"A timely book that should be read by every woman." Los Angeles Times Book Review
A Woman's Decision: Breast Care, Treatment & Reconstructionby Karen Berger
A Woman's Decision is an extraordinarily sensitive and authoritative book that will help women assess their options, familiarize themselves with the techniques used in treating breast cancer, and prepare themselves for what to expect medically and emotionally from reconstructive surgery. It combines complete and fully updated medical information with a/i>
A Woman's Decision is an extraordinarily sensitive and authoritative book that will help women assess their options, familiarize themselves with the techniques used in treating breast cancer, and prepare themselves for what to expect medically and emotionally from reconstructive surgery. It combines complete and fully updated medical information with a detailed look at the emotional issues a woman must face when confronting breast cancer. Especially reassuring are the interviews conducted with women and their loved ones, discussion feelings and reactions at every stage, including the decision to seek reconstructive surgery.
In easy-to-understand language, this new edition features the newest therapies available for breast cancer treatment including:
Genetic and hormonal therapy
Endoscopic (minimally invasive) surgery
Image-guided biopsy and sentinel node biopsy
Lumpectomy versus mastectomy
Skin-sparing mastectomy and immediate reconstruction
Partial reconstruction after lumpectomy
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A Woman's Decision
Breast Care, Treatment & Reconstruction
By Karen Berger, John Bostwick III, Glyn Jones
St. Martin's PressCopyright © 2011 Karen Berger
All rights reserved.
Our Purpose in Writing
Today women diagnosed with breast cancer have more and better options for treatment, preservation, and reconstruction of the breast. No longer is the choice reduced to saving a life or saving a breast. Now the choices are more promising, but they are also more complex. Current diagnostic methods and medical and surgical therapies allow women to make their own decisions based on available information about the effectiveness of treatment, risk factors, and possibilities for breast preservation and restoration. In this context, access to reliable, balanced information becomes increasingly important. This new edition is written to fill that need. Our purpose is to provide our readers with the latest information and to assist them in understanding and evaluating the many factors that will influence a decision that will profoundly affect their lives.
Options now available to women include local therapy that focuses on optimal cancer removal with simultaneous breast preservation or reconstruction and systemic therapy using new chemotherapy and hormonal therapy regimens. Breast-conserving surgery with irradiation has become a widely accepted and increasingly appealing option for most women with early breast cancer. It offers excellent cancer treatment with survival rates equivalent to those for mastectomy. Furthermore, new oncoplastic procedures are now used to reconstruct deformities associated with breast-conserving surgery. Mastectomy operations have also been modified and improved. Many women who require or choose mastectomy can now have skin-sparing procedures for breast removal, followed by immediate breast reconstruction.
Women and their families are far better educated about their health than they were a mere 11 years ago. Vast resources are readily available to them. Logging on to the Internet can yield a wealth of information on a wide variety of topics. Breast cancer and breast reconstruction are covered in abundant detail. In fact, the array of available materials can be overwhelming. The challenge lies in sorting through the data to glean the information that is pertinent, meaningful, and appropriate. Our goal is to give women and their loved ones an overview of current health issues, new developments, and approaches to breast cancer diagnosis, treatment, and rehabilitation. Armed with this information, they can take control of their health, their lives, and their destinies.
This fourth edition reflects the transformation in breast cancer therapy. When we wrote the first edition 26 years ago, our primary emphasis was on mastectomy and breast reconstruction. At that time total breast removal was the most effective therapy for local treatment of breast cancer, and we wanted to let women know that breast restoration was available to them. The second and third editions were written as breast-conserving surgery was gaining more advocates and had become a viable and often preferable option for women with early breast cancer. This edition represents the changing face of breast cancer diagnosis and treatment and the exciting new developments on the horizon.
This book describes the diverse choices that are increasingly available to women. It includes tips on routine breast self-examination; guidelines for mammography, including a discussion of current controversies about screening guidelines; descriptions of commonly occurring breast problems; risk factors for breast cancer; and updates on hormone replacement therapy. Recent research developments and therapeutic approaches to breast cancer are fully explored, as is new information on breast cancer genetics. Image-guided biopsy techniques, sentinel node biopsy, breast-conserving surgery and irradiation, oncoplastic surgery, skin-sparing and nipple-sparing mastectomies, and promising drug therapies for breast cancer prevention are among the many topics that now share the spotlight with breast reconstruction.
