By Barb Horstman, Breast Cancer Survivor

​When I was asked to write about my breast cancer story, I was hesitant as my story is pretty normal – diagnosis, surgery, recovery. No major complications or surprises. But then I realized, there is absolutely NOTHING NORMAL about getting breast cancer, and if my story helps just one person get through this, then I’m happy to share.

I was 52 when diagnosed. My mom had breast cancer previously so I was considered high risk. In addition to having a yearly mammogram, I was also having a yearly breast MRI so I was having a mammogram or an MRI every 6 months. It was the MRI that caught it. My cousin had just been diagnosed 6 months earlier (she was 47 years old at the time) and she was very open with me about her journey which included a double mastectomy, chemo, radiation, and reconstruction, so I knew what was coming - and it scared me. How was I going to do this? How was I going to tell my kids? My daughter was in junior high and my son was in high school. How much time would I need to take off from work? Who was going to help me after surgery? How am I going to tell my parents? So many things to do – where do I even start?

My husband and I decided to wait and tell the kids (and my parents) until after I had a treatment plan in place. We wanted to have as much information for them as possible. This turned out to be more complicated than I thought. Since my breast cancer was caught early, I was lucky and had options. Lumpectomy with radiation was the easiest option, or mastectomy, single or double, with reconstruction, or go flat. I talked myself into each of these options at some point. You may think you know exactly what you would do if you were ever diagnosed with breast cancer – but you don’t.

At this point of my story, I knew I needed help so I reached out to women I knew had been through this. Obviously my cousin was one of the first I reached out to, but I also reached out to women that I hadn’t spoken to in years! It didn’t matter – every single one of them were full of compassion and jumped at the chance to help me. I could hear the pain in their voices – of knowing another person had to go through this – and even bringing back memories of their own stories. I apologized to all of them for asking for advice but they all assured me that it was okay to ask. These ladies spent hours on the phone with me, met me in person for coffee, gave me books to read, and sent me inspirational cards. They even directed me to others that they knew for additional guidance.

Soon after, I was getting calls/texts from complete strangers offering advice and sharing their own stories. I was blown away by the openness of these ladies and how willing they were to talk about their breasts with a complete stranger! To hear their personal stories/struggles with how and why they chose the treatment they did, helped me decide what I wanted to do. In the end I decided on a double mastectomy with reconstruction at the same time. Then I was told some bad news – I would have to wait 8 weeks for surgery/ reconstruction! I was shocked – how could this be? Why would a cancer patient have to wait 8 weeks for treatment? It’s CANCER! I was assured by my doctor(s) that it would be fine. I again turned to my “girls” to vent – the same ones that helped me make my treatment decision - who were able to help me see that I could either change my treatment plan (go with mastectomy only and do reconstruction later – then I could have surgery in 4 weeks), or use these 8 weeks to do things I wanted or needed to do. I chose to wait the 8 weeks and while I had the time, I went down to UIHC for a second opinion. UIHC completely agreed with my local doctors’ assessment of my breast cancer diagnosis, stage, and treatment options which I was so relieved to hear. I would highly recommend getting a second opinion – if you have the time.

I had a double mastectomy and reconstruction on July 23, 2019 – almost 3 months after diagnosis. Recovery was hard, but I again had a lot of support. My co-workers arranged for meals for the 4 weeks I was at home recovering. I had visitors to keep my spirits up and a wonderful friend who is a nurse came over to help me with those crazy drains a couple of times. Those same women who were there for me before surgery, were also there checking up on me after surgery. The final pathology report came back showing no lymph node involvement. I did not need chemo or radiation but was prescribed tamoxifen. After 6 weeks on tamoxifen, I developed a blood clot in my right calf and was put on blood thinners for 6 months. After 6 months of blood thinners, I was told I could go back on tamoxifen, but if I did that, I would also have to be on blood thinners as long as I was still on tamoxifen. Or, I could just not continue with tamoxifen, because my recurrence score was very low. This was a scary decision for me, but I chose to stay off the tamoxifen. (I also went back down to UIHC for another second opinion on the tamoxifen/blood thinners issue. Again, they confirmed what my local doctors advised.)

​I’ve been cancer free now for 4 years. If it comes back, I know that same group of women will help me once again, along with the women in my church’s cancer survivor group, and the amazing women I’ve met through recently joining the Beyond Pink TEAM. Breast cancer survivors are like energizer bunnies – we just keep going – for ourselves and anyone else diagnosed. There is no stopping us. I started helping others diagnosed as soon as I could. I shared mastectomy shirts, recovery pillows, and anything else I used after surgery with two dear friends diagnosed after me, and with a couple of “friend of friends” and I will continue to help anyone who asks. As I said before, my breast cancer story was pretty typical and could have been so much worse. My advice to anyone is to get screened so it can be caught early and you can have options. Reach out for help, accept help when offered, and then continue to help others as you are able.

