Millennial women face a different kind of breast cancer journey and it’s high time breast reconstruction came under the spotlight.

Breast cancer isn’t an “old lady disease.” It’s a daunting reality for many women in their 20s and 30s, and their experiences following diagnosis are drastically different from those of older patients.

A diagnosis for millennial women often means putting careers or academics on hold, undergoing fertility treatments and navigating new intimate relationships while becoming used to their new body image. These women are forced to discover a starkly different or “new normal”existence before they even hit the midway point in their lives.

At the heart of each treatment program for young women is the question of breast reconstruction surgery, an area in which Canada’s healthcare system can certainly improve.

“Some of Canada’s cancer centres are dealing with a lack of resources and huge wait times for breast reconstruction,” says MJ DeCoteau, founder and executive director of Rethink Breast Cancer. “One young patient described her life as being ‘on hold,’ unable to move on from an extremely difficult and emotional time as she waited for access to breast reconstruction.” While provincial healthcare plans have come a long way, with all breast reconstruction options covered, wait times are still lagging behind. 

 

NOW OR LATER?

Depending on their centre’s wait time and resources, women may opt for immediate reconstruction at the time of a mastectomy, delayed reconstruction following therapy or immediate-delayed reconstruction, where tissue expanders are typically inserted at the time of mastectomy, followed by delayed reconstruction post-therapy.

“Immediate reconstruction can offer the benefit of a skin-sparing or nipple-sparing mastectomy to place the reconstruction beneath, often improving the overall aesthetic outcome with fewer scars and a better breast appearance,” says Dr. Laura Snell, MD, MSc, FRCSC of the Plastic and Reconstructive Surgery department at Sunnybrook Health Sciences Centre.

However, Dr. Snell notes that potential complications from immediate reconstruction could run the risk of delaying chemo or radiation therapy. Delayed reconstruction may be recommended if radiation therapy is in the picture, as it could negatively affect the aesthetic outcome. Delayed reconstruction can also help to alleviate some stress during an already difficult time.

To streamline the reconstruction process, regardless of the patient’s decision, Dr. Snell suggests cosmetic surgeons should be part of the patient’s primary care team, if only for a consultation.

DeCoteau agrees: “We know from research and our own experience that access to breast reconstruction lessens the long-term emotional impact of mastectomy related to cancer diagnosis, suggesting it needs to be a part of the discussion at the time of diagnosis.”

 

BREAST RECONSTRUCTION IRL

“When I lost my breasts, it felt like I lost a piece of me,” says Emily Piercell, a lawyer who was diagnosed the summer after law school and underwent two reconstructive surgeries and one repair due to complications stemming from radiation therapy. “Going through so much, it might sound silly to someone not in my shoes, but I wouldn’t do things differently,” she notes. “My breasts are a part of who Iam.”

Dory Kashin, 31, a volunteer with Rethink’s Give- A-Care campaign, counts herself lucky. Her surgeon recommended immediate-delayed reconstruction with replacement surgery post-chemo, pre-radiation therapy. “I was taking a risk since the radiation could distort the implant, but everything went smoothly,” she says.

Lindsey Hope (@tatatomytatas, howtohavefunwithcanc- er.com) was diagnosed at 22. Putting university on pause, Hope opted for a double mastectomy following fertility treatments with one immediate reconstruction and one immediate-delayed reconstruction. While she personally didn’t experience any complications, she knows women who have.





EVERY WOMAN IS UNIQUE

Because every woman is different, Piercell, Kashin and Hope recommend doing your own extensive research before choosing a course of treatment.

“No one will ever go through the exact same thing as you, so take it all with a grain of salt,” says Hope. “The decision needs to feel right to you.” 

 

TIP: STILL CONTEMPLATING RECONSTRUCTION?

Attend a local Breast Reconstruction Awareness (BRA) Day event in October. Speak to cosmetic surgeons in your area and experience the Show & Tell Lounge, where you can see real reconstruction results and talk to breast cancer fighters to help navigate your options. Visit bra-day.com for more information. 

 

POST-SURGERY EXPECTATIONS

  • Even with a nipple-sparing mastectomy, expect numbness in the nipple and skin over the reconstructed breast(s).

  • Medicaltattooartistscanbereferredforthree-
    dimensional areola colouring post-surgery, though this is an out-of-pocket expense.

  • “Typically,immediatereconstructiondoesn’tmeanthewhole thing is finished in one surgery,” notes Dr. Snell. Be prepared for potential follow-up surgeries or procedures to improve contouring or symmetry.

  • Bereadytotuneoutalotofopinions.Familyandfriendsmay not want to see you undergo another surgery, but you need to stay true to yourself and honour your choices. 

 

Q & A CHEAT SHEET

When it comes to reconstructive experts “There are a lot of choices, so don’t be afraid to ask a lot of questions,” says Piercell. Use these questions to help get your list started:

  1.  Can you refer a cosmetic surgeon who may be part of the primary treatment planning process?

  2. What breast reconstruction plan would you recommend considering my treatment plan and needs, and how will this fit into my treatment schedule?

  3. What will my new breasts feel, look and move like following reconstruction?

  4. What are my options regarding nipple reconstruction? Am I a candidate for a nipple-sparing mastectomy?

  5. How much discomfort can I expect following surgery and how can I manage the pain?

  6. How many stages of surgery or treatment might be required to reach my desired end result?