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What Every Woman with Breast Cancer Needs to Know

Pink is everywhere. Corporations go pink. 320-pound linemen in the NFL go pink. Flight attendants on airlines go pink. Entire television networks go pink. It may be impossible to travel through the month of October without seeing pink. Breast Cancer Awareness Month is in high gear. The awareness campaign waged on behalf of breast cancer over the last quarter century has been remarkably successful.

It is, after all, a relatively common disease that takes the lives of too many of our wives, mothers, sisters and friends. Research and screening programs are humming. Exciting new developments in genetics and treatment are here. There are more than a dozen different ways of reconstructing part of the breast or the entire breast after lumpectomy or mastectomy.

Last week, a woman named Penelope walked into my office to discuss breast reconstruction. She is 51 years old, a mother of two and had a right mastectomy last year. She is African-American, unemployed and on Medicaid.  Her cancer surgery was performed at a different hospital than where I work by a breast surgeon I know to be technically good and careful and compassionate. Her lymph nodes were negative and, from everything we can tell, she has an excellent prognosis. 

During her appointment, we had a long chat about different ways to reconstruct her breast. It is one of my favorite parts of my job. There are lots of ways to reconstruct a breast. There are implants. There are ways to use a woman's own tissues – from her belly or abdomen, from her buttocks, from her thighs or from her back. There are ways that require just one operation and those that require multiple operations. There are simple ways and more complex ways. All have pros and cons.

I like having this conversation because after lots of consultations that involve the "have tos" of chemotherapy, radiation, and mastectomy, this is about the "want tos." "Do you want to use your own tissue?" "Do you want to change the other breast to match your reconstructed one?" "Do you want to have the shortest possible recovery time?" We agreed upon implant-based reconstruction with a small enlargement of her left breast at the same time. 

All of that is good. So, where's the problem? The problem is that Penelope wasn't offered reconstruction at the time of her mastectomy, at the same hospital, by the same group of doctors that were treating her cancer. This is not so good.
In New York City, like many places in America, the likelihood that a woman undergoing surgery for breast cancer will receive reconstruction is influenced by her race, her socioeconomic status and her level of education. To put is simply, but accurately, if you are wealthy, White and college educated, your chances of receiving reconstruction are a lot higher than if you are poor, Black and not college educated.

Laws have been passed on the federal and state levels that eliminate financial barriers for women receiving care for breast cancer. Reconstruction is covered for all women, everywhere. In New York State, we, at Montefiore, helped write legislation that mandates that all women be informed of reconstructive options. It has helped but we're not there yet. 

There are still far too many women in America, like Penelope, who weren't offered and didn't receive reconstruction after mastectomy surgery. This is a problem. We need to solve it. Talk about reconstruction with your friends and family. Demand information from your doctors. And realize that rich or poor, Black or White, every woman is entitled to a certain level of breast cancer care – including reconstruction. 

That is breast cancer awareness, too!

Evan Garfein, MD, is a plastic and reconstructive surgeon in the Department of Surgery at Montefiore Medical Center and Assistant Professor of Surgery and Otorhinolaryngology – Head & Neck Surgery at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/16/2013 at 9:20 AM Add Comment