DEAR MAYO CLINIC: My sister was just diagnosed with breast cancer and will have a double mastectomy. What types of reconstruction could she have, and when can the reconstruction be done? Are there any new reconstruction options that she should be aware of? I've heard about 3D tattooing. Is that an option?

ANSWER: Breast reconstruction is a procedure that restores the shape of your breast after mastectomy, which is an operation that removes your breast to treat or prevent breast cancer.

Breast reconstruction can be performed with either an implant — silicone devices filled with silicone gel or saline — or a patient's own tissue. Most people who undergo mastectomy tend to choose implant-based breast reconstruction, with a smaller portion opting for flap, or autologous, reconstruction. Breast reconstruction with flap surgery involves taking a section of tissue — skin, fat and occasionally muscle — from one area of your body, most often your abdomen, and relocating it to create a new breast mound.

Each method has its benefits and drawbacks. For example, implant-based breast reconstruction involves a shorter operation and recovery, whereas flap surgery is a longer, more complex operation with a longer recovery time. Also, implants are temporary and will require removal or replacement on average every 10 years. With flap surgery, typically, no further operations are necessary.

Breast reconstruction starts at the time of mastectomy. A team of breast oncologic and plastic surgeons working together to devise the appropriate plan for your needs is essential.

Depending on the location of the tumor and the patient's breast size, they may be a candidate for a nipple-sparing mastectomy, which allows for a more natural reconstruction appearance. A nipple-sparing mastectomy involves the removal of the breast tissue, but spares the skin, nipple and areola, also called the nipple-areolar complex.

If the tumor is abutting the nipple-areolar complex, the patient will need surgical removal of the nipple. Nipple reconstruction can be done with a 3D nipple-areola tattoo with or without the creation of a raised area of skin to reconstruct a raised nipple. 3D nipple tattooing is highly encouraged for all patients who have required surgical excision of the nipple-areolar complex. Data shows patients are more satisfied with reconstruction and can move forward from their cancer journey when reconstruction of the nipple is performed.

In the past, breast reconstruction would not provide the same sensations as before mastectomy. However, breast resensation is the new frontier within breast reconstruction. This is a new technique of breast nerve repair during breast reconstruction that can potentially restore feeling after a mastectomy. This can be done in one of two ways.

First, suppose the patient is a candidate for nipple-sparing mastectomy and is approximately a C cup or less at the time of mastectomy. In that case, we can identify the nerves on the lateral chest and bridge the gap beneath the nipple-areolar complex with a nerve graft. The nerve will then regenerate through the graft, providing sensation to the nipple-areolar complex. While this can take up to two years, it should restore light touch to the breast and nipple-areolar complex, but it will not fully return premastectomy breast sensation.

The second approach is pursued if the patient is undergoing flap surgery. We can identify a nerve on the tissue from the abdomen and connect that via nerve graft to a nerve in the chest. This can be an option for patients who have already had a mastectomy — and possibly implant-based breast reconstruction — and desire more sensation.

Breast reconstruction is an excellent option for many patients. It can give you a breast contour, provide symmetry to your breasts under clothing and help you avoid the need for an external prosthesis inside your bra. Many patients find that their self-esteem and body image improve after reconstruction, and it helps to erase physical reminders of their cancer journey. However, before breast reconstruction surgery, consult a plastic surgeon who is board-certified and experienced in breast reconstruction following mastectomy. — Dr. Christin Harless, Plastic Surgery, Mayo Clinic, Rochester, Minnesota

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While mastectomy can be a lifesaving procedure for many women with breast cancer, the surgery can take an emotional toll that can lead to a distorted self-image. Breast reconstruction can be part of a comprehensive treatment that can improve the appearance of the breasts, often improving a patient's self-confidence. Some women seek the next step in breast reconstruction.

"Most women go through reconstructive surgery after their treatment," says Jordan D. Miller, Ph.D., director of the Center for Surgical Excellence at Mayo Clinic. "But at the end of the day, how do you ensure that their journey to becoming cancer-free ends with full restoration of their self-image?"

That question was echoed by Dr. Alanna Rebecca, chair of Plastic and Reconstructive Surgery at Mayo Clinic in Arizona, who has observed a need for more resources for women to restore a sense of wholeness and completion following their surgeries.    

In many cases, the lack of a defined areola around the nipple is a significant issue for women who hope to return to normalcy following reconstructive surgery.

