Fertility and Breast Cancer Treatment: Navigating the Challenges

Breast Symptom Assesment and Treatment Thumbnail min

Breast cancer treatment can be a daunting journey, particularly for those who are concerned about their future fertility. With advances in medicine, there are now more options than ever for preserving fertility during and after breast cancer treatment. This article explores the impact of breast cancer treatment on fertility, available preservation methods, and answers frequently asked questions.

Understanding the Impact of Breast Cancer Treatment on Fertility

Breast cancer treatments, including surgery, chemotherapy, radiation therapy, and hormonal therapy, can significantly impact fertility. Here’s a closer look at how these treatments affect reproductive health:

Chemotherapy

Chemotherapy can damage the ovaries and reduce egg quantity and quality, potentially leading to temporary or permanent infertility. The risk varies depending on the type and dosage of chemotherapy drugs.

Radiation Therapy

Radiation therapy directed at or near the pelvic area can harm the ovaries and affect fertility. However, breast cancer radiation is usually targeted away from the reproductive organs.

Hormonal Therapy

Hormonal therapies, such as tamoxifen, can disrupt menstrual cycles and ovulation. These effects are often reversible after the completion of treatment, but long-term use can delay family planning.

Surgery

While breast cancer surgery itself doesn’t directly impact fertility, it can delay family planning due to recovery time and the need for additional treatments.

Fertility Preservation Options

For women diagnosed with breast cancer who wish to preserve their fertility, several options are available:

Egg and Embryo Freezing

  • Egg Freezing: Harvesting and freezing unfertilised eggs for future use.
  • Embryo Freezing: Fertilising eggs with sperm before freezing the embryos.

Ovarian Suppression

  • Medications: Drugs like GnRH agonists can temporarily suppress ovarian function during chemotherapy to protect the ovaries.

Ovarian Tissue Freezing

  • Procedure: Removing and freezing ovarian tissue before treatment, which can later be re-implanted to restore fertility.

Alternative Motherhood Options

  • Surrogacy: Using a surrogate to carry a pregnancy.
  • Adoption: Considering adoption as a pathway to parenthood.

Frequently Asked Questions (FAQs)

How does chemotherapy affect fertility?

Chemotherapy can reduce the number and quality of eggs in the ovaries, potentially causing temporary or permanent infertility depending on the drug type and dosage.

Can I get pregnant during breast cancer treatment?

Pregnancy is generally not recommended during breast cancer treatment due to potential risks to both the mother and fetus. It’s important to use effective contraception and discuss family planning with your healthcare provider.

How soon after breast cancer treatment can I try to conceive?

The recommended waiting period varies, but many oncologists suggest waiting at least two years after completing treatment to try to conceive, ensuring the body has time to recover and to monitor for cancer recurrence.

Are fertility preservation methods safe for breast cancer patients?

Yes, fertility preservation methods like egg or embryo freezing are considered safe for breast cancer patients. However, it’s essential to discuss individual risks and benefits with your oncologist and a fertility specialist.

Will hormonal therapy affect my ability to conceive in the future?

Hormonal therapy can temporarily affect fertility by disrupting menstrual cycles and ovulation. However, these effects are often reversible after completing the therapy.

Is it possible to breastfeed after breast cancer treatment?

Breastfeeding after treatment depends on the type of surgery and other treatments received. Women who have had a lumpectomy or unilateral mastectomy may still be able to breastfeed from the unaffected breast.

Practical Steps for Breast Cancer Patients Concerned About Fertility

  1. Early Consultation: Consult a fertility specialist as soon as possible after diagnosis to discuss preservation options.
  2. Collaborative Care: Work closely with both your oncologist and fertility specialist to create a treatment plan that considers both cancer treatment and fertility preservation.
  3. Explore All Options: Consider all available fertility preservation methods and alternative parenthood options.
  4. Emotional Support: Seek support from counsellors, support groups, or fertility advisors to navigate the emotional challenges of cancer treatment and fertility concerns.
  5. Stay Informed: Keep up with the latest research and advancements in fertility preservation and breast cancer treatment.

Conclusion

Balancing breast cancer treatment with future fertility is a complex but manageable challenge. By understanding the impact of treatments, exploring preservation options, and seeking expert advice, women can make informed decisions that align with their desire for motherhood. With the right support and resources, the journey through breast cancer treatment can still lead to the fulfilment of future family planning goals.

Mr Senthurun (Seni) Mylvaganam

Consultant Oncoplastic Breast Surgeon

www.drseni.com

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WANT TO KNOW MORE

FAQ’s

Breast surgery as any surgery is not without risk. These risks and the relative chance of them happening for you will differ dependent on the type of surgery you have and also personal risk factors. Risks of breast surgery can be early risks related to the surgery itself or longer term risks such as cosmetic changes related to ageing.

Infection and poor wound healing are a risk in all breast procedures whether it is for breast cancer or for cosmetic reasons. Cosmetic surgery has a lower risk of this but it is increased if you are a smoker or have other medical problems which may effect healing such as diabetes. Every breast procedure will have a long list of possible risks or complications however most of them can be quite rare.

