Accessing reconstructive surgery after breast cancer treatment

One in nine Canadian women will develop breast cancer in their life time. The growth of screening programs means that breast cancer is being caught and treated earlier. Often, treatment involves surgery – lumpectomy or mastectomy.

Increasingly, women are also choosing to undergo breast reconstruction surgery following treatment.

However, only some of these breast cancer surgeries are deemed a priority and given special funding to improve access.

Growth in preventative mastectomy & reconstruction

Traditionally, preventative surgery and reconstruction have not been given the same priority as cancer treatment.

Ontario has a cancer system and medical professionals who treat cancer with powerful chemotherapy drugs, radiation and surgery. Sometimes, this system is focused on ’the fight against cancer’, but not dealing with its aftermath.

Florianne Yeung was first diagnosed with breast cancer at the age of 39 and following treatment, which included radiation and surgery, underwent breast reconstruction surgery.

She says “reconstruction was a very important part of my journey … I can forget that I had breast cancer, even with my scars, I am back to normal life.”

Opting for preventative surgery and reconstruction is a personal choice.

Research shows that women who have not yet had a cancer diagnosis but are at high risk of cancer, and younger women, are more likely to choose breast reconstruction surgery.

Kim Winchcombe, diagnosed with breast cancer at the age of 42, describes how she advocated for a second mastectomy and reconstruction after her initial diagnosis. “It’s my body and is what I wanted” she says.

Nancy Baxter, a surgeon at St. Michael’s Hospital says that increasingly people in her field are “seeing reconstruction as part of oncology care.”

“There is an increasing awareness of the need to maintain quality of life, and while research demonstrates that reconstruction isn’t for everyone, it can be an important part of recovery for some women” says Baxter.

Growing evidence for breast reconstruction surgery

Research has found that for women at high risk of developing breast cancer, who have the BRCA1/2 genetic mutation, preventative mastectomy reduces the risk of developing breast cancer by 87%.

Often, women with the BRCA1/2 genetic mutation choose to undergo both prophylactic mastectomy and breast reconstruction surgery at the same time.

Women with a diagnosis of breast cancer are also increasingly undergoing preventative surgery, removing not only the identified cancer, but the other breast as well, to reduce further recurrence.

A United States study published in 2009 found that the rate of preventative surgery for these women doubled in ten years. A Canadian report also found that the rate of preventative mastectomy is increasing.

Kelly Metcalfe, professor at the University of Toronto Bloomberg Faculty of Nursing highlights the increase in preventative surgery for some women, once breast cancer is diagnosed. She says “if we can save a woman from the first breast cancer, it doesn’t make sense not to want to prevent cancer from happening in the future.”

With higher rates of mastectomy, have come increased rates of breast reconstruction surgery. This trend is particularly evident in younger women, under the age of fifty.

Breast reconstruction surgery is usually delayed until after all treatment for the cancer, including radiation, is complete.

While the number of women opting for preventative surgery and breast reconstruction has grown, there are gaps in knowledge and information around how, where, when and why patients are accessing breast reconstruction surgery.

Waiting for surgery

The Ontario Ministry of Health and Long-Term Care provides special priority funding to ensure that women who need surgery as part of cancer treatment get it in a timely way. This was first put in place in 2004, in response to higher than optimal wait times for breast cancer surgery.

Timely access to surgery is critical when a cancer needs to be removed, because longer waits can mean that the breast cancer can grow and possibly spread to other parts of the body.

The current target for breast cancer surgery waits in Ontario is 84 days (meaning that 90% of women get their surgery within 84 days). Many centers across Ontario achieve lower wait times than the target. There is no information available on the average national wait times or targets.

You can explore breast cancer surgery waits for Ontario here and for Alberta here.

However, preventative mastectomies for those who have received a cancer diagnosis, and those women at high risk, are not funded through priority dollars.

As such, waits for these procedures are much longer since the need is not immediate or urgent. Similarly, breast reconstruction is not funded through priority dollars. These surgeries are funded through hospital global budgets and reflect hospital priorities for surgery, as well as the supply of operating rooms and surgical staff.

