Being diagnosed with breast cancer at any age is difficult. Being diagnosed with breast cancer during your pregnancy can make that difficultly paramount. In this blog, we will be discussing pregnant associated breast cancer and its realities.

We hope that if you've been reading our blog consistently, or have stumbled upon it recently, that there are few things we always want our readers to walk away with; that early detection is key, no one determines how you fight your battle, and to eliminate the stigma that breast cancer only appears later in life. While it is more common to be diagnosed with breast cancer after menopause, we hope that you've seen in our blogs that it is more common than you'd think to be diagnosed at a much younger age. Even more eye-opening, you can be diagnosed during your pregnancy. Just like any condition, there are plenty of rumors and myths floating around the internet. One that we've debunked before is that pregnancy and breastfeeding can cause cancer. While the two are not related, it is still possible to be diagnosed with breast cancer during your pregnancy.

• Pregnancy-associated breast cancer or PABC is when an expectant mother is diagnosed with cancer during pregnancy or in the year or two after her baby is born. Treatment is, of course, looked at with much hesitation when diagnoses comes early in the pregnancy. Generally, most doctors prefer to wait to do surgery and chemo until after the first trimester. We've also talked about this a little bit before in previous blogs. When this treatment is delayed until after the 1st trimester, there are no medical findings or studies that show that it harms the baby. When it comes to radiation or IV therapy, that can be harmful to the baby, and in almost every single case, doctors will wait to use these treatments until after the baby is born. According to the Wiley Online Library, PABC affects 1 in every 3000 pregnancies and is more commonly found in women who what to have children in the 40s or 50s. It is also one of the "most common malignancies to complicate pregnancy". However, according to Johns Hopkins Medicine, recent research has shown that pregnant women diagnosed with breast cancer "do as well or even better than non-pregnant women" when it comes to treatment or recovery. Most women and their children go on to have very healthy and happy lives after they go through their diagnosis and treatment.

• The reason why doctors wait for surgery and chemo until after the 1st trimester is that both could cause birth defects or the loss of the baby. Treatment will of course depend on how far along you are in your pregnancy and how far along you are in your diagnosis. According to Johns Hopkins, if your tumor is estrogen, progesterone, or HER2 positive, certain types of hormone therapy is recommended but will be performed after the baby is born. Surgery can be done during pregnancy and can be followed up with radiation after birth in certain situations.

• One of the biggest challenges you will be facing with PABC is breastfeeding. Surgery on a breast that is lactating can be much more difficult and the chemo or hormonal therapy you could be on can contaminate your breast milk, making it unsafe for your baby. It is recommended to postpone or stop breastfeeding until it is safe to do so. There are lactation specialists that you can add to your care team that can help you make the best decision and help guide you through breastfeeding during your treatment. Depending on where you are in your pregnancy and how far along you are in your diagnosis, if it is safe for the baby and necessary for your treatment, your care team might possibly discuss delivering your baby early. This will allow treatment to begin faster. Any lump or any warning signs found during your pregnancy need to be brought to your doctor's attention right away, just like they would be in any other part of your life. Early detection in this situation is not only crucial for your health but also that of your children.

• Remember that rumor we brought up at the beginning of this blog about how breastfeeding and pregnancy can make it more common to get breast cancer? According to BreastCancer.Org, studies have shown that breastfeeding and pregnancy improve survival rates. When a woman's breast is producing milk, this limits the cell's ability to behave or to act abnormally. This, in turn, will limit the ability for cancer cells to being growing. Also, women have fewer menstrual cycles during the time they spend breastfeeding, which lowers estrogen levels. Lowering these estrogen levels cuts down on the probability of cancer. Not only is breastfeeding good for you and your baby to connect and for the baby to be healthy and happy, but it is also natural prevention against breast cancer. So again, please don't believe everything you read!

Being diagnosed with breast cancer at this point in your life can come with a huge mix of emotions, ranging from joy of expecting your first child to the fear and panic of what could happen next. Please know you are not alone, and that there are many positive options to keep both you and your baby safe and healthy. Never hesitate to reach out to us if you have any questions or concerns, and know we are always here for you!

You fight so hard during your treatment while your body gets beaten up every day. What can you do to make yourself feel better in your daily regime of self-care?

As we've discussed throughout many of our recent blogs, claiming and celebrating who you are is a challenge during breast cancer treatment and recovery. Coming to terms with and allowing yourself to feel positive about how you look, feel, and care for yourself is part of your battle and survivorship journey. Self-care and self-love are just as important to your battle as your doctor's visits are. You might be rolling your eyes as you read that, but think about the days where you felt good or were truly realized through your treatment and recovery. Did you get a good night's rest? Feel like yourself again? Feel good in your skin? Did you take time for yourself and maybe had a bath and a facial?

