Dating without breasts
To offer primary care providers a comprehensive summary of breast reconstruction options and complications. A literature search was conducted in PubMed with no time restriction using the search terms breast reconstruction, summary, review, complications, and options. Levels of evidence range from I to III. Breast reconstruction plays a crucial role in the restoration of normality for these women. Women who undergo mastectomy often suffer from challenges related to body image, self-esteem, and a decrease in quality of life scores. The knowledge and guidance of primary care providers is critical to effectively guiding and supporting patients who might undergo breast reconstruction in their decision-making processes.
Daring to date again
To offer primary care providers a comprehensive summary of breast reconstruction options and complications. A literature search was conducted in PubMed with no time restriction using the search terms breast reconstruction, summary, review, complications, and options. Levels of evidence range from I to III. Breast reconstruction plays a crucial role in the restoration of normality for these women.
Women who undergo mastectomy often suffer from challenges related to body image, self-esteem, and a decrease in quality of life scores. The knowledge and guidance of primary care providers is critical to effectively guiding and supporting patients who might undergo breast reconstruction in their decision-making processes. A thorough understanding of patient selection factors, modern options for breast reconstruction, and expected outcomes is essential.
Breast cancer continues to be the most common form of cancer affecting women in Canada 1 in 9 women. Studies show that women who undergo mastectomy often suffer from challenges related to body image, self-esteem, and a decrease in quality-of-life scores. It has been shown to be one of the most important determinants of functional and psychosocial well-being, long-term health, and patient satisfaction compared with patients who have undergone mastectomy without reconstruction.
The key to this lofty goal is complete engagement of the entire health care team. In , Cancer Care Ontario CCO released a Breast Cancer Treatment Pathway Map, 9 which mandated that all women diagnosed with operable breast cancer requiring mastectomy be referred to a plastic surgeon to discuss reconstructive options before their scheduled mastectomies. The algorithm also outlines appropriate treatment and reconstructive options for individual patients. A PubMed literature search was conducted with no time restriction using breast reconstruction, summary, review, complications, and options.
Guidelines published by national cancer-related organizations were also reviewed. A supplemental search of references from selected articles and reference lists of guidelines was also performed. Finally, expert experience from key opinion leaders in Canadian breast reconstruction was included to provide the most up-to-date and comprehensive review of modern options for reconstruction.
The knowledge and guidance of the primary care physician PCP is critical during the time of diagnosis and decision making. Unfortunately, the most recent comprehensive review we found written specifically with PCPs in mind comes from more than 35 years ago 10 and much has changed. The purpose of this review is to provide a modern update on reconstructive options that offers PCPs a framework for discussion with and support of women who are candidates for breast reconstruction.
An unfortunate number of patient and health care provider beliefs around breast reconstruction are outdated and false. Patients often think they are too old, 11 feel vanity in their desire to undergo reconstruction, worry that reconstruction will interfere with cancer treatment, or believe that breast reconstruction is dangerous and fraught with complications.
The reality is that there are no absolute contraindications to breast reconstruction. Certain factors such as morbid obesity and smoking considerably limit options. In most cases, however, health- and tumour-related factors will influence the type and timing of reconstruction but not whether or not reconstruction is an option. Breast reconstruction itself does not lead to an increase in recurrence nor increased difficulty in surveillance.
Immediate breast reconstruction, performed during the same procedure as oncologic resection, has the distinct advantages of decreasing the total number of surgeries, providing improved psychological benefit, and preserving much of the native breast skin and potentially the nipple. Delayed reconstruction might be recommended for patients with advanced disease, those for whom there are uncertainties about disease control, or those not interested in or prepared to make a reconstructive decision at the time of their oncologic procedure Table 1.
In more advanced or unknown breast cancer stages, part of the breast reconstruction can start immediately. Unknown tumour biology with variability in the need for postoperative adjuvant therapy. Before deciding on a reconstructive technique, a decision about which type of mastectomy is appropriate is made by the general surgeon, if possible in consultation with the plastic surgeon.
When immediate reconstruction is not planned, a horizontal incision is made to remove excess skin with the mastectomy specimen and allow the remaining skin to close neatly, flat against the chest wall. When immediate reconstruction is planned, the incision is modified to preserve as much breast skin as possible. In these cases, surgeons will decide where to make the access incision for removal of the underlying breast tissue while preserving all overlying skin, nipple, and areola. A nipple-sparing approach can often be considered if these criteria are met:.
The various incisions types are shown in Figure 1. Types of mastectomy incisions: A Horizontal skin-sparing mastectomy , B skin-reducing, C nipple-sparing, inframammary, and D nipple-sparing, radial incision. Options for breast reconstruction are divided into alloplastic implant-based or autologous tissue-based reconstruction Table 2. Implant-based reconstruction is currently the most common type of breast reconstruction performed in North America. Likewise, advances, particularly in the field of microsurgery, have provided options for transfer of tissue from various body areas with minimal donor-site morbidity.
