HEALTH & BEAUTY Depending on the agent used and the woman’s age, the risk of infertility following chemotherapy can be affected. achieved in 10-20% of cases, as well as significant reduction in tumour bulk in most cases. Rates of over 40% in complete pathological response have been seen in some HER-2 positive breast cancers that are more aggressive and historically have had a poorer prognosis (refer Image 1). Larger numbers of women are choosing mastectomy over lumpectomy and also electing to have a contralateral prophylactic mastectomy with combined immediate reconstruction. This trend as a personal choice has increased over the last decade and has the advantage of reducing the long tail of surveillance required for younger women with breast cancer. There has also been an increase in the rate of nipple preservation with subcutaneous mastectomy, which allows for a superior cosmetic result and optimises the psychological wellbeing of patients. In the case of the more aggressive and less hormone-sensitive disease, patients will often be offered chemotherapy to improve the chance of survival. This results in a number of issues for consideration, including the patient’s management of fertility, early menopause and its associated symptoms, and dealing with major body image changes. This approach necessitates the engagement and cooperation of breast surgeons, oncologists, gynaecologists, psychologists and other health care professionals in the perioperative management of these patients. Depending on the agent used and the woman’s age, the risk of infertility following chemotherapy can be affected. Pregnancy after breast cancer has not shown to increase the risk of recurrence as a whole. The data, however, is limited and caution should be taken especially for high risk and ER positive patients. Treating high-risk patients with a family history requires referral to specialist clinics that provide screening services, genetic counselling and options for surgical prophylaxis for these patients. It is essential that the management of these be individualised to minimise risk and ensure the psychological wellness and comfort of each patient. Along with lumpectomy and mastectomy, oncoplastic surgery is also a management option for breast cancer, and offers breast-conserving surgery to women who were previously destined to have a mastectomy. With the latest techniques and the best principles of plastic surgery, surgical oncology achieves tumour-free margins and optimal cosmetic outcomes. As it allows wide margins, this option can result in a decreased recurrence and improved survival rate, as well as maintaining or improving the shape of the existing breast. There are numerous oncoplastic techniques that can be used, depending on the position of the tumour and its size relative to the breast. Level 1 oncoplastic volume displacement techniques are useful if < 20% of the breast is to be resected. Simple volume displacement techniques are used to move healthy breast tissue into the area where the tumour has been excised, thus filling the space left by the tumour and distributing the volume loss to the whole breast. Level 2 oncoplastic mammaplasty volume displacement techniques are used when 20-50% of breast volume is to be resected. Mammaplasty volume displacement techniques are used for larger tumours or when the tumour’s location renders simple methods unsuitable. The remaining breast tissue is refashioned and the nipple-areola is relocated into a better position, resulting in smaller but normally shaped breasts. When significant breast ptosis or excess breast volume is corrected during these procedures, surgery to opposite healthy breast can provide good symmetry and cosmetic results. Oncoplastic volume replacement techniques are used when removal of a large tumour does not allow a satisfactory cosmetic result. If inadequate breast tissue is present, local tissue flaps can be used for partial breast reconstruction. When mastectomy is required, it may be possible to preserve the breast skin, and in some cases the nipple as part of a breast reconstruction. pm Pindara M 62 agazine Summer | 2014/15
Pindara Private Hospital Magazine - Issue Three
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