LIFE AFTER RISK REDUCING SURGERY
• Will I need further surgery?
• What is anaplastic large cell lymphoma (ALCL)?
• What are the risks of other cancers?
Following surgery to remove the breast tissue, ovaries and fallopian tubes the risks of breast and ovarian cancer have been reduced by 95% and are less that the risks faced by women without BRCA mutations.
Residual risk of breast and ovarian surgery
It is possible in very rare cases for ovarian cancer to develop in the lining of the abdominal cavity, called peritoneal cancer. This would present with abdominal swelling or bloating and if these symptoms persist for more than three weeks you should see a doctor. Blood tests to check CA125 and an abdominal scan would identify the tumour.
In 5% of cases when risk-reducing mastectomies are performed, small tumours or pre-cancerous changes are found within the breast tissue that has been removed. For this reason, it is important that all breast tissue is examined by a pathologist experienced in breast cancer pathology. After risk reducing breast surgery the risk of breast cancer is very small. Most surgeons are happy that no further breast screening is required following bilateral mastectomies.
There will be tiny clusters of breast cells that remain just underneath the skin and it is possible for a breast cancer to develop within these cells. This would present as a hard lump just below the skin. In most cases implants are placed behind the chest wall muscle and there are no breast cells hidden behind the implant.
It is also possible but very rare for breast cancer cells to develop within the lymph nodes in the armpit.
Women who have had risk reducing breast surgery should remain breast aware. They do not need to do a regular breast examination but by massaging body lotion over the chest after a shower they will be aware of any changes.
Will I need further surgery?
Breast implants are not lifetime devices. You may require 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 significant weight.
Implants can rupture and women may notice a decrease or change in the size or shape of the breast, pain or swelling. In some cases implants can rupture without causing any symptoms. The silicone is largely contained within the scar tissue capsule around the implant. Ultrasound scan may show that an implant has ruptured but in most cases women will require a breast MRI to assess whether an implant has ruptured.
Capsular contraction is the hardening of the tissue around the implant and can occur in one or both breasts. 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.
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 the implants have been there for a long time.