Dr. Laura Snell, a plastic surgeon at Sunnybrook Health Sciences Center, acknowledges the challenges of funding all surgeries under tight budgets. “It’s hard to prioritize prophylactic surgery and reconstruction with limited resources in the system” she says.

Pilot program at the Ottawa Hospital

The Ottawa Hospital has recently set up a program at its Riverside site that offers same day mastectomy and reconstruction surgery. It is targeted at improving access for high risk women who choose preventative surgery.

This program runs two operating rooms side by side with a surgical oncologist doing mastectomies, and a plastic surgeon doing breast reconstruction surgeries. This means that more patients will be able to have both surgeries in one day.

Dr. James Watters, medical director of the Women’s Breast Health Centre at the Ottawa Hospital says this program keeps women who are getting preventative surgery “from competing for Operating Rooms and resources  in other streams with patients who have active cancers.”

Access to reconstruction after mastectomy

There is no provincial data available on wait times for immediate breast reconstruction, which is done in conjunction with a mastectomy. However, a 2010 study of 57 women seeking breast reconstruction surgery at St. Joseph’s Health Centre in London, Ontario found an average of 98 days wait time for immediate reconstruction, and a 359 days wait for delayed reconstruction.

The target wait time in Ontario for delayed breast reconstruction is 182 days, and but the actual wait times at Ontario hospitals range from under 90 days to over 650 days.

This wait is measured from the time that the patient meets with the surgeon to the actual date of surgery.

Often, patients wait to schedule breast reconstruction surgery for important medical reasons such as allowing scars from the mastectomy to heal and having radiation treatment following surgery.

Snell suggests “resource availability” of both surgeons and operating room time is a significant cause of waits once surgery is booked. “We cannot accommodate all of the women who want delayed reconstruction” she says, noting that “reconstruction is not considered a cancer operation, with no additional funds for hospitals which treat these women.”

Further, there is tremendous geographic variation in who has these surgeries. Women in the Toronto area are twice as likely to undergo breast reconstruction as those in the rest of the province.

This is in part due to the availability of plastic surgeons who do breast reconstruction surgery. Dr. Baxter notes that when patients undergo breast reconstruction, a plastic surgeon is working in collaboration with cancer surgeons and providers. “It involves coordination of care. Unless there is a systems approach to do it, it will be hard to increase availability” she says.

The comments section is closed.

  • sandra collins says:

    Definitely women having mastectomies because of cancer should receive reconstructive surgery ASAP, whether the cancer is already present or the patient with cancer in 1 breast fears developing cancer in the other (or she is at genetic high risk for development of cancer but doesn’t have it yet). In that situation, both mastectomies are necessary for her health. In the breast with cancer, that mastectomy is to remove cancer (treatment to cure disease); in other breast, to prevent a life-threatening disease (prevention) and to cure emotional suffering due anxiety of developing cancer (for mental health of patient). If she has both breasts removed to prevent cancer in either of them, she should have priority for immediate reconstruction, too. DEFINITELY our hospitals should give both a priority. My concern is about whether surgeons are using our taxpayer funded hospitals to give priority to insertion of silicone implants in women who don’t have cancer simply for cosmetic reasons; they want bigger breasts. Yes, they pay not OHIP, but are women with cancer, or anxiety about developing it, waiting for reconstruction in our hospitals because women who want bigger breasts have priority over women who have cancer or have fears of developing cancer? Why? To give our plastic surgeons the opportunity to use our taxpayer funded hospitals to gain higher incomes doing cosmetic work (for which the patient pays personally) )while forcing women with cancer to wait for reconstruction either to cure or to prevent of breast cancer?

  • Thomas Silvestri says:

    Very nice article informative content thanks we liked it.

