Post mastectomy - and post lymphoedema diagnosis (upper and lower extremity) What is the way forward?

• Mastectomy Overview

  A mastectomy is surgery to remove a breast.

  How is it diagnosed?

  Symptoms include:

  • A lump in the breast or armpit
  • Thickening of breast skin or tissue that lasts through your period
  • A change in the size, shape, or contour of the breast
  • Clear or bloody fluid coming from the nipple
  • A change in how the skin on your breast or nipple looks or feels. It may look dimpled, puckered, scaly, or inflamed.
  • Redness of your breast or nipple
  • An area on your breast that clearly looks different from any other
  • A hard, marble-like area under the skin of the breast tissue.

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  Classification and treatment protocol is due to various factors.

  These include:

  • Tumor size
  • Tumor stage (how far it’s spread)
  • Tumor grade (its aggressiveness)
  • Tumor’s hormone receptor status
  • Whether or not lymph nodes are involved

  Diagnosis usually occurs by physical examination (but not in all cases). Then a mammogram is preferred, as well as a sonar and biopsy to follow.

• Types of Mastectomy

  Preventive Mastectomy

  Women who have a high risk of breast cancer may choose to have a preventive mastectomy, also called prophylactic mastectomy.

  Studies show that women with a high risk of breast cancer may be as much as 90% less likely to get the disease after preventive mastectomy.

  Usually, a total mastectomy — removing the entire breast and nipple — is recommended. In some cases, women have both breasts removed. This is called a double mastectomy.

  Some women who’ve had breast cancer in one breast will decide to have a preventive mastectomy to remove the other breast. This can reduce the chance of cancer reoccurrence.

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  Partial Mastectomy

  Women with stage I or stage II breast cancer may have this procedure. It’s is a breast-conserving method in which the tumor and the tissue surrounding it are all that’s removed.

  The surgery is often followed by radiation therapy to the remaining breast tissue. With radiation therapy, powerful X-rays target the breast tissue. The radiation kills cancer cells and prevents them from spreading, or reoccurring.

  There are two kinds:

  • A lumpectomy removes the tumour and a small cancer-free area of tissue surrounding the tumour.
  • A quadrantectomy removes the tumour and more of the breast tissue than a lumpectomy.

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  Radical Mastectomy

  A radical mastectomy is the complete removal of the breast, including the nipple. The surgeon also removes the overlying skin, the muscles beneath the breast, and the lymph nodes.

  This procedure I have personally only seen in 3 of my patients.

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  Modified Radical Mastectomy

  A less traumatic and more widely used procedure is the modified radical mastectomy (MRM). With the modified radical mastectomy, the entire breast is removed as well as the underarm lymph nodes. But chest muscles are left intact. The skin covering the chest wall may or may not be left intact.

• Fitting a Breast Prosthesis

  Step 1:

  Reach for recovery has then, in most cases consulted and provided the patient with soft filler prosthesis.  If this was not provided, I would provide a soft sponge breast form covered with a silk cover to provide shape and a better cosmetic appearance as soon as 3 days post operative.

     This sponge breast is soft against the skin and will not cause any skin irritation during the healing process even though a drain may still be present.

  This breast form may be used up to week six in the recovery process or until the skin has fully healed.

  When the patient is undergoing radiation treatment, this soft breast form will then be worn in a soft fitted shirt of cotton sport bra.

  I also recommend that this soft breast form be used at night time to sleep with as to comfort sleeping on the affected side.

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  Step 2:

  As soon as all healing, treatment and tenderness has subsided and my patient is emotionally ready for the next step, a permanent external silicon breast form can be fit.

  Consultation include that measurements are taken for under breast size or band size as well as breast cup size

  When a mastectomy is performed a full silicon breast form is provided.

• Different Shape Prosthesis

  Triangular shape

  Heart shape

  Teardrop shape

  These can be fit unilateral or bilaterally

  Individual unilateral breast forms are also available to provide a one sided fit and add more breast volume at the sides or under the arm.

   There is now evaluation that works for 2 patients alike.

  This comes with regular patient fitting experience and training

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  In the case where a lumpectomy was performed, a shell ( or single layer silicon breast form ) as well as a conform (a double layer breast form) can be fit.

  This partial form will fill a surgical site area to provide symmetry or be used to balance out uneven breast reconstruction sites

   

  These breast forms are mostly available in an oval or triangular shape.