My battle with breast cancer: Reconstruction after mastectomy

I am currently undergoing breast reconstruction after my mastectomy. In January 2012, my left breast was removed. I opted for a mastectomy over a lumpectomy for cosmetic reasons. My plastic surgeon said that I would achieve better cosmetic results this way. Is reconstruction an option for every woman?

The law

The Women's Health and Cancer Rights Act of 1998 (WHCR) states that if you undergo a mastectomy for any reason and your health insurance covers the procedure, then the insurance company must cover the cost of breast reconstruction. Any deductibles and co-payments still apply. The insurance company must also cover the cost of a prosthesis--if you choose to use one instead of having reconstructive surgery. Some insurance companies will cover both--check your policy or call for specific mastectomy and reconstruction benefits.

If you are on Medicaid or Medicare, there may be some limitations. Certain government sponsored insurance policies and some church based insurance policies are exempt from the WHCR. Most individual policies, employer-based policies and COBRA policies must abide by WHCR.

Reconstruction options

Deciding to have breast reconstruction is a very personal decision. Some women want immediate results and opt for a tram-flap or other reconstruction technique using body tissue. Any type of flap surgery involves removing fat, skin and sometimes muscle from one area of the body--like the abdomen or buttocks--and using that tissue to reconstruct the breast. Flap surgery is complicated and has risks, including possible necrosis of the transplanted tissue due to flap failure.

Implants are another option. I decided on implants after doing a lot of research. The recovery time and length of surgery a flap required did not appeal to me. With implants, immediate reconstruction is sort of a misnomer. For me, it meant tissue expanders were put in place during my mastectomy. I will have 10 weekly sessions to fill the expanders. After that, the expanders will be exchanged for implants.

Deciding not to reconstruct is another option many women decide on. Instead of having breasts reconstructed, a prosthesis is used. Special bras have pockets to hold the prosthesis in place. I am currently using a soft, foam and fiber-filled prosthesis until it is time for my expander exchange. Instead of a special bra, I use one from Victoria's Secret that has foam cups. Even under snug fitting shirts, you cannot tell unless you are looking for it. If you choose to go the prosthesis route, explore all of your options. Amazing results can be achieved with the use of silicon or other materials. Some breast prosthesis actually glue on. Specialized prosthesis for swimwear can be worn in the water.

The decision to reconstruct does not have to be made immediately. It is OK to wait until after adjuvent treatments are completed to make this decision. Breast cancer patients requiring radiation therapy or chemotherapy may want to postpone the decision to reconstruct until after they recuperate both physically and emotionally from the treatments. The best time to reconstruct is after you have researched your options and are comfortable with what you want to do.

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Bird Flu Studies Can Be Published After All: WHO

SATURDAY, Feb. 18 (HealthDay News) -- Research on a mutated, more contagious form of the bird flu virus can be published in full, the World Health Organization announced Friday, despite concerns that bioterrorists could use the information to start a pandemic.

The decision came during a special meeting of 22 bird flu experts in Geneva, Switzerland, that was convened by the WHO to discuss the "urgent issues" that have swirled around possible publication of the two bird flu studies since last November, The New York Times reported Saturday.

Most of those at the meeting felt that any theoretical terrorist risk was outweighed by the "real and present danger" of similar flu virus mutations occurring naturally in the wild, and by the need for the scientific community to share information that could help identify exactly when the virus might be developing the ability to spread more easily, Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told the Times. Fauci represented the United States at the meeting.

"The group consensus was that it was much more important to get this information to scientists in an easy way to allow them to work on the problem for the good of public health," Fauci said. "It was not unanimous, but a very strong consensus."

However, Fauci added, the United States was not part of that consensus. U.S. bio-security chiefs had urged last November that critical specifics of the papers remain unpublished.

Although the bird flu virus, known as H5N1, rarely infects people, it appears to be highly lethal when it does. Of about 600 known cases, more than half have been fatal. If the virus were able to spread more easily from birds to humans, experts have estimated that millions of people could die after being infected.

The two studies at the center of the debate were to be published in the journals Science and Nature late last year. The papers, which were funded by the U.S. National Institutes of Health, describe how the H5N1 virus could mutate relatively easily into a strain that could spread rapidly among humans. The research was done by scientists at the University of Wisconsin and in the Netherlands.

The editors of both journals said they plan to publish the papers in full at a future date.