  • Jean Laughlin says:

    Chemotherapy allowed me to have what I thought was a simple lumpectomy which was to be followed by radiation. I had no intention to have reconstruction of any kind. I was happy to be rid of the cancer and expected to have some scars and possibly irregular areas. No worries. However, to the surprise of my surgeon I developed inner tissue scar contraction which causes a tightening forcing surface tissue to have lumps and gouges not even near the incision site but unfortunately in the upper breast area. Radiation therapy is next but I have been assured that this will not correct the deformity. A plastic surgeon is to be consulted in about a year following radiation with the view of inserting liquid fat in the area. Everyone is different and faces different challenges. It is a hard road, no question. I have no idea of the standards of care and coverage provided and don’t really know where to find this info. Why is this info so hard to find? There’s a plethora of info on standard treatments and ‘normal’ side effects but …

    • Susan Ruddick says:

      You are so right Jean, information is hard to find . I don’t know where you live but in Edmonton, AB I had a Nurse Navigator and a group called Healing Connections at the Misericordia Hospital who were wonderful resources for me . If not for them I would not have found out about breast reconstruction. I did some research on the Internet about radiation on the left breast and I decided I didn’t want to take a chance on damaging my heart so I opted for a mastectomy which fortunately resulted in my not needing radiation. I had DCIS Stage 0 non invasive breast cancer. Perhaps you could call your hospital to see if they offer a program for women diagnosed with breast cancer to contact for support or perhaps a plastic surgeon or your general surgeon may be able to send you in the right direction. Hope you find the answers you need, things are slowly changing but we women need to speak up and demand more information prior to any treatment beginning so we can make informed decisions. You could try looking up BRA DAY Canada for information. Good luck. Susan Ruddick

  • Susan Ruddick says:

    Have we lost the human touch in medicine? Everywhere you look it’s all about the budget …the budget. ..we can’t do it because we don’t have the budget. Why don’t we have the budget … Alberta supposedly has one of the highest budgets for health care and yet the budget is always the excuse we get ? Why is it that 40% of American women have breast reconstruction after a breast cancer diagnosis but only 9% of Canadian women have this done and yet we are told Canada has the better health care system. If it is the budget … why is it already covered under AHS? When pressed, officials cite lack of qualified plastic surgeons or lack of OR time as the reasons .

    I believe the problem lies with poorly organized hospitals and schedules for highly trained breast plastic surgeons. We have these surgeons working shifts in the ER and not maximizing their expertise restoring women’s breasts after a mastectomy. There needs to be an overhaul on how surgeons are allotted OR time and maximize the coordination of general surgeons with plastic surgeons for immediate reconstruction after a mastectomy. This is the most cost efficient way of giving care to these women.

    Many women are left feeling abandoned by the system once their treatment for the cancer ends and they are not even aware breast reconstruction was an option. I myself was diagnosed with breast cancer in October 2013 and had a lumpectomy which did not result in a clear margin and it was only after I decided I wanted a mastectomy that reconstruction was offered as an option for me. Why didn’t I know this prior to the lumpectomy … I could have saved the system the cost of the lumpectomy and gone straight to the mastectomy and immediate reconstruction.

    Not every woman will choose reconstruction but every woman deserves to know all of her options before any treatment is considered. Not every woman would qualify for breast reconstruction depending on the type and stage of her breast cancer but she deserves to know all of her options up front. The budget seems to get in the way of treating the patient with respect and dignity not to mention fairness. Who decides which woman gets offered breast reconstruction and who tells the women who later find out they could have had immediate reconstruction? Some of these women have gone through years feeling less than a woman, feeling depressed and suffering from low self esteem all because the powers that be wanted to get their bonuses by not breaking the budget. These women are human beings with feelings and long lives ahead of them…are they not worth feeling whole again …feeling normal as they go about fulfilling their career and family obligations? Once they find out they could have had breast reconstruction they face long waits to even see a plastic surgeon and longer yet …sometimes years to have surgery.

    There needs to be a better way to approach this …she should have a medical team who is informed and willing to work together to make her well and whole again. There should be a surgeon, oncologist and a mental health provider working together with the patient …not infighting about who gets paid for what and which department is more important…..the “patient” is the most important and should be treated fairly and with dignity.

    Breast reconstruction is NOT cosmetic surgery and it should be considered as part of the cancer treatment . It is like having physical therapy after an injury or rehabilitation after an amputation, because…after all it is an amputation. Imagine feeling whole again… imagine feeling great again… I feel great again and I want all of these brave women to be treated as I have been. Come on AHS/SCN (Strategic Clinical Networks) you can do it …work together with your various branches and do what is right for the patient.

