Breast Cancer, Breast Reconstruction Surgery and the Heart
15 Feb 2017
Given that February is the month of Valentine’s Day, there are images of hearts nearly everywhere. It’s a fitting time to look at breast cancer, breast reconstruction surgery and the heart.
When you have breast cancer, you have a unique connection to your heart. You have to learn to love your new body again after surgery. You have to find the strength to persevere through your struggles.
And, you might wonder how certain breast cancer treatments and breast reconstruction procedures may affect your heart in the future.
How Breast Cancer Treatment Affects the Heart
Unfortunately, heart failure affects some women with breast cancer at a higher rate than the general population. This is largely due to the damaging effects of some common breast cancer treatments.
According to one report, a common chemotherapy treatment for breast cancer increases women’s risk of heart failure by 20 percent. The study examines medical records of women treated for breast cancer between the years of 1999 and 2007. The treatment consisted of two common cancer drugs from a group called anthracyclines. It also included a targeting antibody drug known as trastuzumab. When combined to treat breast cancer, these drugs increase the risk of heart failure within three to five years following treatment.
Researchers noted that risk of heart failure was also affected by the women’s ages. According to the report, over 40 percent of women over the age of 75 experienced heart failure. This was after doctors treated them with a combination of anthracycline and trastuzumab. Meanwhile, women over age 75 who didn’t receive this treatment experienced heart failure just 13.7 percent of the time. The risk of heart failure in younger women is significantly lower.
Radiation therapy also affects rates of heart problems. Another report looks at radiation therapy’s effects, based upon several factors. These include which breast was being treated and the position the woman lied during the treatment. It also took into account the women’s baseline risks for heart disease. The highest rate (3.5%) was found when treating the left breast of women with a high baseline risk of heart problems who were lying in a face up position.
In many cases, physicians prescribe radiation therapy following a lumpectomy. However, around 30 percent of women who get a mastectomy are candidates for radiation due to their high risk of recurrence.
Breast Reconstruction and Cardiac Bypasses Traditionally Use the Same Arteries
There are a few treatment options for heart problems. The most common treatment for heart failure is cardiac bypass surgery. This type of surgery normally uses the internal mammary arteries (IMAs) to bypass the damaged heart arteries. In doing so, the heart can continue functioning. Surgeons connect these arteries to improve survival rates among patients who undergo a coronary artery bypass surgery.
However, surgeons also use these same arteries during breast reconstruction procedures.
Autologous breast reconstruction procedures use flaps of skin, fat, and sometimes muscle from other areas of the body. Surgeons add these flaps onto the chest to create a breast that appears more natural. When these flaps are attached, the existing arteries in the donated tissue must be attached to arteries in the chest. Without blood flow from these arteries, the tissue dies and must be removed. IMAs are a common choice for connecting the arteries in the tissue flap to the heart.
Solution: Preserving Internal Mammary Arteries
In recent years, surgeons have worked to find alternative ways to attach tissue flap arteries to chest arteries without using IMAs. This ensures surgeons can use IMAs during a coronary heart bypass if women experience heart disease or failure.
Different Attachment Techniques
One way surgeons try preserving these arteries is by using a procedure called “end-to-side anastomosis.”
Anastomosis is the process of connecting two arteries together. Traditional breast reconstruction and heart bypass procedures use end-to-end anastomosis. This involves removing most of the IMA and attaching a new artery to its base. Once this procedure is done, the IMA is no longer available for any additional procedures.
End-to-side anastomosis is nearly identical to end-to-end anastomosis. But it involves attaching an artery from the donated tissue to the side of an existing IMA rather than to the end. The procedure takes roughly 20 minutes longer than end-to-end procedures. Yet it prevents surgeons from cutting the IMA and preserves the artery in case it is needed for a bypass surgery in the future. End-to-side anastomosis is used predominantly with DIEP flap surgeries. These surgeries take tissue from the abdomen to reconstruct a breast.
Using Different Arteries
More recently, researchers have discovered that different arteries can be used during breast reconstruction.
This study compared complication rates among women who had breast reconstruction using IMAs versus intercostal perforating vessels, or IMA perforators (IMAP). It looked at complications among various flap procedures and also checked for differences in procedure timing.
Researchers looked at 515 free flap procedures performed in 2014 and 2015. Of these cases, 424 flaps were DIEP or SIEA flaps, while 91 were TMG flaps. Roughly 22 percent of all cases involved connecting flap arteries to IMAPs.
According to the results, only 6.2 percent of all cases required revision surgery due to problems with blood flow. In most of these situations, the flap was saved. Procedures using IMAPs instead of IMAs had shorter operation times and allowed women to go home one day sooner. Complication rates were higher for IMAPs than IMAs. However, these rates did not increase when large flaps were used or when women had previously had radiation therapy. Further, the study found that IMAP vessels provided consistent blood flow to the reconstructed breast tissue.
The possibility of using IMAPs during a breast reconstruction procedure is promising. Despite having higher complication rates, these arteries preserve IMAs. As a result, women can undergo safer heart bypass procedures if it is needed in the future.
Protecting Your Heart
As technology advances, you don’t have to helplessly wait on the sidelines. There are ways you can protect your heart during breast cancer treatment and breast reconstruction.
First, make sure you’re aware of the different drugs you’re taking for treatment. Ask your physician for an explanation of the side effects of each drug. If these explanations are too technical, don’t be afraid to request a more simplified version. Further, take some time to research side effects of various drug combinations. Your physician should be aware of these, as well, but there is no harm in learning about them yourself.
Second, you can monitor your heart function over time. Most heart problems are associated with symptoms such as leg swelling, intolerance to exercise, and heart fluttering. If you notice any of these problems, tell your physician. These symptoms can be caused by other problems, so it’s important that you are carefully evaluated to determine their true cause.
Finally, take the time to have your heart tested. Most women don’t undergo heart tests during routine visits to their physician. However, it may be in your best interest to start requesting such tests. Some physicians suggest that heart tests begin before you start your treatment for breast cancer. These tests should then continue after treatment to ensure you’re not experiencing any complications.
10 Mar 2017 - I'm Taking Charge - Life After Breast Cancer