[Breast Cancer Special Topic]Breast cancer treatment takes care of both body and mind, and nipple tattooing helps patients regain their self-confidence.

Text: Feng Shuling, “Ming Pao”

October is International Breast Cancer Awareness Month.

Breast cancer has become the number one cancer among women in Hong Kong since 1994. Hong Kong cancer statistics in 2020 show that on average, about 1 in every 14 women will suffer from breast cancer.

The number of new cases continues to rise, and patients tend to become younger. When treating breast cancer, doctors must also take into account the psychological needs of patients.

The radical cure for early-stage breast cancer is excision surgery. Breast removal has an impact on the patient’s appearance and psychology. In addition to considering breast reconstruction surgery, patients can also get nipple tattoos to make the reconstructed breasts look better and reduce the psychological impact.

In the past 30 years, the number of local diagnoses of breast cancer has more than tripled. Data show that the number of new cases of breast cancer in 1990 was 1,097, and a total of 4,956 new cases of female breast cancer were recorded in 2020, accounting for 28.4% of the total new cases of female cancer in Hong Kong; about half of new breast cancer cases occur in women aged 40 to 59.

Breast cancer patients have become younger in recent years

Although the older you are, the higher your risk of breast cancer is. However, surgeon Hong Jiawei pointed out that breast cancer has been trending in younger patients in recent years, with many patients under the age of 40.

According to data from the Hong Kong Breast Cancer Foundation, the median age of patients in Hong Kong at diagnosis is 58 years old. Compared with the median age of patients in the United States, which is 62 years old, and Australia, which is 60 years old, Hong Kong patients are relatively younger.

Early detection and treatment are crucial to patient survival.

Data show that the overall patient 5-year survival rate is 84%. The 5-year survival rate of stage I breast cancer patients is 99.3%, stage II is about 94.6%, stage III is about 76.2%, and the survival rate of stage IV patients is about 30%.

Therefore, in addition to taking care of the patient’s condition, doctors must also take care of their needs for changes in appearance. Younger women, in particular, struggle more with the physical and mental changes after surgery..

Hong Jiawei pointed out that to completely cure breast cancer, especially in stages 1 to 3, surgical removal of tumors is the most effective treatment method. “The younger the patients are, the more they will have certain requirements when it comes to changes in appearance, hoping to preserve their breasts as much as possible. Therefore, the difficulty of the surgery will be higher than in the past, and there will be more aspects to consider and balance.”

The range of tumor resection is also large

There are two main types of resection surgery:

◆Total mastectomy

The entire breast is removed along with the tumor and nipple. After the surgery, the patient’s chest became flat and left a long scar. For some patients, it is not easy to accept because it seriously affects the appearance.

◆Local excision

Only the tumor and surrounding tissue are removed, and the tissue that has not been invaded by cancer cells is retained as much as possible. This method is suitable for single and small tumors. Since the resection range is small, the appearance will not be greatly affected.

However, if the tumor is relatively large or multiple (tumors appear in more than one location), the area that needs to be removed is relatively large, and local excision may cause serious deformation and also affect the appearance; at this time, mastectomy and reconstruction surgery This is a more appropriate treatment plan.

Patients who require a mastectomy may consider breast reconstruction surgery, which is divided into two broad categories.

The first type uses implants such as special saline bags to make both breasts look even and natural. Hong Jiawei pointed out that this method is relatively simple and can be implanted in the same wound as the resection surgery. However, implants are foreign objects and may cause inflammation, infection, damage, displacement, etc. Implants generally last about 10 years before they need to be replaced with revision surgery.

Implanted into own tissue with high durability

The second type of reconstruction method uses the patient’s own tissue as filler, such as abdominal muscles and soft tissue or spinal muscles.

He explained, “The transfer of autologous tissue will create an additional wound. For example, when using abdominal tissue, muscles will be removed in the abdomen. The wound will be relatively large, and the surgery and recovery time will also be longer. Using autologous tissue as an implant is much more durable. , the risk of inflammation and infection, displacement and breakage is also smaller. The chance of needing repair surgery is relatively low.”

He reminded that breast reconstruction is always an unnecessary surgery. Any surgery has risks. Patients need to consider their acceptance level, understand the benefits and disadvantages of surgery, short-term and long-term risks, etc., and then discuss with the doctor to reach a consensus and choose the most suitable plan.

In addition, he pointed out that in the past, during breast cancer resection surgery, the areola and nipple may need to be removed to prevent a small amount of breast tissue from being included, which would increase the risk of recurrence. However, years of research have shown that although there is a small amount of breast tissue at the base of the areola, the chance of breast cancer recurrence is low. As long as the tumor does not involve the areola and nipple, the doctor will try to preserve it to preserve the appearance before surgery.

“However, if the surgery requires removal of the areola and nipple, some patients may also consider ‘reconstructing’ the nipple through tattooing in addition to undergoing breast surgery to reconstruct the shape.”

Deep and light texture effect three-dimensional

Nipple color is highly realistic

Tattoo artist Shienne was invited by a plastic surgeon three years ago to collaborate on tattooing nipples for breast cancer survivors, and provides services to about 15 to 20 patients every year.

