Few women choose breast reconstruction

Low rate linked to resources: surgeon

Fewer than one in five Canadian women have breast reconstruction after a mastectomy, and a local plastic surgeon says that low rate is due to a lack of resources.

Getting enough operating room time is a big hurdle, he says.

“That’s our struggle. That’s always our struggle,” said Dr. Robert Shenker, who is a staff surgeon at Cambridge Memorial Hospital. “That’s the nature of health care in Ontario now.”

However, he added, “in Cambridge, we’re really lucky.”

Few hospitals can do breast reconstruction surgery immediately following a mastectomy, and “Cambridge is one of them.”

Shenker said hospital executives are supportive of the program, and two days a month are allocated specifically for breast cancer reconstruction surgeries.

“It allows us to accommodate these immediate breast reconstructions,” said Shenker, who performs the surgeries with colleagues Dr. Amy Chesney and Dr. Stephanie Ma.

He said the good news is that if a breast cancer patient who is a candidate for reconstruction surgery is seen in Waterloo Region by a general surgeon who knows about immediate reconstruction, they will get the surgery.

The trouble is reaching those women who had cancer surgery in the past decade ago, but are still eligible for breast reconstruction that’s covered by provincial health insurance.

The wait time in those cases is three to six months locally.

“That’s just because we have limited resources,” Shenker said.

This year, an estimated 26,300 Canadian women will be diagnosed with breast cancer, the

Canadian Cancer Society says.

Of those, about 6,000 women will have mastectomies. Yet only 16 per cent will undergo breast reconstruction — less than half the percentage in the United States.

To help address the issue, the cancer society is hosting 25 events across Canada during October, Breast Cancer Awareness Month. The events, called BRA (Breast Reconstruction Awareness) Day, promote education, awareness and access to post-mastectomy breast reconstruction.

“We’ve been doing BRA Day events and we’re trying to raise awareness,” Shenker said.

However, he said it seemed like they were speaking to the same people at the events.

“That’s why our numbers are not increasing,” Shenker said.

This year instead it focused on radio ads that featured patient experiences.

“We’re trying that to see if we can get the message out more broadly,” said Shenker, who would also like to visit hospitals in the area to talk to doctors about reconstructive surgery.

He expects it will take some time before the rate of breast reconstruction after cancer surgery increases. Institutional issues are a barrier, including a need for more government funding and operating room time, he said.

Immediate reconstruction is also difficult in terms of coordinating all the teams involved, and everyone needs to be on board to make it happen.

As well, there are lingering misconceptions about breast reconstruction after cancer.

“In a lot of places it’s still seen as a cosmetic procedure,” Shenker said.

General surgeon Dr. Donna Kolyn, who works closely with the team, says breast reconstruction can make a big difference for women after “a surgery that’s left them feeling less than whole.”

While not every woman is a candidate for same-day reconstruction, many can benefit from seeing a plastic surgeon even years after the cancer treatment.

Kolyn said there’s a spectrum of breast reconstruction after cancer surgery, including restoring symmetry after a lumpectomy.

Restoring the breasts to as natural a look as possible is “huge” psychological advantage in their recovery, she said.

“At the end of the day, women have to live with the disease and the scars.”