Your surgeon will be able to guide you through the individual risks for your chosen procedure explaining about likelihood of occurrence and what that could mean for you if the complication occurs.

This can be a difficult question to answer. In the cosmetic setting your surgeon will listen to you about what you wish to achieve focusing on shape and volume. They will then examine and assess your chest frame to determine what range of implants are suitable for you to compliment your body shape without risk of long term poor cosmetic results.

Implants vary by brand, surface texture, volume and projection. The choices available within each of these categories can be extensive. The right implant for you will be based on a collaborative discussion between you and your surgeon to select the right implant, volume, shape and projection to be the best fit to meet your cosmetic needs.

Same day cosmetic surgery is generally very safe. Your surgeon will discuss with you specific risks which will be related to the surgery that is to be undertaken and the individual risks that may be more specific to you. This can often be related to any other medical conditions you have or if you are a smoker.

Following surgery you are observed for 2-4 hours afterwards to ensure you have recovered from the anaesthetic and there are no immediate post operative complications. If you are then deemed fit to be discharged you will be able to leave with further post operative instructions to guide you at home and also contact details should you experience any problems at home and need further medical advice. You will be required to have a responsible adult stay with you for the first night after surgery to be eligible to be discharged on the same day of your surgery.

The purpose of cosmetic and reconstructive surgery is different. Cosmetic surgery has a goal of improving the cosmetic appearance by complimenting and modifying the shape and/or size of your natural breasts. Reconstructive surgery is primarily considered for patients who may require or have a mastectomy(removal of all breast tissue). This can be for a number of reasons but primarily is for the treatment of breast cancer or risk reduction if patients have a gene defect making them much more at risk of developing breast cancer. Reconstructive surgery involves the recreating of a breast mound and shape. The cosmetic goals in reconstructive surgery can be quite different to cosmetic breast surgery due to the effects of cancer treatments and the loss of all breast tissue often preventing an optimal natural appearance to be achieved.

Both types of surgery can use implants and fat grafting but reconstructive surgery can also be undertaken by moving your own tissue from another area to recreate the breast.

If you are experiencing a breast symptom such as a new lump, skin or nipple change, nipple discharge, breast shape change, armpit lumps or breast/chest swelling in men then this clinic appointment will aim to address these and other breast symptoms. I will undertake a detailed assessment of the symptoms, screen for the need for genetic risk assessment and examine you. Based on this I will give you a clear explanation of that assessment.

I will inform you as to any diagnosis reached or the need for any imaging, which could be a breast ultrasound or mammogram to help reach that diagnosis. This may also be complimented by a tissue biopsy to confirm any diagnosis. Following any diagnosis I will discuss with you a plan of treatment or reassurance as necessary.

Breast symptoms are extremely common and can range from noticing a difference in the appearance or texture of your breasts to new lumps, nipple changes and breast pain. All breast symptoms should be reviewed by either your GP or a breast surgeon. However this does not mean to say that your symptom is likely to represent a worrying change such as cancer.

MOST breast symptoms are either the result of a normal variation in the tissues that comprise your breast or to a family of conditions that are collectively called benign breast disease. In my breast reassurance clinic I will be able to assess you and provide a diagnosis and explanation for your symptoms or if necessary, further assess the symptoms if a cancer is suspected. It is much more likely your breast symptoms are not due to breast cancer but please do be assessed for any new symptoms.

Choosing to have breast augmentation is a very personal decision. Your surgeon should guide you through this process. By doing this they should help you to decide firstly whether it is right for you and then guide you through your vision for the final look and how to achieve it. I always aim to really understand what the final desired appearance is wanted right up to the smallest detail. We discuss this based on the shape including cleavage, appearance in and out of clothes and then also volume. Following this discussion to achieve your look we may also discuss performing a small uplift as well as the use of implants.

I will always be honest about what can be expected and whether your vision of the final look is possible and responsible to achieve whilst respecting your body shape and frame. A library of my work will also be available for you to view. Beyond this it is also crucial that your surgeon discusses with you the potential risks of the surgery which should include short term and what may happen in the long term. With this entire discussion you will develop a rapport and relationship with your surgeon. You can then decide if that surgeon is the right one for you or not.

Breast augmentation surgery can be undertaken as a day case procedure. Hence you can go home the same day once you have had a period of observation after surgery. You will be fitted with a surgical bra and a binder which can be purchased by yourself or provided at the hospital. The binder provides gentle pressure from above the implants ensuring they remain in the optimal position whilst healing occurs. Please aim for about 4-6 weeks of recovery before getting back to anything strenuous such as the gym or long runs. If returning to work this can be done after 1-2 weeks but ensure you only undertake light manual labour activities.

I will ask you to wear the surgical bra as much each day and night as possible for 6 weeks to provide the best cosmetic result. Upon review during your recovery I will inform you as to when to remove the binder.

SPECIALIST

Treatments

Breast Reassurance

Breast symptom assessment utilising the national standard of triple assessment (clinical hist...

Breast Cancer Care

Treatment of breast cancer including a full range of oncoplastic and breast reconstruction techniques.

Cosmetic Breast Surgery

Surgery to change the appearance of your breasts adjusting volume, shape and cleavage.