Once a patient is diagnosed with breast cancer, the patient may be informed of a mastectomy and lumpectomy among his/her treatment options. Mastectomy (removal of breasts) is not the only route to remove cancerous cells. Lumpectomy is a procedure that leaves the breast intact, and removes only the tumor or cancerous cells. Radiation therapy may follow both methods to ensure removal of all cancerous cells. According to Dr. Reshma Jagsi’s latest study
in the Journal of Clinical Onocology, use of bilateral mastectomy increased from 3% to 18% since the 1990′s. 75% of women who undergo bilateral mastectomy opt to follow up with reconstruction. These days, breast reconstruction surgery is becoming an increasingly popular procedure for women post-mastectomy. In 1998, an estimated 46% of women who underwent mastectomies (removal of entire breast) chose to have subsequent breast reconstructive surgery. By 2007, this number had increased to 63%.
Breast reconstruction may be done with artificial implants or autologous tissue (skin, fat, muscle) typically from the patient’s back, inner thigh, buttocks, and belly as material for reconstructed breast. This method has become increasingly safer and often provides better cosmetic results since a reconstructed breast from one’s own tissue feels more natural. Successful autologous reconstruction can also last a lifetime, whereas artificial breast implants must be replaced at 10-20 year intervals. However, reconstruction with self-tissue requires more recovery time at the hospital. Other pros to using self-tissue include adaptability to weight changes in the body and better tolerance to radiation therapy. However, autologous tissue reconstruction has been the less preferred method for many women according to Dr. Reshma Jagsi’s latest study on breast reconstruction trends.
She cites multifactorial decision-making process on part of the patient when it comes to breast reconstructive surgery. But there is also a reimbursement disincentive for doctors to perform complex, labor-intensive procedures. Whether or not the latter prevents a large number of women from seeking autologous breast reconstruction has yet to be examined. Interestingly, rates of reconstruction have also varied widely by geographical region. In North Dakota, 18% opted for reconstruction cmopared to 80% in Washington D.C. Are patients appropriately being offered individualized care? Is this a decision driven by the patient’s best interest or the physician’s? Are there even enough physicians in areas where fewer women undergo breast reconstructive procedures? Breast reconstruction surgery can make a huge impact in a woman’s quality of life. In the age of rapidly advancing medical technology and patient advocacy, these are all questions that should be further explored.