Breast Cancer Surgeons Should Limit Bias in Patient Dialogues

As I celebrate the third anniversary of my reconstruction and, on some levels, my resurrection, I am struck by how little advancement has been made in terms of educating women about their full range of surgical options to address breast cancer. 

As I mentioned in my earlier posts, I often find myself in a counseling role, supporting women newly diagnosed with breast cancer.  One of the most difficult decisions for these women to make relates to breast surgery.  Lumpectomy or Mastectomy? Reconstruction or Not?

Aside from the obvious imperative to remove the insidious cancer cells from the body, there's just so much to consider.  The considerations are extremely unique and personal to each and every individual woman.  Not only do these early decisions effect a woman physically and in terms of recurrence risk, but may impact her psychological and emotional well-being going forward.  These "quality of life" consideration MUST be given weighted consideration by both the patient and her team of physicians.

With the trend towards minimally invasive surgery and breast conserving lumpectomy, those that may benefit from breast removal (mastectomy) and aesthetic breast reconstruction are often made to feel over-reactive or overly conservative in their desire to explore the choice of mastectomy for early stage breast cancer.  I am not advocating for mastectomy.  Trust me, there are many times when I wish I could re-wind back to the days of having real breasts and the associated sexual benefits.  I am advocating, however, that all women facing breast cancer should be presented with their full range of possible surgical options before commencing their treatment plans. 

What many women do not know, for instance, is that some electing mastectomy over lumpectomy may be able to avert radiation therapy, which carries a risk of degrading tissue.  Also for consideration is the fact that lumpectomy can mar the breast aesthetic with its resulting scarring and divets.  It's not an easy or automatic decision.  Women should be shown the possible outcomes of plastic surgery breast reconstruction so that they can envision the end results of their cancer removal decisions.  Additionally, they need to be made aware of nipple sparing mastectomy and its benefit for some (see attached article).

I expect that as chemotherapy drugs continue to improve, and radiation treatment more pinpointed, fewer women with early stage breast cancer will truly gain recurrence risk reduction benefits by having radical breast removal surgery.  However, in the interim, women that want to insure or gain psychological/emotional faith in their survival after breast cancer, and those for whom aesthetic is emotionally important,  mastectomy with reconstruction should be offered, one of many options to fully consider at the very beginning of the breast cancer journey towards overall wellness.

Three happy years later, I feel and look great!

MANGE VENTER MIG (Much Awaits Me)

Mange Venter Mig (Danish). Much Awaits Me. Self-confidence, possibility, faith, and hope – these unyielding elements have propelled me to achieve many things in my life about which I have been proud. Leadership of my high school class; first college degree in an extended second-generation American family; a distinguished graduate degree; a corporate career; the launch and successful management of a small business; civic leadership; elected public office; marriage; and the birth of two amazing children. All highlights in a forward life continuum. Striving, multi-tasking, and juggling were my lifestyle. Overachieving, I was driven by the belief that always there is a next step in life, more rewarding than the last. Ridiculous optimism? Perhaps. Innate determination? Most definitely. Foolish? Perhaps. Much awaited me, just around the next bend… and the next.

Practically from birth I was out to prove something – to the world, to anyone that doubted, and mostly to myself. I am woman. I can do it all. I can run a business full time with my beloved mom, while concurrently working in marketing for Alpha Software company, while maintaining a 4.0 GPA working full-time towards a Masters in Communications at Emerson College. Happy? I think. Tired? Extremely. Stopping to smell a single rose? Never. Much awaited me. I was a “mover”. My beautiful baby boy had captivated my heart, motherhood adding a new and amazing dimension to my complex and exciting life. What I did not realize then was that far too much, too many things that mattered, eluded my appreciation and understanding along the way. On I marched, projecting my future, laying out plans, acccelerating the spinning wheels in my personal “Habitrail”.

Then, cancer happened. It happened to me. It happened in the prime of my life, at just 34 years old. With a four-year-old marriage and an adorable three-year-old son, this was not supposed to happen to me. I was going forward, not staying still. Mange Venter Mig. This was not time for cancer. It was time for loving, learning, sowing, and growing. No, this was definitely not in the plan, this stopping to deal with cancer. I had no family history of cancer in my enormous, extended Italian family, nor in my extended Polish/Danish clan. I breastfed my son, I was not overweight, I did not smoke or drink. No time for this. I’m going places.

The diagnosis stunned me. It hurt my loved ones, and reflected their sorrow back to me tenfold. Relief came; the cancer was early stage. The first surgery was unsuccessful, leaving some cancer cells behind. The next surgery, weeks later, got all the cancer and left me with 1 2/3 breasts. (I shall share in a later post the humor and the challenges of having two thirds of a breast). My surgeon, God rest her beautiful soul, advised that since so much tissue had been removed I may not need radiation therapy. If cancer were to return to that breast (she noted I had about a 35% chance of recurrence over the first few years following the surgery), I would be unable to have radiation treatment to the same area later. So, the decision was made against radiation treatment. Would this have prevented my recurrence? I suppose I will never know.
Forward. Think forward. No looking back. Self-confidence returned and my crazy optimism. The faithful “Donna” engine was refueled, the determined little engine that propels me over the hills and valleys of my life.

