Life after risk-reducing surgery?

Residual risks of breast and ovarian cancer

Following bilateral salpingo-oopherectomy the risk of developing ovarian cancer has been reduced by 95% but not by 100%. It is very important that both the ovaries and tubes have been removed but there may still be residual ovarian endometrial cells remaining in the lining of the abdominal cavity.

If cancer occurs in these cells it is called peritoneal cancer and would present with symptoms similar to ovarian cancer.  If you experience abdominal swelling or bloating that persists for more than three weeks you should see your doctor.  Blood can be tested for CA125 and an ultrasound scan would identify a mass within the pelvis or fluid in the abdominal cavity.

After risk reducing bilateral mastectomies the risk of breast cancer has been reduced by 90-95% but it is not possible to remove every single breast tissue cell. Any residual breast cells will be directly underneath the skin and would develop into a small lump or thickening that would be easy to feel. There is no breast tissue behind the breast implant or reconstruction.

It is also possible for breast cancer to occur within the lymph nodes in the armpit.

It is now possible for many women to be offered nipple sparing mastectomies when the coloured skin of the nipple areolar complex is preserved but the surgeon removes as much breast tissue as possible beneath the skin and nipple. Studies have shown that there is no additional risk of breast cancer with nipple sparing mastectomies.

It is not necessary to continue with mammograms or MRI breast screening following risk reducing mastectomies but women are encouraged to examine their chest wall, reconstructed breasts and armpit every few months and report any lumps to their doctor.

Your new breasts

Following risk reducing surgery it is very common to have persistent numbness of the skin over the chest wall and in the armpit and inner arm. This may improve with time and regular massage with a body lotion can help reduce the unpleasant sensation. If you have had reconstruction surgery the breasts will look and feel very different from your natural breasts.

For women who had reconstruction using their own tissue the breasts usually feel softer, with a more natural shape than after implant based reconstruction and it is less likely that further surgery will be required.

More women now choose to have implant-based reconstruction as it provides pleasing results with a much quicker recovery time. Some women find that the implants feel cold and that underwired bras may not fit the contour of the implant.

Breast implants are not lifetime devices. You may need to have one or more re-operations over the course of your life due to any one or a combination of local complications or if you lose or gain a lot of weight. You may also need one or more re-operations to improve breast appearance if you are unsatisfied with the outcomes of the surgery aimed at correcting any local complications, or if you lose or gain a lot of weight.

Implants can rupture and women may notice a decrease in the size of the breast, an uneven appearance, pain or tenderness or swelling. If you experience pain, tenderness or swelling around the implant following trauma or a fall, you should be referred to a breast clinic. In many cases an implant may rupture without any symptoms, these are known as silent ruptures.  The silicone is largely contained within the scar tissue capsule around the implant. Ultrasound may show that a implant has ruptured but is most cases women will require breast MRI to assess whether an implant has ruptured.

Capsular contracture is the hardening of the tissue around the implant and can occur surrounding one or both implants. The hardening causes the tissue to tighten, which can be painful and in severe cases the implant feels very hard and like a ball within the breast.

In severe cases surgery may be required to replace the implant and release the capsule.  Unfortunately capsular contracture can recur more than once in the same breast.

Many women will have implants for many years without any significant problems and in these cases it is not necessary to replace implants just because.