By Dr. Diane Bowen
Breast cancer affects 1 in 8 women (13%) and is the second cancer killer of women after lung cancer. The good news is that death rates from breast cancer are declining and breast cancer will be responsible for a woman’s death only 1 in 33 (3%). But the phrase “you have breast cancer” strikes fear in any woman’s heart. These words can stop you in your tacks and take you in directions that you never knew existed. As a physician and surgeon, I have had the privilege of meeting and getting to know women of all ages, races and walks in life who because of this diagnosis have had to walk down the road of breast cancer treatment, recovery and survival. I have seen this diagnosis turn women who were otherwise timid in to pillars of strength and help their families recover from the shock.
As a plastic surgeon, I am usually incorporated in to the care team once the diagnosis has been made if the lady wishes to know more about her treatment options. Some treatments directions are directed by the stage of the cancer and all treatment decisions are made after through consultation with your cancer care team. Your care team should be made up of those physicians in whom you have confidence. It is ok to get a second opinion, but try not to get too many cooks in the kitchen. Communication is a must and you need to be responsible for making sure that all involved team members are kept up to date. This is not about you viewing your life through cancer colored glasses and allowing the cancer to defeat you. I have met ladies who have “terminal” breast cancer who are still ministering to others.
Breast reconstruction allows a lady to transition from being “breast” focused to being life focused. If a lady has completed all her treatments and is using a prosthesis to fit into her clothes, often she has to worry if the prosthesis is going to slip or ride up or if it will float away when she is swimming. For these ladies a breast reconstruction allows them to move on with their life without having to be so self-conscious. For ladies who are on the brink of starting their cancer treatment, breast reconstruction is a positive point of focus while completing their therapies. In general, breast reconstruction is for ladies who have felt that their breasts were either too small, too big or too droopy. I think that accounts for abut 75% of us! With new techniques of skin sparing mastectomies, the final visible scars on the breast may be barely noticeable especially after nipple reconstruction and tattoo. Yes, I said tattoo! Just as a face is not a face until the nose is in place, the breast reconstruction is not complete until the nipple has been reconstructed and the areola has been colored in with a tattoo. Breast reconstruction is a process of several stages, much like the process of building a house. The usual time from start to finish is about 6- 9 months. The reconstructive steps can be coordinated with either chemotherapy and/or radiation therapy so that no treatments are delayed or hindered. There are many techniques for breast reconstruction. Many factors including general health, previous surgeries and personal goals are considered in determining which method will best suit a woman’s needs. Often when a lady considers that her risk of developing another breast cancer is increased 3-4 times, she will decide to have a preventative mastectomy on the other side and in the process address issues like too big, too small and too droopy. Some types of breast reconstruction, allow us to take extra tissue from one area to rebuild the breast. This is the “taking from Peter to pay Paul” principle. In the “tummy tuck” technique, both breasts can be reconstructed from that spare tire of extra tissue found below the belly button. Those ladies get two new perky bosoms and one nice tight tummy! Other ladies prefer the “Arnold S. – Pump me up” technique of using adjustable implants to choose what size they would like to be when their breast reconstruction is complete. As you can see the types of breast reconstruction are as varied as the ladies who have to deal with this diagnosis.
To be complete on this topic, I will mention the breast conserving therapy of lumpectomy and radiation therapy. This technique was invented by the Italians back in the 1970’s as an alternative to radical mastectomy for cancer treatment. For some ladies, especially the elderly or a lady who for health or others reasons can not tolerate surgery, this is the treatment of choice. In this case the breast cancer is removed surgically and then the rest of the breast gland tissue is “sterilized” to prevent a recurrence. This is different from the radiation that some ladies have to have if the cancer is very large or there were many positive lymph nodes. Just as there can be complications from surgery, some ladies develop long term side effects from the radiation, including thickening of the skin, stiffness of the breast tissue, oil cysts and asymmetry.
In conclusion, the treatment of breast cancer and breast reconstruction involves much information to process, several decisions to be made and a lot of support from friends and family. You can not make a wrong choice if you listen to sound council, give yourself some quiet time and then proceed with much prayer and hope!