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Breast Reconstruction and the Stages of Breast Cancer

 

 

Pink Ribbon - Breast Reconstruction - Breast Cancer  

Breast Reconstruction is a surgical procedure to rebuild the breast shape – along with the nipple/areola complex. Reconstruction advances in today’s time has allowed for certain techniques to give the patient more options and choices, such as actually having the reconstruction take place immediately after having a mastectomy.

Facing a breast cancer diagnosis is heartbreaking on its own. But knowing that cancer treatments could require the disfigurement or complete removal of one or both of your breasts can be even more devastating. Women facing surgery to remove all or a portion of the breast should know their options before the have surgery to treat breast cancer.

 

Physicians should provide for your health as well as the aesthetic and emotional concerns with the focus being on the long term survival and your quality of life. The following are breast reconstructive basics - from timing to techniques to the patient’s rights and implant options. The goal of breast reconstruction is to give back the breast symmetry that has been lost during the cancer surgery.

 

 

Click here for Interactive Breast Anatomy

 

 

The following are some of the more common types of breast cancer:

 

                                       Breast Cancer Sites in the Breast

                                      Copyright 2010 immunerecovery.net  - Used with permission

                                                       Areas where breast cancer can form

 

 

Ductal carcinoma in situ is the most common type of non-invasive breast cancer. These cancer cells are found within the milk ducts but have not yet spread into the breast tissue. This condition is referred to as a "precancerous condition". In situ is Latin, meaning "in place".  Ductal Carcinoma in Situ means the atypical or abnormal cells are confined to one place and has not spread into the other part of the breast tissue.  DCIS does not always progress to invasive cancer.

Ductal Carcinoma in Situ has the following:

  • DCIS does not normally form lumps

  • No signs or symptoms are associated with DCIS

  • Occasionally, DCIS will form a small lump that can be felt

  • Discharge from the nipple can be a symptom of DCIS

  • DCIS is not invasive or life-threatening

  • DCIS is considered "Stage 0"

  • Cancer cells are confined to the ducts

  • 1 in 5 new breast cancer cases will be diagnosed with DCIS

  • Mammogram is the best way to diagnose DCIS

 

                                   Ductal Cardinoma in Situ and Invasive Ductal Carcinoma

               Illustration showing Ductal Carcinoma in Situ and Invasive Ductal Carcinoma

 

 

IDC - is known as Infiltrating ductal carcinoma or Invasive ductal carcinoma. IDC is the most common type of invasive breast cancer. This cancer type is responsible for approximately 70 - 80% of all breast cancer diagnoses. Invasive ductal carcinoma has cancer cells that originate in the milk ducts and then spread to the surrounding breast tissue. This type of breast cancer can be localize or metastasize to other parts of the body if not stopped in time. 

Invasive Ductal Carcinoma has the following:

  • hard, bumpy, irregularly-shaped lump beneath the areola or around the central area of your breast.

  • the lump may appear as though it is moveable (as it is attached to the surrounding breast tissue)

  • can cause nipple retraction

  • nipple discharge (other than milk)

  • redness, scaly, or thickening of the nipple or breast skin

  • lump in the underarm area

  • skin irritation or dimpling

  • breast pain and swelling

  • on a mammogram, micro-calcifications can be near a IDC mass

 

                       Infiltrating Ductal Carcinoma        Abnormal Cells with Infiltrating Ductal Carcinoma

                                 Copyright 2008 Nucleus Medical Art, Inc. - licensed image

 

 

 

 

Lobular Carcinoma in Situ also known as (LCIS) - is basically a change in the cells of the milk lobules. These milk lobules consists of tiny sacs or glands in the breast that make milk.  With LCIS, the cells do not appear to be normal lobular cells, as their appearance show too many abnormal cells. Fortunately with LCIS, the abnormal cells will stay in the milk lobule and will not spread outside of this area.  LCIS is detected through a breast biopsy. It use to be believed that LCIS is not cancerous, however; LCIS is now thought to be the beginnings of a more invasive breast cancer..

Lobular Carcinoma in Situ has the following:

  • Cancerous cells are not detectable when they first start growing

  • At a certain point, the cells will continue to multiply and eventually grow a mass

  • Abnormal cell growth can go on for years before it is detected

  • Tamoxifen may be reduce the risk of of the lobule breast cancer in the future

  • Some women elect to have prophylactic mastectomies to reduce their future cancer risk

  • 10 times increased risk for getting an invasive cancer

 

 

                        Normal Breast Tissue         Normal breast with lobular carinoma in situ LCIS - Image is a cross section of the lobule

 

                                 Copyright 2008 Nucleus Medical Art, Inc. - licensed image

 

 

 

Invasive lobular carcinoma is not as common as invasive ductal carcinoma, and is only responsible for approximately 10 - 15 percent of all breast cancer diagnoses. These type of cancer cells first grow in the milk producing lobules and then breaking into the surrounding breast tissue.  Invasive lobular carcinoma has the capacity to spread to the distant parts of your body. Also, with this type of cancer, typically a patient will not feel a distinct firm lump but rather the breast will have a fullness or an area of thickening.