"Discussions at the WHO meeting made it clear how ineffective redaction and restricted distribution would be for the Nature paper. It also underlined how beneficial publication of the full paper could be. So, that is how we intend to proceed," Dr. Philip Campbell, editor-in-chief of Nature, said in a statement. "As was expressed at the WHO meeting, there is a need first to explore how best to communicate the issues of publication to a concerned public, and to review safety assurance of labs who would act on this publication. I fully support the WHO's further efforts in this regard."

Speaking at a scientific meeting in Vancouver, Science editor-in-chief Bruce Alberts had this to say about the WHO decision: "So, my reading is that both Nature and Science are to wait until we get some further information from the WHO and other authorities of when, in fact, we are to publish the full manuscript."

Before the two studies can be published, the experts at the WHO meeting said, security assessments must be made, the Sydney Morning Herald reported.

Another meeting on the remaining issues will be held at a future date, the WHO said in a statement.

The scientists behind the research had agreed on Jan. 20 to honor a 60-day moratorium on further studies, the Herald reported, but that deadline will now be extended for an unspecified time to allow for a wider examination of the risks and for public discussion.

More information

For more on how the bird flu virus might be able to infect humans, visit the U.S. National Institute of Allergy and Infectious Diseases.

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Woman Dies After Contracting Legionnaires' Disease From Dentist's Office

An 82-year-old Italian woman died after she contracted Legionnaires' disease, a severe, pneumonia-like illness, from the water in her dentist's office, according to a case report published in the journal The Lancet.

Scientists who determined the source of the woman's illness, which occurred in February 2011, said during the disease's incubation period the woman only left her home twice to visit her dentist.

When they tested the water in both places, they discovered the bacteria that causes Legionnaires' in the dentist's water line. Water lines carry water from the main water supply to certain devices used during patient care.

While the authors wrote the most common sources of infection are air conditioning systems, hot water systems, spas and fountains, a recent study found dental water lines to be another major source of contamination with Legionella bacteria. Legionella pneumophila is the bacterial strain that causes Legionnaires' disease.

"However, as far as we are aware, no case of Legionnaires' disease has been associated with this source of infection," added the authors, led by Maria Luisa Ricci of the Italian National Health Service.

While it was not clear what kind of water line standards were in place in Italy, in the U.S., the American Dental Association (ADA) said infection control standards are very stringent in order to prevent cases like the one in Italy from happening.

"Since the ADA convened a special task force in the mid-1990s focusing on infection prevention, there have been a number of recommendations made to treat the water and keep the number of bacteria down," said John Molinari, the ADA's spokesman on infection control, infectious diseases and allergic reactions.

The ADA recommends that dental water lines contain no more than 500 colony-forming units of bacteria per milliliter of water, the same limit recommended by the U.S. Centers for Disease Control and Prevention.

The ADA also recommends that dentists monitor water quality and maintain a water reservoir that is separate from the municipal water supply, as well as use filters that will keep microorganisms out of the water.

Legionella bacteria is one of the most common types of bacteria found in water.

"Legionella is found in old homes, shower heads and anywhere else there can be stagnant water," Molinari said.

Most dentists take the necessary precautions to protect their water lines from contamination, but Molinari said that the Italian case is an important reminder.

"This report sends the message that it can happen," he said.

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Bird flu study publication gets go-ahead after security check

Bird flu experts meeting in Geneva ruled that controversial research on a mutant form of the virus potentially capable of being spread among humans should be made public.

Security assessments must however be carried out first before the two studies can be published and the research can continue, scientists agreed at a two-day meeting at the World Health Organization.

"The consensus was that in the interest of public health the full papers should be published," said Professor Ron Fouchier from the Institute of Virology in the Netherlands, the scientist behind one of the studies.

US bio-security chiefs urged in November that key details of the papers remain unpublished, citing fears of a pandemic should a mutated H5N1 virus escape the laboratory.

Scientists agreed on January 20 to a 60-day moratorium on further studies.

That deadline will now be extended for an unspecified time to allow for a wider group of scientists to examine the risks and allow for public discussion, Fouchier said at a conference following the meeting.

"This is very important research that needs to move forward," he said.

"The question is, how can it be done safely, what about bio-security, how do we prevent access to bad people?"

"Once there's agreement on all those issues then we can continue our work."

