Not all women choose reconstruction after mastectomy; the options are many - Chicago Tribune




Not all women choose reconstruction after mastectomy; the options are many - Chicago Tribue

CHICAGO TRIBUNE

It had taken some years for Nicole McLean to embrace her God-given breasts, ample at size H cups. So when, at 39, she was diagnosed with stage 3 breast cancer and told, despite her adamant protests, that mastectomy was the best option, McLean never hesitated to pursue reconstruction.
For Barbara Kriss, a second breast cancer diagnosis three years after her first left her eager to do anything to prevent a third. So, at 57, she had both breasts removed — and rather than put her body through any more surgery, she let her chest remain flat.
Deciding what to do about breasts post-mastectomy — implants or natural tissue reconstruction, breast forms or nothing at all — is among the most personal and emotional choices women make in the breast cancer battle.
Some doctors and advocates worry women don’t know all of their options.
A survey last year by the nonprofit Cancer Support Community found that 40 percent of women didn’t receive full information about reconstruction at the time of their breast cancer diagnosis.
“Losing a breast is like an amputation; women need to know that reconstruction is available for everyone,” said Dr. Christopher Trahan, plastic surgeon at the Center for Restorative Breast Surgery in New Orleans. His practice sees many women who were inaccurately told they’re not candidates for reconstruction.
Kriss, by contrast, feels that doctors push reconstruction for women to “feel whole” and don’t acknowledge that breasts aren’t so important to everyone. Kriss, of Miami, was eager to get back to her active lifestyle without further complications, so she asked her mastectomy surgeon to leave her breast-free chest as aesthetically pleasing as possible.
“I didn’t find it very upsetting,” Kriss said of seeing her symmetrical incisions post-mastectomy. Kriss, now 62, wears breast forms under her clothes and runs the nonprofit site breastfree.org to offer advice and prosthesis resources for women who choose not to reconstruct or want more time to think about it.
Federal law requires group health plans that cover mastectomy to also cover the cost of reconstruction, including surgery to balance an old breast with the new, as well as external breast prostheses. Deductibles and co-payments must be the same as those for other conditions covered by the plan.
Women choosing reconstruction have many options, though they may have to shop around to find doctors with expertise in more innovative procedures.
In addition to silicone implants, which are the most common reconstruction choice, doctors can create new breasts using living tissue from the abdominal region (called TRAM flaps) or upper back (called latissimus dorsi flaps), giving the new breast a live blood supply and much more natural look and feel than implants, Trahan said.
While natural tissue reconstruction is more invasive and entails longer recovery than implants on the front end, implants often require more surgery down the road: Half of women who get silicone gel implants for reconstruction have to get them removed 10 years later, according to the FDA, which also advises those with silicone implants to check for subtle tears every two years with an MRI. Implants also run the risk of capsular contracture, wherein the connective tissue overscars and can cause hardness and pain, and they are not advisable for women who must undergo radiation.
One of the most advanced natural tissue procedures is called DIEP, which uses extra tissue and fat without disturbing the muscles and therefore requires less recovery, Trahan said. Doctors can combine fat taken from the abdomen and hips to create a breast, which is helpful for thin women who don’t have much fat to spare or those needing to match a very large breast, Trahan said.
On the implant end, a newer innovation is the adjustable saline implant, which is put in at the time of mastectomy and gradually injected with saline every week, during brief doctor’s visits, until the correct breast size is achieved, said plastic surgeon Dr. Jeffrey Weinzweig. Adjustable implants eliminate the need for expanders, which are commonly required before having an implant inserted to gradually stretch the skin.
For McLean, who chronicles her experience on her blog, “My Fabulous Boobies” (fabulous-boobies.blogspot.com), getting a new breast was worth the long journey.
Because she required radiation post-mastectomy, McLean held off on reconstruction for 10 months, an “unbelievably difficult” period because the prosthesis she wore on her breastless side was smaller than her natural breast, and she was self-conscious about being lopsided.
Reconstruction, when the time came, was a 12-hour surgery for the TRAM procedure with an eight-week recovery at home. A few months later, McLean had her natural breast reduced to match the new one.
McLean, now 42, has no sensation in her new breast and the scars remain. But she likes that she can wear a halter top if she chooses — and a flatter tummy is a nice bonus.
“It was the only thing that I thought would make me feel more normal after everything I had gone through,” she said.

Read more here: http://www.miamiherald.com/2011/09/27/v-fullstory/2426079/not-all-women-choose-reconstruction.html#storylink=cpy

Why I don't care about a bald Barbie

In case you've missed it, there has been a huge social media push for Mattel to produce a bald Barbie doll. [bald Barbie makes the news]

The supporters of this movement believe that the bald doll should be created in order to support children who have lost their hair to illness or cancer treatment. And to also help children to ease their fears and concerns when someone they love loses their hair due to cancer treatment. I think the intention is noble. I really do. But bear with me as I try to explain why I am torn on the issue.

