Let's make Our Community Aware: Under-Ultilization Of Breast Reconstruction

October is Breast Cancer Awareness Month and the American Society of Plastic Surgeons has designated October 16th as Breast Reconstruction Awareness (BRA) Day. We hope that this post will help spread awareness, recognize women who have faced breast cancer and to offer information to the community.A diagnosis of breast cancer can be life-shattering news, but with early detection and aggressive treatment, most people can overcome this disease. Because surgical management is almost always necessary, all attention is initially focused on what treatment will entail and how quickly it can be done. Unfortunately, many times, once the need for mastectomy is established, the conversation often ends there.

What many patients are unaware of is the fact that a mastectomy does not mean a woman is forced to live without one or both breasts. The psychological impact of losing a body part, and one that for many patients affects their sense of femininity, should not be underestimated by physicians who treat women with breast cancer. Unfortunately, a majority of women who undergo breast cancer surgery are not offered reconstruction. There are many reasons for this. First, in some areas, it is difficult to coordinate the efforts of a breast cancer surgeon and a plastic surgeon, which can potentially cause delays in treatment. Fortunately, in my practice, we have close relationships with referring oncology surgeons, which allows consultations to discuss reconstructive options and surgery planning be made without delaying necessary surgical treatment plans. The advantage of this is that reconstruction can take place at the same time as the mastectomy, so that a woman does not have to wait until a second operation to start the process. This lessens overall surgical time and greatly enhances a patient’s not only psychological well-being by shortening the period with which she has to live without a breast but also improves the aesthetic outcome by maintaining the natural folds and shape of the breast . Even when the “immediate” reconstruction option is not available or recommended, reconstruction can usually be pursued months or even years after mastectomy.

Secondly, women are not always counseled on reconstruction before mastectomy due to physician bias. Having trained also as a General Surgeon, I can understand the breast surgeon’s focus on curing a patient of cancer and pushing everything else aside as “unnecessary.” However, while reconstruction may not be “life-saving,” it certainly has benefits, offering an improved quality of life for women who choose to have these procedures.

A third reason for under-utilization of breast reconstruction is fear. The unknown is a bit frightening, and people often prefer to avoid surgery unless absolutely necessary. There is also a misconception that breast implants are in some way dangerous to a woman’s health. Due to the number of lawsuits in the 80s and 90s claiming that silicone breast implants caused systemic health problems centering around breast cancer, autoimmune diseases and other neurological problems, silicone implants were removed from the market for all purposes. However, this ban was lifted by the FDA in 2006 with a new and improved generation of cohesive gel silicone implants. Highly publicized cases of celebrities having breast cancer and reconstruction have raised awareness and lessened fears, but there is still a lot of misinformation. Alternative saline-filled implants became more widely used during the opposition on silicone-filled implants, and these are still available for patients who choose to avoid silicone.

I should mention that while most breast reconstruction in 2013 involves the use of implants, some patients are candidates for, and pursue, other types of breast reconstruction, which are quickly gaining popularity. I should offer the disclaimer that not every patient is a candidate for any or all of these procedures, and it is always best to ask a qualified reconstructive surgeon about what options are best for you. To learn more about the different types of breast reconstruction (ie. DIEP Flaps) that are available within our practice please visit our web page on breast reconstruction which will cover various options and offer 3D animation videos of specific procedures.