Restoring Symmetry and Self-Esteem

Breast reconstruction is one way to speed recovery and restore a woman's sense of femininity after breast cancer surgery; however, surgical reconstruction is not the answer for every woman who wants her upper body to look more balanced.

To enhance a woman's self-perception after breast cancer surgery, it is important to understand both the surgical and non-surgical options available. A mastectomy is the complete removal of a breast from a woman's chest. If a survivor wants to restore the look of her upper body to its pre-surgery state, she can choose surgical reconstruction, which can employ implants, or non-surgical options such as breast forms.

Breast-conserving surgery, or lumpectomy, allows the surgeon to remove a cancerous tumor without completely removing the breast. According to, a nonprofit organization dedicated to providing information about breast cancer topics, some women who undergo breast-conserving surgeries such as lumpectomies encounter breast deformities after surgery. Others who opt for breast reconstruction after mastectomy may have asymmetrical — or different size — breasts after the reconstruction, experience problems healing or eventually have a poorer cosmetic outcome than originally hoped.

Symposium Tackles Question of Why Breast Cancer Patients Don't Adhere to Hormone Therapy Regimen

In fact, each year about 30,000 women in the United States who have undergone a mastectomy will not have breast reconstruction. "I chose not to have reconstructive surgery," says Erin Lutz, a breast cancer patient from Huntsville, Ala., who was diagnosed at age 30. Lutz underwent a double mastectomy but chose not to have breast reconstruction. "Most people just assumed that I wanted reconstruction, when all I wanted was to have them off of me and the cancer gone."

While surgical breast reconstruction is a viable option for some women, it is not without significant risk. Some complications of surgical breast reconstruction include:

  • Infection
  • Extensive scarring
  • Different size and/or misaligned breasts

So what options are available to women if their surgeries fail or if they choose not to have reconstructive surgery at all? Breast cancer survivors can choose among the most advanced breast prosthetics available today, including lightweight models that can fit inside a woman's bra or clothing and others that are custom-fit to attach directly to a woman's breasts or chest wall.

Because many women are not aware of what is available to them, home health providers can fill this knowledge gap by educating health care professionals about the product line available to breast cancer survivors. The variety of non-surgical options, most of which are less expensive than surgery and paid for by a patient's insurance, offer survivors more freedom to workout, swim and wear sleeveless or form-fitting clothes so they can live their lives to the fullest without focusing on the appearance of their upper body.

Another advantage of non-surgical prosthetics is restoring symmetry without more surgeries, pain and cost to the patient.

"The purpose of surgical and non-surgical reconstruction is to restore the breast to the most natural shape possible," explains Daniel Eaton, board certified ocularist with the University of Arkansas for Medical Science's Cancer Research Center. "However, reconstruction is a snapshot in time — surgery cannot account for future changes in weight, the affects of age and gravity on breast tissue, or how cancer medications will influence the breast after reconstruction."

Prosthetics can fill out the irregularities that surgeries such as mastectomies, lumpectomies or reconstruction may create. "The purpose of breast forms is to give a more natural shape to a woman's upper body, and there are a variety of ways the forms can be used," Eaton says. "In fact, using laser technology, we can scan the breast and note the irregular areas. Using this as a guide, a breast form can be constructed to fill in these deviations and restore a more balanced look to the chest."

These forms can fit directly on top of the breast, regardless of the shape or irregularities that exist. Breast prostheses are lighter in weight, more durable and easier to use than in years past, and as a result, non-surgical options are becoming more viable for women looking for alternatives to surgery and solutions for surgeries that have left breasts misshapen.

Linda Major, a breast cancer survivor from Lebanon, Tenn., understands both sides of the issue. After undergoing a double mastectomy, Major "did not want to go from a 40D to nothing. I wanted to have a say in the size of my breasts, and I wanted to be normal after reconstruction."

Major's first reconstructive surgery was immediately following her bilateral mastectomy. After experiencing complications, Major underwent chemotherapy and radiation treatments, which also affected her recovery. The second reconstructive surgery failed after Major's saline implants became infected and had to be removed.

"The surgery left ugly bumps, scarring and unusually-sized breasts," Major explained. "But another surgeon convinced me to try reconstruction one more time. The new implant also became infected, so I had both implants removed."

After so many surgeries and extensive healing, Major's existing breast tissue was left misshapen and scarred, and one breast was lower on her upper body than the other. Major was custom-fitted with partial prostheses that conformed to her existing breast tissue.

"My prostheses are the best option I have seen," Major says. "They were made to fit the lumpy tissue that was remaining after all the surgeries. Each side is formed differently on the side next to the skin, but they look the same once they are in place."

Major urges women who are facing breast cancer and reconstruction options to become as educated as possible about the choices available to them. "I made my decision without being as well-informed as I should have been," Major says. "I was not thinking clearly knowing I had breast cancer, and I had to make my decisions quickly and in a less than stable frame of mind."

For any woman undergoing breast cancer surgery, understanding the options available is paramount to mental as well as physical well-being. While surgical reconstruction is certainly one option, it is by no means the answer to every breast cancer patient's situation. Home health product providers can help educate women and physicians about non-surgical options. With advanced technology, women now can choose a lifelike breast prosthesis and eliminate the need for further surgical procedures.

Symposium Tackles Question of Why Breast Cancer Patients Don't Adhere to Hormone Therapy Regimen

Many breast cancer patients are not reaping full benefits from proven hormonal therapy regimens, and non-compliance rates have reached as high as 40 percent in some clinical studies, according to the Compliance Strategic Initiative (CSI), recently held in Washington, D.C.

According to the American Cancer Society, more than 200,000 new cases of breast cancer are diagnosed annually in the United States. Of those, approximately 100,000 have cancer types that respond to a five-year course of prescribed hormonal therapy. It is this group, about 500,000 women, that are most affected by non-compliance.

Clinical studies show that approximately one in three breast cancer patients may experience a recurrence; however, there are steps, including hormonal therapy, that may reduce the risk of recurrence. The goal of the symposium was to better understand that factors related to therapy compliance.

"Through research, we know that the five years of adjuvant hormonal therapy in postmenopausal women with estrogen receptor-positive breast cancer prolongs survival and reduces recurrence," said D. Lawrence Wickerham, M.D., associate chairman of the National Surgical Adjuvant Breast and Bowel Project. "And yet, studies also show that not all patients stay on hormonal therapy as prescribed. It is important that we understand why women make that decision, so we can address the issue with the information, resources and support needed to help them through this part of their treatment."

According to the American Cancer Society, breast cancer is the second leading cause of cancer death among women in the United States. Studies show postmenopausal women with early breast cancer have the greatest risk of recurrence in the five to 10 years immediately following diagnosis, and no studies have proved that there is a specific time when a breast cancer survivor will be completely free of the risk of recurrence. For more information regarding the Compliance Strategic Initiative, call (212) 330-4600.

This article originally appeared in the January 2006 issue of HME Business.

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