Building Awareness – Program Promotes Options on Post-mastectomy Breast Reconstruction

October is upon us, and the annual campaign to increase awareness for breast cancer is in full swing. This disease has touched so many lives, and the statistics speak for themselves, which is why it is so important to continue Breast Cancer Awareness Month.

According to data from the American Cancer Society, breast cancer is the most common cancer among U.S. women after skin cancer — representing nearly one in three cases. Furthermore, seven out of 10 women diagnosed with breast cancer who are candidates for breast reconstruction are not aware of their options.

As a result, fewer than one in five American women who undergo a mastectomy go on to have breast reconstruction. In support of Breast Cancer Awareness Month, another program has emerged to help women understand their options.

This year, Oct. 21 marks the annual National Breast Reconstruction Awareness Day, or BRA Day USA, an initiative designed to promote education, awareness, and access regarding post-mastectomy breast reconstruction. The American Society of Plastic Surgeons and the Plastic Surgery Foundation help raise awareness and are supported by plastic surgeons who champion the cause on a local scale.

The goals of BRA Day include providing post-mastectomy breast-reconstruction information as early as possible after diagnosis, and giving patients access to plastic surgeons and other medical providers who work in collaboration to treat the patient.

Patients with breast cancer have numerous options to help them restore a breast to near-normal shape, appearance, and size following mastectomy or lumpectomy. Breast reconstruction is performed by plastic surgeons in conjunction with the team of physicians caring for the patient, including oncologic surgeons, radiation therapists, and oncologists.

The creation of a new breast can improve self-image and help restore self-confidence. However, while reconstructive surgery can create a relatively natural-looking breast, it is important to understand that a reconstructed breast will never look or feel exactly the same as the breast that was removed.

Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola, and implants are available in both saline and silicone. The best course of action for patients is very personal and requires individualized care.

Those personal conversations between the patient and surgeon need to include an overview and understanding of risks and side effects. Treatments with chemotherapy or radiation therapy may affect the timing of breast reconstruction, or possibly the alternative choices in type of reconstruction.

Risks of breast reconstruction include infection, bleeding, poor healing of incisions, anesthesia risks, and lack of sensation. The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture.

Breast implants do not impair breast health. With that said, careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases.

Partial breast reconstruction can be performed in patients who have undergone lumpectomy with or without radiation. This might require an implant to recreate the volume lost during excision of the lump, or a flap to repair the altered shape. Tissue rearrangement of the breast allows some women to undergo breast reduction at the time of lumpectomy as well.

In 1998, the American Society of Plastic Surgeons helped create the federal breast-reconstruction law requiring insurance coverage for reconstructive surgery following mastectomies. This includes reconstruction of the breast on which the mastectomy has been performed, as well as opposite breast surgery to produce a symmetrical appearance.

Breast reconstruction after mastectomy may help decrease the physical and emotional impact of breast-cancer treatments, including partial and complete mastectomy. As with all wound healing, some sensation will return, and scars will improve but never disappear completely. For most women, this is a worthwhile tradeoff for the sense of return of symmetry and self-esteem.

Patients are encouraged to continue breast-health care, including self-exams, mammograms, and physician follow-up.

Expertise is essential for the best results, which is why it’s important for patients to consider not just what course of action they prefer, but also the skill level of the medical professional providing the treatment. Patients should be cautious of official-sounding boards and certifications. The plastic surgeon performing breast reconstruction should be board-certified by the American Board of Plastic Surgery (ABPS). These physicians complete at least six years of surgical training following medical school with a minimum of three years of plastic-surgery residency training. While many cosmetic surgeons do practice surgery, it does not mean they are qualified. There is no ABPS-recognized certifying board with ‘cosmetic surgery’ in its name. v

Dr. Glen Brooks is a board-certified plastic surgeon who sees patients and performs procedures at several local hospitals, including Baystate Medical Center and Mercy Medical Center in Springfield, Baystate Noble Hospital in Westfield, and Holyoke Medical Center. Additionally, he is active in the surgical community at large, including memberships in the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, the New England Society of Plastic Surgery, and the Massachusetts Society of Plastic Surgeons (past president, 2007); (413) 565-4400; drglenbrooks.com