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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7 reasons breast cancer survivors shouldn’t be afraid of menopause

I've watched the breast cancer struggle of a close friend over the past few years. She was diagnosed with breast cancer in her early 30s. She fought the toughest fight I've ever watched and she beat that cancer into the ground with a smile on her face and a hop in her step. Now, she has to face the threat of her cancer recurring because she has not passed into menopause. Typically, breast cancer survivors are encouraged to undergo a complete hysterectomy to reduce the risk of relapse or new cancer, but my friend has chosen to keep her womanhood intact. I often wonder, as a woman in her early 30s and in menopause, if there is a fear associated with menopause that stops some breast cancer survivors from having a hysterectomy. Menopause is easy compared to fighting cancer, so here are seven reasons breast cancer survivors shouldn't be afraid of menopause.

Hot flashes don't last forever. I've been in menopause for about five years and I have very few hot flashes. For the first few years I suffered late night hot flashes nearly every night, but they fade.

There are alternatives to estrogen therapy. Estrogen therapy is not an option for breast cancer survivors, but other treatments are available. Doctors can prescribe antidepressants, blood pressure medications and seizure medications to treat hot flashes and other menopause symptoms.

You'll still want to have sex. Many women worry that they'll lose their sex drive after menopause. Nope, I can attest to the fact that you still want to take a trip between the sheets, but sometimes it takes a little more coercion to feel as hot as you did before menopause.

You can still have an orgasm. This was the myth I was worried about when my doctor told me he would be removing my cervix. During an orgasm the cervix moves up and down and I thought this had something to do with the feeling of an orgasm. I was quickly convinced that your cervix is not needed to have an orgasm and I learned for myself in the months following menopause.

Vaginal dryness is painful. Yes, vaginal dryness can be annoying, especially during sex, but there are over the counter lubricants that work wonders. Choose one in a cute bottle that heats or cools to increase sensitivity.

You're still a woman after menopause. I was scared that I would never feel like a woman again, but I was even more scared of turning into a man. Without estrogen I thought my breasts would shrink, I'd start growing facial hair and my voice would lower. That silly thought was soon proven wrong when none of those things happened.

You will be able to lose weight and stay fit. I asked my doctor about testosterone production, as some women in menopause have trouble with low testosterone, which can cause side effects like reduced sex drive. I was told the adrenal gland picks up testosterone production for most women, so I wouldn't lose my ability to build muscle, maintain muscle and feel sexy.

Breast cancer survivors are some of the bravest people in the world, especially my friend and secret muse. I watch her struggles with mammograms and wonder what is keeping her from taking that final step to protect her from another bout of breast cancer. Hopefully, if she is reading, she'll feel a little better about menopause.

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Women in the U.K. May Lose Access to Important Breast Cancer Drugs

SALT LAKE CITY (Reuters) - Elizabeth Smart, who was kidnapped at age 14 from her Utah home and held for what she described as "nine months of hell," exchanged vows on Saturday with her boyfriend of the past year at a private wedding in Hawaii, her uncle told Reuters. Smart, 24, and Matthew Gilmour, whom she met while she …

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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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Psychotherapy May Ease Hot Flashes After Breast Cancer

TUESDAY, Feb. 14 (HealthDay News) -- After breast cancer treatment, many women suffer from hot flashes and night sweats, but a type of "talk therapy" might relieve these symptoms for some women, British researchers suggest.

In a new study, women who received this form of psychotherapy, known as cognitive behavioral therapy, had reduced their symptoms by half within six months.

"Hot flashes and night sweats are distressing symptoms, which cause social embarrassment and sleep problems, and they are challenging to treat, especially for women who have had breast cancer" because hormone replacement therapy is generally not recommended for these women, explained lead researcher Myra Hunter.

According to background information in the study, which is published in the Feb. 15 online edition of The Lancet Oncology, 65 percent to 85 percent of women have hot flashes after breast cancer treatment.

Group cognitive behavioral therapy is a safe and effective treatment for women who have hot flashes and night sweats following breast cancer treatment, Hunter said, with additional benefits to mood, sleep and quality of life.

