BBC News Health
One in five women with breast cancer who has part of the breast removed, rather than the whole breast, ends up having another operation, a BMJ study suggests.
The reoperation rate increases to one in three for women whose early-stage cancer is difficult to detect.
In England, 58% of women with breast cancer have breast-conserving surgery.
Women should be told of the risk of further operations when choosing surgery, researchers say.
The study, led by researchers from the London School of Hygiene and Tropical Medicine and published in the British Medical Journal, looked at data collected on 55,297 women with breast cancer in England.
They all underwent breast-conserving surgery, rather than a mastectomy, on the NHS between 2005 and 2008. All the women were aged 16 or over.
They then looked at procedures carried out in the three months following the first breast operation.
The researchers took tumour type, age, socio-economic deprivation and other health problems into account.
When combined with radiotherapy, the study says that breast-conserving surgery is as effective as mastectomy, particularly for patients with an obvious, invasive tumour.
‘Emotional distress’
However, because some pre-invasive cancers called ‘carcinoma in situ’ are difficult to detect, because they don’t form a lump, breast conserving-surgery may not remove the cancer completely.
This could result in another operation.
The study says that additional operations put women’s lives on hold while they wait for more surgery. It can delay their return to work, cause emotional distress and result in the need for reconstructive surgery to the breast.
Out of the 55,297 women who underwent breast-conserving surgery, 45,793 (82%) were suffering from isolated invasive cancer, 6,622 (12%) had isolated carcinoma in situ (pre-cancerous disease), and 2,882 (6%) had both types of cancer.
Another operation was more likely among women with pre-cancerous disease (29.5%) compared with those with isolated invasive disease (18%).
Around 40% of women who had a reoperation underwent a mastectomy.
Further results suggest that a repeat operation is less likely in older women and women from more deprived areas.
‘Empowering patients’
Prof Jerome Pereira, study author and consultant breast surgeon at James Paget University Hospitals in Great Yarmouth, said the findings would help women to make decisions about their treatment.
“Patients should feel reassured that clinicians can now advise them more clearly.
“We all have a different attitude to risk but this is empowering patients to make the right decision for themselves.”
Prof Pereira said the study results would help surgeons too.
“This research focuses surgeons and challenges us to try and reduce reoperation rates.
“We need to refine imaging techniques to make this happen – and this opens up more areas for more research.”
‘Increase survival’
Ramsey Cutress, Cancer Research UK breast cancer surgeon at the University of Southampton, said it was standard practice to discuss the possibility of further surgery with patients.
“It’s important for patients to fully understand the pros and cons of surgery. The ultimate aim of these repeat operations after breast-conserving surgery is to reduce the chance that breast cancer will return in the breast, and increase survival from the disease.
“Rates of breast cancer recurrence are also reduced by other treatments such as radiotherapy, hormone therapy and chemotherapy where appropriate.
“There’s an ongoing need to better identify those at high risk of breast cancer recurrence, and to carefully select those who would benefit the most from further surgery.”
Women’s Health – LadyRomp.
Your boobs are wily little seductresses. They poke proactively out of bikini tops, peek over lacy push-up bras, and flaunt their fabulousness naked in bed—turning any red-blooded heterosexual male into a panting pile of mush.
But what most women don't realize is that their boobs can give them heaps of satisfaction too. "The majority of research is geared toward keeping breasts healthy, and not nearly enough is known about how women can enjoy their breasts during sex," says Debby Herbenick, Ph. D., a sexual-health educator at the Kinsey Institute at Indiana University.
The truth is, your boobs play an important role in pleasing both of you. These six moves will help you double your pleasure and ensure they're not left out of the fun.
Cuddle up
When your partner caresses your breasts, your brain releases a warm and fuzzy chemical into your bloodstream called oxytocin, says Beverly Whipple, Ph. D., professor emerita at Rutgers University. This powerful love hormone, also triggered by hugging and orgasm, fosters a strong bonding feeling between you and your partner.