Even so, breast reconstruction remains a major focus, and this edition continues to offer a comprehensive yet understandable account of this topic for women who wish to explore this option. All aspects of breast reconstruction are covered: Why do women seek breast restoration? Who is a candidate? What is the correct timing for this surgery? What is the best method for breast reconstruction? What defects can be reconstructed? What are the least invasive methods for breast reconstruction? What are the risks and benefits associated with the different types of breast reconstruction? What are the facts about breast implants? Answers to these frequently asked questions and many others are combined with personal accounts of women who have had their breasts restored. Pain, recuperation, and expense are issues of primary concern to any woman contemplating elective surgery, and these have been dealt with in detail, as have the special problems encountered when dealing with insurance carriers. We itemize the costs, risks, and benefits and describe and illustrate the different reconstructive techniques available. We try to present all sides of this topic from an unbiased perspective. Clearly, breast reconstruction is not for every woman. Many will not wish to undergo further surgery, pain, or expense. But for those who are interested, we provide a source of current, reliable information to enable them to make an educated decision.
This is not intended to be a medical text. We are speaking as professionals, but the scope of our book extends far beyond statistical analysis or scientific explanations of tumor behavior. Rather, we address the concerns of women confronting their fears of breast malignancy and monitoring their breasts. We believe that women with breast problems need to take a commonsense approach in dealing with physicians and the treatments they prescribe. We try to provide a personal yet medically accurate account.
Readers will find these pages liberally sprinkled with medical terms. Care has been taken to define these words, not to eliminate them. We are not proponents of medical jargon — just realists who respect the intelligence of our readers. Despite doctors' best efforts to give their patients understandable explanations, it is only natural for them to rely heavily on the communication tools they routinely use. For a woman to feel fully in control, she must familiarize herself with this terminology if she is not to be frustrated in her efforts to learn more about her condition and to communicate more fully with her physicians. We strongly believe that it is important for women to understand the language they will encounter during the treatment process.
Because breast cancer touches so many people's lives, the audience for this book is a broad one. Since the first edition was published in 1984, more than 2 million women have developed breast cancer in the United States alone. Now the alarming news is that it will strike one out of eight women during her lifetime. For the female author of this book, these statistics have come home. She notes with each passing year that breast cancer is an intimate reality for more and more relatives and friends. She feels that she is writing this book for herself, to answer all of those questions that have always worried and haunted her. The physician contributors see the need for such a book to help answer patient questions. Over the years they have seen significantly greater numbers of women in search of breast cancer treatment and breast reconstruction; alarmingly, many of these women are in their thirties and forties, far younger than the patient population they were treating a mere 15 years ago. We wish to reach women all over the world who have had mastectomies or lumpectomies as well as the more than 192,000 women each year who develop breast cancer in this country. We want these women to know about the options for breast cancer treatment and breast reconstruction and to understand that a diagnosis of breast cancer does not necessarily equate with permanent breast loss or disfigurement.
This book is also directed at women who are disease free. If they know that lumpectomy and irradiation and breast reconstruction are available, they might be less prone to procrastinate about seeking medical attention for suspected breast problems. Early detection remains the key to survival. Women need to understand the critical importance of mammography, breast self-examination, and physician examination.
We are also writing for men, not because they will suffer from breast cancer (the incidence of breast cancer among men is 1% that of women), but because they will know, love, work with, and live among women who have had this experience. Perhaps this knowledge will sensitize them to the psychological and physical concerns that this disease generates.
Much of the information in this book is drawn from more than 26 years of research, over 5000 questionnaires, hundreds of letters and comments received from our readers, and numerous interviews with men and women. We principally surveyed women who had lumpectomies and mastectomies for breast cancer and asked them to relate their feelings about and experiences with this disease, their methods for coping, as well as their subsequent therapy and rehabilitation. We asked women to supply us with questions they wanted answered and issues they would like to see addressed.
We continue to be amazed by the enthusiastic response we have received to our questionnaires. One only has to page through the typed and handwritten pages of these surveys to see that the women who have responded have invested considerable time pondering our questions and thoughtfully answering them. They have painstakingly recorded their thoughts on the backs of pages, typed extra sheets, written letters and personal notes, and attached articles and reading lists that they thought would assist us. They even emailed their responses and articles to us and suggested online resources that we should check out. Especially gratifying for us were communications received from women who had read the first three editions of this book; they graciously described the book's impact on their lives and provided suggestions for revision.
These women's responses prompted us to make critical changes in the tone and direction of the book. Because of them, we have carefully reexamined all of the information in existing chapters, adding, rewriting, and amplifying as we went along and significantly updating this material. We have also updated the Appendix to include current information on support services, patient education resources, comprehensive cancer centers, and online resources, and have expanded the Glossary so that it reflects the latest terminology, research, therapies, and surgical techniques.