The 22 participants included the two teams of researchers and representatives of the scientific journals Science and Nature who were asked to withhold publication.

The editor of the US journal Science said later Friday he supports the decision of the bird flu experts in Geneva.

"The supreme court of decision-making on these things should not be me," said Bruce Alberts, editor-in-chief of Science, which along with the British journal Nature had been on track to publish partial versions of the research in March.

Alberts said the two journals were working closely with each other and with authorities, and would await further information before making plans to publish the manuscripts in full in the months ahead.

"Many people in the government worked very hard to try to see whether they could develop a mechanism that could be used to selectively get redacted information to the right people, and they came across all kinds of difficulties."

The engineered virus, created by two separate research teams in the Netherlands and Wisconsin, was able to spread through the air among mammals, indicating it could potentially be deadly to humans on a massive scale.

Alberts said he hoped that the decision taken after the two-day Geneva meeting would lead to the creation of an international body of scientists and biosecurity experts for making future decisions on such matters.

"The very best possible outcome for this is the establishment of an international version of the NSABB," he said, referring to the National Science Advisory Board for Biosecurity, a US advisory panel that urged the government, which had funded the research, to withhold key details from publication.

However, NSABB leaders said last year that an international decision was needed and that they would obey any decision agreed by the global science community.

Avian influenza H5N1 is primarily transmitted between birds and very rarely to humans.

The Dutch team and another from the University of Wisconsin in the United States found ways late last year to engineer the virus so that it could be transmitted among mammals.

The breakthrough raised alarm that the method could fall into the wrong hands and unleash a massive flu pandemic that could cost millions of lives.

The WHO said 345 people have died from H5N1 from a total of 584 cases in 15 countries. The majority of victims have been in Indonesia.

"Given the high death rate associated with this virus all participants at the meeting emphasised the high level of concern with this flu virus in the scientific community and the need to understand it better with additional research," said Dr Keiji Fukuda, WHO assistant director general of health security.

The body underlined the need to increase public understanding of the research and to review bio-security issues.

The WHO will host further meetings "soon" with a wider range of scientists.

"This was a group of experts on influenza research," said Fouchier.

"We need to consult with the broader scientific community."

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After 37 years, Washington D.C. gets mental health system

A microchip inserted under the skin has been shown for the first time to successfully deliver a bone-loss drug to a small sample of women, according to US-led research published Thursday.

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Talk Therapy Eases Hot Flashes After Breast Cancer Treatment

It was a bad dream that prompted 38-year-old Sheryl Alberico of Los Angeles to demand the mammogram that saved her life.

Although it was small, the pea-size tumor in Alberico's left breast was aggressive. Within weeks, doctors would remove both breasts and pump toxic drugs throughout her body "just in case."

Now, one day after her fourth and final round of chemotherapy, something else is haunting Alberico's sleep: Unrelenting hot flashes.

"Last night I woke up every hour," said Alberico, who is currently on disability leave from her job as an architect. "It just hits you. It feels like there's a fire inside you."

Up to 85 percent of women treated for breast cancer experience hot flashes and night sweats, the often debilitating symptoms of menopause brought on by the hormone-disrupting cancer treatments.

"I wake up my husband kicking off the covers. Neither of us gets any sleep," said Alberico, who routinely irons the cotton sheets to keep them "crisp and cold." "Sometimes I have to get up and take a shower just to cool down."

Certain drugs can provide some relief, but they don't work for everyone.

"Hormone therapy generally isn't recommended for these women because of its association with breast cancer," said Myra Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry. "And many women want to take a non-medical approach."

Hunter and colleagues investigated whether group cognitive-behavioral therapy, a psychotherapy aimed at changing perceptions rather than physical symptoms, could help breast cancer survivors cope with hot flashes and night sweats by changing the way they think about them.

"There is some evidence that cognitive-behavioral therapy can help well women [who do not have breast cancer] cope with hot flashes and night sweats related to menopause," said Hunter. "If we can help them to counter their negative thoughts, they can learn to really let the flash flow over them."

In a study of 96 breast cancer survivors, women who received six 90-minute cognitive-behavioral therapy sessions reported significantly fewer problems with hot flashes and night sweats than women who received the usual care. The findings were published Tuesday in the Lancet Oncology.

"They're still having hot flashes, but they don't notice them as much," said Hunter.

