Reconstructing the Breast

For years, having a new breast after mastectomy was a dream for many Kenyan women. It was either there were no specialised doctor to reconstruct a new breast or the cost was too high or women feared having artificial breast implants.

A team at Aga Khan University Hospital has introduced a procedure which allows for breast reconstruction right after a mastectomy (surgical removal of a breast). And it has nothing with getting an implant.

During the procedure, a surgeon cuts off the cancerous breast and replaces it with tissue including fat, skin and blood vessels, from another part of the body, usually the tummy.

“We take the tissue from the tummy. We then transfer it to the chest. We shape it like a breast, reconnect the vessels to have blood flowing to bring the breast back to life and then we close the tummy,” says Dr Radovan Boca, a consultant plastic, hand and reconstructive surgeon. “So you go to sleep under anaesthesia, we remove the sick breast, we make you a new one when you are sleeping so when you wake up you do not have to go through the trauma of seeing a flat chest or a missing organ,” he adds.

As breast cancer survivorship increases, many face stigma but there are others who feel whole and happy regardless of physical imperfections.

Dr Miriam Mutebi, the breast surgeon who does the mastectomies before Dr Boca gives the patient a new breast says she has been doing research on why women opt not to come for early treatment and found out that “they fear being thrown out of their homes for losing a breast.”

Although Dr Mutebi says that reconstruction on its own is not a magic wand that will wish away stigma, she sees a possible ripple effect to make people less averse to early screenings.

“If you are going to get thrown out of a marriage because you are perceived as half a woman because you have one missing breast, then the reconstruction may help,” says Dr Mutebi.

She adds that in the West, people live 30 to 40 years after breast cancer and they tend to die from something else rather than from the disease.

Dr Boca says, for example in the UK most women do breast reconstruction immediately after a mastectomy, but insists that for it to work, the procedure must be done with a team which has an oncologist, a pathologist, a radiologist, a breast surgeon and a plastic surgeon.

“Cancer care is complex and as professionals we are each other’s checks and balances,” says Dr Mutebi.

For some patients, they start with the surgery first before doing chemotherapy and radiotherapy. Others do the surgery after chemo.

“Unfortunately the reality in our country is that patients get whichever treatment depending on the doctor they see first. A patient who sees a surgeon after a cancer diagnosis will be told, ‘let’s operate you immediately’ yet that patient would have benefited from chemotherapy to first shrink the tumour,” she adds.

Unlike implants which take a shorter recovery time but have long-term risks because they are foreign objects in the body, the procedure that uses tummy skin, muscle and fat, and known as autologous reconstruction, takes longer to heal.

“A patient is usually out of hospital in four days with a new breast,” Dr Boca says.

The cost is also different.

“An implant maybe 30 per cent cheaper than the autologous reconstruction,” says Dr Boca, adding that the good thing is the flesh breast tissue will age with you. Implants may need to be replaced after 10 to 20 years and they tend to travel upwards while a flesh travels inward.

“But it also it depends on the shape of your breast and also if you have a small breast you have relatively good soft tissue cover and implants might be a good option because the small breast is less likely to be droopy,” he says.

Some insurers pay for the procedure.

“Insurers used to perceive breast reconstruction as a cosmetic procedure and automatically declines to pay. But this is slowly changing,” says Dr Mutebi.