Breast Cancer Awareness: The Essentials

October is Breast Cancer Awareness month. As it comes to an end, I thought it would be an important time to share how important awareness is, and how much just spreading information through education can go.

In a recent JAMA Surgery article from August 2014, the authors discovered that less than half of the women undergoing mastectomy for breast cancer have chosen to undergo breast reconstruction. The factors that were associated with not having breast reconstruction were lower educational level, older age or identifying as black race. Almost 30% of the patients surveyed have a fear of implant based reconstruction, even though silicone breast implants are among the most highly studied group of implantable devices that are used in all of medicine. In fact, 20% of those surveyed expressed a lack of knowledge of their reconstructive options. This has become extremely troubling to me if you juxtapose this apparent lack of information on the treatment of a cancer that affects 1 in 8 women, with the “age of information” that we live in today.

The consumption of information across all of the various forms of media (mobile and stationary) is controlled by the user; much of what we see is directed in front of us. Access to medicine and healthcare is a topic of controversy in today’s current forum, however access to information does not hold much controversy today. So, how can it be that so many women are not informed about their own choices when it comes to breast cancer? I think we, as a society and as medical professionals, have to do a better job keeping the focus of the news and on breakthroughs that make a difference in peoples lives, and not so much focus on who wore their dress best on the red carpet.

When it comes to options for breast reconstruction, there are 2 two basic categories:

1) Implant-based reconstruction: Using a silicone gel or saline implant with or without a tissue expander.

2) Autologous reconstruction: Using your own tissue to create your new breast. This includes pedicled musculocutaneous flaps from your abdomen or back and microvascular free flaps including the DIEP (Deep Inferior Epigastric Flap) flap. Being able to perform Microsurgery allows me to utilize free flaps and perforator flaps as an option when creating the right plan. Perforator flaps, including the DIEP Flap, allow me to move skin and fatty tissue from your abdomen, thigh, buttock or back and leave your healthy muscle and fascia intact.

Breast reconstruction can be performed immediately after mastectomy or in a delayed fashion any time after mastectomy has been performed. After battling breast cancer, reconstruction provides many women a sense of being whole again; restoring hope and fullness to their daily life. Breast reconstruction is right for all breast cancer patients who fit the criteria to have it performed and who are generally healthy enough to undergo a prolonged operation. The details of what option is right for your can be discussed in a consultation.

“Chance favors only the mind that is prepared”

“Chance favors only the mind that is prepared.”(Louis Pasteur, 1854).  My father taught me the importance of this statement while we were discussing the options for a specific surgery.  This exercise trained me to envision the possible outcomes of each decision I could make as a physician.  Louis Pasteur’s quotation resonates in my mind because it has always been part of my own philosophy.  The decisions we make as doctors, no matter how small, alter the environment in which we work.  A surgeon should have multiple outcomes in mind prior to making an incision.  Once an action is executed, a cascade of events may prevent the surgeon from encountering the expected anatomical landscape; adhesions remind you of another surgeon’s footprints and a bleeding vessel may alter the course of the present surgery.  The ability to show foresight and assuredness allows the surgeon to gain a patient’s trust.  There is no field in medicine where this idea of consequence is more apparent on both physical and emotional levels than in plastic surgery.  There is also no other field that fills me with more passion and excitement.

Plastic and reconstructive surgery has always impressed me.  The surgeon is able to redefine anatomy and physically alter the landscape of the human body using flap rotations and free tissue transfer while keeping aesthetic ideals in mind.  The surgeon is not confined to a set procedure.  With a profound knowledge of the human body and the healing process, a plastic surgeon is able to create a unique solution to a specific problem.  The physical repair of a defect is accomplished while addressing the patient’s psychological anguish of disfigurement.  Pasteur’s quotation is crystallized with plastic surgery.  As a field it is distinguished from other surgical subspecialties by its meticulous plans and designs. Furthermore, there is consistent innovation when approaching surgical problems.  Operations are filled with options, from primary closure, skin grafts and local flaps to regional, myocutaneous and free flaps.  We have even more options looking toward the promise of tissue engineering.  I have found that plastic surgery has the perfect balance of creativity and precision.