BODY ART AS AN ALTERNATIVE TO BREAST RECONSTRUCTION

More women are choosing not to reconstruct after a mastectomy and tattoo over the scar tissue instead. Photograph: Guardian

Undergoing a mastectomy is a harrowing experience. Although a mastectomy is an undoubtedly life saving necessity, there is something primitive and brutal about the removal of a breast. Many women report feeling less feminine after the operation, or say that their sexuality is compromised. Mastectomy scars are rarely neat and can be perceived as disfiguring.
Reconstructive surgery is difficult, expensive and not always successful. A full reconstruction can take several surgeries to complete, and it is highly likely that the reconstructed breast will bear little resemblance to the original or its twin.
As a result, more women are actively choosing not to reconstruct. There is a small but growing trend in the US (slowly filtering though to the UK) to refuse reconstruction and tattoo over the scar tissue instead. For many women, the battle with breast cancer is the most intense fight of their lives and they are seeking a way to acknowledge this, rather than disguise it.
Pam Huntley from Fort Bragg in California says: "Getting my tattoo was the culmination of a three year dance with breast cancer. The tattoo changed my mastectomy scar into a shield." For many, the choice to tattoo is a liberating alternative to plastic surgery or hiding the loss of a breast.
There are a number of celebrated female tattooists specialising in mastectomy tattoos. Madam Chinchilla, based in California and author of Stewed, Screwed and Tattooed, talks about how mastectomy tattoos differ from other types of tattooing. "These tattoos represent vanity and survival simultaneously", she says. "We are creating a space where beauty can arise from sheer pain and terror".
Roni Falgout from Seattle is also fast becoming a famous name in the mastectomy tattoo business. She says, "Most women seeking this are feeling less like a woman, and either ashamed of the way they look, or just plain sick of people feeling sorry for them.
One client explained it best. She swam a lot at the public pool and when in the changing room she felt the eyes of pity on her. She hated it and wanted to shout, 'this is a victory, not a defeat. I'm alive. I won'. So she asked for the image of a phoenix to cover the scars, which is appropriate if you know the mythology. Now, when she goes to the pool, instead of the pity she sees and hears: "Wow! How beautiful!".
Women who have chosen tattoos over reconstruction cite the reclaiming of their bodies as the main reason for the choice. Some women refuse reconstruction because they feel it is a denial of the impact of cancer, both positive and negative, and that a tattoo (often very carefully designed to express the personal nature of the cancer journey) is the exact opposite.
Denise Levine was diagnosed with breast cancer in 2009 and was clear from the outset that a reconstruction wasn't for her. "I wanted to return to my old self as quickly as possible" she says, "I didn't see how that could happen if I let a plastic surgeon rearrange my muscles and tissue."
It was a year later (the minimum recommended time to let the scar fully heal) that she decided to visit a tattoo parlour for the first time. Although she was worried about it being the right decision, she made the right choice. "It is hard for me to describe how much I love my tattoo and how happy I am with it… I admire the beauty of the bird and the balance it has brought back to my appearance," Levine says.
Earlier this year an image of Inga Duncan Thornell's mastectomy tattoo was posted on Facebook. It quickly went viral, but was removed shortly afterwards under Facebook's obscenity policy. But it was the removal, rather than the original posting, that caused the most controversy. Facebook has now officially changed its guidelines on showing images of mastectomies and mastectomy tattoos, taking another long awaited step toward public acceptance.
Although Curly Moore, resident tattooist at the Tattoo Club of Great Britain and one of the UK's most respected tattoo artists, hasn't yet been asked to design for mastectomy. But if previous north American breast cancer trends are anything to go by (pink ribbons and Breast Cancer Awareness Month, for example), the UK will soon catch up. The mastectomy tattoo will become just another option for post cancer patients and a truly personal way of regaining control over post cancer bodies and proving once and for all that breast cancer is not just a pink ribbon.

MORE DOCTORS NOT TREATING MEDICARE PATIENTS

Posted August 13, 2013 -- A story by the Wall Street Journal reports numbers released by the Centers for Medicare & Medicaid (CMS) indicate that fewer physicians are treating patients enrolled in Medicare, largely due to issues related to payment rates and the increase of burdensome rules.
9,539 physicians who had previously accepted Medicare opted out in 2012 according to data released by CMS. While only a small percentage of the 685,000 physicians that do accept Medicare patients, the number of doctors leaving the program has tripled from 2009 when only 3,700 physicians opted out of the program. Many of those physicians that are still taking Medicare patients are reducing the number they treat. This is the first time that CMS has ever released opt out data related to the Medicare program

ACID ATTACKS

Acid attacks like the ones that targeted two British teenagers volunteering in Zanzibar are grimly effective – and difficult to treat, burn experts say.
The key to recovery is quick removal of acid-soaked clothing, immediate rinsing with copious amounts of water and fast treatment by doctors who can address issues like skin grafts, scarring and dealing with searing pain.
“It’s a terrible, terrible injury and it’s terrible to inflict it on someone else,” said Dr. Sidney F. Miller, founder and past director of the Burn Center at The Ohio State University.
Acid is cheap, widely available and invariably devastating when it is intentionally thrown with the goal of maiming, disfiguring or blinding the victims, according to the Acid Survivors Trust International, a nonprofit group that tracks acid attacks and works to help victims.
Teenagers Kirstie Trup and Katie Gee were due to arrive back in London Friday for treatment of burns suffered Wednesday, when two men riding a motorcycle poured acid on them. The 18-year-olds were in Zanzibar to volunteer as teachers on the majority Muslim island.
The young women reportedly suffered “horrendous” burns to their faces, hands, legs, backs and necks, Gee’s father, Jeremy, told the Telegraph newspaper.
But they are only the latest victims of acid violence, which occurs regularly in several countries, including India, Bangladesh, Colombia, Nepal, Cambodia and Afghanistan, the Acid Survivors group reports on its website.
About 1,500 cases are recorded every year, although that number is likely to be massively underreported, experts say. Between 75 percent to 80 percent of cases involve women, and about 30 percent of the women are younger than 18.
There aren’t many intentional cases of acid attacks in the U.S., said Dr. Tom Tallman, an emergency physician at the Cleveland Clinic. But the key here – or in other countries is to address the injury as quickly as possible.
Depending on its strength, acid can burn through the full thickness of the skin in seconds, even eating into tissue and muscle below. As the skin heals, it develops scar tissue, which creates much of the disfigurement often associated with acid burn victims.
Skin grafts and plastic surgery are often required, he added.
For the British girls, who have access to Western medical care, plastic surgery techniques can include both surgical and non-surgical options, said Dr. Howard Liu, director of cosmetic dermatology at Cedars-Sinai Medical Group in Los Angeles.
Fat grafts, bio-compatible dressings that encourage new skin growth and other innovative treatments could help them heal, even from the whole-body and splatter injuries that typically occur with acid burns, he said.
"For these two young ladies, hopefully they will get the resources they need to recover," Liu said.
But that’s not often the case for typical acid attack victims, said Miller, who is also associated with the American Burn Association. They are forced to contend with medical systems equipped only to provide basic wound care -- at best.
The burn association reaches out to doctors and hospitals in low-income countries to help train medical teams to respond quickly and effectively to the heinous intentional injuries.
“There are a lot of ways to hurt people,” Miller said. But this is one of the worst, he added.