Breast reconstruction after mastectomy becoming more common

Breast reconstruction after mastectomy becoming more common

16/3/2014

A new study by researchers from US private practices and academic medical centers shows that more women are receiving breast reconstruction after mastectomies. The rates, however, vary dramatically based on geographic location.

Six weeks after her mother died of ovarian cancer, Elizabeth Stower, then 21, was diagnosed with Stage 3 breast cancer. For Stower, the decision to have reconstruction surgery was immediate. During almost a year of treatment that included four rounds of chemotherapy, followed by six weeks of radiation, she had spacers placed in her chest to stretch the skin and make room for the placement of the implants.

"Now that I'm healthy again, that part of my body sort of signals health," says Stower, now 27 and working in Washington, D.C. "If I didn't have reconstruction, it would be a permanent reminder that something was stolen."

Under a 1998 US federal law, most group insurance plans that cover mastectomies also cover breast reconstruction. The study published in the Journal of Clinical Oncology identified 20,506 women who had a mastectomy for breast cancer between the time the 1998 law passed and 2007. By looking at data from a nationwide employment-based database of medical claims, researchers found that 46% of women who underwent a mastectomy received breast reconstruction in 1998. The number rose to 63% by 2007.

Study author Reshma Jagsi, a radiologist and associate professor of radiation oncology at the University of Michigan Comprehensive Cancer Center, says the law and increased awareness could be driving the increase. "Reconstruction is an important part of treatment for survivors," she says. "It can have substantial benefits on women's quality of life and improve their physical, mental and social life."

While Stower says she felt lucky that she was able to receive treatment in Minneapolis, the study showed dramatic variation on reconstruction based on geographic location: Only 18% of women in North Dakota underwent reconstruction, while a high of 80% in Washington, D.C., did so.

"We are seeing the difference based on location is largely associated with the number of plastic surgeons in the area," Jagsi says. "So the worry is women who don't live in an area with many plastic surgeons don't have adequate information or access to this treatment."

While the majority of women in the study received implants, Susan Brown of the Susan G. Komen Cancer Society says that today, women have more power in reconstruction options. Though more time-consuming and not right for everyone, options such as autologous reconstruction can create breasts using fat and muscle tissue from other parts of the body.

Victoria St. Martin, 33, was working as a reporter at a local newspaper in New Jersey when she was diagnosed with breast cancer at age 30. Blogging on her website, breastcancerat30.com, about her experiences, St. Martin says she was blown away by the surgeries and possibilities of reconstruction.

"I walked into the meeting with the surgeon feeling like I had no options and walked out realizing I had a choice," she says.

Following a double mastectomy, St. Martin opted to have DIEP flap surgery, in which her breasts were reconstructed with tissue from her stomach through four surgeries, while undergoing chemotherapy.

Reconstructions are not always smooth sailing. Even for St. Martin, two additional surgeries were needed, one to remove a cyst and another to remove dead tissue, but she says reconstruction almost served as therapy.

"In a way, mentally and physically, it fixed me," says St. Martin, who is currently a graduate journalism student at American University and works at The Washington Post. "When you are diagnosed, you feel broken, that you and your breasts will never be the same, but there is sort of a rebirth after chemo and reconstruction."

Brown says that when making the extremely personal choice whether to have breast reconstruction or opt out, women need to cover their bases and know as much as possible before surgery.

"When faced with this decision, women need to be proactive and get the information they need so they can ask questions about the options, rehabilitation and the cosmetic results they can expect, which all contribute to the decision a woman makes."

 

Source: USA Today: http://www.usatoday.com/story/news/nation/2014/03/16/breast-cancer-mastectomy-reconstruction/5619881/