The “cancer” chapter was over, or so we thought.

A Rude Sales Clerk Saved My Life

Yes, a rude salesperson at a Marshall's store unwittingly helped save my life.

For the four years following my mastectomies, one of my greatest challenges involved shopping for bathing suits. Let's face it, no woman really enjoys this affair. For, we are at our most exposed point, most vulnerable in terms of our self-image, when staring at ourselves under the harsh fluorescent lighting in bare fitting room cells. What I saw reflected back to me in that mirror reminded me of my cancer, and made me feel more than physically reduced.

Over the years after the removal of my cancer (and my breasts) I had the pleasure of numerous strange and unsuccessful trips to department stores, attempting to find a bathing suit that "worked" for my "two-dimensional" post-mastectomy body. My beloved mom and daughter normally accompanied me on these annual, dreaded trips to the bathing suit sections of various retail establishments. We would start in the juniors department, and inevitably end up in the little girls area, searching for a suit that would fit my flat chest. You see, my concave chest gave new meaning to the term "pear shaped body", with normal adult-woman hips and an abnormal "blank" chest. At 5'2 and 105 lbs., I was lucky. The girls size 16 suits I often ended up with assumed the wearer had a pre-pubescent body, but also reflected the color and fabric choices enjoyed by little girls. (Picture multi-colored hearts and cheesy plastic trims).

These trips would begin with a deep inhale of resolve before entering the store, and exchanged "here we go" glances between the three generations of women. We would take armfuls of bathing suits into the fitting room, where I would put on a pathetic (sometimes comically theatrical) fashion show to my hopeful loving audience. Other fitting room comrades would lend quick sideways glances; their expressions, though fleeting, would ask more than they would reveal. Often, the absurdity of these sessions would evoke a range of emotions, exploding into laughter or ending with me fighting back tears.

I had tried prosthetic bathing suits. Companies like Lands End do offer women some suits that accommodate a breast prosthetic. (Thank you Lands End!) Unfortunately, most of these have an "older" or "larger" woman in mind. I'd rather the bows and hearts than the matronly cruisewear-style swimsuit. Also, the prosthetics have a tendency to "escape" from the suit at exactly the wrong time. (Picture my coyly chasing my bobbing fake boob floating in a public pool.) Additionally, the shifting wet prosthetic, coupled with the wet suit rubbed horribly against my scarred chest. The chafing was, well, certainly not worth the contour.

Well, in the summer of year four I had finally, I thought, found a woman's bathing suit that would work! Of course, this suit had been settled on after another emotional outing. When I got it home, and modeled it for my equally hopeful husband, we both realized that the "empty" spots on the top just would not do. I also realized that, with no breast contour to hold the suit in place, it rose up my chest every time I lifted my arms up. Hmm. Too bad...I liked it.

Two weeks later the three girls (me, my mom, and my young daughter) returned to the Marshall's store from where I purchased that suit. The plan was to exchange it, but there were no other viable choices. There was a long line at the return desk. This is where the rude clerk saved my life! I had removed the tag from the garment, and she absolutely refused to take it back. I quietly explained the circumstances, still no effect. Well, this was a watershed moment for me, I guess. Four years of suppressed emotion came pouring out. I burst into tears, left the store (followed by my consoling child), and realized at that moment how very much (despite my convincing myself otherwise) I really missed my breasts.

You see, my life had been saved by a year of cancer treatments. But, my "life", had been sorely affected. The scars ripping across my chest healed, but had left much deeper emotional ones.

Two other things happened within weeks of that incident that set me on the path to my reconstruction and "resurrection." I will explain more in my next post.

Breast Cancer and Hope

My name is Donna Bramante InDelicato. I live in Windham, NH. At just 34 years old, I was diagnosed with early stage breast cancer. A partial mastectomy later, I thought I was cured. But, that was not to be. Four years later, I was again diagnosed. This time, the diagnosis was devastating: Stage III cancer, aggressive, and traveling outside my breast. With a bright future, a husband, two beautiful young children, and a wonderful extended family, I had everything to live for. I underwent a year of cancer treatment including several surgeries, chemotherapy, and radiation. When the treatments finally ended, I was thrilled to be alive. But, the effect that stayed with me the longest and pervasively affected my life was the absence of my breasts, a deformity I lived with for 4 1/2 prime years of my life.Several times over those "breast-less" years I visited plastic surgeons seeking the hope of breast reconstruction. Each time, the answer was no. I was too thin, had too much tissue removed, and the radiation damage was too extensive. Finally, through serendipity, I landed in the office of Dr. Karl Breuing, a pioneer of a breast reconstruction procedure that utilizes donor tissue matrix (known as AlloDerm) and implants to recreate breasts. The results have been remarkable, not only in how this procedure restored my appearance, but, more importantly, how breast reconstruction helped restore my life.This blog will chronicle my journey, what I have learned, my collaborations with others, and how, in many ways "Cancer cured me."