[Mental Health and How It Feels]
These little moments of good have such a huge and positive effect on your mental health, which is one of the first things affected by your diagnosis and treatment. Improving any part of your health and quality of life during these difficult times can help strengthen your battle. So please, don't turn your nose up at self-care. Before your diagnosis, you had your beauty regime and care that was unique and so wonderfully you. That doesn't have to stop with your diagnosis. It might change and evolve, but that's ok too! In this two-part blog, we are going to be sharing some tips and suggestions on how to have and maintain a beauty regime that celebrates you and is dedicated to making you feel better during and after treatment.

The physical changes that you can see are sometimes harder than the effects that chemo and treatment leave behind. It sinks in when you can see the changes, and not see you looking back in the mirror. Your body hair can be gone, your skin is dry, blotchy and pained, your nails are weak and cracking, the shape of your body can change, and you could have pieces of you removed and then added back, with scars left behind. Every fashion item you used to come into contact with affects you differently than it did before, from how it feels to how it will affect your skin or toenails. Fashion magazines offer little when it comes to positive reinforcements or guidance. Thankfully, designers like Stella McCartney has designed bras for those who have had double mastectomies. Jewelry like statement earrings and necklaces can really pop against scars or bald heads or hide a chemo port. More and more designers are creating comfortable, flattering, and beautiful clothing pieces, head scarfs, and other garments with breast cancer patients in mind. But what about your skin and the rest of your regime?

[Skincare]
Chemo affects your skin in so many ways and can leave your complexion blotchy and even change it completely. Chemo also affects your sense of smell, so anything overly perfumed or has a strong smell can make you sick during or after treatment. Try finding and investing in natural skincare that has little to no fragrance and is paraben-free. Nontoxic beauty products can limit the exposure to harmful chemicals and ingredients while your skin and body are so sensitive and susceptible during treatment. They are also much gentler on the skin, which could have become extremely sensitive as a result of your treatments. This goes beyond facial lotions, washes, and toners. Look into all-natural and fragrance-free nontoxic eyeliners, lipstick, lashes, lash glue, eyebrow pencils, and more. Be mindful, there are toxic ingredients that still exist in manufactured makeup and beauty products that can cause cancer. You don't want to put these in or on your body, as you are already at risk with a compromised immune system. Adding natural deep hydrating lotion and healing ointments can combat whatever chemo does to your skin and soothe it away. Add in under-eye patches, face masks, sheet masks, and at home facial kits to help you relax, care for your skin, and give it a new glow.

When washing, make sure all of your skin is cared for, and not just your face. Use very gentle soaps that also have light or very little fragrance. Avoid products that contain alcohol and put away your antiaging creams and products. Many of which, according to Everyday Health, can irritate your skin even more than it is during treatment. Cornstarch can soothe irritation on your skin, and limiting shaving can help avoid irritation as well. Make sure to limit your sun exposure, and always wear sunscreen. Don't forget to cover your head and always bring your lip balm!

[Makeup Choices]
In the same safe non-toxic and organic world of beauty products, you can add some fake lashes and brows too. The options are staggering when it comes to these products. You can even professionally have sets of eyelashes put in, and you have the option of stencils, stamps, pencils, and eyebrow wigs to fill your eyebrows. Using bronzers and highlight can help with a natural glow without wearing too much makeup, and quartz colors around your eyes and a bold flash of red can make your lips pop!

Please remember, the choice to do any of this is yours and yours alone. Not societies, not a family member, not a friend. Many of our patients use these tips to feel more like themselves, to feel more feminine, and to care for their skin during and after treatment. But, just like your journey through survivorship, it's unique to your personal needs. In the second part of this blog, we will be discussing tips for your nails, regrowing your hair, and hair care.  If you have any questions about this any of our services, don't hesitate to reach out. Continue to fight, be proud of the journey you're on, and be well.

We have several services to make you look and feel exactly how you want, and to provide natural options for oncoplastic surgery. What should you expect when you're about to go through a breast lift and reduction?

In our last two blogs, we've discussed some of our many treatments and services we offer to help your battle with breast cancer and survivorship journey. Each of these services can improve your quality of life mentally, physically, and emotionally. Today we want to talk about and discuss one of our oncoplastic surgery services, breast lifts, and reductions. Oncoplastic surgery is aimed at breast cancer surgery with or with reconstruction to improve cosmetic outcomes for our patients. Our medical providers are trained and certified in oncoplastic surgery as well as Hidden Scar (trademarked) surgery, nipple spanning mastectomies, breast lift and reductions, implant repair, and natural reconstruction. Today, our blog is going to be focused on breast lift and reduction, what our services look like, and what to expect with the procedure. The surgery itself is the rearrangement of tissue after breast disease is removed. It allows the shape and size of the breast to be repaired.

