Prevention Institute of California

Choosing LASIK as a Refractive Eye Surgery Option
Laser Eye Surgery

Choosing LASIK as a Refractive Eye Surgery Option

There are several refractive surgeries for the eyes, and LASIK is a credible option on many grounds. Moreover, everyone wants to achieve a perfect sight without contact lenses or a pair of glasses. At the same time, some people avoid the procedure because they feel that the LASIK eye surgery is because of the risk. However, the risk of this eye surgery is too low.

This article addresses the peculiar features of eye surgery using the LASIK process. More importantly, the case of using LASIK is in comparison to other refractive eye surgery options. 

What is Refractive Error?

A refractive error occurs due to a mismatch in the eye system of producing clear and sharp images. You see, in the human eye system, there is a frontal surface known as the cornea and then the lens that is inside the eye. Both parts of the eye work together to form the focusing system. The purpose of this system is to focus the incoming light rays on the surface of the retina. 

Choosing LASIK as a Refractive Eye Surgery Option

This system is similar to what the photo camera does by directing light to produce images on the film. In a perfect optical system, the cornea and the lens match perfectly together in the right eye length and ensure the photos remain focused. However, when this system has a refractive error, the formed image becomes blurry and begins at a different location. Frequently Asked Questions (FAQ’s) About the LASIK Eye Surgery.

What are the Main Types of Refractive Errors?

Three major types of refractive error occur to the eye and may require two significant approaches. The first approach may require the use of glasses or contact lens while the other is a LASIK eye surgery. However, let us first examine the main types of refractive errors.

Myopia (Nearsightedness)

The condition of nearsightedness or myopia refers to when distant objects appear blurry and close things are clear. This condition occurs due to a mismatch in the eye’s focusing power length and the focusing power of the lens and cornea interaction. 

Hyperopia (Farsightedness)

Hyperopia, farsightedness, or long-sightedness is when distant objects appear more apparent, but near objects appear blurry. The condition results from a mismatch of the focusing power that occurs as a result of the cornea and interaction and the length of the eye. 

Choosing LASIK as a Refractive Eye Surgery Option

Astigmatism

Astigmatism is a worse condition than both myopia and hyperopia because it causes objects at all distances to appear blurry at all times. The situation results from a distorted shape of the cornea or lens, leading to multiple images on the retina. Patients with astigmatism suffer from a combination of astigmatism with hyperopia or myopia.  

How Glasses or Contact lenses help to manage refractive errors

When there is a refractive error in a person’s eyesight, the first and cheapest option for correction is glasses or contacts. As a lens, these options help to bend the light rays to complement the specific refractive error of the eyes. However, the process is different for LASIK eye surgery because it does a permanent correction, so the patient will not need any visual aid. 

What is LASIK eye surgery?

The LASIK procedure of laser eye surgery Sydney involves using a laser light under the corneal flap to reshape the cornea of the eyes for better vision. However, a special kind of highly specialized laser known as the excimer laser is used for this process. Notably, this laser is targeted at correcting refractive errors from the eyes and improving the patient’s vision. 

Choosing LASIK as a Refractive Eye Surgery Option

LASIK can also help to eliminate every need for contact lens or glasses by reshaping the eye cornea. Meanwhile, the cornea refers to the transparent front that covers the eye. The excimer laser has been helpful for some years past. Still, in 1991, Ioannis Pallikaris from Greece developed LASIK to correct refractive errors in the eyes.

How does the LASIK procedure work?

The LASIK procedure requires a professional surgeon who can ideally use the excimer laser for eye correction. This expertise also requires special training for the eye surgeon. Moreover, the process begins by creating a thin hinged corneal flap on the eyes while using a microkeratome. 

The next step is to gently pull back the flap in a way that exposes the underlying corneal tissue. Following that step, the surgeon uses the excimer laser to reshape the patient’s cornea in a pre-specified pattern. This reshaping step is referred to as ablation. At the same time, the surgeon can also reposition the flap gently to the underlying cornea without any sutures. 

