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When cancer is found in both breasts or there¡¯s a high risk of developing breast cancer, a double mastectomy may be an option to treat or prevent breast cancer.?

This surgery removes all breast tissue. It can be performed with or without breast reconstruction surgery, either at the same time or as a separate procedure. ?

We spoke to surgical oncologist , to learn more about this procedure and what patients can expect before, during and after a double mastectomy.?

Who needs a double mastectomy??

Very few patients need a double mastectomy, but there are some cases where patients and their care teams may decide to seek this treatment option, if they meet certain requirements.

The National Comprehensive Cancer Network¡¯s guidelines outline which patients may benefit from double mastectomy. These include patients who have:

• certain genetic mutations, like BRCA1 and BRCA2, that put them at increased risk for developing breast cancer,?

• cancer in both breasts,??

• several close family members who¡¯ve been diagnosed with breast cancer at a young age, and/or

• a history of radiation therapy to the chest. ?

Patients with a tumor in one breast may consider a double mastectomy, also called a bilateral mastectomy, for cosmetic reasons to achieve symmetry in the other breast. ?

What are the alternatives to double mastectomy??

When you have breast cancer, your first instinct may be to remove all potential for it to grow or spread. But surgery isn¡¯t the only option for many patients. Even if you¡¯re at high risk for developing breast cancer, there are non-surgical treatment options that don¡¯t require a double mastectomy. These include more frequent screenings and surveillance.?

MD Anderson patients can seek care from our High-Risk Screening and Genetics Clinic, where they¡¯ll receive frequent mammograms and/or breast MRIs to detect cancer early, when it¡¯s easiest to treat.?

Talk to your care team to see if you¡¯re eligible for more frequent screenings instead of surgery.

What are the different types of double mastectomy??

There are several different surgical techniques that can be used during a double mastectomy. These include:?

• Total mastectomy: This surgery removes all the breast tissue, including the skin and nipple.?

• Skin-sparing mastectomy: Breast tissue is removed along with the nipple and areola, but the skin around the breast is saved. This leaves a ¡°skin envelope,¡± which allows for breast reconstruction surgery at the same time, either with implants or your own tissue. This approach offers a more natural appearance after patients recover.?

• Nipple-sparing mastectomy: This technique is the most complex option for mastectomy; it saves the skin as well as the nipple-areolar complex. Nipple-sparing mastectomy is performed with reconstruction at the same time, similar to a skin-sparing mastectomy. Surgeons remove tissue inside the breast but save the skin, nipple and areola. ?

Your recovery time will depend on which surgical approach you receive and whether you undergo breast reconstruction. This can range from two weeks for total mastectomy with no reconstruction to 4 to 8 weeks after mastectomy with reconstruction using your own tissue.

What are the risks associated with double mastectomy?

As with any surgery, there are risks associated with double mastectomy. And, because the treatment involves two different spots on the body, that risk is doubled.?

With skin-sparing and nipple-sparing mastectomy, there¡¯s risk that the skin and nipple will lose blood supply and die or lose sensation. Bleeding and infection are also possible side effects of surgery. That¡¯s why it¡¯s so important to seek care from a surgeon with experience performing this specialized surgery to get the best result and minimize risks.

Anything else patients should know about double mastectomy??

A double mastectomy can be beneficial for some patients, but it¡¯s not right for everyone. Having both breasts removed is a big decision, and you want to make sure that it¡¯s the right one for you based on your quality of life and personal treatment goals.?

Talk to your care team to see if a double mastectomy makes sense for you and your breast cancer treatment goals.?

or by calling 1-877-632-6789.?

Hormones control nearly all of our bodily functions, from growth and development to emotions, sexual function and even sleep. But hormones, which occur naturally in our bodies, can also fuel the growth of certain breast cancers. We talked with breast medical oncologist , to learn about hormone therapy for breast cancer, which can stop or slow the cancer-fueling action of hormones.

What is hormone therapy for breast cancer?

Hormone therapy is a form of treatment that deprives breast cancer of estrogen and progesterone, the two main female hormones that it needs to survive and grow.

Estrogen and progesterone are carried along in the bloodstream. When they encounter a breast cancer cell, they stick to proteins called hormone receptors on the cell¡¯s surface. This connection acts as an ¡°on switch¡± and triggers the cancer cell to grow. The goal of hormone therapy is to prevent hormones from attaching to cancer cells, which deprives the cancer cells of the fuel they need to grow.