Both categories of breast reconstruction can be performed in an immediate or delayed fashion. Types of breast reconstruction: Alloplastic versus autologous. Alloplastic implant-based reconstruction: Alloplastic reconstruction Figure 2 is traditionally performed in 2 stages involving insertion of a tissue expander followed by implant exchange. Table 3 provides guidance for deciding between these approaches.
Alloplastic reconstruction involves shorter surgeries with easier recovery but with the possible need for ongoing implant monitoring or adjustment in the future. Surgery can take 1 to 2 hours per side, and return to normal activity is expected within 2 to 3 weeks. Exercise and heavy lifting are restricted for 6 weeks. Types of alloplastic implant-based reconstruction: A Two-stage reconstruction; B direct-to-implant reconstruction.
Stage 2—expander exchanged for implant with or without fat grafting and with or without nipple reconstruction. Expander is filled via transcutaneous injections every 1—2 wk until appropriate volume is achieved Figure 4. Second stage allows for refinement and adjustment or adjunctive procedures nipple areolar reconstruction, fat grafting, pocket adjustment for symmetry, etc.
Internal scaffold acellular dermal matrix or synthetic mesh is placed within mastectomy site to help support implant. Might still require second operation for contouring, symmetry, nipple-areolar reconstruction, etc. Autologous tissue reconstruction: Broadly, autologous reconstruction is divided into pedicled versus free flap. The advantages and disadvantages of each are described in Table 4.
Pedicled flaps originate from tissue close to the breast and use native blood supply to vascularize the breast mound. Examples of pedicled flaps include the latissimus dorsi flap and the pedicled TRAM transverse rectus abdominis myocutaneous flap. Alternatively, free flaps can be taken from close or remote areas. They are disconnected from their native blood supply and reconnected in the breast area via specialized microvascular techniques.
The most commonly used example is the DIEP deep inferior epigastric artery perforator flap, which uses skin and subcutaneous tissue of the abdomen supplied by the DIEP blood vessels to create the breast mound. Common autologous breast reconstruction types are described in Table 5. Autologous breast reconstruction: A and B abdominal-based reconstruction; and C latissimus dorsi reconstruction. Advantages and disadvantages of autologous breast reconstruction: Pedicled versus free flap.
Underlying rectus abdominis muscle is separated from its attachment to the pubis and flipped up onto the breast area along with the overlying skin and subcutaneous tissues. Vessels dissected from muscle and microvascular anastomosis created to recipient vessels in chest. Reserved for unique cases ie, inadequate abdominal tissue or previous failed abdominal tissue reconstruction.
Autologous reconstruction involves longer surgery with donor- and recipient-site involvement. For this reason, return to sedentary activity eg, walking or sitting for prolonged duration is usually 2 weeks, but with restriction in many activities for up to 8 weeks. A hospital stay of 1 to 4 days is generally required. Fat grafting in breast reconstruction: Autologous fat grafting Figure 4 involves harvesting fat from a remote body area via liposuction followed by injection with small cannulas into the breast area.
Most commonly, it is used for refinement and optimization, as an adjunct for both types of breast reconstruction, 13 or to fill partial mastectomy defects. As a filler material it is favourable owing to its availability, ease of harvest, and biocompatibility. This technique has extended the options of reconstruction in many patients who would have previously been poor candidates. It has been shown in many studies to be safe and compatible with surveillance imaging 15 and it does not influence the risk of cancer recurrence.
Lumpectomy defect reconstruction: As an alternative to mastectomy, many women undergo breast conservation therapy BCT. Breast conservation therapy includes lumpectomy followed by radiation and provides equivalent long-term survival compared with mastectomy. In many cases, the contralateral breast will be balanced at the same time through breast reduction or lift Figure 5. Although possible through autologous fat grafting, transfer of autologous tissue flaps, or local tissue rearrangement, 24 reconstructing these defects in a delayed manner is far more difficult.
This highlights the need to consider plastic surgery involvement early in the decision to undergo BCT when a large defect is possible. Nipple-areolar reconstruction: Reconstruction of the nipple-areolar complex NAC Figure 6 is the last step of breast reconstruction and is usually undertaken when the breast mound has healed and settled in its final position. Restoration of the NAC includes reconstruction of the projecting nipple and pigmentation. For nipple reconstruction, local skin flaps can be designed and folded to produce a projecting nipple, a graft can be harvested from the contralateral nipple, or a 3-dimensional tattoo can be used to give the illusion of a projecting nipple.
Pigmentation of the NAC can be obtained via tattoo or skin graft. Nipple areolar reconstruction: A Three-dimensional tattoo, B nipple reconstruction with local flap, and C tattoo following nipple reconstruction. Adjunct procedures: For many women, secondary procedures such as fat grafting, implant adjustments or replacements, or skin tightening procedures are required over time. In unilateral cases, balancing procedures such as contralateral breast reduction, augmentation, or mastopexy can be performed in the immediate or delayed setting to achieve appropriate symmetry.