"The women in this trial reported frequent and problematic symptoms and relatively low quality of life," said Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry.

Hunter's team randomly assigned 96 women who had been treated for breast cancer and suffered from night sweats and hot flashes to either "talk therapy" or usual care.

The 47 women who received the therapy attended weekly 90-minute sessions for six weeks. For the others, usual care consisted of access to nurses and oncologists, telephone support and cancer support services, the researchers noted.

The therapy sessions included psycho-education, paced breathing, and behavioral strategies to manage hot flashes and night sweats, as well as interactive PowerPoint presentations, group discussion, handouts and weekly homework, Hunter said.

In addition, participants learned how to handle the stress associated with hot flashes and night sweats, and found new ways to decrease anxiety, she explained.

The women were also taught to manage hot flashes in social situations and to understand night sweats and improve sleep habits using mental and behavioral strategies.

The investigators found that the women who had received the cognitive behavioral therapy significantly reduced the number of hot flashes and night sweats they experienced in the nine weeks after the start of the study.

This reduction in symptoms lasted for 26 weeks. At nine weeks there was a 46 percent reduction in symptoms and a 52 percent reduction at 26 weeks, Hunter's team found.

However, among women receiving usual care, hot flashes and night sweats decreased by 19 percent after nine weeks and 25 percent after 26 weeks.

"These reductions were sustained and associated with significant improvements in mood, sleep and quality of life," Hunter said. "This is a safe, acceptable and effective treatment option, which can be incorporated into breast cancer survivorship programs and delivered by trained breast cancer nurses."

Holly Prigerson, director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, wrote an accompanying journal editorial.

"Hot flashes and night sweats are very common, distressing and persistent -- women reported being troubled by them for an average of two years after breast cancer treatment," Prigerson said.

She noted that the new study provides sound evidence upon which to recommend cognitive behavioral therapy for breast cancer patients suffering from these symptoms.

"Adaptations to an online, self-management version of the intervention would allow for more flexible scheduling and greater access at potentially lower cost of delivery," Prigerson said. "Combining the intervention with medications that effectively treat hot flashes and night sweats might produce the most dramatic effects with reductions in symptoms as well as the distress caused by them."

Prigerson said this type of therapy might also be used to treat postmenopausal women suffering from these symptoms.

"Of course, scientifically, we can't generalize beyond the sample of women who experience menopausal symptoms as a result of treatment for breast cancer," she said. "But given that they found that [this type of therapy] worked on the distress associated with hot flashes and night sweats, then it would seem likely to generalize to menopausal symptoms experienced outside of this context."

More information

For more about psychotherapy, visit the U.S. National Institute of Mental Health.

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Pregnant With Breast Cancer: Tough Choices, New Hope

Zoila Leiva was 4 ½ months pregnant with twins when her doctor delivered the devastating news: She had breast cancer. And it was advanced.

Ten months earlier, Leiva was told the lump in her right breast was benign -- a swell of fluid that would subside with time. Instead, the lump grew. And biopsies revealed it was a stage III tumor that had already spread to her lymph nodes.

"The oncologist said, 'The only way we can treat you, the only way we can save your life, is for you to have an abortion," said Leiva, who was 38 at the time, with a 14-year-old daughter. "I had two weeks to make a decision."

Chemotherapy drugs are toxic to tumors. And depending on the drug and the stage of pregnancy, they can harm fetuses, too. At her oncologist's request, Leiva attended an "abortion orientation" session that left her troubled after she learned about the three-day procedure to terminate her pregnancy.

But, she said, "Those babies were already moving inside me. I couldn't do it."

Instead, Leiva looked for a second opinion and found an oncologist willing to start treatment right away.

Chemotherapy for breast cancer can be safe during the second and third trimesters of pregnancy, according to a new report in The Lancet. And terminating the pregnancy does not appear to improve the mother's prognosis.

