The Early Days of Breast Cancer
My introduction to breast reconstruction began back in New York City’s bad era of the 1970’s when I was an intern at Bellevue Hospital. At that time, breast cancer was still a hidden disease rarely spoken about in polite company. Women who discovered a lump or a suspicious shadow on mammogram, were sent to the operating room not knowing if they would wake up with their breast or with the devastating burden of a fresh breast amputation and a mastectomy scar.
The breast cancer surgical team would then make rounds on the unfortunate patients who lost their breasts and in a cheery tone our professor would announce to the patient that we had done a great operation hopefully removing their disease and as a bonus we had neatly closed their now concave chest with a scar that wouldn’t show above their bra. In a disturbingly smug way, our team would then expect a smile from the patient before we left the room.
As one of the very first female surgical interns, I was anxious to become a member of the surgical tribe and mimic my professors, but even to this day, my gut twists as I recall watching patient’s faces struggle not only with their diagnosis but also with their life changing amputation that forever would mark them as “damaged goods”.
Patients Speak Out
During the eight years of my surgical training, breast cancer patients found their voices and started demanding breast reconstruction. Yes, it was the women patients who demanded to consult plastic surgeons and begrudgingly, the god-like oncologic breast surgeons would give them a referral followed outside the patient’s room with a sarcastic derogatory comment about “a woman’s folly”. The professor after all had treated her cancer – the patient should be eternally grateful.
Rapid and Exciting Changes in Surgery
Thankfully, the late 1970’s and 1980’s were a time of great exploration of new techniques in plastic surgery. During this era, an entirely new field of microsurgery was developed which enabled us not only to reattach severed fingers, but also to harvest skin, bone and muscle on a single blood supply and do an auto transplant to reconstruct everything from jaws, fingers, legs and yes, breasts.
Plastic surgeons developed a much better understanding of the blood supply to all parts of the body, and there was an explosion of new reconstructive techniques.
Working as a Team
Our first efforts at breast reconstruction were limited by the traditional techniques used by the breast surgeons that removed far too much breast skin. Over time, and with persistent coaxing from both patients and the plastic surgeons, the oncologic breast surgeons began to “save” us the breast skin so that we could achieve more natural-looking results.
Over the decade from 1975 to 1985, those of us who trained in microsurgery, as well as plastic surgery, could offer patients reconstruction using an implant or their own skin and fat.
At first, we only saw the patient’s after they had healed from their mastectomies making a natural result much harder to achieve, but with further cooperation with the oncologic breast surgeons, reconstructive plastic surgeons began performing reconstructions immediately sparing the patient the trauma of the dreaded post mastectomy defect.
Today it is standard practice for a patient facing a mastectomy to consult with a plastic surgeon before their mastectomy and to awake with reconstruction. And our results have continued to improve with nipple sparing surgery, shaped implants made especially for reconstructive patients, new techniques of fat grafting, and refined tissue transfer techniques.
Brave Patients Changing the World
One day when we have conquered breast cancer, I look forward to a time when mastectomy and breast reconstruction is a forgotten word dusty in the history books of past surgery . But until that day, I would like to recognize and celebrate the courageous, outspoken women patients and the innovative breast reconstructive surgeons who listened to them for developing surgical techniques which restore their feminine mystique and allow them to live life feeling whole again.