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A New Paradigm for Breast Cancer Treatment and Reconstruction

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When a celebrity is diagnosed with a serious illness, considerable attention is drawn to that disease. Most recently, E! host Giuliana Rancic's decision to have a double mastectomy after being diagnosed with breast cancer has drawn national attention to an evolving paradigm for the treatment and rehabilitation of this disease.

Breast cancer affects around one in eight women during their lifetime in the USA. It is the second largest cause of cancer mortality. This year, almost 300,000 U.S. women will have been diagnosed with some form of breast cancer. A new trend in the treatment and rehabilitation with women diagnosed with breast cancer has evolved in many major medical centers.

When Dr. Eric Liao, a plastic surgeon at the Massachusetts General Hospital, and his colleagues reviewed the surgical treatment of over 3,000 patients during a 10-year period. He compared treatment and reconstructive modalities of women treated in the period between 1999 and 2004 with those treated in the period between 2005 and 2010. He found that in the more recent group, younger women were being diagnosed and treated for breast cancer, and that more women chose to have bilateral mastectomy (similar to Ms. Rancic) and reconstruction with implants.[1]

Over the last decade, the mean age at the time of diagnosis of breast cancer has decreased. In Dr. Liao's study, it decreased by seven years. This is a result of increased patient awareness, improved mammographic techniques and genetic testing. Discovery of a breast cancer at an early age increases the likelihood of cure, decreases the morbidity of treatment and broadens the spectrum of reconstructive options.

Dr. Liao's group found that there was more than a 2.5-fold increase in the number of women choosing bilateral mastectomy in the more recent patient group,. The majority of these underwent reconstruction with implants. Several factors impact on this decision. Patients found to have the BRCA gene mutation, which predisposes one to develop breast cancer have a high likelihood of developing breast cancer in both breasts. Hence, they choose to have both breasts removed at the time of breast cancer diagnosis. Removing both breasts predisposed to cancer avoids the anxiety of monitoring for the appearance of a cancer in the opposite breast.

An improved aesthetic outcome is particularly appealing to younger patients who are undergoing mastectomy. Reconstructing a breast after unilateral mastectomy to match the opposite un-operated breast is extremely challenging and often requires the surgeon to operate on the uninvolved breast. Bilateral mastectomy with immediate implant reconstruction avoids this problem thereby optimizing the chances for symmetry and improved aesthetic outcome. It is important to note that breast implants do not impair breast health. Careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases.

Even with ongoing procedural advances, it's important to keep in mind that a reconstructed breast will not have the same sensation and feel as the breast it replaces, and visible incision lines will always be present on the breast, either from reconstruction or mastectomy. But overall, reconstructive surgery can give women new breasts that feel natural and have an aesthetically pleasing appearance.

[1] Presented at the Annual Meeting of the Plastic Surgery Research Council, April, 2011.

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