Different Types of LASIK Eye Surgery

The LASIK eye surgery procedure has a variety of options with it as applicable in ophthalmology. Since it requires a particular type of laser – the excimer laser, LASER procedures may be different, especially with other types of lasers such as 

  • Alson
  • Visx
  • Wavelength
  • Bausch & Lomb and
  • Nidek

These types, including the excimer laser, constitute the laser procedures applied in medicine. Meanwhile, in terms of the laser ablations that can be formed, the options include

  • Conventional laser treatments
  • Wavefront optimized treatments
  • Wavefront-guided treatments

Apart from an excimer laser, a femtosecond laser is also valid in creating a LASIK (corneal) flap. This method is a credible alternative to using the mechanical microkeratome. 

What does Conventional LASIK look like?

The conventional LASIK procedure involves an ablation pattern that you find on most laser treatments. This treatment depends on the patient’s glass prescription, which is usually a fixed treatment process for each patient. Meanwhile, the conventional LASIK treatment is suitable for most patients except the older ones above 40. However, it can lead to more visual aberrations like night vision issues, glare, halos, and other forms of problems that can result from laser treatment. 

Conclusion

On a final note, choosing LASIK as an eye surgery procedure is a great choice to be free from glasses and lenses. Meanwhile, the surgeon needs to understand the patient’s medical records and decide if LASIK is suitable for such a patient. At the same time, different steps are involved before, during, and after the eye surgery using the LASIK procedure. 

Frequently Asked Questions (FAQ's) About the LASIK Eye Surgery
LASIK Eye FAQ's

Frequently Asked Questions (FAQ’s) About the LASIK Eye Surgery

At Personal Eye Centre, we will like to address some of our patients’ most vital and commonly asked questions. Moreover, we have a team of experts with loads of experience in ophthalmology. At the same time, we may also be addressing some of the questions you never thought of, or people have assumed their answers. In latter cases, these erroneous beliefs have become myths concerning LASIK eye surgery.

“How long does LASIK Procedure take me off work?”

Many people in the workforce begin to wonder how long they will be off work once they get surgery LASIK. Here is the excellent news: you can go back to work the next day if you like because you will be that fit. If you want to make this further possible, schedule your LASIK procedure for an afternoon or evening where you get to sleep afterward. You can get as fit as a fiddle the following day and get back to everyday life. 

The vast majority of LASIK patients get to do very well the following day to their LASIK surgery. To begin with, the surgery procedure itself does not last more than 20 minutes for the two eyes. And the implication is that you have ample time for your body to readjust and produce an excellent vision through the newly adjusted procedure. More so, your eyes feel comfortable the next day for most patients, which means there is no problem going back to work if you so wish.

Frequently Asked Questions (FAQ's) About the LASIK Eye Surgery

In contrast, if you undergo the PRK laser surgery and not LASIK, you may require a little more time to recover fully. Even at that, there are strong enough patients to get back on their feet the next day after a PRK surgery. Others may spend a few weeks before they feel more comfortable getting back to work to continue with life. So, you see, it also varies from patient to patient. But most people recover as quickly as possible. 

“How long do I have to suspend tanning after a LASIK procedure?”

As a professional surgeon, the official full recovery time for the LASIK procedure is up to two weeks. That is not a contradiction to what we stated above. You can return to work indeed the following day after your LASIK procedure. However, there are certain activities that you need to reintroduce bit by bit to allow the body to adjust sufficiently to the new normal. Significantly if these activities directly influence your eyes, it is better to give them time.

One of such activities is sun tanning after the LASIK surgery. Presently, no definitive studies state the kind of damage or the extent of the damage on the eyes after LASIK surgery. However, medical science already establishes that UV light can damage the cells and tissues of the cornea, retina, and even the lens, which is why you need sunglasses. Moreover, we can guess that natural tanning after the LASIK procedure may not be good in the first few weeks. learn more about sun tanning at https://www.healthline.com/health/how-to-tan-faster

Therefore stay off tanning beds for the first two weeks to fully recover. And when you get back to tanning, always wear UV protection sunglasses, especially when outside. Meanwhile, concerning tanning beds, you need to hold off for about two weeks before returning. As an alternative, you can use some protective goggles for your eyes. On the other hand, whether you had LASIK or not, your eyes are worth caring for in as many years to come. 

What are the red spots on my white eye portion after LASIK?

After a typical LASIK procedure, you may find some red spots on the white part of the eyes. What do they represent? This question is one of the rarest ones, but the answer is straightforward. The red spots are bruises on the eye portion while the LASIK procedure is going on. For instance, while laser eye surgery is going on, there are little broken blood vessels that don’t necessarily hurt. 