Depending on your needs and what your cancer diagnosis is, you might choose to have both of your breasts removed (a double mastectomy) to remove the breast with cancer and to eliminate any risk of it returning. You also might choose to have both of your breasts removed to eliminate any diagnosis if you are a high-risk individual. Some choose to or only need to remove one breast, replacing it with natural reconstruction or an implant to match their other breast. Some only have cancerous tissue removed from one breast, leaving the shape and size of the breast altered and different from the other breast. This is where our breast lift and reduction services come into the picture.

The removal of the cancerous tumor and lymph nodes, not the whole breast itself, is called a lumpectomy. Breast tissue will also be removed with the tumor that it was connected to that could continue to put the patient at risk. This will cause the shape of your original breast to change during this surgery. This is where the lift begins. Your breast will be reconstructed, along with the placement of your nipple and areola. It will naturally be placed higher on your body and look "perkier" since tissue and skin have been removed to create a smaller firmer breast. Your other breast will still be its original size, and your nipples will no longer be symmetrical. This is where the next step, reduction, begins. Your surgeon will remove tissue from your other breast to match the newly constructed breast and move the nipple as well.

You can have a reduction and lift, or oncoplastic surgery, during your lumpectomy. There are many advantages to doing so. One is that you'll only have to go through one surgery, instead of two. It also helps with limiting or eliminating the risk of cancer returning to the breast that held the cancerous tumor, because it allows for more tissue to be removed. It is easier for a surgeon to achieve better symmetry when doing a lift and reduction at the same time as a lumpectomy. Also, those suffering from pain caused by having naturally large breasts will receive relief from that pain while keeping their risk of returning cancer very low.

Please note that a breast lift doesn't make the breast bigger or smaller. That is done with the removal of tissue or adding in tissue from another part of your body or with the use of implants. The lift itself is your surgeon tightening and reshaping your breast tissue, the removal of excess skin, and making sure your areola and nipple are in the desired position. Our services allow the shape and size changes of your breast to be repaired on both the affected breast and the non-cancerous breast. A breast reduction will allow your non-cancerous breast to be reshaped into a smaller, lighter, firmer breast that will sit higher on your chest. Both surgeries can be outpatient procedures, with a short recovery time. Many women can return to work 2-3 weeks after their surgery. As it goes with any surgery, there are some risks involved. Those risks can include the loss of feeling in the nipple or breast, bleeding, scarring, and infection. It can also inhibit the ability to breastfeed. Make sure to speak with us about your pregnancy plans and plans after surgery before deciding to take this journey.

Your breast cancer battle is tough, but you're tougher. We are here to make it as easy as possible and to stand with you along the way. If you have any questions about breast lift and reductions, or about any of our services, don't hesitate to reach out. Continue to fight, be proud of the journey you're on, and be well.

Thanks to our incredible followers and supporters, we have another incredible survivor story that we are very proud to share with you. We hope these words bring you comfort, peace, and hope. 

This hasn't been the spring that any of us could have imagined. But, we are still marching on. We are still here for you as you continue to fight your battle, continue to heal, and continue to carry on every day. A few months ago, we shared a survivor story about Savanna James. Her words continue to echo in our hearts and minds, and we hope they have stayed with you. Just a few weeks ago, another survivor story came into our world, and we are very proud to share it with you here today. We want to introduce Michele Wheeler, her story, and her incredible nurse, Jim. Michele has shared this story on her own website, and we are very thankful to her for allowing us to share it with you here today.  


                                                                                To Be Seen 

     The birthday party was going to be phenomenal. He stood over me explaining how his wife had to bake three cakes  - three! - because they invited all the kids in both classes. I lay trapped in tubes and wires and blankets and gowns while his words passed through the air above me. Some people might think they were going overboard for a four-year-old. Other people might. Not anyone in this room of course. Radiologists rule in this room. I stared at the ceiling thinking What in the ---- is happening here? as the masked techs oohed and awed over those cakes and the balloons and the bouncy house. Trapped, I tried to ignore them all as he shoved a needle into my liver to grab the sample that would confirm if I was dying of cancer or not. 

     That was three years ago. The sample came back hot.  Now, I was back in the exact same hospital, the exact same radiology department, for another biopsy. This time, we were looking for mutations that could provide more treatment options. I insisted on a different surgeon, and I got one, but the stench of frosting and the memory of that big fat needle were still very much with me. They told me, back then, that the meds would give me an I-don’t-care feeling, with a little amnesia mixed in. But I remembered. Oh, believe me, I did care. 
     And so I told them, now, how the baggage from the last liver jab was increasing my anxiety beyond the more “standard” biopsy stress. I’m just barely hanging on here folks, I told them. Please help me out by upping those I-don’t-care meds and skipping the talk about your outstanding personal plans, thanks so much. 
     Sounds fair, they said. That’s exactly what we’ll do. 

