A recent study of breast cancer patients suggests many American women are embracing going flat after surgery, but some physicians appear reluctant to support the option.
Researchers across the U.S. teamed up with patient advocates to come up with a survey they believed would avoid bias towards reconstructing the breast after a mastectomy.
According to the Canadian Cancer Society, reconstruction involves a plastic surgeon and often more than one surgery “to make the breast look and feel as natural as possible after all or part of it has been removed.” Some patients choose reconstruction to feel more confident and comfortable, and to avoid wearing a prosthesis. Some patients avoid reconstruction as it involves more operations. Or they “go flat” because they want to resume daily activities as fast as possible, are concerned about surgery costs, want to avoid an implant, or because “reconstruction was not important for their body image.”
The study, published in the Annals of Surgical Oncology, surveyed 931 women in the U.S. who had a unilateral or bilateral mastectomy without breast mound reconstruction. They found that 74 per cent were satisfied with the outcome. A news release from the University of California – Los Angeles Health Centre suggests the research challenges “past studies showing that patients who chose not to undergo breast reconstruction tend to have a poorer quality of life compared with those who do have the surgery.”
According to the survey, 22 per cent of the women experienced “flat denial” — “the procedure was not initially offered, the surgeon did not support the patient decision, or intentionally left additional skin in case the patient changed her mind.”
Groups such as the Canadian Cancer Society and Breastcancer.org in the U.S. both emphasize that there is no right decision when it comes to “going flat” or deciding in favour of reconstructing the breast. It is very much a personal choice. However, some physicians appeared to go against their patients’ express wishes, according to the survey.
“Some patients were told that excess skin was intentionally left — despite a preoperative agreement to perform a flat chest wall closure — for use in future reconstruction, in case the patient changed her mind,” said Dr. Deanna Attai, study lead and a member of the UCLA Jonsson Comprehensive Cancer Center. “We were surprised that some women had to struggle to receive the procedure that they desired.”
Some patients were told that excess skin was intentionally left — despite a preoperative agreement to perform a flat chest wall closure
In 2013, Canadian cancer survivor Kelly Davidson went viral after posting photos of her tattooed chest on Facebook. After a double masectomy, she chose to forgo reconstruction and instead tattooed her skin with a whimsical scene involving a fairy and butterflies.
“Obviously it’s devastating for anyone to lose their breasts, because it defines us as feminine and female, but for me, I embraced it,” said Davidson, in an interview with the Ottawa Sun.
“I’m still me, I’m still beautiful; I don’t need breasts to feel that way or to portray that to other people.”
In Canada, there is health coverage for reconstruction surgery in most regions, though it varies among provinces and territories. However, far fewer women opt for the procedure in Canada than in the states. According to the Canadian Cancer Society, a 2017 survey indicates that 16 per cent of Canadian women undergo breast reconstruction after mastectomy, a stark contrast to the 38 per cent of American women who do (earlier studies suggested as many as 56 per cent of U.S. women choose reconstruction). According to the agency, many Canadian women are unaware of their options and “timely access to information” is a big problem, especially for women who live outside of major cities. Canada, as well as many other countries, hold Breast Reconstruction Awareness events in an effort to inform women of their options.
Information appears to be an issue south of the border as well, even though more women there opt for reconstruction. Breastcancer.org points to studies from the American Society of Plastic Surgeons that suggest more than 70 per cent of women aren’t fully informed about their reconstructive options before mastectomy.
I’m still me, I’m still beautiful; I don’t need breasts to feel that way or to portray that to other people
Either way, the decision to get reconstruction or go flat should be well-informed and doctors should respect their patients’ concerns and their ultimate choice.
Breastcancer.org suggests getting a second opinion if your doctor isn’t listening: “Because the choice to reconstruct or not is very personal, you need a surgeon who listens to you and explains things in ways you can understand. It’s also important that you know all of your reconstructive options, especially if those initially presented to you aren’t appealing.”
If you or someone you care about is living with breast cancer, connecting with a support network can help to not only learn ways to better manage their health, but also share experiences with others. Some Canadian resources include Rethink Breast Cancer, Canadian Breast Cancer Network, Canadian Cancer Survivor Network and the Canadian Cancer Society.
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