What is a radical neck dissection? when is it done?

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What is a radical neck dissection? The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them.
What kind of incision is made with a radical neck dissection? The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.

How much is a prosthetic breast and where can I buy?

Are there some medical reasons why I should wear a prosthesis? 

Yes, there are medical reasons why you should wear a form to replace the missing breast. The weight of the remaining breast, particularly for women with medium to large breasts, can cause shoulder, neck, and back pain. You may find that your posture will change, with the affected shoulder rising, if you do not have a prosthesis. The larger the remaining breast, the more vital the need, not only for appearance but also for weight. For your own well being, emotional comfort, and self confidence, you should plan to buy a prosthesis. In many cases, a well fitted prosthetic device means the difference between prompt, cheerful, total recovery and long term personal distress. You will need some device to make your clothing fit well.

Can I wear the prosthesis all the time? 

Yes. Many patients wear it all the time, around the clock. Some patients start by wearing it a few hours a day and gradually increasing the number of hours of wear. Wearing the form to bed at night may help prevent a stiff neck and shoulder problems. Waterbeds have also been recommended by some, since they provide support and conform to the body.

Where do I go to buy a prosthesis? 

There are several places: corset shops, surgical supply houses, foundation departments of some large department stores, and some special outlets. Some American Cancer Society offices offer a variety of forms that a woman can examine (but are not for sale) in a noncommercial setting. The Reach to Recovery volunteer or the American Cancer Society office can give you material describing the various forms and a list of suggested outlets available. Most of the outlets have fitters who can help you. The large mail order houses also have prostheses available.

When should I go to get a breast prosthesis? 

Most doctors will tell you to wait until the scar is fully healed before you get fitted for a breast prosthesis. Most patients can begin using a full prosthesis a month or 6 weeks after surgery. However, soft forms can be worn from the very beginning. For instance, at the very beginning you can use simple clean padding in your brassiere. The Reach to Recovery volunteer who visits you may provide you with a temporary Dacron filled prosthesis to wear while the wound is healing and the area is tender and swollen. Some patients tell us they use items such as cotton balls, lamb's wool, handkerchiefs, sanitary napkins, or padded bras during the period between their operation and being fitted for a prosthesis. You should check with your doctor before wearing the permanent prosthesis.

How can I be sure I find the right prosthesis? 

First of all, you should not shop for the prosthesis by yourself. It is much better if an involved person, such as your sister, mother, husband, or a good friend, goes along with you. Second, you should make sure you try on several different kinds and models so that you can be sure the one you finally buy is what you really want. There are more than a dozen different breast forms on the market. You should try on several to compare the way they feel and look. The breast form should feel comfortable, have a natural contour and consistency, and should remain in place when you stretch, bend, or reach. Make sure you shop around and try on different types and different brands. It is important to pay close attention to how the prosthesis feels and how it fits the form should match your other breast from the side, the bottom, and the front. Remember you will be wearing it every day for a long time to come.

Can I make my own prosthesis? 

Some people do make their own prostheses. Some of the material put out by the American Cancer Society has instructions for making your own breast forms and night bras. Some small breasted women or women who have had both breasts removed find that they can use homemade forms. However, in many cases, the homemade forms are too lightweight and tend to ride up. Again, you must be careful because you might end up with aches in your shoulders, backaches, and posture change if you wear a prosthesis which is not of the proper weight for you.

What is a special mastectomy bra? 

It is a bra with a built in pocket to hold the form in place. It also has extra material under the arm and above the breast. The form is placed in the pocket of the bra, which holds it in place. You can bend, stretch, or stoop without jarring it out of place. Some patients have complained that the special mastectomy bras do not fit properly. Many patients have altered their own bras with pockets, and still others have had seamstresses make pockets for their bras. In some stores, fitters will sew pockets into your bras to hold the prosthesis.

What should I wear when I shop for the prosthesis? 

You should bring along some figure revealing clothes to see how natural the form will look a sweater or one of your more revealing dresses. If you want to use your own bras, make sure you bring them along so they can be altered if needed.

What is meant by a cover on the form? 

Some of the forms, both lightweight and heavy ones, have nylon or cloth covers. The covers are made of washable, fast drying materials. The cover allows the forms to be pinned directly into regular brassieres for occasional use instead of in the specially made pocket. Some women prefer to wear the covers on the forms at all times. They like the way they feel. The tricot covers, especially, are easy to wash out every night and dry so that they can be worn the next day.

I have a depression under my arm left from the surgery. Is there any way to fill that? 

There are "back" pads which can be worn under the form or along the side. These are sold with most prostheses and can fill in the depressions left by the surgery.

What are the different kinds of prostheses available? 

There are several different kinds of breast forms made by several companies.