    S. Ruddick

    • Deborah Hannam says:

      Wow you hit the nail right on the head, as the wait can be along time for sure, had double mascetomy but won’t get reconstruction until twenty eight teen ,

      • Susan Ruddick says:

        Thanks, so sorry you have such a long wait,Deborah. You may want to consider attending BRA Day, there is a lot of valuable information presented and you could speak with women who have had different types of breast reconstruction and see the results in the Show and Tell lounge.

  • Mary Bertram says:

    As a woman who was diagnosed with breast cancer six months after my husband passed away, I believe that reconstruction surgery would have been invaluable to my self esteem and my ability to move forward with my life. After 10 years living with one very deformed half breast and the other one normal for my age, I had to have some reconstruction due to scarring and radiation thickening. As a result the plastic surgeon made my deformed breast much more normal looking and decreased the other one to balance with it. I am very pleased with the results and feel normal for the first time in 10 years. I just wish that I had been offered the choice to have reconstruction at the time of my initial cancer surgery and feel that I wouldn’t have wasted so many years feeling that my body was ugly and deformed, but at least I am now happy with the results and am grateful to have had the opportunity to feel normal again.

    • Susan Ruddick says:

      So happy you have had a good outcome, Mary. I too have had reconstruction surgery and have been advocating for the healthcare system to give women all of their options at the time of a breast cancer diagnosis so they can make informed decisions prior to their treatment beginning. I am so glad you feel normal again and continued good health to you.

  • Debbie says:

    I am a Breast Cancer Survivor of 8 and half years. Nov. 22nd 2006 lost my left breast right to the bone. Today I am healing from reconstruction it is a long wait for the operation I wanted but also needed time to treat my cancer and heal from it. Every person should have the right to get reconstruction when they feel ready for it. I have been waiting for a doctor who is wonderful I must add
    to do mine. I am about 13 days post off. My thoughts I am happy and feel whole again. Still alot of healing time adhead of me but I can smile and see me coming back. Scars and all I feel wonderful the pain will start to go away in time but it was 150% worth it.

    Reading some of the comments make me say reconstruction is covered where I live by MSI as part of cancer treatment. I chose to wait to find a doctor who I trusted as I was on the table a long time, worth it as I can feel touch and temps on my new boob I love it. Still more healing and stuff but I love it…………..

  • Bernie says:

    Would nipple reconstruction inhibit detection of a second cancer growth in the same breast?

  • Lily Mathies says:

    Breast are an important part of a woman’s body. Would a man want to walk around without his family jewelry?…I’m guessing NO!

  • Jennifer says:

    I am a 48 year old breast cancer patient. I have had chemo and was very sick with it including hospitalization for infection and blood transfusion. I have met with my surgeon and will have a mastectomy in the next 2 weeks followed by 30 radiation treatments. I learned from my surgeon that I will have a 2 year wait from the time I meet the plastic surgeon until I have reconstruction. 2 years! I am devastated! After going through all of this I am not even going to have my dignity restored for two years? But I will have to bear the burden of seeing the absent breast every time I bath and dress and will be conscious of it when it comes to being intimate with my partner. I will have to bear the expense of mastectomy undergarments and bathing suits and possibly the cost of a prosthetic device if I do not qualify for funding. The worst thing about this whole ordeal is having to prepare my 4 year-old daughter for each stage that lies ahead. Now I have to tell her that my breast will be removed and I won’t get a new one until she is 6 years-old. If she was going to have to watch me go through this hell and I was going to have to experience all of this the least that could happen is that I could come out of this looking womanly and whole in a timely fashion. Mentally and emotionally it is an important part of this journey. The system is very flawed in thinking that a woman can be hacked up and then thrown on a back burner for a few years till they get around to doing what is right and important.

