Breast Cancer
Diagnosis, Treatment & Reconstruction Options

An Informative Article by Frederick G. Weniger, MD
Breast Cancer is a reality that hit home for me this year. After reconstructing mastectomy defects as part of my career as a plastic surgeon for the last several years, I was shocked to learn that my own mom had been diagnosed with breast cancer. My mom still is not done with here chemotherapy and has yet to start her radiation therapy treatments. Unfortunately, this is all happening in Pittsburgh, so I can only help her so much. Thankfully, she has received wonderful care and is doing well. Her experience has helped me to appreciate that, although nobody would choose to have to deal with breast cancer, we are fortunate to be living in a time when truly amazing advances are being made in the treatment of this scary disease.

It turns out most women consider breast cancer to be the most important health issue faced by women today. This fact was confirmed by the incredible attendance (approximately 350 people) at the Rally-for –the-Cure breast cancer luncheon at Sun City where I spoke a few weeks ago. Breast cancer is, in fac, the most common non-skin cancer among women in the United States, and is the second-leading cause of cancer death. Furthermore, breast cancer is the leading cause of death in women between the ages of 40 and 55. Overall, 1 in 8 American women will develop breast cancer in their liftetimes. Worse yet, for American girls born these days, the risk is up to 1 in 7.

A person’s risk of breast cancer is affected by gender, age, reproductive history, use of hormones, and family history. This disease is 100 times more common in women, but I recently performed reconstructive surgery to improve the symmetry on a man who had undergone a mastectomy for breast cancer. Breast cancer is more common as one gets older, with a peak occurrence during the 7th and 8th decades of life. Women who have not been pregnant and who have used hormone replacement therapy for an extended period (probably more than 5 years) are also at increased risk. Certainly, people with a family history of breast cancer, especially with first degree relatives or multiple relatives having breast cancer at an early age, are at increased risk.

Despite these facts, the United States has seen a dramatic DECLINE in the last 2 years in the number of women having annual mammograms. In fact, 25% of women who should have had a yearly mammogram have not done so in the last 2 years. Furthermore, 40% or poor women in the U.S. have NEVER had a mammogram. This is tragic because getting regular mammograms is known to increase survival by 23% in women over 50 years of age, and it is known to decrease the chance of dying by 15% in those aged 40-49 years.

It is a shame that so many women choose not to take advantage of the technology that exists for early diagnosis of who has or will likely develop breast cancer. Currently, newer technology such as digital mammography and breast MRI are available in our area to help with diagnosis. For some women with very strong family histories, genetic testing is now available for patients and their family members to identify who carries the BRCA 1 or 2 genes, which give an 80-90% lifetime risk of breast cancer and a greatly increased risk of multiple other cancers.

For patients who are at a high risk of developing breast cancer, the drugs Tamoxifen and Raloxophene can be used to PREVENT breast cancer. In fact, both of these drugs have been shown to decrease the incidence of breast cancer by 50%. For patients who already have breast cancer, clinical research trials have led to new, more effective treatments. For example, some women now can take advantage of neoadjuvant chemotherapy, which involves giving chemotherapy BEFORE surgery instead of afterwards. This improves the chance for breast conservation and allows doctors to assess the affect of the chemotherapy on the tumor. New drugs are available also, such as Herceptin, which is an exciting gene-targeted therapy which is like a smart bomb for certain cancers. Also, a class of drugs called aromatase inhibitors prevent estrogen from forming. This helps because some breast cancers are stimulated by estrogen. Both of these types of drugs are proven to increase survival.

As a plastic surgeon, my role in helping breast cancer patients is that of reconstructing breasts or improving appearance or symmetry after breast cancer surgery. Traditionally, this has included either delayed or immediate (at the same time as mastectomy) whole breast reconstruction for mastectomy defects. In these operations, a resulting lack of skin and volume (breast tissue and fat) are replaced with either the patient’s own tissues from another part of her body (often the abdomen or back), or the defect is repaired by using a tissue expander and then eventually a breast implant to replace what was removed. Sometimes these reconstructions are even done to both breasts at the same time following a double (bilateral) mastectomy.

What is not realized my many patients is that lumpectomy defects such as asymmetries and depressions can also be improved. In fact, new techniques allow excess fat to be liposuctioned from other areas of the body (such as the tummy) and then injected into the depressions or irregularities in the breast in order to improve shape and symmetry. Also, newer oncoplastic techniques combine lumpectomies with procedures such as breast lifts or breast reductions in order to AVOID lumpectomy defects instead of waiting to treat them later. Additionally, symmetry procedures are available to the opposite breast to improve overall appearance. Using these new techniques- particularly fat grafting - we are now able to also help all of the previous lumpectomy patients achieve a more comfortable appearance after their cancer treatment.

Importantly, patients should know that federal law currently requires that insurance companies not only pay for breast reconstruction (including fat grafting for lumpectomy defects), but that symmetry procedures for the opposite breast must also be covered.

Breast cancer is scary. Despite my mother’s ongoing journey, I am blessed to be able to help provide hope in the form of reconstruction to women with breast cancer. In fact, many of the advances in the treatment of breast cancer give more hope too. Finally, advances in diagnosis such as digital mammography can give more hope and allay the fears of those women without breast cancer. We are truly fortunate to live in an age with all of these medical advances.

But this technology only works if you take advantage of it ( please reconsider the above statistics on mammography). If there is something going on, you want to know as early as possible. OK, here it is- my mom had not had a mammogram in 5 years.

She didn’t like to get mammograms. So now she has cancer in 6 of her lymph nodes instead of just her breast.

I might be a Board-Certified Plastic Surgeon, but now I am asking you as a friend: Please encourage someone you love to get their yearly mammograms.

Hilton Head Breast Reconstruction Main Page