Frequently Asked Questions (FAQ's) About the LASIK Eye Surgery

Of course, during the procedure, your eyes were still and nice-looking. And in the same first part of the LASIK procedure, a suction rink is used in the form of an IntraLase to create the LASIK flap. The flap allows the surgeon to reach your cornea and make the necessary reshaping and adjustment for perfect vision. However, here is the good news; the red spots you see today will soon see them no more. 

The spots are not there forever, so you need not worry. In addition, the spots disappear in about three weeks. Don’t let anyone scare you about the red dots as if something terrible has happened to your eyes. In about two weeks, the blood vessels will reconnect and heal up. Then you can continue with everyday life and enjoy your time. 

“Do I still need glasses after undergoing the LASIK procedure?”

Some patients have heard that they still need to keep wearing their glasses even after the LASIK procedure. The question I love to ask is, why did you go for the eye surgery in the first place if not to correct the refractive error? The argument of such people who believe the myth is that LASIK only provides a moderate treatment of your vision and is not thorough in giving you a perfect picture. That myth cannot be farther from the truth.

The truth is that we have seen a few patients whose vision did not become 20/20 perfect. But it is never the case of the majority because most people can completely do away with their glasses and contact lenses once the LASIK procedure is successful. Based on the current statistics, over eight people out of every ten who undergo LASIK do not need their glasses or contact lenses anymore.  Choosing LASIK as a Refractive Eye Surgery Option

“Are LASIK side-effects severe and permanent?”

This question subtly agrees that everyone who undergoes LASIK experience side effects. That is untrue. Moreover, laser eye surgery involving LASIK is a minimally invasive procedure. Still, it requires some careful steps for a perfect result. Ideally, all medical procedures require some time to recuperate and recover to total activity, no matter how minor, and LASIK is no different. So, the eyes are healing for the first two days, and it is only normal to feel somehow unusual. 

However, let it be clearly stated here that these feelings are usually mild and temporary. Meanwhile, the way to be sure is to keep up with your doctor’s post-operative appointments within the hours of that recovery. In such sessions, you can describe how you feel to your surgeon, and he can advise you on what to do or not do. Afterward, you can still trust that it may take some more days before all things could be restored to how they used to be. 

Frequently Asked Questions (FAQ's) About the LASIK Eye Surgery

Conclusion on LASIK FAQs

Finally, the appropriate body in Australia oversees the affairs of going for LASIK eye surgeries. Moreover, your assurance of good hands begins with the Personal Eye Clinic, and our team of expert ophthalmologists is ready to restore your perfect vision. 

Uncategorized

Understanding Risk and your Options

Patricia T. Kelly, Ph.D.
St. Francis Memorial Hospital and private Cancer Risk Assessment practice in Berkeley, CA

Information to help you make informed decisions

Answers to the following questions will help you make decisions that are right for you:

How does DCIS differ from invasive breast cancer?

One difference is that a DCIS cell lacks the biological capacity to metastasize or spread to other parts of the body.

What is the size of the DCIS?

Hidden areas of DCIS and invasion are rarely present in the same breast when DCIS is less than 5 millimeters (1/5 of an inch) in size.

What is the type of DCIS that was found?

This information is one important element in determining the likelihood that invasive cancer or more DCIS will occur in that breast in the future.

What is the size of the margin (clear tissue containing no DCIS) around the DCIS?

This is a major element in determining the likelihood that invasive cancer or more DCIS will occur in that breast in the future.

  • What is the chance that invasive cancer or more DCIS will occur in that breast in the future if I do or do not have:
    • More surgery on that breast or a mastectomy?
    • Radiation therapy on that breast?
    • Tamoxifen treatments?

What is the chance that I will develop DCIS or invasive cancer in the other breast?

Factors to consider about the treatment and follow-up decisions you make depend on your understanding of the future risks associated with DCIS. Risk is not a single measurement, but a complex of evaluations. Before you make a decision about what treatment advice to follow, you should understand each of the following five parameters of risk and how your own diagnosis relates to them. None of these risk parameters is hard to understand; all it takes is common sense and the willingness to ask questions, here is a good post to read if you or your loved one is planning for eye surgery http://dcis.info/choosing-lasik-as-a-refractive-eye-surgery-option/

  1. Risks Apply to Groups, Not to Each Individual in a Group
    When you learn that a particular treatment provides an advantage of, for example, 10%, remember that this 10% applies to differences between the groups in that particular study. It does not mean that each woman in the treated group received a 10% benefit. Some women in the treatment group received more than a 10% benefit, some less and some did not benefit at all.
  2. What a Risk Refers To
    Risks associated with a diagnosis of DCIS almost always refer to the risk of recurrence in the same breast, the chance that either invasive breast cancer or more DCIS will occur in that breast at a future time. Sometimes the risk is for DCIS only, sometimes for invasive disease only, and sometimes for both combined. Be sure you are clear about what risk is referred to.