Are all breast cancers fueled by hormones?

No, but most are. About 70% of all breast cancers depend on estrogen or progesterone for growth.

These hormone-dependent breast cancers are called ¡°hormone-sensitive.¡± This means they¡¯re either estrogen receptor positive or progesterone receptor positive, depending on which hormone they connect with. Some cancer cells have receptors for estrogen, some have receptors for progesterone, and some have receptors for both. 30% of breast cancers have no hormone receptors and don¡¯t benefit from hormone therapy.

How do hormone therapies for breast cancer work?

Hormone therapies reduce or eliminate contact between hormones and breast cancer cells in several different ways:

• One approach is to block hormones from attaching to the receptors on cancer cells. When the hormones can¡¯t access the cancer cells, tumor growth slows and the cancer cells may die. Medications that block hormones include tamoxifen, toremifene and fulvestrant.
• Another approach stops hormone production in younger women who have not yet been through menopause. This can be done with medications such as goserelin or leuprolide, with surgery to remove the ovaries where most hormones are made, or, less commonly, with radiation therapy aimed at the ovaries.
• Yet another approach stops hormone production in women who have already experienced menopause. Estrogen and progesterone levels plummet after menopause, but the body continues to make small amounts. Medications called aromatase inhibitors to reduce the level of these post-menopausal hormones, which starves the cancer cells of the fuel they need. Aromatase inhibitors are used only in post-menopausal women and include the drugs anastrozole, exemestane and letrozole.

How and when are hormone therapy medications delivered?

Most hormone therapy drugs are taken as a daily oral pill, though a few are given as injections in the clinic.

Women usually begin hormone therapy after undergoing surgery for the removal of a breast tumor. They typically take hormone therapy drugs for at least five years and sometimes as long as 10 years after surgery, depending on how likely the cancer is to return. In some instances, hormone therapy is given before breast cancer surgery to shrink the tumor, which makes it easier to remove.

Women who aren¡¯t healthy enough to withstand an operation may take hormone therapy drugs until they¡¯re well enough to undergo surgery. The treatment won¡¯t get rid of cancer, but it can stop it from growing or shrink it until surgery can be performed.

Can hormone therapy prevent breast cancer, in addition to treating it?

Yes, women who have completed breast cancer treatment often use hormone therapy to help prevent the disease from coming back. Hormone therapy also helps lower the odds of getting cancer in the other breast.

Doctors may also recommend hormone therapy for healthy women who have a family history of breast cancer, or genetic mutations that raise their risk for the disease.

How effective is hormone therapy for breast cancer?

Clinical trials of breast cancer patients show that overall, hormone therapy cuts the risk of cancer developing or coming back in half.

What are the side effects of hormone therapy?

The potential side effects of hormone therapy depend largely on the specific drug or type of treatment. Common side effects of all hormone therapies include:

• hot flashes
• night sweats
• vaginal dryness

Less common, more serious side effects of some hormone therapy drugs may include:

• blood clots
• stroke
• heart disease
• osteoporosis

Is hormone therapy the same as hormone replacement therapy?

No, the two are opposites. Hormone therapy blocks or removes hormones to treat breast cancer, while hormone replacement therapy adds hormones to the body to counter the effects of menopause. Hormone therapy for breast cancer is actually ¡°anti-hormone therapy¡± or ¡°hormone-blocking therapy.¡±

What¡¯s your advice for people considering hormone therapy for breast cancer treatment?

Deciding on hormone therapy for breast cancer can be a complex decision. The type of therapy you receive may depend on the stage of your disease, whether you¡¯ve gone through menopause, and whether you want to have children. Talk with your doctor about your options to help make the best decision for you.

or by calling 1-877-632-6789.

Last updated March 22, 2022.?

Can immunotherapy treat breast cancer? For certain patients, the answer is yes.

Pembrolizumab is approved by the Food and Drug Administration (FDA) for some patients with metastatic and early-stage triple-negative breast cancer. It¡¯s an immune checkpoint inhibitor, the most common type of immunotherapy.

To understand how the drug works, which breast cancer patients are benefiting and what¡¯s ahead with research, we spoke with

How does immunotherapy work to treat triple-negative breast cancer?

Immunotherapy treats cancers by waking the immune system¡¯s natural ability to defend the body from infection and disease, including cancer. T cells are a type of immune cell that help lead the immune system¡¯s response to an illness.