Generally they fall into these classifications:

• Silicone gel filled

Form usually made of silicone skin. Very soft and flexible with the look, feel, and weight of the natural breast. Worn with regular bra. Adjusts to body temperature. Filled with silicone glycerine or gel, fluid, or sponge. Some can leak if fingernail or pin pricks it. OK for swimming. Most expensive. Price ($75-$300)

• Liquid or air filled

Form usually a plastic shell or a soft plastic form. Soft form has natural feel, look, and weight. Usually comes with covers. Depending on make,can either be worn with regular or specially made bra. Air filled has pocket that can be inflated to vary shape or size. Liquid filled can leak if pricked. OK for swimming.  Price ($60-$ 100)

• Foam rubber

Lightweight (molded foam or foam chips) but weights can be added. Spongy feeling. May get stiff and yellow with wear. Good for leisure wear, swimming (needs waterproof cover). Especially useful with lounging bra for postoperative period. Some people like them for general wear.  Price ($10-$50)

• Polyester

Lightweight and long wearing. Soft pads with tricot filling. Good for sleepwear and postoperative wear. Price ($10-$25)

Ask the American Cancer Society or the Reach to Recovery volunteer for a complete up to date list of prostheses manufactured in the United States.

Can I get a breast form with a nipple? 

Some forms are made with nipples. Others can be worn with nipples that are sold separately and can be easily attached.

Can I get a form in a dark skin color? 

Some forms are made in both light and dark skin colors.

The tight elastic bothers me in my bra, but I like the way this particular one fits. Can I do anything about that? 

Notion stores and girdle and corset shops sell bra extenders which can be used to make a bra more comfortable. They also sell shoulder strap pads which some women use to relieve discomfort on the shoulder strap area.

Can I have a prosthesis custom made? 

There are a few manufacturers who custom make prostheses. The American Cancer Society can give you an up to date listing.

What does a breast prosthesis look like? 

Usually it is flesh colored. The prostheses are sized to match the remaining breast both in its shape and its weight. Normally, they are teardrop shaped. The flat side goes against the wall of the chest and the tail end goes toward the armpit. One manufacturer makes a reversible one which can be used on either side.

Does a prosthesis feel cold against the chest? 

Most of them feel a little cold when they are first put on. But after they have been worn for a few minutes, they warm to body temperature and feel like a normal breast to the touch.

Will my insurance cover a prosthesis? 

It depends on your insurance plan. Some health insurance (and Medicare) covers part or all of the cost of the first prosthesis. The doctor should write the prescription for the form. Breast forms and mastectomy bras may also be taxdeductible when medically prescribed. In most cases, only the first prosthesis is covered. A replacement form is not covered. Be sure to read your insurance policy, because some say you must buy the form within a specific period of time and buy a certain type. Keep all your receipts. Most prostheses are covered by warranty.

During the summertime, I perspire under the prosthesis. Can I do anything about that? 

You can buy a sheepskin pad, which you wear facing the body, behind the form, to absorb perspiration. Some patients sometimes use facial tissue under the form during the summer.

Is anyone making special bathing suits for women with mastectomies? 

Many of the major bathing suit companies make special bathing suits for mastectomy patients. You can usually get them through the same source where you got your prosthesis or in large department stores. Your local unit of the American Cancer Society can usually supply you with a list of available styles. There is also a mail order house which carries these suits.

The nurse insisted I look at my mastectomy scar and care for it before leaving the hospital. It's so disfiguring that I don't want to look at it again, and I don't want anyone else to see me, either. Why do the nurses do this? 

The nurse was attempting to help you adjust to your loss. By showing you how to care for the incision, she was giving you an opportunity to take a first look at your scar. This is a difficult step for all mastectomy patients, but when the swelling goes down and the scar heals completely, you'll begin to feel better able to cope. Being able to talk about your feelings will help, too. Until you are able to accept yourself and the changes in your body, it may be difficult for you to resume sexual intimacy.

Since my mastectomy operation, I'm afraid to have my partner get near me for fear of pulling the incision. Is this a legitimate fear? 

This is a natural fear. However, sexual relations can be resumed as soon as you feel ready. The body's ability to heal is quite rapid. Intimacy can help to make you feel better psychologically. A small, soft pillow to protect the scar may be helpful at first. You may need to experiment to find comfortable positions such as side by side that do not put pressure on the area where you had surgery. Be honest with your partner; explain your fears and enlist your partner's help.

Why is it that since my mastectomy I seem to be having difficulties with my partner having sex less often and not enjoying it as much? 

Several studies have shown that some, but certainly not all, women who have had a mastectomy may be faced with a problem involving their sexuality.

There seem to be several parts to it:

• You may be afraid of showing your scars to your partner.

• You may be afraid of having your partner see you with only one breast.

• You may feel you will never be the same person sexually as you were before.

• Your partner may be afraid of causing you pain.

• Your partner may be upset with the change in your body.

• The emotional problems may be more involved than having the breast removed.

For some women, the loss is so great they cannot overcome it alone. If you are having problems of this kind, it is important for you to get some professional help.

I keep feeling as though my breast is still there even though it was removed. Is this a normal sensation? 

The so called phantom breast sensation is experienced by many women who have undergone mastectomy. It can also include the feeling of pain in the missing breast, numbness, or a pins and needles feeling and may last a few weeks to many years.

My whole perception of my body has changed since I had a mastectomy and I'd like to do something positive to help work through the changes. Any suggestions? 