Dr. Rebecca's solution is 3D tattooing, technology that replicates the visual illusion of the areola. It is the final touch in the restoration. The goal is to provide a natural appearance if the color of the actual areola has faded or is irregular. 

It takes significant skill to simulate the natural shape, dimension and color of the nipple and areola, which is why Dr. Rebecca, Dr. Miller and Mark Stemler, a Mayo Clinic health systems engineering associate collaborated on the idea that would improve the appearance of the areola with color pigmentation that restores a realistic look.

Dr. Rebecca and her team worked diligently to not only provide a novel method of tattooing the nipple and areola area to create color-match technology, but also provide the safety that comes from being in a hospital or clinic setting that is required by the Centers for Medicare & Medicaid Services or the Joint Commission to implement appropriate sterilization measures. 

The team's idea was submitted to the Mayo Clinic Innovation Accelerator Program, directed by Dr. Miller, which proposes innovative solutions that improve patient care. Approval came within a week. The mission of the Innovation Accelerator is to create a culture in which novel ideas accelerate to address unmet patient needs.

Given the go-ahead to proceed, Dr. Miller and Stemler worked with a series of specialized external contractors to develop stencils and color-matching technology to recreate a natural nipple appearance. Ultimately, they were able to create a tattoo with a natural appearance using variations of five colors that are used to provide natural hues to a new nipple. Some colors are used for the base color, while others are used to add shading to create a 3D appearance.  The stencil makes it similar to "paint-by-number," ensuring consistent, realistic and customizable results.  

Dr. Rebecca, co-author of a study, "Nipple-Areola Stencil for Three-Dimensional Tattooing: Nipple by Number," advocates that the 3D-tattooing technology is a critical reconstructive component in women following mastectomy. The study concludes that 3D and 4D nipple-areola tattooing is easy, quick and accessible to providers and patients alike.

One of Dr. Rebecca’s grateful patients from Albuquerque, New Mexico, insists that her areola tattooing experience was "the finishing touches on what was already a phenomenal job that Dr. Rebecca did throughout my reconstruction." The patient says her tattooing result is the "icing on the top that allows me to look and feel how I looked prior to my mastectomy. Dr. Rebecca is my saving grace."

While there are tattoo parlors that promote their own nipple and areola coloration, Mayo Clinic’s procedures are performed by professionals in a clinical setting to create a biologically-accurate nipple appearance that is unique to each patient. Women are advised that when their health providers create the tattoos, it is a safer environment. 

The study about 3D tattooing notes that finding a tattoo parlor can be anxiety-provoking to many patients who would prefer the tattooing in a medical facility, preferably where their breast reconstruction was performed.

"In addition to the aesthetically pleasing results, knowing that it takes place in a safe environment with no risk of communicable diseases after you have already gone through breast cancer, is a plus," says Dr. Rebecca. "Another huge benefit to having it performed in our office is because it is certified, rather than going to a tattoo parlor where the artist won’t provide that level of care."

With the help of generous benefactors of Mayo Clinic, including the William A. and Suzanne H. Hodder Family, the Regis Foundation for Breast Cancer Research and William G. Little, the 3D technology for this innovation has become available throughout Mayo Clinic.

The plan for the future is to expand the service using artificial intelligence to create algorithms to generate realistic pigmentation and dye for the tattoos. 

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Around 250,000 women are diagnosed with breast cancer in the U.S. every year, according to the Centers for Disease Control and Prevention. Even as cancer treatments have become increasingly targeted and refined, many women choose to have a mastectomy versus lumpectomy and radiation. And close to half of women who undergo mastectomy have reconstruction using one of two options: reconstruction with implant surgery or reconstruction with flap surgery.

October is Breast Cancer Awareness Month, and three breast cancer topics will be featured on the next Mayo Clinic Radio program. Dr. Sarvam TerKonda, a Mayo Clinic plastic surgeon, will discuss reconstruction surgery after breast cancer treatment. Also, Dr. Jordan Ray, a Mayo Clinic cardiologist, will explain the importance of heart care for breast cancer patients. And Dr. Kathryn Ruddy, a Mayo Clinic medical oncologist, will discuss the rare and often overlooked disease of male breast cancer. 

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Breast Cancer Awareness Month appeared first on Mayo Clinic News Network.

