At the age of 44, Michele Rakoff discovered she had breast cancer. She recalls being “not well-informed” by her surgeon about her options for breast reconstruction.
“I was rushed into making a quick decision and was not given the opportunity or the suggestion to have a second opinion,” Rakoff recalls. “Within four days of my diagnosis, I had a simple mastectomy with no reconstruction.”
After the surgery, Rakoff began investigating the possibility of having reconstruction, educating herself. She decided to have breast reconstruction six months later. That was in 1988. Today, Rakoff serves as executive director with the Breast Cancer Care and Research Fund in Los Angeles, developing a mentoring program for newly diagnosed patients so they can speak with trained, educated survivor mentors.
“It has been 24 years, and as the result of my experience, I always remind women that a diagnosis of breast cancer is not an emergency,” Rakoff says. “They have time to get a second opinion, do research and speak with well-educated advocates who can share their own experiences.”
Reconstruction is one of the toughest decisions a woman faces following a mastectomy. According to a Colombia University study, fewer than one in four women with invasive cancer opt for the immediate reconstruction of their breast. More than one in three with early stage cancer got the procedure. The biggest predictor of whether a woman got reconstruction was insurance coverage.
Ultimately, it’s a personal decision. But many fears can get in the way of making the best choice. We asked a few experts to weigh in on the validity of these fears.
Fear #1: I have to decide right away because reconstruction can only be done immediately following the mastectomy.
“Incorrect,” says Dr. Christy Russell, a spokesperson for the American Cancer Society and associate professor of medicine at the University of Southern California. “They can always have a delayed reconstruction.”
“One can do a delayed reconstruction. But if one can get it together and really make a decision upfront, there’s some economies of scale, so to speak,” says Dr. John Link, author of “The Breast Cancer Survival Manual, 5th Edition” (August 2012, Holt Paperbacks) and director and founder of Breastlink Medical Group, a comprehensive breast cancer treatment group in Orange, Calif.
There are a variety of types of reconstruction, he says. One is a silicone implant. The second type is where fat and skin are brought in from somewhere else to create the new breast. The third option is a hybrid of both.
“When the breast implant is put in after the mastectomy, it eliminates an added surgery,” Link says. “In our practice, 90 percent of women have immediate reconstruction. Those women who deny it are more likely to do it because of age or underlying health issues like pacemakers, severe obesity, diabetes or heart failure.”
Fear #2: If I have to have radiation or chemotherapy, I can’t have reconstruction until it is over.
“Each person receives different treatment and depending upon that treatment, a decision should be made with discussions between the woman and her health care team,” Rakoff says. “Women should be informed that radiation does have an effect upon the skin and can limit the reconstructive choices.”
Fear #3: It is too dangerous to have reconstruction when you have an aggressive form of cancer.
“No,” Russell says. “Even if women are dying of breast cancer, they deserve to have any type of body they want. You just have to make sure a patient is healthy enough to go through the surgery.”
Fear #4: If I don’t have reconstruction, I’ll never feel like a “woman” again.
“There are many women of all ages who have chosen not to have reconstruction and are beautiful, sexy women,” Rakoff says. “I know several who were diagnosed in their 20s, married after breast cancer and had children. They and their partners feel they are lovely, wonderful “women.”
Fear #5: Reconstruction is a vanity decision — I should just be grateful my cancer is gone.
“Absolutely not,” Russell says. “This is all about doing everything you can to try to even out the chest wall, not only for physical appearance but to even out the weight on the chest and stop back problems.”
Following a mastectomy, Russell says women with large breasts “get very unbalanced. They start leaning in one direction.”
“The whole process of being treated for breast cancer is difficult enough,” Link says. “There’s no reason a woman shouldn’t try to feel good about herself at the end. There should be no guilt about trying to become as whole as possible.”
Fear #6: If my cancer comes back, it will be easier to detect if I don’t have reconstruction.
“Absolutely incorrect,” Russell says. “Women who get a recurrence on the skin, it looks like a mosquito bite in the skin. It’s very, very easy to detect.”
“Local recurrences occur less than 10 percent of the time,” Link says. “When they reoccur, they are almost always on the surface.”
Fear #7: My partner won’t be as attracted to me if I don’t have reconstruction.
“I have a lot of patients who have not had reconstruction and they are still functioning normally sexually,” Russell says. “Many of them said the fact that they developed a life-threatening illness changed the relationship both emotionally and sexually. It was a wake-up call to the marriage. My advice is to know how you use your body sexually before you go into these surgeries.”
At the same time, Russell points out that the breast is a sexual organ. A mastectomy will deaden sexual stimulation in the skin over the removed breast. And getting a new “breast” from reconstructive surgery will not improve sexual stimulation, either.
“There is always an adjustment period after breast surgery, and discussions can help,” Rakoff says. “Many couples find it helpful to get professional counseling. Your partner should love you for who you are.”