Cancer patients can keep their curves
When Jamie Inman was first diagnosed with breast cancer in 1993,
she thought it was a tragedy.
Cancer patients can keep their curves
When Jamie Inman was first diagnosed with breast cancer in 1993, she thought it was a tragedy.
“My mom had no cancer, but she was adopted so we didn’t know family history,” Inman said. “Her birth sister died of cancer, but there was no reason to put me in a high risk [group].”
A lump had been found during an annual exam.
“For the first go-round with cancer I had taken the conservative path of lumpectomy with radiation,” Inman wrote in an essay she submitted to a support group Web site.
For 13 years she was cancer free and she said she was well beyond cured. But in December 2005 during a checkup, Ductal Carcinoma In Situ was found in Inman’s left breast. Her father had just died and she had been taking care of her widowed mother when she was diagnosed.
“This time I thought ‘Not cancer, too,'” Inman said. “I was very matter of fact. I began looking for someone to do the treatment.”
Inman wanted to take an aggressive approach to ridding herself of the cancer the second time around. She searched out a doctor who would perform a double mastectomy and reconstructive surgery.
“When you are not in a metropolitan area, there just isn’t as much knowledge,” said Inman, who resides in Hollister with her husband. “There are no plastic surgeons.”
Reconstructive options
There are several options for breast reconstruct ion after a mastectomy and Inman chose a procedure called the deep inferior epigastric perforator flap, or DIEP flap. In the surgery, skin and fat is removed from the lower abdomen and transferred to the breast area where it is formed into new breasts. It is a procedure offered by few doctors because it requires microvascular expertise to work with the tiny blood vessels in the tissue. The surgery has the side effect of flattening the stomach as tissue is removed.
“I was not psychologically ready to not have breasts,” said Inman, who looks young for her age, 60, with dark brown shoulder-length hair.
Inman found a doctor based in San Francisco, Gabriel Kind, to perform the surgery. Other options for breast reconstruction include the TRAM flap, which removes abdominal tissue with the underlying stomach muscles, and breast implants.
“One thing I tell all my breast cancer patients the first time I see them is that there are a lot of choices,” Kind said. “I feel pretty strongly that my role is not to tell them what is better, but to explain what each choice would mean for them in terms of potential benefits and risks.”
Implants tend to require a shorter surgery (usually two hours) and recovery, Kind said, but for younger women they will often require additional surgeries as they age.
“The chances of needing an operation some time in the future is significant because of leak and rupture rate, and other complications,” he said.
Implants often do not work well with people who have undergone radiation treatment. For women who have a unilateral mastectomy, it is hard to match the size and shape of the implant to a natural breast.
“Once you are done with the initial procedure,” said Kind, of the flap surgeries, “That is your tissue. It will age with you and looks more like your own body over time.”
Masectomies and most of the reconstruction surgeries lead to a loss of sensation in the tissue, according to women who have undergone the procedures.
“It was 10-12 hours,” Inman said. “I had three surgeons, one at the donor site.”
During her recovery, she said she had very little pain or discomfort. She had topical painkillers for the incisions she had along her stomach and her chest.
Trends in surgery
The type of women coming in for reconstructive surgery has changed over the years, Kind said.
“When I was training, 20 years ago, the typical woman coming in was much older, generally in their 50s to 60s,” Kind said.
He cited a May 2007 journal article that found that a low percentage of women are still referred for reconstructive surgery. It was found that the socio-economic area in which they live was a big factor in whether are not they were referred, even though most medical insurances now cover reconstruction.
“It’s true across the country,” Kind said. “In places like San Francisco and Santa Cruz, places where there are people doing plastic surgery, the referral is huge.”
A study also found that at centers were breast cancer doctors and plastic surgeons work closely, referrals are higher. Another trend has emerged in recent years, as well.
“Now you see many more younger women coming in with breast cancer or a mastectomy because they found out they are at higher risk,” Kind said.
There is an increase in women who have a mastectomy as a prevention before they are diagnosed with breast cancer if they are at high risk.
In 2001, researchers at the National Institutes of Health and the National Human Genome Research Institute developed a genetic test that could test for markers that indicate a higher risk for breast cancer.
Since her experience, Inman’s daughters have made sure they have regular breast exams.
Eleze Armstrong, the radiology director for Hazel Hawkins Memorial Hospital, said all women over age 40 should have a yearly mammogram, or those who are at a high risk for breast cancer. Armstrong suggested patients look for an accreditation from the American College of Radiology, or an MQSA, in choosing a facility to perform their mammogram because that means it meets certain standards.
Men can get breast cancer, but the incidence in men is rare compared to that in women. Patients at higher risk include those who have a family history of breast cancer, women over the age of 50 and women who have had no children or who had their first child after the age of 30.
In addition to the mammogram, women should start performing self-breast exams and should have a yearly exam performed by their doctor at age 20.
The hospital offers discounted rates for self-pay patients during October, Breast Cancer Awareness Month, and they have extended evening and weekend hours to accommodate patients.
“We don’t accept self referrals,” Armstrong said. “The ideal way is really a clumpenation – a clinical breast exam performed by the provider. Once that is completed, the doctor will refer them for screening.”
Patients without a provider can make an appointment for a clinical breast exam at the Hollister or San Juan Bautista clinics.
For Inman, she no longer has to worry about mammograms since having her surgeries. She is not only getting on with her life, she said, she is thriving.
“It is a treat. I had an extreme makeover paid for by Blue Cross,” Inman said. “I got a boob job and a tummy tuck. I’ve been rejuvenated and I have a body I haven’t had in years.”
