‘Informed’ Breast Cancer Patients More Likely to Undergo Reconstruction

Breast Cancer surgery can be one of the most devastating experiences in a woman’s life. Not only are patients exhausted from their battle with cancer and worried about their future, but a mastectomy (the surgical removal of one or both breasts) can leave a woman feeling less like her old self than ever before. That is why a new statistic by the American Society of Plastic Surgeons came as such a shock: nearly 70 percent of women eligible for breast reconstruction after a mastectomy are not informed of the surgical options available to them.

The difference in those seeking reconstruction and those who did not was most apparent when comparing different racial and ethnic groups. In another study by the University of Michigan Comprehensive Cancer Center Latina who spoke limited English were less likely to undergo reconstruction than white women, black women, and English speaking Latina women. While 41 percent of white women and English speaking Latina women underwent reconstruction, only 14 percent of less acculturated Latinas did. Because of the language barrier that exists between patient and doctor, patients who spoke limited English were less informed of their options.

In fact, a related study showed that women who were simply referred to a reconstruction doctor during their breast cancer surgery were much more likely to undergo the procedure. In the ACS Clinical Congress study, 92 percent of patients who were referred underwent reconstruction and none of the non-referred patients underwent the surgery!

The statistics above show how much a little information can do to help a patient realize their recovery options. That is why new technology is emerging to help patients become more aware of their options. For instance, there is a computer based decision making aid on the market right now that teaches patients their various reconstruction options. According to a study conducted at Beth Israel Deaconess Medical Center and Harvard Medical School, women who used the CD learning module were more involved in choosing reconstruction than those who did not, and they believed they were offered a greater number of surgical options for breast reconstruction – once again highlighting how empowering information can be.

The bottom line is that all women should be informed of all of their options from the onset of their breast cancer diagnosis. Whether or not a woman chooses to undergo breast reconstruction after a mastectomy is a personal decision – yet every woman deserves the right to make that decision.

It is important to present plastic surgery as an option from the onset of treatment; that way, doctors can work together every step of the way to give a patient the best possible treatment. In fact, many patients choose to have their breasts reconstructed during the same time as their mastectomy to reduce the number of surgeries needed.

Education is only one of the ways to make the battle against breast cancer more bearable; that is why Dr. Whiteman developed a “buddy system” in the offices of Southern Plastic Surgery. His support program gives breast cancer patients the option to speak with other survivors to gain a better understanding of what to expect from their surgery.

Source: MedNews

Is there a Bright Side to Cancer?

A note from Dr. Whiteman:
This blog entry is the start of a series of blog entries from the interns that have been working with me at Southern Plastic Surgery and Gwinnett Hospital. I think it is important to get always take a look at a fresh perspective, and look forward to hearing about the insights and experiences of the interns over the coming weeks. I hope you enjoy them as well!

Is there a Bright Side to Cancer?

Is there a Bright Side to Cancer? According to many of Dr. Whiteman’s patients, visits to his office are just that – a ray of hope. As a third year medical student who just spent four weeks learning from him, his staff, and his patients, I agree wholeheartedly. Surgical removal of cancer leaves a permanent reminder and can oftentimes disrupt quality of life. Luckily, the breast cancer journey doesn’t have to end there for these patients.

Breast cancer is a particularly special field because it is not only anatomy, but a source of femininity and life. Recent data trends demonstrate that the incidence of breast cancer has increased. Investigators suggest that this increase may be due to older age at initial pregnancy, increased use of oral contraceptives and hormone replacement therapy, and changes in average ages of menarche (first menstrual period) and menopause.

Because of his expertise and reputation, Dr. Whiteman is referred many breast cancer patients at all stages of their journey, but especially for breast reconstruction. “I always enjoyed coming to see Dr. Whiteman because it marked the positive part of this road,” stated a breast cancer patient of his.

Through his office’s breast cancer support system, many have found lifelong friendships and support from other survivors. This “buddy system” has allowed patients talk to other women not only about the disease but about their reconstructive surgery and what to expect. These women share a unique bond; because no one can completely understand how difficult this is unless they have gone through it.

Just as not all breast cancers are the same, not all of the reconstructive surgeries for these women are alike. There are different procedures according to the needs of the patient. Treatment of cancer can consist of a lumpectomy, radiation, chemotherapy, partial, or radical mastectomy. All of these change the breast in different ways. The important factors in determining the type of reconstruction that is best include the type of treatment received, the patient’s body type, and the patient’s preference.

There are many procedure types and they can range from creating new breasts from the patient’s own tissue to using an implant. Reconstruction can take two or more surgeries in which recreation of the nipple and tattooing of the areolar area is the final touch. The entire process can last months to over a year depending on the patient.

One of the patients that I spoke in detail with decided on the TRAM (Transverse Rectus Abdominus Myocutaneous) Flap operation. In this procedure a tissue flap including skin, fat, and muscle taken from the abdomen is used to make a new breast mound. This surgery may require hospitalization for 3-4 days. Recovery will take 3-6 weeks. Another option is to place tissue expanders in the chest area where the breasts were. These expanders are slowly filled with saline to create room for an implant at a later date. This procedure is better for some who may want only one surgical area or who do not have ideal tissue to create a new breast. This surgery is often done as an outpatient procedure and recovery will take a couple of weeks.

It is also important in some cases to reconstruct the opposite breast to match. As one patient put it, “I had a breast that looked like it was 20 years old and one that looked 50!” Many women opt to have the opposite breast lifted in these situations. After going through the disease many women make the best of the reconstruction and decide on the size and shape they had always wanted. There are several options and continuous advances made for women with breast cancer at any stage. Whether women begin reconstruction in the operating room immediately after their mastectomy or wait until months after chemotherapy or radiation; the reconstruction is vital in their recovery. Dr. Whiteman is known for working hand in hand with the oncologists and other surgeons to determine what is best for his patients. After what these survivors have gone through, the reconstruction is a positive step forward.

My previous rotation was working with an oncologist, therefore, my exposure to breast cancer has come full circle. What a wonderful experience to see these women at this part of their journey with a new lease on life. They are some of the most open and touching patients I have come in contact with. After speaking with many of these ladies, it is easy to understand that they chose Dr. Whiteman to be a part of their journey because of how “comfortable” they felt with him and his office staff. As one woman declared, “It was hard to realize how much of me would be lost, I will never be the same…but Dr. Whiteman made me whole again.”

-Beverly Davis, Student Medical Intern