By Susan Kost

In the last decade, women’s surgical options for breast cancer treatment have increased and as a result, women’s needs following breast surgery have changed.

The number of mastectomies performed each year is declining. Breast-conserving surgeries are now the treatment of choice, accounting for more than 50 percent of all new surgeries. Reconstruction surgery is also on the rise. In 2001, more than 81,000 women had breast reconstruction surgery. Of those, 38 percent was performed at the time of mastectomy. This is a 174 percent increase in the last decade. This increase is partly due to the passage of Women’s Health and Cancer Rights Act of 1998, that mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone a mastectomy.

What Does New Research Tell Us About The Effectiveness Of Lumpectomy Vs. Mastectomy?The results from two long-term studies published in the New England Journal of Medicine in October 2002 indicate that lumpectomy following by radiation is likely to be equally as effective as mastectomy if there is only one site of cancer in the breast, the tumor is less than 4 cm and the tumor was removed with clear margins---meaning no cancer cells in the surrounding tissue. According to these landmark studies, “Women with relatively small breast cancers who were treated with breast-conserving surgery plus radiation therapy were as likely to be alive and disease-free 20 years later as women treated with mastectomy.”

There are a number of reasons why a woman may not be a good candidate for a lumpectomy. They include:

• Previous radiation to the same breast for an earlier breast cancer.
• Extensive cancer in the breast in having two or more separate areas of cancer in the same breast
• Having small breasts and a large tumor, so that removing the tumor would be extremely disfiguring.
• Multiple attempts to remove the tumor that have failed to completely remove the cancer and obtain clear margins.
• Having a connective tissue disease, such as lupus or vasculitis, that would make her sensitive to the side effects of radiation.
• Is pregnant and should not have radiation therapy.
• Is not willing to commit to the daily schedule of radiation therapy or distance makes it impossible.
• Believes she would have greater peace of mind with a mastectomy.

According to breastcancer.org, a non-profit organization for breast cancer education, 75 percent of women who have mastectomies go on to have surgical reconstruction of one or both breasts. Of these women, roughly 50 percent will choose artificial implants. Most of the remaining 50 percent choose to undergo a TRAM flap. This procedure uses the body’s own tissue to reconstruct the breast. When given the choice, the majority of women ask for immediate breast reconstruction. Some women who undergo lumpectomies are left with severe deformities and also will elect breast reconstruction to restore symmetry. According to the American Society of Plastic Surgeons, 20 percent to 30 percent of patients undergoing a lumpectomy will be left with breast deformities that very greatly depend on the tumor size and shape, radiation therapy, breast size, breast shape and tumor location.

This is a difficult question to answer because there are both physical and psychological factors that influence women’s answers. These include body image prior to surgery, type of surgery chosen, cosmetic outcome of the surgery, just to name a few. Highlighted below are the research findings for three separate studies. Each study evaluated different aspects that can influence a women’s self-perception after breast surgery.

The Psychological Effect of Mastectomy with or without Breast Reconstruction was published in March 2003 issue of Plastic and Reconstruction Surgery, and concluded that immediate reconstruction does not necessarily offer a psychological benefit over mastectomy alone or delayed reconstruction. The results of this study showed women still experience issues relating to body image and feelings of self-consciousness regardless of their surgical choice. This study was designed to evaluate the differences in psychological wellbeing, quality of life, body image, and satisfaction with outcome and care among women who chose immediate reconstruction, mastectomy alone, or delayed reconstruction. This study was unique in that it evaluated women before their operation, at six months post-surgery and at 12 months post-surgery. The majority of other research in this area has relied on retrospective evaluations of women’s experiences after they have made their decision, and treatment is complete rather than prior to surgery or during treatment. Retrospective studies do not address the psychological changes that occur prior to surgery or during treatment. In addition, these studies fail to account for the effect that time has on how people remember and report experiences.

A nine-year prospective study of the long-term cosmetic outcome of implant reconstruction was conducted by a group of French researchers and took place from 1989-1997. The researcher’s objective was to access the long-term cosmetic appearance of reconstruction with implants. In 2001, the group published their findings in Plastic Reconstructive Surgery. This study showed a linear decline in the cosmetic outcome over the nine-year period. The acceptable result rate was 86 percent at two years post surgery, versus an acceptable result rate of 54 percent at five years post surgery. For patients without capsular contracture, poor cosmetic outcome was most often due to asymmetry caused by failure of both breasts to undergo symmetrical aging. The study clearly showed that although initial cosmetic outcome may be acceptable, appearance often undergoes significant deterioration in subsequent years.

A series of focus groups looked at body image and patient self-perception. Amoena, a provider of post breast surgery products, sponsored the study. In 2001 and 2002, Amoena hired a research company to randomly recruit breast cancer survivors who were asked to address their perceptions of their surgical outcomes. The results of the Focus Groups include:

• Reconstruction patients and BCS patients indicated their breasts were asymmetric after surgery,which they did not expect.
• Surgeons and doctors providing little or no information regarding non-surgical enhancements or options and are not addressing post-surgical asymmetry issues. Both groups indicated they expected their doctor, nurse, or other health care professional to educate them on all surgical procedures, treatment options and what to expect after treatment.
• Both groups indicated their health care professional could have done a better job at educating them regarding post surgery product options.
• Both groups indicated they have a negative self-image and compromise their clothing to hide the asymmetry of their breasts. Patients also indicated they developed all sorts of methods for compensating for their surgery, the asymmetry and the loss/scarring that is left behind.
• Patients look for strength where they can and many said that if they could look better, they would feel better about themselves.

Women are looking for solutions and often improvise because they are not aware of what product options are available. Causes of breast asymmetry include: 1. surgery and/or treatment; 2. breast shrinkage during and after radiation therapy; 3. different sized breast during the tissue expansion process; 4. weight gain/loss and 5. the failure of both breasts to undergo symmetrical aging.

Balance partial symmetry shapers are designed to help women regain symmetry after breast conserving surgery or reconstruction surgery. Balance products can slip into a regular, non-pocketed, fashion bra. They come in a variety of shapes, sizes, thickness levels and two colors, ivory and tawny. Balance top and bottom pieces can be rotated to accommodate for missing tissue. Balance may be reimbursable by Medicare and private insurance. Balance products can be used:

• When plastic surgery is not an option because of irradiated skin.
• As an enhancer during reconstruction.
• As an alternative to multiple surgeries.
• To adjust for weight gain or loss after reconstruction and treatments.
• To offset imbalance that results from the natural aging process.
• To correct asymmetry from naturally uneven breasts.

Balance offers full shapers for overall coverage for larger lumpectomies and reconstruction imbalance. Full shapers add even fullness over the entire breast area.

Based on focus group research, women are unaware of the product options available and have turned to substandard solutions such as shoulder pads. These patients indicated they expect to receive information on post-surgery issues from their health care provider. This indicates a knowledge gap. The best way to bridge this knowledge gap is to educate the health care professionals on the product options available and where women can purchase these solutions. Here are some ways you can generate referrals and build your relationships with health care professionals:

• Offer to provide patient education on partials to the medical community and newly diagnosed women.
• Sponsor hospital seminars or arrange a fitting day with the hospital.
• Make presentations to support or recovery groups.
• Seek referrals from satisfied customers
• Run an advertisement attracting customers who have had a breast biopsy.

Surgery trends will continue to evolve. The market base of breast conserving surgery and reconstruction patients that need products to address asymmetry will also continue to grow. Staying on top of these changes is critical to your continued success. By establishing relationships with the health care community and creating a strong referral base now, you are positioning your business for continued future growth.