October is Breast Cancer Awareness Month, and three breast cancer topics will be featured on the next Mayo Clinic Radio program. Dr. Sarvam TerKonda, a Mayo Clinic plastic surgeon, will discuss reconstruction surgery after breast cancer treatment. Also, Dr. Jordan Ray, a Mayo Clinic cardiologist, will explain the importance of heart care for breast cancer patients. And Dr. Kathryn Ruddy, a Mayo Clinic medical oncologist, will discuss the rare and often overlooked disease of male breast cancer.

To hear the program, find an affiliate in your area.

Miss the show? Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Breast reconstruction surgery / heart care for breast cancer patients / male breast cancer appeared first on Mayo Clinic News Network.

Soy and breast cancer risk 
It once was thought that soy foods increase the risk of breast cancer. However, studies show that a lifelong diet rich in soy foods reduces the risk of breast cancer in women. In addition, soy contains protein, isoflavones and fiber — all of which provide health benefits. Learn more from Katherine Zeratsky, a Mayo Clinic registered dietitian nutritionist.

Infographic: Breast reconstruction options 
Approximately 1 in 8 women will develop breast cancer in their lifetime, and 35 percent of them will have a mastectomy. Many mastectomy patients experience poor body image, lowered sexual well-being and emotional distress. Breast reconstruction helps many women by significantly improving body image, self-esteem, and feelings of attractiveness and satisfaction. Learn more about breast reconstruction and whether it might be right for you.

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Breast reconstruction with implants: An overview
After a mastectomy, how does a plastic surgeon restore shape to a breast? Read about the process and risks of the reconstructive procedure.

Choline C-11 positron emission tomography scan: An overview
A Choline C-11 positron emission tomography scan is an imaging test used to detect prostate cancer that has returned despite treatment. Learn more about this test and whether it might be right for you.

The post Living With Cancer: Caring for your skin appeared first on Mayo Clinic News Network.

“Nipple-sparing mastectomy is gaining wide acceptance because of its superior cosmetic results, but pockets of the medical community remain skeptical that it is the right choice for the BRCA population,” says study lead author James Jakub, M.D., a breast surgeon at Mayo Clinic in Rochester, Minnesota. “This is the largest study of its kind to address the controversy, and to show that nipple-sparing mastectomy is as effective at preventing breast cancer as traditional mastectomy.”

To determine the incidence of breast cancer in BCRA-positive women who had prophylactic nipple-sparing mastectomies, researchers studied outcomes among 348 patients who collectively had 551 mastectomies performed at nine institutions between 1968 and 2013.

The study included 203 women who had both breasts removed protectively, known as a bilateral mastectomy, and 145 patients who had one breast removed preventively after cancer occurred in the other breast.

None of the patients who had a bilateral nipple-sparing mastectomy developed breast cancer at any site after an average of three to five years of follow-up, the researchers found. No breast cancers developed in the retained skin, nipples, or lymph nodes on the side of the prophylactic procedure. Seven women died from breast cancer during follow-up; in all of those cases the patients had a previous or concurrent breast cancer at the time of surgery and their stage IV disease was attributed to that cancer.

MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

Mastectomies have changed dramatically over the years. The radical mastectomy of the 1950s, 60s, and 70s removed the breast tissue, skin, lymph nodes, and underlying muscle. By the 1980s, that procedure largely gave way to the modified radical mastectomy, which left the chest muscles alone. Next came skin-sparing mastectomies, which preserve an envelope of skin and allow surgeons to begin breast reconstruction during the mastectomy surgery.

Nipple-sparing mastectomies leave the nipple, areola and breast skin intact. Their use is increasing and has gained acceptance as a safe option in breast cancer patients.

In 2009, approximately 8 percent of mastectomies performed at Mayo Clinic were nipple-sparing. Five years later, that fraction had more than tripled to approximately 30 percent, and Dr. Jakub says the number is increasing. Still, controversy remains over whether or not the procedure is appropriate for women with BRCA mutations, who can have a breast cancer risk of 50 to 60 percent by age 70 and up to 80 percent over a lifetime.

“The BRCA population has a genetic mutation in all the cells of their body that predisposes them to breast cancer,” Dr. Jakub says. “We know that a majority of breast cancers originate in the breast ducts, so it might seem counterintuitive to leave behind the nipple and the ducts associated with the nipple when you are trying to reduce the risk of this disease.”