     I didn’t used to lay it out that way. I let uncertainty and fear overwhelm me into passive obedience. Because certainly all those nurses and doctors had been through whichever procedure far more times than I have. But after years of cancering, and too many appointments left feeling undervalued, I’ve matured into the realization that I am, in fact, an expert in Me. More so, I’ve come to appreciate how much doctors and techs really do want to get it right and telling them how I want it just makes it easier for everyone.
     Does it actually need to be said that you shouldn’t talk about your kid’s happy party during a terminal illness reveal? And honest feedback, the part of me that gets angry every time I see a birthday cake, would readily join you in hanging up that first surgeon. 
     But the part of me that needs to let go of that anger remembers that not everyone has experienced the sharp side of the needle. And so yes, it does need to be said. 
     It needs to be said because maybe he was trying to distract me by talking about that party. And maybe it would have worked if he just would have said first, I am sorry that this is happening to you. Then I could have said, Tell me everything about that bouncy house. 
​
     My med guy came, Jim, came in then to introduce himself. He managed to strike up small talk that seemed well placed, asking me about my kids a bit, surface questions, with just enough about his own kids to keep the conversation going. He was gentle. He let me know that I’d get my I-don’t-care meds after just a little more prep. 
     He wheeled me into the biopsy room, and that prep got very active. There were at least another five masked techs hooking me up to wires and hoses. The radiologist came up then and reached across me to adjust the monitor he would use to look for a sampleable tumor with ultrasound. When he started pushing down with the wand on my stomach, just below my ribs, I told him, “Can you move that screen so I can’t see it, please?” As he did, I closed my eyes and said, “And no comments about the size of the tumors either, please.”
     I could still feel constant motion around me, and then a quiet voice from just behind me, Jim, “Michele, I’m going to give you some of that anti-nausea medication now, okay?” I nodded, thinking but what about the I-don’t-care meds?  Not wanting to sound like a junkie, I tried to be patient. 
     But I could feel it coming. Like the vibration on train tracks before any sound of the engine, before any hint of smoke coming from its stacks. I kept my eyes closed and wondered which would arrive first: the panic attack or the I-don’t-care meds. 
     Panic did. And I fought with it to speak, managing only, “I could. Now. The I don’t. Don’t care. Meds. I need them cuz I think I might run. I’m gonna…” I raised my hand just a bit to the radiologist, “So with the wand. It. The. Could you. Wait. Please?” He took it off my stomach and the room got very still. I kept my eyes closed to find the words, and finally managed, in a whisper, “I’m going to have a panic attack. I’m just about to and I need that anxiety medicine right now.”  
     With that, the radiologist patted my arm gently once, and let me know he’d wait outside until the meds kicked in. The rest of the staff left as well. But Jim stayed. He interrupted the quiet only to give me brief updates. I’m delivering those meds now, Michele. And then a few moments later, They should start working really soon.
     It was more like I started leaking than crying. The tears just slipped easily from the corners of my eyes. With all the tubes and wires and blankets and gown twisted around me, I was helpless to do anything but let them fall. But I said nothing, because I thought asking for tear wiping was taking it a bit too far. 
     I didn’t have to ask. Before those tears reached my ears, I felt a tissue on either side of my face as Jim gently wiped them up. And yes, the tenderness of that did make me squeak out a few more tears. But it was far fewer than it would have been, had those tears fallen unnoticed and been left to soak my hair. 
     Thank you, I said.
     You’re welcome, said Jim. And for the next few minutes, I lied there, leaking tears, and Jim sat behind me, wiping them up.
     The meds finally kicked in, enough so that we could carry on with the procedure, but they didn’t erase the reality that put me there. I leaked, intermittently through the whole thing. One click. Two clicks. Tears slipped from my eyes as little bits of cancer and liver were pulled from under my ribs. I kept dripping while I counted three… four... five. I think it was Jim that kept wiping the sides of my face as I silently cried. I don’t know. I kept my eyes closed the whole time. But I do know that not one tear passed an ear, and that was an enormous comfort.

​Because still wrapped in blankets and trapped in illness, I felt seen. 

Thank you so much, Michele, for sharing your incredibly brave story. Our hearts were with you through every written word and will continue to be as you continue your journey. Thank you for lifting up the people in your journey, like Jim, who has helped you through it all. Thank you for sharing with us the need and the right you have to ask for what you need in every step of your treatment and beyond. You are an incredible warrior. Thank you for sharing this with us. 

To learn more about Michele, read more incredible stories like this one, and to follow her journey check out her website by following the link below! 
https://www.acrackinthewall.com/

We would be honored to hear and share YOUR story too. We want to share your experiences to help to continue inspiring others just like Savanna and Michele have. If you would like to share, email us your story and a photo of yourself to survivors@thebreastplace.com and you may be featured on our social media or in an upcoming blog post.