I am an African-American woman. I am also a breast cancer survivor who lost her hair during chemotherapy to treat stage 3 breast cancer a few years ago. I wear my hair very short (nearly bald actually) and that is for two reasons. One, it looks good on me. And two, I have no patience to sit in a hair salon for hours every week to be styled and I don't have the money to support such a habit. Be clear, hair is a big damned deal for black women. A really, REALLY big deal. Ask Chris Rock about it. He produced a stunningly interesting documentary about some of the issues surrounding black women and their hair a few years ago. If you haven't seen "Good Hair" please do check it out. [Wikipedia link on Good Hair]  I promise you that you will be stunned and amazed at the efforts that black women put forth in order to keep their hair perfectly coiffed. And the amount of money. Sisters will go into debt over their hair. Seriously.
(this is Nicole boobies-blogger)
The fact that black women spend 9 BILLION dollars on their hair should tell you just how deep the hair issue is for us. It is not a game. Hair matters.

And I know that hair matters for women of all ethnicities. In many cultures, a woman's hair is her crowning glory. Without hair some women feel like they are not a woman.

So, a bald Barbie doll for a girl like me, makes my heart swell with pride and crack with pain at the same time. Having the "right" hair not only affects how you look at yourself, but your job prospects, your love interests and how other people judge you. I don't want to seem dismissive of how much it can affect a child to lose her hair. It brings grown women to their knees. Believe me, I get it.

I understand that losing your hair can be so heart-breaking that you lose your sense of yourself and your beauty. Barbie dolls have fans in every age group -- from kids to grandmothers -- and we love Barbie because she is a stylized icon of American beauty. But that is where I am challenged about a bald Barbie.

Barbie is a concept of beauty based on European standards. Her features are distinctly white and "non-ethnic". In all honestly, that's fine. That is who Barbie is and we love her for that kind of beauty. Today, Barbie has ethnic friends (dolls  created to reflect different races) However, Barbie's friends look like Barbie with a tan and a different hairstyle (still pretty European looking). That image of what defines beauty challenges me. A bald Barbie is still Barbie. A gorgeous and flawless face, with flawless skin and unrealistic body proportions. Taking off her hair still presents a little girl with very unrealistic standards of beauty.

Barbie, bald or otherwise, is still a reflection of a standard of beauty that is far more fantasy than reality. That comforts me (because that is who Barbie has been all of my life) and it challenges me (because I will never, ever look like Barbie). So a bald Barbie will be hairless and still represent unattainable "perfection". Does this help or harm a sick child who is even farther away from perfection than her healthy friends?

There is no perfection in cancer. Every scar, every surgery, every medicine, every treatment... changes who we are down to a cellular level. Removing Barbie's hair will NOT reflect those changes and challenges. It isn't possible to do so.

Will bald Barbie have scars? Will she come with props that include a hospital gown or an IV drip? Will a hospital bed become an option to purchase? The Barbie accessories are as important as the doll, as far as the experience goes. Will there be miniature MRI machines or radiation machines? Will Ken show up dressed in scrubs and present as Ken, doctor of oncology? I mean... all of those things are also a part of the experience of being a sick person who loses their hair because of cancer.

And since many of the purchasers and collectors of Barbie dolls are adults... can we get a Mastectomy Barbie too? A Barbie with tits that screw off perhaps? A Barbie who has the option to wear a prosthesis or sport her flat chest. Can she come with the requisite scars (maybe stickers would suffice so you could place them just so) and IV drips and hospital gowns? Is there a way that we can dial down her weight... to reflect the effects of the chemo? Or dial it up... to reflect the effects of other drugs and steroids?

See... just cutting off her hair sort of minimizes the entire journey. And while normally I'm all about taking whatever baby steps towards awareness that people can swallow... this is one that makes me very uncomfortable.

When I was in chemo in 2008, I came across a pamphlet advertising a doll for children of cancer patients. It was a soft doll (like a rag doll) and she had removable yarn hair. I believe that she was custom ordered so that her skin tone and her hair color matched the patient she was supposed to identify with. But since she was a cloth doll, she didn't have the exaggerated sexiness and cartoonishly perfect body that Barbie has. She was just a little rag doll with yarn hair and a scarf -- you could tie her head up with or without her hair. And she was totally adorable. In all honestly, I thought it was a fantastic idea and I felt that the dolls would probably make a lot of little girls really happy.

But Barbie? I'm not getting the same fuzzy feelings. I love Barbie. I spent lots of hours learning to play with hair and makeup on my Barbie makeup head. I was a girly girl who always wanted the newest Barbie accessories every Christmas. I must have had two or three Barbie houses, Barbie pools, Barbie cars and tons of those little stiletto shoes (that always managed to get lost). So, please don't take this long post as a bash on Barbie. She was a huge part of my childhood. I think of her fondly and I do still love her. However, I don't know about bald Barbie really helping the way that people are believing that it will.

Those are my thoughts. What are some of yours? Should Mattel go forward with creating a bald Barbie?

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