Maroc - NEWSDAY.CO.TT - A la Une - 13/Oct 04:25

Breast reconstruction:‘It’s about confidence, not cosmetics’

Bavina Sookdeo Breast reconstruction is more than a medical procedure – it is, says breast oncologist and reconstructive surgeon Dr Rajen Rampaul, a pathway back to normality and confidence. In TT, Rampaul has been at the forefront of oncoplastic surgery – a field that merges cancer treatment with reconstructive techniques, offering women the chance not only to survive breast cancer but to regain their sense of self. Who is it for? He explained that breast reconstruction is a broad concept that goes beyond rebuilding the breast after cancer. “It refers to any surgery aimed at restoring the breast to a normal form or appearance,” he said. While it commonly applies to women who have had part or all of a breast removed due to cancer, reconstruction can also benefit young girls with underdeveloped breasts or congenital abnormalities. “In such cases, surgical correction to restore balance or symmetry is also considered a form of breast reconstruction,” he explained. Rampaul said although it’s uncommon locally, women who experience trauma or mutilation may also require surgery to rebuild the breast, which falls under reconstructive procedures. He emphasised, however, that reconstruction should not be confused with cosmetic surgery. “Cosmetic surgery is performed to alter what is already normal, usually to achieve a preferred aesthetic,” he explained. “Reconstructive surgery, on the other hand, is done to restore normal appearance or function after injury, disease or abnormal development. They are two very different forms of surgery.” In TT, he said, more than 95 per cent of breast reconstruction cases are linked to breast cancer. “The remaining five per cent are related to congenital abnormalities such as underdeveloped or absence of a single or both breasts.” Different types of surgery As an oncoplastic breast surgeon, Rampaul offers all forms of breast reconstruction and has pioneered several techniques in TT. “These include oncoplastic surgery, autologous fat grafting and lipo modelling, partial breast reconstruction, as well as the country’s first total fat breast reconstruction and free flap deep inferior epigastric perforator (DIEP) breast reconstruction.” He said being trained in both breast cancer and plastic surgery allows him to provide a combined approach – one that restores form and confidence to women undergoing the often mutilating effects of cancer surgery. Rampaul said after mastectomy (a surgical procedure to remove the whole of a breast), reconstruction can be immediate, delayed or immediate-delayed, depending on the type and stage of cancer. “Not all cases are suitable for immediate reconstruction,” he explained. “The nature of their cancer will dictate this, but there is an in-between called immediate-delayed reconstruction.” Again, he noted that particular situations – for example if they require radiation to the chest or a woman has inflammatory breast cancer (an aggressive form) – would influence how the reconstructive approach is designed, and the timing of reconstruction. A patient’s level of physical activity also plays a significant role in determining the most suitable type of breast reconstruction. For example, women who are highly active – such as those who do fieldwork, rowing or horse riding – may not be ideal candidates for the latissimus dorsi flap reconstruction, since this technique uses a major back muscle essential for those movements. Rampaul explained that patients who undergo a latissimus dorsi flap reconstruction should expect some loss of back strength, and again emphasised that activities such as gardening, rowing or riding might be slightly affected as a result. Gym enthusiasts may face another consideration: when implants are placed under the chest muscle, a phenomenon known as “animation” can occur, where the implant visibly shifts during chest exercises – something many find unsightly. In such cases, Rampaul said, surgeons may opt to place the implant above the muscle and rebuild the tissue layer using autologous fat grafting, a method known as subcutaneous implant reconstruction. Recovery time varies depending on the type of reconstruction. “Implant-based reconstruction has the shortest recovery time,” said Rampaul. “Free flap reconstruction, such as using tissue from the abdomen, takes the longest.” Rampaul also cautioned that reconstruction is not a cure-all. “Breast reconstruction does not restore sensation, and patients should be counselled to anticipate this permanently. It is not a silver bullet or a magic pill. Patients should be counselled extensively to understand that any man-made surgery to rebuild or restore a body part never comes perfectly (back) to what they have lost.” That’s why, in his practice, extensive counselling is key. “I show patients before-and-after photos, and even introduce them to others who have undergone the procedure. It is important that patients understand the limitations of surgery so that they can be well informed to make a decision.” Effects not just physical Beyond the physical, breast reconstruction has profound emotional effects. Rampaul said studies have shown breast reconstruction can significantly help patients recover from the emotional and physical impact of breast-cancer surgery. But he warned that it is not a complete solution. “Even when the physical results are good, some patients still experience regret,” he explained, adding that “a woman’s confidence and satisfaction depend greatly on how well she understands and accepts what the surgery entails before going through it.” Rampaul added that intimacy is a very important area to address in breast cancer surgery, breast-cancer survival and, in fact, in breast reconstruction – and said this issue is underreported in both international and local literature. He has published and presented research exploring intimacy and self-confidence after breast surgery, which demonstrated very clearly that women who undergo surgery to the breast – particularly for breast cancer – experience significantly low confidence and poor body image perception. He explained that many of these patients struggle with intimacy, finding it difficult to expose themselves in personal relationships. They also face challenges in returning to work due to persistent pain and sensitivity, and there is a higher-than-expected rate of partner abandonment, often linked to the couple’s difficulty in adapting to the patient’s altered body image. Naturally, their sexual health deteriorates under these circumstances. But Rampaul says there is clear evidence showing that improvements in sexual health and body image are directly associated with breast reconstruction after cancer surgery. When it comes to fertility, he stressed, “There are no fertility issues related to breast reconstruction, as the function of the ovaries is not impacted by any form of this.” Breastfeeding, however, can be affected, depending on the surgery. “In partial reconstruction, the milk ducts may be disrupted and that can affect the ability for milk that is produced in the intact breast, or the remaining breast component, to travel to the nipple for delivery into it. In mastectomy – total breast removal – the patient would be unable to develop milk or produce milk in that breast, but the unaffected breast is able to produce milk. Changing approach On access to breast reconstructive surgery, Rampaul said when he returned to TT from the United Kingdom a decade ago, he found “almost no awareness” of it. “There was a misconception – even among doctors and insurance companies – that reconstruction was cosmetic,” he recalled. “Fortunately, that has changed. There’s now a much better understanding that it is an essential part of rehabilitation for many women.” Still, he acknowledged that cost remains a challenge. “Reconstructive surgery carries additional expenses due to longer operating time and specialised materials,” he said. “But the value it adds to a patient’s recovery – physically and emotionally – is immeasurable.” For young women considering reconstruction, Rampaul advised taking time to educate themselves. “Have a thorough discussion with your doctor,” he said. “Ensure he or she is qualified to offer these options. See the work that has been done, understand both the benefits and limitations, and, if possible, speak with other patients who have been through it.” He added, “It’s important to appreciate that reconstruction isn’t about recreating what was lost – it’s about giving back the ability to dress and feel normal again. It allows women to re-enter the world with confidence.” The post Breast reconstruction:‘It’s about confidence, not cosmetics’ appeared first on Trinidad and Tobago Newsday.