    Since DCIS cannot metastasize, NONE of these risks refers to the risk of death. The type of treatment a woman has — mastectomy or not, radiation therapy or not, tamoxifen treatments or not — does not change her life expectancy after a DCIS diagnosis. In fact, in one study women diagnosed with DCIS lived longer than women without such a diagnosis, probably because in that study the women with DCIS had better overall health.
  3. Time Frame of the Risk
    Risk information without a time frame is not useful or informative. For example, a 10% risk today is very different from a 10% risk that is spread over ten years or 100 years.

    You may have heard that the average woman’s risk of invasive breast cancer is about 1 in 8 or 12%. This is the risk up to age 80. Of this 12% risk, 2% occurs by age 50. From 50 to 70 the average woman’s risk of breast cancer is 6% and from 70 to 80 it is 4%. The 2% plus 6% plus 4% add up to 12%. As a woman goes through each age without a diagnosis of breast cancer, she leaves behind the risk associated with it. To put risk in another context, you are not at risk of being in an accident on a road you traveled yesterday. You can only be at risk for today’s roads and the roads you’ll travel in the years ahead.

    The risk of invasive breast cancer increases with age, so the risk in a given year to a woman in her 70s is higher than the risk in one year to a woman in her 40s. However, as a woman gets older, her risk to age 80 decreases because there are fewer years left before she will reach age 80.
  4. Margin Size and the Risk of Recurrence
    In one study, when the DCIS was small and the margin around it was at least a little less than half an inch in size, the chance that either DCIS or invasive breast cancer would recur in that breast was 3% for women treated with lumpectomy and 4% for women treated with both lumpectomy and radiation therapy for a period of up to eight years. This shows that if the margins are sufficient there is actually very little difference; DCIS is unlikely to reoccur, even without radiation therapy.
  5. Percent Increase or Decrease
    When you hear that one treatment resulted in, for example, a 40% benefit, remember that such a comparison does not tell you how large this benefit actually is. For example, if you ask how heavy my dog is, it is not useful to hear that he weighs 40% more than my grandmother’s dog. This information doesn’t tell you what you want to know or how much the dog actually weighs. If my grandmother’s dog is small, a 40% increase means my dog is moderately heavy. If her dog is large, my dog will weigh quite a bit. Now let’s apply this concept to the risks you might hear about DCIS.

    Tamoxifen Treatments and the Risk of Recurrence
    In one study, women with DCIS were treated with lumpectomy and radiation therapy. Half the group then received tamoxifen for five years and half the group did not. At five years the group that took tamoxifen had 43% fewer invasive breast cancers. There were 31% fewer non-invasive breast cancers (either DCIS or another type of in situ disease called lobular carcinoma in situ). When presented this way, the decreases in risk to women who take tamoxifen seem quite substantial.

    When these same study results are presented as actual risks, that is, in terms of how much the dog weighs, their actual size becomes apparent. The study found that 4% of the women who did not take tamoxifen developed invasive breast cancer, compared to 2% who took tamoxifen, a 2% difference spread over five years. For noninvasive disease the difference was 1%. That’s right, the 43% reduction was actually a difference of 2% and the 31% reduction was an actual difference of 1% in five years!

    Tamoxifen Treatments and Risk to the Other Breast
    Tamoxifen is sometimes suggested as a way for a woman to reduce the chance of developing either noninvasive or invasive cancer in the opposite breast. The study just discussed reported a 52% reduction in risk to the opposite breast to women with DCIS who took tamoxifen.

    Again, the actual risks were much smaller, 3.4% for the group not taking tamoxifen and 2% for the group that did take tamoxifen. This is a difference of 1.4% spread over five years. It means that of 100 women followed for five years, 1.4 more would develop either a noninvasive or an invasive cancer in the opposite breast if they did not take tamoxifen.

