AN OPERATION THAT CAN DECREASE THE
OF BREAST CANCER
FROM ABOUT 9% (ONE IN ELEVEN)
25%, 50%, 75%, 95%
TO 7% and LESS
DEPENDING ON RISK FACTORS
THIS IS A CONTROVERSIAL OPERATION
or skin sparing mastectomy
You are reading information regarding the surgical procedure
for removal of breast tissue. Sometimes known as subcutaneous
mastectomy, more recently known as skin sparing mastectomy.
The surgery involves removal of most (98% plus) of the breast
tissue which lies beneath the skin. Incisions are used to
try to minimize scars. The skin shell is filled by a prosthesis or implant
similar to that used for breast enlargement OR by tissue
from other areas of the body such as a tram flap or free
tram flap, (see explanation further in this description).
THIS IS A CONTROVERSIAL ISSUE. . . . . . In most cases
this surgery is performed on breasts that are FREE of
cancer or have MINIMAL OR NONINVASIVE cancer.
Some would wondered why a woman would choose to have her breasts removed if there is no cancer.
I have wondered why a woman, at high to very high risk, is told that she
has to wait until cancer actually appears before her breasts
or at least most of the internal breast tissue
Further, why should she be made to wait until there is a significant chance that her disease is no longer confined to the breast(s)?
As a Physician who does advise women about
breast removal because of high risk, I attempt to present
facts as I see them. It is imperative that there be no 'pressure'
to go ahead with such surgery.
Each woman must have ample time to reflect
and decide, without pressure, as to what should be done.
It has been my observation that women who come to see me have thought about removal of their breasts for some time and in some cases for many years.
What is important is that the woman reflect as to how
important her current breast configuration is to her.
She must consider whether long term survival is more important
than the physical and psychological value of the breast
For most women who consult me, long term
survival is of the essence. They want to live to see their children grow, and to see their grandchildren grow.
Whether or not an individual
is a candidate for surgery partially depends on risk factors. These
risk factors have been statistically analyzed and help
give an idea of the probability that cancer will occur.
WHAT DETERMINES 'AT RISK' FOR BREAST CANCER
The statistical chances of developing cancer can be calculated.
While calculated connotes an exactness, certainly any
such calculation is not exact, but it gives a woman enough
of a 'ball park' figure as to the risk.
are associated with increased incidence of breast cancer.
- The presence of 'pre-malignant' changes.
- The presence
of 'minimal' cancer in a breast.
- The presence of invasive
cancer in the opposite breast.
- Pre-menopausal breast
cancer in one's mother, maternal grandmother, sisters,
or maternal aunts.
- The presence of a genetic marker
for breast cancer.
Inability to examine the breast clinically or by mammography.
More than one of the above compounds or increases the
risk. IF THE RISK FACTORS ARE NUMEROUS one might reasonably
state that the development of cancer approaches inevitability.
Removal of the inner portions of the breast(s) with preservation of the skin and nipple areolar complex if possible and with reconstruction, is THE LOGICAL THING TO DO
- TO SAVE LIVES AND TO ATTEMPT TO PRESERVE A SEMBLANCE OF A PLEASING
What are considered pre-malignant conditions ?
It is not necessary to feel or see a lump to have pre-cancerous
conditions. There may be merely a slight thickening or
firmness. If tissue is removed for analysis, it may show
precursors to cancer or 'pre-malignant disease'. Diagnoses
such as ductal hyperplasia, intraductal papillomatosis
or lobular carcinoma-in-situ are associated with increased
chances of cancer. If a woman has had cancer in the opposite
breast, there is an increased chance of developing cancer
in the remaining breast.
The Genetic Marker There are several markers associated
with an increased incidence of cancer. This is not a 100%
correlation but indeed the presence of the gene marker
does carry an increased risk. The cost of testing originally
was two to four thousand dollars. For example, a woman
without known additional risk factors, may have about
a nine percent chance of cancer (about one in eleven will
get cancer of the breast over their lifetime estimated
at 80 plus years). As the risk factors compound, this
percentage may 'add up' over one's lifetime to a fifty
to seventy-five percent chance of cancer.
a calculated increased chance of breast cancer, another
reason for undergoing a reconstruction after subcutaneous
mastectomy or skin sparing mastectomy as mentioned, is that doctors
may be unable to adequately 'follow' breast masses. Cancer,
in its early stages may be present, but undetected in
Other reasons to decide to go ahead with surgery
is because of chronic pain, infections, or the need for repeated
biopsies associated with deformity of the breast.
While this operation is controversial, only a few physicians
would not recommend this operation for a woman whose mother
and maternal grandmother had pre-menopausal carcinoma
of the breast, and who has had one breast already removed
for cancer of the breast or who has lumps in the opposite
breast that are difficult to 'follow', or whose mammograms
shows suspicious microcalcification. If a genetic marker is detected
then indications for surgery are great.
Before going ahead with surgery, IT IS THE INDIVIDUAL'S
JOB to have it perfectly clear why removal of breast tissue
All risks and complications must be considered. This
is an operation that has been done many times and successfully
so. In most cases this type of surgery is done on breasts
that are FREE of cancer or have MINIMAL OR NONINVASIVE
CIRCUMSTANCES THAT INCREASE THE RISK FOR BREAST CANCER
All percentages are estimates and may be revised from
time to time
.Pre-menopausal breast cancer in % increase risk
..genetic cancer marker------------------65-95%
..carcinoma in situ--------------------------25-50%
..cancer in one breast----------------------20-25%
..other "pre-cancerous" conditions-------5-15%
IN THE EVENT A DECISION IS MADE TO GO AHEAD WITH SURGERY
Information - Consultation
SUBCUTANEOUS MASTECTOMY requires understanding before
surgery. If you have questions, you must ask them. Do not request and consent to surgery unless
you understand the benefits versus the risks of surgery.
This information is provided for
your general information. How such information exactly
applies to an individual would depend on a face to face
history, examination, perhaps laboratory exams and individual
treatment plan. Further, because of the nature of electronic
media and information - there is no doctor-patient relationship
but merely a general information display - THANK YOU.