Dr. Toni Zhong - Advanced post-mastectomy breast reconstruction improves women's psychosocial and sexual wellbeing – Division of Plastic, Reconstructive & Aesthetic Surgery at the University of Toronto

TORONTO – Women who lose a breast to cancer report improvements in their state of mind and well-being three weeks after breast reconstruction surgery, a new survey indicates.

However, 20 per cent of the women experienced minor or major complications related to the reconstruction surgery, and many of the women were grappling with significant deterioration in the strength of their abdomen — the donor site for tissue to reconstruct the breast.

But study co-author Dr. Toni Zhong said that even when complications, lack of strength at the donor site, scarring and time off work were factored in, the positives outweighed the negatives.

“The overwhelming answer was these patientsm did not regret it and were highly satisfied,” said Zhong of the University Health Network Breast Restoration Program at the University of Toronto.

The women were questioned three weeks after their surgery, when they were still recovering and probably still in pain, and again three months after the surgery.

“As early as three weeks, these patients were reporting really quite significant improvement in all sorts of quality-of-life issues, like psychosocial well-being, sexual well-being, body image and things like that,” said Zhong.

She and her colleagues collaborated on the research with Memorial Sloan Kettering Cancer Center in New York City.

The study is published Monday in the early online edition of Cancer, a journal of the American Cancer Society.

The 51 women who were surveyed didn’t have implants, but rather surgeries utilizing tissue from the abdomen: free muscle-sparing transverse rectus abdominis myocutaneous (TRAM) flap reconstruction or a deep inferior epigastric artery (DIEP) flap reconstruction.

Zhong said muscle-sparing surgery was first described in the literature about a decade ago, and has become more popular in the last five years.

She said only four surgeons in Toronto, and a total of about 10 plastic surgeons in Canada, do these breast reconstructions which require specialized fellowship training, equipment and nursing staff, and competence using a microscope during surgery to hook up blood vessels.

Many of the complications reported in the study were minor, Zhong said, such as a stitch coming through the skin or scabbing that required dressing changes.

Major complications were defined as having to return to the operating room for unexpected reasons, and this was the case for about 10 per cent of the patients surveyed, she said. Eventually these patients healed fine too.

“Despite having even a major complication, though, these patients reported that they felt overall the reconstruction achieved the purpose that they wanted,” she said.

Zhong was surprised by the findings on abdominal outcomes, as patients are normally counselled that the donor site should be back to normal at eight weeks.

Complaints about abdominal weakness could include difficulty lifting groceries, for example, or getting out of bed — instead of just sitting up, the woman might have to roll onto her side first.

“Maybe there are things we can do before surgery to optimize these patients’ conditions. For example, maybe it’s a good idea for us to have a devoted physiotherapist who can focus on doing abdominal strength training before surgery,” she said.

The research will help doctors counsel patients about the pros and cons of surgery so they know what to expect, she indicated.

Dr. Melinda Musgrave, a plastic surgeon at St. Michael’s Hospital who was not involved in the research, said the study looks at what she calls the “Cadillac of breast reconstruction” that uses abdominal tissue and tries to save muscle.

“She’s shown a pretty consistent outcome, that patients in the long run are pretty happy about reconstructive surgery, and that as early as three weeks after having it, they’re pretty happy with their breast,” Musgrave noted.

“But what she’s found that I think is really interesting is that they’re not so happy with their tummies.”

Maybe these operations aren’t as good as originally thought for women who need to pick up laundry baskets, for instance, or a two-year-old child, she said.

She noted that some women choose implants rather than abdominal tissue for their breast reconstruction because they don’t want a long period off work to heal, even though 30 per cent of implant patients will need to come back for an adjustment of some kind within five years.

“It’s a matter of the patient choosing the reconstruction that fits into her life,” Musgrave said.

She said the rate of women having breast reconstruction surgery after mastectomy ranges from seven to 20 per cent worldwide.

“I think it’s important that we all promote reconstructive (surgery) for the patient … we love how the patients feel about themselves afterwards, and we get a lot of positive feedback.”

Plastic surgeons would ideally like to see breast cancer patients soon after diagnosis to help them make decisions that impact them throughout their cancer journey, said Musgrave.

“I just want people to come and have a consult … I don’t want them to lose the opportunity. I’ve had lots of women come to me delayed five years after, 10 years after, saying ‘I wish I had known 10 years ago about this, I would’ve had it done.’

“I think knowledge is power.”