Reconstructive surgery after cancer treatment

Caren* was only 24 when she was diagnosed with breast cancer. To say she was devastated is an understatement. She stoically went through treatment but deep down she never believed this was happening to her. She always felt like she was watching a series of someone else’s story. 

This was 20 years ago and many of the privileges accorded to our breast cancer patients right now did not exist then. Caren lost her entire left breast and her curvy cup C bosom was left unbalanced. She would trace her fingers along the scar on her chest whenever she summoned the strength to look at her naked self in the mirror and her eyes would fill up with tears. 

For Caren, she had lost her femininity. Her wardrobe quickly shifted from flowery blouses to dark-coloured oversized monotone T-shirts and hoodies. Thankfully her work did not require her to dress formally and so she got away with living in jeans. No amount of counselling could restore her self-esteem. The patient support groups did nothing to help; most of the ladies there were much older and more self-assured than she would ever be. She wouldn’t even dare date because she never wanted anyone close enough to notice her padded bra.

Thankfully, Caren beat the monster and was given a clean bill of health after five years of intense follow-up. It was her best birthday gift ever, to turn 30 and leave cancer behind. However, she was unable to shake off her self-consciousness. That was until she was sent to work in Cape Town for a year by her employer. While there, she met Makena* a fellow workmate who had been there for two years. 

Makena had just recovered from a breast reduction surgery and was excitedly showing off her markedly reduced bust and her newly acquired straighter posture! Being the only other person in the organisation from home, the two girls developed a solid friendship that allowed Caren to build enough confidence to ask about Makena’s surgery. This meant she had to confess about her missing left breast. 

Makena not only talked to her about plastic and reconstructive surgery but also dragged her off to her first appointment. Caren finally found a new lease of life. With the help of the empathetic surgical team, Caren started the journey of reclaiming her breast and in the process, her self-esteem. Six months later, she was the proud owner of a new left breast complete with a reconstructed nipple! 

For all of us walking around with all our organs intact, it is very easy to take things for granted and in the process become insensitive to those who have lost one. It is double tragedy for one to be handed a diagnosis of cancer and then be told that cure from the disease depends on them losing an organ, it does not matter which one. 

This is why surgery to eradicate the tumour must always be accompanied with a satisfactory rehabilitative plan for the patient; one that restores not only function but also aesthetics. No patient wants to walk around with a lifelong physical reminder of their battle with death every time they touch themselves or look in the mirror. 

We cannot thank scientists enough in the advances made in breast cancer surgery; so much so that the patient can go under the knife with a cancerous breast and wake up from anaesthesia with the cancer gone and a new breast in place! This should not be considered a privilege but as a part of completeness of care. We thank God for the ever-expanding pool of specialists in onco-plastic breast surgery that make this possible. And this skill too, right here in our borders! 

This does not apply to breast cancer only! Men who have suffered from testicular cancer necessitating orchidectomy (surgery to remove the testicles) greatly benefit from silicon-based testicular implants put in the scrotum to give the feel of normal testicles even when they have lost testicular function. 

Children with advanced retinoblastoma (a childhood cancer of the eye) may undergo enucleation of the eye, which involves total removal of the eyeball. This must be replaced with an orbital implant specially made and attached to the eye muscles so that it mimics normal eye movement and maintains normal facial expression. This is covered by a glass eye implant with a matching pupil to the normal eye to ensure uniformity. 

Even if these prostheses do not improve functionality of the lost organ, they are no less important! They address the emotional functionality of the patient, which is of paramount importance in the healing process and in the life after treatment. Fighting cancer is a gruelling battle. Not everyone wants to wear the scars of war on their forehead as an attestation to what they have been through. Sometimes these scars are best concealed!

Dr Bosire is an obstetrician/gynaecologist