After my mastectomy, I am not a candidate for breast reconstruction. What are my options?

Sometimes after a mastectomy, women experience swelling or lymphedema in the remaining breast tissue and are not candidates for breast reconstruction surgery.  Kristen demonstrates how a special breast prosthesis works with massaging technology to actually help remove fluid while you wear it! You can even insert it into your favorite pre-mastectomy bra.

Rita Wilson Has Breast Cancer, Undergoes Double Mastectomy and Reconstructive Surgery

BY ELIZABETH LEONARD
Photo Credit: Kristen Lara Getchell

Rita Wilson is sharing some difficult and very personal news: she was recently diagnosed with breast cancer and has undergone a double mastectomy and reconstructive surgery.

In an exclusive statement to PEOPLE, the actress, 58, reveals the diagnosis and how she feels "blessed" to have the love and support of her husband, Tom Hanks, friends, family and the doctors who saved her life.

"I have taken a leave from the play Fish in the Dark to deal with a personal health issue," reveals Wilson, who will return to the Broadway play on May 5. "Last week, with my husband by my side, and with the love and support of family and friends, I underwent a bilateral mastectomy and reconstruction for breast cancer after a diagnosis of invasive lobular carcinoma. I am recovering and most importantly, expected to make a full recovery. Why? Because I caught this early, have excellent doctors and because I got a second opinion.

"I have had an underlying condition of LCIS, (lobular carcinoma in situ) which has been vigilantly monitored through yearly mammograms and breast MRIs. Recently, after two surgical breast biopsies, PLCIS (pleomorphic carcinoma in situ) was discovered. I mention this because there is much unknown about PLCIS and it is often found alongside DCIS (ductal carcinoma in situ). I was relieved when the pathology showed no cancer.

"However, a friend who had had breast cancer suggested I get a second opinion on my pathology and my gut told me that was the thing to do. A different pathologist found invasive lobular carcinoma. His diagnosis of cancer was confirmed by, yet, another pathologist. I share this to educate others that a second opinion is critical to your health. You have nothing to lose if both opinions match up for the good, and everything to gain if something that was missed is found, which does happen. Early diagnosis is key.

"I feel blessed to have a loving, supportive husband, family, friends and doctors and that I am the beneficiary of advances in the field of breast cancer and reconstruction. I am getting better every day and look forward to renewed health.

"I hope this will encourage others to get a second opinion and to trust their instincts if something doesn't 'feel' right."

For more information, please go to the Breast Cancer Research Foundation website at BCRFcure.org.

Mastectomy vs. Lumpectomy for Early Breast Cancer: How to Choose

Weighing the pros and cons of two different surgical options.
By Deborah Kotz

Each year more than 200,000 women diagnosed with early-stage breast cancer, the most common kind, must make myriad treatment decisions. Among them: whether to have a mastectomy or breast-conserving surgery known as a lumpectomy.

If you’ve been diagnosed with a stage 1 or 2 breast tumor that’s not highly aggressive, you may have been offered both surgical options and left to decide which is best for you.

“Once we determine that we can remove the tumor with clear cancer-free margins, we generally leave the choice up to the woman whether to have a lumpectomy or mastectomy without recommending one over the other,” says Bonnie Sun, a breast surgeon at Sibley Memorial Hospital in the District of Columbia. “It becomes a personal decision, and the patient will have to decide, ‘what do I really want?’”

A large body of evidence indicates that breast cancer patients who have mastectomies face the same survival odds as those who have lumpectomies along with breast radiation, and for the past few decades oncologists have been encouraging women with early-stage breast cancer to opt for the less radical surgery.

In fact, an expert panel convened by the National Cancer Institute declared in 1990 that lumpectomy with radiation was “preferable” to mastectomy for women with stage 1 or 2 breast cancer – which helped drive down mastectomy rates for these patients from 100 percent in the 1980s to less than 40 percent today.

