During October, pink ribbons seem almost as ubiquitous as jack-o'-lanterns. If that's any indication of breast cancer awareness, knowledge of the disease must be at an all-time high. However, one aspect of recovering from breast cancer remains obscured by lack of information and a degree of stigma: breast reconstruction. A 2008 study revealed seven out of 10 breast cancer patients are not told their options for post-mastectomy reconstruction.
"We don't do an adequate job informing patients about what's going on," says Dr. Scott Sullivan, a general and plastic surgeon and co-founder of the Center for Restorative Breast Surgery. "The general surgeons are the gatekeepers (for reconstructive surgery), and they may not know the options or may choose not to discuss it. A community hospital may not have a plastic surgeon around, and even in some big cities, the quality of the surgery is not what it should be."
Two-time breast cancer survivor Kim Sport knew about her reconstruction options because she was an active volunteer in the cancer community. It wasn't until after her mastectomy and reconstruction that she learned this made her a bit of an anomaly.
"I didn't know that doctors weren't telling their own patients they didn't have to live with disfigurement after a mastectomy," says Sport, who created Breastoration, an organization that sheds light on breast reconstruction. "I was so outraged by it. I can't imagine looking down and dealing with disfigurement as a daily, constant reminder that at two times, I had a life-threatening disease."
Sport and Dr. Malcolm Roth, president of the American Society of Plastic Surgeons (ASPS) and chief of the division of plastic surgery at Albany Medical Center, say that some surgeons may intentionally or unintentionally lead women to believe that breast reconstruction is an unnecessary or narcissistic cosmetic procedure.
"The fact that we have mandated insurance coverage takes (reconstruction) out of the realm of cosmetic surgery and makes it medically necessary procedure for a woman's physical and emotional well-being following her mastectomy," Sport says.
Roth says not only does reconstruction pose no risk to survival in suitable patients, it also aids recovery.
"Women who have immediate reconstruction are more likely to return to work and social situations faster, have less chance of depression, and the quality of life gets back to normalcy much faster," Roth says. "So it may actually be better to do it immediately, though in some cases it is better to wait. A board-certified plastic surgeon is knowledgeable about that and collaborates with the oncologist, the breast surgeon, about what the best road for her may be."
There are a number of sophisticated techniques for breast reconstruction, with implants being the most common, according to Dr. Frank DellaCroce, co-director of the Center for Restorative Breast Surgery. Cohesive silicone gel or saline implants and supportive collagen are placed immediately following the mastectomy. Often, the skin and nipple can be spared, though sensation and functionality are lost. Fat transplant procedures involve transferring fat from the stomach or hips to create a natural feeling breast from living tissue that responds to weight gain or loss. The operation and recovery are longer than with implants — five or six hours in surgery compared to one or two, and a hospital stay that's two days longer — but fat transplants never wear out or need to be replaced.
"Plastic surgeons are at the ready with super-sophisticated technology that women need to know about," DellaCroce says. "And they need to know about them before they need them, ideally."