Several studies have shown the procedure is safe among BCRA carriers, but some physicians have been waiting for more evidence, Dr. Jakub says. He believes the study results offer further proof that nipple-sparing mastectomies are effective in preventing breast cancer among women carrying the BRCA mutation and should be offered when they consider prophylactic surgery.
https://youtu.be/h-VNMkMMHp4
 

“There is no question that this option of nipple-sparing mastectomy can often provide an outstanding cosmetic result and may make it easier for women who are at risk to take this preventive measure,” Dr. Jakub says. “Though the nipple is preserved, it unfortunately will not have stimulation or arousal. Despite that,  studies looking at the impact of risk-reducing surgery on quality of life, sexual satisfaction, and intimacy, suggest that being able to preserve aesthetics and body image can improve all of these factors.”

The study’s senior author is Shawna Willey, M.D., of Georgetown University. The co-authors are Richard Gray, M.D., and Sarah McLaughlin, M.D., of Mayo Clinic; Anne Peled, M.D., of the University of California San Francisco; Rachel Greenup, M.D., of Duke University; John Kiluk, M.D., of Moffitt Cancer Center; Virgilio Sacchini, M.D., of Memorial Sloan Kettering; and Julia Tchou, M.D., Ph.D., of the University of Pennsylvania.

The study was supported by National Institutes of Health Specialized Program of Research Excellence in Breast Cancer grant CA116201 and the Breast Cancer Research Foundation.

About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call 1-855-776-0015 (toll-free).

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

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ANSWER: In general, breast reconstruction surgery falls into two categories. The first involves using a woman’s own tissue taken from another area of the body to form new breast mounds. This is called autologous breast reconstruction. The second uses breast implants to reshape the breasts.

If you decide to have breast reconstruction at some point, the standard treatment option based on your history would be autologous reconstruction. It would offer you the best chance for a successful outcome with the lowest risk of complications.

In most cases when women have a lumpectomy to treat breast cancer, they also undergo radiation therapy to the chest wall. Radiation can damage skin, making it firmer, tighter and less flexible than skin that has not received radiation. Implant surgery requires use of expanders that gradually stretch the skin and tissue over your chest to make room for the implants. Radiated skin does not stretch easily, so using tissue expanders in women who have had chest-wall radiation can be difficult.

Another reason autologous reconstruction would be a better option is that you chose not to have reconstruction right away. When breast reconstruction is done immediately, the surgeon performing the mastectomy typically leaves a flap of skin that can be used to help reshape the breast. When no reconstruction is planned, the surgeon does not leave any extra skin. Without the skin flap, it is more difficult to reconstruct the breast area in a way that allows for an implant.

It’s important to also understand, though, that autologous breast reconstruction is a complex surgery. During the procedure, the surgeon transfers a section of skin, muscle, fat and blood vessels from one part of your body to your chest. The tissue most often comes from the abdomen, but it can also be transferred from the back, buttocks or inner thighs. The skin and tissue may need to be supplemented with a breast implant to achieve the desired breast size. The entire procedure can take up to ten hours or more.

Some women don’t want to undergo a surgery as invasive as autologous reconstruction. If that’s the case for you, but you decide you still want breast reconstruction, another option may be available. In some cases, women who have skin damaged by radiation may be able to get breast implants if the chest skin is carefully prepared prior to surgery.

The preparation may involve receiving a type of treatment that can improve the quality of radiated skin, called hyperbaric oxygen therapy. Surgical preparation may also include a liposuction procedure that takes fat from another area of the body and puts it into the radiated area. This creates a more pliant, softer skin envelope for the implant, as well as a thicker fat layer beneath the skin, under which the implant can be placed.

Using this type of preparation for breast implant surgery is not common, and it is not widely available. The rate of complications and implant failure with this technique is higher than autologous reconstruction. There has been success with this procedure, however, and it can be an effective option when performed by an experienced plastic surgeon that specializes in breast reconstruction.

If you decide you want breast reconstruction, the best first step is to meet with a plastic surgeon to discuss your individual circumstances and review all your options. Together, you can decide on the right choice to fit your needs. — Steven Jacobson, M.D., Plastic Surgery, Mayo Clinic, Rochester, Minn.

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Myth or Matter-of-Fact: The best time to start treating hair loss is when you first notice it.

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