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.
What is anaplastic large cell lymphoma (ALCL)?
Over the past 20 years, 10 million breast implants have been used throughout the world for women requiring breast enlargement and breast reconstruction. There have been about 170 cases of women developing a rare form of cancer called anaplastic large cell lymphoma (ALCL) within the capsule around the implant. There is no evidence that ALCL is specific to any one type or make of implant.
Following surgery it is not uncommon to have swelling around the implants but this should settle within 6 months. If however you develop unexpected pain, swelling or a lump around the implant more than one year following surgery you should be referred to a breast clinic for further investigation.
An ultrasound scan detects collections of fluid around the implant and testing the fluid can show whether there are abnormal cells present.
If ALCL is found, the implant and tissue around the implant would be removed but it is unlikely that chemotherapy or radiotherapy would be required.
What are the risks of other cancers?
Breast and ovarian cancer account for about 35% of all cancers in women in the UK. The other most common forms of cancer include lung, bowel, endometrial, melanoma and lymphoma and these become more common as women get older.
There are some studies that suggest that pancreatic cancer is more common in those with BRCA2 mutations especially if there are other family members who have had pancreatic cancer.
No additional cancer screening is required for women with BRCA mutations for any of these cancers.
At least a third of all cancers in the general population are preventable and the following lifestyle factors will not only reduce the risk of cancers but of other diseases including heart disease, stroke and diabetes.
Maintain a healthy weight
Take regular exercise
Reduce alcohol consumption
Eat more vegetables and fruit, less red meat and processed foods.
Use sun protection