Restored to health – breast cancer reconstruction surgery
This month more than most, you will read about the devastating impact breast cancer can have on women’s lives. October is the time when charities around the world raise awareness and much-needed funds in the fight to end a disease that affects one in every nine women in the UK.
The primary aim of all treatments is to help sufferers survive, but surgery and procedures can leave women mentally and physically scarred, something a growing number of reconstructive surgeons are trying to change.
Douglas McGeorge, a private reconstructive surgeon and a member and former president of the British Association of Aesthetic Plastic Surgeons (Baaps), is passionate about raising awareness of the options for reconstructive surgery.
“Breast cancer affects so many women and, of course, the primary aim is to cure the disease,” he says.
However, most women nowadays do survive but are often left traumatised and devastated by their appearance afterwards.
Their physical outcome is often a postcode lottery, despite the fact that reconstruction should be offered within the NHS.
It’s often a case of the patient having to request it rather than being offered it and when women are diagnosed with cancer, their first thought is survival, not how they will cope with their appearance afterwards.
While primary and secondary breast reconstruction is covered by the NHS, each patient’s treatment and care varies according to their diagnosis, type and stage of cancer and the options for reconstruction.
“Tumour removal can be done in varying ways, either by a local excision followed by radiotherapy and/or chemotherapy or when required a formal mastectomy, followed by radiotherapy and chemotherapy,” says Douglas.
“That decision is made jointly by the oncologist and by the breast surgeon in conjunction with the patient, talking through the pros and cons of each option.”
“If you’re having a formal mastectomy then I believe you should be counselled for the option to be given reconstruction at the time of mastectomy. There are many advantages of doing it at the same time.”
While the management of the tumour is often out of the hands of the patient, reconstruction should be a personal choice and women should be informed that there are options.
Not everyone will want a reconstruction, but for many, it is a good thing.
“The NHS is not deliberately trying to prevent healthcare, it’s just that the drive of the clinician is curative and a lot of breast surgeons simply do not do reconstructions; they have to rely on secondary referrals to someone like me,” says Douglas, who started a clinic in Cheshire to offer such a service privately in 1993.
“That’s why I made myself more available to hospitals. Reconstruction is available and you should discuss it with your breast surgeon. It may not be technically or feasibly possible to do it on every patient, but it is something the surgeon and hospital should try to accommodate if the patient wants it.”
What are the options for women about to undergo surgery to remove a breast cancer, Douglas?
“Every woman needs something to put into her bra to rebalance her breasts and this can be an external or internal prosthesis.”
“External prosthesis are not ideal: they don’t move like breast tissue and they restrict what you can do in life – how you move, what you wear – and every time you get undressed, you’re reminded you had breast cancer, so reconstruction is a very positive thing to do for women, for their mental wellbeing and their recovery.”
“The aim is to provide skin and volume, which can be done with your own tissue from your back or stomach, or with an internal prosthesis or implant.”
“If you have localised tumour removal, it is essentially a breast-preserving decision and, depending on your breast size, it should be feasible to reconstruct the breast. You might be left a little asymmetrical, but your breast will essentially remain intact.”
“However, this is often not possible with small-breasted patients with a large lump and they’re better off having a formal mastectomy and then primary reconstruction using an internal prosthesis.”
What types of internal prosthesis are available?
“Sometimes we use the sort of silicone implants seen in traditional breast enlargement agency, or we use inflatable, expandable tissue implants so we can slowly stretch skin over time, so as not to traumatise the area post-surgery.”
“Often the skin is thin, as obviously it has no breast tissue underneath it, so we use silicone-covered expanders that we can slowly fill with saline solution via a tiny portacath under the skin.”
“After radiotherapy, the skin can be severely burnt and scarred and the options are limited and require a skin flap and fat taken form the abdomen or back to reconstruct the breasts.”
Is it always possible to preserve the nipple?
“This is a highly contentious area. There is often no need to remove it – you simply take out the ducts underneath. My view is that even if there is a tiny risk of a cancer reoccurring in the ductal tissue within the nipple, it can be excised at a later date.”
What advice do you have for anyone about to undergo treatment for breast cancer?
“Think about and ask for a discussion of your surgical options. It will mean getting a reconstructive breast surgeon involved, but in an ideal world you will be offered primary reconstruction and that can aid your recovery and wellbeing for the rest of your life.”