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Question: What are the differences between saline and silicone implants, and which type would you recommend?

Answer: All breast implants have a silicone shell. Silicone is a biologically inert substance, and is the most extensively studied medical device in the history of medical devices! Many implantable devices ranging from intravenous tubing, to the lining of a pacemaker or joint replacement, are made of silicone. There are also no known allergies or sensitivities to silicone.

The fill of an implant can be either saline or silicone gel. Saline is sterile salt water that can be absorbed by the body if there is ever a leak of the implant. This would result in slow deflation of the implant with gradual flattening of the breast reconstruction.

Saline implants tend to feel slightly less natural, and can have more rippling of their surface than silicone implants. Silicone gel implants have a slightly more viscous nature and can feel and look more natural than saline. Rippling is slightly less noticeable in these implants.

As opposed to saline, silicone is not permeable in the body. If there is a leak of a silicone-filled implant, the silicone cannot be absorbed by the body or travel outside the pocket where the implant has been placed. MRI is the best method to detect leakage of a silicone implant.

For the permanent implant used in breast reconstruction, I usually recommend silicone for the most natural looking and feeling result. The same goes for cosmetic breast augmentation. I advise my patients that implants may not last forever and may need to be replaced during their lifetime. Implant replacement is never an emergency and will require a return trip to the operating room.

A comprehensive and informative website to learn more about the science and safety of all breast implants, saline and silicone, is www.breastimplantanswers.com.

 

Question: If you've lost your sex drive completely, is there any hope that it will come back? How do you get back into the swing of things?

Answer: First of all, I would like to thank the Young Survival Coalition for inviting me to guest host, Ask the Expert.

Sexuality is such an essential aspect of life. It is especially important after a trauma, like breast cancer, to find a way back. Probably the hardest part is just getting started again, working out how to negotiate that beginning, and where things will go with your partner. Many women assume they have to feel like they want sex or "be in the mood" in order to begin a sexual interaction, but the feelings of arousal or desire may come after touching has already begun. Just give yourself permission to be open to the possibility of getting turned on.

I suggest letting your partner know that you would like to be sexual again, but haven't been feeling as spontaneous as you once did (this may be especially true after a surgical or chemical menopause). Let your partner know that you'd like to start some more intimate touching, but might not feel ready to "go all the way." This means talking to your partner "outside the bedroom" some time before any interlude is even contemplated, and deciding what you feel comfortable doing at this point, and what you don't feel comfortable doing. Your partner may also have reservations about certain activities.

You and your partner might instead begin, what sex therapists call, a "non-demand" exercise…that is a sensual interaction that does not (necessarily) end in sex. An example of this is just kissing and holding one another, or soaping one another in a shower or bath. Another example is touching each other's entire bodies, with or without undergarments depending on your initial level of comfort, but excluding the genital and breast areas at first, and finding other areas of the body that are responsive to sensual contact. The goal is to begin sensual touching again, feeling comfortable being touched, enjoying the sensations without worrying about your response or your partner's response, enjoying being with your partner as you can be with no one else. Allowing yourself to have sexual fantasies during these interludes is also helpful. The sexual interludes should continue at this level until you are more comfortable to go on to the next level, which might include genital touching.

 

Question: Is it safe for ER+ women to have a child? Is it safe to stop tamoxifen to have a baby and then go back on? We would love to have a child, but do not want to if it's not safe.

Answer: Women of childbearing age diagnosed with breast cancer may be concerned about their future fertility and family planning. Today, there are more options available and talking with your oncologist about these issues can be very helpful with this important decision. Although research in this area is limited, available studies have revealed no increased risk of breast cancer recurrence in women who become pregnant after breast cancer treatment, regardless of the ER status of a woman's tumor. Furthermore, children born after treatment for breast cancer seem to have no increased risk of birth defects.

Many oncologists encourage patients to delay child bearing after diagnosis. This is because the majority of young women who develop recurrent breast cancer do so within the first five years of diagnosis with the most aggressive cancers recurring within the first 2-3 years.