By Deniz F. Bastug, MD, FACS

​Breast Cancer continues to be one of the most prevalent forms of cancer for women. Currently, breast cancer will affect approximately one out of every 7 to 8 women, an increase from previous decades. There still remains no cure for breast cancer, but research is strong in that direction. Advances are made yearly in detection and diagnosis, in treatment protocols, as well as other factors and associated conditions affecting the discovery of breast cancer in a woman.

Treatment involves a multitude of factors including family history, genetic components, type of breast cancer, and individual personal preferences regarding treatment options. For all these reasons, treatment of this disease is heavily individualized and consists of a concerted effort by many different specialties, including the general surgeon, oncologist, geneticist, and radiation oncologist. The reconstructive portion of treatment is performed by a plastic surgeon, and this article will touch on the various reconstructive options.

When considering reconstruction after mastectomy, a woman must consider many factors. The first important question to ask should be „is reconstruction right for me?‟ Women choose breast reconstruction for many reasons, and the method of reconstruction chosen is very individualized. This depends on personal desire, physical attributes, type of breast cancer, lifestyle and psychological characteristics. No matter which method of reconstruction is chosen, it usually will entail multiple surgical procedures.

Breast reconstruction can be performed at the time of mastectomy, known as immediate reconstruction, or anytime later, typically months to years, which is known as delayed reconstruction. The timing of the reconstruction depends again on individual desire, but many times is more influenced by the disease itself, i.e. whether other adjuvant treatment such as radiation or chemotherapy will be needed. Once the timing is determined, the next step is in determining which type of reconstruction is best for the individual.

There are many types of reconstruction available, but all fall into one of two types. Either a portion of one‟s own body will be used, known as autologous reconstruction, or a breast implant will be used. Sometimes the two are combined. The procedures vary in complexity, recovery time and risks. Despite the method chosen, all can give a nice cosmetic result, and again choice is based on individual preference, anatomy, type of cancer and lifestyle.

Probably the gold standard in reconstruction these days is the ​autologous reconstruction, which is using a women‟s own tissue to create the breast. This is done with what is called a flap. This flap, which consists of skin, underlying fat, underlying muscle, and associated blood vessels can be taken from many different areas of the body. These are too numerous to go into detail here but these flaps can come from the abdomen (called a TRAM flap), from the back (a Latissimus Dorsi flap), or from other areas such as the buttocks region (Gluteal flaps). These flaps are either left attached to the underlying muscle, or can be completely disconnected from the muscle and placed into the chest to create the breast using microsurgical techniques. Flap or autologous reconstruction involves complex surgery, longer recovery time, affects other parts of the body and have the greatest risks. The benefits of these trade-offs are typically beautiful and very natural appearing breasts.

The alternative to the autologous reconstruction uses an implant to recreate the breast mound. In certain instances this can be performed as a one time procedure, but typically this will be at least a two stage process. Following a mastectomy, there is deficient skin. The various flaps provide for this skin, otherwise we need to place a special type of implant called an expander to stretch the skin and muscle slowly. This provides the room for the second procedure where the expander is removed and a permanent implant is placed.

Women have a choice of either saline implants or silicone implants as the permanent prosthesis. There has been a lot of press in the past regarding silicone implants, and unfortunately this has only confused and frightened women. Countless studies over the past 16 years have been performed, all verifying the safety of silicone implants. However there is still apprehension in some women. Talking to your plastic surgeon is the best way to get the information you need to make the proper informed choice.

As mentioned earlier, reconstruction usually involves more than one procedure, and many times one of these procedures needs to address the opposite breast. Often the non-reconstructed side needs something done to it in order to achieve symmetry with the reconstructed side. This can involve a breast lift (mastopexy), a breast reduction or a breast enlargement (augmentation). Once the reconstructions are done, symmetry has been achieved and the woman is well healed, one more decision needs to be made. This is whether or not to have a nipple and areola reconstructed. Several methods are also available for this, but fall into two categories, either tattooing or flap reconstruction if an actual protruding nipple is desired.

Breast reconstruction is a decision based on many factors involving many decisions and individual circumstances. In careful discussion with your plastic surgeon the best method for you can be determined. It is also very important to be aware that federal law requires insurance companies cover breast reconstruction for mastectomy following breast cancer, as well as cover procedures on the opposite breast to achieve symmetry. With the widely available options present, mastectomy alone need not be the endpoint for breast cancer. Through education and involvement in the decision making process, breast reconstruction can be a very fulfilling and satisfying option.

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