  • Ahsaet B says:

    Having had the unfortunate experience of TWO double mastectomies (YES TWO), due to a complete disaster of the first, and then being TWO years on a waiting list in B.C., Breast Cancer Reconstruction should definitely be a priority!! Funds should also be increased so more Cosmetic Surgeons are willing to do Breast Cancer Reconstruction right the first time with no rush in the OR!!! This should be CANADA WIDE!!!
    As far as cures vs treatments, a breast cancer patient should be given an option to trials regardless of what Province you live in!! We are ALL Canadians and each should be treated equally. I personally would love to see Dr. Stanislaw Burzynski, (Burzynski, The Movie on FB) welcomed by the Canadian Cancer Society for trials in CANADA to start immediately!!

    • Karen B says:

      Hi Ahsaet,
      I am moved by your comments and I feel the same way about Dr. Stanislaw Burzynski. I just came back from my appointment with the plastic surgeon today, I can’t get my surgery until Sept. 2015. At least I had a great surgeon for my bilateral mastectomy (but only because I didn’t accept the idiot they sent me to the first time). Thinking this over and pretty confused right now. What a friggin journey this is. Just want closure on this and to feel normal again. Will that ever happen?

  • Heather says:

    I am BRCA 1 Positive! I had a prophylactic double mastectomy!

    So I vote YES

    I have never had cancer, but many of my family members have. I put off genetic testing because I didn’t think I needed to know the results. Boy was I wrong! Family history should have been my wake up call earlier, but it wasn’t until my daughter was told she had breast cancer at the age of 28 that it hit home. After her diagnosis, we had the genetic testing done. We knew the answer before we got the results, so I figured it wouldn’t change my life, knowing that I am BRCA. I would take the steps needed to keep an eye on myself, but everyday after we found out we were BRCA, I lived in fear. Will I be next…..can I be as strong as those who have survived. I knew I had to do something to prevent cancer. I went to counseling and I joined groups. I researched my information and I was prepared for this drastic change.

    My daughter had one breast removed and she tried to cover it up….trying to look “normal”. She put on a brave face for everyone, but she couldn’t wait until she could have the other breast removed and have reconstruction surgery. She wanted to be back to “normal”. The way she was before the breast cancer. We both were time bombs waiting to go off and my daughter lost her battle. I don’t want to start the battle! Everyday that I waited for a qualified surgeon to see me, was another day closer to the battle field.

    Now…..3 years later, I’ve finally had my double mastectomy. They removed my triple D cups and did the reconstruction immediately. As I said earlier I went to counseling and I joined groups. I had a chance to go to the Force Conference in the USA where I saw and spoke to hundreds of women who have chosen different routes. I knew what I was up against and I was ready. I didn’t want reconstruction because women have boobs, I wanted it because I would feel “normal”.

    I am still waiting for the expanders to be replaced and I am a patient woman, but when we are sitting on a time bomb, action should be faster so that one can get on with living and feeling whole again.

  • Chris says:

    I wish I could have immediate reconstruction as an option but with the need for radiation, that is not an option. Now I am looking at a couple of years before I can start reconstruction process as it will be many months before I can even get a referral in Ottawa. I am very close to deciding to forgo the radiation so that I can have the reconstruct right away. If the wait times were not so long, it would be bearable but two years is a very long time.

    I woman diagnosed with breast cancer goes through so many emotions throughout the process but the one we are least prepared for is dealing with having one or both breasts removed and not have the necessary resources to do anything about it for several years. I feel this should be part of the treatment process for all women having mastectomies or breast disfiguring lumpectomies. Or at least woman should be informed of the options after mastectomies and be made aware of the wait times so that they can make the choices that are right for them and their well being.

  • a. kawa says:

    I’m 25yrs old have BRCA 1, decided to have the prophylactic mastectomy, cant say I would have been on board if there was a waiting period for reconstruction. My mom has been through numerous reconstructive surgery’s, and if it wasn’t part of her treatment I think that her psychological health would have been drastically effected. I prevent ted cancer, she’s trying to pick up the pieces after cancer, both should be considered important cost effective areas.

  • RKLW says:

    My reconstruction: A Skin-Sparing Bilateral Prophylactic Mastectomy using Alloderm with Tissue Expanders. Operating time: 7 hours. Appointments: Countless. Results: Priceless. Regret: Not a single second.