Even these very small differences in risk may not be due to tamoxifen use, however, because:

  • The study included women whose DCIS was not completely removed.
  • The study did not examine all of the tissue removed, so some of the women appear to have had invasive breast cancer, not just DCIS.

Conclusion

By asking questions such as those in the earlier checklist and by having a clear, commonsense understanding of the risk you face, you will be able to make informed decisions about treatments for DCIS and are more likely to feel comfortable about your decisions.

Getting a Biopsy
Biopsy

Getting a Biopsy

Mammograms can give us a picture of where the potential problem is, but they cannot diagnose cancer — only a biopsy can do that. A biopsy is a sample of breast tissue taken from the patient and used to establish a diagnosis. If a mammogram shows a worrisome area, a biopsy is likely to be recommended.

The biopsy procedure provides one or more pieces of breast tissue for examination under a powerful microscope by a medical doctor called a pathologist, who will study the tissue to determine whether or not cancer is present. The pathologist diagnoses breast disease by performing a variety of microscopic and other laboratory examinations on the biopsied tissue. If no cancer is found, the pathologist will determine what kinds of cells are in the tissue sample and whether they are likely to develop into something that might become cancer. It is important to have the biopsied tissue examined by a cytopathologist — that is, a pathologist who specializes in cancer. LASIK Eye Surgery is a common problem these days.

There are a number of different kinds of biopsies, each useful in some cases. To get the right diagnosis, and then the right treatment, it’s critical to have the right biopsy done. Here’s why: Let’s say that around a teaspoonful of cookie dough represents breast tissue and that a small frozen pea represents the suspicious area that is needed for biopsy. Now put the two next to each other and roll them together until the pea disappears inside the ball of dough. It is impossible to see where the pea is located.

It might be in the middle, off to the side, or somewhere in between. If you take a hollow needle, such as one that is commonly used in a biopsy, and put it into the dough, you will get something in the hollow of the needle — it might be a piece of the pea or it might just be cookie dough. It might be necessary to take multiple samples with that hollow needle before you find the pea.

Getting a Biopsy

This illustrates the importance of getting several biopsy samples from different parts of the tissue specimen. If you just test one area, you may miss important cells and misdiagnose the problem as a result.

Also, some important reassurance: biopsy surgery cannot cause breast cancer to spread.

Ductal carcinoma in situ (DCIS)
DCIS

Ductal carcinoma in situ (DCIS)

Although breast cancer has been a human illness for thousands of years, ductal carcinoma in situ or DCIS (also known as intraductal carcinoma) is a relatively new diagnosis, and we are learning more about it all the time. Until mammography became a routine part of medical care, we didn’t see much DCIS. Now, we do. Approximately 24% of all new breast cancers diagnosed in the United States in 2002 were DCIS.

Most breast cancers (carcinomas) arise in cells that line the ducts and lobules of the breast. We still don’t know what happens exactly, but for some reason, the cells start growing when they are not supposed to be growing. When cells in the lining of breast ducts are growing inappropriately, this is called hyperplasia; when they grow inappropriately and do not appear normal under the microscope, they are called atypical.

DCIS is a term used to describe cells that are growing inappropriately inside the ducts of the breast (see diagram) and look like cancer cells under the microscope. These abnormal cells have not spread into the surrounding fatty breast tissue or to any other part of the body.

Some cell changes are important, while others are less important. DCIS cells lack the biological capacity to metastasize or spread elsewhere in the body as cancer cells do. So why do DCIS cells fall into the category of cancer cells?

Some DCIS cells can change genetically and become true cancers, and women should not be lulled into thinking that a DCIS diagnosis can be ignored or dismissed. We still do not know for sure which DCIS cells will change and become invasive and which will remain DCIS. It is probably most useful to view a diagnosis of DCIS as an indication that a woman has a greater risk of developing breast cancer, especially if she receives no treatment for the DCIS.

There are different kinds of DCIS. It is important for the individual who is diagnosed with DCIS to know how aggressive or risky her cell type is. For example, comedo is considered more aggressive (high-grade) than cribriform (low-grade). This information is part of an accurate diagnosis by the pathologist and helps define treatment options, which in turn affect whether DCIS becomes invasive breast cancer.

