Onwards and upwards!

Well, here we are in 2016, ready to jump in to all that this year will bring.

We hope you will join us as we carry on advocating for an equitable breast health policy in South Africa!

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Explaining lymphoedema

B9319068312Z.1_20151002152238_000_G2FC3T7CP.1-0Breast cancer related lymphoedema (BCRL) Lymphoedema is a chronic, debilitating condition that is caused by the malfunctioning of the lymphatic system due to damaged lymphatic vessels and lymph nodes. Breast Cancer Related Lymphoedema (BCRL) is one of the most dreaded side effects post breast surgery and radiation therapy.

All diagnosed with breast cancer are at risk of developing BCRL in their life time. It might never or it may develop years post cancer treatment. It is important to be aware of the risk factors, symptoms and most importantly how to reduce the risk and manage early stage BCRL.

So how does the lymphoedema develop? The lymphatic system in our bodies is responsible for draining all the toxins from the tissue spaces, transport it to the lymph nodes where the toxic waste is removed from fluid known as lymph.

With surgery and radiation therapy lymph nodes may be removed and lymph vessels damaged resulting in a partial mal-functioning of the lymphatic system especially on the side of body affected by the treatment. It is also referred to as the blockage of the lymph vessels. This may result in swelling of the upper limb and alternative pathways are required to facilitate the drainage and flow of lymph from the affected areas.

So what are the symptoms of BCRL? The physical symptoms occur most commonly on the side where the cancer was treated and these may include:

Early stage symptoms

  • Feeling of heaviness, numbness, pain of the upper limb
  • Swelling of the limb and subsides after elevation
  • Fingers swelling so ring not able to fit, or sleeve too tight or wrist swollen so watch strap not able to fit Moderate to Late stage symptoms
  • Pitting of skin and swelling which does not subside after elevation – Hardening and or discolouration of skin
  • Skin may tear or become infected (cellulitis)

The psycho–social symptoms may include:

  • Anxiety and fear of cancer recurring
  • Anti-social to avoid questions about the condition
  • Low self- esteem and poor body image due to enlarged upper limb How to reduce the incidence risk?
  • Be aware of the early stage symptoms
  • Exercise is very important
  • Taking good care of the skin to prevent damage through cuts and burns
  • Don’t wear too tight clothing or jewelry
  • Avoid very hot water, so wear gloves when washing dishes and bath and shower in warm but not very hot water
  • Protect the skin by wearing long sleeve clothes or gloves when working in the garden
  • Apply anti-bacterial cream immediately if cut or tear of the skin.
  • If skin becomes very red and painful go to the community health center, or medical facility to receive antibiotics for the infection (cellulitis)

BCRL is a chronic condition that cannot be cured but it can be managed through a range of treatments and these include:

  • Manual lymph drainage (gentle massage technique)
  • Multi-layered compression bandaging or compression garment
  • Exercise
  • Skin care

Finally all breast cancer patients and survivors must become aware of the early symptoms and how to prevent or manage BCRL.

Compiled by: Colleen Marco Lymphoedema Therapist

Before cancer I didn’t realise just how much I was loved

Tanya Keevy says when your back is against the wall you can either fall apart or you can give it your best. I chose to give it my best!

Reconstruction after mastectomy

There are various types of reconstructions that can be offered to a patient after a mastectomy. There are many factors that need to be considered before one can decide on a reconstruction and this needs to be discussed between the patient and the surgeon. Each person is different and the type of reconstruction is based on many various factors including:

  1. The choice of the patient as discussed with the surgeon and multidisciplinary team
  2. The type of cancer
  3. The location of the cancer
  4. The build of the patient
  5. Involvement of the nipple
  6. Whether the patient will still need radiotherapy or not

 

There are many types of reconstruction, most of which are available in South Africa. Reconstruction can be done as an immediate reconstruction or a delayed reconstruction.

  1. A flat chest: many people will request a flat chest. Women will often choose this procedure as it is a fairly quick operation with minimal pain post operatively and has a low risk of complications. A prosthesis with a special mastectomy bra can be fitted a few months after the operation. The patient can also have a reconstruction a few years after having a flat chest mastectomy, this is known as a delayed reconstruction.
  2. A reconstruction using expanders: this is where an expander is placed beneath the muscle in the chest wall. It is then inflated every few weeks until it reaches the appropriate size. An operation to remove the expander and replace it with a prosthesis will follow.
  3. An immediate reconstruction using prosthesis: this is done in certain cases where a skin sparing mastectomy is performed and the tissue is immediately replaced with a prosthesis.
  4. Reconstruction using body tissue:
  5. A flap from your back (latissimus dorsi flap) – the surgeon will make a new breast by using the muscle, skin and fat from your back.
  6. A flap from your abdomen (a TRAM flap) – the surgeon uses part of the muscle with its skin, fat and blood vessels to make a new breast.
  7. A flap from your abdomen (a DIEP flap) – the surgeon takes only the fat and skin from the abdomen to make a new breast. This procedure often has a very good outcome as the breast looks and feels natural as it consists of fatty tissue.
  8. A flap from the thigh (TMG or TUG) – the surgeon will use the fat, skin and muscle from the thigh, either making use of the outer or inner thigh.

