What Women Should Know About Breast Cancer Awareness
October 21st, 2015 is the fourth annual Breast Reconstruction Awareness Day. The aim of this important day is to remind everyone of the availability of breast reconstruction after cancer surgery. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 mandated that patients would have a breast reconstructive option available through their own insurance plan. Unfortunately, studies have shown that less than 25% of women in the US are offered a breast reconstruction consultation with a plastic surgeon prior to their breast cancer surgery or treatment. This pre-operative consultation is important because a patient must be well informed and fully educated about all options before decisions can be appropriately made. The timing of breast reconstruction with breast cancer surgery can have a major impact on outcomes of shape, size, safety, and type of reconstructive methods. Of course, not all women will want a reconstruction. Others may not want reconstruction based on inaccurate information, or they may be overwhelmed with the recent news of a breast cancer diagnosis. Nonetheless, having all the information up front allows a woman to make the best decision for her own individual circumstances. Sometimes, a woman will change her mind years later and desire “delayed” reconstruction. In most cases, a plastic surgeon can devise a plan that is suitable for the patient. Breast reconstruction can have an amazing impact on the physical and emotional well-being of a cancer patient.
Most people are now accustomed to the theme of Breast Cancer Awareness in October. Many folks have pink shirts in their closet waiting to be used at work or school in October. Even entire football teams dress up in pink. This grand media attention has paid off in big ways. Breast cancer gets a lion’s share of money directed to research, compared to other diseases like brain cancer. Today, this means more breast cancer patients are living longer and curing their disease compared to thirty years ago. Most women know about the importance of a monthly self-exam and yearly mammograms, because diagnosing the disease earlier makes beating the disease easier.
The upswell in breast cancer research and treatment has also reflected advances in plastic surgery. Some lumpectomy patients now benefit from an “oncoplastic” approach, whereby the plastic surgeon helps the general surgeon perform a lumpectomy and breast reduction at the same time. Today, we perform reconstruction through smaller incisions when possible, and we can even spare the nipple in appropriate cases. We also spare more skin over the breast when possible. The last ten years have seen significant advances in implant styles to match different body types and breast sizes. Implants don’t “leak” like they used to in the 1970s, thanks to an advanced cohesive gel material. In fact, breakages are quite rare. Tissue flap surgical refinements have made surgery recovery faster and safer. Skin, fat, and sometimes muscle can be harvested from one part of the body and moved to the breast. Some patients need a combination of implant and tissue flap. Of course, the plastic surgeon would advise which methods would be available for each individual patient. There is no “best way.” Rather, a well-trained and experienced plastic surgeon would explain the pros and cons of any method chosen. Plastic surgeons review multiple variables in the medical history and physical presentation. Some variables raise the risks involved with mastectomy and reconstruction. These include a prior history of radiation, diabetes, smoking history, advanced age (over 70), and obesity. Smokers in particular raise much concern about higher tissue necrosis rates and infection rates, so reconstruction is often delayed until they quit nicotine products of any kind.
Finally, let’s use the month of October to reflect on one of the most common cancers seen in our society. We probably all know at least one breast cancer survivor. The national media attention given to breast cancer has paid off with ever-improving therapies that continue to evolve and successfully treat this cancer. On the horizon are new genetic tests that can predict which patients should get more aggressive therapy. Hopefully, awareness of breast reconstruction surgery helps remind patients to ask for all available options.