A diagnosis of DCIS depends on the pathologist, and the diagnosis may be controversial. Therefore, second opinions may be important. If a woman seeks a second opinion, she needs to take her slides and blocks that contain samples of the cells taken during her biopsy to another pathologist, and she must be prepared to pay for this additional opinion.

People often fail to get a second opinion on pathology. However, if the pathology is incorrect, the treatment choices are much more likely to be incorrect and possibly ineffective as well.

You can also request second opinions for mammography, ultrasound, and treatment. If you choose to have a second opinion for mammography or ultrasound, it is important to take the original films, not copies, to the physician, and to carry them to the radiologist yourself if possible.

Whether your doctor refers to DCIS as cancer or pre-cancer, it requires careful treatment and follow-up to avoid the possibility of invasive breast cancer developing. On this Web site, we refer to DCIS as cancer.

There is a lot of research going on that will help sort out which kinds of DCIS are aggressive and how to determine optimal treatment for each kind.

Indications for Mastectomy
Mastectomy

Indications for Mastectomy

A mastectomy is a preferred treatment if either of the following conditions applies: There are two or more areas in the breast with DCIS greater than 5cm apart (called “multicentric”), or there are diffuse, malignant-appearing microcalcifications in the breast.
There are persistent positive margins after surgical lumpectomy was done in an attempt to remove all of the DCIS.

Breast cancer surgery scars by partial mastectomy. With effect filter.

Even when these conditions are not present, there are some women for whom the risk/benefit ratio of breast conservation must be carefully assessed and consideration given to mastectomy as a treatment alternative. Neither size nor histology of DCIS is an absolute indication for mastectomy. A relative indication for mastectomy is the presence of extensive DCIS; this usually refers to an area several centimeters in diameter or encompassing an entire quarter of the breast that can be removed with only a small negative margin.

Mastectomy is particularly appropriate for women with small breasts in which an adequate resection would result in a significant deformity. Studies indicate that 1 to 2% of patients treated with mastectomy will have a recurrence of DCIS or invasive cancer, either in the same area or elsewhere in the chest wall. Although mastectomy results in cure rates approaching 100%, this may be overtreatment for many patients with DCIS, particularly those with small lesions detected by a mammogram.

There is increasing evidence that in these patients the risk of a breast cancer recurrence diminishes when they are treated with conservative surgery resulting in wide surgical removal and negative margins, followed by postoperative radiation. The most important thing to know — with either lumpectomy or mastectomy — is that the prognosis for complete recovery is excellent.

DCIS Treatment Options
DCIS

DCIS Treatment Options

The initial treatment for DCIS is always surgery. There are two surgical approaches to DCIS treatment: lumpectomy, or a total mastectomy.

Lumpectomy

Lumpectomy is a surgical procedure that removes the breast lump or suspicious tissue seen on the mammogram and some surrounding tissue as well. Lumpectomy is also called “breast-sparing”, “breast-conserving” or “segmental mastectomy”.

Generally, lumpectomy is the first step in breast-conservation therapy. Lumpectomy is usually performed in an outpatient setting using local anesthesia. However, general anesthesia can be used for greater patient comfort. If cancer cells are present at the margin (the edge of the biopsied tissue), a re-excision needs to be done to remove the remaining cancer. If you are large-breasted, most of your breast can be preserved and you will still have the image you are accustomed to. If you are small-breasted and need additional surgery, lumpectomy may not result in a good cosmetic result; mastectomy with reconstruction can be a good option.

Lumpectomy alone is the adequate treatment if:

  • Only one area of abnormality is found on exam or on a mammogram.
  • The area of abnormality is very small.
  • The surgeon is able to remove the DCIS completely and no DCIS is left behind in the breast.
  • The mammogram of the breast shows no more suspicious findings after the lumpectomy.
  • The woman is elderly or has other serious illnesses and would not be able to tolerate more extensive surgery or breast radiation therapy.
  • The type of DCIS is a less aggressive, or non-comedo, type.
  • The woman consents to close follow-up and surveillance.

Lumpectomy alone carries special concerns and considerations. Because the remaining breast tissue is not treated with any other intervention, there is the possibility that if the woman lives many more years, she can develop cancer — either DCIS or invasive cancer in the same breast. This option is only effective for carefully selected patients with early, small DCIS lesions with very easily interpreted mammograms. Comedo-type DCIS tends to be more aggressive and careful judgment needs to be used in offering lumpectomy alone in women with this cell type of DCIS.