Invasive Lobular Carcinoma has the following:

  • Does not always show up as a firm lump

  • 1 in 10 breast cancers are ILC

  • Can develop in women of any age - most common however in 45 - 55 years of age

  • Possible for men to get ILC, however; this is very rare

  • Does not show up on mammograms

  • Difficult to diagnose

  • Tumors once found tend to be larger, since this cancer is difficult to find

 

 

                                                Infiltrating Lobular Carcinoma

 

                                      Copyright 2008 Nucleus Medical Art, Inc. - licensed image

 

 

 

Inflammatory breast cancer is a rare but very aggressive type of breast cancer in which the cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed". ridged or dimpled breast skin.  This cancer is characterized by the diffused inflammation and enlargement of the breast - sometimes without a mass present. 

Symptoms of inflammatory breast cancer include:

  • Swelling that comes on suddenly and can gain up to a cup size in a few days.

  • Itching

  • Pink, red, or dark colored area (called erythema) sometimes with texture similar to the skin of an orange (called peau d’orange)

  • Ridges and thickened areas of the skin

  • Nipple retraction

  • Nipple discharge, may or may not be bloody

  • Breast is warm to the touch

  • Breast pain (from a constant ache to stabbing pains)

  • Change in color and texture of the areola

The redness, swelling, and warmth in the breast, often  are present without a distinct lump in the breast. The redness and warmth are caused by cancer cells blocking the lymph vessels in the skin. The skin of the breast can also be reddish, pink or appear bruised.

The five-year overall survival rate for women treated for stage III breast cancer is 54 percent to 67 percent.

 

 

                                          Inflammatory Breast Cancer

 

                                            Copyright 2010 ADAM, Inc. - Used with permission                

 

                                                           Inflammatory Breast Cancer

 

 

 

 

 

There are four Cancer stages which are based on the  following:

  • size of the tumor

  • if the cancer is invasive or non-invasive

  • if lymph nodes are involved

  • whether the cancer has spread beyond the breast

 

 

                                                   Photo of a Breast Tumor

                                                Licensed image for CosmeticSurgeryForums.com

                                                                       Photo of a Breast Tumor

 

 

Different Stages of Breast Cancer

 

  • Stage 0 - Breast Cancer

Intra-ductal cancer, also known as DCIS (ductal carcinoma in situ) is considered stage 0 breast cancer; and is a non-invasive breast cancer. Treatment includes usually a surgical procedure called a lumpectomy. If the cancer is extensive, then it a mastectomy is called for.   Most of the time the patient will not need chemotherapy and if you have a lumpectomy – more than likely you will have to have some radiation.  

 

 

 

  • Stage I Breast Cancer

If the cancer is truly invasive - the most common is called infiltrating ductal carcinoma or invasive ductal carcinoma. This stage of cancer is called Stage 1, which means the tumor is less than 2 centimeters (or 3/4") and the lymph nodes are negative (no cancer cells are found).  Stage 1 is considered an early stage invasive cancer, although cancer cells have not spread to other parts of the body.

 

 

 

  • Stage II Breast Cancer

A Stage II tumor is typically between 2 to 5 centimeters (three-quarters of an inch to 2 inches) across. It is possible that during Stage II, the Cancer has spread to lymph nodes near the breast.

This stage is divided into two sub-categories:

  • Stage IIA

  • Stage IIB  

Stage IIA – describes invasive breast cancer: 

  • No tumor is found in the breast - but there are cancer cells that are found in axillary lymph nodes (under the arm)

  • The tumor is no more than 2 centimeters and has spread to the underarm lymph nodes (axillary lymph nodes)

  • The tumor is between 2-5 centimeters and has not spread to the underarm lymph nodes

Stage IIB – describes invasive breast cancer: 

  • The tumor is larger than 2 centimeters but no larger than 5 centimeters and has spread to the axillary lymph nodes

  • The tumor is larger than 5 centimeters but has not spread

 

 

 

  • Stage III Breast Cancer - (Locally Advanced)

Stage III is considered a locally advanced cancer. This means that the cancer has spread to nearby tissue or lymph nodes. 

This stage is divided into three sub-categories:

  • Stage IIIA

  • Stage IIIB

  • Stage IIIC

Stage IIIA describes invasive breast cancer:

 

  • No tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone

  • The tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures

  • The tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer:

  • the tumor may be any size and has spread to the chest wall and/or skin of the breast AND

  • may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone

  • Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC describes invasive breast cancer (can be operable or inoperable):

  • There may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast

  • The cancer has spread to lymph nodes above or below the collarbone

  • The cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

 

 

 

  • Stage IV Breast Cancer - (Advanced Cancer)

Stage IV Cancer has spread to other parts of the body.

