Accompanied by her husband, Guo Lan arrived at the breast reconstruction centre of the Beijing EverCare Cosmetic Surgery Hospital for her surgery appointment. After years of low self-esteem, she just wanted to feel like a whole woman again.

Breast reconstruction is a procedure designed to restore the appearance of a breast for women who have had one removed because of cancer. October was Breast Cancer Awareness Month worldwide.

 

Guo (not her real name), 49, was diagnosed with breast cancer in 2004. Though doctors offered her the chance of keeping her breasts, she chose to have a bilateral mastectomy, eliminating the risk of the cancer coming back.

 

"After the operation, the cancerous cells were gone from my body, but the mental scar remained," said Guo. "I felt like I wasn't a complete woman any more."

 

Guo, a kindergarten teacher, had always loved dancing. But after the surgery, she became miserable whenever she came to chose an outfit for dancing most of her favorite costumes were low-cut dresses.

 

"She was in low spirits ever since the mastectomy, and lost a lot of weight," said her husband He. "I hope the reconstruction will help her recover her self-confidence."

 

According to Dr Wang Jiguang, chief of cosmetic surgery at EverCare, although the treatment options for breast cancer include surgery, chemotherapy, radiotherapy and hormone treatments, surgery offers the best chance of ridding the body of cancer completely.

 

"However, many women find it difficulty to face life without a breast or part of a breast," said Wang.

 

Many of them choose to wear external breast pads, or use cotton wool to reproduce the look of a breast under their clothes. But these measures are unlikely to compensate for the inferiority they often feel, Wang noted.

 

He said he has even seen couples break up because the wife's feelings of inadequacy after losing her breasts.

 

Reconstruction options

 

Today there are two major options available for post-mastectomy reconstruction.

 

One combines skin expansion and implants.

 

Following the mastectomy, the surgeon inserts a balloon expander beneath the patient's skin and chest muscle. Then, through a tiny valve, the surgeon injects a salt-water solution at regular intervals, filling the expander over time. After the skin over the breast area has stretched enough, the expander is removed in a second operation, and replaced with a permanent saline implant.

 

But patients who want implants are often too thin for the procedure or have had most of their breasts cut away, with little tissue left to stretch.

 

Therefore, the other option involves creating a skin flap using tissue taken from other parts of the body, such as the back, abdomen, thighs or buttocks.

 

The flap, consisting of skin, fat and muscle, is surgically removed from the back, abdomen, thighs, or buttocks and transplanted onto the chest, reconnecting its blood vessels with vessels in that region.

 

As the breast is reconstructed entirely with the body's own tissue, the results are generally more natural than an implant. In some cases, it can even offer the additional benefit of a slimmer figure around the abdomen.

 

Guo took the second option. "I immediately liked the idea that my own tissue would be used in the reconstructive process," she said. "That was one of the key reasons I agreed to go through with the surgery."

 

In preparation for the surgery, she tried to gain weight and so there would be more tissue for surgeons to use in her abdomen.

 

The timing of breast reconstruction generally depends on each patient's state of mind and what other cancer treatments they are undergoing.

 

Reconstruction can start as the mastectomy is taking place, but it is also possible to wait until months or even years after the mastectomy.

 

Women who postpone reconstruction may go through a period of emotional readjustment before accepting the reconstructed breast, just as they had to get used to the loss of their first breast.

 

According to Wang, reconstruction cannot restore normal sensation in the breast area, but the scars may fade substantially over time, leaving a normal appearance.

 

Factors influencing the decision

 

One of the most important factors is age younger women are likely to be more concerned about their body image and want to look good.

 

Younger women will also need a longer time to emotionally overcome the surgery.

 

So generally younger women are more likely to opt for reconstruction, as opposed to older women.

 

As much epidemiological research shows, breast cancer patients in China are getting younger and younger, often experiencing cancer 10 to 15 years earlier than women in the West do. The result explains soaring demand for breast reconstruction surgery.

 

Even so, whereas 70 to 80 percent of women opt for breast reconstruction after a mastectomy in the West, the rate in China is still quite low. Wang says the lack of public education on reconstruction may be to blame.

 

Cost is another factor the surgery generally costs tens of thousands of yuan, beyond the reach of many women.

 

But for Guo, going through the difficulties and emotional adjustment of reconstruction is well worth the effort.

 

"The result I expect from breast reconstruction goes far beyond beauty," she said. "It's more about regaining self-confidence as a woman and preserving my psychological well-being."

 

(China Daily November 2, 2006)