Beautiful After Breast Cancer Foundation

Prevention

Modern medicine is increasingly transitioning towards preventive care. This shift towards prevention has also been observed in breast cancer care in recent years, particularly with the discovery of the BRCA gene. Subsequently, multiple genes and risk factors have been identified. Depending on these factors, a personalized screening strategy can be chosen. Therefore, it is crucial to understand these genetic and risk factors.

Diagnosis

I was diagnosed with cancer ... This website serves as a portal designed to assist you and your loved ones in accessing personal information and finding solutions to your concerns.

The primary goal of this website is to offer guidance and support to patients as they navigate their journey toward recovery and improved quality of life. The "Diagnosis" section of our website is divided into two main categories. Firstly, under "Anatomy and Physiology," we provide fundamental knowledge about the breast. Secondly, in the "Tumors and Disorders" section, we delve deeper into various breast-related conditions.

Moreover, we aim to provide information to women who may be concerned about potential breast issues but are hesitant to seek immediate medical advice. Knowledge and information can often offer immediate reassurance if a woman is able to identify the issue herself and determine that no specific treatment is necessary. Conversely, we also strive to educate women who have received a diagnosis of a serious breast condition, such as breast cancer, and wish to approach their doctor well-informed and prepared.

Treatment

The treatment for breast cancer should immediately include a discussion about reconstruction. Our foundation has no greater goal than to raise awareness of this among patients and oncological surgeons. By making an informed decision beforehand, we avoid closing off options for later reconstruction while still considering the oncological aspect. Of course, survival is paramount, and the decision of the oncologic surgeon will always take precedence.

The "Reconstruction or not?" page contains all the information you can expect during an initial consultation before undergoing tumor removal. This page is comprehensive, and your plastic surgeon will only provide information relevant to your situation.

"Removing the tumor" details the surgical procedure itself. This is the most crucial operation because effective tumor removal remains paramount. We guide you through the various methods of removal, a decision often made by a multidisciplinary team comprising oncologists, radiologists, pathologists, radiotherapists, breast nurses, gynecologists, oncological surgeons, and plastic surgeons.

The "Breast Reconstruction" section includes information and illustrations of the different reconstruction options along with corresponding steps.

Revalidation

Those treated for cancer often need a long period to recover.

Cancer is a radical illness with a heavy treatment. Often, people have to deal with psychosocial and/or physical problems afterwards, such as stress, anxiety, extreme fatigue, painful joints, reduced fitness, lymphedema... This can have a major impact on general well-being.

There are rehabilitation programmes offered by most hospitals. We cover some of the major topics here.

Quality of life

Quality of life is a key factor in coping with breast cancer. Therefore, it is important to find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, physical exercise... Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping, as well as focusing on mental strength to allow the patient to move on with life. In this section we are addressing some topics that patients experience during and after treatment and we are providing information to address them.

Skin, nail and hair care

The skin is the largest organ in our body, acting as a barrier to protect us from bacteria, viruses and fungi. It also regulates our body temperature and enables us to receive sensory impulses: the way we perceive things in our environment, heat or cold, and when we touch things. The skin is also responsible for forming vitamin D, which is very important for our overall health.

Skin troubles and skin care during chemotherapy

During chemotherapy, most chemotherapy products block the activity or ability of cells in our body to divide or grow. However, these products are not able to distinguish between a cancerous cell that they destroy or a normal cell such as skin cells that grow. This leads to the dermatological side effects described below:

  • Dry skin

  • Skin rash

Chemotherapy may cause photosensitivity that appears as redness. Skin rashes resembling acne can sometimes be improved with steroids

  • Hand-foot syndrome

This is a side effect of chemotherapy certain drugs such as oral capecitabine, 5-fluorouracil and doxorubicin

  • Radiation recall

This is an area of redness that occurs in the area of radiation after certain chemotherapeutics

  • Inflammation of the oral mucosa

Hand-foot reaction

This side effect occurs in many patients during the course of chemotherapy. The hand-foot skin reaction manifests itself as:

  • itching and tingling

  • a feeling of numbness

  • burning

  • peeling, dry skin

  • a dull feeling

  • painful palms of hands and/or soles of feet

  • increased sensitivity to warm objects

  • redness

  • swelling, fissures, calluses or blisters on the rubbing sites of the palms and soles of the feet

The symptoms usually occur after a few cycles. You can apply the tips from the start of your treatment.

 

TIPS

  • Have the existing callus formation on hands and feet taken care of by a medical pedicurist before starting the treatment. Have the callus well taken care of, but do not cut it away!

  • Apply a softening cream to your hands and feet often, especially in places where the skin is dry. For example, a cold cream or a lipophilic cream.

