Breast Reconstruction and Emotional Wellbeing
A study led by researchers at the University of Michigan has found that breast reconstruction after mastectomy can have significant psychological and emotional benefits for breast cancer patients. Writing in the October issue of the journal Plastic and Reconstructive Surgery, Dr. Edwin Wilkins of the University of Michigan and colleagues also determined that women who had immediate reconstruction at the time of their mastectomy had more of a psychological boost than those who waited to have the procedure at a later date.
Interestingly, the researchers further concluded that the specific type of reconstructive surgery-saline or silicone implants vs. using the patient's own tissue-made little difference for a woman's psychological recovery. "We saw emotional benefits from both types of procedures," said Wilkins. "Quite frankly, the actual type of reconstruction technique often meant more to the surgeon than to the patient-and usually reflected the surgeon's own particular experience with a procedure."
Breast reconstruction is an option offered to some women who have had a breast removed because of cancer. It may be done at the time of the mastectomy (immediate reconstruction), or performed months to years after the mastectomy (delayed reconstruction). The breast may be reconstructed with an implant or with tissue from one's own body.
Saline (salt water) and silicone (liquid plastic) implants are both available to women with breast cancer, although the use of silicone implants has been dramatically reduced. The implants are generally placed under the skin behind the chest muscle. Implant procedures usually begin with a tissue expander-an inflatable implant containing a metal port for saline injection-to stretch the skin. Then the skin expander is replaced with a permanent implant.
When a person's own tissue is used, muscle, blood vessels, fat and skin from another part of the body can be moved to the chest area to form a new breast. Tissue can be taken from the lower stomach area (called a Tram flap), back or buttocks.
After the first reconstructive surgery, smaller surgeries are usually needed to complete the process. Creating and tattooing the nipple is one extra step in reconstruction. Small changes in the shape of the reconstructed breast might also be needed, as well as surgery on the opposite breast to create similarly shaped breasts.
The Michigan-led study, called the "Michigan Breast Reconstruction Outcome Survey," evaluated 250 mastectomy patients at 12 medical centers in the U.S. and Canada. Two separate surveys were given to each patient to assess their emotional state-the first a few days before the reconstructive surgery and the second a year after the surgery. The surveys evaluated each woman's emotional wellbeing, vitality, general mental health, social functioning, and body image. After reconstruction, the women were also asked about their satisfaction with their surgery. The results were then compared among the women who chose different reconstruction approaches and different timing for their reconstructive surgeries.
Most of the women (184) had breast reconstructions from their own tissue, while the rest had artificial tissue expanders or implants filled with saline or silicone. More than two-thirds had reconstruction at the same time as their mastectomy surgery.
According to the authors, the study confirmed that any kind of reconstruction gave women a psychological and emotional boost during their recovery. But they added that the timing of the reconstruction did indeed make a difference.
The researchers found that the biggest psychological boost was experienced by women who opted for reconstruction during the same operation as their mastectomy, rather than waiting until a later date for the additional surgery. "The largest effect seemed to occur in those who came out of mastectomy surgery with a new breast already in place," said Wilkins. "But even patients who waited experienced a substantial positive upswing."
Emotional and psychological benefits accrued regardless of the type of reconstruction performed. "The true objective for the reconstruction should be to produce the quality of life benefits that matter most to the patient," Wilkins said. "And simply having a breast reconstruction, rather than the specific type of surgery, is what mattered most."
The 1998 Federal Breast Reconstruction Law, sometimes referred to as the Women's Health and Cancer Rights Act of 1998, has had a dramatic impact on the number of breast reconstructions being performed in the United States. It requires group and individual health insurance plans to cover reconstructive surgery after mastectomy, as well as implants and other work needed to make the other breast symmetrical.
"Our findings appear to justify recent efforts by legislators and policy makers to widen the availability of reconstruction after mastectomy," added Wilkins.
SOURCES:
University of Michigan Health System (http://www.umich.edu)
Plastic and Reconstructive Surgery, October 2000
The Susan G. Komen Breast Cancer Foundation (http://www.komen.org)
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