To maximize its effect, while you're on top, have your guy sit up and wrap your arms around his neck, pressing your breasts into his chest. Or, while in missionary, pull him toward you until your nipples graze his chest and focus on synchronizing your breathing. This touching and heaving at the same time will boost intimacy, and—because arousal increases blood flow—your breasts will feel warm, making your embrace feel even cozier.
Tease them
The same way a guy can become erect just like that, a woman's breasts can stand at attention sans direct contact. In fact, the mere suggestion of sexual touch can fire off pleasurable sensations in your breasts. To make your hills come alive without actually touching them, "have your guy rest his fingertips lightly on your sternum (the middle of your chest), then move them toward either breast, drawing light circles over the entire area," says Jaiya, co-author of Red Hot Touch. His barely there caress will stimulate the microscopic hairs on your boobs and the fine-touch nerves under the skin's surface, creating bliss-inducing shivers.
Relish new sensations
Your man may be good with his hands, but encourage him to touch your chest with something less expected once in a while. The feel of soft jersey sheets, cool body lotion, or even silky fabric can make sex more thrilling. "Introducing various types of sensation adds a new feel to ordinary touch," says Ian Kerner, Ph. D., author of She Comes First. During sex, have him rub your breasts with a pair of silk underwear, tickle your nipples with a feather, or smooth hand cream all over your girls. And don't overlook the benefits his body can bring. Press your boobs into his smooth back, or dangle them over his face during girl on top, tracing them over his nose, cheekbones, and lips—or just glide his penis across your chest.
Focus above the areola
Those nipples, always hogging the spotlight. But they're actually not the most sensitive region of the chest. The flesh directly above the areola (the colored skin surrounding the nipple) is the real star of the show. "We think of nipples as primary erogenous zones—which they are, to a degree—but that's partially because they're so visible," Jaiya says. "However, studies have shown that women feel more pleasurable sensations above them."
Have your guy rub the 10 o'clock to two o'clock zones with an ice cube, then blow hot air on the wet parts for head-to-toe chills. Or, while in missionary, he can use the tip of his tongue to lick circles around the area, slowly moving down to your nipple and areola (the second most sensitive zone on your breast). The pressure from his tongue will activate a tiny muscle just beneath the surface that flips on your headlights so he can then flick them ever so gently with his tongue.
Get wet
Mix things up by hopping in the shower with your guy and turning the faucet to hot (but not scorching). The heat brings blood to the skin's surface and elevates body temperature, both of which make your skin more sensitive to the touch, says Sandor Gardos, Ph. D., founder of mypleasure.com, an online sex-toy store. Then have your guy soap up your breasts. The feeling of his hands slipping and sliding all over your boobs combined with the hot water will get both your libidos racing. Also consider experimenting with the settings on your shower head—the pulsate function will provide direct, massaging pressure, while a lighter one will feel more soothing. Not in the mood for a shower? Having your guy massage your breasts with a steamy wet towel will reap similar benefits.
Maximize your size
Your breasts may be his go-to spot on your bod, but how often do you luxuriate in the sensuality of your own curves? Never? Well, you're missing out. "Some women don't take the opportunity to relish their breasts during sex (or solo sex), especially if they're self-conscious about their cup size," Kerner says. But guess what—all women, regardless of bra size, have the same amount of nerve endings and feel an equal amount of pleasure--and experts say boobs can grow up to 25 percent bigger when aroused.
The trick is to tailor the type of touch to your size. In general, women with larger breasts can handle a slightly firmer grip because they have more fatty tissue. So when you're on top, cup your boobs, lift them slightly, and squeeze. Feeling their full weight can be a huge turn-on. If you have a smaller set, push your breasts together with the sides of your arms to create eye-popping cleavage. Or, while you're in the spoon position, reach up and feel them jiggle with every thrust.
Read more: http://www.womenshealthmag.com/sex-and-relationships/sex-tips-2