  • If it is itchy, you can rub your hands and feet with an ointment containing urea

  • Before going to bed, apply a thick layer of ointment with a pair of socks on top to keep the ointment in place

  • In the evening, wear cotton gloves and socks to allow the moisturisers to penetrate optimally

  • Take a lukewarm shower and use a neutral and unscented shower gel. Gently pat the skin with a soft bath towel

  • Use a sun protection factor (e.g. Factor 50) and an after-sun spray to soothe the skin

  • Wear wide footwear, make sure your feet are not trapped in the shoes. The use of insoles is recommended

  • Wear gloves, your hands can be very sensitive in the cold

  • Use gloves when doing the dishes, wear fine cotton gloves first and only then rubber gloves

  • A foot bath with magnesium sulphate (MgSO4) can be soothing

  • In case of open wounds, use an antiseptic footbath once a day

  • Consult a podiatrist or chiropodist if you have hard and thickened skin patches

  • Apply corticoid ointments only to the affected areas otherwise you will irritate the healthy skin

  • Ask your doctor for a remedy for itching or pain

 

BEWARE

  • Avoid prolonged exposure to the sun

  • Avoid hot showers or baths

  • Avoid contact with detergents or other maintenance products. These dry out the skin

  • Avoid friction on the feet and hands, for example during long walks or when working with certain tools for a long time

  • Do not puncture blisters, as this may worsen the symptoms

  • Be careful with the use of plasters

  • Avoid standing up for long periods of time

  • Avoid shoes with thin soles

  • Avoid walking barefoot. It can cool you down but you have to watch out for wounds

 


Inflammation of the oral mucosa

The mucous membrane in the mouth can become inflamed by chemotherapy. This is called mucositis. The inflammation is usually temporary but can be painful. The gums, tongue and lips can be sensitive, especially when eating and drinking.

 Other symptoms in the mouth are:

Aphthous ulcers

  • Dry or painful mouth

  • Sores

  • White deposits on the tongue

  • Red mucous membrane

  • Bleeding gums

  • Chapped lips

  • A sensitive throat

 

TIPS

  • Maintain good oral hygiene and well-groomed teeth

  • Brush your teeth after every meal, at least 3 times a day

  • Always brush your teeth with a soft toothbrush

  • Use a fluoride-containing mild toothpaste

  • Rinse the toothbrush thoroughly and store it dry with the brush head facing upwards

  • Replace your toothbrush every 2 months

  • Use a tongue cleaner once a day to clean your tongue. Brush or scrape the back and sides of the tongue

  • Floss your teeth once a day

  • Always rinse your mouth with water after vomiting

  • Rinse your mouth with Dentio 0.05% or another mouthwash without alcohol

  • Use the mouthwash after brushing and before going to bed

  • Keep lips moist with a lip balm

  • Drink plenty of water and lukewarm tea

  • In case of pain it is best to eat food that is soft

  • If you have pain or open sores in your mouth, always contact the nurse. The painful areas in your mouth can be relieved by laser treatment

  • Remove your dentures and rinse your mouth in case of pain

  • Clean the dentures with a denture brush and neutral liquid soap. Do not use toothpaste, as this will damage the denture. An effervescent tablet does not replace brushing your dentures

 BEWARE

  • Avoid food that is too spicy, acidic (lemon juice, vinaigrette, mustard), dry, crunchy, hard, very cold or very hot in case of pain or open wounds in the mouth

  • Avoid toothpaste with whitening effect (e.g. with peroxide)

  • Avoid alcoholic drinks

  • Cutting down or, better, quitting smoking is recommended

 

Source: brochure UZ Gent

 

Links

www.breastcancer.org

https://www.cancerresearchuk.org/about-cancer/coping/physically/skin-problems

 

References

Radiation induced skin damage

Effects of radiation therapy

There is a range of effects that can occur in irradiated skin over time. In general radiation can damage cells by directly disrupting DNA or through free radical production. This damage results in disorganized fibroblast activity, micro-vascular thrombosis and inadequate tissue oxygenation. During the 3rd to 6th week of therapy, populations of basal layer stem cells become depleted in the treated area. The gross skin changes occurring with standard schedules and doses of radiotherapy to the breast are categorized as early or late effects, as determined by the time at which they present.

Early effects are defined as those that occur within 90 days of the 1st radiation therapy. The skin reactions include dryness, epilation, pigmentation changes and erythema. Dryness and epilation are results from destruction of the dermal layer. Hyperpigmentation is a result of epidermal melanocyte stimulation. Some patients may develop hypopigmentation due to complete eradication of all melanocytes. Acute erythema is caused by cytokine- mediated inflammatory reactions.

Late effects are considered the effects that present more than 90 days from the first radiotherapy. These effects are related to dermal injury. Until the moment that late effects appear the skin can appear “normal”. Late effects can appear after months or even up to 15 years later. These late effects are directly related to the dermal fibroblast response to radiotherapy and the reabsorption of collagen fibers. Telangiectasia is another effect of radiation that can manifest months or multiple years after the therapy. If necrosis appears this is associated with doses of radiation higher than those used in breast cancer treatment.