This stage describes invasive breast cancer:

  • The cancer has spread to other organs of the body - usually the lungs, liver, bone, or brain.

  • Known as "Meta-static at Presentation".  Meta-static breast cancer happens when the cancer has spread beyond the actual breast and lymph nodes (near the axillary).  When the cancer is termed "meta-static" - it means that the primary breast cancer tumor was not found when it was only inside the breast tissue.

  • Meta-static cancer is considered stage IV.

It is so important that every woman should be proactive with knowing your own body. And if you feel that something isn’t right, do not ever take “no” for an answer. If you do not feel comfortable with your doctor’s diagnosis, then it is encouraged to go for a second, third, and even fourth consult to get the necessary opinions you need to make an informed decision.

The best reconstructive options - depend on the type of breast cancer treatment you have had along with your body type and preference you and your surgeon decide on together.

 

 

 

 

 

 

 

 

 

It is extremely important to offer hope to women facing breast cancer. Someone with no family history of breast cancer can face chances that are 1 in 8 and after age 40. It then increases 1% per year thereafter. With a family history your chances of facing this nightmare are even higher. To be proactive with this insidious disease there is BRCA testing and Oncotype DX testing methods.

 

 

Some people have the genes that make them more prone to developing breast cancer. 

These genes are called:

  • BRCA1

  • BRCA2

These genes normally produce proteins that protect you from cancer. However, if a patient passes the defective gene - then the patient will have an increased risk for breast cancer. Women with one of these gene defects have up to an 80% chance of getting breast cancer sometime during their life. 

Certain ethnic groups - such as Jewish women of Eastern European (Ashkenazi) descent tend to have a higher prevalence (2.5%) of the BRCA gene mutations.

BRCA gene mutations are also seen in some African-American and Hispanic women.

 

                                              Image of a BRCA Gene

                                         Licensed image for CosmeticSurgeryForums.com

                                                                 Image of BRCA Gene

 

 

A blood sample is taken for testing. This test requires the blood to be drawn in a laboratory, doctor's office, hospital or clinic and sent to a laboratory that specializes in these tests. The results can take up to several week before they are available.  

Genetic counseling is generally recommended before and after a genetic test. This counseling should be performed by a health care professional who is experienced in cancer genetics. Women who do test positive for the BRCA Cancer gene tend to view preventative mastectomy as the best way to reduce their risk of developing breast cancer.

 

 

  • Candidates for the BRCA Testing

BRCA Genetic Testing is available to women who have the following:

  • Breast cancer in two or more close relatives (mother and two sisters)

  • Early onset of breast cancer in a family member before the age of 50.

  • History of breast cancer in more than one generation

  • Frequent occurrence of ovarian cancer

  • One or more BRCA positive relatives

  • Eastern and Central European (Ashkenazi) Jewish ancestry, with a family history of breast and or ovarian cancer (both the BRCA1 mutation and the BRCA2 mutation are prominent in this group)

 

 

 

Other diagnostic testing available for breast cancer:

 

 

 

 

According to the United States Cancer statistics Working Group in 2004 - 186,772 women and 1,815 men were diagnosed with breast cancer, with 40,954 women and 36s men died from this insidious disease. Breast Cancer Awareness Month is coming up soon – so make sure you get to your physician and have a full diagnostic work up done. 

There are a couple of women on this forum that have had the unpleasant experience of dealing with a diagnosis of breast cancer, and it is amazing to see the fortitude they both had to face this disease and how they overcome the odds.

Beating breast cancer with the diagnosis, surgery and the treatment afterwards takes a remarkable person. Each of us realize how fragile life can be it is so important to see the odds these ladies overcame to reclaim their lives once again. A month after being diagnosed with breast cancer, actress Christina Applegate who is 36 years old is 100% cancer free now.  She wanted to know that she never had to worry about this happening again, so she elected to have a bilateral mastectomy. 

After testing positive for the BRCA1 breast cancer gene, the cancerous lump was found only in one breast. Yet, she decided to have both removed, so she would never have to walk down this road again. Christina Applegate is going to have bilateral breast reconstruction in a few months. 

It been stated that breast cancer in young women is “uncommon”.  Only 4% of women diagnosed with breast cancer every year in the United States are under 40, but that still represents 8,000 women. The American Cancer Society's records for 2000-2004 show that 95% of new cases and 97% of breast cancer deaths happened in women age 40 and older and the median age at diagnosis was 61. Yet breast cancer can be more aggressive in young women than in older women. 

Christina Applegate’s cancer was found through an MRI, and it is important to say that any woman that is showing positive for the BRCA1 or BRCA2 [breast cancer] gene – that they should in fact get a routine MRI to make sure. This MRI saved her life. If a patient should have dense breasts, an MRI could be extremely beneficial with finding a tumor.

 

 

 

 

More Breast Reconstruction and Breast Cancer Information:

 

 

 

 

 

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