Many recent studies have looked at outcomes, complications, and satisfaction rates after breast reconstruction.
THE WORST DATE EVER Oddly, my breast cancer odyssey began on a Shame on those doctors for not ordering a breast biopsy sooner, just. How one woman battled breast cancer—and the L.A. dating scene—and came out on top.
In , eight months after I learned I had the same genetic mutation, I also elected to have a preventative mastectomy. I was At the time, I searched the internet for a community, for people who could understand not only the fear of removing your healthy breasts, but doing it while young, single and childless.
Save the Date: London Breast Meeting , 4.
Sex after cancer is complicated. You know what else is complicated?
Dating After Breast Cancer…With No Nipples
The taxi arrived at dawn but it could have come earlier. Will you tell me one more time: She turned back to me, and I could see in her face that she already knew what, deep inside, I had felt all along. We were going to have to find another way. Breast cancer had engulfed my life a few weeks earlier, when I noticed a small dimple near my left nipple. I was shocked, but not devastated.
Man who avoided dating because of his ‘moobs’ has them surgically removed
If you've had one breast removed and feel self-conscious about looking lopsided, try going without a breast form at home. Then try running an errand or going out for coffee without your prosthesis. Women who choose not to reconstruct may do so for a number of reasons, including:. The decision to reconstruct or not is very personal. There is only the way that is best for you, your preferences, and your healing. Because the choice to reconstruct or not is very personal, you need a surgeon who listens to you and explains things in ways you can understand. Your doctor or nurse will likely have recommendations. Recovering from a mastectomy with no reconstruction is generally easier than recovering from mastectomy with reconstruction. If you have immediate reconstruction reconstruction at the same time as surgery , the recovery time is longer than it is with no reconstruction.
An unreasonable list of dating demands Source: The unidentified Aussie guy took to Facebook in his quest for love, reeling off a staggering list of requirements in his future lady.
Picture this: You're in a bar, and a guy a few seats over starts flirting. Soon, you're sharing personal details—the last movie you've seen, music you like.
I'm Young, Single And Dating After A Preventative Double Mastectomy
After forcing my third and final child from my womb two years ago, I turned out the lights, hung a CLOSED sign on my uterus, and locked the door. I worked really hard on eating right and exercising that first year after his birth and miraculously lost all the baby weight. Things shift. Things sag. Things rearrange. Things become displaced. Those things are the same things you now have to brazenly reveal to a new someone in a moment of passion — or stark terror — when you attempt to date after divorce. Seeing someone seriously or semi-seriously depending on your standards generally involves sex. Sex generally involves getting naked. Getting naked involves showcasing certain body parts including but not limited to:
I was 31 when I was diagnosed with breast cancer. My gynecologist called, and I ducked into the supply closet of our Union Square office for some privacy. She said something about a New York Times article, about estrogen receptors. I texted my pregnant coworker, I cried in the bathroom, I cried at my desk, and then I did some work. This was not my first foray with having a sick breast.
"My Dating Profile Says I'm a Breast Cancer Survivor"
Two years before I was diagnosed with Stage 2 Invasive Ductal Carcinoma at the age of 47, my husband decided he was done with me. Otherwise, I probably would have taken more time to figure out that my marriage was not healthy or salvageable… and it may have killed me in the process. So, as hard as it was to go through cancer treatment and the subsequent journey as a single woman, it was where I needed to be. I joined a dating website approximately a year after my divorce and was excited ish at the prospect of meeting men and dating. I had been married for 11 years, and I was completely out of practice. I live in a rural area with a limited pool of eligible men.
‘Cancer I could deal with. Losing my breast I could not’
My answers: The first guy I had sex with after cancer was a beautiful, tattooed philosopher. My relationship of three years had just crashed. So when I met this man at a bar on a rare night out with a girlfriend, I was out of practice; my sexuality was asleep. On our second date, I started to wake up. That was 10 years ago. Guys who read my profile say, 'Congratulations on your survivorship! Women often ask, 'How did you deal when you lost your hair?
Guy’s dating advert goes viral for ‘appalling’ list of requirements
Sex after cancer is complicated. You know what else is complicated? Writing about sex after cancer. As I said in the story, cancer cuts us to our sexual quick. We lose body parts. We lose our libido.
Dating After Divorce Means Showing Your Saggy Mom Boobs to Strangers
Uber driver Alex and gymnastics teacher said the condition has taken a huge psychological toll on him. He has even avoided dating because his insecurities about his breasts made him anxious of being intimate with a partner. After almost two decades of turmoil, Alex underwent breast reduction surgery on 23 April, which he said has greatly impacted on his happiness. It really does. You take it day by day and week by week.Living Without Breasts