The reconstructive change
As a reconstructive surgeon, one of the most difficult parts of the job is to get the patient and family to understand the change that will happen following a breast cancer diagnosis and subsequent reconstruction. The change following cancer surgery and reconstruction would be perceived as a “good change” – the cancer source has been removed, and the first step of the feminisation process has begun, but lo and behold, that is not the case!
Studies have shown a clear physiological benefit in patients having reconstructive surgery following breast cancer surgery. The psychological benefit in terms of anxiety, depression, self-image and interpersonal relationships is seen in both immediate and delayed reconstruction. In many studies, immediate reconstruction seems superior in terms of patient satisfaction, number of operations required, and financial implications to both the patient and medical aid.
A seemingly healthy, happy woman has to accept that she has cancer – a single diagnosis that irrevocably changes everything in a very short period of time. The change from healthy to cancer is perhaps the most difficult, I would think, and to make matters worse the future is largely unknown.
Although we very well know that breast cancer can be cured, we certainly don’t know if you will be the one to be cured. This change to uncertainty is emphatically traumatic, and who but God, and of course an excellent therapist, could possibly get you through a harrowing life event of that magnitude.
We should also look at changing the possible causes of the cancer. It is well-known that stress causes cancer thus the first thing about the cancer diagnosis is change the possible cause. You’ve got to stop stressing!
It is very clear that in women, the amount of stress they experience is directly proportionate to the stressfulness of their job. In an ideal world, these patients would be able to quit their job immediately, and avoid a stressful job at all costs, and warn their family and friends. The cancer diagnosis should bring the biggest change of all: “Stop…breathe…relax, this is an order!” An impossible order, though.
Secondly, everyone you know should have a mammogram or ultrasound and/or breast cancer risk stratification. Slowly, we will change to early diagnosis, which saves lives.
You’ll need to take time off to recover from the surgery and the reconstruction. You will most probably never return to the state you were in before the diagnosis. Your life has changed forever. Your life will change from constantly busy to deliberately down-gearing to a Sunday drive, with plenty of unwanted thinking time.
A couple of decades ago, reconstruction was not an option, and women were banished to a flat chest, either on one side or both, forever. Gradually, the shift was made to delayed reconstruction following sometime after the cancer operation, and then the modern practice of immediate reconstruction. None the less, it is reconstruction. When your car goes to the panel beater, it never comes back exactly like before the panel beating was needed.
As a reconstructive surgeon, I try to prepare you for these changes. Just like the panel beater can’t exactly tell you what will be different about your car, so too will the reconstructive changes be difficult to explain.
The breast will never ever be the same as before. It will never feel or behave like before. You’ll always have a degree of pain and discomfort following the procedure, or any procedure. Reconstruction is a process, and no one can give you a breast like your natural one, and never ever in one operation. And, the reconstruction changes over time. It hardens or softens, and experiences the effects of gravity but, more importantly, you get used to it.
It’s so essential to listen to each woman’s need and then decide together what the best approach to treatment is, so that in the end the cancer will be gone, and the woman can move on with her life.
It also helps to speak to other patients that have had the same operation by the same surgeon. In doing so, you’ll realise that the same operation behaves very differently in different patients, and you’ll hear both good and bad remarks.
I wish I could give a fairy tale account about reconstruction, but the truth is I cannot. I can only tell you that I have remarkable patients, and that I’ll be here to walk the road with you.