Unfortunately melasma and postinflammatory hyperpigmentation are cosmetic problems with limited options for treatment.

Many dermatological treatments are proposed in letterature, but without any optimal result for the moment (selective photothermolysis of pigmented cells by Q-switched ruby laser, MedLite C6 Q-switched Nd:YAG laser, laser resurfacing).

Promising results have been observed with the use of lipofilling. The injection of body-own fat into the subdermal layers have induced improved pigmentation, increased suppleness and better elasticity of the skin. The working mechanism is unclear for the moment but the positive influence and reparatory function of stem-cells on the damaged tissue seem to be the most logical explanation today.

Camouflage options are discussed in the session make-up and camouflage*.

References

Immediate and long term damage

Immediate damage

It is normal for your irradiated skin to react to the radiation. The extent to which the skin reacts differs from person to person and depends on the radiation technique used.

The skin reactions are only possible at the place where you are being irradiated and usually occur at the level of the surgical scar or at the level of the skin folds (under the breast or in the armpit). People often speak of 'burns' as a result of radiation (acute radiodermatitis). Usually the skin becomes red in the 2nd to 3rd week of the irradiation.

Typical symptoms after radiation:

  • redness

  • Skin flakes, dry skin

  • Itch

  • Irritation and pain at the level of the irradiated skin

  • The skin is sensitive and can feel warm

  • An open wound

The skin reaction peaks in the last week of treatment until the first week after. At the end of the irradiation, your skin may be an open wound, but this is certainly not the case for everyone. To prevent this as much as possible, it is important to correctly apply the tips below. Skin reactions usually heal within four weeks after the last irradiation.

TIPS during the radiation period

  • Inspect the irradiated skin daily.

  • Wash with a gentle shower oil or soap (eg Eucerin wash lotion, Bodysol shower oil, Mustela baby soap, Mustela baby shampoo 2 in 1, Sanex zero or Sebamed soap). These products have no perfume and no preservative.

  • Rather take a shower than a bath. Bathing can soften the skin too much and make the marks on the skin disappear.

  • Pat your skin dry with soft towels, never rub.

  • Keep the skin folds dry. Apply a cotton swab or cotton handkerchief between the skin folds, for example under your breast.

  • Sometimes the skin can also suddenly react sensitively to a detergent. Then use a neutral detergent and do not use fabric softeners for a while.

  • Wear loose-fitting clothing to avoid pressure and friction. For example, wear a cotton tank under your bra or a bra without underwire. Preferably wear cotton clothing, this is lighter.

  • If necessary, the doctor will prescribe you a moisturizing cream. Only use this if the doctor advises you to start with it.

  • Apply the cream as a prevention for drying out the irradiated skin. Do this at least 2 times a day. Do not put a thick layer of cream on your skin but massage a small amount in completely. For an area comparable to a palm, you need about a pea-sized amount of cream. The products penetrate best when you first moisten the skin slightly, for example after showering.

  • Do not wash off the moisturizing cream before irradiation.

  • If you experience itching, a cold cream with urea can be prescribed to reduce the itching. You can also prevent itching by refreshing yourself regularly and wearing light, cotton clothing.

Pay attention

  • Do not rub too hard with a washcloth at the level of the irradiated skin, rinsing is allowed.

  • Avoid aluminum deodorants, perfume, perfumed soaps, body lotions and shampoos. These can cause irritation and eczema. If you do want to use some perfume, apply it carefully to your clothing.

  • Do not use products that contain alcohol such as cologne or aftershave lotions. These dry out the skin.

  • Do not use powders as they are too abrasive.

  • Do not apply adhesive plaster in the irradiated area. Don't use ether either.

  • When itching, do not scratch the irradiated skin. Sometimes it can help to uncover this place. Also discuss this problem with the radiation doctor. He will prescribe you the appropriate ointment.

  • Do not expose the irradiated skin to UV rays (the sun & tanning bed). Always cover the irradiated area with clothing or a scarf.

  • Do not swim in chlorinated water and do not go to the sauna. This has a drying effect.

TIPS after the radiation period

  • Still keep taking a shower. The skin must first be recovered before you can take a bath or go swimming again.

  • Do not wash off the applied markings immediately after the last irradiation. Rubbing too much and too hard can damage your skin even more and they will disappear on their own, after about 1 week.

  • Moisturize your skin further if your skin is dry after the irradiation. Do this for as long as your doctor considers necessary.

  • Be careful when sunbathing, especially the first year after irradiation. Always cover the irradiated skin and use a sun cream (Sun block factor 50). It is recommended that you continue to do this after the first year.

