What are breast reconstruction benefits and are the benefits vs. cosmesis equal or separate? Although this question may not have been stated in these words, women considering breast reconstruction must think about this complex question. No one can come close to knowing what this decision involves except the patient themselves. Not only is it a difficult and complex process of logic but it involves a great emotional decision as well. I am speaking about breast reconstruction in very specific circumstances.
Humans are faced with many unexpected events in life catapulting us to become educated about a topic we never imagined we would be learning about. A cancer diagnosis or finding you have a gene mutation putting you at high risk for breast cancer is one of those life events. Those who are considering breast reconstruction after cancer or for prophylactic reasons to greatly decrease chances of a cancer occurrence go through great mental gymnastics to come to a decision to have breast reconstruction. There will be an assault to your body under either circumstance. A cancer diagnosis can very suddenly turn a woman or man with all body parts intact into an amputee within hours after surgery when diseased, cancerous, breasts are removed. A young woman, still of child-bearing age, and who chooses a prophylactic mastectomy, can suddenly face the loss or ability to nurse a future child when the breast tissue is replaced with an implant or by using other body tissue if flap reconstruction is chosen.
The Unintended Education of the Patient.
You go through the process of becoming educated on the topic first with your medical team. A patient will hopefully work with a compassionate breast surgeon and plastic surgeon through this shared decision making process. If you choose free flap surgery then the selection for a qualified microsurgeon becomes even narrower because of the specialized nature of the profession. It takes more years in medical school and the hours of dedication to become skilled at microsurgery. The hope is with any of these surgical specialties there is an element of compassion and dedication endearing you to these professionals in way that gives you complete confidence in their skill.
Let me put your mind at ease. There are those micro-surgeons who exist! Take a look at a blog written by one such micro-surgeon, Dr. Karen Horton, who I know through social media. Not only does it reflect her own passion for the profession but her blog shares the vision of those in training to become equally as gifted in the field. My own micro-surgeon who I researched diligently has a level of emotional intelligence and compassion immediately putting my mind at ease the moment I met him at our initial consult.
Breast Reconstruction: Cosmesis
When a patient begins to explain to family members and friends the choice to have reconstruction the initial reaction can often be one of an assumed cosmetic value. I told my own plastic surgeon once I never thought I’d be sitting in a plastic surgeon’s office. I had predetermined ideas about plastic surgery based on non-evidence based articles and articles I read about celebrities. Then my own life event, a second breast cancer occurrence of cancer forced me to learn about plastic surgery and the sub-specialty of microsurgery. It was then I started evaluating breast reconstruction: Benefits vs. Cosmesis.
The True Gain of The Cosmetic Value
When I had my mammogram and found out from my radiologist the image she saw was likely cancer, my thoughts immediately went to double mastectomy. I knew enough then a second occurrence a high likelihood of losing my breasts. What I didn’t think about was reconstruction. Fortunately for me, I was told immediately, the very day of the confirmed diagnosis, about DIEP flap surgery. Thinking back, I was fascinated and had a sense of hope, relief, I had options to restore a lost body part. Did I consider it cosmetic at the time? I suppose as a woman, a wife, and one who believes femininity is a gift, a womanly quality to be valued and nurtured, yes. I thought of it as a cosmetic benefit. What I didn’t appreciate at the time was the true gain of the cosmetic value.
Dealing with the Repercussions of the Diagnosis
Confidence can be stripped away after losing the very thing defining you as a woman, a feeling I wasn’t prepared to deal with. Before my mastectomy, I wanted the cancer gone. Get rid of the disease and deal with the repercussions later. After the mastectomy, I began dealing with the loss of my breasts, mourning the loss of those body parts and truly understanding the cosmesis of microsurgery. I began researching micro-surgeons to perform my DIEP flap surgery and looked in amazement at the before and after photos. Is it possible that my feminine shape and figure could be restored in a manner that was reflected in the photos? This research was all taking place during a time I was frequently declining social engagements because I was uncomfortable wearing breasts prosthesis. I did not feel feminine in my clothing. Declining social engagements was not in my nature. I am the type of individual who is generally energized by interacting with people. This personal change was difficult for me to deal with. Was I becoming an unintended recluse now because I was finally dealing with those repercussions? This process of mourning and loss was all part of the education of the cancer patient. The event of dealing with mastectomy catapulted me into a new realm of learning I never imagined I would have to deal with.
