Less than one-fifth of American women who undergo mastectomy currently choose to undergo breast reconstruction. Dr. Melinda Musgrave, a plastic surgeon at St. Michael's Hospital who revealed findings that in Canada the number is as low as 7%, is determined to find out why this occurs.
"Reconstruction has a very positive effort on these women as they go through their breast cancer journey," she says. "The problem is that it's still seen as cosmetic or unnecessary and it needs to be brought into the correct light."
Musgrave says there are two separate stigmas at work in a woman's mind when considering reconstructive procedures. "People put their perception of reconstructive plastic surgery into the same boa that they put their perception of elective or cosmetic surgery. It's not right, but when we think of people who choose to spend thousands of dollars on a cosmetic breast augmentation we generally think of them as a certain kind of person," she says. "I think most breast cancer survivors don't want to be associated with that mindset, and that's a huge concern."
But it isn't just a concern over vanity that's holding women back, Musgrave also points to a woman's fear over whether or not she even deserves the surgery in the first place. "A lot of women think of reconstructive surgery as total disfigurement — people who need facial transplants," she says. "In comparison, a breast, which is hidden, might seem to her as so much less than that." In other words, how can she legitimize this surgery when so many people are so much worse off.
Musgrave says this may fall in line with a woman's hesitation to put herself first. "There's a lot of guilt associated with this surgery," she says. "After surviving cancer they want to feel better, they want to look better, but it can feel like a very selfish thing to do. After all, in their minds, it's only a breast."
To be fair, there are other factors at work that may be keeping more women from opting into reconstructive surgery. The surgery itself can be complex. According to Dr. Richard Chaffoo, a San Diego-based plastic surgeon with experience in the area, reconstructive breast surgery is more complicated than purely aesthetic surgery of the breast and is associated with more surgical procedures and subsequent complications."
Musgrave also points to a lingering misconception among some surgeons that the surgery can affect the chances of cancer returning to a patient. "It's very scary in today's society with all of the technology and science we have, but some old fashioned thought are still propagated that just have no basis in reality." According to Musgrave there is no medical data to support these theories, and that, in fact, studies exist that hint reconstructive surgeries have been shown to increase a patient's survival rate, something she attributes to "multiple sets of eyes on the patient."
So what's next? Musgrave thinks the medical community has to work to educate patients about reconstructive surgery before mastectomies and other surgeries are performed to help them to make well-informed decisions, something that is not legislated in Canada. In the U.S. though, states have taken action. In New York, for one, before a surgeon can perform a mastectomy or lumpectomy on a breast cancer patient, that patient must meet with a plastic surgeon to learn her options.