Joining a support group can help you discuss your feelings with others who have shared your experience. A hospital social worker, your local American Cancer Society, or the Cancer Information Service 1-800-4-CANCER can put you in touch with a group in your area.

Physical exercise, such as tennis, swimming, dance classes, or exercise classes, can help to improve your feelings about yourself. Your sense of balance and grace can be enhanced through dance exercise classes. Yoga has been recommended as a way of achieving a sense of wholeness about the body. Many persons have taken up such challenging new activities as skiing.

Others have returned to college and found a whole new sense of self worth. Creative activities such as music, painting, sewing, needlepoint, and writing are excellent fields to explore to help to strengthen self image. In addition, you may want to explore the possibility of breast reconstruction if you have not already done so.

Is there anything that a family member or a friend can do to help a woman who has had a mastectomy adjust to the loss of her breast? 

Patients who have gone through the experience tell us that several things have been helpful to them.

Of course, different things are beneficial to different people.

• Many women find that talking about the loss ofthe breast is very helpful.

• A husband who tells his wife that he still loves her and needs her and will help her through these difficult days and makes her feel worthwhile is of great reassurance to the patient. It helps if the husband can also talk about the loss of the breast with his wife.

• Friends and family members who are willing to talk and who are not afraid to bring up the subject make it easier for conversation to begin.

• Nurses who encourage the patient to look at the scar and who listen to what she has to say are helpful.

• People who are willing to go with the patient to buy her prosthesis are helpful.

There is also help from the American Cancer Society the Reach to Recovery program and the support groups for cancer patients are designed to help. In some towns and cities, the YMCAs run programs of exercise and support for recent breast cancer patients.

BRA Day Top 3 Options For Breast Reconstruction

I have had a breast removed. I felt that I had faced this fact very honestly and well and had accepted the mastectomy. Now a few weeks have gone by and I feel very depressed and cheated. Is this a normal reaction? 

Patients react to a mastectomy in very different ways. Much of the reaction, it has been found, depends upon the expectations you have and how you approached the operation. It is not unusual for women to have emotional distress. It may be a feeling of panic. Some women cry. Others say they don't feel like eating. Some can't sleep or concentrate. Still others can't talk about the operation to others. Many women have a "why did this have to happen to me" feeling. These are normal kinds of feelings for mastectomy patients. It is not abnormal to be afraid of what the disease will mean to the rest of your life. If you are married, you may be worried about your husband's attitude and what he will think about your scar. If you are not married, you might worry about what you might face with a mate in the future. You may be concerned about how you can face people when you return home or to work. Discuss these concerns if you can.

Don't be concerned about when you have these feelings; some people have them directly after the operation, others not until a month or several months have gone by. Just understand that they are normal reactions to losing an important part of your body and to the feeling of helplessness about it.
Most important, don't feel that you are strange because you have these feelings. It is normal to have them. Get some help. Sometimes you can talk with a member of your family or a good friend. Other people turn to the American Cancer Society or the Cancer Information Service to have someone to talk with. The American Cancer Society in some areas runs sessions where cancer patients can talk with each other. You may want to go back to the hospital and talk with the social worker or a nurse who was helpful to you during your admission. Or maybe your physician or your clergyman can help you.

Who will be responsible for my follow up care? 

You will want to discuss this with your surgeon. Some surgeons monitor patients themselves. Others, if there has been chemotherapy or radiation therapy used as a follow up, may decide those physicians or a family doctor will be responsible for following your progress. During the first 3 years,you will be asked to see the doctor about every 3 to 6 months, then every 6 months to a year. Regular visits to a doctor following a mastectomy are important.

What will the doctor do during these follow up visits? 

The doctor will probably check your scar, the other breast, and the lymph nodes. He will tell you to make sure you are practicing breast self examination on your other breast each month and make sure you know what you are looking for. He will answer any questions you might have about how you are feeling. At the annual visit, he will give you a physical examination, including a Pap smear. He will probably order blood tests, x-rays, a mammogram, and bone scans.

Custom Breast Prosthesis for Breast Cancer Patients


Should I be examining the side where my mastectomy was done? 

Yes, you should be doing it each month as part of breast self examination. Examine the scar from beginning to end, raising your arms as necessary to expose the scars in the underarm area. With your fingers together, place the tip of the middle finger directly over the beginning of the scar line. Press gently in small circular motions. Lift up and move on to the next section of the scar. Repeat until you have checked the entire length of the scar, feeling for any lumps, hard knots, or thickenings. Feel gently, carefully, and thoroughly. If you find something that is different for you, contact the doctor.

In front of a well lighted mirror, check for swelling, lumps, redness, and or color change. Redness may be caused by irritation from your prosthesis or bra, but if it persists, let your doctor check it. Make sure your doctor has taught you how to do breast self examination in the other breast. If you have had both breasts removed, don't neglect the sides of the chest, the armpits, and particularly the scar examination. Be aware of any pain in your shoulder, hip, lower back or pelvis. Also note any unusual breast ache or pain that does not come and go with your menstrual cycle. Report any new pain to your doctor.

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