There’s no one right way to time reconstructive surgery after breast cancer treatment – only what works best for you based on the recommendations of your doctor, and how you feel.
Many times, breast reconstruction takes place immediately after breast cancer surgery – so soon that you might wake up from your mastectomy with a newly reconstructed breast. In many young women’s minds, this is the expected norm, depending on the conditions of the cancer – if radiation is planned, immediate reconstruction is usually not recommended by most surgeons.
However, breast reconstruction is never just one procedure, and some women wish to avoid subsequent surgeries. Other young women feel they need more time to decide on a type of breast reconstruction. In fact, in 2007, 20,900 of the 78,000 women who had mastectomies did not elect to immediately reconstruct their breasts.(1) Amoena Life spoke to a few women who were diagnosed young and decided to postpone (or forego) their reconstructive surgeries.
Not convinced
Kimberly H. was 37 when she found out she had breast cancer. "Initially I wanted reconstruction so that things would appear 'normal' to my 2 young daughters (ages 13 and 7), but after running into complications I decided against it," she explains. "The plastic surgeons really tried to encourage me to have the reconstruction because of my young age, and actually followed up with me for a full year after my initial surgery, thinking I'd change my mind." But Kim was speaking to other survivors, and says that no one was able to convince her she really needed it. "I don't feel like my quality of life has changed because I no longer have breasts. I may change my mind, but right now isn’t the time." Kim wears breast forms when she wants to, or wears nothing at all.
Kate B. has her daughter in mind, too, but for a different reason. "Originally I said I would consider reconstruction when I hit the five-year survival mark. And I have considered it, but I have a young daughter (she's five now) and I'm not sure what the effect of reconstruction would be on her body image. I'm not sure that I want to model surgery as a way to 'fix things.' We work to teach our girls to love themselves and their bodies, but then we model make-up and hair coloring and botox. I also don't know if I want her to associate breasts with pain, blood, surgery, etc. I am lucky that she was so young when I went through my treatment -- she doesn't even remember it."
It seems these body image questions are something that a lot of young mothers might struggle with as they consider reconstruction.
Complicated recovery
Erica B. originally had a lumpectomy followed by chemotherapy, but halfway through that treatment, learned that the cancer had spread and she needed a full mastectomy of her right breast. "If I had wanted immediate reconstruction, I only had two weeks around Christmastime in which to decide." Because she knew that the cosmetic options might not be as good with planned upcoming radiation, Erica says, "I knew I was in for a long haul of being breastless on the right."
The reality of Erica's situation was that additional complications forced her to wait about three full years until her reconstruction this past February. "The norm for younger women is that yes, they all presume they'll have immediate reconstruction, but it's never clear who's going to have lymph node involvement, and then have to have radiation. It's not much of a patient decision; it's really often dictated by the medical issues." For Erica, having her reconstruction is a big relief. Although she says it's been "life-changing" to wear an Amoena Contact adhesive form, the daily reminders are something she's ready to put behind her. "Putting the form on in the morning, washing it at night, wearing a certain kind of bra… I just want to be free from some of the physical reminders of having had cancer. I’m looking for some closure."
Other considerations
There are many other reasons to consider a "time out" before reconstruction.
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Maintaining control. Cancer can be scary and overwhelming. "My number one reason for waiting is that I felt that my life was out of control," shares Clara M. "I knew that reconstruction would take about a year to finish. So I wanted to get back to work as soon as I could and not have continuous doctors' appointments aside form chemo and radiation. I wanted to be in control -- not the cancer. I'm still thinking about reconstruction, but I just want to be done with doctors every week."
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Getting Healthy. On the Young Survival Coalition’s Ask the Expert web page, Dr. Karen Horton, a plastic surgeon in California, discusses her recommendation that patients achieve their most realistic weight and level of physical fitness and health before taking on breast reconstruction. Each woman's body is different, but Horton says good nutrition (as well as quitting smoking) helps wounds to heal properly. Sometimes it takes time to develop good health habits. "Surgery is a major injury to the body, and being as fit and healthy as possible will enable you to have smooth healing and to help to avoid complications." In some studies, patients with a Body Mass Index (BMI) over 30 (classified as obesity) saw an increased risk of complications from reconstructive surgeries. (2)
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Worries about complications. It's no secret that reconstructive surgeries don't always go as planned. Sometimes skin breaks down, sometimes the donor site experiences problems (such as a hernia in the abdomen with a DIEP flap), and any surgery site can be subject to infections. That was the case with Bonnie M., who had immediate implants: "Between my chemo port and my 2 reconstructed breasts, I've had 4 serious staph infections in the past 5 years." As an active 53-year-old, Bonnie has recently considered trying again, but hesitates. "With my previous experiences, I am just not sure I really want to go through with it."
Most of the women we talked with recommend that newly diagnosed women not rush into making a decision about reconstruction. Be sure you get all the information you want from your surgeons. Know the risks, explore all the different options and weigh all the pros and cons for you and your particular situation.
It's important to note that your insurance coverage plays a role, too. While the Federal Women's Health and Cancer Rights Act of 1998 stipulates that reconstruction must be covered when the insurance has also covered a mastectomy, it's a good idea to check the fine print on your policy. Make sure you're aware of timing, deductibles and state laws in connection with your reconstruction.
In most cases, you can wait months or even years before you have reconstructive surgery, and products like Amoena breast forms can help you during the in-between time. It's a choice that's truly up to you.
Post your comments in our Discussion Forum.
(1) Anne Krueger, Christina Applegate Chose Breast Reconstruction, So How Come Other Women Do Not? http://www.health.com/health/condition-article/0,,20228215,00.html (September 2008).
(2) Young Survival Coalition, Ask the Expert, http://www.youngsurvival.org/young-women-and-bc/Ask-the-Expert/.