don't—and why.

The Susan G. Komen Foundation
www.komen.org
The Susan G. Komen Foundation is a private fundraising foundation that raises awareness and awards grants for research and programs that prevent breast cancer through research, education and screening.

Visiting Nurse Associations of America
www.vnaa.org
Provides information, education and other resources for accessing nurses and other healthcare professionals who can provide care in your home.

Y-ME National Breast Cancer Organization
www.y-me.org
This organization's goal is to ensure no one faces breast cancer alone. It provides information, support and a 24-hour-a-day hotline for times when you need to talk.

Young Survival Coalition
www.youngsurvival.org
This international network is dedicated to the concerns and issues unique to women younger than 40 who have breast cancer. Besides focusing on advocacy and awareness, the group also provides emotional support for young women living with breast cancer.

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Selected breast cancer references

A Woman's Decisions: Breast Care, Treatment, & Reconstruction, Third Edition. Written by Karen Berger and John Bostwick III, M.D. Quality Medical Publishing, 1998.

Advanced Breast Cancer: A Guide to Living with Metastatic Disease. Written by Musa Mayer, Edited by Linda Lamb. O'Reilly & Associates, 1998.

Be a Survivor: Your Guide to Breast Cancer Treatment, 3rd Edition. Written by Vladimir Lange, MD. Lange Productions, 2006.

Breast Cancer Husband: How to Help your Wife (and Yourself) Through Diagnosis, Treatment and Beyond. Written by Marc Silver. Rodale, 2004.

Breast Cancer: The Complete Guide. Written by Yashar Hirshaut, MD, FACP and Peter I Pressman, MD. Bantam, 2004.

Cancer for Two: An Inspiring True Story and Guide for Cancer Patients and Their Partners. Order from www.ThePatientPartnerProject.org.

Dr. Susan Love's Breast Book, Third Edition. Written by Susan M. Love, M.D. with Karen Lindsey. Addison-Wesley, 2000.

''I Flunked my Mammogram!" Written by Ernie Bodai, MD and Richard Zmuda. B2Z Publishing, 2005.

Ice Bound: A Doctor's Incredible Battle for Survival at the South Pole. Written by Jerri Nielsen. Talk Miramax Books, 2002.

Living Beyond Breast Cancer. Written by Marissa Weiss and Ellen Weiss. Three Rivers Press, 1998.

Living Beyond Limits. Written by David Spiegel, M.D. Ballantine Books, 1994.

Living Through Breast Cancer. Written by Carolyn M. Kaelin and Francesca Coltrera. Harvard Medical School, 2005.

Medicine and Compassion for Caregivers. Written by Chokvi Nyima Rinpoche. Wisdom Publications, 2004.

Reconstructing Aphrodite. Written by Terry Lorant and Loren Eskenazi, M.D. Verve Editions, 2002.

Taking Time: Support for People With Cancer and the People Who Care About Them. National Cancer Institute, 1996.

The Breast Cancer Book of Strength and Courage. Written by Ernie Bodai, M.D. and Judie Fertig Panneton. Primi Lifestyles, 2002.

The Healing Power of Movement: How to Benefit from Physical Activity During Your Cancer Treatment. Written by Lisa Hoffman with Alison Freeland. Perseus Publishing, 2002.

The Hope Tree: Kids Talk About Breast Cancer. Written by Laura Numeroff, Wendy Schlessel Harpham and David M. McPhail. School & Library Binding, 2001.

Uplift: Secrets from the Sisterhood of Breast Cancer Survivors. Written by Barbara Delinshky. Pocket Books, 2001.

Victoria's Secret Catalog Never Stops Comings: And Other Lessons I Learned from Breast Cancer. Written by Jennie Nash. Scribner, 2001.

Woman to Woman: A Handbook for Women Newly Diagnosed with Breast Cancer. Written by Hester Hill Schnipper LCSW and Joan Feinberg Berns. Wholecare, 1999.

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