In 2012, cancer deaths worldwide flared to a staggering 8.2 million, up by 11 percent in five years. The biggest spike in the cancer death toll was due to breast cancer, according to “GLOBOCAN 2012”, the report by the World Health Organization’s International Agency for Research (IARC), which covers 28 cancer forms in 184 countries. Breast cancer fatalities reached as many as 522,000, increasing by as much as 14 percent from 2008 to 2012. It is the top cause of death among women globally.
What has been causing this dramatic increase? A change in lifestyle, says David Forman, head of the IARC Section of Cancer Information. “A shift in lifestyles is causing an increase in incidence, and partly because clinical advances to combat the disease are not reaching women living in these regions.” The lifestyles of the more cancer-prone countries—more industrialized nations, “leads to a rising burden of cancers associated with reproductive, dietary, and hormonal risk factors.”
For developing or less-developed countries, the rate of cancer deaths is higher because their tumors are not detected, diagnosed and treated early enough, adds Christopher Wild, IARC director. These deaths accounted for as much as 65 percent in new cancer cases in 2012.
Related articles:
• What you Need to Know about Postpartum Breast Cancer
• Data: Mortality Rate among Younger Breast Cancer Patients Higher than Older Counterparts
Last year, Angelina Jolie made headlines when she revealed her ordeal and the tough choice she faced regarding her mastectomy. Having a family history of cancer, Angelina underwent a preventive double mastectomy which happened in phases for several months.
Photo by Airman Magazine via flickr creative commons
What has also got the web buzzing were Angelina’s choices regarding breast reconstruction. People are curious as to what they are to do after the surgery – can things be brought back to the way they were before? If not, how much closer to normal can life be like? What are plastic surgeons capable of restoring?
To get a clearer picture of the situation, we interviewed Dr. Benjamin G. Herbosa, MD, FPSGS, FPCS, FPAPRAS, FICS, FACS, FIPRAS, a diplomate of the Philippine Board of Surgery and also a diplomate of the Philippine Board of Plastic Surgery.
Smart Parenting: Can post mastectomy breast reconstruction be done here in the Philippines? What are the surgical procedures that doctors can perform?
Dr. Benny Herbosa: Of course, that is what we've been doing.. We can make something close to what the original breasts were like, but they will never be exactly the same. Since there are many options in breast reconstruction, we definitely can restore volume, size and shape, although they will be a bit less accurate, in terms of how the original pair of breasts looked.
We can also do autogenous (using the patient’s own tissue to repair the damage done by the mastectomy) or non-autogenous procedures like implants, as well as large volume fat tissue transfers and/or transplantation.
SP: Is it possible to save the breast tissue or nipples after a mastectomy? If not, is it possible to reconstruct them? Can breasts be reconstructed to look as they were before or even better?
BH: Nipple sparing can be done depending on the breast cancer stage (for early stage and small lesions) and breast cancer type. We use skate flaps or free nipple transfers from the opposite breast (both are forms of tissue grafting). We also use full thickness skin grafts from other parts of the body that are designed to look like nipples. Breasts can be molded and shaped to look better if not larger.
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SP: How much do these procedures cost?
BH: It depends on what is used for the reconstructive surgery. If autogenous tissue is used, it is more expensive than the insertion of implants. It also depends on whether both breasts will undergo reconstruction. A single breast reconstruction would cost for P120,000 for professional services, excluding anesthesia fees and operating room charges.
SP: How will the breasts be like after the procedure? Will there be discomfort? Will the breasts feel strange or alien to its owner?
BH: The breasts should be nicely shaped after the surgery, though they may be swollen and will feel "heavy" for a few days, up to two weeks or so. As this is a surgical procedure, there will also be initial scarring and that will also require just as much time to heal, when combined with the mastectomy.
SP: How does a post mastectomy breast reconstruction affect one’s chances of having children in the future?
BH: Breast reconstruction has nothing to do with pregnancy and childbearing. You can have as many children as you wish before or after the procedure. However, when a breast cancer patient gets chemotherapy as an adjunct treatment, sometimes her ability to get pregnant may be affected. This basically means a breast reconstruction patient can still have children but [this] may be affected by her cancer treatment modalities. Chemotherapy especially has that effect on the human body.
SP: What will be the consequences of this procedure for a woman? Her partner? Her existing children?
BH: All in all, the procedure is good for a cancer survivor. The husband and the children should support her in this endeavor since of course, she just experienced a deforming, "dismantling" of her body, and that can take its toll on her self-image.
SP: Will a woman be able to breastfeed after undergoing breast reconstructive surgery?
BH: Normally, yes, a patient can continue to breastfeed, so long as her breasts were not completely removed and irradiated. Of course, this is highly unlikely in women who have had severe procedures such as radical mastectomies.
SP: How will this procedure affect her sex life?
BH: Breast reconstruction should help improve or restore the positive body image of a cancer survivor, which can rekindle a sex life placed on hold due to therapy, surgery and recuperation. However, there are those whose initial reaction is horror upon seeing the initial scars resulting from the procedures. It’s like people who have endured terrible injuries during wartime, and that can become a stigma for them, and for others around them. The after-trauma or post-traumatic stress disorder that results affects the psyche more than the physical, and therapy and counseling would be advisable under those circumstances.
SP: How will this procedure affect a woman’s self-image as a person? As a woman?
BH: When you start to look good, you will also start to feel good and self image improves tremendously especially for women who undergo this procedure. They feel whole again.
SP: If I must have post-mastectomy breast reconstruction, what must I do to prepare for it? Should I already begin preparation even before the mastectomy?
BH: Yes, you will have to prepare and think about everything when the option of mastectomy has been handed to you. You will need for your psychological disposition to be at its best, as scarring and pain will all be part of the reconstruction process.
SP: Should men consider this? After all, a small percentage of men are also at risk for breast cancer and if they have theirs removed, they may want to know what their options are.
BH: There is not much reconstruction for men as the chances of breast cancer in men are hardly ever even encountered.
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