Simple (total) mastectomy

This is a surgical procedure in which the entire breast is removed but not the lymph nodes under the arm or the muscle tissue from beneath the breast. The nipple will be removed in this procedure, but much of the original skin of the breast may be preserved.

Simple mastectomy is used to treat noninvasive breast cancer and is one way to remove DCIS that is multifocal (appears in many places within the breast). The surgeon does not need to remove lymph nodes from under the arm, because DCIS does not spread to the axillary lymph nodes.

If the DCIS is high grade and larger, your surgeon may suggest a sentinel node biopsy at the time of lumpectomy or mastectomy. This is because of the possibility of invasive cancer. By doing the sentinel node biopsy at this time, the need for additional surgery may be eliminated.

If invasive cancer is found, the surgeon will remove the entire breast tissue and some lymph nodes, which is important to determine the spread of the disease. This is called a modified radical mastectomy. When lymph nodes are removed, there is a small risk of lymphedema, or swelling in the arm.

Simple mastectomy is appropriate management for all kinds of DCIS. It is the only recommended treatment for multifocal DCIS, extensive DCIS, or DCIS that has recurred after lumpectomy and radiation therapy. This procedure is a relatively short surgery, requires general anesthesia, with a short hospital stay followed by a quick recovery. Reconstructive surgery to recreate the breast can be done immediately at the time of mastectomy or at a later date. The recurrence rate and overall chance of dying from cancer after simple mastectomy is between 0 and 2%.

Women who have the simple mastectomy procedure rarely have difficulties with shoulder movement or arm swelling after surgery. As compared to a modified radical mastectomy, the surgery time is shorter and the recovery period faster.

If a simple mastectomy is chosen as a treatment for DCIS, radiation therapy is not needed following the surgery.

DCIS Treatment Options
Ductal carcinoma of the breast, detailed medical illustration. At the beginning normal duct, then hyperplasia, after that atypical cells are invading, Ductal cancer in situ and invasive ductal cancer.

Modified radical mastectomy

Modified radical mastectomy is a surgical procedure in which the entire breast and some or all of the nearby lymph nodes are removed. Underlying muscles are left intact. This procedure is not usually used for the treatment of DCIS, but may be used if invasive breast cancer is found.

Postoperative radiation therapy

If lumpectomy is chosen as the surgical method, the remainder of the breast is usually treated with radiation to minimize the chances of having a recurrence of DCIS in the breast. If, after biopsy, there are cancer cells present at the margin (the edge of biopsied tissue), and excision can usually be done again to remove the remaining cancer cells. Radiation treatment is usually begun three to four weeks after the lumpectomy or when the wound has healed.

Radiation therapy is used to destroy any cancer cells that may be left behind in the breast. Radiation treatments are usually given five days a week for six to seven weeks. The daily sessions take only a few minutes each.

The side effects of radiation can include swelling and heaviness in the breast, sunburn-like skin changes in the treated area, fatigue, and loss of appetite. For some women, the breast may become smaller, firmer, and more tender after radiation therapy.

These common side effects generally begin toward the middle of the treatment and continue for a short time after the completion of radiation. The side effects are usually gone within six months to a year. Radiation can only be used once for primary treatment because the breast does not tolerate repeated radiation therapy at the doses required to eradicate cancer.

Radiation therapy after lumpectomy is considered an adequate treatment in the following situations:

  1. When there is only one area of abnormality in the breast, either on physical exam or mammogram.
  2. When the surgeon is able to remove all of the DCIS cleanly, and this is verified by mammogram after the surgery. When additional DCIS is found, re-excision (additional surgery) is necessary.
  3. When the size of the DCIS is small enough in relation to the size of the breast so that the woman is left with a cosmetically acceptable result.
Indications for Mastectomy

Some of the problems with having lumpectomy and radiation therapy are:

  • Radiation therapy is time-consuming, with treatments lasting five to seven weeks.
  • While risk of recurrence is reduced by adding the radiation therapy to lumpectomy, about 8% to 10% of women with this treatment will have a recurrence in the treated breast. Half of the women who have recurrence will have invasive cancer when the cancer returns. Women with comedo DCIS have the highest risk of developing invasive recurrences. Cosmetic results may be of concern. While lumpectomy and radiation therapy may preserve the breast and breast sensation and “feel,” radiation and surgery sometimes result in a change in the texture of the breast, a poor cosmetic result and deformity.

