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Jane Obadia was 43 and about to do an embryo transfer with her surrogate when she found herself facing a breast cancer diagnosis. Always vigilant in her screenings, she was told at a routine mammogram that she had multiple cancer sites in both her breasts and needed surgery right away. Her family-building plans went on hold while she focused on her upcoming treatments.
“I was very lucky that they were able to get everything,” she says after her mastectomy and implant surgery. But three months later, she experienced complications and needed to have the entire reconstruction process performed again.
And then six months later, it happened again.
Obadia decided to look into an alternative to implants because the chances of another complication were too high. She chose to do another reconstruction using her own tissue.
“I think when you’re initially diagnosed, you’re coming from a place of doing anything to save your life. You’re not really considering the impact of the lack of sensation, the numbness. You’re met with your chest wall being numb, and that’s hard to deal with.”
“One of the big emotional struggles women have is when it doesn’t go the way they anticipated it would.”
According to a report published last fall, reconstruction after a mastectomy rose by 62 percent from 2009 to 2014. As surgical techniques advance, results are growing increasingly more natural, but it doesn’t mean that a woman feels her body is natural.
“Breast reconstruction is a process and multiple surgeries are often necessary to achieve the best result,” explains Dr. Constance M. Chen, a board-certified plastic surgeon in New York who performed Obadia’s tissue surgery after her complications. “The body is only able to handle so many changes at a time, and it also changes and settles after surgery so something that looks great on the operating room table may not look great months or years later.”
After her surgery, Obadia was grateful to be able to have sensation in her breasts again, thanks to a nerve graft procedure. She could feel temperature changes and skin touch again. “It was life-changing.”
Many women undergoing reconstructive surgery after breast cancer are surprised at how different their breasts feel, especially after implants. “It’s a far more complicated and longer process than most women realize. They don’t realize they’re signing up for a year’s worth of reconstruction,” explains Dr. Laura Howe-Martin, a psychiatrist and associate professor at UT Southwestern Medical Center.
“Cancer is a lot more complicated than people think, so is reconstruction.”
Good communication by the plastic surgeon is important. Reconstruction options are usually addressed around the time of mastectomy, but a variety of factors play into whether or not rebuilding the breasts will happen immediately. That provider-patient relationship plays a major role in how well a woman is able to come to a good place emotionally when facing reconstructive surgery.
“That’s an absolute must,” explains Dr. Anne Wallace, director of the Comprehensive Breast Health Center and professor of plastic surgery at UC San Diego Health. “People come in with the expectation of everything being perfect, or the opposite — expectations of total disasters. The biggest thing at the beginning is to manage expectations.”
Wallace finds that the women she works with who struggle with their self-esteem are the ones who put the most emphasis on the results of their reconstruction. “That’s where we need to do better,” she reflects.
“We need to recognize how to make them feel good about themselves, when not related to a perfect breast. It isn’t even about having a mastectomy. It’s turning their own anxieties on their breasts and realizing how we can help them through that.”
It surprises women how uncomfortable they are after reconstruction and that can carry over into their relationships and everyday life.
“One of the big emotional struggles women have is when it doesn’t go the way they anticipated it would,” explains Howe-Martin. “It’s getting used to this new body and maybe there was a gap in intimacy and now they’re getting back into being a couple rather than a caregiver and patient.”
Obadia understands the process of redefining the relationship after mastectomy and reconstruction. “There’s a level of intimacy that you get to and it either turns you away from one another or creates a great intimacy within your relationship.”
There’s a tendency to go into survival mode when a woman gets her initial diagnosis because she just wants to be cancer-free. Obadia encourages other women to know that yes, you’re dealing with cancer, but there’s life beyond it, and to have faith that you’ll get there.
“Mastectomy and reconstruction is starting all over,” says Wallace. “It’s a lot more complicated, but once women know that, they’re fine with it and they’re not disappointed. But it takes a team to deliver that information correctly. Cancer is a lot more complicated than people think — so is reconstruction.”