Why are women STILL being denied breast reconstruction?
By a breast cancer surgeon who had the disease herself
HAVING operated on thousands of women with breast cancer, few people are as familiar with its realities as Ruth Waters.
As a consultant plastic surgeon who specialises in a complex type of mastectomy, which involves rebuilding women’s breasts using their own tissue, Miss Waters believes every woman has the right to wake from breast cancer surgery ‘feeling like herself’ again.
It is a belief rooted in her own experience — not only her 21 years of expertise, but as a patient. For the mother of two was herself diagnosed with breast cancer at 41.
‘The prospect of losing a breast can be devastating since it is at the heart of our femininity,’ says Miss Waters. ‘Doctors have to understand the importance of reconstruction.’
For 17 years, Miss Waters has been doing the DIEP flap procedure, in which blood vessels called deep inferior epigastric perforators (DIEP) as well as the skin and fat connected to them, are removed from the lower abdomen and transferred to the chest to reconstruct a breast.
It takes ten hours, and its success hinges on stitching together the blood vessels, which are 3mm wide.
For all its technical challenges, Miss Waters, 58, believes it is worth it. However, she says, many women miss out on reconstructive surgery.
‘ The guidelines state that all women should be offered reconstruction,’ says Miss Waters. ‘But not all hospitals offer operations like the DIEP flap, as they have to be done by plastic surgeons rather than a general breast surgeon.
‘But women are entitled to know their options. With the DIEP flap, for example, using a patient’s own skin and fat is wonderful because it mimics breast tissue.’
Out of 23,000 mastectomies performed on the NHS every year only 21 per cent of women have an immediate reconstruction. While some women won’t want it, there are concerns that this is lower than it should be.
It can be a matter of cost. NHS trusts will pay a certain amount for the operation — say around £7,000 — but this type of surgery can cost up to £20,000, so some don’t regard it as cost effective.
But as Miss Waters counters: ‘ Implants don’t last for ever but with operations such as the DIEP flap, once it is done it is done. So the cost to the NHS is less.’ The surgeon can be seen in action in a new BBC series which goes behind the theatre doors at the Queen Elizabeth Hospital in Birmingham, to witness some of the UK’s pioneering surgeons at work.
Despite facing women dealing with breast cancer on a daily basis, Miss Waters says she never imagined she would get the disease, too.
‘Naive perhaps, but breast cancer was not on my radar,’ she admits. She discovered the lump during a skiing holiday, guessing it had been there for a few months. ‘I knew from the hard feel it could be cancer,’ says Miss Waters, who lives in Leicester with husband Mark, a pharmacologist.
Experiencing life on the other side of the consulting room was difficult. ‘My medical training didn’t mitigate the shock I felt,’ she says. ‘ My daughters were then four and seven. I desperately wanted to survive.’ The cancer was grade three (a measure of a cancer’s aggressiveness, with one the lowest and three the highest) and Miss Waters says her ‘gut reaction was to have a mastectomy’.
However, the reconstructive surgery she now performs was only just being introduced. After much reflection, she opted for surgery to remove the lump rather than full mastectomy, followed by six cycles of chemotherapy, then daily radiotherapy for three weeks.
ASTONISHINGLy,during her treatment Miss Waters continued to operate. ‘I wore a wig under my surgical cap and didn’t advertise my illness to my patients. I could really understand their terror and desire to feel like the person they were before.’ In the new series, she is filmed performing the DIEP flap on motherof-two Donna Wilson-Mills after a mastectomy. Amazingly Donna had no idea Miss Waters previously had breast cancer. ‘I always felt she understood and she really did,’ says Donna. ‘And she did the most amazing thing for me. I thought my breasts would feel numb. But I can feel them, they feel part of me. I really feel like I have my life back.’ It’s a phrase which has become something of a mantra for Miss Waters and one she hopes other doctors understand, too. ‘ I want my patients to leave my care and still feel whole. It’s every woman’s right to get her life back. It’s what I have in common with my patients. For I’m just as determined to have that for me, too.’