Reconstructive breast surgery – know your options


For many cancer patients undergoing mastectomies, reconstructive breast surgery can seem like a first step to reclaiming their bodies. Last month I wrote a piece on reconstructive breast surgery and specifically the lack of options presented to women by their surgeons. This piece was prompted by an article which appeared last December in the New York Times stating that “Even as promising new operations are gaining traction at academic medical centers, plastic surgeons often fail to tell patients about them.” The article reports that ” only one third of women undergoing operations for breast cancer said their general surgeons had discussed reconstruction at all, according to a study published in the journal Cancer.

I was struck by a piece in the article which said that patients should not necessarily accept the first thing they hear as the end-all, because that is not necessarily the full story and once again highlights for me the importance of patient empowerment.  Although women “don’t choose their diagnosis, they can choose to go ahead with reconstruction or not, and with the aid of a knowledgeable plastic surgeon they can choose what their options might be…Then they have that much more power over their lives if they have that power to choose.”

This week I read an article reported in Medical News Today, which states that many women in the US who undergo mastectomy surgery which will result in disfiguring scars because they are unaware of the availability of Skin-Sparing Mastectomies and did not ask their surgeons about this treatment option.

A Skin-Sparing Mastectomy is a surgical technique to remove cancerous breast tissue by using the same minimal and judiciously placed incisions used by plastic surgeons for elective breast surgery.

Despite the availability of skin-sparing mastectomies, a recent California study published in The American Surgeon found that more than one-third of board-certified breast surgeons surveyed still regularly use the archaic practice of cutting across the whole breast, resulting in unnecessarily disfiguring scars even after breast reconstruction.

“Amidst the shock and anxiety of a breast cancer diagnosis, many women and some physicians consider the appearance of the breasts of secondary importance and not worthy of serious consideration compared to the treatment of cancer,” said Joel Aronowitz, M.D., Clinical Chief of Plastic Surgery at Cedars Sinai Medical Center and founder of the Breast Preservation Foundation, a non-profit organization dedicated to increasing awareness and educating women and their caregivers about skin-sparing mastectomy.

“We know that skin sparing and old style transverse mastectomy techniques are equal in effectiveness as cancer treatments. Therefore, every woman has a right to be informed about choices in mastectomy surgery that improve the cosmetic appearance of the breast and be able to consider all options before embarking on major surgery that will impact their overall quality of life.”

The skin-sparing technique uses a simple, small, circular incision around the edge of the nipple area. The surgeon leaves all or most of the overlying breast skin, preserving the natural skin envelope that can be filled with an implant or with a patient’s own fat tissue from another part of the body. This skin-sparing technique is appropriate for women whose breast cancer does not invade the skin of the breast and particularly when immediate reconstruction is planned.

Today, effective mastectomy can be performed with far better cosmetic results. Since new breast cancer cases are among the highest rates ever recorded and breast cancer survival rates are also on the rise it is necessary for patients and their physicians to consider what treatment options will positively affect the patients’ overall health, healing and quality of life, post cancer.

I want to make sure that the information I put forward in this blog is accurate and relevant to the Irish context, as part of my frustration when I was diagnosed with breast cancer was what I found to be a lack of information relevant to Irish women.  Since then, I have become much better informed and now through my connections in the breast cancer charity field have a team of breast cancer experts to call on.  So I brought this article to the attention of an Irish breast surgeon to establish its relevance to the Irish woman, considering reconstructive surgery. She confirmed that Skin Sparing Mastectomy (SSM) has been around since the 90s and in carefully selected patients is a perfectly good option.  What is critically important is that whoever is doing it is trained to do so and it is performed in a properly selected breast cancer population.  It is growing in popularity as we have more and more data to suggest it doesn’t affect the outcome of affected women.  Hence the importance of someone trained to do it .  That population is officially women with Stage 1 or 2 cancer, however, the boundaries of this are being pushed out so maybe we will see that change with time.  She also points out that there is some controversy as to the role of SSM with women with hereditary breast cancer as we know that any amount of residual cancer tissue left has the propensity for breast cancer develop.

I hope this post has been of benefit to any woman considering her options when it comes to breast reconstruction. It is important to inform ourselves of all our options, as we may not always be offered them by our medical team.