Using relaxation techniques such as "paced breathing," the women learned to counteract the stress, embarrassment of hot flashes and their effects on mood and sleep.

Holly Prigerson, director of psychosocial oncology at the Dana-Farber Cancer Institute, said the study "demonstrates the power of the mind as medicine."

"By encouraging someone to think about physical symptoms in a different way -- a way that's less stigmatizing and more normalizing -- you can substantially improve her quality of life," said Prigerson, who wrote an editorial accompanying the study. "Just like anxiolytics or antidepressants, how you think about something can have a dramatic influence on how you feel physically and mentally."

An online version of the therapy sessions could improve access for women limited by money, geography and busy schedules, Prigerson said. But there are advantages to sharing the experience with a group of women in the same boat.

"This study didn't really parse out the effect of sharing with a group of other breast cancer survivors -- how the social support of sisters in suffering might also prove empowering and make women more resilient," Prigerson said.

Learning to counter negative emotions can give women back some of the control they feel they lost during their cancer diagnosis and treatment, Hunter said.

"I think it's very empowering, actually, because they've been going through a process where they feel as if their bodies are being managed by other people," she said. "The cognitive-behavioral therapy approach lets them feel as though they've got some control, and think they can apply that to different areas of their life."

After a double mastectomy and aggressive chemotherapy, Alberico said she likes the sound of cognitive-behavioral therapy.

"I'm just sick of all the pills and needles," she said. "If I can do something more natural, that's better. I'm in my 30s, and this is going to go on for a while, so it can't hurt to try."

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Official quits US breast cancer group after funding row

A senior executive with the US-based Komen breast cancer foundation with strong anti-abortion views stepped down Tuesday in the aftermath of a bruising funding furor with Planned Parenthood.

In a statement, the Susan G. Komen for the Cure said it had accepted the resignation of Karen Handel, its senior vice president for policy since April 2011 and a one-time Republican candidate for governor of Georgia.

"I have known Karen for many years, and we both share a common commitment to our organization's lifelong mission, which must always remain our sole focus," Komen founder Nancy Brinker said. "I wish her the best in future endeavors."

On Friday, Komen reversed its decision to stop funding breast screenings at Planned Parenthood clinics after an outcry over the move triggered a political and fund-raising backlash by women's health advocates.

Handel, 49, was widely believed to have been a key player in Komen's decision to end its long-standing ties with Planned Parenthood, given her opposition to abortion.

She had been hired by Komen to be its vice president for public policy and chief lobbyist in Washington.

But in her letter of resignation, Handel said the decision to cut funding was not based "on anyone’s political beliefs or ideology," according to an excerpt in the Atlanta Journal-Constitution newspaper.

She said the way Komen gives money to other organizations had been revised before she joined the foundation, and the decision to halt funding to Planned Parenthood had been vetted at all levels.

"I am deeply disappointed by the gross mischaracterizations of the strategy, its rationale, and my involvement in it," she wrote in her emailed letter to Brinker.

"I openly acknowledge my role in the matter and continue to believe our decision was the best one for Komen’s future and the women we serve."

Last week's very public row drove in nearly $3 million in donations for Planned Parenthood in a matter of days, before Komen backed down and apologized, pledging to continue its funding.

Planned Parenthood is the biggest single abortion provider in the United States, especially for low-income women, while Komen has been a leader in the fight against breast cancer with its high-profile "pink ribbon" campaigns.

Komen had initially said it would cease funding because Planned Parenthood was under investigation, and new rules agreed by the charity's leadership allowed it to stop issuing grants to groups in such cases.

The probe was by a Republican lawmaker from Florida, Cliff Stearns, who launched an inquiry into Planned Parenthood over how it handled federal funds and whether such money was used for abortions, which would be illegal.

The ensuing row saw an outpouring of support for Planned Parenthood, with 10,000 supporters -- including New York Mayor Michael Bloomberg and Tour de France cyclist and cancer survivor Lance Armstrong -- coming forward to help.

Komen reversed its decision on Friday, as Planned Parenthood alleged that the foundation had been the victim of what it called "political bullying" on the part of anti-abortion activists.

In her statement Tuesday, Brinker said: "We have made mistakes in how we have handled recent decisions and take full accountability for what has resulted, but we cannot take our eye off the ball when it comes to our mission."

She added: "The stakes are simply too high and providing hope for a cure must drive our efforts."

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