    My journey, however, did not begin that way. When a genetic blood test informed me at the age of 26, that I had inherited the BRCA1 gene that substantially elevated my chance of developing breast and ovarian cancer, I tucked this information away to the far back of my mind. This is where it sat. For 12 years. I smugly pooh-poohed the recommendations of prophylactic surgery and merrily skipped through my 20’s and most of my 30’s in blissful denial.

    My motive: Shame. Fear. Worry. I had seen the damage breast cancer inflicts, when as a young girl, I watched my mother grapple with breast cancer. Twice. I attempted to cleverly hide this information alongside the memories I had growing up in the shadow of my grandmother’s untimely death from ovarian cancer.

    That is until, one day, I myself became a mother. I could no longer ignore the compelling statistics, medical science and overwhelming desire to live my best, most prolonged life. I needed to get real. I needed to face the facts that the only proven method of helping me prevent breast cancer was to remove them. Thus, began the multi- year process that has gradually and gracefully transformed far more than my physical appearance.

    Despite the challenges of living in a rural location, I began to learn, with the guidance and help of knowledgeable health care providers that there were many possibilities available to BRCA1 patients. Some I recognized; others, I had no idea existed. One such option was breast removal with immediate reconstruction. The notion of awakening from double mastectomy surgery – with breasts – created using my own skin – was simply stunning to me! The slash scars I had seen on women a generation earlier did not have to be my fate.

    Given the coordination of medical services, dedicated surgeons and cutting-edge advancements in reconstruction, the idea of proactively removing my breasts soon became palatable. But one nagging issue remained; even with reconstruction, removing the very body parts that embody my sensuality and femininity seemed so radical. I ping-ponged for months: Take my chances? Fervently cross my fingers at every mammogram? Or undergo a double mastectomy with immediate reconstruction?

    This surgical option became a vital part of my decision. For this reason: I had no clear idea of what this procedure would ultimately feel like. But, thankfully, with immediate reconstruction, I could now grasp on to what I would look like. If other women could love the look of their new chest, created within the same surgical procedure as their mastectomy, then maybe I could too? If I could carry on with the same quality of life I had pre-surgery, looking like the woman I am, without the BRCA1 cloud tick-tocking above my head, why wouldn’t I?

    Led by experienced doctors whose uncompromising dedication and skills I respected, I was able to move forward with confidence. With the unyielding support of a husband who helped reassure me that my whole was greater than two of its parts, I underwent the operation. And I’ve never been happier! Less of a woman? No way. Outcome from this surgery: The courage and strength to share.

    I began this experience shrouded in secrecy and shame. Now, I could flash the world. Thanks to immediate breast reconstruction, I have been able to recover and return to my life after surgery-physically and emotionally intact.

    Sometimes, the most important decisions are life-changing because they bring about a shift in your priorities and a transformation in your outlook. This same shift needs to take place in our health care system, where reconstructive breast surgery should absolutely be considered part of cancer treatment. The prophylactic surgery and reconstruction I had once disregarded, has in fact allowed me to embrace the life I now lead, free of the invisible load of shame, fear and worry I had been toting around for over a decade. I realize now that I am one of the lucky ones.

    All women, in any urban or rural location, undergoing the removal of her breasts from cancer or a predisposition to the disease, should have timely access and availability to all reconstruction options- funded with priority dollars. Those willing to use preventative health measures as opposed to treating the sickness down the road, should be considered just as important of a patient. It will allow them, like me, an opportunity to define the rest of their lives, despite their current or imminent cancer status and come through to the other side, even better than before.

