Elizabeth Anderson had to act fast when she learned she had advanced breast cancer in April 2009. Just one month after her diagnosis, she had a bilateral mastectomy, a surgery removing both of her breasts.
“With a Stage 3 diagnosis it was either breasts or life. There was no decision to be made. I had to take them off,” recalls Anderson, a 47-year-old fitness instructor from Naples, Florida.
Following the surgery, Anderson says, she had to mentally prepare before taking a first glimpse at her new body; she knew it would be difficult.
“I just stared at myself in the mirror for a few minutes saying, ‘It’s OK, it’s OK. This is what you had to do,’” she says. Anderson, who also had chemotherapy and radiation during the course of her treatment, was elated to finally be cancer-free, but says it was difficult to adjust to her new body.
She figured her days of having breasts were gone forever. She was not a good candidate for breast implants, not commonly recommended for women who have had radiation. Instead she wore breast prostheses, but found them to be cumbersome. Then, there was the emotional frustration.
“This is zero. This is scars on your chest. This is absolutely nothing,” Anderson explains. “As a woman, to look in that mirror and not see anything, it doesn’t feel right.”
During a chance visit to a different radiologist near the end of her treatment, Anderson was told about bilateral delayed breast reconstruction, a procedure pioneered within the last decade, where doctors re-create breasts using fatty tissue taken from other parts of the patient’s body, often from the buttocks, the abdomen or the back.
Anderson says neither her oncologist nor her regular radiologist mentioned this type of surgery while she was being treated, and none of the women in her survivor group had even heard of the procedure.
“They all looked at me like I had two heads,” Anderson says. “People were very surprised. They assume implants are the way to go.”
Seven in 10 breast cancer survivors may be unaware of reconstruction options
That’s actually pretty common, according to a survey from the American Society of Plastic Surgeons, which found that out of every 10 women who qualify for reconstructive breast surgery, only three are fully informed of their options.
Each year more than 254,000 American women learn they have breast cancer, according to recent estimates from the American Cancer Society, and many need a mastectomy to remove the cancer.
“Those who diagnose breast cancer and those who do mastectomy are separate from the plastic surgeons who do the reconstruction,” explains Dr. Frank DellaCroce, a surgeon at the Center for Restorative Breast Surgery in New Orleans, Louisiana, the place where Anderson’s breast reconstruction was performed.
“Integration of those two sides affords a global conversation with the patient before mastectomy,” he says.
“That is absolutely the case,” agrees Dr. Ann Partridge, clinical director of the Breast Oncology Center at the Dana-Farber Cancer Institute, who also does research on improving health care communication. “Medicine is not a solo-practitioner profession anymore; we need to work as teams for a better outcome.”
Partridge says there have been several new reconstructive breast therapies developed over the past several years, and though she agrees patients should be informed of them, she says in some cases if the patient doesn’t bring it up, the oncologist may wait to have this discussion, especially when radiation treatment is needed.
“Reconstruction, while important, is not a medical necessity,” she explains. “We as oncologists tend to focus on the treatment of the disease, and while in the throes of things, all [patients] care about is life or death.”
Partridge also notes that new therapies spring up in small pockets of the U.S., and if a therapy is not available in the city where the patient is being treated, it may not be considered a viable option by the oncologist. Anderson, for example, traveled from Naples to New Orleans for her procedure.
Partridge and DellaCroce agree that regardless of the circumstances, reconstruction should be discussed as soon as possible, because having the option is an important facet in the patient’s full recovery.
“When you lose some component of your physical self, you also lose some of your emotional self,” DellaCroce says. “To have the breast rebuilt erases some of the injury of a very difficult event, a diagnosis of breast cancer and the devastating deformities that can occur with mastectomy.”
‘I’ve got them back!’
Anderson says when she first learned about bilateral breast reconstruction, she turned to the web for more information and located a surgery center that could remove fat from her buttocks. She went for a consultation, and had to gain 23 pounds in order to have enough fat to form small C cups, one cup smaller than she had before cancer.
After living without breasts for 18 months, she finally got them back on October 21. Anderson will need one more surgery, a butt lift to close the gap where fat was removed, but for now she says her battle against cancer has come full circle.
“Gotcha cancer! You took them from me, but I’ve got them back!” Anderson says. “It’s amazing what doctors can do today. I’m absolutely thrilled I can just be normal. That’s all I want, is to be normal again.”
Where to find information on breast reconstruction
If you’re interested in learning more about breast reconstruction options and the risks associated with the various procedures, both the American Cancer Society and the Susan G. Komen Foundation answer questions about breast reconstruction after mastectomy on their websites.
Breastcancer.org provides photo images to help explain how procedures like implants and flap reconstructions work.
The Department of Health and Human Services has a chart detailing the surgery choices for women with early-stage breast cancer.
You can also find a board-certified plastic surgeon in your state by visiting the American Society of Plastic Surgeons website.
Keep in mind that the Women’s Health and Cancer Rights Act includes protections requiring insurance companies who offer mastectomy coverage to also provide coverage for reconstructive surgery.
The American Society of Plastic Surgery has a list of state laws concerning breast reconstruction.