A diagnosis of cancer is a life changing moment. One of the main goals of breast reconstruction is to allow the restoration of normality. Are trends in breast cancer treatment and reconstruction being driven by the new aesthetic “normal” of the current generation, and is this being interpreted as an opportunity to “improve” your appearance?
The fact that we are discussing this at all seems to be driven by several specific factors. In an interesting intersection of modern, social-media driven lifestyles with reconstructive surgery, we have seen a rapid increase (courtesy of the “Pink movement” in its various guises, breast cancer bloggers and celebrities) in pop-culture awareness of breast cancer and breast reconstruction. The so-called “Angelina effect” has even become widely reported terminology in reference to the increase in social awareness of breast reconstruction after Mrs Jolie-Pitt’s widely publicised procedure.
The fact that Gen-Y and now the “millennial” generation have driven a radical shift in the way women perceive themselves is nothing new. One of the most overt manifestations has been the incredible surge in acceptance for cosmetic breast augmentation. Everywhere from Broadbeach & Byron Bay to Paddington to Perth, to St Kilda & Toorak, it is safe to say that the normalisation of cosmetic breast enhancement has created a new attitude with regards mastectomy and breast reconstruction also. And nowhere it seems is this new attitude more prevalent than in those women diagnosed with breast cancer in their 30’s.
“…just take my boobs off and give me implants. Everyone has implants now, its no big deal.”
Recently, a paper was published by Komenaka et al. in the journal The Annals of Surgical Oncology, asking a rather penetrating question: What is a woman’s expectation of “ideal” breast appearance, and how is this influencing both the treatment of breast cancer and breast reconstruction? What they found was that “expected breast appearance” was best represented by the augmented breast (a full, round upper pole in particular) in all patients under the age of 60, with a marked increase in the expectation of an augmented look as the age of the patients dropped into their 40’s or 30’s.
To quote the article, “significant concern now exists that rates of….bilateral mastectomy and contralateral prophylactic mastectomy with reconstruction are increasing even with no clear evidence of oncologic benefit.” In other words, women are choosing to have both breasts removed, even if they only have low-risk disease in just one breast, even when they have no genetic risk profile (such as BRCA) or strong family history. The question that is being asked is whether some women (especially in the younger age brackets) are choosing such a treatment pathway to satisfy a desire for larger breasts, which is being met by the use of implant-based reconstruction? And are they making these choices in spite of there being no benefit in doing so with regards the treatment of their cancer?
As we have discussed previously, implant-based reconstruction remains (by far!) the most common form of breast reconstruction. Even if the above holds true, should we even pause at such a question? Don’t women have the right to make these choices? After all, why shouldn’t there be some kind of silver lining for anyone with breast cancer? Breast reconstruction is widely accepted to offer massive quality of life benefits to women: functionally, psychologically & sexually – isn’t it a logical extension then that we accomodate aesthetic desires in the planning of breast reconstruction? I don’t pretend to offer the answers, and I think every surgeon operating in the field needs to hold their own (ethical and technical) position.
So, this brings us back to the question that I find really fascinating: are these aesthetic desires (and norms) of the current generation beginning to dictate the nature of breast cancer treatment, and is this driving current trends in breast reconstruction? And if so, where to from here?