PD-L1 is a protein that can be found on the surface of cancer cells and/or immune cells. It binds with a partner protein called PD-1 that¡¯s on the surface of a T cell. But this bond turns off the T cell and allows the cancer cell to hide from the T cell. Immune checkpoint inhibitors take off this brake, which increases the likelihood that the T cells will attack and destroy the cancer cells.

Is immunotherapy an option for all patients with triple-negative breast cancer?

Pembrolizumab is currently approved to treat some patients with early-stage or metastatic triple-negative breast cancer.

For patients with metastatic triple-negative breast cancer, immunotherapy in combination with chemotherapy is an option if the PD-L1 protein is detected on the cancer and/or immune cells within the tumor. We determine if a patient has a high expression of PD-L1 through an immunohistochemistry test. This is performed on tissue that¡¯s removed during a biopsy or a previous surgery. If the PD-L1 protein is not found on the cancer cells and/or immune cells within the tumor in patients with metastatic triple-negative breast cancer, a PD-1 immune checkpoint inhibitor won¡¯t be effective.

Patients with high-risk, early-stage disease will be eligible to receive a combination of pembrolizumab and chemotherapy before surgery. After surgery, patients will continue receiving pembrolizumab alone. While ¡°high risk¡± isn¡¯t defined by the FDA, most providers rely on the definition used in the clinical trial that led to the approval of pembrolizumab. Specifically, this includes patients with breast tumors larger than 2 cm. Patients with smaller breast tumors may be eligible to receive immunotherapy if there is evidence of cancer in the lymph nodes.

Importantly, immunotherapy may worsen symptoms of autoimmune disorders like lupus and rheumatoid arthritis, so these drugs aren¡¯t typically used in women with these chronic illnesses.

What are the side effects of immunotherapy in patients with breast cancer?

Immunotherapy side effects are the same, regardless of the type of cancer being treated.

Immunotherapy increases the ability of the immune system to attack cancer cells, but it also increases the chances that the immune system will affect normal cells. This can cause inflammation throughout the body, which can lead to side effects, such as skin changes, cough, chest pain and diarrhea. In some cases, these side effects can be debilitating, depending on the organ(s) involved.

For example, if the thyroid gland is affected, the patient may develop a condition called hypothyroidism (low thyroid hormone) and may need thyroid hormone replacement in the future. In rare but extreme cases, liver or kidney failure can develop.

When treating breast cancer, is immunotherapy used alone or in combination with other therapies?

Right now,?pembrolizumab is used in combination with chemotherapy to treat metastatic triple-negative breast cancer.

However, there are ongoing clinical trials studying other combinations. For example, researchers are trying to find out if immunotherapy is more effective when combined with targeted therapies, such as PARP inhibitors. One challenge with treating breast cancer with immunotherapy is that immune cells have a harder time infiltrating the tumors. By combing immune checkpoint inhibitors with targeted therapies, we hope to help the immune cells better enter the tumor and, therefore, make these drugs an effective treatment option for more patients.

There is also hope that we may be able to use therapeutic vaccines to train the immune system to fight cancer.

Lastly, we know that radiation therapy helps jump-start the immune system. Through clinical trials, researchers are exploring how we might optimize immunotherapy by combining it with radiation therapy.??

What are the immunotherapy options for patients with other breast cancer subtypes?

Clinical trials are working to expand the use of immunotherapy to more patients, including those with other stages of triple-negative breast cancer, as well as other breast cancer subtypes.

If you¡¯re interested in immunotherapy options for breast cancer treatment, I encourage you to talk with your care team about clinical trial options. You may find a clinical trial opportunity that can give you access to immunotherapy and also enable you to pay it forward for future cancer patients.

or by calling 1-877-632-6789.

Whether you have a lumpectomy or a type of mastectomy, your chest may be flattened, misshapen or asymmetrical after surgery. Breast reconstruction can recreate the look of natural breasts either by using implants or tissue from another part of the patient¡¯s body.

We spoke with ., to learn what patients with breast cancer should know about their reconstruction options.

There are multiple types of breast reconstruction

Breast reconstruction after mastectomy can help overcome body image concerns by rebuilding natural-looking breasts ¨C and not just with artificial implants. In fact, Largo explains, many patients choose what¡¯s called an autologous breast reconstruction that uses their own tissue to rebuild breasts. ¡°Tissue can be donated from other sites, like the stomach, flanks, thighs or buttocks,¡± Largo says.