Lumpectomy with postoperative radiation therapy may not be appropriate for:

  • Women with a local recurrence or new primary DCIS or breast cancer who have already had radiation therapy to the affected breast or chest.
  • Women with two or more areas of DCIS in the same breast, too far apart to be removed by one incision.
  • Women whose first excision biopsy — or when needed, their re-excision — has not completely removed the DCIS, or whose re-excision may result in an unsatisfactory appearance of the breast.
  • Women with certain autoimmune diseases that make body tissues especially sensitive to the side effects of radiation therapy. Ask your doctor if you have one of these conditions.

If a woman is pregnant when diagnosed with DCIS, radiation therapy may be delayed until after completion of her pregnancy because DCIS is not an emergency. Although radiation is often delayed, surgery can be safely performed during her pregnancy or can be done after the birth of her child with no compromise to the mother.

Choosing your DCIS treatment

If you are choosing which kind of surgery to have, here are some facts that will assist you in your decision-making:

  • For anyone choosing mastectomy it is important to know that it is almost impossible to remove all of the breast tissue, and therefore a recurrence is still possible in the remaining tissue.
  • Possible short-term side effects of both lumpectomy and mastectomy include wound infection, hematoma (accumulation of blood in the wound), and seroma (accumulation of clear fluid in the wound).
  • About 95% of women with DCIS do not require a mastectomy.
  • The survival rates for a combination of lumpectomy with radiation therapy have shown that is it just as effective as mastectomy.
  • Local recurrence with total mastectomy is rare.
  • Women who opt to preserve their breast with a combination of lumpectomy and radiation therapy have a higher rate of recurrence than women who have a mastectomy, but there is no proven impact on survival.
  • Following lumpectomy or mastectomy, some women experience discomfort or pain that comes and goes. It is not uncommon to feel discomfort at the site of the incision when there are significant climate changes. Women may also experience breast tenderness after radiation therapy.

Information. Before discussing treatment options, the doctor needs to conduct a physical examination and ask your medical history. This will include questions about your family history, such as the following:

  • Relatives who have had breast cancer
  • Their age at diagnosis and whether one or both breasts had cancer
  • Whether any relatives had ovarian cancer or other cancers
  • Any history of radiation to the breast area
  • Any history of vascular disease
  • Whether you have breast implants
  • The date of your first menstrual period
  • The date of your last menstrual period
  • The possibility of present or future pregnancy
  • Your use of hormone replacement therapy
  • Your use of oral contraceptives
  • Whether you have had fertility or gynecologic surgeries
  • Whether you have nipple discharge

The doctor will use this information and the pathology results to determine which therapies are most suitable for you, and will then discuss treatment options with you. To summarize: Most women and their doctors prefer lumpectomy and radiation therapy rather than mastectomy. The advantage of lumpectomy is that it may save the appearance of your breast. The disadvantage of a lumpectomy is that it is followed by several weeks of radiation therapy. Unfortunately, for some small-breasted women, a lumpectomy may be very disfiguring, and a simple mastectomy with reconstruction may be a better cosmetic option.

Your individual feelings, attitudes and values may be just as important as the scientific facts in weighing your options. As you consider your choices, think about the following questions:

  • How do you feel about losing your breast?
  • How much breast tissue will need to be removed?
  • How far will you have to travel for radiation therapy?
  • Do you want or are you willing to have reconstructive surgery after mastectomy?
  • Are you thinking of mastectomy as a way to rid yourself of your cancer as quickly as possible? Or is it because it represents the least chance that cancer will reappear?
  • How important is it to have a normal-appearing breast when all treatment is complete? If your breast is small or the amount of tissue that must be removed is large, a mastectomy with or without reconstruction may yield a more pleasing appearance.

Remember, lumpectomy and radiation for the treatment of DCIS are not appropriate if:

  • You have had previous radiation to the breast or chest wall.
  • You are pregnant (although radiation can be performed after delivery).
  • The disease is in several areas of your breast.
  • There are suspicious areas of calcium throughout your breast on a mammogram or breast MRI.

Furthermore, lumpectomy and radiation as treatment for DCIS may not be appropriate if:

  • Two separate incisions are needed to remove the disease.
  • You have an autoimmune disease such as scleroderma or systemic lupus.