Explaining Breast Reconstruction: Benefits vs. Cosmesis to Others
Speaking to others about your decision to have reconstruction and you will be going to a plastic surgeon does conjure up some of those same preconceived notions I had myself about plastic surgery. Some family members and friends I spoke to understandably went straight to the cosmetic reasons to reconstruct. It is in the education we help both ourselves and others understand the added value in cosmesis of breast reconstruction. Let me put it in very tangible terms.
Most individuals desire to be contributors and to have a purposeful life. I have spoken to many women through my education and outreach about breast reconstruction who say over and over again, “I’m so happy I can get back to my life.” There are those, like myself, who have found a new purpose in life through their reconstruction. Either way, it is gaining back an individual and their ability to contribute to family, community, an organization, or a profession in a way bringing value to their own life and to others. So make no mistake, the cosmesis of plastic surgery in breast reconstruction is of value.
No less important are the actual benefits of the surgery. So the question becomes; is the cosmesis a benefit? Indeed it is but how do you separate benefit from cosmesis? I suppose this might be an individual opinion regarding how you do separate the two. But I am the breast reconstruction patient. I am the one who was unintentionally educated and can speak with true authority of both the cosmesis as well as the benefits.
Breast Reconstruction: Benefits
I did not know after losing my breasts I would literally feel out of balance. I spoke to my breast surgeon about this at a follow up appointment after my mastectomy. I told her I felt clumsy, out of balance. She explained to me many women feel this way after surgery and the loss of their breasts. This is something I never really considered before surgery. It is hard for the general public to understand this when you are a “hidden amputee”. I am not comparing apples to oranges here. There is no comparison. But we frequently look at the visible loss of a limb of an amputee and think to ourselves it took surgery and physical therapy to regain balance and getting used to the loss of their body part. Only a mastectomy patient would truly understand what I’m speaking of when I talk about the loss of symmetry and what it does to your sense of physical balance.
Women choose to have reconstruction under many circumstances. My own reconstruction was delayed seven months after my mastectomy. Additionally, because I had radiation to my left breast for the first occurrence of breast cancer 12 years previous to my reconstruction, I had skin compromised by radiation. Dr. Gary Arishta of PRMA plastic surgery explains it well.
Radiation also has deleterious effects on normal breast tissue as well. The radiation causes permanent changes to the normal breast tissue. It causes fibrosis of the tissues and decrease in elasticity. The breast feels tighter and the skin and underlying tissues are less stretchy. The micro-vascular circulation is damaged and blood flow is reduced. These effects are present in the breast and skin forever. The changes can be more pronounced in some patients, but all treated tissues are affected. ~ Dr. Gary Arishta, PRMA Plastic Surgery
Many women I have spoken to say how pleased they are to regain the range of motion lost due to radiation after cancer. I also speak to women who have had implants or tissue expanders replaced by their own tissue using various flap surgeries. The new breasts are warm, they are soft and they are truly a part of you. The fact blood vessels are disconnected from one part of the body and reconnected to the breast area lost to disease is a feeling only the patient can truly appreciate the benefit of. You feel “hug-gable” again. You don’t have any foreign objects in your body.
A day still does not go by I don’t look at and touch my warm, soft reconstructed breasts and feel so very thankful I had this choice and option to enjoy the benefits and advancements of plastic surgery not available to others years previous to microsurgery in breast reconstruction. You simply cannot understand or feel the true benefit unless you have had this procedure performed on your own body.
The benefits, I’m sure, are varied and far more detailed and intricate than what I have outlined here. Which is more valuable, the cosmesis or the benefits? Are they one in the same or truly independent of each other? My plastic surgeon summed it up quite nicely, “The benefits of breast reconstruction extend beyond the cosmesis.” The two become intertwined in the careful balance and subsequent results of microsurgery for the patient.
An Era of Unprecedented Passion and Evidence Based Research
We are living in an era of unprecedented passion to challenge the science and evidence based research about what can be done to use our own body’s mechanisms to restore them to a balanced state after the loss of a limb or body part due to amputation from trauma or disease.
Let us encourage education and outreach about these amazing topics so judgment and assumptions are not made about a patient’s decisions or physician’s statements regarding the benefits of these procedures. The physician becomes the instrument that can determine the true benefit, cosmesis or otherwise, for the patient. I consider it a privileged to inform and educate others about breast reconstruction. My hope is you are patient, open-minded, and not judgmental about why anyone compassionately chooses to reconstruct breasts for a profession or chooses to have the procedure done to rebuild their life.