It is an important topic to discuss. Who is responsible for the aesthetic outcomes of breast reconstruction surgery? The headline in the September 6, 2018, online article from Cosmopolitan reads:
These Cancer Patients Wanted to Get Rid of Their Breasts for Good. Their Doctors Had Other Ideas.
It is an emotionally filled article from women who chose to go flat. These women woke up after surgery with results that left them angered, saddened, disappointed, and fighting a battle to find out how to change things. In fact, on September 8, 2018, the article mentioned:
… she’s organizing the first Not Putting On a Shirt Nationwide Walk in Cleveland, Ohio, in which women will join her to march topless and raise awareness around the issue. A sister march will be held in Los Angeles in the same day.
The article speaks of women who chose to remain flat after their mastectomy and not to reconstruct. This decision I respect greatly. As women and men faced with the potential loss of breasts after breast cancer, we have a right to choose what our bodies will ultimately look like after surgery.
I can relate to the women in the article when they speak about the difficulty of looking at folds of skin left after mastectomy. It seems the difference between their experience and mine, my breast surgeon completely respected my wishes. We discussed a skin sparing, nipple sparing double mastectomy. I knew I would wake up with folds of skin. We discussed, in a shared decision-making consult, I would be perusing a plastic surgeon to perform my DIEPflap breast reconstruction after my mastectomy.
I lived with folds of skin, the inability to find clothing to fit my body, excusing myself from public events, parties, and get-together with friends for the seven months I lived without my breasts. I couldn’t bare to look at myself in the mirror. But I knew my breast surgeon left the skin folds for a reason, to prepare for my choice to reconstruct my breasts after a second breast cancer diagnosis.
The Responsibility for Aesthetic Outcomes Ultimately Lies on the Surgeon
This is true of both breast surgeons and plastic surgeons who are part of the surgical process for mastectomy patients. A notable oncoplastic surgeon, Dr. Patricia Clark states in the article:
“Women have to live with this outcome for the rest of their lives,” Clark says. “The burden is on the surgeons to make it a good one.” She notes that more recently trained surgeons are more interested in learning techniques that make a woman truly flat, which she says is a hopeful sign. But, she predicts it will take five to 10 years for the new class of doctors to fill the pipeline.
What Happened with My Aesthetic Outcomes after Seven Months of Living with No Breasts?
They improved beyond my expectations. I was told where my scars would be. I was told I would need more than one surgery to achieve the desired aesthetic outcomes we discussed at my consult with the plastic surgeon who performed my delayed DIEP flap breast reconstruction. To read this article saddens me for women who do not experience the same results I did. For this reason, I will continue to advocate for women and men who do make the choice to reconstruct after a mastectomy, whether delayed, immediate, implant-based, or the choice I made, autologous (using your own tissue).
How did this happen for me? I chose a plastic surgeon who engaged in a topic I will continue to discuss with patients and physicians to improve patient outcomes and ultimately the patient/physician relationship. Through a shared decision-making approach to any type of breast surgery, mastectomy, going flat, or choosing to have breast reconstruction, you have ownership and therefore accountability in the process, no matter what choice you make.
As patients, the information we bring to our consult is honored by the physician in a shared decision-making conversation. As patients, we honor the skill and expertise the physician brings to the conversation based on our health status and what they can achieve for us aesthetically. The ultimate decision is made in a cooperative manner by both parties. I am saddened for the women in the article from Cosmopolitan. I only wish the best aesthetic outcomes for all patients. I feel so fortunate to be a patient who can talk positively about my experience. It is important to hear both kinds of stories so we can learn from each other.
A Video Offering Aesthetic Questions to Ask if Going Flat After Mastectomy
Regarding going flat, I can only offer the video I made with two notable microsurgeons Drs. Minas Chrysopoulo and Ramon Garza III. They routinely and successfully perform breast reconstruction in a shared decision-making process as part of each consult at their practice. In the video, they discuss important aesthetic questions to bring to the shared decision-making consult with any surgeon performing your breast surgery if choosing to remain flat.
Changes are only made through our collective voices. I maintain that not all surgeons, plastic surgeons or breast surgeons, are ignoring or challenging our voices for our desired aesthetic outcomes when faced with breast cancer, the loss of breasts, choosing to remain flat, or choosing to reconstruct. There is hope and there are those surgeons who engage in a shared decision-making conversation with patients, honoring their voices and choices.