Another option is a hybrid augmentation, which combines implants with your own tissue.

Some patients may opt for breast conservation surgery, also called lumpectomy, instead of a mastectomy. This often requires rearrangement of breast tissue after the lumpectomy. Many patients who choose breast conservation surgery also choose a symmetry procedure or lifting technique to achieve a natural look, Largo says.

For male patients with breast cancer, symmetry concerns after breast tissue removal can usually be resolved with fat grafting. This is where your doctor takes fat from another area of your body with liposuction and injects it into the breast to replace tissue lost during tumor removal surgery. Only small parts of fat can be transferred this way.

Cancer treatments, medical issues may impact your breast reconstruction options

If you have diabetes, asthma or blood clotting issues, certain surgeries may not be a good fit for you. ?

The type of breast cancer treatment you¡¯re undergoing can also have an impact on the timing of your reconstruction. ¡°We typically wait a month after chemotherapy, immunotherapy or hormone treatment to schedule reconstruction, to make sure there are no complications,¡± Largo says.

This is especially true for patients undergoing radiation therapy. ¡°Radiation changes the breast tissue, so you¡¯ll likely have some kind of asymmetry after treatment,¡± Largo says. This can be addressed through reconstructive surgery on the affected breast and the unaffected breast if necessary.

When to undergo reconstructive surgery

Most patients with breast cancer are able to undergo reconstructive surgery. The timing depends on each patient¡¯s unique treatment plan. Patients often choose to have reconstructive surgery at the same time or shortly after tumor removal surgery, but that is not always the case.

¡°Even if you had a mastectomy 20 years ago, you can still choose to have breast reconstruction surgery,¡± Largo says.

Through clinical trials, researchers are investigating if it is beneficial for patients to receive radiation therapy first, followed by a mastectomy and reconstruction surgery at the same time. ¡°This is an innovative approach that can really help patients to achieve their final outcome of reconstruction sooner,¡± Largo says.

Understanding the risks of reconstructive surgery

As with any treatment, there are risks. While these are rare, especially when your surgery is performed by a specialist, you should talk to your doctor about the risks and benefits of your treatment options.

Infection is one of the risks, especially if you choose breast implants. ¡°Any time you introduce something foreign to your body, you risk your body rejecting it,¡± Largo says. Your body creates a capsule around breast implants which can result in painful contractions and require another surgery to remove or reposition the implants.

And there¡¯s a risk your implant could rupture, change shape or become asymmetrical. Generally, manufacturers recommend replacing the implants from time to time, usually after 10 years.? Breast ¨Cimplant-associated large cell lymphoma has also been linked to certain types of textured implants, though this condition is very rare.

With autologous reconstruction, you may experience tightness, pain or numbness at the donor site.

¡°No matter which option you choose, you may have more than one surgery to achieve your desired look,¡± Largo says.

You may have options for preserving sensation after breast surgery

Patients who undergo a mastectomy often lose nipple sensation or feeling in the breast.

There are ways to recreate sensation during reconstruction. Largo says with autologous reconstruction nerves can be reconnected to the breast area to regain sensation. Sometimes, a nerve allograft is necessary to connect the nerves of the chest wall with the autologous tissue.

¡°Even if we don¡¯t do any sensation restoration, patients may gain some kind of a protective sensitivity,¡± Largo says. This means a patient can feel pain on the breast, but they may not be able to differentiate between hot and cold temperatures.

Recovery times vary depending on the type of breast reconstruction

Patients who choose autologous surgery usually take more time to recover, Largo says. That¡¯s because they¡¯re recovering from breast surgery, as well as surgery at the donor site. ¡°This usually involves a three-day hospital stay, then four weeks of recovery time,¡± he says.

Patients who choose implants usually undergo an outpatient procedure and recover within a few weeks. ¡°Full range of motion is usually back to normal around the two- to four-week mark,¡± Largo says.

Choose the right breast reconstruction approach for you

When it comes to breast reconstruction, the amount of information and choices can be overwhelming. Largo says it¡¯s best to talk to your care team about your lifestyle and desired outcomes to make sure that breast reconstruction is the right choice for you.

¡°Each patient is different, so what works for someone else may not be the best option for you,¡± Largo says.

or by calling 1-877-632-6789.