Tamoxifen is a hormonal therapy that is often used in women with estrogen receptor–positive breast cancer. Treatment with tamoxifen is usually given over a period of 5 years to block the action of estrogen and potentially stop or slow the growth of cancer cells. Five years of tamoxifen offers women the greatest benefit in prevention of breast cancer recurrence. Tamoxifen treatment generally does not cause early menopause; however, periods can become irregular. Furthermore, fertility may be naturally declining with age during this time. Some women with low-moderate risk tumors may decide with their doctors to take less than the full 5 years of tamoxifen and forego some of the benefits of tamoxifen in terms of disease recurrence. Pregnancy can occur during treatment with tamoxifen but is not safe because of an increased risk of birth defects and miscarriage (the first trimester). Therefore, effective non-hormonal contraception is strongly recommended during treatment with tamoxifen.

 

Question: Does drinking alcohol have an effect on recurrence and survival rates?

Answer: Few studies have been done to evaluate the role of alcohol consumption in breast cancer survival. The findings of these few studies are inconsistent, which make it difficult to make any specific recommendations. Overall, the impact of alcohol consumption on breast cancer survival is uncertain. Alcohol Consumption and Breast Cancer Survival, written by Elisa V. Bandera and David A. August from the Division of Surgical Oncology, The Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, NJ, does a nice job reviewing some of this literature.

However, it is well documented in the literature that alcohol has been shown to increase the risk of developing breast cancer and other cancers as well. A study done by Marilyn L. Kwan, PhD and colleagues called Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States), found that cancer is 34% more likely to come back in breast cancer survivors who drink more than three drinks a week, compared with those who abstain or drink less.

As you can imagine there are pros and cons to all subjects on the Internet. I do think it is safe to conclude that when it comes to alcohol consumption and breast cancer, it is important to refrain from alcohol or only consume on an occasional basis.

Links related to this topic:

Alcohol Consumption and Breast Cancer Survival (Journal of Clinical Oncolgy)

Alcohol and Breast Cancer in Women (The Journal of the American Medical Association)

 

Question: Do you have any suggestions for managing hot flashes?

Answer: Hot flashes are sensations of increased body temperature. A hot flash usually begins in one region of the body and spreads quickly. A sudden wave of warmth in the face, neck and chest occurs and usually lasts between a minute and several minutes. Researchers attribute hot flashes to irregular expansion and contraction of the small blood vessels of the skin, which produce perspiration and blushing. Hot flashes are usually caused by a lack of estrogen. The sensation from a hot flash is unexpected and can be very bothersome. Most women, however, notice that their hot flashes tend to occur during certain times of the day. Most chemotherapy drugs, including anti-hormonal drugs such as Tamoxifen, cause hot flashes.

The best management technique is to control body temperature and the immediate environment. Hot flashes can also be associated with nausea, dizziness, headache, irregular heartbeat pattern and sweating. Hot flashes are not a disease, even though they may feel that way.

Suggestions for coping with hot flashes:

  • Notice a time or pattern for your hot flashes. Expecting them can give you some sense of control.
  • Dress in light, layered clothing so that outer garments can be removed during a hot flash. Avoid turtleneck sweaters. Wear slip-on shoes that can be quickly removed so you can place your feet on the cold floor.
  • Avoid hot environments, if possible.
  • Drink cold liquids; avoid hot drinks. When a hot flash starts, try drinking cold water to reduce the sensation and keep yourself hydrated.
  • Sleep in a cool room. Use cotton sheets and bed coverings that can be quickly removed. Select cotton pajamas or nightgowns.
  • Turn on an electric fan.
  • Avoid highly seasoned foods, alcohol and drinks with large amounts of caffeine (coffee, tea, soft drinks).
  • Avoid stressful situations that can stimulate you emotionally.
  • Avoid activities that can increase body temperature such as hot baths, saunas and sunbathing.
  • Learn mental visualization techniques that can reduce the intensity of the sensation.

Medications
If your hot flashes are interfering with your quality of life and are not managed with the above suggestions, talk to your doctor. Several of the selective serotonin reuptake inhibitors (SSRIs) medications have proven effective in reducing hot flashes. If you are taking Tamoxifen, the SSRIs citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox) are recommended in recent studies because they do not to interfere with Tamoxifen's effectiveness.