Long term damage

Long-term side effects (weeks to months after radiation) in most cases only occur in the irradiated areas and not elsewhere in the body. Permanent cosmetic changes may occur after radiation. The irradiated breast may look different from the other breast: harder, firmer and discolored. These changes will be monitored during your checks.

After healing, your skin may remain darker.

The breast or armpit may feel firmer and harder due to scar tissue forming. Tissues become tougher and lose their elasticity. This is called fibrosis of the breast.

Some women feel that the breast has increased in size. Usually this is temporary and due to reactive edema. Fibrosis can also cause problems with the joints and this can be annoying when moving, for example, the arm and shoulder. Kine can help with this.

Source: UZ Gent brochure

Wigs and head wear

Chemotherapy can affect hair growth: sometimes hair becomes thinner and in some people it falls out completely. Any hair loss from chemotherapy is almost always temporary.

Many people see their hair as an important part of their appearance, and are worried that a different appearance might affect their relationships with family and friends.

Hair loss may make you feel less confident, vulnerable and exposed, especially if you feel forced to tell people about your cancer diagnosis when you do not wish to do so.

Talking is important to cope with hair loss, both practically and emotionally. Some people find it easier to talk to someone they don’t know, or to a cancer support specialist, others to fellow patients who already went through hair loss. The latter can often give helpful advice and personal hints on how they have coped with the issue.

Possible alternatives or solutions to hair loss are:

  • wigs

  • hats, turbans, scarves.

  • professional haircuts and hair products can help in the regrowth phase.

 

Websites on this topic

www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Hairloss/Hairloss.aspx

www.headcovers.com/

 

References

Make-up

Chemotherapy can give unpleasant aesthetic side effects like the loss of lashes and eyebrows, and irritated or very sensitive skin, with possible color irregularities.

Make up can help improve your look, but also your mood. Lipstick, powder and mascara make you feel safer and more attractive: in a word, more beautiful, even during chemotherapy.

With determination and optimism, it is possible on the one hand to "hide" these effects, and on the other hand to highlight a new kind of beauty, stronger and more aware.

The so-called camouflage products are cosmetic products used like the regular ones, but offering specific features to be tolerated even by sensitive skin or irritated skin. They are hypoallergenic, waterproof, long-lasting and contain a sunscreen.

Sunscreen should be worn at all the time, also if you do not want to put make up on, because the skin is very sensitive and prone to burns in that period.

To camouflage the missing lashes it is possible to apply false eyelashes with a special glue. It is anyway often sufficient to use a water resistent eye liner to delineate the upper and lower eyelid to give greater intensity to the eye without lashes.

Eyebrows can be drawn with a special brush and pencil, replaced by stencils or by a realistic eyebrow in human hair (to be applied with a special glue).

If you do want to wear makeup every day you can intervene with a semi-permanent make-up. This is a non permanent tattoo that can be maintained even after the natural regrowth of hair. Colors used are non-toxic, hypoallergenic and have a very natural effect. The long term effect varies from person to person and can be touched up regularly.

Nails and nail care

Good nail-care is important in order to prevent infection. Avoidance of infection is particularly important whilst receiving chemotherapy when one’s natural defense, the immune system, is compromised. Also in the setting of previous under arm surgery, to remove the glands that drain the lymphatic fluid from the breast, one is at risk for developing lymphoedema (accumulation of fluid in the soft tissues of the arm). Good nail care to avoid infection is a first line prevention for lymphoedema.

Changes you may notice

  • Brittle and dry nails may occur which are prone to breaking easily.

  • Cuticles may fray.

  • The nail will not grow as fast as it would have prior to the introduction of chemotherapy.

  • Multiple horizontal lines may develop along the nail. In medical terminology these lines are called “Beau’s lines”. Each line represents a cycle of chemotherapy. They are not permanent and will grow out with the nail usually in about six months.

  • Taxane-based chemotherapies, commonly used in breast cancer management, are known to cause nail discoloration and brittle nails. The nail can lift away from the nail bed and in a small proportion of women some nails may fall off. The nail will regrow.

 

The following are key tips to maintain good nailcare

  • Keep your nails short.

  • Don't cut your cuticles.

  • Avoid biting your nails or cuticles.

  • Use protective gloves while exposed to washing dishes/gardening to avoid developing a fungal nail infection.

  • Massage cuticle cream into the nails on a regular basis

  • Nail polish will give added strength to the nail. However, use non-acetone-based remover to remove polish as it is less drying than acetone-based removers.

  • Avoid fake nails, acyrlics or nail wraps that can increase your risk for developing infections

  • If going for a manicure bring your own manicure set with you again to reduce the risk for infection.

  • Attend your doctor if you notice redness or cream discoloration under or around the nail bed.

 

External Links

http://www.oncolink.org/coping/article1.cfm?c=496&id=1157

 

References

Help Beautiful After Breast Cancer Foundation

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