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Triple-positive breast cancer is a type of breast cancer that occurs when breast cancer cells use estrogen receptors, progesterone receptors and the human epidermal growth factor 2 (HER2) protein to grow. Triple-positive breast cancer is a subtype of HER2 positive breast cancer; it accounts for about 10% of all breast cancer diagnoses.

We spoke with breast medical oncologist , to learn more about triple-positive breast cancer, including how it¡¯s diagnosed and the latest research advances.

What does it mean when breast cancer is triple-positive?

Normal breast cells have receptors for the two hormones, estrogen and progesterone. When these receptors attach to the estrogen and progesterone hormones, it promotes cell growth. Some breast cancer cells use these hormone receptors to fuel the cancer to grow. This is known as hormone receptor positive breast cancer.?

The HER2 protein is involved in cell growth and can be found in normal breast cells. Breast cancer cells that contain a higher-than-usual amount of HER2 are considered HER2 positive.???

¡°About 20% of breast cancer diagnoses are HER2 positive,¡± says Mouabbi. ¡°Of those, about half are also estrogen-receptive and progesterone-receptive. So, patients with breast cancer cells that contain estrogen receptors, progesterone receptors and high levels of HER2 are referred to as having triple-positive breast cancer.¡±???

How is triple-positive breast cancer diagnosed?

Triple-positive breast cancer has the same symptoms as other types of breast cancer.

¡°A lump is the most common symptom,¡± says Mouabbi. ¡°Sometimes, very early-stage breast cancer can only be detected on a screening mammogram. That¡¯s why it¡¯s so important to get your breast cancer screenings.¡±

If a mammogram detects a suspicious lump, your doctor will biopsy the lump. This is when tissue from the tumor is taken and inspected under a microscope. If the tumor is determined to be cancerous, your doctor may also do immunohistochemistry (IHC) tests to determine whether the cancer is driven by the estrogen receptor, progesterone receptor and/or the HER2 receptor.

¡°With an IHC test, we¡¯ll stain the tissue and look at it under a microscope,¡± explains Mouabbi. ¡°We¡¯re staining for the estrogen receptor, progesterone receptor and high levels of HER2. If all three of them come back positive, the patient is diagnosed with triple-positive breast cancer.¡±??

Is triple-positive breast cancer aggressive?

HER2 positive breast cancer grows quickly and is considered more aggressive than hormone receptor positive breast cancers. Remember, triple-positive breast cancer is a subtype of HER2 positive breast cancer.

¡°HER2 positive breast cancer is the most treatable type of breast cancer, and it is the most responsive to treatment,¡± says Mouabbi. ¡°So, yes, it¡¯s more aggressive, but it¡¯s the most responsive to therapies we currently have.¡±

How is triple-positive breast cancer treated?

Treatment for triple-positive breast cancer depends on the stage. It is treated comprehensively, using techniques to treat both HER2 positive breast cancer and hormone receptor positive breast cancer.

Patients with stage I tumors that are smaller than 2 centimeters will usually be treated with surgery first, followed by chemotherapy in combination with HER2-targeted therapy. They may receive radiation therapy, then hormone therapy (also known as endocrine therapy).

Patients with more advanced cancers are typically treated with a combination of chemotherapy plus HER2-directed therapy, followed by surgery. They¡¯ll be evaluated to see if they need radiation therapy, and then they¡¯ll receive hormone therapy to keep the cancer from coming back.

Is triple-positive breast cancer curable?

Curability for triple-positive breast cancer depends on many factors, including the stage of the disease.

¡°Because it¡¯s very responsive to the kinds of therapies we have, triple-positive breast cancer has a more favorable prognosis,¡± says Mouabbi. ¡°Patients with triple-positive breast cancer who respond to treatment have excellent five-year survival rates.¡±

What research is being done to advance triple-positive breast cancer treatment?

MD Anderson is looking to change the standard of care for triple-positive breast cancer by eliminating chemotherapy as one of its treatments. MD Anderson breast medical oncologist , is leading the ADEPT clinical trial, which is studying a combination of HER2-directed therapies and hormonal therapy as a treatment after surgery for stage I triple-positive breast cancer patients.

¡°For patients with early stage I cancer who have an excellent prognosis, we think that chemotherapy isn¡¯t necessary, and we want to eliminate the use of chemotherapy in those patients,¡± says Mouabbi. ¡°So, the patients would have surgery, possible radiation and then HER2-targed therapy in combination with hormonal therapy. Because they would receive no chemotherapy, the treatment will be better tolerated with fewer side effects. We think this is going to change the way we manage very early-stage triple-positive breast cancer.¡±

or by calling 1-877-632-6789.