Once a mastectomy with reconstruction has been performed, a nipple can also be made. This would be done only once the reconstruction has entirely healed and would involve small procedures. A tattoo can be done to give the nipple areolar its colour.

Reconstruction is a very personal decision and the patient should not be rushed into something that they do not feel comfortable with having. It is important as a patient to look into the various options that are offered before making a decision.

 

Sr Lieske Wegelin

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

Finding out more about surgery

Surgery for breast cancer includes surgery to the breast and surgery to the axilla (armpit).

Surgery to the breast. 

Although there are many operations that we do, they fall into two groups: breast conservation surgery (wide local excision, lumpectomy) and mastectomy.

Breast conservation means removal of the cancer and some surrounding tissue.  It is important that there is no cancer or precancer in the surrounding tissue. (We refer to the normal tissue around the cancer as the margin.  A negative margin means all the cancer has been removed and normal tissue surrounds the tumour). Breast conservation surgery is generally followed by radiotherapy.  If it is not possible to have radiotherapy, breast conservation is not generally advisable.

Mastectomy means removal of the breast.  It may be done with or without reconstruction.

On some occasions, the outcome for an individual is better if a mastectomy is performed. Indications for a mastectomy include:

  1. Patient preference
  2. Widespread pre cancer (DCIS)
  3. More than one cancer in the breast
  4. A strong family history of breast cancer
  5. If the cancer is large/the breast small, the cosmetic result may be better after a mastectomy with reconstruction than after breast conservation.

Axillary surgery

Axillary surgery refers to the management of the lymph nodes. The reasons to do axillary lymph node surgery are:

  1. To see if the cancer has spread. This is very important as we generally base our adjuvant treatment of breast cancer on the behavior of the cancer rather than only on the size or grade.  The commonest way to do this is with a sentinel node biopsy.  Before surgery, the breast is injected with a dye.  At the time of surgery, the lymph node containing dye is removed and is tested.

There are several variations on the techniques used

  1. The dye used may be blue dye or radioactive dye or both
  2. There may or not be a preoperative scan
  3. The lymph nodes may or not be tested at the time of surgery.
  4. To remove the lymph nodes if they are involved with disease.

Commonly used terms:

Simple mastectomy: removal of the breast

Modified radical mastectomy: removal of the breast and the axillary lymph nodes

(Radical mastectomy is rarely done any more: it involves removal of the underlying muscle).

by Jenny Edge

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

It has been a good journey!

Merlin Osborne – a survivor for eight years – says that running keeps her sane – including running away from negativity!

walk

What do you want to know about your surgery?

What are the implications of losing a breast or both breasts? Will it be painful? How long will I take to recover? When I get back to my normal day to day activities? Will I have scars? These are the questions that follow once a patient knows that they will need a mastectomy. People respond to the news of needing a mastectomy in many various ways. Some people want it as soon as possible, others delay as they are not sure that it is the right thing to do or they may be anxious or nervous about it. Everyone is different.

What are the implications of losing a breast or both breasts?

When you research a mastectomy it is very easy to become anxious. Whether about the operation, recovery or what you will look like after the surgery. Many people, organisations, doctors and surgeons will write about the topic but unfortunately what you read is not always accurate and can cause mixed emotions. The best way to understand the process is to listen to your options from your surgeon and to meet and talk with a person that has been through a similar experience or had a similar operation.

Will it be painful?

Very often there is more emotional than physical pain after a mastectomy. It is something new that one has to get used to. It takes time and everyone will go through their own recovery at their own rate. You may be happy, sad, teary or relieved. A whole wave of emotions may follow after having a mastectomy.

How long will I take to recover?

This will depend on the person, the type of operation and the circumstances that surround the patient. It takes a good few weeks to recover from a breast operation but again the emotional side may take longer than the physical side. Getting back to day to day activities will gradually increase and become easier with time. It is important to take time to recover and to not do too much too soon. If you rest in the beginning your recovery tends to be quicker. If you are very busy straight after your surgery and do not give yourself time to recover, the patient will tend to have a lot more aches and pains that may continue for a lot longer than usual.

Will I have scars? The answer is yes. If you have an operation, you will have a scar. Scars however, do not have to be associated with something bad. There are ways to minimise scars and each surgeon will have their own way of looking after wounds and scars. The emotional scars on the other hand may remain for quite some time. As we are all different, we will all heal in different ways. It is very important to ask for help if you need it. Whether speaking to a fellow patient, a psychologist, your GP or your medical team, it is important to communicate. It is a natural feeling to be anxious regarding a pending operation and even after the operation it remains important to communicate. Therefore speak to someone before your operation and have that person as a support during your operation and after your operation as you recover. Recovering mentally is a process that starts from the time that you are diagnosed.

Most importantly, try to stay positive! Surround yourself with positive, happy and supportive people that make you feel good. Do not be afraid to ask for help when you need it! A little bit of support goes a long way when needed.

Sr Lieske Wegelin

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses