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Terminology
Lumpectomy: surgical removal of a cancerous tumor along with a small margin of surrounding tissue.
Simple Mastectomy: surgical removal of breast tissue only; lymph nodes and pectoralis muscle are preserved. Modified Radical Mastectomy: surgical removal of breast tissue, some fat, and most of the lymph nodes in the armpit, leaving the chest wall muscles largely in tact.

Stages of Breast Cancer
The term "early breast cancer" refers to stages of breast cancer labeled 0, I, & II.
Stage 0, Cancer cells are present in either the lining of a breast lobule or a duct, but they have not spread to surrounding fatty tissue. This stage is also called ductal carcinoma in situ or DCIS.
Stage I, Cancer has spread from the lobules or ducts to the nearby tissue in the breast. At this stage and beyond, breast cancer is considered to be invasive.The tumor is 2 cm or less in diameter (approximately 1 inches or less); the lymph nodes are not involved.
Stage II, Cancer has spread from the lobules or ducts to nearby tissue in the breast. In this stage, the tumor can range from 2cm to greater than cm in diameter (approximately 1·2 inches); sometimes the lymph nodes may be involved.
A recurrence is a return of breast cancer. After surgery for early breast cancer, adjuvant, or additional, therapy may be given to reduce the chance of a recurrence.
The term "advanced stages of breast cancer" refers to stages of breast cancer labeled III and IV.
Stage III, Known as locally advanced cancer; tumor may be larger than 5 cm (2 inches) in diameter, and the cancer may or may not have spread to lymph nodes or other tissues near the breast.
Stage IV, Known as metastatic; cancer has spread from breast and lymph nodes under the arm to other parts of the body, such as bone, liver, lung, or brain.

Legislation
The Women’s Health and Cancer Rights Act was passed in October 1998 by the United States Congress. The act requires group health plans and health insurers that provide medical benefits covering mastectomy, to also cover the cost of reconstructive breast surgery for women have undergone a mastectomy. Coverage must also include all stages of reconstruction of the diseased breast, procedures to restore and achieve symmetry on the opposite breast, and the cost of prostheses and complications of mastectomy.

Breast Reconstruction
Not all women will have mastectomies. Some will choose lumpectomy and irradiation. Nor will all women having mastectomies want the additional procedures involved in breast reconstruction.
Despite the growing acceptance of reconstruction among mastectomy patients and members of the medical community, the general public is still largely unaware of the physical and psychological transformation that is possible through reconstructive breast surgery. The education of all
women about the spectrum of therapeutic alternatives available to them is necessary so that they can more effectively influence their own destinies and play an active role in their own health care.
A plastic surgeon is a part of the "Breast Management Team" and should be visited before having breast cancer surgery to review the possible breast reconstruction options that would apply to individual diagnosis, general health and personal desires.
Natural Reconstruction, a tissue flap created by using a section of your own skin, fat, and muscle which is moved from your abdomen or back to your chest and shaped into a new breast.
· TRAM Flap (Transverse Rectus Abdominis Musculocutaneous flap), creates a breast mound with the skin, fat and strip of abdominal muscle.
· Latissimus Dorsi Flap rebuilds the breast mound using the skin and muscle from the back with or without a breast implant.
Implant Reconstruction, a breast implant filled with either saline or silicone gel is placed behind the chest muscle to create a breast mound after expansion of the remaining tissue with a tissue expander.

Timing
Today with increased emphasis on informed consent and the help of "The Breast Management Team" many women learn of the option of reconstruction before they have their cancer surgery and have the opportunity to discuss the correct timing of their reconstruction in conjunction with any adjunctive treatment. The optimal timing of breast reconstruction is considered after full discussion and consideration of the benefits and risks and the individual woman’s needs.
Immediate Reconstruction begins at the same time as your mastectomy.
Delayed Reconstruction can begin months to years after having a mastectomy.

Next Page: Questions to Ask Your Plastic Surgeon


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Questions to Ask Your Plastic Surgeon
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