As a former nurse in MD Anderson¡¯s Post-Anesthesia Care Unit (PACU), I felt pretty familiar with breast cancer surgery. So, I thought I knew what to expect when I scheduled my own mastectomy last August.

But, as it turns out, going through the process as a patient myself held some surprises. Here are five things I didn¡¯t anticipate and how I handled them.

1. Embrace your range of motion exercises

When I was a PACU nurse, I mostly cared for patients who were just waking up from breast surgery, so they weren¡¯t as active as they would be later on. That¡¯s why I don¡¯t think I fully understood the limited range of motion that comes with having both breasts removed.

The first time I tried to lift my arms after my surgery, the discomfort in my muscles stopped me cold. I¡¯d been given stretching exercises to slowly work my way back to full range of motion. But until I got there, I needed help to take a shower, because I couldn¡¯t reach around to wash my back.

That was a very humbling experience. I¡¯d given many baths as a bedside nurse, but until then, I¡¯d never been on the other side of the sponge. And though I have a much better range of motion today, there¡¯s lingering tightness in the muscles under my arms. So, I still do my stretching exercises daily. It really helps.

2. Ask caregivers to go slowly when stripping drains

I¡¯ve taken care of many patients with drains, where I had to ¡°strip¡± ¡ª or empty¡ª their drains. I didn¡¯t realize that patients could actually feel (and hear!) the fluid being removed ¡ª and that it sometimes hurt. After my surgery, I went home with four drains, two on either side. And during the stripping process, I experienced a sharp pain each time the fluid was drained. Over time, I learned that going more slowly reduced that pain.

Fortunately, removing the drains went much better than I expected. It was quick and easy, and I didn¡¯t feel any pain. Draining the seroma ¡ª or collection of fluid between the skin and the expander that accumulated in my left breast after the drains were removed ¡ª was also easy. I had to have it done three times, but it wasn¡¯t painful and it only took a few minutes.

3. Be flexible about getting comfortable

After my double mastectomy, the plastic surgery team implanted tissue expanders to help stretch my remaining skin (in preparation for permanent implants, which would be installed later). I was able to see the expanders during my pre-surgery consultation, but I didn¡¯t realize they¡¯d be so uncomfortable.

Tissue expanders aren¡¯t as soft as permanent implants, so I sometimes felt restricted in my movements, due to their firmness. Finding a good position to sleep in was the biggest challenge. The expanders sometimes felt like bricks on my chest, and when turning from side to side, I couldn¡¯t reposition them the way I would my natural breasts.

I had to be creative and use additional pillows to get comfortable enough to fall asleep. And when I returned to work, I also had to place a pillow between my expanders and the seatbelt to be comfortable while driving.

4. Managing breast discomfort with oils, massage

About two months after my mastectomy, my tissue expanders were inflated to their final size before placement of the permanent implants. A few weeks later, I noticed skin discoloration on my left breast that was very itchy. I tried several different methods to relieve the itching, such as antihistamine cream and oatmeal paste. Nothing really worked. Eventually, the itching subsided, but then the left breast became even more discolored. It was also very shiny and painful to the touch.

The surgeon said I had ¡°capsular contracture,¡± which is a tightening of the scar tissue. He was able to remove the majority of it before placing my permanent implants, but there¡¯s always a chance of recurrence. I massage my skin twice a day with coconut/shea oil to try to prevent that. I would¡¯ve done it before I developed the condition, too, if I¡¯d known it might help.

5. Beware of hugs after breast surgery

I didn¡¯t know receiving hugs after breast surgery would never be the same. Naturally, everyone wanted to hug me when I returned to work. And people were so excited that they wanted to squeeze me tight. But I had to put up a cautionary hand and say, ¡°Please don¡¯t squeeze my fake boobs.¡±

Even now that I have permanent implants, my chest is still slightly sensitive, so I have to give what I call the ¡°church lady hug,¡± which is a hug with a lot of space between us. Most people understand and don¡¯t take it personally, but even if someone does, I don¡¯t worry about it. Being gentle with others is a natural thing to do, and I¡¯m not afraid to ask for it.

or by calling 1-877-632-6789.