  • Sayler says:

    Reconstructive surgery is not “cosmetic” and anyone who would suggest this is severely distorted. To just have breasts as a way to fill ones clothing is a narrow minded comment Chris. Thank you Leah for expanding on the comment by Chris. I have dealt with many women in varied degrees of breast cancer and for many the trauma of losing one breast never mind both is overwhelming. I know all too well from my personal experience as I represent the high risk population being BRCA1. The wait times for women in Alberta now is as bad as it was when I went through it in 2004 and I am not just speaking of the surgery. I waited almost a year before I had the consult with a surgeon. I did not question but accepted this as there was no other choice. I cannot understand why Alberta Health Services (AHS) and the Alberta Government have not made an effort to implement immediate or reasonable wait times for reconstruction and not to mention qualified reconstruction surgeons. This is more standardized in many other provinces in Canada as well as other countries. There is a constant tug of war with AHS and the Alberta Government concerning the wait times and the medical field. Not to mention the issues for high risk patients to navigate through a very complex process. This is completely unacceptable. We are a rich province that is willing to boast about our resources and riches, but are backward thinking in our Health care programs when it comes to the needs of quality breast reconstruction and immediate reconstruction.

    Now Ruth’s comment mentioned being so overwhelmed and just needing to survive cancer first and I do not mean any disrespect to you Ruth as certainly that is a battle above and beyond. That said many high risk women & men do not have the luxury of surviving cancer first. They need to stop the train wreck before it happens. Too many of our young BRCA 1 & 2 women and men are left floundering around trying to navigate through a cancer world that does not see them. Last year we lost my 30 year old niece to breast cancer she was BRCA1 but did not know it. She may still be with us but the lack of understanding about BRCA1 from the general front line medial personal made the difference between her life and her death. So now her 3 year old daughter will never know this wonderful brave young woman who fought to just be…Let the numbers speak for themselves about 22,700 Canadians will be diagnosed with breast cancer about 2600 with ovarian cancer and about 23,600 with prostate cancer. Of these numbers 5-10% will be hereditary.

    Today there is no excuse for not educating or arming yourself before you sit with your team of doctors once you have received a diagnosis of cancer either high risk or not. Above all you have the right to say what treatment you would like. It is laid out for you to make the decision as to whether or not you want to accept it. This should include reconstructive surgery by a qualified reconstruction surgeon. I know myself I would not have accepted a general or orthopaedic surgeon. I wanted a quality outcome and expected that given where I lived. I could not imagine being a young high risk woman making the decisions without known the outcome of the surgery would be of a high standard and not just a patch job. When will the light come on by the Alberta Government and AHS that our province is rich in many ways but Alberta could stand out as a leader in education of high risk and timely, high quality and immediate reconstruction?

  • Mary McDonald says:

    At the moment the ONLY proven way to significantly reduce breast cancer risk for our women (and men) is prophylactic double-mastectomy. Because young persons will not generally remove their breasts without immediate reconstruction, it could mean a cancer diagnosis during the long wait to see a plastic surgeon and then for the surgery to be performed. The fact that there are no targeted chemotherapy treatments available for hereditary breast cancer makes their situation even more grim.

    For those with an hereditary predisposition, the lack of timely immediate reconstruction isn’t just an inconvenience, it could mean the difference between life and death.

    Mary McDonald, CEO
    Hereditary Breast and Ovarian Cancer (HBOC) Society

  • Leah says:

    As a woman who was diagnosed with breast cancer at 23, I would 100% recommend that reconstructive surgery be considered part of cancer treatement and get funded as a priority area. I had a lattissimus dorsi flap reconstruction immediately following my skin sparring mastectomy. They were unable to save my nipple, but through a feat that I describe as a miracle in engineering, science and art, my surgeon was able to build me a new nipple from skin off my back.

