Treatment

Breast Reconstruction: BRA Day USA Spotlights Options

PJ Hamel Health Guide October 17, 2012
  • Today, October 17 – the third Wednesday in October – is BRA Day USA, an annual push by the medical community and breast cancer support groups to “promote education, awareness and access regarding post-mastectomy breast reconstruction.” ("About Bra Day," 2012). Have you had a mastectomy? If so, did your doctor discuss reconstruction options with you prior to surgery? Or were you like the majority of mastectomy patients: almost totally uninformed about the possibility of a new breast?

     

    BRA Day USA.

    The headline certainly catches your eye, doesn’t it? And if you check out the bright pink BRA Day USA Web site, your first thought (as mine was) is probably “Huh, maybe someone’s finally advocating for post-mastectomy bras that are actually comfortable AND attractive.”


    Not quite. The site is actually devoted to a subject near and dear to my heart: raising awareness of reconstruction options for women facing a mastectomy.

    In my 7 years of experience writing for this site, I’m continually surprised that more women don’t choose to rebuild their breast(s) after a mastectomy.

    Unfortunately, it’s often not even a choice a survivor gets to make. In a 2007 study, 365 surgeons in the Detroit and Los Angeles metropolitan areas were surveyed as to how often they referred patients considering a mastectomy to a plastic surgeon, to talk about reconstruction. Nearly half the physicians – 44% – referred fewer than one-quarter of their breast cancer patients to a plastic surgeon prior to mastectomy.

    And only 24% of surgeons referred three-quarters or more of their patients to a plastic surgeon. Thus the majority of women who would probably benefit from reconstruction are never even told about the possibility.  

    Why not? Fifty-seven percent of those same surgeons said reconstruction wasn’t important to patients; 64 percent said patients weren’t interested; 39 percent said they thought patients believed reconstruction would take too long; and nearly half said they believed patients were concerned about the cost. (Hamel, 2007)

    And this information is based on… what? The personal opinion of a doctor (probably male) about how interested women are in how they look?

    I can safely say that I don’t know a single woman who doesn’t care, to some degree, about her looks. Hairstyle, body weight, clothing… perhaps sad but certainly true, we do care what we look like when we step out of the house each morning to meet the world. If we didn’t, hair stylists, makeup manufacturers, and Spanx would all be out of business.

    Are you about to have a mastectomy? Or have you had one, and are sorry you didn’t know about (or consider) reconstruction? In honor of BRA Day USA, here are five important things I think you should know about breast reconstruction.

    •If you have health insurance that covers mastectomy, reconstruction is covered as well. The Women’s Health and Cancer Rights Act of 1998 provides that insurance companies must cover the cost of reconstruction (or a prosthesis) for women having a mastectomy – both for the affected breast, and for the opposite breast to achieve symmetry, if necessary.


  • For women without health insurance: yes, cost is a HUGE concern, and an obvious barrier to reconstruction. But for those with health insurance, cost shouldn’t be an issue.


    •You don’t have to make up your mind right now. Reconstruction can be done months, or even years, after your mastectomy. Many women opt to “get it all over with at once.” But if you’re feeling pressured, and need more time to consider all your options, it’s OK to just go for the mastectomy, knowing that you can still explore reconstruction down the road.

    •There are two basic types of reconstruction: implants (either silicone or saline), and autologous reconstruction, which uses tissue from your own body to construct a new breast. Each type has its pros and cons. As with so many decisions around cancer treatment, it’s a tough one – and only you can make it. 

    •In my opinion, based on what I’ve read on this site, surgeons tend to downplay the pain and discomfort associated with the implant process. Many women have detailed here the severe and unrelenting pain they go through during the several-month expansion process leading up to their final implant surgery.

    Why the disconnect between the commonly noted side effects of this surgery, and many women’s actual experience?

    It could be a case of surgeons trying to sell what they do best. Many more surgeons do implants than the much more complicated body tissue (autologous) reconstruction. If you’re interested in autologous reconstruction, discuss it with a surgeon who’s comfortable with the procedure, rather than one who seldom performs it.

    •It’s OK to NOT have reconstruction; the majority of women don’t have it. A prosthesis (breast form, usually silicone) inserted into a special bra can give you your shape back without further surgery.

    What’s NOT OK is not knowing and understanding your reconstruction options. If you’re having (or have had) a mastectomy, and never knew you could replace your missing breast with a new, surgically constructed one, ask your surgeon for more information.

    And if s/he’s not willing to provide you with the information you need, ask for a second opinion. Or a third. You’re the one making this very personal decision about your body; it behooves you to know as much as you can about your options.  

    Source

    About Bra Day USA. (2012). Retrieved from http://www.bradayusa.org/
    Hamel, P. (2007, April 09). Why do so few of us opt for reconstruction? Retrieved from http://www.healthcentral.com/breast-cancer/c/78/8348/opt