"The situation remains challenging since in some situations an advanced cancer can be fatal for mother and fetus," said Dr. Frédéric Amant of the Leuven Cancer Institute in Belgium, lead author of the report. "The patient and her partner should be informed about the different treatment options and the physician should explain that termination of pregnancy does not seem to improve maternal outcome, but the decision to continue or end the pregnancy is a personal one."

In a separate study published in The Lancet Oncology, children whose mothers underwent chemotherapy during pregnancy were found to be normal on measures of general health, behavior and growth out to 18 years of age.

One week after her first round of chemo, Leiva's hair started to fall out. She hoped to hang on to some of it for her daughter's Quinceañera -- a Cinderella-themed birthday celebration with a 350-strong guest list.

"The stylist pulled off a miracle that day. My hair looked really good," she said. "It all came out the next day."

Over 12 weeks, Leiva had four rounds of chemo. During that time, she said the tumor shrunk to near nothingness. But the stress was hard to bear.

"It was a real rollercoaster," said Leiva. "But I would go to chemo, with my bald head and big belly, and I actually looked forward to it. It was nice having all those women around me."

Leiva's doctors said she was an inspiration to other breast cancer patients.

"Pregnant patients are warriors," said Dr. Jane Kakkis, Leiva's surgical oncologist and medical director of breast surgery at Orange Coast Memorial Medical Center in Fountain Valley, Calif. "Most pregnant women are more concerned about their child's life, but they also want to be around to care for their baby."

Kakkis said the goal in Leiva's case was to save three lives, which took a lot of team work.

"These patients need extremely individualized care and a lot of communication between the treatment team," she said.

Thirty-two weeks into her pregnancy, Leiva delivered two boys by C-section. Julian weighed 4 pounds, 3 ounces; Joel weighed 3 pounds 12 ounces.

"I had three high-risk obstetricians in my delivery room," said Leiva, alluding to fears that her preemies would be small and weak. "But they were breathing on their own, eating on their own. They were strong boys. And they're still strong boys."

After the birth, Leiva quickly started a second string of chemo treatments with a more aggressive and toxic combination of drugs. And when her boys were 6 months old, she had both breasts and 11 lymph nodes removed.

"I didn't want to risk it," Leiva said, explaining her decision to opt for the radical 13-hour surgery over the less invasive lumpectomy. "These babies need to have their mother for a long time."

After the surgery, she had six more rounds of chemo and seven weeks of radiation.

"I wasn't really able to enjoy them as baby-babies," said Leiva, whose babies are now 3 years old. "But I was always thinking about when I get better, when my boys get bigger, and how I was going to be around to see it all."

Although pregnancy does not increase the risk of breast cancer, the decision by some women to delay motherhood might be increasing the number of pregnant women with cancer, according Lillie Shockney, a breast cancer nurse at Johns Hopkins Hospital in Baltimore.

"We know age is a risk factor, and so is having your first child after age 30," said Shockney, who is also an associate professor of surgery, gynecology, oncology and obstetrics at Johns Hopkins University School of Medicine. Pregnancy also causes breast changes that can mask the signs of cancer, delaying the diagnosis.

"I think a key message for women having babies if they see something different about their breasts -- even if a doctor says, 'Oh, your breasts are going to change because you're pregnant' -- go to a breast center for a clinical exam," she said. "Changes in one breast, not both, are a classic sign that something's wrong. Follow your instincts."

Also Read

View the original article here

Pregnant With Breast Cancer: Tough Choices, New Hope

Zoila Leiva was 4 ½ months pregnant with twins when her doctor delivered the devastating news: She had breast cancer. And it was advanced.

Ten months earlier, Leiva was told the lump in her right breast was benign -- a swell of fluid that would subside with time. Instead, the lump grew. And biopsies revealed it was a stage III tumor that had already spread to her lymph nodes.

"The oncologist said, 'The only way we can treat you, the only way we can save your life, is for you to have an abortion," said Leiva, who was 38 at the time, with a 14-year-old daughter. "I had two weeks to make a decision."

Chemotherapy drugs are toxic to tumors. And depending on the drug and the stage of pregnancy, they can harm fetuses, too. At her oncologist's request, Leiva attended an "abortion orientation" session that left her troubled after she learned about the three-day procedure to terminate her pregnancy.