    I am inclined to disagree with Chris’s comments below. Like so many others, he believes that breasts are merely for aesthetic purposes, something to help fill out clothes. Reconstruction is so much more than cosmetic, and I actually find such narrow-minded thinking laughable and quite frankly, absurd. More often than not, a womans identity is tied almost entirely on how she looks. If a woman feels she looks beautiful, she will feel better, and if she feels good about herself, she will have a far greater chance of beating breast cancer. As a man, would you want to walk around without your testicles? They might not be as outwardly noticeable as breasts, but they are still intrinsically linked to how you feel as a man. Could one not argue then, that the only purpose that testicles and a penis serve is to fill out a pair of boxer briefs? Could one not say that prosthetic testicles are just costmetic then? How would you feel when you took off your clothing, on the verge of intimacy with another person, and have to stop so you can explain to someone why your testicles were gone? Would that not make you feel less of a man? As woman, breast cancer often robs us of not only our breasts, but also our hair, eyelashes, and eyebrows, making us feel self conscious and often times ugly. It robs us of feeling beautiful and desired, of being human. Being faced with an ugly disease, shouldn’t we want to make women feel the best they possibly can? Shouldn’t we want to reconstruct right away, and give a woman a much dignity and support we can? At the end of the day, a woman diagnosed with breast cancer, is more than just her cancer. She is first and foremost a woman, and she wants to feel like a woman. I know I did. I was so worried about how I would look after. Never mind that I had a tumor that spanned the entire diameter of my right breast that had the potential to kill me. I was worried about how I would feel when I looked in the mirror after a shower, and about how I would explain it to other people, and I how others would feel. I needed, and was lucky enough, to have an immediate reconstruction. Without it, I don’t think that I would be in the place that I am today. I was angry enough over having cancer, I certainly didn’t need to feel self loathing and ugly because I was living with a flat, scarred chest.

    %featured%I know that immediate reconstruction is not possible in every case. Every cancer diagnosis is different, but I honestly believe that this needs to be part of the discussion, and I believe that it needs to be offered as an option in a treatment plan. Just because it is offered, and because it is part of the discusison, doesn’t necessarily mean that a woman will choose that path, but having the option avaible is a truly powerful tool on the path to recovery.%featured%

  • Dr. Botswa says:

    For God’s sake, please take down that photograph of the pink ribbon. That thing represents the commercialization of cancer.

  • Chris says:

    %featured%I vote No because reconstructive surgery is not part of cure, it is essentially cosmetic to shape a woman’s chest under clothing. However if we were not competing for limited funds I would vote Yes. There are unfortunately other treatment/curative surgeries for other cancers that would be competing for these funds.%featured% Prostate cancer continues to receive very little funding compared to breast cancer while it is just as common (1 in 6 men will get it ) and has a similar mortality ( 1 in 27 men will die from it ). Speaking from family experience, diagnosis, treatment and follow-up for breast cancer was streamline, not so for prostate cancer with delays , uncertainty and variable programs. Unfortunately we are still at the stage that men have to pay for prostate blood screening if they want to get tested. This bias has resulted in a lack of research funding such that prostate cancer is still not very well understood judging by the multiple treatment options offered and significant side effects of even investigating the disease with biopsies. I find that discussing funding for cosmetic procedures is out of place considering the urgent need for research and treatment funds for conditions such as this. The irony is November is prostate cancer month for the Movember Foundation which tries every year to raise awareness. As stated above, if we were not competing for limited funds I would whole-heartedly support cosmetic reconstruction for every woman who wants it.

  • Dana says:

    %featured%Here in the U.S. I had my surgery and reconstruction all on the same day. There is no way I would have wanted to delay my reconstruction as it’s a long healing process as it is%featured%. I started in mid June with my first surgery and reconstruction, and now almost 6 months later I am having my revision surgery which happens in about 85% of the cases. It’s enough dealing with the cancer diagnosis, so looking as normal as you can can be an important part of the emotional healing as well.

  • Ruth says:

    %featured%I think it should be discussed as part of oncology care and for me it was discussed but it is a complicated matter and a difficult decision that could be asked of a patient at a very vulnerable time. My head was certainly not in a place beyond the immediate treatment options. Reconstruction seemed far in the future – I needed to survive cancer first!%featured%

    We need to review our surgical techniques as skin-sparing mastectomy has been available to women in the US for decades. I was never offered the choice and it has a significant bearing on quality of life and self-esteem as the aesthetic results of post-mastectomy reconstruction is quite different.


Karen Born


Karen is a PhD candidate at the University of Toronto and is currently on maternity leave from her role as a researcher/writer with

Verna Yiu


Verna is the President and CEO at Alberta Health Services.

Terrence Sullivan


Terrence Sullivan is an editor of Healthy Debate, the former CEO of Cancer Care Ontario and the current Chair of the Board of Public Health Ontario.

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