Because there is no high-profile publicity, the public does not have much awareness of this type of service.

The whole recovery process from the discovery of the disease to the removal of cancer cells is physically and mentally exhausting for the recovered patients. Nipple tattoos are a halfway point in the recovery process.

Shienne said, “Whether the patient accepts it or not depends on their individual needs, but beautifying the appearance will increase the self-confidence of the recovering patient.”

Draw the shape against the other side

During the tattooing process, Shienne will draw the corresponding size and shape of the other nipple, “but it won’t be exactly the same, even if the nipple or breast is healthy, it won’t be exactly the same.”

If both nipples are removed, the tattoo artist will make a draft based on experience, and the tattoo will be started only after the patient confirms it.

“The color will be adjusted as close to the original color as possible. The effect is so realistic that no difference will be noticeable from a distance.”

Shienne explained that the tattooing process is divided into two times. The first time is to apply the base color, and then about 6 to 8 weeks later, the pigment is applied again to create a three-dimensional visual effect of dark and light textures.

“The ink is a permanent tattoo pigment, which is the same as that used in ordinary tattoos. However, daily care may affect the coloring. Recovering patients can choose whether to touch up the color.”

Fill the psychological gap of recovered patients

Shienne believes that nipple tattoos can fill the psychological gap of recovered patients. “As a woman, losing breasts or nipples is a big deal. When you look in the mirror, you will definitely feel a sense of loss and lack of self-confidence. There was a patient who had undergone a mastectomy. After recovery, she did not dare to look in the mirror until she got a tattoo. She was very happy and He said that he likes to look in the mirror now. The idea behind nipple tattoos is to bring new hope to the recovered patients and help them live the second half of their lives with confidence.”

However, she emphasized that not all tattoo artists are suitable for nipple tattoos. “In addition to having sufficient experience, they also need to be empathetic and careful to make the recovering patients feel at ease and respected.”

3D mammography + ultrasound

Uncover the cancer monster

In the 2020 World Health Organization global cancer report, female breast cancer surpassed lung cancer for the first time and became the most common cancer in the world.

Although there are many risk factors related to breast cancer, such as family history, early menstruation, late menopause, never having children, giving birth after the age of 30, long-term use of female hormones, etc., more than 80% of breast cancer patients do not have any risk factors. As age increases, the risk of breast cancer increases over the age of 40.

Affects detection capabilities

Breast cancer cannot be prevented but it is not a terminal disease. According to foreign literature, regular screening can reduce the risk of breast cancer death by 41% and reduce the incidence of late breast cancer by 30% compared with women who do not receive screening. Therefore, early screening Diagnosis and treatment are currently the most effective preventive measures.

Although mammography is highly accurate, about 10% to 15% of breast cancers cannot be detected, which is the so-called “false negative”, especially for women with high breast density, because breast tissue and tumors are not detected by X-ray It appears bright white underneath. If the tumor is obscured by surrounding dense breast tissue, it affects the ability of mammography to detect the tumor. At this time, it can be combined with other imaging examinations, such as ultrasound scanning.

Reduce false positives

Generally, for 2D mammography examination, the breast is squeezed to a thickness of 3 to 6 cm and an image is taken, that is, a three-dimensional breast is taken into a flat image. Therefore, it is easy for the breast tissue to overlap and cover the tumor, resulting in false negatives (sometimes Breast cancer but not visible); it may also be a false positive (seeing a shadow but not breast cancer) due to the summation effect of breast overlap.

3D breast tomography squeezes the breast into a thickness of 3 to 6 centimeters, then uses low-dose X-rays to surround the breast and photograph the breast from multiple angles, similar to shooting a three-dimensional breast into a series of cross-sectional images with a thickness of only 1 millimeter; Using a computer to recombine cross-sectional images, compared with traditional images, can eliminate interference from overlapping tissues, helping to identify small white spots, calcification, fibrosis and other problems, thereby improving breast cancer detection capabilities and reducing the occurrence of false positives.

Increase detection rate by 40%

Regarding the accuracy of breast cancer screening, most literature around the world shows that 3D breast tomography is superior to mammography, regardless of whether the breast density is high or low, and the results are more significant in young women or women with high breast density.

Research points out that 3D breast tomography can increase the detection rate of breast cancer in dense breasts by 41% and reduce the re-examination rate by 20% to 40%. However, for women with extremely dense breasts, ultrasound examination is still necessary.

In addition, if further tissue sectioning is required for positive screening cases, the new 3D tomography-guided slicing system can be used to quickly and accurately locate the lesion, and perform sectioning in a minimally invasive manner under local anesthesia. The cut wound is only about 0.5 cm, and the recovery time is fast. .

In addition, a vacuum suction system can be selected to obtain more and complete tissue specimens. All of the above are outpatient surgeries and do not require hospitalization.

3D breast tomography has the advantage of high detection rate of early breast cancer and reducing false positive cases, and has become a trend in breast cancer screening and diagnosis. We must make good use of imaging screening to effectively prevent and treat breast cancer through early detection and early treatment.

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