But the pendulum is starting to swing back a bit toward mastectomies. A 2014 study published in the journal JAMA Surgery – which examined anonymous records from 70 to 80 percent of American women who had breast cancer surgery – found that the percentage of those with early-stage breast cancer increased from 34 percent in 1998 to 38 percent in 2011.

While the study authors could not explain the reasons for the increase, several developments over the past decade may have contributed.

Improvements in breast reconstruction following mastectomy provide patients with more natural looking results than in decades past, says Mehra Golshan, director of breast surgical services at Dana-Farber Cancer Institute in Boston. More breast cancer patients are also getting insurance coverage for the procedure, thanks to a 1998 federal law mandating coverage.

In recent years, oncologists have moved away from strongly recommending lumpectomies toward involving women in a shared decision-making process, which entails a more in-depth discussion of the pros and cons of both surgeries.

Ask yourself the following questions to help determine which surgical option is best for you.

1. How much do you fear annual breast screenings and a potential new breast tumor? Many breast cancer patients opt to have a mastectomy – and even a prophylactic mastectomy on the other healthy breast – because they know they’ll feel extreme anxiety during future annual mammograms and over any abnormal finding, follow-up biopsy and possible diagnosis of another breast tumor down the road. About 5 percent of patients who opt for a lumpectomy will have a recurrence in the affected breast or opposite breast, Golshan says, but it’s rarely life threatening.

2. How much do you want to avoid a painful recuperation? Mastectomy with breast reconstruction typically involves multiple surgical procedures and a painful healing process that can last for weeks or even months. Lumpectomy, on the other hand, is usually a shorter procedure with a shorter recovery time but sometimes also requires a second surgery if a pathologist later finds cancer cells in the tissue surrounding the removed tumor.

 “I give patients the option of speaking with women who have had lumpectomies and mastectomies, so they can get first-hand experiences of what others went through,” Golshan says.

3. Do you have concerns about radiation treatments? After lumpectomy surgery, patients typically need five to seven weeks of radiation therapy, five days per week, to destroy any stray cancer cells. Side effects from the treatments can include breast swelling, fatigue and skin redness and blistering (like a sunburn). Scatter from the radiation can, in rare cases, damage the heart, lungs or surrounding bones.

Some women are now being offered a new option called intraoperative radiation therapy, IORT for short, in which a single dose of radiation is delivered directly into the tumor site during lumpectomy surgery. Those who have IORT do not need subsequent radiation treatments, but only certain patients are candidates. “These are women over age 45 with early-stage invasive tumors less than 2.5 centimeters in size,” says Andrea McKee, chairman of the radiation oncology department at Lahey Hospital and Medical Center in Burlington, Massachusetts. Candidates also must have only ductal breast cancer, which occurs in the milk-producing ducts, with no signs of tumor cells in healthy tissue surrounding the excised lump and no spread to local lymph nodes.

Some caveats: Since the procedure is fairly new, many cancer treatment centers do not yet offer it, and some insurance companies do not cover it. What’s more, about 15 percent of patients who have IORT wind up needing traditional radiation treatments because their final pathology report shows that they weren’t appropriate candidates, McKee says.

4. How much importance do you place on breast appearance? On sexual pleasure? Reconstructed breasts may look great, but they don’t respond to cold, heat, touch or stimulation, which can reduce sexual pleasure, Golshan says. Lumpectomy will retain the sensation of the breast, but may result in a lopsided appearance if a large amount of tissue is removed or if a woman has a small breast. For this reason, breast reconstruction may be offered along with lumpectomy to even out breast size.

5. What’s your life expectancy? Women diagnosed with breast cancer at a younger age may be more likely to opt for mastectomy because their longer expected lifespan means they have a higher lifetime risk of recurrence. “We typically tell patients that their risk of developing another primary breast cancer is about ½ percent per year,” Sun says. A 30-year-old breast cancer patient who expects to live another 50 years will face a 25 percent risk of developing another breast cancer compared to a 5 percent risk for a woman diagnosed at age 70.

Young breast cancer patients are also more likely to carry gene mutations that put them at even greater risk of recurrence, Sun said, which could tip the balance toward having a single or double mastectomy.