But, she said, "Those babies were already moving inside me. I couldn't do it."

Instead, Leiva looked for a second opinion and found an oncologist willing to start treatment right away.

Chemotherapy for breast cancer can be safe during the second and third trimesters of pregnancy, according to a new report in The Lancet. And terminating the pregnancy does not appear to improve the mother's prognosis.

"The situation remains challenging since in some situations an advanced cancer can be fatal for mother and fetus," said Dr. Frédéric Amant of the Leuven Cancer Institute in Belgium, lead author of the report. "The patient and her partner should be informed about the different treatment options and the physician should explain that termination of pregnancy does not seem to improve maternal outcome, but the decision to continue or end the pregnancy is a personal one."

In a separate study published in The Lancet Oncology, children whose mothers underwent chemotherapy during pregnancy were found to be normal on measures of general health, behavior and growth out to 18 years of age.

One week after her first round of chemo, Leiva's hair started to fall out. She hoped to hang on to some of it for her daughter's Quinceañera -- a Cinderella-themed birthday celebration with a 350-strong guest list.

"The stylist pulled off a miracle that day. My hair looked really good," she said. "It all came out the next day."

Over 12 weeks, Leiva had four rounds of chemo. During that time, she said the tumor shrunk to near nothingness. But the stress was hard to bear.

"It was a real rollercoaster," said Leiva. "But I would go to chemo, with my bald head and big belly, and I actually looked forward to it. It was nice having all those women around me."

Leiva's doctors said she was an inspiration to other breast cancer patients.

"Pregnant patients are warriors," said Dr. Jane Kakkis, Leiva's surgical oncologist and medical director of breast surgery at Orange Coast Memorial Medical Center in Fountain Valley, Calif. "Most pregnant women are more concerned about their child's life, but they also want to be around to care for their baby."

Kakkis said the goal in Leiva's case was to save three lives, which took a lot of team work.

"These patients need extremely individualized care and a lot of communication between the treatment team," she said.

Thirty-two weeks into her pregnancy, Leiva delivered two boys by C-section. Julian weighed 4 pounds, 3 ounces; Joel weighed 3 pounds 12 ounces.

"I had three high-risk obstetricians in my delivery room," said Leiva, alluding to fears that her preemies would be small and weak. "But they were breathing on their own, eating on their own. They were strong boys. And they're still strong boys."

After the birth, Leiva quickly started a second string of chemo treatments with a more aggressive and toxic combination of drugs. And when her boys were 6 months old, she had both breasts and 11 lymph nodes removed.

"I didn't want to risk it," Leiva said, explaining her decision to opt for the radical 13-hour surgery over the less invasive lumpectomy. "These babies need to have their mother for a long time."

After the surgery, she had six more rounds of chemo and seven weeks of radiation.

"I wasn't really able to enjoy them as baby-babies," said Leiva, whose babies are now 3 years old. "But I was always thinking about when I get better, when my boys get bigger, and how I was going to be around to see it all."

Although pregnancy does not increase the risk of breast cancer, the decision by some women to delay motherhood might be increasing the number of pregnant women with cancer, according Lillie Shockney, a breast cancer nurse at Johns Hopkins Hospital in Baltimore.

"We know age is a risk factor, and so is having your first child after age 30," said Shockney, who is also an associate professor of surgery, gynecology, oncology and obstetrics at Johns Hopkins University School of Medicine. Pregnancy also causes breast changes that can mask the signs of cancer, delaying the diagnosis.

"I think a key message for women having babies if they see something different about their breasts -- even if a doctor says, 'Oh, your breasts are going to change because you're pregnant' -- go to a breast center for a clinical exam," she said. "Changes in one breast, not both, are a classic sign that something's wrong. Follow your instincts."

Also Read

View the original article here

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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Roche breast cancer drug gets FDA priority review

A lead poisoning epidemic in Nigeria's north that has killed 400 children and affected thousands is the worst in modern history, but cleanup has not even begun in many areas, Human Rights Watch said Tuesday.

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