According to the American Cancer Society, breast cancer is the most common cancer among women excluding skin cancer, and accounts for nearly 1 in 3 cancers diagnosed in US women. It is estimated that 232,000 new breast cancers were diagnosed in 2014. Published research shows that almost 70% of women with a breast cancer diagnosis are not informed of their care options. While that seems like a high number in the Northeast United States, the statistics include middle America and many communities underserved by breast specialists and reconstructive plastic surgeons.
The Breast Cancer Patient Education Act of 2012 was originally introduced by Representative Leonard Lance from the 7th district in NJ. The legislation is designed to increase awareness among breast cancer patients about reconstructive options. It requires the Secretary of Health and Human Services to plan and implement an education campaign to inform breast cancer patients of the availability and coverage of breast reconstruction, prostheses and other options.
I remember the exact moment when I really understood the true essence of breast reconstruction. I was a plastic surgery resident at Memorial Sloan Kettering in 1996 when I had the opportunity to observe a consultation by one of the plastic surgery attendings. There was a 60ish year-old woman interested in delayed breast reconstruction after having had a one-sided mastectomy almost ten years earlier. She came to the appointment with her husband and I overheard them talking before the consultation began. The husband made it very clear that he did not understand why they were there. He told her she looked fine, and it didn’t matter to him whether or not she had breast reconstruction. The woman then turned to her husband and said, “When the doorbell rings, you run to see who’s there and I run to get my prosthesis.” It was a defining moment for the woman’s husband. He finally understood. It was not about him or what he wanted or would accept. The moment felt like yesterday for me and I was humbled to truly understand the importance of what I was being trained to do.
The concept of body image is very complicated and encompasses much more than the words used to define it. Body image is the mental picture we have of ourselves and it is connected to personality, most likely with some genetic basis. While there are certainly cultural differences about body form, beauty and modesty, there are also many similarities that cross cultural lines.
Body image is a complex perception of one’s appearance that involves emotions and physical sensations that develops over time as a result of interactions with people and the social world. Cues about what we should look like come from our parents, our peers and the media. Especially in our current world, television, magazines and the Internet contribute a great deal to the internal “vision” of one’s self. It is indeed difficult to escape the media’s ideals of body form, including breast size and shape. In some ways, the public unknowingly adopts these ideals, often creating feelings of inadequacy, which are internalized. As a result, the idea of a mastectomy may cause some women to feel less feminine.
Since that day as a resident nearly two decades ago, I have countless stories of breast cancer survivors who have taken control of their own destiny, like the wife answering the doorbell. Breast reconstruction is much more than physically restoring a lost part. It’s a psychological victory of preserving one’s body image, which goes a long way towards the mental recovery after breast cancer.
As a medical community and a society, we need to continue to increase education and awareness of breast cancer screening and options for treatment and reconstruction. We also need to eliminate the stigma of breast reconstruction as a sign of vanity. Every woman deserves to feel whole. How about calling it “restoring wholeness” rather than “breast reconstruction”?