Breast cancer diagnoses continue to increase. Recent Australian data have shown that the rates of diagnosis of early forms of breast cancer in particular are on the up. Because these early forms of breast cancer are very often treatable, one consequence of this phenomenon is an ever-increasing number of women who are living for many years of their lives with the stigmata of their breast cancer treatment.
Breast cancer treatment continues to evolve. We have witnessed the evolution from the radical, mutilating surgery of the past, to the more modern concept of “breast conserving” surgery, and more aesthetically nuanced mastectomy operations. These evolutions have accompanied our increasing understanding of breast cancer, and what is necessary to treat and cure this disease.
If we put these things together, and we consider the impact for a woman of a long life dealing with the consequences of treated breast cancer, then we can start to understand the imperative for both patients and doctors to understand the options for breast reconstruction, and how this can positively impact on a woman’s life.
Huge amounts of data are now available based on long term studies of many thousands of women, all of which tells us that treating cancer is one thing, but if we ignore the functional impact of that treatment and the negative consequences of surgery, radiotherapy and chemotherapy, then we are not fulfilling our role in the treatment of this disease which ultimately will affect 1 in 8 women.
Breast reconstruction is not a “cosmetic” procedure.
Breast reconstruction is not a “luxury”.
Breast reconstruction is covered by both Medicare and private health insurance. The option to have breast reconstruction surgery is one of the most important aspects of a woman’s recovery, and it is now almost universally acknowledged that the reconstructive process should be inextricably entwined with cancer treatment procedures.
Breast reconstruction procedures are varied. There are a number of procedures available, some of which will suit certain patients, and some which will not. The greatest challenge is ensuring that patients are offered every suitable option available to them.
So what are the choices?
That depends heavily on what is required to treat the breast cancer. It depends on whether the cancer can be treated by removing just the tumour with a small amount of surrounding tissue whilst sparing most of the breast, or whether the whole breast needs to be removed as a mastectomy. It depends on whether a mastectomy can be performed whilst sparing the skin of the breast or even the nipple. It certainly depends on whether radiotherapy is required.
Why do these things matter?
The simple answer to that is that breast reconstruction is fundamentally a process of replacing or restoring that which has been taken away. So, depending on what is removed (and how), there are different procedures that will allow us to restore the shape, size, position and feel of a breast.
Breast reconstruction can be performed at the time of a mastectomy. This isn’t always an option, but where it is this will always offer a woman the greatest chance at preserving a natural appearing breast. Breast reconstruction can also be performed months or years down the track, for women who have had to live “flat” after a mastectomy.
Most people have heard about breast reconstruction using implants.
This is typically a two-stage procedure involving the initial placement of an expandable device which can be inflated to the desired size, and this is then replaced with a definitive silicone breast implant to provide the shape and volume of the breast. This is a great option for some women, particularly those women who are having a mastectomy where the skin of the breast and/or the nipple is being spared and just the internal breast tissue is being removed. But it is not a good option for every woman. This operation works best for ladies with smaller breasts, for ladies who have opted to have both breasts removed at the same time, and for ladies who don’t need (or never had) radiotherapy after their surgery. The problems with using implants to reconstruct a breast are that an implant does not feel like a natural breast, and over time further surgery is typically required as a patient ages.
Many people however will not have heard about using a woman’s own tissues to reconstruct a breast.
There are a number of ways of achieving such a thing; plastic surgeons can use tissue from the abdomen, the thighs, or the back depending on the patient and the requirements. Using a patient’s own tissues is the only way of reconstructing a breast that looks, feels, and ages as nature intended.
The current gold-standard in breast reconstruction is a procedure called a “DIEP flap”.
A “flap” is just a short-hand term used by plastic surgeons to describe the use of living tissue from a patient’s own body in reconstructive surgery; a “DIEP flap” involves the use of skin and fat from the abdomen to build a new breast. Many women have a little excess skin and fat in the lower abdomen, allowing a plastic surgeon to remove this excess tissue and then suture the abdomen closed (similar to a “tummy-tuck” procedure). The excess abdominal tissue, which looks and feels like a natural breast, can then be shaped and used to reconstruct a breast which has been removed during a mastectomy. Moving this tissue is only possible because of our ability to perform microsurgery to connect blood vessels from the abdominal tissue to other blood vessels in the chest. It is possible to reconstruct just one breast so that it matches the other side, or the tissue can be split in half to build two breasts at the same time.
Breast reconstruction can rebuild a breast, but it can also dramatically alter a life.
For a woman facing the thought of losing a breast to cancer, the ability to replace that breast offers dramatic physical and emotional benefits. A woman’s ability to wear the clothes they want and not worry about looking “lopsided”; the ability to hug her children (or grandchildren) without worrying about which side to hug them on; the ability to just get on with life – these are things that matter. More and more, cancer (and its consequences) is something that people live with. Life after cancer is something that must be in the foreground during the treatment of that cancer.
The issue is choice.
Not all women with breast cancer want breast reconstruction. Not all women with breast cancer will be suitable candidates for breast reconstruction. But every woman with breast cancer deserves the choice, and the opportunity to discuss the possibilities available to them.