Since our last literary excursion, many new developments have occurred in breast cancer research and therapy. Despite the numerous books and articles on the general health issues related to breast disease, our surveys indicate that many women remain woefully ignorant of them. Therefore we have interwoven basic information on these subjects throughout. Of particular interest are expanded sections on new tests and therapies for diagnosing and treating breast cancer, sentinel node biopsy, methods for breast cancer staging, updated criteria for choosing lumpectomy with irradiation, information about oncoplastic techniques for reconstructing lumpectomy defects, and the latest chemotherapy and hormonal therapy regimens. In addition, we have greatly expanded the discussion of breast cancer genetics and the breast cancer genes (BRCA1 and BRCA2), with a new chapter devoted to this topic and a new section on the role of the genetic counselor in advising women about their risks. We have also placed greater emphasis on the social, psychological, and wellness issues confronting breast cancer patients. Consequently, the chapter on breast cancer and its effect on relationships has been expanded to include more input from men and single women and greater attention to the practical realities of daily life. In our surveys and interviews we probe the strategies others have used to help them cope with dating, sex, communication, making new acquaintances, and building lasting relationships. Their solutions are surprising, creative, and always inspiring.
Finally, we have totally updated the chapters on breast reconstruction to incorporate the numerous advances that have taken place in the past 11 years and to respond to women's questions about breast restoration. All of the currently available reconstructive techniques, from the simplest to the most complex, are described in detail and accompanied by numerous photographs and drawings of the procedures and the anticipated results, as our readers requested. We have also expanded the chapter on frequently asked questions about breast reconstruction, incorporating information about currently available implants and expanders and adding details on perforator flaps and on fat grafting. In view of the mounting demand for and trend toward more immediate breast reconstructions, this topic has been explored in depth. We have also added information on oncoplastic reconstruction after lumpectomy and partial mastectomy, and perforator flap procedures, such as the DIEP flap.
The concluding chapter of the book has always been cited by our readers as being particularly helpful to them in understanding the possibilities and limitations of breast reconstruction. It captures conversations with breast reconstruction patients throughout the country. In this edition five new interviews have been added to reflect the latest reconstructive techniques and to capture special reconstructive scenarios for women who have been diagnosed with breast cancer genes and have opted for preventive mastectomy or those who have had particular risk factors that have complicated their recoveries. These women poignantly explain their motivations for seeking breast reconstruction. They candidly discuss such diverse issues as dating and sex after breast cancer, postsurgical depression, and the doctor/patient relationship. All of these women share the details of their surgery as well as their intense feelings about it and about the breast cancer experience. To assist the reader in differentiating among these interviews, we have included a short index at the beginning of this chapter that lists each woman's name, age, and type of reconstructive surgery.CHAPTER 2
Breast Anatomy and Physiology
How much do most women really know about their breasts? Most likely, very little. Unless they develop breast problems, they usually are not motivated to learn about the inner structure of this intimate female body part. Yet women need to be more familiar with the normal anatomy and physiology (function) of their breasts if they are going to be able to recognize the earliest and most treatable signs of breast cancer. With this knowledge, they will not be so frightened every time they notice a breast change. This chapter provides that information in a simple, straightforward manner. It offers women a baseline for evaluating their own health care requirements. Additionally, it provides assistance for women interested in performing breast self-examination, a crucial routine for proper breast surveillance.
The breast is a mound of glandular, fatty, and fibrous tissue located over the pectoralis muscles of the chest wall and attached to these muscles by fibrous strands (Cooper's ligaments). The breast itself has no muscle tissue, which is why exercises (often vigorously engaged in by teenagers intent on enlarging their breasts) will not build up the breasts. A layer of fat surrounds the breast glands and extends throughout the breast. This fatty tissue gives the breast a soft consistency and gentle, flowing contour. The actual breast is composed of fat, glands (with the capacity for milk production when stimulated by special hormones), blood vessels, milk ducts to transfer the milk from the glands to the nipples, and sensory nerves that give feeling to the breast. These nerves extend upward from the muscle layer through the breast and are highly sensitive, especially in the nipple and areola region, which accounts for the sexual responsiveness of some women's breasts.
Excerpted from A Woman's Decision by Karen Berger, John Bostwick III, Glyn Jones. Copyright © 2011 Karen Berger. Excerpted by permission of St. Martin's Press.
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Meet the Author
Karen Berger is a medical writer and publisher who lectures widely on women's health issues.
John Bostwick III, M.D., is chairman and professor of surgery of the Division of Plastic Surgery at Emory University School of Medicine and is one of the world's foremost authorities on breast surgery and reconstruction.
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