Health

Tuesday 2 September 2014

'I was in shock when I found out I had to have a mastectomy. But now, after surgery, I can even look forward to wearing bikinis again. . .'

Breast cancer treatment once meant having to wear awkward surgical bras after the operation. But advances in reconstructive surgery have enabled women to feel confident about themselves again. Liz Kearney reports

Breast cancer survivor Ann Middleton is delighted with her surgical results.

It all happened so quickly. As far as she was concerned, Mary Kelly was just going for a regular all-over health check, something she'd promised herself she'd do every two years once she turned 40.

So, when she visited the Mater Private Hospital in March for a series of standard tests, Mary, a 44-year-old promotions worker from north Co Dublin, was shocked to be called back. There's something amiss with your breast, the doctors said. You need to come in for an ultrasound.

After that came a whirl of tests, exams, scans. And then the chilling news that spun the world on its axis: you've got cancerous cells in your left breast.

In August, Mary had a full mastectomy and breast reconstruction. This week, she is already back at work. Thanks to the reconstruction, there was no need for a new wardrobe or specialised underwear -- and most importantly for the vivacious, down-to-earth mum-of-one, the only way anyone would know she's had a breast removed would be if she chose to tell them.

A decade ago, Mary would have been dispatched from hospital with one breast, her cancer eradicated but facing a lifetime of fitting a prosthesis into her bra each day and shopping for underwear in the specialist mastectomy section of lingerie departments. A small price to pay for being rid of cancer -- but a daily reminder of the terrifying diagnosis.

Today, things are different. Thanks to the huge leaps made in the cosmetic breast surgery industry, reconstruction is now part and parcel of mastectomy care and is offered to most cancer patients here.

Those patients tend to be younger and younger -- the Breastcheck screening programme and increased awareness of the signs of breast cancer means that diagnoses are being made earlier. But they're also more likely to be successfully treated.

Today in Ireland, one in 11 women will develop breast cancer during their lifetime. Of that number, nearly 80pc will live for five years or longer.

With so many women surviving cancer, it's no longer enough to simply deal with the disease itself, says breast surgeon Malcolm Kell. Now doctors are focused on the next step -- what will life be like for women who've had breast surgery, and what can doctors do to ensure their life returns, as far as possible, to normal?

In Mr Kell's practice at the Mater Private Hospital and its public wing, 70pc of his patients opt for reconstruction. Of the 100 or so reconstructions he performs each year, each is different, he explains. Some choose to have the reconstruction at the same time as the mastectomy, while others wait until months later to have the final surgery.

The surgeon's priority during treatment is to eradicate the cancer by removing the cancerous tissues of the breast in either a full or partial mastectomy. The surgeon removes the nipple and the breast tissue, leaving behind the skin.

Then reconstruction can begin. In some cases, tissue is taken from the patient's back or abdomen and no implant is needed. In others, saline or silicon implants are used, in conjunction with the patient's own skin and tissue, to recreate the breast shape. Patients even have the option of having a nipple tattooed on to give the breast a more natural appearance.

Waking up with two breasts after mastectomy -- or having the option of having the breast rebuilt a few months or even years after initial surgery -- helps women recover quicker from the psychological blow of a cancer diagnosis, doctors believe.

"Your breasts are a big part of your femininity, aren't they?" says Sinead Murtagh, a nurse and breast-care co-ordinator at the Mater Private Hospital. "Psychologically for the patients, it's a big thing to wake up from surgery and to have a shape there. Of course, the main thing is that the cancer is all gone, but they are worried too about how they will look in clothes after the operation. How they look is a big thing."

'If I hadn't had the reconstruction, I'd have found it more difficult to get over the cancer diagnosis," says Mary Kelly. "At the end of the day, your breasts are like another limb. You breastfeed your children, they're a big part of your life. And they're visible -- it's not like getting your appendix out. And it isn't just if you're wearing a low-cut top that your breasts can be seen. If you're wearing a cardy, or a sheer knit jumper, you'd be able to see and I didn't want anyone to know that I'd had an operation.

"Having had the reconstruction, I didn't have to think: will I have to change my wardrobe or be able to wear this top? But now, I look great! I look the same as I did prior to diagnosis and I can wear anything. I went to a friend's wedding last week, and not one person would have known I'd had a mastectomy."

For Ann Middleton (45), a primary school teacher from Co Cavan and one of Malcolm Kell's patients, the thought of having her breast reconstructed after doctors found a cluster of pre-cancerous cells measuring 5cm across her left breast was the only thing that got her through the shock of diagnosis.

"It was very big and they insisted on a mastectomy. The whole thing was just such a shock -- I didn't want them to remove the whole breast.

"I got a second and a third opinion, but it was clear it was the only way. I was completely traumatised. When I heard the word mastectomy, I couldn't bear to think about it. I couldn't have coped without knowing I could have a reconstruction."

Ann's breast was reconstructed using a silicon implant and tissues from her back. A few months later, she returned to the Mater where the implant was replaced with a bigger one to ensure both her breasts were the same size.

She is delighted with the results. "I can wear the same clothes that I wore before. I have a cleavage, so I can wear low-cut dresses or tops. I've already bought some new bikinis since the operation."

But it's not all about appearance. Reconstructing a breast after mastectomy is also deeply practical, Mr Kell believes, and he regularly reconstructs breasts for women in their 70s and older.

'Often patients are embarrassed asking about reconstruction as they think they are asking for an aesthetic thing. But it's very pragmatic. It means they can buy a normal bra and clothes without thinking how the mastectomy has affected them.

"It is not a vanity thing, but it means not having to buy some weird surgical bra. That makes life easier, they don't have to buy a new wardrobe because everything is lopsided now. A lot of patients say to me they were uncertain of reconstruction at the time but now, they are happy with it."

Reconstruction adds significantly to the surgical impact of the operation, concedes Malcolm Kell. He recommends that anyone having a mastectomy operation should be offered counselling, either at the time of the mastectomy or later on.

His patients at the Mater are given pamphlets and as much information on the process as he can find for them. In some cases, patients meet his former patients, to see what the reconstructive surgery looks like in the flesh.

"The key thing is that patients are offered the choice. Reconstruction is a very personal decision. As with any surgery, there is the potential for things to not go right, but 90pc of patients have no problem at all."

For patients who must undergo chemotherapy or radiotherapy in addition to surgery, reconstruction is not so simple. Radiation damages the breast tissue, making it less able to support an implant.

"Radiation has a detrimental effect on breast reconstruction," explains Kell. "It can scar and doesn't work as well. If radiation happens, you'll probably have to do revisional surgery afterwards to try and get rid of the extra scar tissue."

And not everyone is suitable for breast reconstruction. Reconstructions are very difficult on obese women, and similarly smokers, whose arteries and veins are in poor condition.

"With heavy smokers they have narrow arteries and blood vessels, and the skin becomes thin and the blood supply is compromised and the skin just dies," explains Kell. "They just don't tolerate it very well."

But for those who've been lucky enough to receive an early diagnosis, like Ann and Mary, mastectomy and reconstruction allows them to carry on with their lives, largely unaffected by their physical ordeal.

"Having gone through breast cancer, I realised that it wasn't the end of the world," says Mary. "And as it turned out, it wasn't the end of my breast either."

Ann Middleton feels the same way. She's returned already to her teaching job and is looking forward to wearing that new bikini on her next holiday.

"On my last appointment at the Mater, Mr Kell told me to put the cancer behind me. I told him I already have."

Irish Independent

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