Explore Plastic Surgery - Dr. Barry Eppley

Breast cancer continues to be a major health issue for women, averaging just under 200,000 new cases per year. It is the second leading cause of cancer-related deaths in women. From a plastic surgery standpoint, cosmetic breast surgery cases well exceed this number with over 500,000 procedures being performed per year. The crossing of these two breast treatments places plastic surgeons in a position to help improve breast cancer screening. Because all forms of cosmetic breast surgery produce irreversible changes to the breast parenchyma, the importance of presurgical screening is even more important.

In the November 2009 issue of Plastic and Reconstructive Surgery, Drs. Selber, Wu and colleagues looked at this very issue. Their study looked primarily at the behavior of plastic surgeons in knowledge and adherence to the American Cancer Society (ACS) Breast Cancer screening guidelines. The greatest relevance of their report, however, is to create awareness as to what preoperative breast screening should be done when cosmetic changes are anticipated to be done.

As a review of the ACS guidelines, women at average risk should begin self-breast examinations at least every 3 years for women in their 20s and 30s and yearly for woman over 40. Mammogram screening begins at age 40. This means that any woman undergoing cosmetic breast surgery under 40 should at least have a breast examination. Once over 40, all should have a mammogram as well.

These guidelines change for women at increased risk. A more aggressive screening program which may include MRIs should be done for women who are BRCA mutation carriers, a first degree relative of BRCA carrier and radiation exposure between the ages of 10 and 30 years of age. Women at increased breast cancer risk include two or more relatives with breast or ovarian cancer, breast cancer occurring before age 50 in an affected relative, one or more relatives with two cancers, male relatives with breast cancer, or a family history of breast or ovarian cancer with Ashkenazi Jewish heritage.

Because of the frequency in which cosmetic breast surgery (breast augmentation, breast lift, breast reduction) is done, plastic surgeons are in a unique position to screen women for breast cancer. Often, this would be the first and in some cases the only breast cancer screening that they may receive. Taking a family history, performing a breast examination, and referral for a preoperative mammogram if indicated are in the patient’s best interest. Women over age 40 should not undergo any form of cosmetic breast surgery unless they have been baseline screened regardless of their risk factor. Women under age 40 with moderate to high risk should have the same baseline breast information obtained prior to surgery.  

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

As October is Breast Awareness Month, it is important to realize that men, like women, can develop breast cancer. Men just like women have breast tissue that can develop abnormal cancerous cells. But by comparison to women where about 500,000 new cases of breast cancer are diagnosed a year, the number of male cases is around 2,000 for about a 250:1 female/male occurrence ratio. This much lower incidence in men is due to a variety of reasons including the smaller amount of breast tissue that men have and the hormonal differences. As men age and their testosterone levels drop, the risk increases. This is most likely why breast cancer is most common in men between the ages of 60 and 70.

While male breast cancer may be less common than other male cancers, the death rate is significantly higher than for other typical male breast cancers such as prostate and testicular cancer. Whether this is because the breast tumor is more aggressive is speculative but late diagnosis is likely a contributing cause. There is a generalized lack of awareness of male breast cancer. As a result, men often mistake palpable or visible lumps for other problems and ignore them until the tumor is more advanced. This would also explain the higher mortality rate of near 30 % compared to 20% in women.

Risk factors for male breast cancer are numerous and include aging, family history of breast cancer, obesity, liver disease, alcoholism, estrogen drug treatment, radiation exposure, and certain genetic conditions such as Klinefelter’s syndrome and inherited gene mutations. Although these risk factors may increase a man’s chances of developing breast cancer, the cause of most breast cancers in men is still largely unknown. Suggestions for prevention have included keeping one’s weight down to as ideal as possible and limiting alcohol use. But there is no guaranteed way to prevent its occurrence.

The physical signs of male breast cancer include a lump or swelling, which is usually (but not always) painless. Dimpling or puckering of the skin overlying a lump is ominous and needs to be evaluated immediately. Other signs include nipple retraction (turning inward), discharge from the nipple, and redness or scaling of the nipple or breast skin. These changes aren’t always caused by cancer though they all merit a physician’s evaluation. The vast majority of breast lumps in men that I have seen in my Indianapolis plastic surgery practice have been due to a far more common and younger male breast condition, gynecomastia or benign male breast enlargement.

Presently the best strategies for reducing the number of deaths caused by male breast cancer is early detection and prompt treatment. As previously noted, the concept of early detection has been a problem for men who tend to ignore breast lumps and see a physician only when it has gotten quite large.

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While not commonly asked, one of the first questions a potential breast augmentation should ask is…does the breast implant interfere with being able to detect breast cancer? Since breast cancer in the United States affects one in 11 women during their lifetime, this is a fairly important question. As breast augmentation procedures continue to be on the rise, this important question should be thoroughly addressed.

 
In a recently published analysis of this topic by Dr. Neal Handel of Santa Barbara, California in the December 2007 Supplement issue of Plastic and Reconstructive Surgery, he does exactly that. Using over 4,000 patients over a 23 year period, he assessed how easily mammography detected breast lesions. Women with breast implants presented more frequently with breast masses, invasive tumors, and axillary node spread. However, there was no significant difference in stage of disease, tumor size, recurrence, or survival between the two groups. Despite the diminished sensitivity of mammograms to detect breast cancer in women with implants, nonaugmented women and augmented women are diagnosed at similar stages of disease and have similar prognoses.

 
In a companion study in the same Supplement, Dr. Dennis Deapen of Los Angeles, California evaluated literature over the past 20 years which examined breast cancer-related risks among breast implant patients. He found that women with breast implants do not experience delayed detection of breast cancer. He summarized that breast implants are not associated with an increased risk of breast cancer incidence or death and these patients do not experience delayed detection or poorer survial after breast cancer treatments.

 
These two published studies should go far to alleviate any concerns in potential and existing breast implant patients about the detection and treatment of breast cancer.

 
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis